HomeMy WebLinkAboutPermit Field Test & Inspection Report 1985-01-01B q1
Springfield Utility Bo ard
INSPECTION FORM
ACCOUNT NO
INSPECTION DATE .-t Ak) ZZ
REINSPECTION DATE-
cusrouen's NAM
ADDRESS /Eqq nn .Ll"-
ZIP CODE
E 3 3 5.:g!.loe8- B H 8'^Tf
SS
LOW INCOME
lqa - | lD?t AUDIT DATE
twe t/.'00 tNSpEcrroN No.
TIME-INSPECTION NO.
INSPECTED BY Zo
INSPECTE D BY
OWNERS NAME tr-l l}ashQo[4m q c\ADDRE SS
STATE ZIP CODE
gt Ltt{.o
OWNERS PHONE
( NO. OF UN ITS )autLolNGTYPEALLMEASUREScoMPLETED-cHEcKToo/c
IAO SUBTOTALPREVIOUS REIM. TO CUSTOMERKWH SAVED
PREVIOUS INSTALLED MEASURES
RE I MBURSEMENTCO STKWHAREAMEASURE
Lv7). sToRM WINDOWS
PATIO/FRENCH DOORS
WALL INSULATION
?LoMYCEILING INSULATION
/7?/,7qLFLOOR INSULATION 2/WEATHERSTRI P
,DOO RS WI N DOWS
CAU LK I NG =d
SEAL DUCTS
DUCT WRAP
CLOCK THERMOSTATE
OTHER
TOTA L
TOTAL REIMBURSEMENT
COMMENTS
,-*t'/("
INSTALLED MEASURES APPROVED
FOR REIMBURSEMENT BY:DAT E