HomeMy WebLinkAboutPermit Fire Damage Report 1999-02-14Il-l-1Q
FIRE DAPIAGE REPORT
OR
ELECTRICAL HAZARD
Siqq cc:c'4
DATE: 2-/4 -
T0: Building Departrnent
FR0l"1: Springfield Fire Department
SUB,-rECT: Structural Damage to Bui I di nqe-/Ji==
Address or location of buiiding
Name of ol./ner
Srsc
Type of buiiding
(Dwelling,Store, l{arehou , etc. )
Estimated value of buildinq .EC-GCQ
Estimated loss to bui'ldino $
qCt.
Date of fire .?_ _/q_?g
Locat'ion of damage i n bu i I di nq4*l ,:>-,/*<-Ar-//;
(Roof, l,rlalJ, Exterior, Interior, etc.)
Structurai weakness as a result of the f.ire
(Burned rafters, Beams, ")oists, etc. )
Additjonal pertinent information
Electrical Hazard
(l,Ji ri nq , 0utl ets , etc. )
-tf 't I tcc L ?i,t
S i qned
7
!
E'(P\OFf.ICts,
EIRADEPT.AI,^RMT().'of)5
I\ORAIjL sA ,7G I
i\
Dtrn,rcror.rcrDEn* 1 . t (- b cornrrr Lane
' ldryry q l bW 1 "4':ff l XfrYYq ARRIVAeE
O OtherOutsideFte
WithValue
OTrashFire
O OtkFire, Bplosion
P€tucture Fire tlllbbife_PropeqtyFire
E Firc In Mobile Property O Fire h Natural.' -
UsedAsAStructure Vegetation
O Firc In Mobile koecrty 0 Fir€ Io Cultivatd
FircInAStnrtre
DOverheat ORescueCell Ocoodrntrrtc.all
B Service Call E EIVXS Csll O l{aaathcide'rt
B Falsc Call - ]v{alicious O lllegal Burn O Non-firrer>m"ge
BFslseCslt-Uaintcational OlegalBrrrn Rr1lqt
GIARKALL
Elv{alfiruction
CEh{SUSIRACT
101t4ttZP DXSIPJC?
ZONE2345t/z s4 h 5l-5 INCIDENIADDR.ESS
DOBa OCCUPANT NrMEg:s. fir4lv{I)
t/aq'-g/
DOBS BUSINESS owNERNAv0(t <, FiId Mr)
DP<:6 BUSINESS OWNER,IDDRESS
DOB
t
oli bb .{o 64bbl\zta N
26tS
€
Bt:t>. e
ZP
Qt4b3
oulzs / 4g
DOB
1 4t2 - 4ua4
IT'rFerrolfi9 II{GDENTREPORIED BYgre( Fits( Mf)
Seuz.r . Jo Anr^ A urce
9t4ltZP
2341 SrxSrrz:ru SPzr^cFrErI),O2.
10 INCIDEI{T REBOEED BY T,DDRESS
#OFOTEB,rIRESRVTCE
VEETCTESRESPONI'INCaa
ldurgrl,rIDo GrlfEN
O EET\1ED
f oI.EI{GMIES
XE?,Dn{G
#OTTERIALTPPANATUS
RESRONDINE
U I OF EREPERSONNELNXSFONDING
cu..r /2 lvauntc.r
II 1YPE OF ACIION IAKEN ( CX{ECKAIL I1{AI APPLY )OFociblcEutry &frvestigate OTransputg?rdinguish 0ftsqrc fir{Prnat]P
Eteotihrc EElfiicate ERemoveFlezqrd
0&lnase BELf,S OEstablishsafeArrea
trDeconArca B S€arch
BDecmPcoplc@uip O Shodby
E }donritorlla'rm4 O ltfiove IIp
OProvi&Pcrsmd
(hherOEvacuate
IELEPEOITE
FORAI-LEIRES
O Grormd Chews llf/Equip And/&Air SopPrt
t:, ldtrEon
Asmatic S5nfiemBdngrdshing
\4rater Cagied OnlnitiatApparers
Ort4t*q trEPubblc
CISclf-DCinguiScd
OMakc$iftAi&
OuIy " tr ClassAEldtrg. A CkssAlB/CFrdD& O@2'.', . O CompressedAirFom
ODirt
la
15
ee
O Class OClassAFoaa
(CodaclUfOn+(
BClsssBFoarD/AEfF ONoc' .' :
WWater D
5i[AIELICE}GB#SRIAL#/AIRCRAFTIAIL#M IEAR II{AKE
EQT'IPMENT IWOLVE) IN ICNIIION
(CooptacUepf)
t6 ng)MrrREA ,
OTtrIREORIGIN
POWIERSOURCE OFXXED
gFETTE,ESERIAL#B YEAR MI|KE
FACIOR QE rty*lty .-
*.aru*ca O
lrd[icPtstE
L'a* O
Agc
Ilftaib-(Coqldcturcaile -
O wrFircFm)
Eld.{ty
(ee"e5+) Ee*cp B Orar .
