HomeMy WebLinkAboutPermit Field Test & Inspection Report 1985-01-14INSPECTION FORM
AUDIT DATE
F4-ooL6
2
Springfield Utility B o ard
-lACCOUNT NO-
INSPECTION DAT
REINSPECTION DATE
HOM E
PHON E
d-\
11tltg cl lNSpEcTtoN No.
TIME-INSPECTION NO.
INSPECTED BY cb
INSPECTED BY
cusroueR's NAME OWNERS NAME r(I+rnQ.
ADDRESS ADD RE SS
ZIP CODE STATE ZIP CODE
BUSINE
PHO NE
SS
OWNERS PHONE
LOW INCOME
( NO. OF UNITS )auir-otNc TvP'E ALL MEASURES coMPLETED cHEcK ro o/c
o5
c;
o5
IAQ SUETOTALPREVIOUS REIM. TO CUSTOMERKWH SAVED
PREVIOUS INSTALLED MEASURES
REIMBURSEMENTCO STKWHAR EAMEASURE
tLul,r,.riSTORM WINDOWS
3 E'l-t"ilPATIO/FRENCH DOORS
WALL INSULATION
R.AODEO. CEILING INSULATION
" FLooR INSULATION
DOo RS /wTNDOWS
WEATHERSTRI P
CAU LK I NG
SEAL DUCTS
DUCT WRAP
CLOCK THERMOSTATE
OTHER
TOTAL
t/COMMENTS
u-s )
TOTAL REI MBURSEMENT
'.e/9/t/o (L
DAT EINSTALLED
FOR
MEASURES APPROVE
REIMBURSEMENT BY:
A5 t- oaar s n u-.nu
I
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