HomeMy WebLinkAboutPermit Building 1984-11-29
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Springfield Utility Board
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INSPECTION FORM
ACCOUNT NO ~ - ~ 04--45 AUDIT NO
INSPECTION DATEA1o.J;::J,) TIME q,' 3D INSPECTION NO
AUDIT DATE J () - J 0 - 8<-J
/ INSPECTED BY ~
INSPECTION DATE TIME INSPECTION NO
CUSTOMER'S NAME RlrhG1?r'1 GROSS
STREET I ~ q 0 C'Je.A-R\'uQkRw LA-I'Ve
CITY Spt:\d STATE
HOME PHONE TLJ t - U 0 ';),3 BUSINESS PHONE LJ8<-i - LP-I 6) g
. (NO OF UNITS)
LOW-INCOME Ala BUILDING TYPE
INSPECTED BY
OWNER'S NAME
<v4. \V\ ~
. STREET
ZIP CODE
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ALL MEASURES COMPLETED
CHECK FLAG (O/C) ()
I MEASURE AREA
CJC IS/WINDOWS
of) PATIO SLIDERS
WALL INSULATION I
CEILING INSULATION I
FLOOR INSULATION I
I DUCT INSULATION I
I MAJOR MEASURE I
SUBTOTAL
I WEATHERSTRIP I
DOORS/WINDOWS
I CAULK ING I
I SEAL DUCTS I
/CLOCK-THERMOSTAT I
INSULATED DOOR I
OTHER I
.I OTHER L
ITOTAL
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[T?TAL REIMBURSEMENT
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COST
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COMMENTS
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INSTALLED MEASURES APPROVED
FOR REIMBURSEMENT BY
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_ DATE