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HomeMy WebLinkAboutPermit Fire Damage Report 1991-12-5 ,.. _'._i .. . ~t{ II Y?7'6 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD . J~;f~fK~,;::.;:; . . . . . " .... DATE:!..?- 5"", ~I .'\- ..,.... ...... . --:.....TO:i..:... ._. -.- . ,...,., ,', Building'Department Springfield Fire Department . FROM: SUBJECT: ',.Structural Damage to Building Address or location of building . Name of, m.mer. . R..., b ev-- -+- S2. 5'tf ?o "'><=r... ~ /"'";)<-1 +h:..... Type.Of building 11-10 h~ 'e... h."......e. ('S':"',lc -PdW>')'1 dv.><:./' 'I-c.j) (Dwelling, Store, Warehouse, etc.) I Estimated value of building $ So ,00 0 5u c)o D J '.' ,E,stimatedloss to building $ Date of fire. 12- 5 - 'j / Location of damage in building c"'- -h'-e ") -+ r- ..... L ~v-e... .- (Roof, Wall, Exterior, Interior" etc.) Structural weakness as a ,result of the f,ire .f' /00.- , c e; /,...... . w4lb (7 ;' (Burned rafters, Beams, Joists, etc.) Additional pertinent information Electrical Hazard .ill/ '" /<=.c. -I. e"'r"'-.'t.?~+ cb'<:l""'.'lrri cc: (Wirinq, Outlets, etc.) Si,oed 71f~~L~) Df'pt. Respondin~ OA~A~M ~I;E 410 A;~V:L;'~12 ZIP CENSUS TRACT '11:U11-h8 I "I? t 61 DOB(optionall 1-j~ - 6:2.09 TELEPHONE ,J n() ~OT WRITE 1:-1 TillS SPACE CONTROL E.XP, 1\0, NO. ST A TE OF OREGON FIRE REPORT STATE FIRE MARSHAL .l...RE DEPT. _ARM NO. . Dstrictoflncident So ",~'"'\q -r; ~ \ A II ~~ 16D:~II';~;I,1 ~~~~F INCIDENT ADDRESS -+: OCC!~!.~LuI.Finl.M~ r- '5 '1 ~l~ I l1- Ro ~ ~I"-+ KO'$C'h BUSINESS OWNER NAME (Last. Fin.t. Ml) S~lYlv County J Cc...~, r- o Tues o Wod o Satur M," l2i o Fri o Sun o Th.. 5.,3' '1 ~ . ADDRESS DOB (optional) ADDRESS DQB(optional) 5 O'WNERNAME(Last.Fint.MI) 3.i'l""~ 6 FIRE REPORTED BY (Last. Fmt. MIl 3aW\e. \. pav',~ K05e"t'l I o Tele::lhone Direct 0 Radio o MunK:ipal Alarm S)'5tem 0 Verbal o Private Alarm System 0 No Alarm Rec'd 8 lOFFlRESERVICEPERSONt>."EL I ;OFENGINESRESP07"ffiED RESPONDED IIf .J ADDRESS DOB(optional) Stl~ C' 'f" ( ,) ,;').-f"c....' ,t- ) I 'TIMEHACK Il\ SEH\'ICt-: OIZ 13 13 ! l IS'3L,^' TELEPHONE TELEPHONE TELEPHONE Mutual Aid (utinguu., or investigattonl)'} Recel\'td 0 Given ~ N/A ,0..911 (Tie Line) I o Voict'SignaJMuniAlarm 0 o Not Classified. Above . I' OF AERlALA~PARATUS RESPONDE? o Other (List) I TYPE OF ACTION TAKEN ~ Estinguish 0 Remo,'ed Hazard o In\'estigation 0 Stand By o Hand.laidhoae!hydrant.standpipe o MuterStreamne..'~ o Not Classified Above METHOD OF ALARM I ' OTHER VEHICLES RESPONDED (do not indude PA's) .3 MOBILE PROPERTY (Compll'le line M) P1" h;'c:. I MOD~ ,If')( tp ()' SERIAL I I LICENSE I . ~I~MENT IN)\OL\'ED IN IGNITION (Co~}l'k Line E) . +.s b' J . T.V. ~ 4!u.e.,Sa.y-) Vc...R-1h1 U IsnL I SERIAL' U 13to24slOrirs o 25 to 49 stories U IO.OOO.19.999aqft D SO,OOO-99.999sqft o 20.00Q.4lfJllflf 110 ft 0 100.000.499.999 act ft U Unprottct. Masonr)" Ext. & Wood Int. ~ Unprotecttd Wood Framt' o Proll'<:ttd Wood Frame 0 Not Classified Abo\,t SPRI:"\KLER PERFORMANCE 10 Equipml'ntoperaloo o Equip. should havl' oper.