HomeMy WebLinkAboutPermit Fire Damage Report 1988-3-6 (2)
~ 329 969 955
I
,
, 0{)
i p !
, ~ ~ e
I <t i ~
, ~ ~
'J'~~
~ Ii:
II 0
I 8
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIOEO-
NOT FOR INTERNATIONAL MAIL
(See Reverse)'
SENT TO in I
\r\ M .1)5< j,,,,,, ~Ari ,^ )
SrR AN'1"'t J
;:l'i( I ~ Pn. tP\fV\A'lv--A. F~..v,
P~ATEANDZI';CODE f-t
"..',,^t ~,,,I..o Oe. W)"
POS AGE 0 , :J:> ,
J~
CERTIAED FEE
I SPECIAL DELlVEAY
I RESTRICTED DELIVEAY
'I
IoU SHOW TO WHOM AND
~ DATEOEll~REO
~ SHOWTOWliOM,OATE.
~ :~.:fR:ESS OF
w
:ill SHOWTOWHOMANDOATE ~
II: OElIVEREOWlTHRESTRICTE
~0E1I~,
ffi ,T......, ","AND I
a: 'dt1iB.lvtR.YWITH C
'" ,mCTEOD<L1VElfi<1:,', '70
~ -;;;T~~ STj~~~ t~ '1,/:'7
.( POSTMARK~.J, I '/1j,
~,\.; , lHU~'
E
-
.z
'"
c..
,
,
,
"
~\.
ru-J.O
.
~
IJee;; 1tl)~ FIC~
'11
t11.j()' \I
, FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
&:r
DATE: l1M.d.. (, ,Qrr,r
TO: Building Department
FROH:
Springfield Fire Department
~j() \0~
SUBJECT: Structural Damage to Building
ZBI
~ OF. nd,..,oNc( F"',",, 0:(.
,
Address or location of building
Name of owner
~,
f~,. SLi..ioee. Ner/>"t,a..
I.Jl.X,{j i IVC,
tOwel/ling, Store, Warehouse, etc,)
Type of building
Estimated value of building S
30) oce.
Estimated loss to building S
..10.CJ('C'
Date of fire
/'1f1I"L r. ,Ci W
Loca ti on of damage in bu il di n9 -1J." {/ <: ,fi-",tJ ',(' fil'I,,, 1 , 0 4-
...illu.ff r("N"N.~ rl"l7t11 r jf{.t.Erf 1] I. ri..r:p.
(Roof, Wall, Exterior, Interior, ,etc;)
Structural weakness as a result of the fire ~ 1'.....u~I'Dr p,^,,-/-".J..;'N ::>
,'.J Uu."" rOOM ,c-tH":J.(1l...J.d... bM r.vd - p,,<;<::;,'h~ k~,,'n~ uJ~, W
J, (Burned rafters, Beams, Joists, etc.) ~
1.J.J.Li:.J/.'~ r~
I
Additional pertinent information
Electrical Hazard l'ihAlSiul r(~",,,,,.. -Ie .4tf r;,.-! !''it hm'f-.I nll.J h'''-rr
I
~ {Dr y: '!.OJ'''''' WI'/I.(" ~
,''v ([i ';"'1 "~, ,t-..s. {b,r bUI!N'f.
(Wiring, Outlets, etc,)
Signed
.J.1,."r'JI
f) iV/ii,] 1.1 {",
, /
cc:
c~c t:)iY~j
,
" .
~. '.
.
"/I t!6V7?5e- ~~/:Vl ~ I!P~~
.... :2, rk< ~15T1 (lu pt,..e) /Jv1(A/lJV ,~~ FTie~?(
"'3, lJlf.y;? M8z) 6>'~fIie ~a ~/tfQ ?f-T
nle& fJ~ 0~U ,ao ~/c:.r77J ~~~~&"
/,llnll!)l et~ &57-Nt3C1U I'#~ ~M?~I
P~tJX, f kk Um,(3a-tll~a /)4~'7-;;;e~
rl 2Jrwv~l7t1~J /1)1A.7J,.Wj i ;)~ ~~
'" \5 i I1JIf1,C ~im;e,J 1JIW-t.JST1t7A?-j G c.G1 t.... ;:; kt-r ~)
'" ~ I ~AJ Tl; t/lJ'/A7~: 5~~ IW~ (L~U
rr e6VJPeM ~~ ~~~.1 ;):Ic--r /JKt5'/~ -<)
I' TN., , " (1IBt7- f7/tYV/7C:V
pjA. :-:..--//
fb, /5)< (t5( SI ,lJ/~ e ACA.-I.!!. ,- ~'4(~?"' ch>-fK -0/<::....
, '
i ,'.' :
,
, -
.... ~..
