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Home My WebLink AboutPermit Fire Damage Report 1987-06-29FD-l6 {4il r/(& .trtrlla FIRE DA}4A.GE REPORT OR ELECTRICAL HAZARD No Drtorrue lpbt@t fio /WN"iD ^'r/ortzr(x*DATE: G- eq - gl TO: FROI4: SUBJECT: Building Department Springfield Fire Department Structural Damage to Building Address or location of building 3s 3).One (oo. St- Name of ot.,ner 0nnn ,I.l*tc-[r.ir.r sonr[J Type of building (Dwelling, Store, l^larehouse, etc. Estimated value of building Es timated I oss to bu i 'ld i ng $ 40, $'& Date of fire [,- 19 - f, ? Location of damage in bui'lding lhr)F_ (Roof, Wall, Exterior, Interior, etc.) Structural weakness as a result of the fire Dour (Burned rafters, Beams, Joists, etc.) Additional pertinent information Electrical Hazard r$,rtrr^A cc: ,r[ ^'{ i., u S i gned (tli ri nq , 0utl ets, etc. 1r,,i n P l'lr,ueo[.'t I ,A rr NO, DO NOT WRITB IN TIIIS SPACE CONTROL EXP. District of Incident 2 INCIDENTADDRESS NAME (kst, Fi6t, a BUSINIiSSOWNERNAME Fint"MI) 6 OWNERNAME(I.4t.FiEt,MI) 6 FIREREPORTEDBY 7 METHODOI. AI.ARM Telephone Muicipal Aiao Syrtcm Privlt AhrSyEt E , OF FIRE SERVICE PERSONNEL RESPONDED 3 STA Itadio Verbal No Alum Re'd FIRE REPORT A FIRE IVIARSHAL 9ll (Tie Voice Signal Mui Alam Not Clasifed Abovc IIRE Df,PT, NO. Hand-laid hore/hy&mi,, Et{ndpipe Ma8lrr Streu D€vie I Not Clasified Ahrve MI) 1,? Ji5:.-iltJr5at rt *Fii>Fr{ ooE> 0?j -,E ird E'!l dF'a>-r oo2 -o.. rd-l(5 ,t, t. U).t l. 15r, F tl1a CN-l -i :0E'rt :dl., U)ozrr 9 TYPEOFSITUATIONFOUND O StructuE Fin I out"ide strut- w7"alu IO METHODOF EXTINGUISHMENT ll M MOBILE PROPERfi 12 ROOM/AREAOFFIREORIGIN EQUIPI\IENT INVOLVED IN IGNITION 13 IGNITION FACTOR I{ FORMOFHE,ATOFIGNITION 15 LEVELOF FIREORIGIN '6 vtrup lnss Self- Ertingu ished Mate-ahift aidr ! PonableErtinguisher ! vehicteFin I Bruh,Gras,I:ave ! Traah,Rubbish l0 to l9 fet 20lD29 fel 2 Ebn6 3 to I Btoric! fi! othertList) CIoPes &1.* AutoMtic ErL Syst m ! Prc-onnrthre/tanlonly ! Pre-onnect ho*/hydrant. standpipe 30 to 49 fet fl Underermined E sot,zof*t Over 70 Obj6ts in Flight OF STORIT]S It BUILDINGAGE(ln 19 CONSTRUCTIONTYPE 3-{ hr. EXTENT OF DAMACE CONFINED TO: I ThcobjGctoforiain 2 Part of mm or ea of origin 3 Rmo of orici!& t Fi--od -mp. of origin 6 Fhor of origir 6 StructureoforigiD 7 ErEndedbeyondrtructlnof oridn g Nodaruteof thctype(N/A) 2f REMARKS W6th€r Conditions (optional): Fire Scrie 2a Mcmbcr MakinS R€gott lnfotution abrrea ? to 12 storiE eF Y- N l- lfya,rhowillinvmtfuate l3 to24 Et ri6 25 to {9 rtoria 50 storres or more SmokeFlame ED tr trtrtr tr tr D! tr trtr D I 2 I 5 6 7 n u UpFollos TIME BACK IN SERVICEotBr4rS ALARMTIME orB rLrB ARRIVAL TIIlTE or6 r3 r\0tG MO DAY }.rQ rhln I gtgtT DAY OF WEEK Ds* B t"t"o n n!ft1 rn* D s.t* Ewd EFi tso crAss -3 CENSUSTRACT ItQtDrf,r r7 t1fl t7B ztP DOts (options.l)TELEPHONE 1q'r - o7.33 TELEPHONEDOB (optional)ADDRESS DOB (optiond)TELEPHONEADDRESS