HomeMy WebLinkAboutSpecial Inspection Fire Damage Report 1988-5-12
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CONTROL EXP.
NO. NO.
,c:.;OP iNC,-F/c (r1
YEAR I DAVOF
nJ . WEEK
STATE OF OREGON FIRE REPORT.
STATE FIRE MARSHAL FIRE DEPT.
I ALARM NO.
-,
LIlJ.JI~
p?J Thur
o Fri
o SlltUl
D,p1. Responding ,<;' PRi/l)(".,f //LfrJ
ALARM TIME I. ARRIVAL TIME I TIME BACK IN
SERVICE
07fFS 6 7 'J../ f') 75<1
Q?Z;;?,.I 3EN3uS TRA<:f [,".3 CL\SS
DOB (optional) TELEPHONE
District ofIncident
Co~ty
D ThQ
D W..
..C ' I MO I OAY \.
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1 r. ,'2
D Soo
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Mon
INCIDENT ADDRESS
ol7~ SO, {j
3 OCCUPANT NAME {l...ut, Fint, MIl
....,.-;, tftHJ hA-{( Q,{lds-t<.
''',. " BUSINESS OWNER NAME (Last, F1!'lIt, Ml)
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. ,: './ 5 OWNER NAME (Last, Fll'St. MI) f
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ADDRESS
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TELEPHONE
141- 6132.
TELEPHONE
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ADDRESS
DOB(optional)
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-.~' /. 6 ~IRE REPORTED BY (Last, First, MI)
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ADDRESS
DOB(optional)
TELEPHONE
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to .Autual Aid (ntinguisb or investigate only)
o ~iv<<l. " :f..:- 0 Given \:: >,0 N/A
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.' I' OTHER VEHICLES RESPONDED
(do not include PA'I) . :;L -, ..~ '
o Salvage ,.
o NotCJassified
-::.,'i....
'''1 t-
I EQUIPMENT INVOLVIID IN IGNITION (Co~leteLineE)
I MODEL I SERIAL I
UI<~
I LICENSE I
I VOL~A~~.~. :.'
Idt
. f . .
tu. tc'/G. ho ~ ~'1 ,
ITEM FIRST IGNITED:
uX'}nrP iJaA!I1JL
o BeloWgrd.level 0
o Not CJusified
Oth"
TOTAL
/tJiJO
(.!. f fI AIJ111 6u r:JlL;.J'1
I MATERIAL FIRST IGNITED WAS MADE OF 0
o 10to 19 feet l1JI.JlfO e~4~::!(Jj U Over70feet
o 20 to 29 feet 0 SOto7Qfeet 0 ObjectainFlight
Contents Vehicle and Contents
1Sl. .00
i!J...
B 2storie3 B 5to6atories
3to4atories 7to121torie8
I BUILDING SIZE (Gmd FIr Only) 0 1000-4999 sq ft
or 0.-999 sq ft 0 5000-9999 Iq ft
19 CONSTRUCTION TYPE U Heavy Timber 0 Unprotect.. Steel Bldg
o Steel&Concnte.3-4hr.wo\.. 0 Protect..SteeIBIdg 0 Pn>teel.MuonryExt.&Woodlnl.
EXTENT OF DAMAGE CONFINED TO: Flame Srnoke DETECTOR PERFORMANCE
1 The object of origin 1 0 1 0 0 I Inroornoforigin-oper.
2 PlIIrl of room or Ilfta of origin 2 0 2 0 0 2 Notinroornoforigin-opu.
'20 3 Roornoforigin 3 IZd""" 3 ll.Y'''' 0 3 In rJIlof origin-not oper-firetooam.all
.. Fire.ratedcornp.oforigin 4 0 4 0 0.. Notin nnoforigin-notoper. fire too Im.all
5 Flooroforigin 5 0 5 0 0 5 In roornof origin-not oper.power disconne<:t
,- ..,6 Structure of origin 6 0 6 0 0 6 Notinnnoforigin-notoper,powe1di8eon.
,~;;:J..'.7" .EJ.lendedbeyonchtructureoforigin ,',,- 7..0 7 0 0 7 Inroornoforigin-notoper.deadbattel)' .
,'\' 0 a. NOl'l\roomu{~-tu)tcpet.deadhattery"'" .~.
9 No damage of the type (N/A) 9 [J ~ No detector present 0 10 Vndetermined
Undetennined
'6
VALUE
Building
loon
.00
.00
..00
"~'. ~.
LOSS
.00
.00
.00
.. -.00
fWO
lCOo
. ~ 17
NUMBER OF STORIES
~latol'Y
BUILDING AGE (In Yean)
o 50 atories or more
B 13to24aoories
25 to 49 atoriel
o IO,ooo-19,999sqft 0 5O,QOO-99,999sqU
o 2O,OOO'49.9991Q ft 0 loo,OOO.499,9998Q ft
U Unprotect,Masonl)'~t,&Woodlnt. ~l\protectedWoodFrame
o ProteetedWoodFrame 0 No'l.CbtYifledAbove-
SPRINKLER PERFORMANCE
. ,18
o 5OO,OOOsqft, ~,.,
"',
,;'1.
1 0 Equipmentoperated ~. ''c. ,- ,
2 0 F..quip.shouldhaveoper.-didnot
3 0 Equip,presentfln!too.m.alltooper,
90 Notelaaaulfdabove
o ~tenninedornotreported '.
:Prin~::::!:~:5;;~D "~~i:j' ':?,\
I of Heads. Opened
21
en
REMARKS Weather Conditionl (optional):
o conl.onback
Follow Up Investigation Requested
Y-
N_
If yes, who will investigate
23 NumberofInjuriea
Fire Serviee
24 Member Makin<< &port
I NumberofFate.lities
Fire Serviee
T""
-'-of -,;
Other
Other
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25 Additional Information by
Title
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814-440-10 tR-86)
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