HomeMy WebLinkAboutSpecial Inspection Fire Damage Report 1985-3-14 "'6 -..' .~ :,t>~ DO NOT WRITE IN TillS SPACE CONTROL EXP, NO, NO, ~,IREDEPT. ALARM NO. STATE OF OREGON FIRE REPORT STATE FIRE MARSHAL District of Incident S (") ~ ~'\ -aQJ DAY' \YEAR "\ j DAYOF WEEK 13 \ I~ \ Itt,<j!15' INCIDENT ADDRESS /"' -n, ,() \ \? ~ ~"'- \H.'cfLX. 3 OCCUPANT NAME (Last, First, MI) ~ ()...v\~<: '" ()W {Y\ orquJ\"h' 4 BUSINESS OWNER NAME (Last. First. MI) C ADORESS ~,. Dept. Responding ~ D """' "''' L' \ & J ALARM TIME ARRIVAL TIME MO; County o Tues o Wed ~ \1<f1~1~ CENSUS TRACT o Satur - T~E BACK IN \ I qE7~EI I ISO CLASS '"3 :s.. Thur o Fri o Sun o \ Iq', \ ZIP 9111 Y I 7 17 Mon 313 TELEPHONE 1 'i \c;l S 3 'i DOB (optional) .,,'!} DOB (optional) TELEPHONE OWNER NAME (Last. First, ML S f\ ~ "C.- 6 FIRE REPORTED BY (Last. First, MI) ADDRESS S Pt tv\-c TELEPHONE DOB (optional) ADDRESS DOB (optional) TELEPHONE v-.J?- METHOD OF 3 Telephone Direct 0 Radio ALARM 0 Municipal Alarm System 0 Verbal o Private Alarm System 0 No Alarm Rec'd 8 # OF FIRE SERVICE PERSONNEL # OF ENGINES RESPONDED RESPONDED , "3 \ o 911 (Tie Line) o Voice Signal Muni Alarm o Not Classified Above # OF AERIAL APPARATUS RESPONDED Mutual Aid (extinguish or investigate only) o Received 0 Given ~N/A # OTHER VEHICLES RESPONDED (do not include PA's) 9 TYPE OF SITUATION FOUND l)J Structure Fire o Outside Struct: w /value ' o Vehicle Fire o Brush, Grass. Leaves o Trash. Rubbish , TYPE OF ACTION TAKEN ~ o o Salvage o Not Classified o Undetermined o Other (List) 10 METHOD OF EXTINGUISHMENT o Self,Extinguished o Make-shift aids o Portable Extinguisher o Automatic Ext, System g Pre-connect hose/tank only o Pre-connect hose/hydrant, standpipe Extinguish 0 &moved Hazard Investigation 0 Stand By o Hand,laid hose/hydrant, standpipe o Master Stream Device o Not Classified Above FIXED PROPERTY ~SE _,_ () . _ II . , I /....J PROPERTY COMPLEX (If applicable) \<.~~~'~, I~ I " M MOBILE YEAR "MAKE ' PROPERTY 11 , MOBILE PROPERTY (Complete line M) SERIAL' LICENSE' MODEL 12 ROOM/AREA OF FIRE ORIGIN ) ~''''~ ~ CO\.,,- E EQUIPMENT YEAJ;t MAKE mig~i~I~N \ '1.~ l\ UJV\ \) Q.J:-O V- ' 13 IGNITION FACTOR ~~~ U-f> ~ 14 FORM OF HEAT OF I~NITION ,EQUIPMENT INVOLVED IN IGNITION (Complete Line E) ~ S ~\-o. Cl MODEL 11 \.v-o-ba SERIAL # VOLTAGE ~~ ITE~~: o o MA~GNITED WAS MADE OF o 30 to 49 feet 0 Over 70 feet o 50 to 70 feet 0 Objects in Flight Contents Vehicle and Contents ;O.OW'oo ,00 ,00 ~~ 15 ,!