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HomeMy WebLinkAboutPermit Fire Damage Report 1985-6-12 .. RESIDE"IAL" APPLICATION/PERMIT 225 North 5th Street Springfield, Oregon 97477 Building Division 726-3753 ' ~/;2o ~ U' W~J} CLJ~ &,/;;;Lv rx~ ~i. Ar/--' ~9 ~ .1ob Loca.tion: ABC/BSDOl'S Map # Subdivision: ().mer: Address: City: n n Nm,} Tax Lot # Phone: Zip: 9?1.f7t Des,rribe rl'ork: Addi "tien ~Odel e:r d.-Cd ~ n :.!obile Bom3 Date of Application COntractors Value Address General Plumbing T../!.ACw.lA.""" (/I~2K.. f'(u,.,..br',.\' // <.J CIvLiv.J\ p ::J~~3CfJ Q)-;;:l(-g(,., .cce:pt #, 1310 <f't 2 g 1 1){. }u '~ Vt Sigr.ed: Date: Po 10 'I 2-'t, )' Lise. # EXDires Phone Electrical Uechar:ical Con8t~ction Lender It is the responDibility of the perntit holder to see that alZ. irwpeetiona are made at the ppoper tim€~ that each address is rea.dab~e f1"Ot1l the st1"eet, and that the permit caN is located at the front of the proper-ty. *Bui!dirzg Diviaior:. approved plan shaZZ remain on th2 Building Sit$ at all times. PROCEDURE FOR INSPECTION RE:QUEST:CALL 726-3769 {recorder} state yoUP City designated job nwnber, job address, type of inspec-;icn ~aquestcd and when you wiLL be ready for inspection, Contractors or OWne~s ~e and phone number. Requests received befere 7:00 ~ z.."iU be made the same day, requests made after 7:00 am LJiU be made the nc:z;t :.JOrking day. r/~f1:pi "!P.n.. hlPT?t:>r:oHnnR 0" SITE INSPECTION: To be made after excavation, but prior to set up of forms. O UNDERSLAB PLUMBING. ELECTRfCAr. ~ " MECHANICAL: To be made before any . work is covered. o FOOTING & FOUNDATION: To be "",de after trenches are excavated and forms are erected, but prior to pouring ccncret~. o UNDERGROUND PLUMBING. SEWER. W.4TER. DRAINAGE: To be nrule prior to fiL- .Ur.g trenches. D, UNDERFWOR PLUMBING & MECHANICAL: . To be rncuJ.e. priel' to installation of ftoor insulation or decking. O POST AND BEAM: To be made pPior to instaZ1.a 'on of flool' insulation or decki [4i3 H PLUMBING. ELECTRICAL & MECH- I VAiiicAL: No lJOl'k is to be covered ,ur.til theBe inspections have beer. made and approved. . O FIREPLACE,: Prior to placir.g facing materials and before framing inspec- tion. O FRA/.1ING: Must be l"equeDted aftel" approval of l"ough plwr.bing, electn- .aal & mechanical. AU roOfing bracing & chimneys, eta. rrr..lst be ;' completad. No work is to be con- <..:..cealed until this inspection has ~be~n made and approved. ~WMB:' o FINAL ME~HANICAL o FINAL ELECTRICAL o Your City Desigr4ted Job Number Is: O INSULATION/VAPOR BARRIER INSPECTION: To be made after all insulati:Jn ar.d .'. required vapor ba:tTiers are in place . . ~ but 1;efore any lath~ gypsum board or wU covering is applied~ and before . Cl1'!-y insulation is concealed. O DRYWALL INSPECTION: To be made after all drywall is in place~ but prior to any taping. O MASONRY: Steel location~ bona beams~ grouting 01' verticals in accordance LJi th U. B. C. Section 2415. O WDODSTOVE: After installation is ccmpleted. o o CURB & APPROACH APRON: After forms are created but prior to pouring eoncrete. SIDEWALK & DRIVEWAY: For all con- crete paving IJithin street right- .of-wc.y, to be made after all exca- vating complete & form work & sub- base rrr:zteria l in place. 