HomeMy WebLinkAboutPermit Fire Damage Report 1989-07-25FIRE DA}4A.GE REPORT
OR
ELECTRICAL HAZARD
8qc157
DATE:l lzs /u
TO:
FROI,I:
SUBJECT
Building Department
Springfield Fire Department
Structural Damage to Building
Address or'locatjon of bui'lding Lcc A,tl g-
Name of or/ner o
Type of bu i 'ld i ng
Estimated val ue of bu'i1di ng
Estjmated loss to building
e5t
1 i ng , S tore , I^la rehou se , etc . )
?-0.ato
tMx G
d1t
(Dw
5
Do> L<wAt4 ae6_ ?q1*
s z0,0oo
Date of fire 1 /Lzl ?,c1
I
Locat'ion of damage 'in bu i i di ng To*al I ,# s* rvci"iceC) <<
(Rcof , l/a1 1 , Exter jor, Interior, etc.
Structural weakness as a resuIt of the fire \t /A
( Burned raf ters , Beams , ")o i s ts , etc . )
Add'i tional perrinent'i nfcrmat'ion n o/\e
Electrical ilazard
sEE loBd g <1
(llirinq, 0utlets, etc. )
S os^,t +D P.u)
?-21-t1cc tt4@ _.
S j qned /rh,C" Vl-a tA
)
U
ro
DO NOT WRITE IN THIS SPACE
CONTROI, EXP.
NO. NO.
District of Incident t u D
2 INCIDENTADDRESS
6ca /lilt 5t. €FicU. 9c
10 METHOD
EXTINGUISH\{ENT
ll
E aQulpln{exT
!NVOLVED
IN IGNITION
I3 IGNITION FACTOR
E S€lf-Extinguished
E Make-shift aids
E PortableExtinguisher
Flame
rEzZrnrDsContB
I'IRE DEPT.
ALAR]\I NO,
Dept. Responding
Not Classified
Undettrmined
Undetermined
Unprotrcted Wrcd Frame
Not Classified Above
lt
STATE OF OREGON FIRE REPORT
STATE FIRE MARSHAL
/-^onc
9l I (Tie Line)
E Voice Signal Muni Alarm
E NotClassifiedAbove
*tt' I L'/ '/
ckl €' r<
3 OCCUPANT NAI\IE (Irst,Fi6t, NtI)
Lanl
{ BUSINESS O\\'NER NAME (Last, First, MI)
5 OWNERNA\{E (Last, Fist, MI)
Ma/ri wr
6 TIRE BY (lrst. First, MI)
Po
7 METHODOF
AI-ARM
Telephone Diret Radio
Verbal
o
:E9
@:
=hrHld ltJtlE
E>l.t.
oo12
@,:-]in
r. 'lltlrt!tE
U)PFl.
ooz
F0
r.
rj
t5
Eo
r.
r<
oaFl
r<
t4
EJa
art
F
o
"l
4)
15a)
zrr
E Municipal Alarm System
! PrirateAlarmsystem E NoAlarm Rec'd
D v"hicleFire
E Brush,Orass,Leave
E Trash, Rubbish
D orher (List)
Automatic Ext. Syst€m
E Pre-connecthose/tank only
.Ef Pre-connect hose/hydrant,
l0 to l9 feet
20 to 29 feet
30 to 49 feet
50 to 70 feet
D 2stories
D 3to{"to.i""
Heary Timber
Protect, Steel
D Hand-laidhose/hydrant,standpipe
Al Master Stream Device
! NotClassifiedAbove
(tou| an tt1
Over 70 feet Below
8 # OF FIRE SERVICE PERSONNEL
RESPONDED t3
9 T'I'PEOFSITUATION FOUND
El Structure Fire
! other Prop. w/ralue
USE
5i.,A,-clli
M
PROPERTY
I2 ROOM/AREA OF FIREORIGIN
fi75i cat\ ol fu,lA;<trwhr cafytorts
Un acgot iaVcgli Oi'\ll or,t )bt< sv
t4 OF HEAT
Lr /r
15 LEVELOF
E Grade lerel to 9 fet
l6 VALUE
LOSS
ln
T7 NI]N,lRER OF
18 (ln Yers)
19 CONSTRUCTIONTYPE
E Steel & Concrete,3-4
EXTENT OF DAMAGE CON-FINED TOr
t The objet of origin
2 Part of loom or area oforigin
zO 3 Roomoforigin
.l Fire-rated comp. oforigin
5 Flmr of origin
6 Structure oforigin
? Extended be5'ond structure oforigin
5to6
7 to 12 stories 25 to 49
Unprotect. Steel Bldg Unprotet. N{asonry Wood Int.
