HomeMy WebLinkAboutPermit Fire Damage Report 2004-06-22FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
Building DepartmentTO:
Address or location of building
FD-O16
Date: {c - Z z - oY
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
04.pS(
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Name of Owner / ar ;,1 .t-Fof,rmo..4 S 5.1 4
Type of Building da. //,
Store,
e
etc.)
Estimated value of building S
Estimated loss to building
Date of fire
$() \- (-)
F -zL-o/
Location of damage to building r-). // *F /oo.
(Roof, Wall,Exterior , fnterior, etc.)
structural weakness as a resurt of the fire b u, rn ,.{F/r..^{7
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazdrd.UJ t c)ct
(Wiring, Outlets, etc.)
CC:
Y:\FD_FORMS\FD-OI6 FrRE DAMAGE REpORT.doc
Signed
,ar
-t/q./r