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HomeMy WebLinkAboutPermit Fire Damage Report 2002-6-19 . o~ (JOg(~y of e:1-I<;{ ~ d~ FD-16 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD DATE: (J~I/~/C2. TO: Bu il ding Depa rtmen t FROM: Springfield Fire Department SUBJECT: Structural Damage to Building Address or location of building 5f!9 dr III '^? -#.r Name of O\'mer Type of bui lding 'DI~\P IL'Nq (D~elling, Store, Harehouse, etc.) Estimated value of building $ 'no; om.on Estimated loss to building $ ~, ,- -, I'?nfl7. 17 n ; Date of fire --\;" 11', J q,u . ~()(}2 &Jr~or'\A (xJl'Mriouo.$ /I Location of damage in building (Roof, Wall, Exterior, Interior, etc.) Structural weakness as a result of the fire l/f.?^j~ (Burned rafters, Be~~s, Joists, etc.) Additional pertinent information ~I <:mtJ}:; JI'1JlA.a~ ~' .P1.d:frl'crJ . .\) c,f.,.lAejycJ ~f . Electrical Hazard (Wiring, Outlets, etc.) Signed ~- v/ib cc: J);:) - () 7 '119 d Ow rj, r _____. ,