HomeMy WebLinkAboutBuilding Miscellaneous 1985-10-9 (2)
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COURTESY INSPECTION APPLICATION
(RENTER REQUEST)
INSPECTION w2,(p W. 9ulnol+
PHONE NO. W Id-.(o- () Or) )
li\~(L'-
1Y\-l'SS . \... I J::...b ~
PHONE NO. 1'-1 (- (7'78" rw.xf doill
~. 0A,p.)~9- j
'71.(-1- /?1r
CITY OF SPRINGFIELD
DATE
) 0 - c; - 8' ~ ADDRESS OF
IfuvJ !20b./lA/5,
OWNER
ADDRESS
RENTER CKl,I-f\/l(\ L. rrQ h Ty.p-Q...
SIGNATURE OF OCCUPANT (RENTER) (J .-a...l~...
FOR ACCESS TO PROPERTY - TELEPHONE N~MBER ~
BUILDING DIVISION
TYPE OF DWELLING: SINGLE FAMILY 0 DUPLEX 1&1 MULTIPLE 0
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BRIEF DISCRIPTION OF MAJOR PROBLEMS: -"E=. . '. - ,,~ -..J n
J-- - _
CU'\.o\ LAY\~-Qx- \<\\eJ,~ S\~~ ~
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~ '\ ...- -e \?\a- L-e..,' S VV'l r, 1:::..0 0\ (? C +-.p r +6 .-
""Y 'r n n +--9 . aD a yo-
~"?-Q~ '\" P V\+- r 1\
'1\0 ~uo e..x \ 1-.::;
ha-\..\-.. y- t'\ t'\ I'V1
FOR OFFICE USE ONLY
Date of Inspection
Courtesy Letter Sent
Notice and Order Issued To Owner
Date For Compliance
Compliance Obtained - Date
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'1520 I Dip
Springfield Utility Board
INSPECTION FORM
ACCOUNT N02Lrn -[Y2f1{r-,O /6cf1W AUDIT DATE
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INSPECTION DATE.'- \~l\J ~.Lj_ TIME-?'
INSPECTION NO.
HlI-(OE
/
INSPECTED BY
2D
REINSPECT ION DATF TIME
CUSTOMER'S NAM0\~d /Ol \UC'LS
ADDRESS~/$b (0. f)bft~+
INSPECTION NO
OWNERS NAME. ~~llrQ
AODRES~ /.,?-..:?-I ~ 1'\
'NSPECTE 0 BY
'HJ'eEk
ZIP CODF
HOME ..
PHON"
BUSINESS
PHONE
(NO. OF UNITS)
RUI LDING TYPE
STATF ZIP COD"
OWNER'S PHONE~:;:)io-oao..~
LOW INCOME
ALL MEASURES COMPLETED
CHECK TO O/C
KWH SAVED
PREVIOUS INSTALLED MEASURES
PREVIOUS REI M. TO CUSTOMER
IAQ SUBTOTAL
I
r
I STORM WINOOWS
I
I
I'
MEASURE
AREA
KWH
COST
REIMBURSEMENT
2/.r.{
PATIO/FRENCH OOORS
WALL INSULATION
IIR-ADOEO
CEILING INSULATION
FLOOR INSULATION
WEATHERSTRI P
I DOORS / WI N DOWS
I CAULKING
I
I
I
I
l
I
I
I
I
I
I
I
I
. [ TOTAL REIMBURSEMENT
COM,MENTS ~MAJ,)J~lb) / ~ l=~U'r .tC>?"DPI /".") (/ A,);"I 6cf'{;, ~
.~A"t_.. / r. - .a.,I<~ ::AH7S. ''-.In L ~ ~AJ
t<.)/lU[jtn.<J .,,,) 0'.,..... 62...,e/ u ~~ ~~ . to.
b J J "
- IIL/I'# f,U ~...,
- A.J.,~.r
SEAL DUCTS
DUCT WRAP
CLOCK THERMOSTATE
OTHER
TOTAL
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~D"7"'i -
-
DATE:
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['NSTALLED MEASURES APPROVED
FOR REIMBURSEMENT BY:
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