! Protect.Ext. & Wood Int. n Protected Wood Frame
13 to 2{ stories 50 storiB or more
Smokern
2!
3D
4D
5!6nrE
en
2l
9 No daroge of the ty"€ (N/A)
of
l'ire Sen ice
2,1 Member lUaking Report
25 Additional
22 FollowuplnvestigitionRequested y X N
-
rfy6,whowilrinvestigata
ALARM TIME
z32 z
ARITIVAL TIIVIE
23 z,
I'IMI] BA(:K IN
SIiRVICEo+4+
YE.4R
ngl
E srn
D Mnn
Tue
Wed
D rhrt
E r.i
EI s"t*DAY OF
\\.EEK
o'7
MO DAY
1-)L.b
11111
ZIP CENSUS TRACT
3Z
ISO CI,ASS
3
DOB (optional)TELEPHONE
ADDRESS DOB (optional)TELEPHONE
DOB (optional)'lz|- 7q<Z
TIiLEPHONE
Itlo
ADDRESS
SI
q1+'?7
tA o<
DOB (optional)TELEPHONE
Unkno-ntUakn,na
ADDRESS
D R"""ir"d D ci,"n I *rn
or
I OF AERIAL APPARA'TUS RESPONDED-o # OTHER VEHICLES RESPONDED
(donotincludePA's)
3
# OF ENGINES RESPONDED
3
I Extinguish
E Invetigation
E RemovedHaard
E st"na ay
E srtr"g"
! Not Classilied
TYPE OF ACTION TAKEN
MOBILE PROPERTY (Complete line M)PROPERTY COI\,lPLEX (If applicable)
,SERIAL #LICENSE #MAKE/MODELYEAR
EQUIPMENT INVOLVED IN IGNITION (Complete Line E)
MODEI-SERIAL #VOLTAGEYEARNIAKE
FIRS'TITEM
.i'ei.)
WAS N,IADE OF
OS
Ivl.{TERIAI-
a<L4-
,oo.NOther TOTAL
ooo'@.00
Contrnts
,CIo
and Contents
.00.00q
9ao .oo 34 orn .*.00'Zq,oo2 .oo SDO .oo
500,000 sq ftSIZE (Grnd Flr Only)10,000-19,999 sq ft
.D o-ggg"qrt ft ft5000.9999 ft
50,000-99,999 sq ft
100,000,499,999
1000-4999 sq ft
SPRTNKLER PERFORMANCE
I E Equipmentopetat€d
2 [ Equip.shouldhaveoper.-didnot
3 D Equip.presentfiretoosmalltoop€r.
g E Notclassifiedabove
0 E Undeterminedornotreported
8 .EI Noequipmentpraent(N/A)
SprinklersControlledFire: YES E NO E
I of Heads Opened
DETECTOR PERFORMANCE
D t In room oforigin-oper,
E 2 Notinrmmoforigin-oper'
D 3 In rm of origin-not op€!-fire too small
n 4 Notin r-oforigin-notoper.firetoosmall
! 5 Inroomoforigin-notoper.powerdisconnect
E 6 Notinr-oforigin-notoper.powerdiscon.
