Loading...
HomeMy WebLinkAboutPermit Fire Damage Report 1992-11-8 \ ~. 1 ',.::_.-'" . I . . ,'. I \ . ',," " TO: FROt.l: FD-16 . . naBd.~~ OI~OO . 1U50 3 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD DATE: }J-?- 92 Building Department Springfield Fire Department SUBJECT:. Structural Damage to Building <,1/:2.4 #d/n + If/~ . Address or .location of building Name of>o\'lner JaW7/1( "/P/J,a./-W . . Type of building (,L"j.", . /"'''0"-,, .J//-V/t::.i' J~A.~/d:n' (Dwelling, Store, Harehouse, etc.) Estimated.value of building $ Estimated loss to building S /4/J,nt>O '. I .r- I':) () Date of fire II - Y- 9.2- . Location of damage in building Jl/hv"," II. ,Jn~"; q J,L,.,~/ " /' (Roof,Wall, Exterior, Interior, etc.)' Structural.weakness as a result of the fire (Burned rafters, Beams, ,Joists, etc.) Additional pertinent information . ". ElectricalHa:i:a~d cc: E / n_ . /1/ n. :, //. '~1J '-0 n ",,,./ ." '-'. :'.' ':-. ~:: ...' (Wiring, Outlets, etc.) Signed;tt~ _~,~~~~. .Y - ~ " DO NOT WRITE IN THIS SPACE , ST ATE OF OREGON FIRE REPORT -c"NT~ EXP. STATE FIRE MARSHAL NO. NO. D;.tri'lolIndd,nl J ,cJ ~ /;" C/ L- ;.. / ./' Counly L /7 ~:7 /' '7:,. l MO I DAY l YEAR I ~~F lli! S~ 0 Tua 0 Th" 0 So'" !I :r /99.2- 0 Mo. 0 W<<l 0 Fn 2 INCIDENT ADDR&SS /// J.. ~ ~#//7 .3 OCCUPANTNAME(lat,Fint,MI) / . ~ ~~ c../? J/~t/'/L./" 4.. BUSINESS OWNER NAME (Last, Fint. MI) --r;.A c(I-V I )/L .-,J Ii OWNER NAME<(Lut, rirlt, MI) -1I-t/4 Y - ;/"j"l.~/J. 6 FIRE REPORTED BY u...t. First, MIl r/7,/1/-o, i/ t'F" 7 METHOD Oy 0 'Teltpbone D~ 0 Radio ALARM 0 MunicipalAlannS)'Sttm 0 Verbal o Prlvlte Alarm System 0 No Alarm Ree'd 8 I OF FIRE SERVICE PERSONNEL , OF ENGINES RESPONDED RESPONDED 9 ).. 1 'OTHER VEHICLES RESPONDED (do not include PA'I) :L ~AER~E~: S-Pl d- - ;;;277;;)-- ] J>//-/ f /1'< D,pt. Respondin, . ( p ~ /,;., d ./.,,;. /..,/ ALARM TIME ARRIVALTIME 'TIME BACK IN SERVICE ;2.1/.2- I ':;CLASS )).)./ ZIP I 9?'I?~ ? ~.23 CENSUS TRACT l~n.L DOB (optional) TELEPHONE 7/d',,-, 008 (optional) TELEPHONE ADDRESS ~/.P{) ADDRESS /j"4s./fhflH? J61,!,-41 f,U-?j' 7;1.. TELEPHONE DOB (optional) J"//,,.,n /J.k " /. )>.!p'-JI 7-3/)..f TELEPHONE ADDRESS DOB (optional) ..1.utual Aid (e:rtirIJUiL. or invatipt.e only) o Received 0 Given J:t N/A o VehideFire o Bruah, Grall. Laves o Trash. Rubbish o Self-Elltinruished o Mab'lhift,icb o PortableElllinruisher Ii{ 911 (Tie Line) o VoiceSiplMuniAlarm o NotClallifttdAhove 1 lOF AERlALAPPARATUSRESPONDED o Other (List) I TYPE OF ACTION TAKEN 0' EnirIJUish 0 Removed Hazard [j Investigation 0 Stand By o Hand.laid holt/hydrant, ltandpipe o Muter Stram Device o NotCluaifiedAbovI MOBILE PROPERTY (Complete line M) o Salvace o NotClallified 9 TYPE OF SI'nJA TION FOUND .ar Structure Fin: o OtherProp.w/value 10 METHOD OF EXTINGUISHMENT Automatic En. S)'ltem Pre-connect bOlt/tank only o Undetermined 11 FIXED PROPERTY USE o o ~ Pft..connect bOlt/hydrant..tandpipe 1 PROPERTY COMPLEX (lr applicable) dr/,V/L / J...L'... /",,::-. I. MODEL SERIAL I I LICENSE I M MOBILE .1 YEAR PROPERTY - \2 ROOM/AREAOFFlREORlGIN /11/(..// A !! t'" /' ~ "./.f E EQUIP,.mNT r YEAR 1 MAKE INVOLVED IN IGNITION 13 IGNITION FACTOR 1 MAKE EQUIPMENT INVOLVED IN tGNI'TION (Complete Line E) J /d~ , MODEL I SERIALI I VOLTAGE rl-:,,- r.4/.s- r- 14 FORMOFHEATOFIGNmON liTEM FIRST IGNITED: Wd<ld o Below crd. level o NotC....ified Oth~ .00 U Undatermined TOTAL 1<;t:J~A/1/) .00 " IS (}() .00 16 VALUE .00 LOSS .00 .00 .00 o 5OItOriesormore . Noda~oh.bet~'PttN/A) I 0 , 0 2 IA! 2 0 , 0 , 0 . 0 . 0 , 0 , [j[ , 0 . 0 7 0 7 0 . 0 B 13to241tories 25 to 49 stOne. o lO,000-19,999lqft 0 1)(),000.99.999aqft o 20,000-49,999 ~ ft 0 100,000-499,999 IQ ft U Unprotect. Muonry Ellt. & Wood Int. j!I UnproteCted Wood Frame o Proteet.ed Wood Frame 0 Not Clualfied Abo\', SPRINKLER PERFORMANCE 1 0 Equipment operal.ed 2 0 Equlp.lhouldhaveoper.-didnot 3 0 Equip.p~trlfttoolmaUtoopet. 9 0 Not cluau*, above o 0 Unclttermined or not reported 8 t!' No Iquipmentprnent (N/A) o &OO,OOOaqft Sprinklen Controlled Fir.: I ofHeadt Opened YESO NOO 21 REMARKS Weather Conditionl (optional): o cont.onba.ek d. Dn, -.1.2 Follow Up Investigation IUquested Y_ N~ Il)'es....howillinvestigate 23 Numbtroflnjuriea Fire Senrke J NumbtrofFata.litin FirrService Title D... //- .J>.- <?.A I lA"" ,~--'...,;-4 ,/ Oth" " M.m""M.ki.._rt '/~ Jb. ..,(/--' U Additional Informatio~ J} ~L ;~d//7 ", D... Tille 814.44(1.10 (R-86) n :to 0:;: ","" ...'"' ~~ :llCl ;0;0 f:l> '"' '"' n :to 0:;: ~;E ~~ ~6 ;0;0 f:l> '"' '"' n o 3: ~ Cl ;0 > '"' '"' :I: o '" ... ~ .., :;; f:l ;j c: ~ E:l .., ~ o z '"' -<