HomeMy WebLinkAboutPermit Fire Damage Report 2000-7-12
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CITY OF SPRINLLD
Fire & Life Safety
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sf 00. 2.3"(,
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
..
DATE: 07-1Z--(JO
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building '-1'17::'- DAIS:; S'o 128
Name of owner Robert- T1l. PAt0I<o
Type of building [)vuel I IflC
(Dwe11ing, Store, 14arehouse, etc.)
Estimated value of building $
'-Is-. 00 0
Estimated loss to building $ uncler
Inue<.f-,(,At-IV";
;;.
Date of fire
07-IL-()O
Location of damage in building Root:. l.uAI/,; /nfene>,-. e_)(fe'((Jc
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire P,v..~ne_ d. rAt:/-erS
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
IAJlrlnc.
./
~-
(Wiring, Outlets, etc.)
Si,oed r>:? ,L~
cc:1w
1- 1'1-00
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STATE OF OREGON OFAF $TATE FIRE MARSHAL
2000 OREGON AU IN~ a.,.. V"'AU,," SYSTEM
I FlREDEPT,~O,
ExPoSuRE~fOO.z ~'P(P
~EWL....-.."..
o OIANGE TO REPoRT
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I DISTIUcrOflNCIDENT,'St;>n"c.~I'" \ d.
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" l ALARM DATE LALARMTlME I DAVOF I ARRIVAL DATE I ARRJV,y.~,E
0]-(1..-0(J 03't.'h WEEK We.. 0:>3'1
I ZA PRIMARYTYPEOFSITUATIONFO!lliD:(lhfo~"InYoI_""_orfi~)
!Ont:Rcoo!lforEacbT~O(Firel {II "Truc....1'1.Are.. t-lr~
2B OTHER 1YPE OF SrnJATION FOUND:
COMPLETE FOR ALL INCIDENTS
COUNn' lane
DEPT......::.,)".....,..mc Snrinofiplrl Firp
I DA1EBACKIN I ~~~'2'N
HI
2C OTHER TYPE Of SITUA nON FOUND:
SP~~~I~ ,",'.- ,,'Ftddl:; I 'Field;::,' I' ',' ::-'~F~'~::
~IUse)'. --
13 INCIDENT ADDRFSS
4475"' OAIS'1 Sf' #-/2.8
4 OC~ANT NAME (l.asCliru, Ml) or COMPANYIBUSlNESS NAME
f-ht:dk.o, f?(,J-,prf- dl
5 BUSINESS olYNn NAME (last. fim. MI)
''I' F""'.: ,/,:" F....S: I Fodd6: , ,"
197475 ~r7;;J
DOB
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DISTRJCI'I
ZONE
2-
08 -02.. - s-s-
DOB
TELEPHONE
(~"/) 7</1~ - 35""99
TELEPHONE
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I ' BUSINESS OWNER ADDRESS
I ~ BVn.~INGlMOBILE PROPERTY ~WNER NAME ~ First, MJ)
8 BVn.DlNGlMOBlLE" A...." ~.... . OWNER ADDRESS
ZIP
I DOB
I TELEPHONE
( ,)
1 ZIP
9 INCIDENT REPORTED BY (Last. Fint. MI)
I DOB
I TELEPHONE
( )
1 ZIP
'10 lNQDENT REPORTED BY AD~RESS
11 #OFFJREPERSONNEL l#OFENG.IN. ES I # OFAERlALAPFARAnJS I
RESPONDING ~"..... ....aNG Il.;..:........ ,.....LNG
c...... 12- t Vol....... ~
U TYPEOFACIlONTAKEN(CHECKAlLmATAPPLY)
370 Forcible Enny 71 f;(IQvestigate 360 Transport 470 Decon Area
15lCExtinguish 31 0 Rescue 420 Hazmal ID 46 0 Decon PeoplelEquip
16 ;rventilate 320 Extricate 41 0 Remove Hazard 450 Monitor Hazmat
140 Salvue 330 EMS 44 0 Establish Safe Area 431;1 Evaawe
COMPLETE FOR ALL FIRES
I 13 PRIMARY ~OD OF EX11NGUISBMENT
I 0 Self-Extinguished 40 Automatic Extinguishing System
20 Makt:shift Aids 50 Wak:r Cmried On Initial Apparatus
30 Portable Extin~sher 6lit\Vater From Hvdran~ Draft Or Standoioe
