HomeMy WebLinkAboutPermit Fire Damage Report 1986-02-21i-o-15
K f (,c tt6FiRE DAI4A.GE REPORT
OR
ELECTRICAL HAZARD
DATE: J-s l4 /"
Tn.
FR0r.1:
SUBJECT:
Bujlding Departnent
Soringfield Fire Department
Structural Damage to Building
Addres s or I ocati on of bu i i di ng t rf ,U n rarH ,/d ril
Name of oh/ner
Type of building
(Dwel ling, Store, [.larehouse, etc.
Estinrated value of building
Est'imated I oss to bui'lding
Date of fire e';)-8L
Location of da;nage jn buiiding 5r,'* BEf on , ?8"'lG
I
( Rcof, l^lal I , [xterior, interior, etc.)
Structural weakness as a resul t of the f i re ,4 /tr,rl,rvl ///95 -<a.rrl E '
,
/ Q,,-nori r: jtcr( laem< ,tn j < +< )+n )
\ gul rrlu I u I vsr J t , -'v L J i! ,
Adoi t: ona'i oerti nent 'inf crma ti cn
El ectr i cal llazard
(l,ii ring , 0utl ets , etc. )
Siqned
CIfi OF SPRINGFIELD
(RENTER REQUEST)''
"tn
t(qt
BUILDING DIVISION
DArE l2- ?f b ADDRESS oF TNSPECTToN / < q i) ,/a
PHONE NO.1a1:35{7OWNER
ADDRESS
RENTER
SIGNATURE OF OCCUPANT (RENTER)\'/ 4,42;/,zFOR ACCESS TO PROPERTY - TELEPHONE NI'MBER
TYPE OF DWELLING: SINGLE FAMILY tr DUPLEX MULTIPLE
BRIEF DISCRIPTION 0F tlAJOR PROBLEMS:
q
6oa
FOR OFFICE USE ONLY
Date of Inspection
Courtesy Letter Sent
Notice and Order Issued To 0wner
Date For Complianc
Compliance Obtained - Date
PHONE NO. 144-)z
STRUCTURAL INSPECTION REPORT
z '?7 tr G-f DATE
PHONE
JOB ADDRESS
OI.JNER
TENANT OR OCCUPANT
TYPE OF INSPECTION: HOUSING OCCUPANCY COMPLAINT 4'RE DAMAGE
I
Ii'ISPECTOR
ft?t
Z,
t