HomeMy WebLinkAboutPermit Fire Damage Report 2000-5-29
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STA7F OF OREGON OFFICE 0; . FIRE M~"':
1998 OREGON ALL INCIDENT REPORTING SYSTEM
FIREDEPr. ~
51= C()- J7S?
ExPosURE No.
o CifANGE TO REPoRT ,
SA 00,2"'"
}2l-l~~.~u
COMPLETE FOR ALL INCIDENTS
I DJSTRlcrOFINClDENT 5PtU'AJ6FfM COUNTY l..A-o.JlI'. DEPT.J<...,u,w~.'; gpU~6-R~ () .
II I ALlRMDATE LALIRM. TIME I DAYOF I ARR1VALDATE I ARR1VALTIME I DATE BACK IN I T1MEBACKIN
S-?-"J.<>.O Ol5f'1 WEEK ft1b.,.) Ou,'I OI./S8"
IlA'PRIMARY TYPE OF SITUATION FOllND;.(ICpflrebln..............lhetypeo,fIre)
jOnll!'RItI)G..Hor'bda~.rFl~\ ~!l Rl.dG t-7Y'r" .
I 28 01HER. TYPE OF SITUAll0N :roUND:
Ie OtHER TYPE OF SITUAnONFOUND:
'-'--2387 l-~h Drive- I Q7'177 a;::;cr =cr13
4 OCCUPA.Ji\ITNAME(Last.Finc.MI)orCOMPANYJB1JSINESSNAME DOB 'IEL.l..t.........1.l.l.
B~eJ R..cs~ Od'l.7/'fS <5it/) 7lf1-Z3'"
. BUSlNESSOWNERNAME(Lal.F'....MtJ DOB TElEPHONE
< )
9 ~ClDENT R.w: ...A&,w, BY (Last. FiJst. M1)
L.41/LO. "fZ1u !'I-d.a- t2.
10 INCIDENT~~:......~BY ADDRESS
2363 'Lol'loln-td ~.
11 fl!OFFIREPERSONNEL I"OF.6t........,~
RESPONDING a-UjIU.Ll''':;
c....... ! ~ .1 Vol....... 2-
11 TYPE OF ACTION TAKEN (CHECK AlL lHAT APPLY)
370 Fon:ible En1Iy 7!A1Investiga!e 360 T'-r-.. 470 Decon Area '
I~sh 310Rescue 420HazmatID 460DeconPeoplelEquip
16 o Ventilate 320Extricate 410RemoveHazard 45 o MonitorHazmat
l4J'l"Salv~e 33 OEMS 44 o Establish Safe Area 43 o Evacuate
COMPLETE FOR ALL FIRES
13 PRIMARY ME1HOD OF Ln...... ,....JISHMENT
1 0 Self-Extinguished 4 0 Automatic Extinguishing System
2 0 Makeshift Aids 5 0 Water Carried On Initial Appallltus
3 0 Portable Extinll!'!!ber 6&Iil"\Vater From Hvdmnl. Draft Or Standpioe
14 PRIMARY AGENT OF EX1lNGUISHMENT
l~aterOnly 30ClassAExting, 50ClassAIBICExting. 70C02 90C_"'r.~..JAirFoamlI o ClassBFoamIAFFF
20Dirt 40ClassBlCExtin~. 60ClassD~.80Halon !QgclassAFoam 120Wettinl!M~tW/Water
'15 5PECIFICPR~PERTYUSE I G~PRv'_" USE _' I MOIlIIE'A_,_..INVOLVEII(,,-letdineM)
4r/ <SfMt~ ~4~..;., 2nl'ltzLt f~l.,'Bv<{1
I M I YEAR l MAKE I MODEL ~ ., SERIAi.#IAIRCRAFTTAIU I UCENSE#
116 ROOMlAREAOF FIRE ORIGIN EQUIPMENTmYOLVEDINIGNm:ON (CompIct.cLmeE)
. BUSINESS OWNER ADDRESS
I' BunDllIl'G/MOBILEPROPERTYOWNERNAME(Last.Fint,MI)
Sf!. /VII!- k'; MJillJf
8 BUIlDINGlMOBILE PR.....~.... OWNER ADDRESS
100B
100B
Olf.og-" 3
Sf /lA)Jt; F<€-t f)
I tlOFAERW.APPARATIIS I NOFOlHERFlRESERVlCE
RESPONDING VEmCLES RESPONDING
, ~
3S~
53 0 Standby
52 0 Move Up
!JOt".,.
m
7'EL:..I:..1._..o:.