2stJ3(,,3 I DEnOLITION OR ;',,'OVED BUILDIHGS =:J Sani tary BB".Jer capped at pr:..op.;:r't-:j lir:e ~ Septic tank F'~~ed and fill2~ with gra~eZ I Final - fl'hen above ite.-ns are cc:rrpleted ~ and when d~olitior. is complete 01' 8t:>u~- ture moved and premises cleaned up. I Nobile Homes :::J Blocking a1Ui Set-~p :::J Plumbing connections scwer and water :::J Electrical Connection - Blocking~ Bet-up and plwnbing connections rrr..;,st be approved, " before requesting electrical inspection :::J Ac.:!esGo1"d Building J Pinal - After p:;rcr.es, skirting, decks, ~ etc. are completed. o All pl'oject conditions, such as the installation of street trees, co~lction of the requil'ed landscc:pir.g, etc., must be satisfied before the BUILDING FINAL can be l'equest:;d. o FINAL BUILDING: The Final Building Inspection must be requested after the Pinal Plwnbing Electrical, and Mechanical Inspections have been made and apP~ov2d. O !"ENCE: When compl.;:te -- Provide" gates or movable sections through P.U.E. ' o "ALL MANHOLES AND CLEANOUTS MUST BE ACCESSIBLE, ADJUST!fEllT TO BE MlIDE AT NO CaST TO CITY I Page 1 of 2 I JOB NO, ~C:;D3(".:) Zone: Lot Sq. Ft;;. $ of lot Cove~ag~ # of Stories Total Height Topogrophy I lITEM I Main I~aae I Carport I Acc6s8oru SQ. FTG I I Is.D.c. TOTA& VALUE (vaLUe) 1.5 % Building P~t State Surcharge Total Cha.,...ges SOLA.CESS OCc:upancl./ Grau.;J: WT TYPE lITEM IND. I FEE I Fixtures I Residential (1 bath) I I Isanita:r<y Sewer I I I Water I I I I I Plumbing Perri t State Surocr.arge Total Charaes lITEM I Res. Sa. fto. I NeLl/Extend Circuits I Tenrool'ary Service I Ele~tricaZ Permit State Suroharqe Total C'ha.rqes lITEM I PuMtace ETU'S I Exhaust Hood I Vent Fan I JlOodstove Pel'rllit Issuance Mechanical Permit State Su:rcharae T"tal Cho:rop.EJ I NO'1 I I I I I I roo I I I I -- ENCROACHMENT -- ISec-.aoitll Deoosit Storage Maint~e Ip~t Total Chapqcs Curbcu1; I SidezJa lk I..r;>en:::e I Electroica l Labe 1. I Mobile Home TOTA& AMOUNT DUE:- Interior Corner Panhandle Cut-de-sac x Value CHARGE FEE 1t),O 0 I ,V t) I 10,1.(0 l - CHARGE I I I I I I I I I I- I CHARCE I I I I I I I I I - FEE I I I I .iJ I() .CjO :-:::.ge ~ :, REQ,- L:'COG~ . Type/Cor.at: Bedrooms: I Lot Faces - I SetbackB I P. L. House Caraqe Access. INo"th lEast jSou th IWeBt I, Enerau Scr..lrces 1 Heat i I II : I I Il i TU:Je Water Hp.atp-Y' Range Fireplace Wood.a tove Fees I I I I I I I ,- Building Value & Permit This permit io granted on the erpY'ess condition that the sdid construction shall, in all respects, conform to the Ordinance adopted by the City of Springfield, including the Zoning C'rdinance, regulating the construction and use of buildings, and m~y be suspended or revoked at cr.y time upon vio- lation of any provisions of said Ordinances. I- Iplan Check Fee: Date Paid: IReodpt #: I Signed: Plumbing Permit No person shall cons~ct, instal!, alter or change any ne1J or e::isting plumbing or drainage system in ~hole or in part, unless such person is the legal possessor of a valid plumber's license, except tr~t a person may do plumbing lJOrk to property which is owned" leased or operated by the appli- cant. Electrical Permi t Where State LahJ requires tr.at the electrical work be done by an Electrical Contl'actor" the