HomeMy WebLinkAboutPermit Fire Damage Report 1985-12-09I u-.1" o
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FIRE DA}4P.GE REPORT
OR
ELECTRICAL HAZARD
DATE:,/)- I - 8'{
TO:
FR0r'1:
SUBJECT:
Building Department
Springfield Fire DePartment
Structural Damage to Building
Address or location of building ,e44 1)il/r &
Name of ou,ner .-l DH N G. R tr C. o rc,
Type of bu'ilding A P/),)T
(Dwel 1ing, Store, I^Jarehouse, etc.)
Estirnated val ue of bui 1 di ng
Estimated loss to building $
Date of fire
Locaticn of damage in building Ltt "\tG \t1,,.r1 FLCr.l4/ So/'Tq /')r<-
AF T)EL/TP-.
(Rcof , liJal I , Exterior, inter jor, etc.
Structural wea kness aS a resul t of the f i "e f1j ,R NF D .trL(oZ wtnl <7r.,
(Burned raf ters , 3eams , .1gi sts , etc.
Acidi t';onal certi nent'infcrmat'ion
El ectri cal 'Jazard
(l,li ri nq , 0utl ets, etc. )
S iqned
+
lt-9-
)
LOG SHEET TNSPECTIONS
JOB LOCATION:
JoB NUMBER: ,gS//7 /DATE RECEIVED 2 ./ ? '
OWNER:
OWNERS ADDRESS:
CITY, STATE, ZTP:
TYPE OF INSPECTION
_ CoURTESY (Renter Request)HOUSING
X rrnE DATVTAGE _REFERRAL FRoM orHER AGENcy
-
DANGEROUS BUILDING NUISANCE COIU.PLAINT
OTHER
PHONE:
OCCUPA}TCY
ZONING CO}@LAINT
INSPECTION DATE:
OUTCOME
INSPECTOR(S):
1ST LETTER DATE:
COMPLIANCE GAINED:
NOTICE AND ORDER DATE:
COMPLIANCE GAINED:
DEAD LINE:
YES NO DATE:
DEAD LINE:
YES NO DATE:
REFERRAL TO LEGAL PROCESS:
CTTY ATTORNEY NOTTFIED:
COMPLIANCE GAINED:
COMPLTANCE DEAD LINE:
YES NO
REFERRAL FOR PROSECUTION:
OUTCOME:
DATE FINALED:
CERTTPICATE OF SUBSTANTIAL COMPLIANCE TSSUED:
fsEE OTHER SIDE FOR ADDTTfoNAL)( uorEs )
tu-lo
urfu,od
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FIRE DAI4P.GE REPORT
OR
ELECTRICAL HAZARD
TO:
FR0r'1:
SUBJECT:
Building Department
SprinEf ield Fire Department
S tructura'l Damage to Bui 1 di ng
DATE: ./.)- 9' I'd
)/) /r ezAddress or'location of building 9 44 rv tt-/ 1
Name of otmer ..lnHN 4,RE(\nft,
Type of building APAnT/YEt.tr
(Dwel 'l i ng , Store, I^Jarehouse, etc. )
Estinrated value of building 5 / .t oa
Estimated loss to building $ /O* oort.ao
Date of fire l.t-91f{
Locat'icn of damaqe 'in bu'ildinq Ltt.ttN(. Rrln,ryl <a)/)TH /])F\r
RF n EDDT1
(Rcof , [^Jal I , Exterior, interior, etc. )
Structural weakness as a result of the fire Ai )RNtr(1 trt oo.e Jpl.srs-.,
Acidi tional
( Burned rafters , Beams , Jo i s ts , etc . )
cert"r nent i nfcrma tion
Electrical Hazard
('iji ri nq , 0utl ets, etc. )
S iqned
+
=!a frcefil d
APPL
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L
COURTESY INSPECTION ICATJON
(RENTER REQUEST)950 5
CITY OF SPRINGFIELD BUILDING DIVISION
DATE ?- t'7 - 8 S ADDRES' oF rNspEcrroN <Llt{ ill -L!- S-J- +o5-
SteuOIVNER ?_,PHONE NO.
ADDRESS I
RENTER
a
L -2//a-;14,-
R rcu r/r-L D eu<PH.NENo. 1/O-8/qa
)
SIGNATURE OF OCCUPANT (RENTER
FoR ACCESS To pRopERTy - TELEpHoNE NTTMBER /1,1 ft € V l-l 6DDCLIC
TYPE OF DWELLING: SINGLE FAMILY D DUPLEX N MULTIPLE I]
BRrEF DrscRrprroN oF MAJoR PROBIEMS, saiL lt]c{-r-,,3 ,;61[dn d-
Vrolrn^ , 2rnou d rCo:Jn-ti--,u) U,l-=tv,9*ofk-U
T- tl
NL
dt -d
FOR OFFICE USE ONLY
Date of Inspec tion
Courtesy Letter Sent
Notice and Order Issued To 0wner
Date For Comp liance
Compliance 0btained - Date
7
*
+. +- l+
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