Or*k
Lhoooci<xs
Pcso O .
thd.odcdrt EUMANTACTIOBS
IWOLVEDTN.. .
IGNTIION
IITX\IFIRST
'WBr^rRrarl A-tr/t6v6t$,165
MAIERIAI,EIRSTIGMTED19 troBMOF
EEAroFrGNrrroLe"ru Fta"n6.
Bunig,r Flor of Origio (Sturart fiG Ooty)Oeborccroooa2, IIVELOFFIREORIGIN Os.lorGtorod Dc-,ra
IffI
I.:}fl}o -lo
O[bd
.oo
Mobilc Propaty md Cotas
.00
Buildim-.6-sffi ry21 ESIIMATE)
VAII.,E ?,agg ,o.o0.@J6,e.oQ,,22 DSTIMAIED
ross
l,
IEIJEIIONE
7 BIrIIDINSMOBE F PROPERTy OWNER NrMr.G$qIiIq Mf)TEX.TEONE
o
tr.IP
O sqooo-eorep
r0q0o0-.199.Cr0
IITIID{G @ (&ouDd\_. Clr)
5f,-grserr
o
B
tr
8IUIITINCzIG.E(h Ycrr)
60
B Scd&Ooattq 3-.1 llr (t!"cl& tr ER), :.,
O hccrcd Mesory E a & Wood Id. (t]"c tr f h)
tl(hprotoaca ldesoryE:d. & Wood tnt G1pc f)
D Prolcdal_Stccl Bldg: (t]c m - I hr)
D [loprucacd Stcd BI& (t]"c ltr N)
DHgaryTimbcr(tf fV)
tr Protbacd Wood Fnmc (t5tpc V f hr)
Odprcicaea Wooa Frrm (5pc v N)
ClasscdAborc
9-M&uarrc
B Opcnstructrc
O Air&pportcd S'trucurc
O OpcoPhtfom
tr undcrgrouadstrudtte
E Tffc of Strucarc Not Classcd Abbvc
--
IIPE
25
2t BY
EKTINGT,ISHINCAGENT
tr ObjcctofOrigin
tr Pert of Rooa/Area of Odgin
O RoomofOrigi!
O fircrdcd Coop. oforigin
O Floc ofOrigh (Muhidoc Struorc)
*ducarrcofOrigia
tr Bqmd Stnranc ofOrig"
trNoAdimof,ILisTlpc
EIRE@NIROL
trObjcctofOrigin
tr P{t of Rooor{rca of Origitr
ORomofOrigin
tr fire-ratcd Co,rp. of Origin
tr Floor of Origiu (Multi-foo( Stu{trE)
EeftcturcofOigin
tr Bcyood Seu.turt ofOdgin
O No Aaioaoflhis $pc
EI/r}TE
BObjcdofOigin
tr P.rt of Rooo/ArcE of Origin
O RooorofOrigin
O ftrr.Ld Cory. ofOrigin
B Eoor of Origitr (Muhi-floor Struttrc)
d66xancoforiein
B Bclrcod S\rudrE ofOdgi!