DOB (optional)TELEPHONE -rq r. o't -1 f ADDRESS ft ncivea ! Givo fl N/A or I OTHER VEHICI-ES RESPONDED (do not irclude PA's) il OF AERIAL APPARATUS RESPONDED, OF ENGINES RESPONDED l Ertinguirh InvdtigstioD D!I RemovedHaand Sund TYPE OF ACTION TAKEN Salvage Not Cla$ified I\tOtslLE PROPERTY (Complek line M) LICENSE #SERIAL ' MODELYEARMAKE EQUIPMENT INvOLvED IN IGNITION (Complete Line E) fjothes 0Rv r.a VOLTAGEIto Y. SERIAL I Yva. ti6 La.-71-3 - v6w tMODEL ts/n YEAR T MAKE (). E FIRST IGNITED:MATERIAL FIRST IGNITED WAS MADIi OF UndeterminedBelow grd. level Not Classified TOTAL .000ther .00Vchicle and Contentr .mC-nt€nta .mBuilding .00o .oo.00.00.00E..00a ft 1000-{999 Eq ft 5Oo,0O0 sq ft50,000-99.999 8q ft10,000- 19,999 Bq ft. fr BUILDING SIZE (Grnd Flr OnlY) Not Clasified Above FreHovy Timber Unprcht. Metrry Ett. & Wqld lnt.Unprctect. Stel Bldg & Wood lnt.Wood Frame SPRINKLER PERFORTTTANCE I E &uipment operated z E Equrp-shoutdhaveop€r.-didnot 3 ! Equip. p."*nt frc t@ Em!.ll to opcr. 9 ! Notclasifidabovc 0 D Und€t rminedotlotEportad a ft Noelu;omentprunt (N/A) SprinklcnControlledPirc: YES E] NO E I ofHqds Opencd DETECTOR PERFORMANCE D D Etrtrtru tr D I Inmmoforigin-opcr. 2 Not in mm of origin-oPcr. 3 In m of origin-not op.t-fiE to rull { Not in m of oriSin-not op€r. fw te.mdl 5 In rum olorigin-mt opet. poecr di@nncct 6 Not in m of origin-not opcr. powcr diocoo. ? In mo of origin-not op.r. d6d battery 6 Not in Dm of oridn-notopcr. dad batt€ry I Nodetst rprent E l0 Undetcnined Numbcr of Fataliti6 b- xq -81DatcTidoA/tc DttaTitb elI-ddn-in /tr-R/'l Othcr E "ont- oo b""L 3 I 2 3 I 5 6 1 8D-16 TO: FROI4: SUBJECT: Building Department Springfield Fire Department Structura'l Damage to Bui 1di ng FIRE DAMA.GE REPORT OR ELECTRICAL HAZARD #M(a DATE: G- Iq - gA lr\ Qqtt td /\ v Address or location of building 3s 3e.Ono romN Sf. Name of or.,ner (1n*"n,il,^*n-lnirrl Snn-/t, Type of bu i 1d'i ng Estimated value of bujlding Estimated loss to buiiding (Dwel'ling, Store, Irlarehouse, etc. $rl O,ttD $h Date of fire (,- 19 - S ? Location of damage in building thr tr (Roof, hlall, Exterior,Interior, etc. ) Structural weakness as a resu'lt of the fire )D (Burned rafters, Beams,Joi sts, etc. ) Addi ti ona'l pert'inent i nforma ti on Electrical Hazard VJi ri nq , 0ut'l ets ' etc .) CC: Siqned ,Ar{ DO NOT WRITE IN THIS SPACE CONTROL EXP, District of Incident 2 INCIDENTADDRESS NAME (last, Fint, { BUSINESSOWNERNAME FiEt,MI) 5 OWNERNAME(ISt,FiNt,MI) 6 FIREREPORTEDBY MI) Telephone ALARM MuDicipd AlaE S,sttE PrivEt Al,am SyEt m NO. STA tladio Verbal No A.tarm Rc'd FIRE REPORT FIRE MARSHAL 911(Tie Voice Signal Mui Al.am Not Clasifed Above INE DEPT Hand-laid ho*/hydnnt, standPipe fl Undeermined # OF FIRE SERVICE PERSONNEL RESPONDED .J 9 TYPEOFSITUATIONFOUND ! Vehicle Fin I Brush,Grres,l*avo ! Truh,Rubbisb flt orhe. tLier) Cloltres ch'{"e Autoetic Ett. SysteB fl Pre-onnrt hm/tanL onlY I Pre-onnect ho*/hydrant,standpipe tr D Structure Fire Outside Struct. e/v8lu o :c9 V': -Err- trJln E!, fi3 F o oo/.