HomeMy WebLinkAboutPermit Fire Damage Report 1987-6-11
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
, ~~O ,\\3)
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DATE: 0 b - 1/- '8 '7
TO: Bui 1 di ng Department
~ 1..,/,)'
FROM:
Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building
2-5 S 0- &'" hwa.y
(
:# 'IS-
Name of owner C ha./ e; AJJo. rtmt"rr V
Type of building A parT/J1M1.s
, (Dwelling, Store, Warehouse, etc.)
,
Estimated value of building $
Estimated loss to building $
/OD: "=10
/,bDO
Date of fire
C:r//-5''7
Location of damage in building
/;t>d rOD/1"1
A:;IJ
l/t/::; r;C>H7/
(.U'a./ / CW1d Ceo r tJ( t,/'o
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
)JDI1~
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information Ci bc.(rnj /;('d /11a ITrC'.5..f
I"'..a.rr/ed <::<A..r .
waS qL-< rn ""0 sLJofs //1
,J ,
,- , . The (;'( Ie> ':/
C"'~ 7'* f ..,,)a , /'
Electrical Hazard Verne' 7'
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(Wiring, Outlets, etc.)
Signed
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STATE OF OREGON FIRE REPORT
STATE FIRE MARSHAL
_, IRE DEPT.
ALARM NO.
I DO NOT WRITE INTffiS SPACE
CONTROL EXP.
NO. NO.
'-eld
LOlfT<'
o
So."
Dept.Respondin. SfJr;n .J;" lei
/iii'ME I 7:;7rTIME ~;I~~~r
'l7~711 Lt~8DL l I:3CLASS
District of Incident
Moo
~Tbw
o Fri
Counly
D_
O Wol
o 800
o
0-/ [;C: I il t /r??
2 INCIDENT ADDRESS
2-{SS &O<.f<.wo..y
3 OCCUPANTNAMEIl..aal.Firll,MI)
. ,. M,~!'J ~ (I k<^ tk If
4 BUSINESS OWNER NA~ (Lul.. Fint. MI) I
LtNle. Ld/1o"
5 OWNERNAME(~t,Finl,MI)
IIf} i y/"t"O/1 .4 S5 D,
B FIRE REPORTED BY fLat, Fint. MI)
(;roo delle R ic.l-to..rcJ
o T.I~hon. Dinct 0 Radio
o MunicipalAlarmS)'It.em 0 Vub&J
o PrivateAlarmSyatem 0 NoAlarmR<<'d
8 , OF FIRE SERVICE PERSONNEL , OF ENGINES RESPONDED
RESPONDED / 0 L
#= is
I
DOB (cptaonal) TELEPHONE
72.JrJJ. 0 I].
ADDR&SS DOS (optional) TELEPHONE
LSSS- &A.t~w".r it It, 72.(., -.~77o
ADDRESS DOB(optional) TELEPHONE
ADDRESS 'IS- DOH (optional) I TELEPHONE
lSSS (;,.,..:1 e w""y #- 72.C#-~OI3
L.
a 911 (Tie Line)
o Voice Signal Muni Alarm
o Not Cluairled Above
I, OF AERIAL APPARATUS RESPONDED
'..e-:- .
o Other (List) 'I TYPE OF ACTION TAKEN
~ En""""" 0 R.m,,.ollluanl
o Iny~tiption 0 S~dBy
o Hand.laid bo./hydrant. llandpipe
o Mutel Stn!a.In Deva
o Not ClaairJed Above
7 Mi'."THOD OF
ALARM
.Autual Aid (ntm,uiah Of invntipt.e only)
o ........ 0 GiWD i:ll' N/A ,
I ' OTHER VEHICl.FS RESPONDED
(do not include PA'" 3
9 TYPE OF SITUATION FOUND
.M Suuct.urlFirI
t1 Other Prop. w/value
10 METHOD OF
EXTINGUISHMENT
o Vehiclefire
o Brush, Gnu, LeI.~
o Truh. Ruhbi.,b
o .......
o Not CIualf1ed
o Undewnnined
o SeU.E:s:tinCUi:.hed'
o Mah.thit'teidl
~ Portable Ertinruiaher
o AutoID.atic Ex\. Sylum
m Pre.eonnect bo./tank onty
o Pr-;onnect hOK/bydrant.ltindpipe
I PROPERTYCOMPLEX(Happlicable)
AfJOlrtlrl""T /;u;/d,'1I9
I MODEL J
SERIAL'
I LICENSE'
1 J FIXED PROPERTY USE
Sl"'1Ie. f",,,,;ly
M MOmLE , Ycia
PROPERTY
. MOBILE PROPERTY (Complete lin. M)
Ap...rr m'''f
I MAKE
EQUIPMENT INVOLVED IN ImilTioN (Complete> Line E)
pOrTa..b/e. header
MODEL I SERIAL'
Two -lfe<<T' A~Th"""tiY 33/
I vo/;~
12
-)
ROOM/AREA OF FIRE ORIGIN
Bcd. roon1
E EQUIPMENT I YEAR I MAKE .
