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.
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(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
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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
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5417263.
54148
MARKUS-THOMPSON .
ANAL "'TICAL LAB
PAGE 01
PAGE 01/03
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!I"-A~lllyti~1 L~b;~tory & Con~~ltaDts, h'~~'
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~ 361 West Fiffll Avenue. Eugene, OR 97401 ,
:i S41-48...~4 .1-800-262-5973
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i! Fex: 541-484-5995
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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
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______,._..==:r..=;::"..;::;a:;~l~~.....' "__j'
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Aecn!<lite<l analyIM ..ark$d ... I
SCANNED!
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i (PfYI'ZurJ1- ol?1b'( CASE NARRATIVE ;1
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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, ~
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0l1l90n ORELAP AccnorJitGd
ORELAP 10 OR'OOO12 E;>A 10 MOOO'S
AccreditGd in accordance with NELAe
--+
_..,..="="",_L_,"_~=.=~==,,'
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, No anomalies associated with the analysis of these sample(s) were observed,
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Laboratory Supervisor Date 12/31/07 i
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29074.x1S NELAC
Page
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01/02/2008 10:21
,~01/02/2008 09:29
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5417263.
541484
MARKUS-THOMPSON .
ANAL VTICAL LAB
PAGE 02
PAGE 02/03
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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
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ICollform. E. CoD (CF.PA) '" I 8M 9223 B Colllert ! Absent i Abient I NIA ,12127107 1330 CF!I
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Oregon ORELAP Accl'lllfrtad
LaboraIDry 10# ORl 00012
ACc:rediled In accordance wllh NELAC
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IIAnalytita) Laborato~ & Consultants, Inc.
, 361 West Fifth Avenue. Eugellll, OR 97401 '
,
I 541-485-8404.1-800-262-5973
I FRlI:541-484-!99S
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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
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29074Jds
12/31/07 il
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