HomeMy WebLinkAboutPermit Miscellaneous 1984-12-19FD- I 66/83
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T0: El ectri ca'l inspector
Plumbing Inspector
Bui I djng Inspector
Mechanical Inspector
Environmental Inspector
SPRINGFIELD FIRE DEPART},IENT
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INSPECTION REFERRAL FORM
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Date of Referral I k.t
Inspection Number
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Address /J/ =fa.W
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EXPLANATION OF REFERRAL
ACTI0N TAKEl,l (Attacfr copy of orders)
Date
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SPRINGFIELD FIRE DEPARTMENT
NON-FIRE REPORT
2. ADDRESS OF INCIDENT tar s,-atd i+-.l
ALARM MJMBER srStl-tlft
CENSUS TRACT 3L{
I-OW REPORTED
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4. OCCUPANT NAME Q. o,^\.. S *"i.L.0"- TELEPI-€NE NJMBER
5. BUSINESS NAME
6. TYPE OF SITUATION FOUIO Qul,\ic Ss o
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7. TYPE OF ACTION TAKEN
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8. MUTUAL AID: GIVEN RECEIVED NAME OF OTHER DEPTS USED
9. TOTAL TII'IE OF II.}CID 39 TorAL MANHouRs \r T
( IN MINUTES)
SIGNED BY:
( IN MINUTES)
TITLE DATE
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