HomeMy WebLinkAboutPermit Field Test & Inspection Report 1985-01-08Ffoo>f
Springfield Utility B o ar d
INSPECTION FORM
ACCOUNT NO.453:l8I3O AUDIT DATE to- lt^- S(l
ed-Bp--B-r, r.t=- r NSP Ecr r oN No INSPECTEO BY
INSPECTE D BY
rnINSPECTION DAT
REINSPECTION DATE
cusrouen's NAM
TIME-INSPECTION NO
OWNERS NAME Sftrna,
ADD RE SS
STATE ZIP CODE
OWNERS PHONE
ADDRESS QuP, R^,,,.8
ZIP CODE
HOM E
PHON E 1?/"-Dl4e PHONE
BUSINESS
( NO. OF UN ITS )BUILDING TYPE ALL MEASURES COMPLETEDLOW INCOME cHECK 10 O/C
PREVIOUS INSTALLED MEASURES
K SAVED PREVIOUS REIM. TO CUSTOMER IAQ SUBTOTAL
ME ASURE AREA KWH CO ST RE I MBURSEMENT
. STORM WINDOWS ?c{
. PArto/ FRENCH DOORS flc,a fi 2-rA
. WALL INSULATION
, CEILING INSULATION
zsq d,qtc
r ozd &-
FLOOR INSULATION
WEATHERSTRI P
oooRS/wrNDows
CAU LK I NG
SEAL DUCTS
DUCT WRAP
C LOCK THERMOSTATE
OTHER
TOTA L
COMMENTS
TOTAL REIMBURSEMENT
INSTALLED MEASURES APPROVEO
FOR REIMBURSEMENT BY DAT E