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HomeMy WebLinkAboutPermit Fire Damage Report 1987-8-6 (2) I ,; " . -- . ........ ," ---,.- ,. . " , e .'1 . . : . .'~ . .'. . ~. '. ~.~ :.' . . .:~,. .' ::;P'~7(j.'2~l:',~-", ~" ."<.'" '~,:' .~'~ . .' L.' .:- . ~:..- ..~; ""~.', .\~'i ..' . . , .' , . .~ ., "): ...., 100"", . "J.; o' ',." . <~I': . . -, . .'f1," . . ,.~t'. .~' .'~ ., .,......\J, . '...." . . .j.'IiI~'~~' ,. -~ . 'fo... ~ ~ , -'(:" -., ,- '-:".,"'.., ,t," ,- . '} " ..^ :' c. Co.... DATE ',' 0_ /- ~ 07 .>.:<\:~'. "~::;l~~j,~~ 6"', (::t 0 _, ". ,', . .~, . .. ,..- e , " . ",." . .. """,...-.' """. ...... ..... ...... , . . ~ . ,".. ., ~ . '.. FIRE DAMAGE REPORT OR ELECTRICAL HAZARD ......:....". '. . . .., ',' .. ., - .. ". ~ -. ,. ",' .' . . \' .", "'" FRO~1 : Building Department Springfield Fire Department & C6lio. q~61 I \\. \ ...,~ , . ....f ';.;, . . , " TO: :' ';"';"- ," ....' SUBJECT: Structural Damage to Building ~3. . Address or location of building L/C:<3o ])/J/,sy . Name of a.mer ..:JIM .;;JO,u"":5 ( ~6eRr c";UcM'I- Dcc"-'f"l9JtIr) Type of buildi ng &)')Gt~ ~MI L y ])tu&LL11..JG- (Dwelling, Store, 14arehouse, etc,) :~ "1/ . v' , ~" .;;. , .., Date of fire Estimated loss to building $ g'- ~-J7 Location Of damage in building G/9;(fAuc $ .:5c:J c10C? . ~ /cs 0 ., ," . Estimated value of buil~ing ~R()5"5t5 U)I1-~ , (Roof, Wall, Exterior, Interior, etc.) Structural weakness as a result of the fire ~R()5 5ES t) Ub/( &A.Rft6E (Burned rafters, Beams, Joists, etc.) Additional pertinent information Electrical Hazard fb~5/ 8L1= ~ ~/R/A)G /AJ C;+~f-- (Wiring, Outlets, etc.) Signed ,~(d-;/7 ~AM/ "c ' '" , County LfbVE Dept. Responding ~9pe/AJ6-r Ie-in o Tues S" Thur o Satur ALARM TIME ARRIVAL TIME TIME BACK IN OWed ) 191/ ~ /lq ,I Ir ..('I SERVICE 1J o Fri 10 [I I ZIP CENSUS TRACT ISO CLASS (') 9171~17(f 1/ fl"tJ I z.. d ::I: 0 o is: DOB (optional) TELEPHONE w"'C ?~6~6?tJJ >-3t"' ....tr:l t"'>-3 ADDRESS DOB (optional) TELEPHONE tr:ltr:l ..,.., ....0 ~~ ADDRESS! (!)~ DOB (optional) TELEPHONE tr:l> Wt"' . \; t=:.J1 Jt?71J CJ35 - 376t t"' ADDRESS I DOB (optional) TELEPHONE ,'. .f' . ~ .- eT ATE OF OREGON FIRE REPORT STATE FIRE MARSHAL _EDEPT. ALARM NO. ~ , DO NOT WRITE INTWS SPACE CONTROL EXP. NO. NO. District ~f ~.,cident ~ T to.. MO DAY _\'PR / t.)("';f laD o o Mon DA Y OF WEEK YEAR Sun If 1& 11b117 2 INCIDENT ADDRES~ .4c:( 3D ,J~f}15 y 3 OC(jO~A:JAtVint.MIr!tJ bERi 4 BUSINESS OWNER NAME (~t, First, MI) 5 OWNER NAME (Lost. First, MIl ~A)F:5 01M 6 FIRE REPORTEU BY (Lost, Fi"'i. MIl 7 METHOD OF 0 Telephone Direct 0 Radio ALARM 0 Municipal Alarm Syste"; 0 Verbal o Private Alarm System 0 No Alann Rec'd 8 , OF FIRE SERVICE PERSONNEL , OF ENGINES RESPONDED. RESPONDED '1 c2 Mutual Aid (extinguish or investigate otJ. o Received 0 Given ~/A o 911 (Tie Line) o Voice Signal Muni Alarm o Not ClassiflOd Above , OF AERIAL APPARATUS RESPONDED , OTHER VEHICLES RESPONDED :#M8vt/J}vrE 9 TYPE OF SITUATION FOUND P( Structure Fire TI Outside StrucL w/value o Vehicle Fire o Brush, Grass. Leaves o Trash. Rubbish o Salvage o Not Classified o Undetermined o Other (List) TYPE OF ACTION TAKEN o Extinguish 0 Removed