electrical portion of this permit shall roOt be valid until the labe l has been signed by the Elecrnca l ~ontractor. Mechanical Permit Plan Examiner ua<e I I I- I I I I I I I HAVE CAREFU&&Y EXAMINED the oompleted application fop permit, and do hereby certify that all information hereon is true and correct" and I further certify that any ar.d all work perfom/ed shall be do:1e in accor- dance with the Ordinances of the City of Springfield" and th;: L<r..;s of tho State of Oregon psrtaining to the work described herein" and that NO OCCU- PANCY will be nn.de of any structure without p:3rmis8ion of the Building Di- vision. I further certify that only contractors ar.d e:rrpt.:Jyees who are in compliance with ORS 701.055 will be used on this project ~~ Signgd ~-ll-b6' Date - ~I .. RESIDlaTIAL" APPLICATION/PERMIT 225 North 5th Street Springfield, Oregon 97477 Building Division 726-3753 II Job Location: !n1610 ~ /7t!'J2. ~,G.3 / ASGBS80l'Z Map # Subdivision: Tc;:r: Lot # 341'/(;) / ) r C.JJ :i.;~'I~9gg~ OtJner: ~ ~i: Address: ~,~ <... l;Lo yy\:, ~V~ City: !k:, n Addi ticn n Remodel n :.!obi 1.e Homa Phone: 7f.((.,- I~J7 Zip: 1'7 L/ 7 fI Describe ~'ol'k: ~&. . ~ ,,- , o ,s-, 3/- YS-: Value -# p.O, {j-(J-O Date of Appliaation Uontl'actol'S ~1 General FAl'aJL~' numbing / a~~~ Electrical l.fechar.ica 1. C~nstruction Lender Address J.1..jt....{} ,T5~, ~AJ __ o Af~ / . Rcce:pt ,Ii Y~MLI-/bY n,$ !jJ-'.r O,u ~/ ( Po-~ ~,~~ r Signed: Date: ftflt- Lisc.f1 ]7cjft,3(YO ExPires Phone ? /19 /'If'S ~ lD 't q An l,oJZ-<iH5 It is the r6sponoibility of ths permit holder to see that all. irwpections are made at the p2'oper ti.m&, tr.at each .:ddress is l"eadab~e f1"Ol'll ths street, and that the permit card is located at the f:ront of the property. ABui!di~ Ir~vi::ior: appl'oL'ed p'Lan shall, remain on tha Building Sit;; at all times. PROCEDURE FOR INSPECTION R':;:QUEST:CALL 726-3769 (recorder) state your City designated job nur.:ber~ job adC:l'css~ type of ir..:;pea:;icn requested a~.d when you wiH be ready for inspcation~ Contraators 01' Owners ncme end phone number. Requests reaeived befcre 7: 00 a-:; :.."iZZ be made the same day~ requests made after 7:00 am will be made the next :JOrking day. ~(~r~~.# f35(l~1 03 J<l00"1";:~~1 T....".,,,...+...r.....~ D SITE INSPECTION: To be rn::de after e:rcavation~ but prior to set up of forms. O UNDERSLAB PLUMBING. ELECTRICAL ~ : MECHANICAL: To be made before any work is cOIJcred. D FOOTING & FOUNDATION: To be ""de after trenches are excavated and fo1'177s are erected, but prior to pouring ccncret~. UNDERGROUND PLUMBING. SEWER. W.4TER, DRAINAGE: To be rrrlde prior to fi~- .7,ir.g trenches. o o UNDERFWOR PLUMBING & MECHANICAL: To be made prior to insta ~ lation of 12001' insulation 01' decking. POST AND BEAM: To be made prior to installation of floor insulation 01' decking. ROUGH PLUMBING FrFr'frqcAL & MECH- ANICAL: No worKiB-fo~oL'ered ,until these inspections have beer. made and approved. . FIREPLACE: Prior to pLaair.g faaing materials and before framing inspec- tion. flii71 FRAJ.!ING: Must be requested after ~ approval of rough plwr.bing~ alectri- .cal & mechanical. All roOfing bracing & ahimncys~ etc. nr.lst be ,:aompletad. No work is to be con- .......cealed until this inspeation has ~ be~ made and approved. o [Z] D Your City Desigr.ated Job Nwnber I8: Ixl INSULATION/VAPOR BARRIER INSPECTION,: To be made after all insulati:m W.tl ,- .. required vapor barriers are in place , , but before any lath~ gypsum board or llJalZ covering is applied~ and before - any insulation is conceaLed. rVl DRYWALL INSPECTION: To be made !AI after all drywall is in pZaae~ , but prior to any taping. . 