form fhwa 17-348 (12/2007) date stamp u.s. … · form fhwa 17-348 (12/2007) u.s. department of...
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Be sure to adjust designed clearing distances and areas to reflect actual areas of work performed
20101Clearing and grubbing
13+320 to 14+500: 28,628 m2 per FHWA clearing report = 2.863 ha
see attached documentation:(a) Contractor clearing report(b) FHWA clearing report
see stations above 2.863 ha
2.863
ha
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These support pages should bechecked and signed by FHWA
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20101Clearing and grubbing
375+00 to 400+00: 3.107 acres @ 75% complete = 2.330 acres
**Area grubbed, per Appendix A, 75 % partial payment
see attached documenation:(a) MS Excel spreadsheet(b) FHWA clearing report
see stations above 2.330 acre
2.330
acre
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Sta Sta SF375+00.00 376+50.00 7,876.00 1 acre = 43560 square feet376+50.00 383+61.10 33,298.00383+61.10 389+00.00 25,048.00389+00.00 394+50.00 34,852.00394+50.00 398+00.00 19,164.00398+00.00 400+00.00 15,103.00
135,341.00 Total 3.107 acre
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Be sure to confirm that tree isoutside of original clearing limits
20204Additional clearing and grubbing, removal of tree
10+04 LT81' from center line: 1 @ 20" dia: A = (pi/4)(20in)^2 = 314.159 sq.in78' from center line: 1 @ 26" dia: A = (pi/4)(26in)^2 = 530.929 sq.in
11+94 RT79' from center line: 2 @30" dia: A = (2)(pi/4)(30in)^2 = 1413.717 sq.in
2258.805 sq.in = 15.686 sq.ft
Total for payment = 15.686 sq.ft
see stations above 15.686 sq.ft
15.686
sq.ft
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20303Removal of Pavement, Asphalt
Area G = (119.88 x 1) = 119.88 m2
see attached plan sheets
0+280 to 0+360 119.88 m2
120
m2
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Example 1
20401Excavation and embankment, roadway exc
105+366 LT to 105+381.5 LT: 33.03m3
see attached documentation for sliver excavation:(a) differential leveling survey notes(b) scaled cross section notes(c) average end area calculations(d) irregular polygon area calculations
see stations above 33.03m3
33
m3
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20401Roadway excavation
Performed 85% of the roadway exc from station 27+857 to 33+500.
Total excavation from 27+857 to 33+500 = 24,205 m3
24,205 x 0.85 = 20,574.3 m3
see attached documentation:(a) total mass spreadsheet(b) guidelines for percentage of payments for partially complete work
see stations above 20,574.3 m3
20,574
m3
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Contractor Generated Notes
FHWA project staff should provide a note toreflect that calculations are accurate and reflectthe original design or adjusted quantities
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20402Excavation and embankment, subexcavation
487+82 to 488+38: (56' long)(8' wide)(1' deep) = 448 ft3
489+07 to 489+28: (21' long)(24' wide)(1.75' deep) = 882 ft3
491+58 to 492+06: (48' long)(10' wide)(1.5' deep) = 720 ft3
490+72 to 493+80: (308' long)(14' wide)(0.8' deep) = 3449.6 ft3
Total = 5499.6 ft3 = 203.7CY
see stations above 203.7 CY
204
CY
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20402Excavation and embankment, subexcavation
101+440 to 101+680 = 2639.4m3
see attached documents:(a) average end area calculations(b) cross-section end area reports(c) irregular polygon area calculations
see stations above 2639.4m3
2639
m3
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
20406Select Borrow
Subexcavation backfill from station104+200 to station 104+220
see attached documentation:(a) daily mass record(b) street delivery report - spread report
see stations above 115.7 t
115.7
t
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement:
(h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Manager
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
Field Sample Notebook April 2011
Page 59 of 171
20701Eathwork Geotextile, Type VIII-B
Crew Installed Fabric From 11+696 to 11+765
Total Length=69m
Width of Fabric=16.3m
Depth of Trench= 1m x 2 for both sides = 2m
Total Installed: (69m x 16.3m)+(69m x 2m)= 1262.7 m2
*See attached sheets
11+696 to 11+765 1262.7 m2
1262.7
m2
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
21101Roadway Obliteration, method 1
Obliteration Area Calculations:30+00 27' LT, 36' RT = 63'
avg. width = 64.5' area = (64.5')(50') = 3225 sq.ft29+50 30' LT, 36' RT = 66'
avg. width = 64.5' area = (64.5')(50') = 3225 sq.ft29+00 24' LT, 39' RT = 63'
avg. width = 66' area = (66')(50') = 3300 sq.ft28+50 27' LT, 42' RT = 69'
avg. width = 66' area = (66')(50') = 3300 sq.ft28+00 27' LT, 36' RT = 63'
avg. width = 63' area = (63')(50') = 3150 sq.ft27+50 27' LT, 36' RT = 63'
avg. width = 64.5' area = (64.5')(20') = 1290 sq.ft27+30 27' LT, 39' RT = 66'
Total = 17490 sq.ft = 1943.3 sq.yd
see stations above 1943.3 sq.yd
1943
sq.yd
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25101Placed riprap, class 3
19+320: 10m long x 2.5m wide x 0.5m thick = 12.5m320+140: 7m long x 2m wide x 0.3m thick = 4.2m3
Total = 16.7m3
see attached placed riprap detail
see stations above 16.7 m3
17
m3
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Sta
tion
19+3
20@
20'l
efto
fcen
terl
ine
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Sta
tion
20+1
40@
24'r
ight
ofce
nter
line
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25101Placed riprap, class 2
Class 2 riprap placement at 104+300 LT to 104+447 LT: 2503.2 m3
see attached documentation:(a) average end area hand calculation sheet
see stations above 2503.2 m3
2503
m3
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In order to check the As-Builts when the project iscomplete, these quantities should also have areference to center line. Page 58 of 134
FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25103Keyed riprap
Station 1+005 – End SectionArea Volume = 215.0 m3
Station 1+015Area Volume = 729.3 m3
Station 1+030Area Volume = 789.3 m3
Station 1+045Area Volume = 695.3 m3
Station 1+060Area Volume = 208.5 m3
Station 1+070 – End SectionTotal = 2637.4 m3
see attached criss-cross + average end area calculation spreadsheet
see stations above 2637.4 m3
2637
m3
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
25125Boulder
Crew placed 4 boulders as directed by FHWA in Rockefeller Turnout.
see attached plan sheet
see stations above 4 EA
4
EA
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FORM FHWA 17-348 (12/2007) U.S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION Western Federal Lands Highway Division 610 E. 5th St. Vancouver, Washington 98661 FP-03 109.01
Date Stamp
(a) Project Name: Project Number:
(b) Item Number: Item Description:
(c) Date work performed:
Copy Stamp
Daily Record Of Miscellaneous Items (f) Calculations*:
(g) Supporting sketch and details*:
Summary of Quantities (d) Location: (e) Measured quantity:
*Attach additional sheets if necessary. Total Quantity: Unit of Measurement: (h) Name of person measuring work:
FHWA Use Only(i) Interim Measurement Final Measurement Verified By:
Construction Inspector
I certify the above measurements and calculations are correct and the total quantity is subject to direct payment for the item identified. Approved Entered To Record
Checked By:(j) Contractor Representative FHWA Representative Date:
26201Rockery Wall
Rockery wall station 104+31 to station 104+61.1 (12' left offset from center line)= 134.27 m2
see attached documentation:(a) field cross section(b) irregular polygon area calculator sheets
see stations above 134.27 m2
134.3
m2
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