HomeMy WebLinkAboutMiscellaneous Fire Damage Report 1987-7-16
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- ,FIRE -DAI1/l.GEREPORT
OR
ELECTRICAL' HAZARD
DATE:
TO: Building Department
FRor1: ': ,Springfield Fire Department
. SUBJECT:' Structural Damage to Building
#- f?or96
.~
It,.
(/\ lIP
Address or location of building 1'3/./'l }1/l /J1
Name of o\'tner . :1;:;//1;' ,C;" ;/Ii/o. '"
Type of building -r;, ,If' rAl
(Dwelling, Store, Warehouse; etc.)
Estimated value of building $ 4/1'), ,..,/')()
Estimated loss to bui ldi ng $ :J.';) Dn
Date of fire 7//b /S7
t' /
Location of damage in building _I,)P"'';'' c;(,j~ aL'I?~Ir1 J:;:' ,LA)
'~p l-!"'o.1-~A;1- /'I.MI;;-:D~ "_0/ ~.h '
.' oof._.Wall, ,Exter.ior.! Interior.__etc.)
Structi.iral weakness-'as' a 'result of the 'fire AI 01/1 P
~~A>7
ql.-/Oj 1\\ \
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information (nt,,,,-) #/)/-1' 'IN AJorr'h aH/L
F;re 1.)(.1.11 1J...,r-II(. . 0.. e. /-apt ;.. "lUff _ J.Jot- 7?e./a.frA r/J
, '. '
P;....P .'
Electrical Hazard 13" .~+- LJ ,>..... [AJ a;~Ca..d;I}'OY1 e.V'
'X...a~".. 1.)1. <; -r;;n,prP ?Jf'F.
(Wiring, Outlets, etc.)
2/1
'. /7 /
Slgned Il~, .' ,.:;"~d.r
" ~-.
i/
cc:
..'1 _'
1;. - DO NOT WRITE IN TillS SPACE
f.'ONTROL EXP.
NO: . . NO.
^ , -. I I
Districtoflncident.l.). ')n r1t1 + , V' t::4
'Tb'lo~;I/:~I(I~~1 ~~F
2 INCIDENT ADDRESS '
'-I..~ h(J 11 tt,'u ~f
3 OCCUPANT NAMElLut, Fint. )
7ht> Mtl 'illY! J(n tJ. 0/
.. BUSINESSOWNERNAME1Lut,Fiflt,MI) /
f"Y(l~t/~/_ fwJ
6 OWNER A (Lat. Fint, MI)
_<fA //,'//0.'" I_a)) ~.
6 FJREREPORTEDBY(Last,Fint,MI)
. 7 METHOD Of'
ALARM
~
STATE OF OREGON FIRE REPORT~
STATE FIRE MARSHAL FIRE DEPT.
ALARM NO.
" i ". 1/
Dent. RespondinK ~ I ()y I fA 0. ...... ....J:......Ld
Satur I ALARM TIME I;RR,VALTIME I 'TIMEBACKIN
SERVICE
DI '6/</ (; 0.)<;("t'll?-- Dff JilJ'!
Ir ZIP CEN~~S.~RACT _ I ~~OCLAss.
""lZlZli/ 1/'.5? ' I I ~I~ ,"5'
I DOB',pt~noJ' 1X7~~Of.E96'
I DOB"ptwnoJ) 17/f~;;77
I TELEPHONE
.2d.. {,,-/?? 6.2 ,
I TELEPHONE
Count" L"~ o-t,,e
.--
0 SUr! o Tu.. )l'1 Th~ 0
0 Moo o Wod 0 Fri
..
I ADDRESS
ADDRESS
'PO "B/J It
ADDRESS
<.,~
o Telephone Direc\ 0 Radio
o Municipal Alarm S)">wm 0 Verbal
o Private AlUm S)'ItI!m 0 No AlIrm Rec'd
8 I OF FIRE SER\'lCE PERSONNEL I 'OF.EN..G1 .,NES_" RESPONDED
RESPON~ED 7 . . "'^'
9 TYPEOFSrruATIONFOUNO 0 VebideFirI
. . a: StnJctuJ'e Fin -. 0 Bnah, Graa. LeaVeI
o Outaide SUUCL w/value 0 Trash. Rubbilh
. 10 METHOD OF
EXTINGUISHMENT
D SoU...."""""""