0, MASONRY: Steel. location~ bona beam8~ grouting or verticals in accordance with U.B.C. Section Z415, l\:A""WOODSTOVE: After installation is ~ ccmpLeted. D CURB & APPROACH APRON: After forms are created but prior to pouring concrete. SIDEWALK & DRIVF:WAY: For all con- crete paving within street right- of-IiX:.Y~, to be made after all exca- vating compLete & form work & sub- base m::teria l in p Za:le. DEUOLITION OR nOVED BUILDIilCS =:J Sani tCWj S6"..1er :lapped :=t ~opi:r~. lir.e ~ Septia tank p-..ci.ped and fiz.za.~ with grcr~eZ ---, Final - f{hen above ite.'7Is Cll'e completed ! ~ and when d~lition is compl.ete 01' st~~- ture moved and premises aleaned up. Mobile Hemes =:J Bloaking and Set-up =:J Plumbing aonneations -- sewer and water I Electriaal Connection - Bloaking~ set-up --.J and plwnbing aonneations nr~st be approved . before requesting elec:;riaal inspeation =:J Aaaessol"'.i Bui7.ding I Pinal. - Aft:Jr' p:Jrcr.es~ skirting~ deaks~ ~ etc. are campleti:d. o All project conditionB~ Guch as the instaLlatian of street trees~ co~lation .of the required Zand8cc:pi1'".g~ etc. ~ must be satisfied before the BUILDING FINAL can be requested. o FIliAL PLUUBI/lG o FINAL ME~HANICAL P8t FINAL ELECTRICAL o )iQ FINAL BUILDING: The Final Building Inspection must be requested after the FinaL PlwnbinJ Electrical~ and Meahar.iaal InspeatwntJ have been made and apprav2d. o D FENCE: When compl~te -- Provide' gates 01' mavable sections through P,U.E, D ~ALL MANHOLES AND CLEANOUTS HUST BE ACCESSIBLE~ ADJUST,'SUT TO BE NAVE AT NO COST TO CITY Par;e 1 of 2 9xC,()':'~'o-:z.. I JOB NO. ~I'-c~ SOLAR.CESS Zone: Occuoancl./ Grou.,: Lot Sq. Pt{;. ~ of 'Lot Coverag~ fi. of Stories , Total Height T....t'....:;;.'""'t'hy ITEM IMIin I GaraJ1e I CarvOl't I Aceessol'u I I TOTAL VALUE IS,D.C. 1.5 ;r: (vat.uc) Bui /.ding Pernri t State Su1'cha:rqe Total Cha.....gea I ITEM I NO, I Fi:r:tuJoes Residential (1 bath) I Sanitary Se1.Jer I I Weter' I I I Plumbing Pemit State Surcr.apge Total Charaes ITEM ReB. Sa. fto. /t1tJ.')..J.- I NEL)/Extend Cil'cui ts I Temporary Service Elec:trical Permit State Sur::iharae Total Charces ITEM I Purnace ETU'S I Exhaust Hood I Vent Fan , Woodstove I Permit Issuanca Me~hanicaZ. Permi t State Surcharoe '1'nta1. r.JtaTonRtl SQ.FTG I NO./ I I I I I I I I LOT TYPE Interior Corner Panhandle CuL-de-sac x Value PEE ~o..oco . q2 (J"C .