HomeMy WebLinkAboutSpecial Inspection Fire Damage Report 2006-2-7
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FD-016
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
TO:
Building Department
Date:
Z.J '11'{)~
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Name of Owner
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Address or location of building
Type of Building
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Estimated loss to building $
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Estimated value of building $
Date of fire
Location of damage to 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
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(Wiring, Outlets, e~c);
Signed} fI y. r1/~
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Electrical Hazard
CC:
V:\FD_FORMS\FD~16 FIRE DAMAGE REPORT.doc