HomeMy WebLinkAboutPermit Fire Damage Report 2005-11-1
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FD-16
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE: /1 -1- a~~
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building ~"':s.3 <-"'h... Jc..v ,(I
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Name of o~mer Pc. ,.'tor
Type of building MoJ/-/;;
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(Dwelling, Store, 11arehouse,
Estimated value of building $
etc.)
Estimated loss to building $
Date of fire 11_ J-~,,,
Location of damage in building T...-b-r Y",'.n.- Ccifi.Y,'",-~/ ~ e..d , n
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1"01 :....~_
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(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire n/J
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information N A
Electrical Hazard M ~
(Wiring, Outlets, etc.)
Signed ~J"~.jJ~_
cc: