HomeMy WebLinkAboutMiscellaneous Fire Damage Report 2000-10-4
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
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DATE: IlJ - Lt -00
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
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Address or location of building
IS/b
MIAI'.L+
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Name of owner
Type of building
U\lVe,,\\: "'-r
(Dwelling~ Store, Warehouse. etc.)
Estimated value of building $
Estimated loss to building $
. Date of fire 10- ~-OCl
14n Clon,-
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Location of damage in building
:rV\Tt-~:or
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire No
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(Burned rafters, Beams, Joists, etc.)
Additional pertinent information
Electrical Hazard
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(Wirin~, Outlets, etc.) ~~
Signed~. d/ _
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DO NOrwmn:lNnDS SPACK
NO.~. EXPNO.
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_ STATE OF OBEGON
Wna OF STATE F'IBE MARSHAL
.. IN'-"UI.II..~""-A.A..
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""'1lo.III" .~NO.
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o New lDcident
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. coMI'I.B'iE FOR AI:L.u."Io.o.&&.I~''''.)
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Lane
JlEI'T.~ ..~_,.--.Spr; nof; p 1 d .
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OCCIlPANr NAMIl(Lal...... MIl
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IIUSII'IESS OWNER NAMi:(l.al, .....MIl
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lAllll1VAL1WIl I JI.lo.UIlAClCIN 11'DdB1lAClC1N
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Tn"EOI'....&~ _&w'A110Ni'OtJND(MAKKAU.1HAT APPLY) .
o OvClbeat 0 R=ue Call 0 Good Intent Call
o Scnice Call 0 EMS Call 0 Hazmat JncidcIII
. 0 False Call - Ma1icious 0 II1ega1 Bum 0 Ncm-liIe Damage
o False Call - n.:... .., ,: anal 0 Legal Bum Rqlcrt
.08ystemW.lfimmnn 001her
I ZIP I CKI<SUnBAC1'I_'_~
Sf;".. -k~ ,J "I7Lf71 33' ZONE.
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L.AL\IlMDA'IE ., ~1WIl I JI.lo.yO~WlW' I ARRlVALD.\U
\.0-'(-00 ~.t~q '!H.l!.c) J()-'t.-C1o"
TYPE OFI'IRE SIIUA.'I10N FOUND (ONE TYPE OF.mEFOR.BAal~"J
lr\Il:lIlte Fire 0 Mobile Property Fire . 0 Other Outside Fire
Fire In Mobile J"". .;, 0 Fire In Natunll With Value
UsedAsASlr\Il:lIlte Vegelation o TIlISh Fire
FmoJn.MobiIeI'"....;.' OFire'&.CultiVBlal:. 001herFire,L...L':lIIl
InASlr\Il:lIlte Vc:gelaIian D3:0~.._.Fire.
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I ZIP
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IIUSII'IESS OWNER ...nnD~
1lUlUllNGlM0lllLEl'ROPIlR1'Y OWNERNAMIl(Losl...... WI)
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D"fG/MOBlUtl'B.-..:.w...... OViJ'ImR ..t.nnvV'CCl:
..~__~_ ~ _.:1."':- BY .&nnD~
. ~lDml'EllSONNELRESPONDINO I'~ ~ ,-~ I'~ AIlIIIALAPPAII.U'IJS
_ ( In j V"aateer e- -'o.:,o.W ":.r-~'" ~ ...\..0_".. \ .
Tn'Il O~ ACIIONUKEN (amcKAU.11lA1' Al'l'Ly)
Gn:ibIc&lry llLi.. ....:;,..., 01:"........ ODccoD.AIea HsC.m:h
O:R= OBazmatID . ODeccm.PcopIdEquip 0 StaDdby
o Extriadl: 0 RaIIo>e Hazard 0 MoIlitar Bazmat 0 Mow Up
OEMS OE"'1>I;d1SafeAlea . 0Ew<:uate o Other
COMPLETE FOR ALL FIRES
l'O~orm:aJlBll""";."" . I MUrILU._ . ,
~~_ ....u..IM.'... ..,. Q. GIVEN I
. . c;,.. D 1lIlalMlD"
OPmider _.._.1 '..
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~__ .ll~EXmlGUISBMEN1'
~.".... 0 ".rtnmm. I:....:......:.sbiD& Syslr:m
. Aicls1tw"awCalriedOnJnitialA. ...........
Ie l'.xliDiuisbtr :Ill' Waw From Hvdmnt. Draft Or J.... L:..
o Class A ExliDg.
o Class BlC ExIin.e.
o Wafa' From Tanb:dfmder ShultIe. ";' :..... ,.
.'. OGrouDdClews 'W/EquipADdlClrAir.l... .". ,"",.
o t1DknowD/Not Reoorted . ....
"t
meED
n....~_" VSE D .\ \.
. . \/'Iv . "\
1 YBAR, I MA1CIl
OOWA1lE4 ~e.el'lItJ..-.. Fl'.,t.
1Dm0llIGU'f " .
71AoU~ +k~CI.<I..<-"t
I YBAR 1 UAXE I MODEL
ONFACIOR
o Class AlBIC ExliDg. 0 CO2
o Class D ExIin.e. 0 Halon
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'., I SBlUALlIfA.IllaAFrTAIL.
JI:Qt.OPMJI:NTJNVOLViD 1Nl-.........:....~
(~LiDoE)
I MODEL
llc........_.JAirFoam OClassBFoamIAFFF. ONaue..
o Class AFoam 0 WetIiw!Al=l W/Waw 0 Other
I Moiu.&..'"'-.:.:-l....:nwoL.WD
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11JCIlNSIl.
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lSl'Am
ho.......
SERIAL .
I POWER SOUllal
: I DFIXED
OPORTABLB
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1""'"[("
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_ 0 O' ",...Form)
MAl'ERIALfJRSI'lGl'llTED
WAS MADE OF
11lId<zIy' II'I\JIicIU1
(Afc6S+) 0 ~:... .... .,.10
II1'EM fJRSI'
.......u....-,
0__ .IOlDFliabl J FIoarGfCJriajD('S<no:lmo.aaOoly)
Mobile Prcpcrty cod c:.oo- . 00Ilc0-
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IWuIIiPc-:
IIMlIwd 0
iEvELOnUlJlORIGlll 10Bclow-
BuiJdioa
l'to . tJ D(J .00
irnMA1'JlIl
VALVJl
Esm.u1'Jlll
Loss
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zo, rJou ,00.
0(-
LeYd
Cool<DIs
1, 0. Dfl () .00
/ fI, ()O(J
.00
,00
TOTAL
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.00 ~
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.00 .
"So.. Q(JO
.00