HomeMy WebLinkAboutPermit Fire Damage Report 2001-11-14rD-16,-o tzt ?-o(
FIRE DAIVIAGE REPORT
OR
ELECTRICAL HAZARD
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DATE:DI
TO:
FROM:
SUBJECT:
Building Department
Springfie'ld Fire Department
Structural Damage to Building
Address or 'location of building
Name of or{ner
Type of building
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(Dwel I ing,Store, l,larehouse etc. )
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Estimated value of building 0 c)
Estimated loss to bui'lding $ t Doc)
Date of fire l(o
Location of damage in building
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(Roof , [,Ja]'l , Exterior, Interior, etc. )
Structural weakness as a resu'lt of the fire
(Burned rafters, Beams, Joists, etc.)
Additionai pertinent information
Electrical Hazard
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l,liring, Outlets, etc. )
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Signed
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