HomeMy WebLinkAboutPermit Building 1984-11-13
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Springfield Utility Board
INSPECTION FORM
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ACCOUNT No.::f~ 0 - Di1130 AUDIT NO. AUDIT DATE
INSPECTION DATEA1D tJ:J!l TIME /0 AM INSPECTION NO. k INSPECTED BY
INSPECTION DATE., \AtJ g TIME 11.<30 INSPECTION NO. ..t...... INSPECTED BY
CUSTOMER'S NAME \ ) I O\~ )-4, I~I~ ~"J OWNER'S NAME _C:A~ ,
STREET dloP>S r)~~+\{>_ CJR\ \J -e, STREET
CITY Sp.C\d STATE
HOME PHONE iLJ to - 30Q.~ BUSINESS PHONE
(NO. OF UNITS)
LOW-INCOME NO BUILDING TYPE
C) 6
ZIP CODE
Q'll/7R
ALL MEASURES COMPLETED
CHECK FLAG (O/C) _ a _
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S/WINDOWS
_l_K~.~- SAVE~I
MEASURE
AREA
COST
PATIO SLIDERS
INCENTIVE J
7
WEATHERSTRIP
DOORS/WINDOWS
CAULK ING
I SEAL DUCTS
/CLOCK-THERMOSTAT
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1112 Nil\. 11r;-/'i1~-
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INSTALLED MEASURES APPROVED ..I /J ,1.0 ~ A j /
FOR REIMBURSEMENT BY: d .w-i,f/YY/cUl.A~
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DATE J 78.-/36'