-did nOI o Equip. preM'nt fin" 100 small to oper. o Sotdassifil"liabo\'l' 00 lIndett'rrnint'do: nul reported S~'\<'Kluil'mt'nIPrf'st'nt\S!Al 9 TYPE OF SITUATION roUND RStructureFire D' Outsidl' Strucl. w/,'alue o Vehicle Fire o Brush. Grass. Leaves o Trash, Rubbish 10 METHOD OF EXTINGUISHMENT o Self-Eninguishtd o Maltl'-,hift aids o Portable Extinguisher o Automatic En. System o Pre.connKt hose/tank oni)' t)i{ Pre-connl'Ct hoae/hydrant.l~ I PROPERn' COMPLEX (If applicable) I~""'c.. 11 FIXED PROPEF1' USE :;:jn<; It' -h-',)... d"",,1 j,!'I M MOBILE I 'I'EAR I I MAKE G PROPERTY t 7- CDr-, 1'\ .hc...v- "'~2 ROOM/AREAOFFlRE~IGIN ) S. 'S ;,1.. 0+ /, 'u 10--J r-ool"l'j E EQUIPMENT I YEAR I Mi)C'E INVOL\'EJ) IN IGNITION 13 IGNITION FACTOR 'fY\O:::.t 'eI"'DIoa...\o~ 14 FORM OF HEATOFIGl"TTION ..... I MATERIAL FIRST IGNITED WAS MADEOt _ J II lITEM FIRSTTGNITED: 5''''M--t~<DV~~ \~r>1- \P..."lor..lol......V\Q.s~LG ~k:. 15 LEVELOFFIREORIGIl" U IOtoIlftet U 30to49ftet U (h'er 70 feet ~ Gradfl~'elto9feet 0 20to~ftet;. 0 SOto70ftel DObje(tsinFlight 16 VALUE Building :2' Contents Vl'hicll.'8ndContents .1)0 DO 0.00 :A 'f 000.00 I {) 000 .Jd o~ () MODEL ~hc.J- o-'t ()ll~~-f'v-c. rri t: II. lib If e tr._ U BeIoVlgrd.lm'el o NOIClassified Other .00 .00 LOSS .00 :;. 5,ooe) .00 ....e-- .00 .00 . 1 i NUMBER OF STORIES ~ lsto~. 18 BUJLDINGAGE(lnYean) U 50 fitories or more U25tori5 U 5to6atories o 3tohtories 0 itn12stories I BUILDING SIZE IGmd Fir Only) ~ 1000-4999 sq ft I] O.999.aqft 0 5OOO.9999~ft 19 CO:\STRUCTIo=--n'PE U HeavyTimber U Unprottct,SteelBldg o St.tel&Conc~u,,3-~hr.~rol. 0 Prott"Ct.StteIBld2 0 Protect. MalOnn' Est. & Wood Int. EXTEl"T OF DAMAGE CONFINED TO: namt Smoke DETECTOR PERFORMANCE I ThfobjKloforigin 1 0 I 0 ~ 1 In room oforigin-oper. ! Pa"ofroomorareaoforigin 2 0 0 0 2 f'.;otinroomoforigin~oper. I Roomoforigin 3 0 3 0 0 3 Inrmoforigin-notoptr-I'itt'lOOlmall 20 I Fin".raledoomp.ofonpn 4 0 4 0 0 4 Not in nn of origin-not optr. fire too small Flournfuri!-,in 5 0 5 0 0 5 Inroomoruril!in-notopt'r.p"\IOerdi~cnnnert Slnlcturt'ofor;!-'in 6 0 60 0 6 :>:ot inrm<lforiRin-nOI oper, po"..er discun. Exlendfd beyondslructUn' nforij;:in ~ ';)SI 0 Inroomoforigin-n(lIOpt'r.deadbalt.e~' 08 :\ot in room uforipn-no(opt'r. dud balt.t'f)' o 9 No dt'lecwr prt'sent 0 10 l1ndelt~rmin\'d ~prinkler~ConlrullKl fift': , 01 Head~ (l~lt'nt'd I, S"dllmIlRt' of the 1)'Pe INIAl 90 2\ IlEM!\RKS WealherCondilion~lnplionan: c!"1 ..j..... Cc'" / Y..),;:.... N Ifyt's,who,,'iIlinnSliJ,:lIte .s::' uc:"v\. c..:.,.. ~ j'\.. .~ 22):suJ ~nnfU.qut'slt'd '(> :~lImt~r"f Injuries , '- Flrt' Ston'i{'f' " Sumberurrallllilit'S Fin.St.rvkt' Titlt, ~ ._ 1.-41,1., -, T;," D F (Jl 1fR- o C> .. Olhf'r ," " -..,.n;m,........,. .';""'-7;)1. /. '-;7-- ,;, '-;;/ //I~I ./~' 7....-u.Ld.c "../?~ :!f, }rlrlili,onlllInf"rmHli"nb~O(~O dL ~-f.::..e-,'\... o Salvagr o NotClassifitd o Undetermined I VOLTAGE Surd-eM<\', . U Undetermined TOTAL 1:1 _'S".OO 11 ,00 '7 ~ ()CTt) .00 U 5OO.000aqft YES 0 NoD o nont.unbad, Olh!'r \ I'~ ~/ --- j (') :to 0::: en'" ..,t'" t:::~ "'''' ..,.., -0 :ll:ll "'> ent'" t'" (') :to 0::: en'" ..,t'" t:::~ ",,,, ..,,,, -0 :ll", "'> ent'" t'" (') o ::: ", t'" ~ '" .., o :ll > t'" t'" :t o en .., t::: '" .., ;;; '" en 7 en .., :ll c: Sl c: :ll '" ::a '" '" en o Z ~