-~VEL OF FIRE ORIGIN ~rade level to 9 feet o 10 to 19 feet o 20 to 29 feet Building ~(j,OW'oo o Undetermined Below grd, level Not Classified Other TOTAL '50,000 16 VALUE LOSS ,00 ,00 ,00 ,00 - - 17 NJ:1,MBER OF STORIES U 2 stories U 5 to 6 stories IZh.I story 0 3 to 4 stories 0 7 to 12 stories 18 BUILDING AGJB!n Years) I BUILDING SIZE (Gmd Fir Only) 0 1000-4999 sq ft 3 ~ ~O'999 sq ft 0 5000,9999 sq ft 19 CONSTRUCTION TYPE 0 Heavy Timber 0 Unprotect. Steel Bldg o Sleel & Con ere"', 3,4 hr, PlOt, 0 Protect. Steel Bldg 0 Protect. Masonry Ext, & Wood Int, EXTENT OF DAMAGE CONFINED TO: Flame Smoke DETECTOR PERFORMANCE I The object of origin I J5- I 0 0 I In room of origin-oper, 2 Part of room or area of origin 2 0 2 0 0 2 Not in room of origin-oper. 3 Room of origin 3 0 3 0 )gl 3 In rm of origin-not oper-fire too small 20 4 Fire,rated comp, of origin 4 0 4 0 0 4 Not in rm of origin-not oper, fire too small 5 Floor of origin 5 0 5 0 0 5 In room of origin-not oper.,power disconnect 6 Structure of origin 6 0 6 0 0 6 Not in rm of origin-not oper, power discon, 7 Extended beyond structure of origin 7 0 7 0 0 7 In room of origin-not oper, dead battery D 8 Not in room of origin-not oper. dead battery 9 ,29- 0 9 No detector present 0 10 Undetermined U 13 to 24 stories o 25 to 49 stories o 10.000-19.999 sq ft 0 50.000,99.999 sq ft o 20,000-49,999 sa ft 0 100,000,499,999 sa ft o Unprotect. Masonry Ext. & ,Wood Int, g Unprotected Wood Frame o Protected Wood Frame ' 0 Not Classified Above SPRINKLER PERFORMANCE 1 0 Equipment operated ~ 0 Equip, should have oper,-did not 3 0 Equip. present fire too small to Opel. 9 0 Not classified above o 0 Undetermined or notreported 8 0 No equipment present (N/A) U 50 stories or more o 500.000 sq ft Sprinklers Controlled Fire: # of Heads Opened YES 0 NO 0 9 No dsmage ofthe type (N/ A) 21 REMARKS Weather Conditions (optional): .0 cont. on back 22 Follow Up Investigation &quested Y~ N ~',,,-,-- ~ ~-Q.........._~'o-- If yes, who will investigate 23 Number of Injuries 24 Me:~~ ~~\~a \JL;"U 25 Additional Information bY' (' \:J' -,~ -. Number of Fatalities Fire Service Other Other Titl~'"\-' _ CD \(11 , Title Date ,"\. \~gS- Date (") XO O~ W"tl >-3t"' .....trl t"'>-3 trltrl 'Tl'Tl .....0 ::0::0 trl> Wt"' t"' (") ;r:0 O~ W"tl >-3t"' .....trl t"'>-3 trltrl 'Tl'Tl .....0 ::0::0 trl> Wt"' t"' ,00 (") o ~ "tl t"' trl >-3 trl 'Tl o ::0 > t"' t"' ;r: o W >-3 ..... t"' trl 'Tl ::a trl W ,00 W >-3 ::0 C (") >-3 C ::0 trl 'Tl ::a trl W o Z t"' 0< ~. j~ ,,/ ..;~.~ ~ .- ,,' t, / SPRINGFIELD FIRE DEPARTMENT SPECIAL INCIDENT INFOR~1ATION FOR~1 DATE: TmE: SHIFT: \ u..... ('Y\ 0-.. ~ \.. '\.. <t )- :\C\.\, ~ ~ ~\\ TO: \=- \"'-'L ~~ ~~<>--- FD -1 30 ," . FRDr1: C~4;;;: \\~~ mCIDENT: ~\........SL ~v-SL ~ '\.\.d- ~~. l;"~~ \.Au- ~~~t.- ~~~, ~ ~v-..9..AVf C"- \..M...V 9-~. ~ ~ ~ ~ ,cr 't-- . .. ~~ ~ ~ 0- . 'c-. C1LA~" \ \'-'> B U-"-'l~-' -\\...<> ~ ~ \-,~~\..:\- ~ ~ ,~(OvuA\ ADDITIONAL REPORTS: \=,'-'L ~~ , ACTION TAKEN: DUTY DISPATCHER: DUTY OFFICER: o/~ L~ ~\f-t9 I ;,r ,1' .l ;r <Jf. 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