HomeMy WebLinkAboutPermit Fire Damage Report 2004-2-26
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
TO:
Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building
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Name of owner
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DATE: 2/ zru/O+
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(Dwelling, Store, Warehouse, etc.)
Estimated value of building $ '2~roD
Type of building
Estimated loss to building $ 500
Date of fire
2{ 21;, (04-
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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'(Wiring, Outlets, etc.)
Signed
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