HomeMy WebLinkAboutPermit Correction Notice 1987-8-10
tJob N~~ber ~ 706 to l.o
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_PECTOR \6 f}tl- ." w ~__ pi.. TE '\/r 0 /~l
CITY OF SPRINGFIELD I I
BUilDING DIVISION 346 MAIN STREET 726-3753
WE-HAVE INSPECTED THE ELECTRiCAl WIRING AND EQUIPMENT INSTALLED BY YOU AT THE PREMISES NAMED HEREIN AND SUBMIT
THIS REPORT FOR YOUR RECORDS.
TO' 1!..,~~.l
.
OWNER OR
TENANT
lOCATION OF
JOB
;
~CJ f\rA~
o WIRING APPROVED FOR COw:R 0 A PERMIT IS REQUIRED -....J
o APPiROVED FOR SERVICE 0 HEAT CABL'E APPROVED FOR COVER
o WIRING tNCOMPUET'E 0 UNDERGROUND APPROVED FOR COVER
o WIRING COVERED WITHOUT INSPECTION 0 CONDUIT SYSTEM APPROVED FOR COVER
o DU.E TO THESf: PREMISES BaNG LOCKED AN INSPEClION COULD NOT BE MADE
o DUE TO NO ONE HOME AN INSPECrON COULD NOT BE MADE
o ~1!R1NG APPROV:O FOR COVERING EXC'EPT THE FOllOWING _ C .
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TO:
Building Department.
Springfield Fire Department
:SUBJECT:
Structural Damage to Building
'. . ~.' ~.','-
.-
. .
Address or location of building
Name of o\'tner J;h~,vG"S
Type of building &AJGt.G. ~MILY
( Dwell i n9 ,
L/c:< 30 ?Jt/J /,5 Y
( i!b6E::RI 0tUWR V -
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))to&LLJ ),)G-
Store, l~arehouse, etc.)
:.'......
C5cc~?fi~r) ....
$ 5'c:J &100
.~ ~~o
U)/1U ','
(Reof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire ~12{)5~ES
. Estimated value of buil~ing
Estimated loss to building
Date of fire
7""RU5'513S
I
() U6:/( &AgFt6E
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
fb~5/8~
/6
.
a...J;R/A )~
bJ1~':"-:,
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(Wirinq, Outlets. etc.)
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Signed '~"il.tl.;~(JJ1.t/
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~TATE OF OREGON FIRE REPORT
I" STATE FIRE MARSHAL
UhvE
aEDEPT.
ALARM NO.
;. DPNOTWRITE INTWS SPACE .
OlNTROL EXP.
NO. NO.
S::PR/Dk~ laD
o
o
Dept. Responding L 9p...<" / AJ6- r / cL-D
ALARM TIME ARRlVALTIME
JI91/~ I,ql/'?
ZIP CENSUS TRACT
9,71'117(1 I ,/ fJ'.H:P,"Z,
DOB (optional) TELEPHONE
?~6'6?tJ J
County
District of Incident
.'\ T~ MO DAY
.,./
;~ J ~ I & I Iql7
,iifiv~ ,INCIDENT ADDRES~
'.i'\r<.. ,4c:( 3D , UIH:5 tj
<~:;\~.~,OC9i'ANT NAM~iiot, MilO
',''''1' l/O f..J ~ K tJ bfP-r'
;:t\"'~ .. BU~INESS OWNER NAME (~t, Fint, Mil
, ~<'.~ I' > ~ '. "
.s.. Thur
o Fri
YEAR
DA Y OF
WEEK
. Sun
0Tue8
o Wed
o Satur
TIME BACK IN
..<'I rJE77El 't
ISO CLASS
~
Mon
ADDRESS
DOB (optional)
TELEPHONE
.~, ...,.
-I
. ,<;. 6 OWNER NAME (Lut, Fint, MIl
."~:~tJJ.P:5 Sw
.'!'~ 8 FIRE REPORTEU BY (i-t, Fin&. MIl
ADD~S I
. v~,>e-[ll
ADDRESS' I
(!)~
DOB (optional) TELEPHONE
935-37M,
DOB (optional) TELEPHONE
'i.~i~\,V,l '.:
;..1.-,,;'" '
,}1,(7 METHOD OF 0 TelepboDeDiJect 0 Radio
'~~f; ALARM 0 Municipal Alarm S,.te"; 0 Verbal
"V~.-,:,,, 0 PrivateAlarmSystem 0 NoAlarmRlJl:'d
:~ ',' 8 , OF FIRE SERVICE PERSONNEL , OF ENGINES RESPONDED.
. ,./'.1\" RESPONDED a F)
'.' t~~. / eX
.
Mutual Aid (..tu.,uiah or inv..tigate o~.
o Received .'. 0 Given . _~/A
.,
D 911 (Tie Line)
o Voice SisnaI Muni Alarm
D Not Cluaif"'" Above .
'OFAE~APPARATUSRESPONDED
, OTHER VEHICLES RESPONDED
(cjqnotincludePA'~1Ire
.HMbVL./)~ .
"\:\,1,9
If ..~';~' .;.
o Vehicle Fin
D Brush, GI'88I, Leav..
o Trash, Rubbiah
o Self.EEtu.,uished
o Mue.shift aido
o Portable EEtinguisher
o Salvage
D Not Classified
o Undetermined
o Other (Liat)
TYPE OF SITUATION FOUND
P( Structure Fin .