! 7 Inroomoforigin-notoper.deadbattery
E 8 Notinroomoforigin-notoper.deadbattery
E 9 No detector pre*nt 8I to Undetermined
l'ire Sen ice 4-Other
'o-
Da," I I zzlttLd ak,i^
'fitle
Dat?I'fitle
814-440-10 (R-86)
-a-
rWk
Othet
D cont. on back
t
\
2:l
I
'n tt ll
|I:IIit'Idt,t03 99 iI$vHVr] gxI J_[90_800dv3 uef'lS$ 'NU5-8fl0-ro0
- * -- -- sr N3l{H03-- - - .. _ _sN0 I I 3 g.tSNI _-.il3 $
N0I LI'I0HH'l-990-*00
dux ug$ils . NVS-8[0_[00
n$VLlVrl gUI t-*90-I00
-.--dsNI --I'InSXU - - - - gI Hfi
'lX3- ---SINgl.tIlII nEgX SNCII T,3iI.J$NI HNHI NI I.I..I]IIS+
I [/,068
I It,068
TIII'IVI TNg|]I SflU
uI vdxu*OJNI -
$NI tHn"Id-s00-f,o0
NOI T,I "IOH:It]- I I O* I OO*--3n'Ivn --+rI h*rgd-r.rl grru-g,v[-gE uvHrun$-iIHJ- -..srl r.txg.I 'ltilI nu3H"-u3s
-NSSgil
-H33H-I33'riI
-fl!,1'Id..eNoHd uot3vllLN03
- "IN:I$
-slr0t3vlrLN03*gdI.I T,SNO3
I,iI3J OS
SII NNdug, 33CI ,,ttr]3{I *g$NVU
Nr v1dfloCI,IJ seI uolsrNoz r,fi'rfl -E -r;$5il_.srvr$_ _rsxgr,li_
0t6* IV3 I.lflu
{38 }JO /OI I6E8f, ){u ?0s068
?08068
e0rI68
-glv{ I3u---gtrvfl
0$
0*
/,0I I6S /
lt
*xn'IUn*
'l UNI J
CIS}I
/ISbT 6/,'0
06"0
00'$1
00'8I
{,t v L6
{,6$t-9t L
00?[0ctge[0c r
){30'I|I r0'I
-'ru$g'r_
N0E gt0 'rllgI Jt NI H.ISI33Htr,5 Vlrnv"i c001
'IVg,I UilVH Iug{0u
-)IXNf,l0_
g3N:rilI s3u HsI10H3|1: u3sfl{l
IS 'I'II t^t g0g
"ss3[iluv..
/.Ir068
LgIAGE *UOf NBI SI,1I I SNI fiTI nrl
Job Loeation:
Tc.x tot flAscesaona MaP #
$tbdioieion:
A-mer:
Phone:Addreas:
City:
ValueDate of
ffq->rPffiE /*z*t*xAdditian
Deacribe h'ot'k:
Reeei,lt.. RESIDFNTIAL- APPLTCAN /PERMIT
225 North |th Street
Springfield, 1negon 97477
Building Diuisio.n
7 26-37 53
SPFINGFIEI.D
?,q.6{
"2'rl*-*
Date:
racn
Ceneral
Plurnbin
l.lec ].c
lec E. r
lanec trSu1Efv
Soilary ser.tet capped at propartg Line
Septi.c tank pto'tped and fitted vith gta:tel
Pinal - tthen aboue i.tens aPe ccnrpleted
and uhen Cenolition ie canplete or strur-
iure noued atd ptemtsee cleaneC up'
Hcmes
Blocking otd Set'uP
P\,rnbi.ttg connectiona " aa)tet od uater
Electrical Connection' Blockitrg' aet-up,
and olwbinq connectione nast be aPPr.ca*ed
b;
"
f ;, "
- ie qu"e eting eL ec ! rt c aL in sp e c ! iott
AccessorJ Buildittg
Pinal - After pcnchee, ekirting' decks'
etc. ate conPleted'
Page 1 of 2
to gee thataLLinapectiotaa,,:enadeatthePl:o?ertine'thateaehaddteasi'sreadabieIt ie the
fron thetAuilding
neeoooibility of the pentrit lplden
sb?e'et' ald ttat the -p*nrtt card ia-;;i 1o;. approu*ed plan alull nenain
Located at the ftont of the Ptopetty'
on the BuildinlT SiLc at aLL tines'
PRocsDUPE Fon INSPE1IION ,8-18!E,T:CALL 7
requested and uhen you t'tLLL be ready !o"
-^iil be nnde the aone dcy, requeate made
26-3769 (recorder) state yout' City
inspection,Contraetore or A^mers ncme
after 7:00 on viLL be nnde the ncxt lnrking daY.