~ ~8 o/5b$ . CHARGE 110'1 I I I I. CHARGE I ZS"''' I I I I 2StrD I / qc# I 2"- - I. PEE FEE CHARGE -- ENCROAClIMENT -- IseC'o.lrittl D2POsit I Storage I Maintenanae Ipormit I Total Chal'aes I Curbcu; I Sidewa lk I Pen::e I Electrical Label I Nobi te Hame I TOTAL AMOUNT DUE:.t /2Jb~ I. F::.ge G ~ I REQ,- L~COG~ . Type/Cor.st: Bedrooms: I' Enarau SO'..tl'ces I Heat I I Watel' Ht?at/:rl' I I Range II' Fil'e." lace Wood:; tove II TilDe I Lot Paoes - Setbacks P. L. I House Caraqe I Access. f{ol'th lEast South IWest -- Fees Building Value & Permit This permit ia granted on the expl'ess condition that the said construction shall~ in all l'espccts, confo~ to the Ordinance adopted by the City of SpPingfield, inc!uding the Zoning Ol'dinance, l'egulating the constp".J.cticn and UDe of buildings, and m:zy be sucpended or '1'evoked at c:r:y time upon vio- lation of any p'1'ovisions of said Ol'din.ances. !pwn Cheek Pee: 4(/(,.00 Date Paid: 5"'.. a - IS s' IR~odpt #: ~(~ </'''' V CI ISt.gned: J C!./ Plumbing Permit No pe'1'BOn Dhall constl'uct~ instalt~ alter 0'1' change any r~ 0'1' e:isting plumbing 0'1' drainage system in ~hole or in part~ unless such person is the legal possessor of a valid plwnber's license, except that a pe:'son may do plUr.Jbing work to property which is owned, leased or operated by the appli- cant. Electrical Permit Where State LOJ.J requires tr.at the electl'ical work be done by an Electrical Contractor~ the electrical portion of this permit shall roOt be valid until the label has been signed by the Electrical ~ontractor. Mechanical Permit ! . - EK~-nv Pl.aiI E.xam1.1fer - va<r3 f/9K I I I. I I I HAVE CAREFULLY EXA./tIINED ths completed application for permit~ and do hereby certify that all i:-:fo:omation hereon is true and correct, and I further certify that any ar.d all work perfor:ned shall be dons in acO'ol"- dance with the OPdina.nces of the City of Spl'ingficld~ and tho: Lct:JJs of tha State of Ol'egon p8rtaining to the work described herein~ and that NO OCCU- PANCY !.ril1.. be m:r.de of any structure without permission of the Building Di- vision. I further cel'tify that only contl'actOI'S arKi ~loyees who are in compliance ~ith ORB ?Ol.05~ ~ill be used on this project c%~~ CJh . . ~ Signad l/Z?.{/' .3/, / j? I!.s- DaY. /' .~, l' . . SPRINGFIELD viTI OF SPRING.t''1l!iLD Department of Public Works 1885,1985 Springfield Centennial year May 9, 1985 Mr. and Mrs. Howard A. Antone 6120 Main Street Springfield, Oregon 97478 * RE: Fire Damage Inspection at 6120 Main Street, Springfield, Oregon Dear Mr. and Mrs. Antone: Because of the recent fire at the above referenced location, the Springfield Building Safety Division conducted an inspection to determine potential hazards or damage caused by the fire. The inspection revealed the following items that require correction: STRUCTURAL 1. The main roof structure was extensively charred from'the intense heat. The damage appears severe enough to varrant replacement of the entire roof, including required insulation and sufficient attic ventilation. 2. The joists above the kitchen ceiling, particularly the east half, vere burned through at the supporting wall adjacent to the family room. Josits that have burned sufficiently to reduce the effective cross section of the members by 1,;" or more at any location , must be replaced. 