14 PRIMARY AGENT OF EXTINGUlSBMENT
I }!(Wak:rOnly 3 oOass AEottiDg. 50 Oass AIBICExting. 70 CO2 9 OCompresscd Air Foam II oOass B FoamIAFFF 130 None
,20Dirt ' 400assBlC~ 600assDExtin~: 80Halon IOOOassAFoam 120Weain~A~tW/Watec 1400ther
'y. \' ISI~~:-:i~lISEOwe' JIt1~ I GENERAL'A_'~" tlSE lMOBJLEPROPERTYINVOLVEDtcccq>Ioo:l!DeMl
M -t YEAR, l~. I MODB. SERlALIIAIRCRAFJ'TAIL, l UCENSE. I STATE
16 ROOMlARE4 OF FIRE ORIGIN EQUIPMENTINVOLVEDINIGN1TION ~Lm::E)
, BRc/<:. {6rc.1-l
E I YEAR I MAKE
11 IGNITION FACl'OR
1\" Occ.u.pArd- deAnc.d bArbf9,uG And puf /he. df.lrco.<ll ,,, 10 pAper bA<j RAJrI ~
'SIItlMAioFACt'ORS I "'kcp 1,!ll(1oWo I U~] UDaaCDdodPasoo llU'O<OiJo 0 N.......of ~EIdc\y I"""""'" IMu1tiploP=om
INVOLVED IN li ~O' 0 0 PutAgeandGenderiD JuvcuiJes: (Age6S+) 0 Disadvanaged 0 InYolved 0
IGNITION 2 Female REMARKS
19 FORMOFIfEATOFiCNlTlON I'MAttJUALFlRSTIGNJTEI)WASMADEOF IITEMFlRSTIGNITED
Dlrec.f ConMd- OApe-r pi+pe.r SAC. "-
120 LEVEL OF FIRE 1 0 Below Gcocmd 2 ~ l..eoid 3 0 Above Ground 4 0 In Rigbl Aoor of Origin
ORIGIN (St:l'\Iaure FIt'CS Onl,!:l
12J ESTIMATED BuiktiDg CoaterltS MobiJePropc:nyandCoacCDls Other TOTAL
VALUE 45-:000 ,00 lS':oO().oo ,00 ,00 ci,OIOOO
122 ESTIMATED
LOSS .
.00 .00 I .00 .00
. OF OTHER FIRE SERVICE
VEIfICLES.....::.,);; .....l__.G
'Z..
I MtrrUALAID
10 GIVEN
20 ~.c.oJ
o K NONE
35 0 Search
53 0 Standby
520 Move Up
, l) Other
34 0 Provide Personnel
74 0 Canceled at Scene
72 0 Canceled Enroule
70 Wak:r From TankerII'ender Sbuttle
80 Ground Clews WI Equip And/Or Air Support
90 Method Not Oassified Above
I MODEL
SERIALO
I POWERSOURCE
I'OFIXED I
20 PORTABLE
I
I
I
I
,00 I
001
R
T\.,
, _ COMPLETE FOR ALL SfRUcrrn&rns
23 APl"ROXlMATE I BUD.D1NC1Ir(Gn>aod""'''''''' 305000.9999SQFT - - --,~~;'''''SQFT
BUlLDlNCA~(laYCln) t OO.999SQFT 40Io.000-19.999SQFf 701OQ.OOO.499.000SQFT
25 216')(lOO-'999~ FT sO 20,000.49.999 SQ FT 80 SOO,oooSQ FTOR MORE
Z4 STRUCTURE TYPE . CONSTRUcnON TYPE ROOF COVERING
f)!( Enclosed SlnIc,"<< 1 0 St<cI & Conaet<. 3-41lr I 0 Cass A Or B (NOlI Combustiblc; Mcul, Tdc. Compos;tio~)
30 Open Strocture(No Wa1Is) 20 I'IoCl:ctcd MasoolyExt. & WoodlnL 2)1CassC ~_~_":~__orPlq>:utd.Mal'1 (AsplW,Shinglcs)
40 Air Supponed Strocture 3 0 u~ Masomy ExL & WoodlnL 30 Cass C (T.-:d and Usled Wood Shingles)
50 Tent 4ol'loCl:ctcd.St<clBIdg. 4oUn......sWoodShi~
60 Open P1atfonn (No RooO S 0 U~ St<cI Bldg. SO Nonntcd Roofeo.cring (Canvas. Plastic:. Hot Tar)
60 Heavy Tunbcr 80 SlnI= Witbou, Roof
70 Un;_...,...; Strocture 70 I'IoCl:ctcd Wood Fwnc 90 a.;.,fNotC3sscd Above
90 TypeofStrucwre NotOass'd Abo"C g'J(u~WoodFnme
_ 9' 0 T~ Not Oasscd AboYe
2S PRIMARY FAcroR CON11UBUTlNG 1'0 FlAME TRAVEL
EXTENT OF DAMAGE CAUSED BY
SMOKE
I oObja:< of Origin
20 Part ofRoomIArca of Origin
3 0 Room of Origin
40 fino.ra1cd Comp. of Origin
SO Aoor of Origin (Multi-floor Bldg)
61iSaucture of Origin .
7'0 Beyond SlnI= of Origin
, 90 No Dama<e of This Type
ALARM POWER SUPPLY
I 0 Baa..y 0tlIy
2.l('HardwiJe Only
30 Plug in
40 HanIwUe w/Bancy
S 0 Plug in wt Battay
60 Mechanical
70 Multiple AIann & Power Suppli<s
..
