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HomeMy WebLinkAboutPermit Fire Damage Report 2004-1-12 -:. FIRE DAMAGE REPORT OR ELECTRICAL HAZARD .~ FD-016 TO: Building Department Date: / - / Z. - u l/ FROM: Springfield Fire Department Q,,4..DD\D\ SUBJECT: Structural Damage to Building Address or location of building ".> '2S 'S ;, K ..d1v"1 '"'- $/-. Name of Owner ,~:LL'-<. D. lI'1 ~ ... '\I ~"'.'l.Q.. ~ (Dwelling, Store, Warehouse, etc.) Type of Building 5 ;'otl-I/J'. Lv,'~k .. Estimated value of building $ >, .,a:a Estim.ated loss to building $ /2.00 Date of fire / - ,I 2., - ':>7" Location of damage to building . I r e.-/'/J__..... /" b'v <--- t-uo=~ ..,~V""- . (Roof, Wall, Exterior, Interior, etc.) Structural weakness as a result ofthe fire -;<:.!Jo<> ~ : ~t'~.j.4d'~'.,J). (Burned rafters, Beams, Joists, etc.) . Additional pertinent information >I~JL. .~'f7.f2.. /',..s../a//",j.,'.n.." t......J.4-< r;d~ UP .. / -~ t' It':.d//'''_, S'7~ I~..I/ /~-"" Electrical Hazard P CC: (Wiring, Outlets, etc.) Signed (? f? 4-" V:\FD_FORMS\F~16 FIRE DAMAGE REPORT,doc 01/02/2008 10:21 : 61/02/2008 09: 29 ~ 5417263. 54148 MARKUS-THOMPSON . ANAL "'TICAL LAB PAGE 01 PAGE 01/03 ..- tr .- c;:.- .-",,_Il.'''lI'Ut.,. !I"-A~lllyti~1 L~b;~tory & Con~~ltaDts, h'~~' II ~ 361 West Fiffll Avenue. Eugene, OR 97401 , :i S41-48...~4 .1-800-262-5973 ii i! Fex: 541-484-5995 Ii 'I I:, ANALYSIS REPORT i~_'__4___~'~"_~'_ _..._.,~._ -~~_':'~~----=-~~In;~':::.':..",:;,::"."':-----,~~_",;"......~.__.--.-.~. 'Ii AtlQtltlon I Howard Thompson il Lab Report No. 29074 1~_!::lient__~_MarkUS- Thompson Construction ..--' .. Dale Received .. ._~3127~~! iL-..__.. ,~38 Kathym A""nlJl! I !I -,- Springfield, OR 97478 i 11 Proiect 10 I 3804 KlllhYin-.'-=:-.........---. ---,~~i :r _____"...._m..'n .._,--~--'-'=.- ______,._..==:r..=;::"..;::;a:;~l~~.....' "__j' ., i; !\ ij Aecn!<lite<l analyIM ..ark$d ... I SCANNED! .,..._~ J - - "-'--'.'-jl " [I '-' " :! ----..-ji ._#~_~~,_~___ij :i -11 i (PfYI'ZurJ1- ol?1b'( CASE NARRATIVE ;1 1----..-- -,~ - =-..... --.--.....-------...-...-..---.---.---.-.......-.-.----.".- .-~-~.,--".-.'"""'=.-.- ""'..-.-.-"-' ......;....;~l 'I q I, This report presents the resullli of the analyses of tile sample(s) received on the date above and asaisned the listed ALe Ii I lab report number., Test results mlate only to the parameter; tested and to Ina samples as IQceivad by the laboratory. U I This repert shail not be I'Oproduced. exoept in full, witholJt wriltlln consent of Analytical Laboratory & Consultants, 100, ,; , Ii i All analYll'" _re perfonned according to the Amilytical Laboratory & Consultal1111, Inc. Quality Assurance Program. An Ii . QAlQC requirements were me! eXlOept as no~ bellll/i, For ORELAP acaedned analytes (ident1ftea Dy 'll") test llilSulW 'I i me!!! all requlremenu: of NELAC e'.capt as noted below, Analytieal comments are noted with data flags on the reports, ~ , , ! 0l1l90n ORELAP AccnorJitGd ORELAP 10 OR'OOO12 E;>A 10 MOOO'S AccreditGd in accordance with NELAe --+ _..,..="="",_L_,"_~=.=~==,,' i , No anomalies associated with the analysis of these sample(s) were observed, I , Ii !' i I , i ~ j .< 1( " , .. . II ! , i i ., I I , I I. i' ,I ,J II 'I 'I I II II ., Ir"--"'---'-'~" - I! Approved A,c.:'" ../, ~ -' " .' :1 ~1 :1 " " " ;! ,j 'I i, I' 'I r! " Ii " " i! .' " ;1 " ,I il ,: If () ........,...L-..---J Laboratory Supervisor Date 12/31/07 i I -_....~='::~ ...-.,---.....:===-~=-:=:.~-...-=~=.:....~..._._._._.._.._.._._':i_t"~.";:::.._:;_=:_!:;::-.-:.-.--~._ 29074.x1S NELAC Page I or () 01/02/2008 10:21 ,~01/02/2008 09:29 "~ 5417263. 541484 MARKUS-THOMPSON . ANAL VTICAL LAB PAGE 02 PAGE 02/03 ...~ . 1 I ANALYSIS REPORT . I! '"AttentIOn Howard iiiOil1PsOii'..'n._~ ,..,., II LBI;Re~rt'NO, T 29074 '-~-''''---=~'''=--11 Client Markus-Thompson Conslruotian II Date Raoeiwd I 12127/070950 Ii I! 3838 Kathy.n Avenue 'Ii Collection Date I 12/27107 0923 Ii I Sprlngfleld, OR 97478 i! Collected by I Howard Thompson II. i I Ii Client I D , ~~ryn Ave, ~ l Proiect ID i. 38,04 Kall1ym _' ~_ _ II Sample Matrix i water)1 [ CPMMH",.t":.IONG ~A': ~OLl;": BACTERIA -----i r .., -'~a;:-_n_--f----;~~"-'-!~ ~~L' Re~~r:ng' ~";b~-Un;:-r Dat~:~~'l !coliform, Tolal (CF.PA) '" I SM ~22J B COII$I'I Absent . Absent I NIA j 121271071330 OF'I , ICollform. E. CoD (CF.PA) '" I 8M 9223 B Colllert ! Absent i Abient I NIA ,12127107 1330 CF!I Ii " i; I' " 1/ Ii II I ! Oregon ORELAP Accl'lllfrtad LaboraIDry 10# ORl 00012 ACc:rediled In accordance wllh NELAC -----'-il !I , I IIAnalytita) Laborato~ & Consultants, Inc. , 361 West Fifth Avenue. Eugellll, OR 97401 ' , I 541-485-8404.1-800-262-5973 I FRlI:541-484-!99S , AooI"lMlItad .n~ marked -V" PWS MCL means,ptllIlc Water Supply Maxlmum Co""'minant lBl/l!l . Absent means Not Dete<:te<1 ~t 1/100 ml I I I , , I II , ,i 'I i " ii " i'! ,I :1 :i 'i ,. . . . . I I i , i i . " 11 29074Jds 12/31/07 il -......_,-,...--..:J~.-..~~_~__~____.__] Page ,,), of J