HomeMy WebLinkAboutPermit Fire Damage Report 2004-12-16
S_ of Oregon Office of State Fi"hallnCident Report '
DISTRICT OF INCIDENT: COUNTY:
II
ALARM NO:"_7
;R:SPONDlNG:
0347: SPRINGFIELD FIRE LIFE SFTY
EXPOSURE NO: 0000
0347: SPRINGFIELD FIRE LIFE SFTY
ALARM DATE: 1211612004 I ALARM TIllE: 7:54:00
TYPE OF SITUATIONS FOUND:
121: Fire in mobile home used as fixed residence
INQOENTADDRES5: '2054 .INLAND WAY --",
)
ClTYIZIP, SPRINGFIELD, OR 97477
OCCUPANT/COMPANY: MARY HAMMOND
20: LANE
I ARRIVAL DATE' 12/1612004 I
ARRNAl nilE: 6:02:00 I BACK IN DATe: 12/1612004
IBACK IN nilE: 9:57:00
CENSUS TRACT: 35
ZONE: 4
ooa, 511511958 TELEPHON'" (541)741-3766
BUSINESS OWNER:
ADDRESS:
'008:
TB.EPHONE:
BUILDlNGIMOBD..E PROPERTY OWNER: MARY HAMMOND
ADDRESS, 2054 INlAND WAY SPRINGFIELD OR 97477-
I OOB, 511511958 I TELEPHON'" (541) 741-3766
REPORTED BY:
ADDRESS:
I DOS: TELEPHONE:
CAREER FIF:
17 VOLUNTEERFIF:
o I ENGINES:
2 I AERIAL APPARATUS:
2. I OTHER VEHICLES:
4
MUTUAL AID: 0: None
ACTIONS TAKEN:
12: VENTILATE, EXTINGUISH, SALVAGE & OVERHAUL 71: INVESTIGATE
METHOD OF EXTINGUISHMENT, 5: WATER ON FIRST ALARM UNITS
:~~;~~~ us'" 411 : ONE-FAMILY DWELLING, YEAR ROUND USE
MOBILE PROPERTY INVOLVED: 17: MOBilE HOMElBUILDING
ROOM/AREA OF ORlG!N: EQUIPMENT INVOLVED:
71: CRAWL SPACE, SUBSTRUCTURE SPACE, BASEMENT 9800: NO EQUIPMENT INVOLVED
I JUVEN~~ COU~T: I
98: NO ACTION TAKEN
AGENT OF EXnNGUlSHIIENT:
;:~~~TY US", 47: MOBILE HOME PARK
IGNITlON FACTO'" 53: SHORT CIRCUIT, GROUND FAULT
FORM OF HEAT: 1 MATERIAL ARST IGNITED WAS MADE OF: I
35: ARC FROM FAULTYILOOSElBROKEN CONN 43; FLEXIBLE PLASTIC (SOFT, ELA
ITEM RRST IGNITED:
61: ELECTRICAL WIRE, CABLE INSULATION
BUILDING:
ESTIMATED VALUE $30,000.00
CONTENTS
$25,000,00
MOBILE PROPERTY AND CONTENTS:
$0,00
$0,00
OntER:
$0,00
$0,00
ESTIMATED lOSS $10,000,00
$5,000.00
I COMPLETE FOR ALL STRUCTURE FIRES
DETECTOR TYPE: I...::..::.......~ POWER SUPPLY: I DETECTOR PERFORMANCE:
8: NO ALARM PRESENT 8: NO ALARM PRESENT 8: NO ALARM PRESENT
SPRINKLER SYSTEM TYPE: I . OF HEADS OPENED: I SPRINKLER PERFORMANCE:
8: NO SPRINKLERS PRESENT 0 8: NO SPRINKLER PROTECTION
COMPLETE FOR ALL INCIDENTS
REASON FOR DETECTOR FAn.URE:
8: NO ALARM FAILURE
REASON FOR SPRINKLER FAILURE:
8: NO EXTING, SYSTEM FAILURE
FOLLOW-UP INVESTIGATION REQUESTED:
Y
IF YES, WHO WIll INVESTIGATE, Y: LOCAL FD PERSONNEL OR TEAM
NUMBER OF INJURIES
FIRE SERVICE:
o OntER:
o
NUMBER OF FATALmES
. FIRE SERVICE:
o
OntER:
o
MEMBER MAKING REPORT: Young, Andrew
ADDITIONAL INFORMATION BY: Wicks, Joseph
TITLE: AIC Captain
TmE'DFM
DATIC
DATIC
1211612004
1211712004
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