F1.AME
10Obja:<ofOrigin
20 Part of RoomlArca of Origin
3 0 Roo~ of Origin
40 Firc-ratcd Comp, of Origin
SO Aoor of Origin (Multi-Door Btdg,)
~ Structure of Origin
i 0 -Bcyood SlnI= of Origin
80 Non-fire ~ Reoort
Z\ ~TI'PE
1 Jl(Smoke
20 Heat
30 Combination SmokdHeat
40 Sprinldc:rlWater flow Alann
50 Special Hazasd Sy> RcIc:ase Device
60 Moie Than One Type Pr=n'
70 Carboo Monoxide AJmn
80 No ~ present
90 Other Type of AIann Pr=n'
00 AIann Unknownlnot_~
.. SPRJNKLER SYSTEM TYPE
1 oWct Pipe System
20 DIy Pipe System
30 Deluge System
4 0 Prc-actiou System
5 o Comb, DIy Pipe ... ~._ _.:.,.. System
6 0 "Qn.()fl" SptiDkIcr Hc:ads
70 Open IIcad Sys<cn1. Manua1 Coouol
8)jfNo Sprink1c:r Protection
dciTvoes...U~
29 rou.ow UP INVESllGA110N
REQUESTED 00 NO
30 NUMBER OF
INIURIES
31_.....;.......;..~._
MAKING
REPORT
32A-_.........JJ..
lNFORMA110N
BY
FlRESERVlCE
NUMBER OF ID!ADS OPENED
PRIMARY A VENUE OF SMOKE TRAVEL
<"
.'lo._-",~_OFsrolUl:.S
(Not IDdudln& Ilao:a>ool)
FIRE SUPPRESSION EfFORTS CO.I..'UI~ TO
EXTINGUISHING AGENT
I 0 Obja:< of Origin
20 PanofRoomlArca of Origin
3 0 Room of Origin
4 0 fino.ra1cd Comp, of Origin
SO Aoor of Origin (Multi-Door Bldg)
6~StructureofOrigin
7 0 Beyond Strocture of Origin
9 0 Nop~_ofThis TyPO
ALARM PERFORMANCE
lOin Room ofOrigjnlAlaled """"""
2 0 Not in Room IAlerted Occupanrs
3 0 In Room of OriginlOid Not Operate
4'llNot in Roomfl);d Not Operate
S 0 Presen' in Room/FiJe Too Small
60 OpcnttdlNot Faaor in Disco>ay
70 OperatedIOccupanls Failed to At:!.
SPRJNKLER PERFORMANCE
1 0 Opcnttd & CoouollcdlExting'd Fin:
20 Opcnttd &< Not ControllExting, Fin:
30 Shoo1d ba.. 0peratcdI I);d Not
40 Sysrom Pn:sentlR>e Too Small
80 No Equip in Room of Origin
OO~ODWlDCCt:_""y._._J
FIRE CONTROL
1 0 Obja:< of Origin
20 Part ofRoomIArca of Origin
3 0 Room of Origin
40 Firc-ratcd Comp. of Origio
50 AoorofOrigin (Multi,Door Bldg)
6....;,.____ofOrigin
70 Beyond Sttu= of Origin
9oNo~ofThisTYF!:.
REASON FOR ALARM FAILURE
10 _ Power Sopply Failed .
20 lmpropcr Installation or PIacancn,
30 Defective A1ann
4olnadcqlWeMointcnllnOl:
S 0 Battay Missing or DiscoonCCled
6 0 Baa..y Ilisc:baJ&<d
80 No AIann FaiIwe '
CJ.l(FaiI= Undettnnined
REASON FORSPJUNKLER FAILURE
1 o System Sbut Off
20 Not Elloogb Apt to CoalroI F=
30 Apt CooId Not ReacI1 File
40 Sysrom Pipin& Dama&<d
50 No Heods In Room of Origin
80 No System Fail"",
00 Rtasoa for hnme lIm<pon<d
COMPLE'lE FOR AIL INCIDENTS
IFYIlS,WBOWILL ,- 0SfM 2~ 3- OSP 4- Loa1P1liSb<ri/f 9- 011."'......._
JNVES11GATE '~_ <;n~J_J F..... l'YIArd-.AI
tll.aU .Au. JJ~ ,~.!' FIRESERVICE 01'BER
FATAllTIES '
nn..E DATE
(/A,06:t/,J
1)(=
~.~.;(/~~L
~ .;
1111.E
07-/:1--00
DATE
: 33 SPECIAL OSFM SIUDY: Was 1hls. ~r .~_ delayed due to access cliflicu1ties resulliDg from aarTOW _1 YES - NO-
, If YES, please descn'be ill remarks. ..
Juveniles Involved(~Id. J...nile wffUY FtmnJOJ)
! ~er I Juv,#1 I JUV,#2! Juv, #3 1 JUV,#4l
_') plf.l.c.e.d. t+. -e.. SACIC. 0" bACIL pare/.J,
20-03-IO(R2OOO)
REMARKS