HomeMy WebLinkAboutPermit Building 1985-1-10
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Springfield Utility Board
INSPECTION FORM
ACCOUNT N00'7{o-!'.)() lein/ ."'i:> I q ~
INSPECTIDN DATE~ TIME
INSPECTION DATE ~C\.lu I D TiME
CUSTOMER'S NAME
. STRE~~~-P,'l() N. C\o\JelC..\oo r-
CITY !1
AUDIT NO.
AUDIT DATE
Ib....18-fN
- ,
~
INSPECTION NO. ( INSPECTED BY 0 to
INSPECTION NO. 2.... INSPECTED BY 2,-()
OWNER'S NAME~t\J S,hI.JJXlRd
Po eo~ RSl(., .
STREET
S TATE ......fS1:?
ZIP CODE
qlWD!
HOME PHON'"
LOW-iNCDME
(NO. OF UNITS)
BUILDING TYPE
BUSINESS PHONF
ALL MEASURES COMPLETED _ CHECK FLAG (O/C)
MEASURE
~, WINDO;"'S
I PATIO SLIDERS
WALL INSULATION
I CEILING iNSULATiON I
I FLOOR INSULATION I
I DUCT INSULATION I
I MAJOR MEASURE J
SUBTOTAL
WEATHERSTRIP
DOORS/.....INDOWS
CAULK ING
SEAL DUCTS
AREA
KWH- SAVED I
CDST
L
I
.~.-
I
iNCENTIVE
").).4 J,
I
CLOCK-THERMOSTAT
INSULATED DOOR.
10THER
10THER
[TOTAL
------
II
I
I
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L2i
I
I
I ()? I
(] /!.-'- / b --- I
I
I
I
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II
I
I
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COMMENTS'.M"',:;t....".. /.-y( .v,""" r:l.w~ t!!lcI. LUeeJ?/.r.I~ 1'/", a!~ b~ ....~<..<J <;10,.........
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AI u e..,.."7.,, "I r;;) 9" C; y
I N.:1 r /l1'f?"p v...../ lfi,
II/INSTALLED MEASURES APP.ROVED
rr FOR REIMBURSEME1'IT BY,_
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DATE
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