HomeMy WebLinkAboutPermit Building 1985-1-10
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Springfield Utility Board
INSPECTION FORM
ACCOUNT No3J1~-~"'fiJ..~IJ6.{)~U n AUDIT ND. AUDIT DATE J 0-/2- BU
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INSPECTION DATEl'P^. t&?_ TIME INSPECTION NO, I INSPECTED BY ~ rJ
INSPECTION DATsJAl0 co TIME INSPECTION NO.2-INSPECTED BY 20
CUSTOMER'S NAM> OWNER'S NAMEC\-xl.M l,oc ~lTd
STREETffi';:;).p.,SI.Lf\),GIDUee!eo{1 STREET \?() Bc-(, RStG:>
cine .n'n.L'\c... STAH re ZIP CODE qlJ-joJ
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HOME PHON>
LOW-INCOME
BUSINESS PHONE
(NO. OF UNITS)
BUILDING TYPE
ALL MEASURES COMPLETED
CHECK FLAG (O/C)
AREA
KWH- SAVED
COST
INCENTIVE
PATIO SliDERS
I WALL INSULATION
I CEIL ING INSULATION
FLOOR INSULATIDN
DUCT INSULATION
/'12..9
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I MAJOR MEASURE
SUBTOTAL
I WEATHERSTRIP
DOORS/WINDOWS
1 CAULK iNG
SEAL DUCTS
!CLOCK-THERMOSTAT
IINSULATED DOOR
IOTHER
IOTHER
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INSTALLED MEASURES APPROVED
FOR REIMBURSEMENT BY'
DATE
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