HomeMy WebLinkAboutPermit Fire Damage Report 1991-12-03FD-15
SPF,II;GFIE:i FiR.E DEPAE.T}lENT
FIP.E DAi4PGi P.EPORT
OR
EL ICIR I CAL IiAZA,P.D
6a+ 4it.{L3
DATE -7/.C
TO:
FROII:
SUBJ ECT
Bu'i I d i ng Deoa rtmen t
Spri ngf i el d F'ire DePartment
Structural Daniage to Building
Address or location of bujlding (il ,/, /9 g
Name of ol',ner
Tyoe of bu i 1di ng I bx'
(Dwelling, S re, I.iarehouse, etc.
Est'imated val ue of bu j i di ng J
Estimated loss to building s
Date of f ire t2 - c;3 - ?/
..
Location of dama-oe 'i n bui 1 di ng E"lr< i' i't'tErincn-? - E"J.*a<'
€xk--l-..1-
(Rcof, Wall, Exterior,Interior, etc. )
Structural weakness as a result of the fire
(Burned raf ters , Beams , ")oi sts , e tc. )
Additional pertinent information
El ectri cal Hazard
(tli ri nc1 , 0utl ets , etc
)'ir/
CC:
S'iq ned
)
i-l
DO NOT WRITE IN'
CONTROL
NO.
tsIqlr- ltt- l,
OF OREGON FIRE REPORT
STATE FIRE NIARSHAL Sfqt- ,835
f] lvlotrr Stram Derice
E] NotClrcified.\bove
FIRE DEPT.
ALAR}I NO.
Below grd. level
\ot Classified
District of Incident
? INCIDENT.{DDRESS
\>1
! Municipal Alarm System
n Private A)am Sysem f] lin.\lamRec'd ! ),iotClsifiedAbove
Dept. Responding
Hand.laid ho*l hydrant. sundpipe Undeermined
Coun t1-LA.UE {
N#,. ts+ #? s ')rl O?
o
Tz
-:L
!i{
i/i >
o
f7
a:-i
!-;
=l iq
t*ii>--
3 OCCL PANT N.{IIE (tast. Firet. Itl)
t-
{ BUSINESS OWNER N.\!IE FiNt. UI)
5 OWIIER NANIE (Last. Fi6t. NII)
6 FIRE REPORTED BY (llst, Fist. lvtlr
.\LARIlI
Telephone Dirmr
6 #OFFIRESERVICEPERSONNEL
RESPONDED
Padio
! verbat
fl vuhr"le Frre
n Bruh. Grcs. Leaus
E r*h, Rrbbi"h
9l I {Tie Line)
Voice Signal lltuni Alam
et
9 TYPEOFSITUATIONFOUND
trn Structure FLe
Other Prcp. */value
10 METHODOF
LXTINGUISHMENT
II FIKEDPROPERTYUSE
M
PROPERTY
OF
\ED
IN TGNITION
l3
E Sef-Erringuished
E Ma&e-shiftaids
E Portabte
E other(Lisr)
! .{utooatic Ext. Sysem
Pre-connrct hor/tark only
Pre-connct ho*/hydrut. standpipe
)>t LvD),
D
E
dr./..-L<! cL
I{ FOR\IOF ,T OF IGNITION
15 LEVELOFFIREORIGT.\
Gndelevelo9feet
I6
V.I,LUE
LOSS
l0 b t9 tei
20 to 19 fet
30 b.l9 feer
50 b ?0 fe!
o
r
{
,n
a
.J)
:n
z
Over i0 t'eet
Objrcr in
50 itoriB or more
U ndeermined
Unprotected lVmd Frame
Not Clasified.\bove
NUMBER OF STORIES soales
E t r..y :l b { ibries
l8 BUILDINC.{GE 1ln Yeaai
19 CONSTRUCTTONTYPE Hean Timber
E s*ta 3-.1 hr.f] Protct. Sel D P.ot*r. Ma*nrv Ext. & wood Int.
