HomeMy WebLinkAboutPermit Building 1989-1-17
~~~
.----
\Jot--" #;
'if9 ()o1l
FIRE DAM~GE REPORT
OR
ELECTRICAL HAZARD
1;\~
ql.{b, 111/
DATE r1j-/ 7~? 9
TO
8ulldlng DeDarD~ent
/t?3
F~OM Sorlngfleld Flre Department
SUBJECT S:ructural Damage to 8ulldlng
Address or locatlon of bUlldlng "jj--go fJL~_
Name of O\/ner );1. .:::fcc> M1 r ^.An~___
Tyoe of bUlldlng rO~l~
(DwelllngMtore, Harehouse, etc )
Est1f11ated value of bUlldlng $ '/'iJ,ooo
Estlmated loss to bUlldlng $ ~YCJQ
Da te of fue t! ( ~ I 7 - J f
Locatlon Of damage In bUlldlng
~~
(Reof, Wall,
Exterlor, Interlor, etc )
[}~
1/
rJ-. t.'-'.~
pi
Structural wea~ness as a result of the flre
1A~
,-,--
(Burned rafters, Beams, J01StS, etc )
~ flJ~ ,~-j d~/
tJL~_ /t~.~~
i )~" l "1--'1 eJl~ JL-<"<sfL
~'--~ ~- c?~
(Wlrlnq, Outlets, etc )
Slqned Gc~
-1~J
....
~dQltlonal oertlrent lnformatlon
~-
El ectrl ca 1 Hazard
d- r1;tl~-Au
~
r:A~~
./
cc
STATE OF OREGON FIRE REPORT
ST A TE FIRE MARSHAL
I DO:r-.OT WRITE IN THlS SPAClo I
CONTROl },P
'0 '0
_~"tlnc~IO~'"'1 ;~:, 1,::pe/1"
I weEK
W () /7 'ire; OMo"
"ClD"TAOO"ESS 3S- 7, J ( L~
I FIREDEPT \. nrQ - 01 b I
ALARl\1 NO "-Sf CJ I
~Lr //
Dept Re<;pondlllg I ;ff....v
ALARMTI\.H I ARRIVAl T1Mhll 1r~ACKIN .
o 703 0 7 {J 7 0 )"y
f7V;? I C5?CT I ':3ClASS
TELF'PHQNE
lYIt -!JG.03.
(I: FJr~t MI) Jf1
NAME (Last ~ lrst Mil
A' f./A
OVlNERNAMl:.(~~
6 FIR}:. RFPORTFD ~q:;) ,,;
o
o
o
ME1 HOD OF
ALAR\{
TelephaneDlrect
MUOlclpal ~Iarm S\swm
Pr1\8te Alarm ~\Slem
Count)
~~
o
C;lltur
~ues
o \\ed
o
o Fn
Thur
/
ADDRESS
ADDRESS
~
ADDRESS
-
o Rad,o
o \ubal
D l\oAlllrmRecd
~ll (TIe Lind
o VOIce ~lgnal Mum Alarm
o t-.ot ClassIfied Abo, e
I ,OF AERIA/PO\RATUS RESPONDED
o Other (LIst} I T)PEOFACTIONTf<KEN
'\d" ExtmgUlsh
. -0 ]n\e~tlgaJon
1/ OF E!'.GINES RESPONDED
ffZ
"OF FIR} SERVin, PERSONNEL
RESP01'<DED /
9 T\PEOFSITUATIONFOU"JD
.g Structure Fm~
o Other Prop ..../,lIlue
o \ehldeFtre
o
o
Bru,h Grass Lell\es
Trash RubbISh
10 METHOD OF
E). TI!\(,UISHME~T
o SelfExtmgulshed
o Make<;hlftlllds
o Portable Extmgulsher
II j'ED~SE SJ~
\1 MOB]LE I \ EAR r MAKE 0
PRO PERT) I
12 ROO\1/AREAOFFlREOR]GI~
lJI; ~I "AKE
-1)
E
DOB (optlOnIlll
DOB(optlOnlll)
DOB(opllonlll)
DOB(optlOnaJ)
TELEPHO!\E
TELhPHOl'.E
-----
TEI..EE!:!ONE
MutOll] Aid (extmguls_ orlmestlgat.eonl})
o GIHn
~N/A
o ReceIved
()
:I: 0
00::
UJ"'
>-3~
t=>-1
",,,,
..".."
-0
""
"'>
UJe<
e<
()
~O
-0::
0",
UJe<
>-1",
r>-3
t:'JtIj
..".."
