HomeMy WebLinkAboutPermit Building 2004-10-30
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FD-016
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
TO:
Building Department
Date:
/0 /30 /oc;
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
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Address or location of building
Name of Owner
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Type of Building
(Dwelling, Store, Warehouse, etc.)
Estimated value of building $ /90, 000
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Estimated loss to building $
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Date of fire
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Location of damage to building
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(Roof, Wall, Exterior, Interior, etc.)
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Structura'l;')v.eakness as a result of the fire
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(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
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Signed "---:J-.-.- ~/
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V:\FD_FORMS\FD-OI6 FIRE DAMAGE REPORT.doc