INVOLVED A
IN IGNITION .' r 1/ i Y1
13 IGNITION FACTOR
He.xTer Was
14 FORM OF HEAT OF IGNITION
flea. 1-e r
15 LEVEL OF FIRE ORIGIN
.GJ Gradelnoelto9(.
"
VALUB
/0.. vt:d 0/1 "'- bed "",J f'-'-I'n eJ 0,/1 by' Yt>ul'1'i
I I MATERIAL FIRST IGNITED WAS MADE OF I'TEMFIRSTrtN'TErI "'-oJ
cotton 6<d lYIo..lfr-ess
B IOto191. U 3Oto491eet U ()Yer70feet 0 Belowpd.1eve! 0 Unde~m1in<<1
20 to 29 1m 0 5Oto70leet 0 Ob.iecta in Flight 0 NotCw.ifled
BuiJdinr Con~nta Vehicle and Conteota Other
ObO'OO SO. Deo .00 .00.00
ch,ldrt'''l
/00
TOTAL
ISO,DOO ,00
LOSS
/,060,00
(,ODC .00
,00
.00
,00
17 NUMBER OF sToRIES B 21torifto B 5to61tora B 13to241toriel
a Iltory 3to41tnne. 7to121tone. ~to49ltnrils
18 BUILDING AGE{ln 'r'ears) I BUJLDING SIZE (Gmd Fir Only) g IOOO-4999lqft 0 IO.OOO.19.999aqft 0 SO.ooo.99.999lQft
/ D 0 O.999lC1ft 0 6OOO.9999lQft 0 20.000.49.999lQft 0 IOO.OOO.499.999lQft
19 CONSTRUCTION TYPE U HellV)' Tialber U Unprot.ect. Steel Bid, U Unprouct. Muonry Ell. &; Wood InL 24 Unprowttd Wood Frame
o Steel&Concftle,3.4hr~p.rot. 0 Protect.SueIB!da' 0 Proteet.MuonryEIL.lWoodlnL 0 ProtK1edWoocIFrame 0 NotC1uaifwdAbm9
EXTENT OF DAMAGE CONFINED 1'0: FIam8 Smokl DETECTOR PERFORMANCE SPRINKLER PERFORMANCE
t Tbeobjectolon,in I 0 1 0 0 1 Inroomofon,io-oper. 1 0 Equipmeotoperattd
2 PllJ"tofroomorarer.ofori,iD 2 BJ 2 0 0 2 Not in room olon,in-opa'. 2 0 Equip.lbouIdhaVfloper.-didnol
20 3 Roomofon,in 3 0 3 0 0 3 IDmlolon,in-notoper-firetoomWl 3 0 Equip.prewntrlJ'ltootmloULooper.
4 Fire....tedcomp.oforiria 4 0 4 ~ 0 4 Notinrmofon,in-notoper,ruetooe.ma1l ~ 9 0 NotcluaifM!ldabow
5 F1owolon,in 6 0 5 0 0 5 Inroomolon,in-notoper.p:lwerd*'Onned. 0 0 Undetermined 01 not reported
8 SlnIctureof,on,m 6 0 6 0 .fit 6 Not in m1ofori(in-notoper.powerdilcoD. 8,Bl: No equipment pretent (N/AI
7 Enendedbeyonchtructul"uJoririD 7 0 7 0 0 7 Iuoomofon,m-notoper.deadblttery
o 8 Not in roomolofirin-notoper. dead bitter)'
9 No cIamap of the type (N/A) 9 El 0 9 No detector prnent 0 10 UndetemUned
o 50 ltone. or maR
o 6OO.oooIQR
Sprink1en Controlled FiN:
YESO NOD
, of H~ Opened
21 REMARKS Weather CondiLiona (opc.ioIW):
o coaLonbec:k
\
.12 FoUow Up Inyatiption Requested
N K..
Y-
lCya, who will invatiptl
23 Number o! Injuria
FiI"e Servke
24 Member Muin& Report
l Number of ratalitil!a
Fire Servb
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