HomeMy WebLinkAboutPermit Fire Damage Report 2001-11-1
.
<
"
~. .
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
FD-16
.0\. (1'25'\-0)
\~D'1.D4L\ DDr~cxJ
DATE: II. I . 0 I
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
5" .t <g:::r -00r-~'1 + ~~ "'- S+
Address or location of building
Name of owner kvdA..",-. f "'-V\~<...e.
Typeofbuilding 5/....'11... Io~J;. ""c..:>b,\, ho~_
(Dwelling, Store, Warehouse, etc.)
Estimated value of building $ ~ 0 006
Estimated loss to building $ J 0 00 c>
Date of fire
/1- 1,0
Location of damage in building b~!\"'Oc>....... ......"'-A Ir.".. d~, ~"'"
I
to 0,.-' I ~
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
h~" e_
(Burned rafters, Beams, Joists, etc.)
(Wiring, Outlets, etc.)
Signed,~4~_/~
:/~/(/ - -
Additional pertinent information
Electrical Hazard
~v."................., f'
,
J"",
cc:
0\ - IL\&RLlD
~w \\ h
-o..h
\r') ~...._