HomeMy WebLinkAboutPermit Fire Damage Report 1991-12-13FIRE DA}4A.GE REPOIIT
OR
ELECTRICAL HAZARD
:jab *Qtnxl
DATE: /4't3 ?l
TO:
FR0r'1:
SUBJECT:
Building Deoartrnent
Springfield Fire Department
Structural Samage to Building
Address or location of buildinq /, t 71 -7-/t n,= L^ Ra
Name of or.,ner pona)d y'a,"12
Type of building 1)o"//tn.-t
(Du/el 1 i ng , Store, I{arehouse, etc. )
$ 7{,co<sEst'imated val ue of bui i di ng
Est'imated loss to buildino s AU V
Date of fire /.2 ' t3 ? /
Location of damage in building n (,e
(Rcof , i^jal I , Exterior, In',-erior, etc. )
Structural weakness as a resul t of the f ire 2o n€
(,lurned raf ters , Beams , .10':sts , etc. )
ACditicnal pertinent inrcrmation
El ectrical l'lazard
Ib t/* /.)r^r-
dce h eu *.sRD r/f de
)11 d rreeJ_ L, he C)"e.kd
cc:
Sioned
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ALARM TI]\!E ARRI\'AL TII\{E
Jo'-l 5a
TII\,IE BACK IN
\.ICE
FI )EPT
AL,...M NO.
DO NOT WRITE IN TTIIS SPACE
CONTROL EXP.NO. NO.
DAY L(l saturN,to \.}:AR
)\1 O
DAY OF
\A'EEK
'I'hur
Fri
I Tues
! \\'ed
! sun
[ \tnn
ZIP
t,t,'1,+,8
CEr*SLrS TRACT
rO^r)I I lL,l,ul^-
ISO CLASS3
f)OB (optional)
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TELEPHOT-E
ADDRESS DOB (optional)TELEPHONE
ADDRESS DOB (optional)TELEPHONE
ADDRESS DOB (optional)TELEPHONE
I Rmeived f] Gi'"' [Nle
o!onlt)
* OF ENGINES RESPO\DEDI
i OF AERIAL APPARATUS RESPONDED ,.<-
I OTHER \'EHICLES RESPONDED
(do not include PA's)
Removed Haard
Stand 81'
TIPE OF ACTIO^* TAKEN
Nor Classilied
Salrage! Ertinguish
MOBILE PROPERT'i (Complere line M)
do'r ll
SERIAL #LICENSE #IEAR \MAKE {Jr MODEL
EQIIIPMENT INVOLVED IN IGNITION (Completa Line E)
SERIAL #YOLTAGEYE.AR MAKE MODEL
l r(5* 1 " {- , q-r r.-
FIRST IGNITED:
e trc_
FIRST IGr'ITED lt AS MADE OF
l.:-, *,.-
.00
AL&o '00
Conlenls
.00Cr-
Vehicie and Contents
.00.00
Buildingd)c)
oa .00.00 .00:lao .00 ,2 cc .00
1000-,1999 sq fi
5000-9999 fl
500.000 sq fi10.000- 19.999 sq ftBUILDING SIZE rGrnd Flr Onll)
Not Classified Above
\\'rrcd FrameLinprotet. Ir{asonn Ext. & Wood Int.
Protectrd \\'qrd Frame
SPRI N KLER PERFORMAN*CE
I ! Equipment operated
2 C Equip.should hateoper.-did not
3 [ Equip.presenl fireloo small boper.
9 ! Notclassilredabove
0 fl Undeterminedornotteponf,d
6 ,8-\u equipment pre*nt (l\,;.{)
SprinklerscontrolledFire: \'ES ! NO D
N of Hads Opened
DETECTOR PERFORMANCEEtr
n
D
D
D
tr
tr
tr
I
2
3
4
6
i
In room oforigin-oper.
Not in r@m of oririn-oper.