- Job Number
--aTY & nS~ l~~~ p^" :!,~'
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. , \ OWNER 01l l\^ ' r, c- Q W
TO TENANT . V \0 " ~^'" ~ ~ ,^
LOCATION OF ,t C'\ ' I I"
JOB ,,-. "I 'I...\~L":\ 1M"......... -I'~
o WIRING APPRO'IED FOR COVER 0 A PERMIT IS REQUIRED ' IJ
o APPROVED FOR SERVICE 0 HEAT CABLE APPROVED FOR COVER
o WIRING INCOMPLETE 0 UNDERGROUND APPROVED FOR COVER
o WIRING COVERED WITI-lOUT INSPECTION 0 CONDUIT SYSTEM APPROVED FOR COVER
o DUE TO THESE PREMISES BEING LOCKED AN INSPECTION COULD NOT BE MADE
o DUE TO NO ONE HOME AN INSPECrON COULD NOT BE ,MAD!:
o WIRING APPROVED FOR COVERING EXCEPT THE FOllOWING
Y.~t:/Qj
~ ~A.,~ "->rY A -~ r.,~ J ^/"/?'A~ ~ ~^" . .
Q ~t"^A . \ P J-I,' .w: ' ~~" 1'. ...J cJ i :I.l'v,tvuJ ch.-",...:"u:;.
PAJ::h;-\ ._.:.v,<2-j/;,J).,^~--t. QL..~',r_.l ,c~ ~A..J~....; Lc-:-1o-:t, ,
\~~ lAtJ' i"; a." (p.n....~~ ,J- J~,,..--"-< t_ .o--,^"^--,"''lAA~'v'\.>-""~,,
, - I" . II ~ 1 J
^ '^--'" ~"-~\ -f-x/VVI" I
U
, A. K. Brl;;. Company. Inc.. f\lgClM. Oregon
~1~ ~il '(~C~.J()
~45-8 . V !/'. .
.. ( ~. ~:.
.
,
BUILDING LETTER REQUEST FORM
Date:
3/ID /e~
/ I
Name: .-lf~ t!/J3fb4
Salutation:
/?/77# ~ fl!;8~OIe; r
1
Fi rst
Last Name:
S'LtllJ~,
Owner's Address: ,*'^
.-:2- @o I ~~.)) ,~ ~ I
~A/#'J"P/e--(.(,), tJ)( ~ 7,77
Review Date: 4.-11l) lee
( J
Number of Bldgs.
Header Paragraph # ~
Is This Letter Certified? ~/ No
Inspection Address:
S"'~ ~
Proposed Use:
Type of Bldg.
Is This Letter Formal? Yes /~
--------------------------------------------------------------------------
--------------------------------------------------------------------------
STRUCTURAL PARAGRAPH #' S __ r ELECTR ICAL PARAGRAPH #' S
5~1Ji~? ~J ~~""u~
/ ()'PtA- 'M.. &k. ~~; ~,' r,' I, '..... ) ,
Ahy Changls V-- es No' J Any Changes Yes No
: \.
---------------------------------------------------------------------------
---------------------------------------------------------------------------
MECHANICAL J'ARA,GRAPH' II'S
",,' 'I
PLUMBING PARAGRAPH~II'S
I'Hd....
~
Any Changes ,/' Yes No Any Changes LYes _ No
==~?::~=~==~~"P:~l!~========1E~==~=~~(,~=~L~l!!~J
\
SPECIALTY HEADING CLOSING PARAGRAPH #'S
Title: - /1 J 2-
Paragraph #'s .-
Any Changes Yes No Any Changes Yes ~o
==========================================================================
SIGNATURE #'S ~J"~
CARBON COpy #' S )1IfYE. >>/.;A:;,I;- ~
.
1125
< ,
'-
,
.
NOTE: Place an asterisk (*) in front of paragraphs to be placed in
the review buffer for the library.
c:.~~c;z,~
_&) l1IG ,~JL~ s..~~~;??~f ~'
/)~E1l ~ A })~.- u~J.}; n~~
~ ~btrhH~)!!
.4-. 1~~~i!iI'+LfA.JZ WAL~mll!1B.1,
fJ. ,~1JtJ ST'JtU/("~ Ai; lAw 7JB .n~.vA u.rK~
IJ. ex.~~ I.i.)kl.l. ,~~.
~.+tU;~~ .~u/}. oAf THH J?~~
~~ .Jl.!3 A15t1bILr m ;,#,Ai!AV//J,;!; A .h'uL)J~b1
l" cL~. A.er~ .vL.L ~~,(r./(!J~
1
~J;tL.r; AtUlJ -ptr; 7nWK~r /.:Hrm"u4''' ~,
*' (f)[t!$fY.J1'] ~ (!))VExIAJz m*,~U IU~' '
FD IrJIDf. .1JAonH-!:U ~ .A- ~,4zst:: /-v~T'/L..Z iR04~6;r)/:
tflt/vJJt~ . . ___
<. ./. P /.j.J ht.f:3 '"'"
-~"I _" ~/~
=# .......- '~f{. ~) ~'S8(,//~ l-r,= ~S'~
I ~.t~':~ I .z.. .. ,
.-s.I"1'r;ttJ-nc. ~ .:AA-~~/\ ~CAt:".r w -~ '--..r~,,)tf
~~h-# ~
~ 711fE aev~ ~A.h flAYT MiIhf );A.M~~\
=-q 7H5 ,F-MA ? ;.)b~S'~t ).",!"ruJ~ U' .hU'<O~f