HomeMy WebLinkAboutPermit Fire Damage Report 2002-04-25i? 03 )Q 'tA oo Goo
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FIRE DAI,IAGE REPORT
OR
ELECTRICAL HAZARD
DATE:q/zs/oz_
TO:
FR0t"1:
SUBJECT:
Bujlding Department
Springfield Fire Department
Structural Damage to Building
Address or location of bu'ilding
Name of o\.rner V^thzt^,'au
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Type of building L 2!-grt f ole< q7f
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Estirnated val ue of bui 1di ng $ 4)C,ACC.
Est'imated loss to bu.ildine (v l, J^r.)
Date of fire 1[z: loz
Location of damage 'in build'ing
(scarr;f,tAs
atAc
(Roof, Wal l, Exterior, Interjor, etc. )
Structural weakness as a result of the f ire TJ"r*A c.ar/wr qr+uJl
(Burned rafters, Beams, "loists, etc.)
Additjonal pertinent information
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Electrical Hazard W a/1
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(l,li ri nq , 0utl ets , etc. )
S'iqned
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