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HomeMy WebLinkAboutPermit Building 2004-10-30 J .QA.\l\~\ FD-016 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD TO: Building Department Date: /0 /30 /oc; FROM: Springfield Fire Department SUBJECT: Structural Damage to Building Lf35 Gc5CO de ~rlJ e Address or location of building Name of Owner Rr~ u mo VI.. J I 7)UJeI (, "J mora Q f1 u Type of Building (Dwelling, Store, Warehouse, etc.) Estimated value of building $ /90, 000 t Estimated loss to building $ /11 (JOG / 10/30/c; t/ Date of fire , . .~ . ........... K X lerror 5 rA, ~ LtSerfdr Location of damage to building . . , . f.:.' ,," ~"-....;, (Roof, Wall, Exterior, Interior, etc.) , . Structura'l;')v.eakness as a result of the fire tUo t/J P . ". ~ ~ (Burned rafters, Beams, Joists, etc.) Additional pertinent information Electrical Hazard dQW/Qopd 0(1I17/l~ U U ,trY! /YkJ/J0/p / J I' (CJC(t; 7 (u/O cc: (Wiring, 0;2: etc.~ / Signed "---:J-.-.- ~/ u hv-e ~<<fl-o I~ 6 kJ-[;~ /fIt V:\FD_FORMS\FD-OI6 FIRE DAMAGE REPORT.doc