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HomeMy WebLinkAboutSpecial Inspection Fire Damage Report 1985-12-23 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD ~ --IF 6.5 1/5? ~: FD-16 /)_-1 ~II fZ; r, 1 ~"'""'t DATE: Jr2 -eJ,3 -gS- TO: Building Department FROM: Springfield Fire Department SUBJECT: Structural Damage to Building Address or location of building .J1)G " , J (0 J Name of o\'tner f?() v h.f.hl Y .( =p 9 ..5 [) /I AI Y tL?.i.J,!fi, ~')F (),;' f')'ta!f -- 6 J'tf- (.,)ys- Type of building JUPLE'i- cl <;;T/)/PV (Dwelling, Store, Warehouse, etc.) , Estimated value of building $ &S; (){)O .on Estimated loss to bui lding $.-:;) J7. ()OO. 00 -' Date of fire h~ -c.J3-~J Location of damage in building ,for)!=;,;:O.4 LI5, / ~t. cJf)1!' I ijJ~n11tL.SJ rI-1Ii-.JO ((.. JNTFI?IO(' ,(J1'1/')1 Ar::.E-_ (Roof, Wall, Exterior, Interior, etc.) Structura 1 wea kness as a resul t of the fire Rt"Y)F b )4// "'... r(.i,2t')P.. I !f1~TAIPS, .f.1J1!1JFf1 ,i()I<;T~ 5TO/)5 T/f'u S"~_ , ". " - ~ . . (Burned rafters, Beams, Joists, etc.) Additional pertinent information Electrical Hazard l--t)/!f/v(; /JlI?f)f}r:;;-/~VJI ~ /.'i ~)j?F LI/i/YlA(2L/J (Wiring, Outlets, etc.) Signedc;:jzif.~d , cc :.