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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 ~L\. \cj.CA