HomeMy WebLinkAboutPermit SUB Sanitary Sewer 2004-10-29
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Springfield Utility Board
I NSPECTION FORM
ACCOUNT No.A~- ()~q....C)Q AUDIT DATE
INSPECTION DAT~Pt~ ') \l...o TIME3 INSPECTION NO.
REINSPECTION DATE FEf3 16 TIMEA'J}fO INSPECTION NO
CUSTOMER'S NAMECl2.f\}~..k....l1Ch.:h~lU_iL\O~ER'S NAME
ADDRESs39J ~ ~('/) AJO ADDRESS P 0
/()-~q-RCL
. . ~
/
,
2. INSPECTE D
14 A-C < A
BDX-
INSPECTED
By2n
BY 20
ZIP CODE
HOME 7 FJ./ _t"J/ /5. BUSINESS
PHONE ~~ ~~0 PHONE
Li ^ <:: (NO. OF UNITS)
LOW INCOME~ BUILDING TYPE
KWH SAVED
PREVIOUS INSTALLED MEASURES PREVIOUS REIM. TO CUSTOMER
STATE='
qO'l
CODE--914LJb
ZIP
OWNER'S PHON~
ALL MEASURES COMPLETED
CHECK TO O/C
IAQ SUBTOTAL
I MEASURE
~'\)' STORM WINDOWS
PATIO/FRENCH DOORS
'\.""\ WALL I NSULATI ON I
),)/D'CEILING INSULATION" R-ADDEDI
'~ FLOOR INSULATION I
, WEAT HERSTRI P I
\ _'DOORS / WI N DOWS
\..bcAULKING I
,- SEAL DUCTS I
I DUCT WRAP I
I CLOCK THERMOSTATE I
.I OTHER I
AREA
KWH
COST
REIMBURSEMENT
L.J<2
L.,I;t
?
/g~
//&~
,
/hsy
TOTAL
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INSTALLED MEASURES APPROVED" -/ /'/~' L/<' 7'----, _
FOR REIMBURSEMENT BY: ~~-'t.c~TE: 2-l.r-R\--_