HomeMy WebLinkAboutBuilding Fire Damage Report 1989-09-20rv
FIRE DAjYAGE P.EPORT
OR
ELECTRICAL HAZARD
DATE: o?-'lo-Y/
T0 : Bu 'i 1 d i ng Depa rtmen t
FR0t4: Spri ngf i el d F i re Depantment
SUBJECT: Structural Damage to Suilding
Address or location of buiiding
Name of or./ner
Type of bu i 1d'i ng
Estimated value of building
Estimated loss to buildinq
A,J
(Dwel 'li ng, Store, I.lareho e, etc. )
s
s )o
Date of fire o
Location of damage'in building
(Rcof, W a ll, Exterior, interior, etc.
Structural weakness as a result of the fire
Additional oert'inen
(Burned ra f ter"s , Beams , .lo i s
t i nforna t'icn U*P.-
ts, etc. )M
Electrical i'iazard 1)
A-a;- fo F#-ffi trt <
(lti ri nq , 0uilers , etc. )
*ie_.3yh, fL..1?:e7 Sicned
cc Olil-^ r/,e{L
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NO.
CONTROL
District of
2 INCIDE\T ADDRESS
o
3 OCCUPANT
5 O\+'^-ER
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STATE FIRE MARSHAL
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Dept. Responding
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D
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Thur Sst ur
9l I (Tic Lihe )
D loie Staal Muni Alarm
E Not Clsified Abovc
70 fet
ln
ALAltr...ll\lE
E Hand-bid ho*/h;-dranr smdpipe
E Mastrr Stm Devie
D Norch$ifiedAbov.
Not Classified
q)dl)
Fint. MI)
O\\ NER NAlttE (LEst,t\fl)
FiEt, Ml)
OT Telcphone Diret
6
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ALARM E Xuni"ip.t eurm S1'stcm
D Pri"ar AIam Spteo
E t'erbat
E v.hi"l. Fi.
E Brush, Gros, I;rtc
fl Trash. Rubbish
D NoAl* R."'d
E Otter(Lisr)
D Auromatic Ert. S1'sem
D Pre*onnea ho*/mk onty
he/hydrant, standpipc
A>.l2
8 IOFFIRE
RESPONDED r
9 T1'PEOTSITLIATION FOUND
E(tr
Sh@Fin
Otlrcr Prcp. c/valw
l0 LIETHODOF
E)(TINGUISHMENT
II FIXED
M MOBILE
PROPERTI'
D SelrErrinsuished
D ltske-shiiaids
E Pomble Ertiaguishcr
l0 t! 19
20 t! 29 fet
50 storir or more
Undeurmined
Undetemined
Unprcllcted \Tod Frooc
Not Classified Abovc
EQUIPMENT
INVOLVED
In- IGNITION
I{ FORM OTHEATOFIGNITION
15 LEVELOFFIREORIGIN
EF God" L."l to 9 f*t
16 veLuo
LOSS
17 NUMBER STORIES B 2 rtoriQ
3 to 4 storie!
5to
7 to 12 rtoris
Unprctea. SeelBldg
30 ro 49 ,et
50 to 70 fEt
Er
l8 BUILDINCAGE(InYee)
I9 CONSTRUCTIONT}'PE
fl st*te 3-,t hr.D Prctec.stet
EXTENTOFDAMAGECONFINEDTO: Flame Smolc
The obirt oforigin
Part of mo or aro of origin
Rom of origin
Fin.ratcd omp. of origin
Flor of origin
Structur of oriFin
Erended be.r'ond structure of origin
Ext. & Wood Int.
13 !o 2{ 6tori6
49
Unprcrxt. Mrcnry Ert. & lVod lnt.
Prcbcrrd W@d Fnme
I
2
203
1
5
5
i
I
J
4
6
i
9 No&u3tofthetrpc(N/A)9D
2t l\'Ether
2? Pollow Up Requesed
'
)(N
-
If ye, *ho *itl invotigate
33 Number
Fire Scn'icc Othcr
21 MaLing
D ont. on bacl
I
35 Additionll lnfomsrion by
814-440-10 (R-86)
81 t> ts
ARFI\'AL TII\'E
4.3 t v o e7
FIRE DEPT.
ALARM:\O.
TI1\IE BACX IN
SERvICE
\.EARMO
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Drz z
CENST'S TRICT
3Ll
ISO CL.{SS
.J
DOB toptional)
I
TELEPHONE
TELEPHONEADDRESSDOB (optionall
DOB (optional)
-L7
(optional)
L
TELEPHONE
a4
l),,1ADDRESS
)D3
REPORTED BY (r '.t" Fint,
lrlutual Aid (ertinguish or investigate onll )
El n oi'"a D ci'.n )E[ xla
RESPONDEDLldo nor include PA's)
I OTHER \f OF EI'GINES RESPONDED
2
, OF AERI.{L APPARATUS RESPONDED
El Rroored Haard
fl srand 81'
D sul""g.
E Nor Clasified
TYPE OF ACTION TAKEN
Ef Eninsuish
PROPERTY CO}{PLEX (lf applioble)MOBILE PROPERTY (Conplete line M)
SERIAL
'
LICENSE fYE{R MAKE MODEL
EQUIPMENT INVOLVED IN IC .ITION (Conplet Line E)
YEAR MAKE MODEL SERIAL #VOLTAGE
MTTERIAL FIRST IGNITED q'AS MADE OF ITEM FIRST IGNITED:
.00o .00
Corlt nrst>.00 .00 .00
.00aoooo o .00 .00 .00 .@
l000-{999 sq ft 50,000.99,999 sq ft 500,000 sq ft
0.999 fr 5000.9999 ft
10.000-19,999 sq ft
fr
DETECTOR PERFORMANCE
D
D
tr
tr
tr
tr
D
Dv
I ln mm of origin-oper,
2 Not in r@mof origir-oper,
3 ln rmof origin-notopcr-firtesmll
,l Not in m of origin-not oper. fire t o shall
5 tn rum of origin-not oper. power disconned
6 Not in rmoforiFin--notoper.po*erdLscon.
7 ln room of origin*not oper. ded bat*ry
I Not in mm of origin-not oper. desd b8tGry
9 No dctcat pent El to Und"t"-ir"d
SPRINKLER PERFORMANCE
t E Equipnentopcreted t
Z E Equip.shouldhlrcoper.-didnot
3 D Equip. pre*nt fin to smll rc oper.
9 E Notchssfiedabove
0 D Undeterminedornotreponed
8-*l- r..o equipment prelent (N/A)
Sprinklen Conrrclled Fire: )'ES ! NO D
rl ofHeads Opened
of
Scn ie other .'.,.......-
Tille /O I
L-C,u2L{4<--1-:,\-
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TELEPHONE
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COURTESY INSPECTION APPLICATION
(RENTER REQIJEST)
CITY OF SPRINGFIELD
DATE <,92 r*7 OF INSPECTION 74
BUILDING DIVISION
a"7- n/ |
O}ITIER
ADDRESS
PHONE V
No. -aRENTER
SIGNATURE OF OCCUPANT
FOR ACCESS TO PROPERTY . TELEPHONE NTJMBER
TYPE OF DIVELLING: SINGLE FAMILY P DUPLEX tr MULTIPLE
BRIEF DISCRIPTION OF MAJOR PROBLEMS:
,
a
FOR OFFICE USE ONLY
Date of Inspect ion * -v't -B 7
Courtesy Letter Sent
Notice and 0rder Issued To Owner
Date For Compliance
Compliance 0btained - Date
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