HomeMy WebLinkAboutPermit Fire Damage Report 2004-05-26FD-016
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r{d FIRE DAMAGE REPORT
OR
ELECTRICAL I{AZARD
Building DePartment Date: .f -t
TO:
FROM: SPringfield Fire DePartment
SUBJECT: Structural Damage to Building
Address or location of building /b / t/i,iai< ,4t"
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Name of Owner
Type of Building e
@welling, Store, Warehouse, etc.)
d D a.>oEstimated value of building $
Estimated loss to building $6Dc
Date of fire -{-Za - o
Location of damage to building
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire ?/1 a,1 <
@urned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazdrd.
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u<)er
(Wiring, Outlets, etc.)
CC:
V:\FD_FORMS\FD{16 FIRE DAMAGE REpORT.doc
Signed
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