Iour City Deaigr,ated Job Nwnber fa:
?o la
rcquined oapor bat:riera are LN plaee
Cesignated iob nwtbet', iob aCircss'of inspeclior
and phone numbcr.7:00 c-:r
,)
\NDERSLAB PLUMBTNC, EL;EelRr=cAL &
ffiHinrcAt; To be nade before anY
ffi-ia cor)ercd.
F11TING 4 FOUNDATION: To be nnde
;fi;;-ttenc6; are "rcavated
and
7or*, orn erected, but Pniot to
Wurtng ccnctet€.
\N1nRGROUND PLUMBTNG? SSrytR, .W,4TE-:1,
DRAINAGE: To be nale Prlor to JLL-
T@-lfrnchee.
uttDERFrcOR PLU!.EINC q ME1HAilICAL :
?o be rnde Drior to tiiTd|ffiid
floor inau\a,tion or decki'ng'
SITE INSPECUON:
excaoation, but priot,
To be
tc
forna.
deckitq.
FIIIAL PLUMBINC
FINAL MECIIANICAL
FINAL ELECIRICAL
th, gypdwn boarC or
applied, atd befote
concealed.
set
aftet
uP of
but be
rnL
oty
fore @ta La
L covering
inaulation
LA
LA
of
DRYWALL ITISPECIION: Tc be nnde
@ie.in place,
but Pnior to cnY taPt'ng.
MASINRI: Steel Locati'on, bond
iffilgrouting on oerticala in
i"oorld&." Ltith u.B.c- section
2415.
IOODST7VE: After installation ie
@futeA.
CURB 8 APPROACH AP|I,ON: . Aftet .fornsdZirected bub Pt'iot to Pour+ng
concrete.%#w; ",izi:'"1nir-nf-tnu'. to be nade after aLL exca'
iltLn"o'canplete E forn urtk & sub'
fuse l,nteii-al in Plaee'
POST AND BEAM: To be nade PrLor to
TGiiTTil$Vof floor inaulation or
R1ucH PLIIltBrlc. .EI:.ECIRI?AL E MECH;
TNT1AL: n;,lork ia to be couered
ffif|-theae irupectione lwtse been
nade anrl aPProued.
FIPEPLACE: Prtor to Plccirq facing
,,a;e"ffi; and before frantng inePec-
tion.
FRA]'!ING: ttust be tequeabed after
ffit of rough plwrbing' electt'i-
&'L a necln ieal. - ALL roofittg
bracittg E chinmeYa, ete, rruat be
. conoleTed. No r,tork ia to be cor-
,."il"d until thia inaPeotion lae
'been nnde anC aPPtoued.
IENCE: ithen comPlete -' Ptotide
ffi o, mortable aecttone through
P.U.E.
