HomeMy WebLinkAboutPermit Building 1984-12-7
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Springfield Utility Board
INSPECTION FORM
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REINSPECTION DATI' TIME INSPECTION NO, It 2. INSPECTED
CUSTOMER'S NAMfr~oILj \,) \-bJ\'l:~ OWNER'S NAME ~<:;,q,fY\-R.
ADDRESS 3~/~ FII_'J::;t-t lDV\l ADDRESS P,D <M('~ J.\q9
ZIP COOE ~()~..+ STAT" 8e.. ZIP CODE
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PHON- PHONE
(NO, OF UNITS)
BUI LDING TYPE
ACCOUNT N(l~'0I- D~{() U('\
INSPECTION DATE~' ~
3"
TIM8
LOW INCOME
KWH SAVED
PREVIOUS INSTALLED MEASURES
AUDIT DATE
INSPECTION NO,
BY Z. ()
BY ~ZO
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OWNER'S PHONF
ALL MEASURES COMPLETED
CHECK TO O/C_
PREVIOUS REI M, TO CUSTOM E R
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[ TOTAL REIMBURSEMENT J
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.Jl MEASURE
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I WEATHERSTRI P
DOORS / WI N DOWS
I CAU LK I NG
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I CLOCK THERMOSTATE
I OT HER
I TOTAL
AREA
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MEASURES APPROVEO /,
REIMBURSEMENT BY: /,' ,{l,tviA./ D ;;;{ZCtt4 DATE:
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