HomeMy WebLinkAboutPermit Fire Damage Report 1983-07-12rD-16
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FiRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
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DATE: 7- /,7-r3
TO:
FROI4:
SUBJECT:
Building Department
Spri ngf i el d F'ire Department
Structural Damage to Building
Address or location of building 4 3 fO .j,,r, ,/y't ,J", ,r/
Name of ot./ner / /r-n E 1.7. /2,4 7o-z-
Type of building 4r,r,z/;trr/
(Dwel''ling, Store, l,larehouse, etc. )
Estimated value of building
Estimated loss to building
Date of fire
$ :a/z)
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Location of damage in building -7'.r,r,/n F-r/ ll a l/ /J"../rn r,/
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( Roof ,I l, Exterior, Interior, etc.
Structural weakness as a result of the fire
(Burned raf ters , Beams , "]oi sts , etc. )
Ldditional pertinent information /.,'
Electrical Hazard
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Siqned
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I,li ri nq, 0utl ets , etc. )
LOG SHEET TNSPECTIONS
Qz ge {tar^ h4 uJOB LOCATION:
JOB NUMBER:DATE RECEIVEDl. /-/2-4ts
OWNER, AZ-E</ E F<ar<.rtap
OWNERS ADDRESS:g
CITY, STATE, ZIP:
TYPE OF INSPECTTON
COURTESY (Renter Request) HOUSING
PHONE:
OCCUPANCY
_K rrnE DA.I'IAGE _RE
DANGEROUS BUILDING
FERRAL FROM OTHER AGENCY
NUISANCE COI{PLAINT ZONING COMPLAINT
_ oTHER
INSPECTION DATE:INSPECTOR(S):P..
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OUTCOME €D Ra<
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 NOTIFIED:
CO}PLTANCE GA]NED:
COMPLTANCE DEAD LINE:
YES NO
REFERRAL FOR PROSECUTION:
OUTCOME:
DATE FINALED:
CERTTFICATE OF SUBSTANTIAL COMPLIANCE TSSUED:
,SEE OTHER SIDE FOR ADDITIONAL)( r'roTEs )
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