HomeMy WebLinkAbout3145 BIRMINGHAM DR - SPECIAL INSPECTIONS - 4/14/2021City of .
~ort Collins ,, ~ rs_. -..........__
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Community Development & Neighborhood Services
281 N College Ave; P.O. Box 580; Fort Collins, co 80522-0580
Phone: 970 221 6760 FAX: 970 224 6134
Field Verification Form
Job Site _::,..c_l_'--\_S __ n_, 1_<-_rvi_, l"__,(,;;_I_CJ-_A_· VV1 __ 1_:-)_i_Z. __ Permit No. _B_2_/__c0 ___ 2_'S_cv:_/ __
r.-:--/~~ ( LL ~ 1+c~-1 11-..JG ;::,1vD Company Name I"-0 ~ I c, 1 rv, ', r• p, 11:2_ City of Ft Collins Lie# ____ _
__ Replacement of Sewer line
__ Replacement of Water line
.....,:::Add __ Replace gas line
Materials used: 1 Q fl '-l P E
Tested at __ L_6_-'P_1_1 _Lbs.
approx. ___ ft. (100 ft. maximum)
approx. ft. (100 ft. maximum)
approx. I S ft. ( 50 ft. maximum)
for _s_C/.l __ minutes
Installer Name (print) ?__r.;.c.. ~ LP-...,..,. l 5
Installer Signature __ ~ _________ · ___ _ Date _'--J~/_l_'-1_/ 'L __ I __ _