HomeMy WebLinkAboutPermit Fire Damage Report 1996-2-3
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CITY OF SPRING.r.D
Fire & Life Safety
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DA TE: ;Z - 3 - 7' 6'
TO: Building Department
FROt1: Spri ngfi el d, Fi re Department
SUBJECT: Structural Damage to Building
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Address or location of building
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Name of O\'mer
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Type of building
(Dwelling, Store, I~arehouse, etc.)
Estimated loss to building $
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Estimated value of building $
Date of fire
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Location of damage in building/leu'ier "J1 ;CV+
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire ''N,.
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information "'f9....
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Electrical Hazard b..fu...YcI' 6Lf:/:l~.ir' JVr;/ famed' flYI f///
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(Wiring, Outlets, etc.)
Signed ~tJ/N f t1URrJlh
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