F?zoo ft.?r>azE-/t/< <'
-fuZrs m"zztr'g>
-.:ALLpt,ojectconditione,suchaaLhei.nstallationofstreet-lly.l,conetcbionofthe
requi.red Landsccpus)"L.,,.,-,|.it t e ,otis1izl- a"rz:r"-l\L BUILDTN| PritL can be requested'
f>, \INAL BU?LDING: the Final Building fnepection mtst be reouested after the Final Plwnbing
(& ;:ri2i,i\:,1: h fi ir-,t"i t n" p"
"
tlo;: ; ;';' ; ;
"
; iie- a'd' appr ort e d'
*ALL MANHCLES AND CLEA NOUTS TIUST BE ACCESSIBLE, ADJUSTIIENI TO BE TL4DE AT NO COST TO CIIY
wrl
OLAR ACCESS REQ.-L-CO G+JOB N
Total
t:Bedrooma:
77r*>
-
I HAW CAREFULLY EXAI,IINED tle canpleted application fon permit' and do
hereby certify that aLL infomntion hereon ie tnue and. correct, anC f
further centify that any ard aLL uonk penfor-ned alnll be fune in accor-
dance vttlt the 1rdinanoee of tlw Citg of Springficld, atd the Icae of tha* State of 1regon pertaining to the tlrrk Ceecribcd hereln, atld that N0 )ccu-
PANCY trill be nsCe of any atructure tithou.t permiesion of the Building N-
uieion. f further certify that otly contractoro ad enployeee uho are in
canpliance uith oRS 701.055 uiLL be uaed on thie project
1-3 (- k?
Signed -\_
Enerou Sourcee TyneIot Faeee -
!leatSetbacke
Ilouse Garaac Acceaa.Wate? lleaterP.1,.
North Range
FirepLaccl)as L
WoodstoueSouth
l,lest
! of Sbrtee
Tot;al lleight
Topogmphy
Interior
Corner
Panlnndle
CuL-de-eac
INT TYPEtot Sq. Ptg.
z of Lot Cotterage
Building Vqlue & Permit
This pernr,t ia granted on the etpPesa cottd-ition that the said-consLraction
"l-LL', in all rZepecti,- conform'to the orditunce adop-te,l by the CitY o.f
Spiingyieta, inctluding- the'Wning Cvdittanc_e, regulating the ccnstntcticn
id "bb of buildinge,- and may be euspended or reuokeC at cny time upon uLc-
lation of any prcoisione of daid ?t'dinanees,
TOTAL VALUE
VaITEMFTG
DC *
Fee
{
S.D-C. 1.5 x,
Building Perwlt
?otal Chnrges
State Date Paid:
Signed:
Receipt fl:
Plumbing Permit
No person alnll conatntct, inetall' alter or clatqe -GnA nel-cr existing
ptltinfing or drainage ay|tait in uhote on in patL, unlees euch person is the
iegal p-oeaea"on of a ootid plwrber's Licenoe' ezcept tlnt a pe"son nag do
ptunttig uork to property ihich is oumed' Leased on operated by the appli-
cant.
CHARGE
ee
*
ITEM
Fi.*tt*eg
Resi.dential (1 bath)
Sani Seuer
Plunbing Penr:it
State Surcl",arge
Total
Electricql Permit
Were State tant requites that the electrical uork be done by an Electrtcal
Contnactor, the electnieal portion of this permi.t alall rat be oalil wttil
the Label lue been aigned by the Electrical Conttactor.
1'TL:M NO.
*
te
Total
Na,t/htetd Circuits
Seruice
,
Mechqnicol Permit
tuhanet llood.
Ilcodstoue
Vent Pat
Pernrlt Isaudnce
Mechanical Permit
.. EIICROACI]MENT -.
Secaritu Dewait ry).-'./
Storage
l,laintenance
Permit
Curbcut
Sideualk
Electrieal label
Mobile Horne
/G-n*----v?\
,TCTAT, AMOI]IIT DUI|: A V6s'Date
NO.FEE
l,lcten
NA.EET CIIARCE
Total Charae,a
State Swclunae
Fence
r t,?
I