HomeMy WebLinkAboutPermit Fire Department Referral 2004-2-28
FD-O 16
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
TO:
Building Department
Date: .2. - ).. g -0 <.1
FROM: ,:
Spri~gfield Fire Department
~t\.OOlo1--
SUBJECT: Structural Damage to Building
Address or location of building
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Name of Owner
tcu"L
Pi' /11.1 e.- N f d-
Type of Building
~ltIT.~
(Dwelling, Store, Warehouse, etc.)
Estimated value of building $ ~00. (:, c;
Estimated loss to building $
300 c . c c
Date of fire
J.-. - :t' <to - G t./
Location of damage to building
12.0 t- f ~ W(~
. (Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
r;. )' t t ... ~' I: r rc 0 +-
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
s/~r --Is fA,;' JtuT, fk.~-/ c. {)~{;":t II(!. 1.5 .
CC:
(Wiring, Outlets, etc.)
Signed K t2 J1tuv'KJ L~
I. or'
V:\FD]ORM~\FD-OI6 FIRE DAMAGE REPORT,doc