HomeMy WebLinkAboutPermit Building 1985-1-10
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Springfield Utility Board
INSPECTION FORM
ACCOUNT NO.3Jic. - M":l..1d2../ 5021cJ,/>
INSPECTION DATE\Y>(' 1--8- TIME
INSPECTION OAT" ~ lO TIME
CUSTOMER'S NAMF
STREET C]{rQ-qtnl..j f\..\, Cbl19E'Jeo+
CITY C'c,Y--u Pc..
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AUDIT DATE 10'- J R.. 8(j
20
INSPECTED BY 2.()
OWNER'S NAME Cl:Y1~ AJ, ~~
STREET p, () ~'~Slk,
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-ZIP CODE (\'lUo\
INSPECTED BY
AUDIT NO.
INSPECTION NO.
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INSPECTION NO.
STATE
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HOME PHONF
LOW,INCOME
(NO, OF UNITS)
BUILDING TYPE
BUSINESS PHONF
ALL MEASURES COMPLETED _ CHECK FLAG (O/C)
i
MEASURE
&1 '5/WINDOWS
I PATIO SLIDERS
j ,WALL INSULATION I
~ ,lYEILING INSULATION 1
1 FLOOR INSULATION I
lDUCT INSULATION I
rMAJOR MEASURE I
I SUBTOTAL
WEATHERSTRIP
D00RS/WINDOWS
1 CAULKING
,I SEAL DUCTS
I CLOCK-THERMOSTAT
INSULATED DOOR
~H
I
AREA
KWH- SAVED
COST
INCENTIVE
q 60 1/:l
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Itf:?$
1
d? IX'
OTHER
[OTHER
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IINSTALLED MEASURES APPROviFo~ / A/ h. ~ /.:, ...t/~ '., "
FOR REIMBURSEMENT BY' k1 .j/l'~~ ~,,~
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DATE
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