HomeMy WebLinkAboutPermit Building 1985-11-16Sp rin gfield Utility B o ar d
I N S PECT ION FORM
ACCOUNT NO
INSPECTION DAT
I /. -?-,5
E lru of
-r,r. lo 3o rNSPEcrroN No rNSPEcrEo ey 2c1
REINSPECTION DATE-TIME-INSPECTION NO.INSPECTE D BY z-b
cusrou en's NAM E OWNERS NAME
AUDIT DAT E lt-
ADDRESS / 7S3 Alo ADD RE SS
ZIP CODE STATE Ztp CODE
HOM E
PH ON u1-q oeg PHONE
BUSI NESS
OWNERS PHONE
Low r Nco M E _- SUPi 3[*3*'irtrL ALL MEASURES COMPLETED CHECK TO O/C
loth
PREVIOUS INSTALLED MEASURES
K H SAVED
MEASURE AREA
1.ro^, *,**,ra'rZ ^4 ?t
PATIO/FRENCH DOORS
WALL I NSULATI ON
CEILING INSULATION
R-ADOEO
FLOOR INSULATION
EWEAT H
DOORS
RSTR I P
WIN DOWS
CAULKING
SEAL DUCTS
DUCT WRAP
CLOCK THERMOSTATE
OTHER
lAn clror^+'PREVIOUS REIM. TO CUSIOMER
K!
il,oD
TOTA L
EMENT
COMMENTS
TOTAL REIM
A
INSTALLED MEASURES APPROVED
FOR REIMBURSEMENT BY:DAT E