Hazard o Investigation 0 Stand By o Hand-laid hose/hydrant. standpipe o M88ter Stream Device o Not Classified Above o Self-Extinguished 0 AUlOmatic Ext. System o Make.shift aids 0 Pre-connect hose/tank only o Portable Extinguisher [Z3) Pre.connect hose/hydrant. standpipe 11 . FIXED PROPERTY USE PROPERTY COMPLEX (If applicable) 0("-\ ~~ V :Dw~L-U /...Y:s-. M MOBILE YEAR' MAKE PROPERTY 10 METHOD OF EXTINGUISHMENT MOBILE PROPERTY (Complete line M) MODEL SERIAL' LICENSE' -L!l2 EQUIPMENT INVOLVED IN IGNITION (Complete Line E) ROOM/AREA OF FIRE ORIGIN GARA~ E EQUIPMENT YEAR INVOLVED IN IGNITION 13 IGNITION FACTOR MAKE SERIAL' MODEL . VOLTAGE 14 FORM OF HEAT OF IGNITION MATERIAL FIRST IGNITED WAS MADE OF ITEM FIRST IGNITED: 16 VALUE o 101.0 19f..t o 201.0 29 f..t Building ~r:::, 0 eX') () _00 .5500.00 o 301.0 49 f..t DOver 70 f..t 0 Below grd. level 0 Undetermined o 50t.o70f..t o Objects in Flight 0 Not Classified Contents Vehicle and Contents Other ;; TOTAL /..5 ~{)OOO .00 .00 p~~a?6 .00 6dO .00 .00 .00 &tJOtJ .00 15 LEVEL OF FIRE ORIGIN a Grade level 1.0 9 f..t LOSS 17 ~BEROFSTORlES U 2slOries U 5106slOr;es ~ I story 0 31.0 4st.ories 0 71.0 12 st.ories 18 BUILDING AGE (In Years) I BUILDING SIZE (Gmd Fir Only) 3- 1000-4999 sq ft / 0 n 0-999 sa ft 0 5000-9999 SQ ft 19 CONSTRUCTION TYPE 0 Heavy Timber 0 Unprotect. Steel Bldg o Steel & Concrete. 3-4 hr. Drot. 0 ProtecL Steel BId>>: 0 Protect. M880nry Ext. & Wood InL EXTENT OF DAMAGE CONFINED TO: Flame Smoke DETECTOR PERFORMANCE 1 The object of origin 1 0 1 0 Olin room of origin-oper. 2 Part of room or area of origin 2 0 2 0 ~ 2 Not in room of origin-oper. . 3 Roomoforigin 3';2f. 3 0 0 3 Inrmoforigin-notoper-firetoosmaD 20 4 Fire-rsted compo of origin 4 0 4 0 0 4 Not in rm of origin-not oper. fire 1.00 smaD 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 g 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 hettery o 8 Not in room of origin-not oper. dead battery o 9 No detector present 0 10 Undetermined U 131.0 24st.ories o 25 1.0 49 st.ories o 10,000-19.999 sq ft 0 50,000-99.999 sq ft o 20.000-49.999 8(1 ft 0 100.000-499.999 so ft o Unprotect. M880nry Ed. & Wood Int. 'J5..Unprotected Wood Frame o Protected Wood Frame 0 Not Classified Ahove SPRINKLER PERFORMANCE I 0 Equipment operated 2 0 Equip. should have oper.-did not 3 0 Equip. present fire too small 1.0 oper. 9 0 Not classified above o 0 Undetermined or not reported 8 }gLNo equipment present (N/A) U 50 stories or more o 5OO,OOOsqft Sprinkle", Controlled Firs: , of Heads Opened YES 0 NO 0 9 No dsmage ofthe type (N/ A) 90 21 ) -../ REC~rrc:~iOnaI): o cont. on heck fi.g,1=: ~~LJ~ Y~ N If yes. who will investigste 22 Follow Up Investigation Requested 23 Number of Injuries r Fire Service Other 24 Me~ Ijaking Rp>ort h A _ -+-I--- '''N...I.~W:1 .{ .I-I J.r ..AI A~ 25 Additionallnfrnation by - ' - I Number of Fataliti.. - Fire Service Title C +:tOT: Title J - Other - DateX' _ b - 8' 7 Dau I A14-440-10 (R.A4\ (') ::I: 0 o is: w"'C >-3t"' ~~ ..,,,, ....0 ~~ tr:l> Wt"' t"' (') o ;s: "'C t"' ~ tr:l .., o ~ > t"' t"' ::I: o w >-3 .... t"' tr:l .., .... ~ tr:l w w >-3 ~ c: (') ~ ~ tr:l .., .... ~ tr:l w o Z t"' -<