In rm of origin-nor op€t-fire t@ small
Not in rm of origin-not oper. fite bo small
ln rmm of origin-not oper. power disconnet
Not in rm of origin- not oper. pt wer di*on.
In room oforiFin-not oper. ded batte4'
\'ot in r@m of oriEin-not oper. dead bstt€r)
No detstor presnl D l0 UndeErmined
8
dNumber of Fataliri6 C)
tZ'ri 7/DaltTirle
I)at eTirle /
'ATE OF OREGON FIRE REPORT
STATE FIRE MARSHAL
S f-,^,.t s.C\
or more
Undetermined
I'District of Incident
2 INCIDENTADDRESS/7
ANT r-Al\{E lLast. First. N{l)
/t r.. r -t
l,
eqr
It\ +-. I l'q'
l0 to l9 fet
E :or:9r*t
E 3ro4"tories
Heavl Timber
Prorcl Steel
Flame Smoke
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a BUSINESS O\VNER NAI\{E (trst. First. l\{I)
5 OWNER n-AlrlE (Last. First, MI)
in4 e
6 FIREREPORTEDBY (Last.Firet.MI)
<-{
Jc\rrt€
-ALARM
E Prirstc Al8!m S]'sttm
8 *OFFIRESERYICEPERSONNELRESPONDED Ao
9 T'I'PEOF SITI'ATION FOUND D Orhe!(List)
! Autorutic Ert. Sysem
! Pre-rcnnea how/unk only
! Pre-onnecr hose&ydrant. standpipe
.8.tr .Structure Fire
Outside Struct. s/talue
Telephone Diret
Municipal Alarm S1'sem
Radio
fl lerbal
D NoAlarmRe'd
9l I (Tie Line)
Voice Signal Muni Alarm
r-ot Classified Above
Over ?0 fet
\.ehicle Fire
! Brush. Crass. kaves
fl Trash, Rubbish
10 METHODOF
EXTIT.GUISHMENT
D Self-Exringuished
fl Mske-shift aids
Exrin;uisher
Hand-laidhor,/hydranr.sundpipe ! Llndetemined
fi Maser Sream Device
fl Not Classfied Above
t1
ln
1\,1
PROPEBTY
12 ROOM/'AREAOFFIREORIGIN
catlslg,- |*'r't A ht'<'re
E
*>e
EQLUP]\,1ENT
In-\tOLYED
II{ IGNITION
r3 IGNITION F,ACTOR
2 icc-1- s h<,,-+
I4 FORM OF HE,AT OF IGNITION
I r-c-
I5 LE\'ELOFFIREORIGIN
Grade leve) to
'6 r'ILUE
LOSS
1? NLTMBER OF STORIES
*a 2/,O u"it fte"-)ers
30 to {9 feet
50 b 70 fer in
l3 ro 24 sbries
! :i, * 49.rori..
Belo* grd. lesel
E Not Classified
50
l8 BUILDING AGE iln Yqrs)
19 COr*STRUCTION TYPE
E s*r
EXTENT OF DAMAGE CONFINED TO:
I Tbeobjecroforigin
2 Part of rmm or area of origin
3 Rrnmoforigin2o { Fi*-r",od"ump.oforigin
5 Flor of origin
6 Structure of origin
? Extended beyond s!ructure of origin
9 No daruge of the tlpe lN,rA)
:3 of lnjuri*
Fire Sen'ice
J.t Mcmber lUaking Rrport
t{) 6 su)ries
; b l! shries
LlnprotBcr. Stel Bldg
Protet.\l md lnt.
I
2
3
4
5
6
'i
2l REMARKS WearherConditions(optionsl): C >r. / , Cl ^1
'J2 FollouLlplnvesligationR.quested \'- N > lf)'es.shosillinvesligate
x
l5 -Additional Information
814-440-10 (B-84)
o
cont. on back
3
l,d
Other
l
50.000-99.999 sq ft
c)