-0
""
12>
e<
e<
N OTHER VFHlCLl<.S RESPO!\DED
(donotmcluoePAsl /
o Removed Ha1..llrd
o StandB,
o Handlaldhose/hvdrllntstandplpe
o MasterStreamDe\lce
o
o Automatic Ext S\ stem
:::B:. Pre conne-ctho<;e/tankonlv
o Preconnecthose/hHirant standpipe
,\ PROPJ...RTY CO\1PLEX UfllpphcabJel
I MODEL
Not Classllied Alxne
\IOBILE PROPERTY (Complete hne M)
SERIAL P
EQU(O~.C'IT:J:z:;:;t
MODEL ~ I SJ...RIAL,
o Sahage
o NotClasSlfied
o Vndetermmed
I LICE'\SE ~
EQUIPME.NT
]!\VOL\FD
]'\ IGNIT]O~
13 IG!\ITIO!\ FACTOR :c-L
l' FORM~'
15 LE\ EL OF F]RE ORIG]!\
o Grlldele'e]to9ft"et
I vOLTAGE
, ~UJ
~.. ro,.,j)A~ /Lj)A-~ ~ l--k/J
MA'J.]IA~iIRSTIGN'ITED\\A~ADEOF IITE~O~~ITED 17
. (A ~.--'- o-<:7<V
CJ 30 to 49 feet 0 OHr iO feet 0 Belo.... grd le'e]
o "OwiOfeet 0 Ob;O'elsmFhght 0 l'.otCla<;<;llied
fJ....j~eaO 00 \ehlC]ellndContent.s 00 ~r
,
~
I
16
VALUE
~IOto19feet
'D 20 lo 29 feet
BUlldmg
000
5"<::>0
t./?5
@.
00
00
LOSS
00
B 13t.o24stones
2<l to 49 qones
J7 NU\1BEROFSTORIES 0 2stones 0 <lto6stone<;
~lswr. 0 3to4stones 0 itol2swnes
18 BU1LDI/'>.G AGE (In \ ellr<) I BUll DING SIZE (Grnd Fir Onh) ~ 1000 4999 sq ft
f~O D0999sqft D50009Qg9Sqft
19 CONSTRUCTIO!\ T\ PE 0 Hea\") Timber 0 Unprot.e<'t Ste"l Bldg
o Sl.eel8. Concrete 3 4 hr prot 0 Protect SI.ee1 Bldf: 0 Protecl Masonr) Ext & \\000 Int
E\.TE'TOFDAMAGECOT\F]!\EDTO F]ame Smoke DbTFCTOR PERFORMA"JCE
00
o "nswnesurmore
o undetermmed
00
7.:;> TOTAL
./ .) 000
---
tQ.j~<.lC'
("J
0
0::
"'
e<
'"
>-1
'"
.."
0
"
>
e<
e<
:I:
0
UJ
..,
t=
'"
::J
"
00 '"
UJ
00
o 10000 19999sqft 0 ,,0000 99999sqft
o 200004Q999<.qft 0 l0000Q499999sqft
[.J Unprotect Ma<;onr. Ext &. \\oodlot -fg..,Unprotected\\oOOFrame
o Prolected \\ nod Frame 0 Not Cla<'<;llied Abo\ e
TheobJectoforll'ln 1 0" 1 0 0 1 Inroomofonl'ln-oper
PlIrtofrooffiorareaofongm 2.R 2..:B-- 0 2 '\Olmroomofongm-opn
20 3 Roomofotl!rln 3 0 1 0 0 1 ]n rm ofongm-nOl oper~fire too "mall
. FlTeratedcompofortl'lO 4 0 4 0 :fi(. '\lot m rm of OOl:1n-oot oper fire too ~mall
5 Floorofongtn 5 0 5 0 0 5 In room of()T1gm~not oper po....er dISconnect
6 Structure of on!rln 6 0 6 0 0 6 Not m rm of ()ngm~not oper po....er dlScon
i'.xtendedbe\ond<;tructureofotll'ln 0 1 0 0 ]nroomofonl'ln-nOloper deadbattef\
0 8 '\ot m room of ongm-not oper dead batten
'\odamageoflhe I've (!\/A) 9 0 0 9 '\udetE'ClOrpre<.,nt 0 10 LJndetE'rmmed
21 RE"'IAR"~ \\eolher CondltlUn<; \opllonal1
" Folln.... Up In'eql~aIlUn fuque'lt.d
,_ NX
21 "Jumrn-rof]nJune'
FIre <:;er.lce ------.-J)
24 "1ember\111~mgRY'>Ort V ~ /,., '(
~ l-----::t~ /......A.....-4'./ _ ~
25 Addlllon/lllnformlltlOnb,
]f)e5 ....hu" 1]lln\e~llgale
Dther
l NumhcrofF/llllhtle<;
Flr"Sef\ICe
Title ^) /
{ - #4 /~ A./-1
Tille p7
L0.
00
o 500 000 sq ft
SPRll\lKLER PERFOR\1ANCE
o EQutpmem operlltro
o EqUIp shouldhll\eoper-dldnot
1 0 EqUIp present ftre too sffillll to oper
9 0 Notcla<;<lfiedabo\e
o 0 Undetermmedornolreported
8~oequlPment pr~ent ('/A)
Sprmklers Controlled Flrp
/t of Helld<; Opt'neil
\ESO '\00
o contonback
Olher
0"'0 {- 0- <;(9
D.~
UJ
>-1
"
c:
()
>-1
c:
'"
.."
::J
"
'"
UJ
o
Z
-<
.