3. The family room roof was compirsed of double rafters. The upper-rafters, 2" x 4" spaced @ 24" centers supports the roof, vhile the lower rafters, also 2" x 4" but " at closer spacing supports the ceiling. The lower rafters were damaged by the fire, as were several of the roof sheathing boards. These rafters must be replaced in such a way that viII provide for R-19 (6" Batt) insulation and yet provide for required attic ventilation above the insulation to comply with the present structural code. In addition, these rafters must be tied together every 4' along the length of the roof to restrain the outward thrust of the walls imposed by the roof loads. This may be accomplished by the use of ceiling joists or collar ties nailed across the rafters belov the ridge. Fire blocking must also be installed at the juncture 'of the walls and the attic area. The roofing must be repaired to provide weather resistance. 4. The north kitchen wall and the east family room vall require repair where studs and plates were burned beyond superficial surface charring. 5. The exterior patio structure was demolished by the fire, and this area must be cleaned of debris. If you choose to replace the structure, it must be designed to meet current structural code standards (State Structural Specialty Code and Fire and Life Safety Code). 225 North 5th Street · Springfield, Oregon 97477 . 503/726-3705 . . " ~. Mr. 'and Mrs. Howard A. Antone Fire Damage Inspection 6120 Main Street May 9, 1985 Page 2. NOTE: It did not appear that the ground floor structure was damaged by the fire, how- ever, this should be verified after the debris is cleaned from the floor to allow for easier inspection of the structure. PLUMBING 1. Water, waste and vent lines should be inspected when all the damaged surface materials are removed and the plumbing is exposed. All such lines, inlcuding joints and connections, vhich are damaged must be repaired or replaced. ELECTRICAL 1. The intense heat of the fire permeated most of the structure before the fire vas extinguished. The electrical cable used for wiring throughout the structure is rated for a maximum temperature or 140. F. (60. C.). Since the heat in most areas far exceeded the permitted maximum temperature, the wiring and equipment must be viewed as defective and must be replaced throughout the structure, vith few excep- tions. Only those areas where evidence can shov that the permitted temperature was not exceeded will be considered for salvage. As you address the foregoing hazardous conditions, please consider the folloving. The present height of the second level ceiling is insufficient to allow use of the upper level for habitation. If, during replacement of the roof, the ceiling can be raised to provide 7'6" in 50% of the areas over 5' high, then use of the second level for habitable purposes is acceptable. Furthermore, if use of any of the areas for sleeping rooms is desired, windows or doors acceptable for emergency egress or rescue are re- quired. They must be of sufficient size to provide a net minimum openable area of 5.7 square feet, vith minimum open dimensions of 20" horizontally and 24" vertically. Also, the headroom at the first landing of the stairway is lover than the minimum 6'6" required by current code and there are no handrails or ballaster on the stairs for safety. We recommend that these conditions be corrected in conjunction with the fire repairs. In addition, as a matter, unrelated to the fire damage, but of equal importance in the interest of fire and life safety, we observed a wood stove chimney emerging from the shop building which is constructed of