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HomeMy WebLinkAboutPermit Fire Damage Report 1995-12-18CMY OF SPRINGFbI,D Fire & Life Safety qs(q15 qq 1j $G ^J 5( FIRE DAMA.GE REPORT OR ELECTR]CAL HAZARD t, DATE: lL -Lg -a5 TO: FROM: SUBJECT: Bui'lding Department Spri ngf i e'l d . F'i re Departrnent Structural Damage to Bu'i 'l di ng Address or'location of building ll+-7 -7r9 Name of orcrner Type of bu i 'ld'ing (Dwe'l'li , Store, llarehouse, etc. Estimated va'lue of bui 1d'ing Estimated 'loss to bui 1d'ing $ (\0.0 od- Date of tire lZ-l ?-75 Locat'ion of damage in bui'ld'ing 5F ,; rl< o? h ous c a"t e lec*ric..l (q zto,r e rte- i cf $ (Roof , l,'la'l 'l , Exterior, Interior, etc. Structural weakness as a resu'lt of the fire (Burned raf ters , Beams , ,-10'i s ts , etc .) Additional pertinent jnformation E]ectri ca'l Hazard /Uo e /e v,'. c- / fv*.- ,t/ o c-. (tlli ri nq , 0ut'l ets , etc. cc ,7N 12 -2C- S'igned )