HomeMy WebLinkAboutPermit Fire Damage Report 1995-11-12
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CITY OF SPRINGALD
Fire & Life Safety
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE: J I-I z.-~S
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building
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Name of owner lu..\...~\ 4., 'I!
Type of building '":>\......... \c:. ~; \"\ d-.v<. t~~
. (Dwelling, Store, Wareho~e, etc.)
Estimated value of building ~
Estimated loss to building $
Date of fire JI- I 2.- '1 ~
i-5 000
ICO
Location of damage in building
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(Roof, Wall,
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Exterior, Interior, etc.)
Structural weakness as a result of the fire
- (Burned rafters, Beams, Joi s ts, etc.)
Additional pertinent information
El ectri ca 1 Hazard W I ..':v .\:'r-OooY-- w.u..~ p \..~t. p.......... \ h....'\ "-
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(Wiring, Outlets, etc.)
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Signed ~1/~~