HomeMy WebLinkAboutPermit Fire Damage Report 2004-01-12FD-016
TO:
FROM:
SIJBJECT:
Building Department
Springfield Fire Department
Structural Damage to Building
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARI)
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Date:_ ,/ Z__ <>
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Address or location of building
Name of Owner L..
Type of Building C.)ltr l"
Estimated value of building
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@welling, Store, Warehouse, etc.)
$7 D@
Estimated loss to building $Za<)
Date of fire
Location of damage to building
Additional pertinent information
(Roof, Wall, Exterior, Interior,
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etc.)
Structural weakness as a result of the fire t-o2
(Burned rafters, Beams,Joists, etc.)
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Electrical Hazatd ,d
(Wiring,Outlets, etc.)
CC
V:\FD-FORMS\FD{16 FIRE DAMAGE REPORT'doc
Signed
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