17lP
I TElEPHONE
<9{ () 7t.p(
17lP 7=;lf?:;
- 2Z'f~
IMUrUALAID
, 0 GIVEN
20 RECE.IVED
<0 NONE
34 0 Provide PersonneI
74 0 Canceled at Scene
72 0 Canceled Enroute
70 Water From Tankerffender Shuttle
8 0 Ground Crews WI Equip And/Or Air Support
9 0 Method Not CJa$ffied Above.
E L YEAR l MAKE
I11GNlTIONFACTOR
L<V1kkl1A.<'tVld- SuSPiC'-PUS ,{'> j\.JA:>rutf~
'8 HUMANFAcrORS lAst"!' I' o Mol, I Unromci.... \JnottcndodP= IJuvaill,.(Complele 'N","""of JEldorly l~oUIy IMultipl'J><nom
~~~IN 0 2 OF=!, O. 0 o JuvonlI,wIFu.Fonn) : Ju=il.., (....65+)0 DUodwn_O _0
119 FORMOFHEATOFiGN1110N MATERlAL FIRST IGN1TED WAS MADE OF [1TEMFlRSTIGN1TED
fA VI f:4>eWM Uyt ~ U /.-1 k-vt L""'-
120 LEVELOFFiRE I OBclowGn>und 2~L=I 3 o Above Ground 40lnFtight Floor of Origin
ORIClN (StNdure Fires~}
.21 ESTIMATED Building Contents MobilcPropcrtyandCorrtcnts Other TOTAL I
VAUJE /50,=-0 ,00 SO,(JCO ,00 .00 .00 .?<;o,u;,6 ,00
22 ESl1MATED I I
LOSS '70,000 ,00 'SO, bl'lO ,00 ,00 ,00 I'{O, ()C"O ,00
I MODEL
SERIAL #
I POWER SOURCE
I, OFlXED
20 PORTABLE'
13 o None
14 o Other
I STATE
,- ._u_ ,..,' ...,;"f,~__:~",~-~""'~'--:~~-~'.;:.~':-;-
'",.'. . ".c~MPLE~A~~:~i's~u,-. U"'" ~
BUWlINGSIZE(GnluodF\ooo'OnIy) 30 SOOO.m95OFr 60 SO,ooo.99,9995OFr
100.9995OFr 40IO,ooo.19,999SQFr 70 IllO,ooo.499,ooo5OFr
2&:1000.4999 SO Fr sO 20.000.49,999 SO Fr 80 500.000 50 Fr ORMOIlE
L....,o).A..JCTIONTYPE ROOF COVERING
1 D _I" Cooc:me. 3-4/1r 1 D Class A Or B (Non Combus'ible; MelaI, Tde, C."" ,;.: ..,)
2 D ProlcdcdMasomyExL" Woodlnt ili)CIassC C,.., ,;,:.". ...I'r<pared. Mal'I(AsphaIlShingla)
3 DU", .....1 MasomyExL" woOd lnt 3 DCIassC(TRaledandLisled Wood ShingIa)
4 D Prul<cltd. SlceI B1dg. 4 D Uatroaled Wood Shingles
S D U ,~" .....1_1 Bldg. S DNcmratcd Roof Covering ( Canvu, Plastic, Hot Tar)
6 D Heavy Tuuher 8 D Struclurc ~ Roof
7 D Prolcdcd Wood F..... 9 D Roof Not Classed Ah<M:
4t>-...".-'CSCd Wood F.....
9 D Tn!".1'ot Classed Above
115 PlUMARYI"ACIOR_....,..-..:..JlINGT .P'L\ME1RAVEL
ZG.
126
FLAME
I D Objecl of Origin
2 D Pan ofRoomfAra of Origin
3 D Room of Origin
4 D F__ Comp. of Origin
S D Floor of Origin (Muhi-ftoor B1dg.)
6 SStruclunl of Origin
70 Beyond Struclurc of Origin
80NOD-fin:~~
27 DETECTOR TYPE
1 )tsmolco
2 0 l1ca1
3 0 ComhiIWion SmokefHcat
40 SprinklerfWater Flow Ddeclion
S 0 Spccia.l1lazonI Sys Rd....1Jevj'"
6 0 c.rhon Monoxide Deleclor
7 0 More Than One Type PreseoI
80 No Deleclor pr=I
90 0Ihcr Type ofDeleclor PreseoI
o 0 Dctcctor UnIcnownfnot ~
28 SPRINKLER SYSTEM TYPE
1 0 Wet}';pc System
20 Dry Pipe System
3 0 Deluge System
40 _OIl System
SO Comb. Dry}';pc" _00 System
6 0 "Oo-OfI" Sprinkler I!oads
70 Open Head SysICm. Manual ~I
(SNo Sprinkler:. ....~._
00 Tvoc Svs. L __ ",..JflJocIeIamincd
;".-
23 APPROXIMATE
BUWlINGAGE(In Y....)
