HomeMy WebLinkAboutSpecial Inspection Fire Damage Report 2001-5-18
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FD-16
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE: 5-J<i"O!
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
,
Address or location of building Jr-L5 ~""'~\("-~ C
Name of O\'mer KQ...",,-- ~\ Y>cc:--\<-.e.v- \\()~~~ ~\ \D~ \,
Type of building S~"'~\c- ~,.:.., \'\ ~vJ e.\\,~'
(Owe 11 i ng, Store, I~a reholts"e, etc.)
Estimated value of building $
Estimated loss to building $
Da te of fi re 5" ~ I ~ - 0 I
) gz) I 000
NO vO ()
Location of damage in building
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(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
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(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
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(vn ri n(f,
Out1 ets, etc.)
Signed ~~AA
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