improper materials and which does not provide proper clearances from combustible materials for safe operation of the wood stove. This wood stove installation must be removed entirely, or modified to provide the proper materials and clearances. Permits for alterations to the structure, electrical installations and wood stove in- stallation are required and may be obtained from this office. Obtaining the appro- priate permits and inspections will ensure that your repairs/replacements are installed in an approved and safe manner. .~ ~ . . Mr. and Mrs., Howard A. Antone Fire Damage Inspection 6120 Main Street May 9, 1985 Page 3. Drawings for plan review "ill be required for the follo"ing structural alterations. 1. Main roof structure, showing span, size and spacing of structural members, ceiling heights, required insulation and attic ventilation and pertinent connection details. 2. The family room roof, showing the same information in #1. above. 3. Stair details showing structural changes for head clearance and handrail details. We will check on your progress by 30 days from the date of this letter. Mean"hile, please initiate the necessary drawings and secure the permit application. All inquiries should be directed to the Springfield Building Safety Division at 726-3753. ):flf~ rM~-YL Jim Matteson Electrical Inspector Don Moore Structural Inspector DM/lh , '. ,,'~:-: <~,' t 'i1Wl ""~L~; ",..rfr~ ~"\r~""'~l4f... :' ~~''i4 "'~:"'1:; ~~~'~.~ .r ..;';....0"'>:\ "'i~l:..;,..;J-".... : ~~1' i,~~:'~1f~. ) ~~~...~;~~~ r\-"':{J)\.\ . ~...-j ;;)~1};~; . ."1"'......,_J':. ....i. it. '\ t ' \ C' :~ii" .~! :';: ~~" ~ "'1''''',J;. , ., ... i:h , , ",.if.~::i:;?7"r.;';:':~::.'.,:~'~ '" ".~:; ::'~:::.)O~#.::iLifd>.:.3.ci :i,;,i:.-:.'-r~;~;::~~~~: ~"",_",:...:,.._".,:,_,.." C,'"C",',' '" -.' Vl , WJ::',"'"'' " " ......::.... ',,'..;c , " "~:,~:,:,,','..,., ',..",:~,",~. ),'_''':,.:J~:;:_::f~~'.~~.". ~~~~',~'.:,u.~"":j,~.,,,,:~,',',:',:,:.:,',,~~,:,~~,~,~,~~,~,~,;:,i,:~,;,h., .. , , ':<.::, :,:_'~'.r :",.,',~"" ::,' :' ....~:: , :,' "'" ' ",.: :':~';f~::~:~~~::-~~~;~:Y':{F,;~~~~;~~:t;;~~~};~e' '. ...:.~...:'.~'~~. ',,"''''.''~' ,;' ,,-~ -"",.' .. " . - _...' .', -.~"";':."~-'.,.:",-" , . .....',~ '. '-';., . .~ . ,- ,.. -. . ,~:- ...,' "';" .j: ~':'. ,;". ': . ;, . . , . .~;':..: ." -~ ..... , FIRE DAMAGE REPORT OR ELECTRICAL HAZARD, DATE: 5-;-?..J "'<0, :""";:'.' . " ,.~~ ", ',' " TO: . . i'i ,. -. --., .. ~ui1ding Department\.c-{:;:':';' ''''':" " .' FROM::',: 'Springfield Fire Depa.rtm~nt SUBJECT: Structural Damage to Building '* Address or location of building C/;2./!? }/",,:' .S/~,LI / cI Name of Ol'mer /~ hi' b .....I A An /"n /' Type of building /- ';:-b"'" ..!lu,//, n' ", (Dwelling, Store, Warehouse, etc.) Estimated value of building $ 7Z',o-o--o Estimated loss to building $ <:;n hrv', Date of fire .(' - J - S" 5" Location of damage in building ''1h,.,,,,,.,.,i,,u ;i- " ----- (CRoof, Wall, Exterior~r, etc.) Structural weakness as a result of the fire' E.I. !P/l ~ /e:' E" ./ (_~ rafters, Beams~'etc.) Additional pertinent information ~ /~t".-I',..,~..l Electrical Hazard E-I. !--P/I ,/1""/,,, (Wiring, Outlets, etc.) " , , ~..::'.. ,. ... ~,~,.:"" ~'".~'.-- . ~.':. .... i",' Signed / '-/ -..II.!', ,/ /I -..,~ cc: "