'0 Outside StrucL w Ival\JI
TYPE OF ACTION TAKEN
o &:tinguish 0 Removed HIZSld
D Investigation D Stand By
D Hand.laid h_/hydrant, standpipe
o Master Stream Device
o Not Classified Above
. 'f.'~".
~';\ 10 METHOD OF
';!:~i.... . EXTINGUISHMENT
'.""},'" .
.It r. .'
, ",. ,i
..
. D Automatic EltL System
D Pre.connect hooe/tank only
fi5> Pre.connect hose/hydrant, standpipe
PRO, "'n, ,'COMPLEX (U applicable/.
MOBILE PROPERTY (Complete line M)
"".' 11 . FIXED PROPERTY USE
..:3(N~~ feMU'! :Dw~{"UD6-
'M MOBILE YEAR'
. PROPERTY
'.'
MODEL
MAKE
SERIAL ,
UCENSE,
-1!:i2 ROOM/AREAOF FIRE ORIGIN
. G~.e Ar-;;:=:
E EQUIPMENT YEAR MAKE
INVOLVED
. IN IGNITION
,13 IGNITION FACTOR
EQUIPMENT INVOLVED IN IGNITION (Complete Line E/
MODEL .
SERIAL'
VOLTAGE
14 FORM OF HEAT OF IGNITION
MATERIAL FIRST IGNITED WAS MADE OF
ITEM FIRST IGNITED:
18 VALUE
U 10 to 19 feet
D 20 to 29 feet
Building
.,t;o ()f') 0.00
bSc>o .00
U 30 to 49 feet U Over 70 feet lJ Below grd. level U Undetermined I
o 50 to 70 feet D Objects in Flight D Not Classified
Contents Vehicle and Contents Other ;; TOTAL
I5~C>t?00 .00 .00 d~ ~Z}:?6 ,00
.5dO .00 .00 .00 t;tJ 0 tJ .00
15 LEVEL OF FIRE ORIGIN
a Grade level td 9 feet
LOSS
17 J;i!!.MBER OF STORIES U 2 slOr;... U 510 6 stor...
~ I story 0 3 10 4stories D 7 10 12 ston..
18 BUILDING AGE (In Yean) I BUILDING SIZE (Gmd Fir Only) 3- 1000.4999 sq ft
/ 0 n 0.999 sa ft 0 5000-9999 80 ft
III CONSTRUCTION TYPE 0 Heavy Timber 0 Unprotect. S"",I Blda
o StHl" Cone......, 3.4 hr. orot. D Protect. Steel Blcbl D Protect. Ml80nry EEL & Wood InL
EXTENT OF DAMAGE CONFINED TO: Flame Smoke DETECTOR PERFORMANCE
1 The object of origin I DID Olin room of origin-oper.
2 Part of room or area of origin 2 D 2 D Jii 2 Not in room of origin-oper. .
3 Room of origin 3 ji;!t 3 0 0 3 In rm of origin-not oper-fira too sman
20 4 Fin.ratedcomp.oforigin 4 0 4 0 0 4 Notinrmoforigin-notoper.f1l'8toosman
6 FIooroforigin 5 D 5 D 0 5 Inroomoforigin-notoper.powerdiaconnect
8 Structureoforigin 8 0 6 & 0 8 Not in rm of origin-no toper. powerdiscoD.
7 &:tended beyond.tIuclura of origin 7 D 7 0 0 7 In room of origin-not oper, dead battery
o 8 Not in room of origin-not oper. dead battery
D 9 No detector p......nt 0 10 Undetermined
U 1310 24storiel
o 25 to 49 storieo
D 10,000-19,999 sq ft D 50,000.99,999 sq ft
o 20.000-49.999 oa ft 0 100.000-499.999 oa ft
D UDprotect. Ml80nry EEt. & Wood InL ~Unprotected Wood Frame
D Protected Wood Frame 0 Not Classified Ahove
SPRINKLER PERFORMANCE
1 0 Equipment operated .
2 D Equip. should bave oper.-did not
3 0 Equip. p......nt f1l'8 too.man to oper.
9 0 Not classified above
o D Undetermined or not reported
8 }.8[.No equipment pzeoent (N/A)
U 50 slori... or mora
D 5OO,OOOsqft
Sprinklen Controlled Firs:
, of Heado Opened
YES 0 NO 0
9 No damap of the type (N/A)
90
21
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o cont. on back
fJ.,g:e::
1..!,:b::lJ~
22 Follow Up Invesligotian Req_ted
N_
If yeti, who will inVestiglte
23 Number oflnjurieo
r Fi...Service
24
I Number of Fatalitieo
- Fin Service
Title C Ao-r-:-
Title I
-
Other
Other -
~e~ )lkin&
2li Additionallnf
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1114-440-10 (R-1I4\
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STRUCTURAL INSPECTION REPORT
JOB ADDRESS +2-'3 t;) ~~.~
OWNER ~Iu ~C.~ f
ADDRESS 1;~, ~PX ;? I ,;/ 6u~/A:
DATE ~ /k~/~ 7
~ I
PHONE
77dB?
, .
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TENANT OR OCCUPANT
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TYPE OF INSPECTION:
HOUSING'
OCCUPANCY
FIRE DAMAGE
COMPLAINT
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INSPECTOR ~t:>Z' ~~
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