O NoefrcDrraaecRcport
silfoKr
O Objctt ofOrigitl
tr Put of Room/Arca of Origin
oRiioforiein
B firc-ratcd Coq. of Origin
B Flon of OriSin (Muhlfl oor Strudrc)
pffirctrrcofOrigin
D Bc:pd Struct .E ofOrigin
U No DaoageofTLb1lpc
27 DEIDCTOB,TTTE
O Snrok
trl{cd
OCmbindioSookc/Ilcat
tr $doldcdWacr Flov Dacaioo
O qrocll llrard S5dco Rdcesc Dcvice
trCrrtoMmxi&Daas
O l,!ac Th.a Ooc Rpc PEs.d
B o6nT5/pc dDdoda Plcscd
[NoDacamprrscc
O Dctestc (homfoot rtpqtca
DEECTORFOWB,ST'PPLY
OBdcryOoty
Oll:dwircOoly
trP{ugin
BllerdwireVBatcry
trPluginw/Bancry
O Mcchanical
O fvfuftiplc Dacaors & Powcr Supplics
DETECr|ORTERFORM/UiEE
O h Rom dOigio/Alcdd Ooq.ils
tr Nd h Ro@ dOrigh/ALddt Ooqryads
O In Roo of Oigio/Did Nd Opcralc
BNcriaRoo/DidNdOpqrt
OPrrcscdhlom/FnelooSanll :
tr Dacctr OpcrdcrUNot ffdn in
Oiroottty
O Dacar Opcatcd/Ocoryrats Frihd to
AN
REA^SON tlORDEIECNOR AIII'RE
O l{rrdwircd Pur &{pty Flild
O Iopropcr rn<.ltetio c Plamcd'
ODdcaiwDacaa
Olnrdcqudclhidcorc . .. .
O Bls.ry lfisnng a Disooocscd
OSucryOis*arged t.'
ENoDdcaaFeilurc
O Feilurclhdctarincd ,
U s8RII{KI.E AY8 ETIIPE
trW.a?ipcsl ilcm
trDryPhqrtal
ODchgeSJr{cE
trPrr+raiosyrlca
tr Ood. Dry Pipc & Pnarain S5Acu
Orco{)fl@I{c.ds
O Ooca Ecrd Srntca Mrall Cdol
a(oSp.ialgcr-Plotcct-
O TlrDc $4fca lhcood.ilthddcrrio.d
NUMBR,OTHEADSOPENED SPRINKI'R,PBFORMANCE .
O Opcr:ccd & CmoUcd/Eriagui$cd Firc
trShould OpcotcdDidNc
ONoEqriphRooofOrigin
RBAION rlOR SRINKIj8R,TAIrI,RE
trS),scaSfonOf
tr Not Eoongh Agdto Cooot Fnc
O AgEdCoutdNdRc.Afirc
O S:rscuPipitrgDrD4d
O No Disctrrge E ads Ir Ro@ of
Origin - .. '
trNo$6cuFelilurc ''
.
tr Rasoa fa Frilurc Lhftpqtd
COMPLEIE FORALLINCIDENTS
rIRESERVTCE .. '..,r ,
SPFII'
II\UT'RIES
rrYDs,wlro
IIAFS}IAL
29 IiOIII)W UP D{I,ESIIGAIIONRXaUESTT
i - .l
3--/1-3l
g f\ ,^ "i "'. "-'H.^rq *=z^e U\ttaizS.LlaL '.
2043.10(R-96)
1,,:
o
O N6rr.d Roof Covcrlng ( Crrras, Plafic, Hot Trr )
B StuctrcwithoutRoof
tr RoofNcCtasscd Aborrc
tr
Shiogtcs)
UtldcdcdWoodShioglcs',
rIRE SUPSRESSION EFT\ORTS OONIINE) Tro
t.l
DAIE . IDz/u.lqq . '.