EXTENT OF DAMAGE CONFINED TO:
I The objet of origin
2 Pan of mm or area of origin
20 3 Rmo of origin
{ Fire-mted comp. of origin
5 Flmr of origin
6 Structureoforigin
i Ertended beyond structure oforigin
Flame Smoke
9 \io daruge of the twe { N,/.A.)9E
- i2 Folbw Up Invetigation Requesed
\' ^\ N _ li yes, whr) wrll rnvesrilare
5 b 6 sbries
; b 12 storis
13 ao 2{ storiG
25 co {9 storie;
Unpmtct. Munry Ext. & Wmd [nt.
Promed Wood Frame
n
tr
tr
tr
ntr
D
n!!
D
C
&E
fl e,,nt.,,n back
M.xt (l..J,rrc,r .. (...r.r \,-{ r i. c /."l
!:i Numberoflojuries
Fire Senice
2t Member Making
25 Additional Informatbn by
l2
i\to DAY
L/->tl/
YEAR ! sun
E ltton
p Tu". D rhu. E s.,u.
! w'.4 D p.i
DAY OF
IvEEK
ALARII TIIIE
o32c)
ARRIVAL TIitlE
(.13 L3
TIIIE BACK IN
SERVICE
O{St
<i1q7)
ztP CENSUS TRACT
4a
ISO C[,ASS
3
DOB (optional)
1'-zz 49
TELEPHONE
TLll - <tl7z
.\DDRESS DOB (optional)TELEPHONE
ADDRESS DOB (optiooal)TELEPHONE
.\DDRESS DOB ioptional)TEI-EPHONE
4 Recei"ed I cir.n
ot
N,.\
I OF ENGI\ES RESPONDEDrJ
+ OF AEzuAL APP.\R\TUS RESPONDED
I
I OTHER VEHICLES RESPONDED
(do not include PA'st ,\,
g
n
Ertinguish
lnvatigation
E Removed Haard
D st "aay
E s"lr"g"
E NotClsiflred
TYPE OF ACTTON T.{KEN
PROPERTY CO!!tPLEX I If applicablei MOBILE PROPERTY iComplete line M)
YE{R ir.{KE l,lbDEL SERIAL I LICENSE I
EQUIPMEIIT INvOLVED IN lC ':ITION (Comple@ Line E)
YL{R }T.\KE \IODEL SERI.{L i VOLT.\GE
FIRST IC lV.\S IIADE OF ITEII FIRST TGNITED:
Conenr
.00
Vehicle and Contenre
.00
Other
.00
TOT.{L
.00
Building
.00
.00.00 .00 .00 .00
500.00() sq ft
E o-ggs rt!ft 5000-9999 It 20,u)0-19.999 t!
BUILDTNG SIZE (Grnd Flr Ouly)1000-{999 sq ft 10.000-19.999 3q tl 50,000.99.999 sq ft
! roo.ooo-rgg.gsg
!
D
tr
tr
,e,a
n!
tr
ln rcom of origin-oper.
Not in mm oiorigin-oper.
ln rm of orifin-not oper-fire tm sroll
Not in m oiorifin-not oper. fire too small
In oom oforigin-not oper. power dironnect
Not in rm of origin - not oper. power discon..
In room of origin-not op€r. dead bsttery
Not in rrxrm oforigin-not oper. dead battery
N() derech. pre*nt ! l0 Undetetmrne,l
DETECTOR PERFOR\I.\\CE SPRINKLER PERFORM.{NCE
Equip. should have oper.-did not
Equip. pre*nt firc t@ sull m oper.
Noa classified above
Undeermined or not reponed
No equipmenr pr*ent t N .{t
Sprrnklen (i,rntrolled Fire: \'ES D \O I
tr
tr
n!
tr
D Equipmencoperaed
r,ri Hea<is Opened
other
Number of Fatalities
Fire Seruice
'fc--tt
Title
( --t Date/Z-c3-7/
Title Drte
814-440-10 (B-86)
I Other
I
2
3
{
5
6