HomeMy WebLinkAboutPermit Fire Damage Report 2003-11-17QA -og - tsozl-t
Date:\?
Ut- or?o?-
FD-016
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
TO:Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building il <t 32*L <k.$
Name of Owner
Type of Building
Estimated value of building
\
@welling, Store, Warehouse, etc.)
$ tD,ood
Estimated loss to building $ s00
Date of fire
Location of damage to building
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire Nr, "
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
\Electrical Hazard,
CC
V:\FD_FORMS\FD{Ir6 FIR"E DAMAGE REpORT.doc
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