HomeMy WebLinkAboutPermit Fire Damage Report 2002-8-16
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE:
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TO: BUilding Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Date of fire
Address or location of building
Name of owner QS " L I l-J t i.-\. c j. .
Type of building ?S(OV~ ~CCI.\ ~..........~ C.......,olc:y
(Dl4e11ing, Store, l~arehouse, etc.) I
Estim~.ted value of building $ 150/ DOc)
Estimated loss to building $ 50, DO ()
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Location of damage in building
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
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(Wiring, Outlets, etc.)
Signed
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