HomeMy WebLinkAboutMiscellaneous Fire Damage Report 2000-05-23lytal +Tc'x brk lTBMtj @
Qvc #N-cowc'ot
Sf oc tt l0
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE:-s/ss /oo
TO:
FROM:
SUBJECT:
Bujlding Department
Springfield Fire Department
Structural Damage to Building
Address or location of building 2c9 U^
Name of or./ner
Type of building
(Dwelling, S , I^larehouse, etc. )
Estimated value of buiiding
Estimated loss to building
Oocs
Date of fire f 7/oc
Locatr'on of damage in bui'ld'ing
V1.\,
Roof, hlal I , Exteri or , Interior , etc . )
Structural weakness as a result of the fire
o
(Burned raf ters , Beams , .)o'ists , etc . )
Addjtional pert'inent information
EleCtrical Hazard
t -lo
(
(l,Ji n , 0utl ets, etc. )
(
cc 5' 21- 00
Siqned
/98
(