5'
24 STRUCTURE TYPE
u;(Eudosed Struclurc
3D Open~,., ...,.(NoWalIs)
4 0 Air Supported Struclurc
S 0 Tent
60 Open Plalform (No Roof)
7 0 lJDdcrsround Struclurc
9 0 Type ofStruclurc NoI Classcd Ah<M:
-,-=..~'"
,<
NUMBER. OF STORIES
(N" mdudinslla=xm)
PRlMARY AVENUE OF SMOKE TRAVEL
?
~...r.tU OFDAMA ;ECAUSE/JBY
SMOKE
1 D Objcd of Origin
2 0 Pan ofRoomfAra of Origin
3D Room of Origin
40 F__ Comp. of Origin
S 0 Floor of Origin (MuItHloor Bldg.)
6~ofOrigin
70 Beyond Struclurc of Origin
90No~ofThis~
DETECTOR POWER SUPPLY
1 0 Bauoty Only
~0nIy
30Plugin
40 IIanlwU< wf Bauoty
S 0 Plug in wi Bauoty
6 0 Mcdwlical
7 0 Muhiplc Detedors &; Power
Supplies
FIRE SUPPRESSION EFFORTS CONFINED TO
~&lo __I, mLovAGENT FIRE CONTROL
'lOObjcdofOrigin ,; tOObjeclofOrigin
20 Pan ofRoomfAra of Origin 2 0 Pan ofRoomfAra of Origin
3 0 Room of Origin 31i1:lloom of Origin
40F__Comp. of Origin 4 0 :~..__~Comp,ofOrigin
S 0 Floor of Origin (MuIti-ftoor Bldg.) S 0 Floor of Origin (Multi-floor Bldg.)
6 ~ of Origin 6 D Struclurc of Origin
70 Beyond Struclurc of Origin 70 Beyond Struclurc of Origin
90Not~ 90No\~
DETECTOR PERFORMANCE REASON FOR DETECTOR FAILURE
lOin Room ofOriginlAlert.ed 0<-<0'1'0"" 10 HsnIwir.d Power Supply Failed
20 Not in Room IAlerted Occ:upants 2 0 Improper Inct.ll.tion or P1aoemeat
3D In Room ofOriginfDid Not Operate 3D Defcotive Deleclor
40 Not in RoomfDid Not Operate "40 InacIequatc ",.;",-"""
SO PreseoI in RoomfFire Too SnWI S D Bauoty Mis;ing.. r.:..,__...d
6}lDpenled1NoI F..... in Discovery 60 Bauoty Disdwged
70 OperaledIOc:<:upanls F&led" Act BoSNo Dctcctor Failure
00 F&I... UucIet<nDined
COMPLETE FOR ALL INCIDENTS
I29FOu.oWllP_"~,,l;AnONREQUESTED IFYES.WHOWJLL 100SFM ~FD 300SP
, 00 NO 1 JiyEs INYESI1GATE
Name: __
130Ij%~~OF FIRE""""'i"'; OTHER 6 ::::;:/~_.. rFiRE;;;"";,O
31 MEMBER NAME 1l1l.E DATE
=; B/'rIVf W1c~t)( k('e~&~ 5"-24-&0
31 ADDmONAL NAME 11TLE DATE
~RMAnoN Jos.eoh lV, WJ~kS" ~..-4, J=;>".e /Il,A.4-JeSll4-L O'--oS~
~33 SPECIAL OSFM STUDY: "Was recycling material or'l! containertbe cause oftbe fire or did it contribute to the fire?" YES 0 NO)!(
REMARKS
2l><l3-1O(R.98)
NUMBER OF HEADS OPENED
SPRINKLER PERFORMANCE
10 Operated" ~IledfExting'd F..
20 Opcrated" Not CoIIlIoIfExIing. F..
30 Should have Openledf Did Not
40 System PrcsCaIIF.. Too Small
80 No Equip in Room of Origin
00 I _..,_.. Umq>orted
REASON FOR SPRINKLER FAILURE
1 0 System Shut Oft"
20 NoI Enough ApI" ~ F..
3D Agent Could Not Reach F..
40 System Piping ilOmaged
SO No Heads In Room of Origin
gO No System Failure
00 Reasoo r... Failure Umq>orted
40 LocaIPDISh<rift'
90 OlhcrPasoolAp<y
OTHER
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