> u?j -,6 i- -Ji'Ea4JAJVdF Epr o rtrl,ltt1l F F a-l trla, FIlIa C'),i o,t 41 15a z r< 10 METHODOF EXTINGUISHMENT I 2 N1 5 6 lietf-Ertinguished Mahe-Ehift aids Porrable Extinguisher El D MsBEr Streu Device ! NotClassifiedAbove FIXEIJ M MOBILE PROPERTY 12 ROOM/AREAOFFIREORIGIN EQUIPMENT INVOLVED IN IGNITION 13 IGNITION FACTOR 14 TORMOFHEATOF IGNITION 15 LE!'ELOFFIREORIGIN l0 tD 19 fEt level E zotozgr*t " veluE LOSS OF STORIES 3 to 4 storiG 18 BUILDING AGE (ln Yan) 19 CONSTRUCTIONTYPE EXTENTOT'DAMAGE CONFINEDTO: Flame 30 to 49 fet 50 to ?0 fet sbneS ? to 12 8tori6 eF 70 fet Objects in 13 to 24 6bri6 Dzs ,19 8bri6 50 stories or mole Below grd. level Not Classilied Undeurmined Smoke The object of origin Part of mm or rea of origin Rmm of origin Fire-mted omP. of origin Flor of origir Structur€ of origiD Ertended beYond atructure of origin I 1 5 6 I 2 3 1 5 6 1 E!u tr D D! Dtr D tr!trtr 9 Nodarugeof thetrPe(N/A) 21 REMARKS Weather ConditionE (optional): 22 FollowUP Seruie 2{ Memb€r Repo( TIMT] BACK IN SERVICEorBt4t6 ARRIVAL TIME or0 r3 t\ ALARM TIME orB rLtBot6 MO DAY vtln I gtqtl DAY OF WEEK fl sun n r"!fo l'* E s".. p uoo fl w"d D Fn ISO CLASS _3 CENSUS TRACT I tQ tDrl rI tlfl t7 $ ztP TELEPHONE 1.t-r- o7.li DOB {optioml) TELEPHONEDOB (optional)ADDRESS DOB (optiona.l)TELEPHONEADDRESS TELEPHONE -rcJ1. r)1 -1f DOB (optional)ADDRESS f| Givo D N/^! ne"lrea or # OTHER VEHICI.,ES RESPONDED (do not include PA's)# OF AERIAL A9PARATUS RESPONDED# OF ENGINES RESPONDED l TYPE OF ACTION TAKEN D Ettinguish I Removed Harud Stand By Salvage Not Cla6sified LICENSE #SERIAL #MAKEYEAR EQUIPMENT INVOLVED IN IGNITION (Complet€ Line E) VOLTAGEItoSERIAL # - v6w?t MODELMAKEYEAR ITEM FIRST IGNITED:WAS MADE OFMATERIAL FIRST IGNITED TOTAL .00.00vehicle and Conten* .00Cont2nts .00.00 Buildingooo .00.00.00.00E..00g 500,000 sq ft50.0O0-99.999 8q ft10,000-19,999 sq ft1000-4999 8q ftBUILDING SIZE (Gtnd flr OnlY) Not Clmified Above Fram Frame Unprct6t. Mmnry Ed. & wod lnt. Hovy Timber Int.& Unprot€ct. Stel Bldg ! D D D F Equip. should have oPer.-did not Equip. preent fue te small to oPer' Not clasified abovc Un&termined or not rePortld No equipmnt PrePnt (N/A) SprinklenContrclledFin: YgS 5 NO fl SPRINKLER PERFORMANCE t E EquipmentoPeratedonroc'ron pERFoRMANCE Dtr E trU Dtr tr tr 2 I 5 6 E 9 Not in rom of origin -oPer' ln m of origin-not oP€r-fire t@ sosll Not in m of origin- not oper' fw tm mall ln ruo of origin-not oper' power di@nrect Not in m of origin-not op€r' power di*ou' In mo of origin-not oper' de'd battcry Not in rom of origin-not oper' dad b8ttsry No d€tstor prrent f] 10 undet€rmined 1 In mm of origin-oPcr. ofFataliti6 6- rq -g?Dat€Title Titb ald-dr'o-10 /tr-nrl by Y- N X ffYe,whowillinveetigate E cont. on bach 3 ).rQ MOtstLE PROPERTY (Complet line M) MODEL YVr r1[, ].a. t (: ts.