"0 Make-mitt aidr.
o PortebJe EltinlNilher
- 11 !;9P PROP~TY USE
/ (i V.P r ~/
M MOBILE - I YEAR I MAKE
PROPERTY
12 ROOM/AREAOFFIREORIGIN R n ()
E . EQUIPMENT I YEAR I MAKE
INVOL\'ED'
, IN IGNITION
13 IGNITION F ACfOR
J-DOB (optional)
P //'J 1-7>1'Y
I DOB (optional)
61911 (Till Line) .
/0 VoaSpMuniAlarm
o NotC.....ifledAbove
I' OF AERlALA.vPARATUS RESPONLEn
()
o Ot.her(ListJ
Mutual Aid leJ:tinpilb or invatipteonly)
o -- 0 G""" ]ifNIA
I ' OTHER VEHICLES RESPONDED
(doootiodudePA'" A -
I TYPE OF ACfION TAKEN
Ia Eltinruilh . 0 Removed Hazard
"'0 Investintioo 0 Stand By
o Hand.18id how/hydrant.ltandpipr
o Muter Stre&lll Dmce
o NotClusifl<<lAbove
I MOBILE PROPERTY (Complete line MI
.1, SERIAL'
I EQUIPMENT INVOLVED.Y' IGNITION _(Complete Lint E)
/-Ipcrh r /A,'f' COY1.
I MODEL / I SERIAL'
o AutolOl.t~ Ell. Syat.em
o PN-conoect bc.e/tank only
t'l ~.mnn<<t how/hydrant. ltandpiJ>>
.
IPRO~ERTY CUMPLEX III appIicablej
I MODEL
F
o SaIv...
o Not Clusifwd
o Undetermined
I L~CENSE'
I VOLTAGE
14 FORMOFHEATOFIGNITION
-r
MATERIAL FIRST IGNITED WAS MADE OF
Shfln- ..i-itJ f-1.t)fnr ?Iflsf/( .J-'/~,It1f/lJ~
15 LEVELOFFIKEORIGlN ~lOto 19fNt U 30 to 49 feet U Over 70 feet
o Gradelevelto9reet D20to29reet 0 5Oto70reet o Objecta in Flight
-. Buildilll ConteaJ.I i, ,VahitluDdCoDleDtI
""~(),,'''{l .00 -..:J. 1(."", 0 ' ,.00
/ - /
LOSS . -J . n (J{) ,00 .00
17 N~HER Uf STOEUES U :.! lturiel U ow oltum
"B,.llJtory ...', 03to4IJtorn 07tol2IJtorieIJ
18 BUiLDING AGE(Jn Yid I BUILDING SIZE (Gmd FlrOnly) .:KJ iOOO.49991Q ft
?") f1 O.999~h '0 5Q00-9999!Olft
19 CONSTRUCTION TYPE U Huvy Timber 0 Unprot.ect. SteelHldf
o SIHI"Coneme.:l-4ht.~. 0 Prot<<t.St.efo]l!~ p_protect, Muol!.n:,E.t. &. Woodlnt.
EXTENTOFDAMAGECONFlNEDTO: n.rne Smoke DETECTOR PERFORMANCE
I TheubjectoforiciD I 0 1 0 ,0 I Inroomofori,in-oper.
2 Partofroomorarao(on,iD 2;jg 2 0 0 2 Not in roomo(on,in-oper,
3 Roomo(on,in 3 [) 3 0 0 3 Inrmofori(iD-notoper_fuetoolrnaIJ
20 , Fire.ratedmrnp,o(on,in '0 '0 0 4 Notinnno(on,in-notoper,ruwlootmall,
li F1oorofon,in li 0 5 0 0 6 Inroomo(ori(in-notoper,powerdiloonnec:t
a Struct\mofon,in 6 0 6,8 0 6 Not in rmofon,m-notoper. po_rdiK:oD,
7 Ertendedbryondstroc:tureo(ori,iD 7 0 7 0 0 7 In room o(ori(in-not oper. dead battery
o 8 Notinroomo(on,m-notoper.deadbattary
"S 9 No detector pfflfDt 0 10 Undetermined
_ . 18 VALUE
, No damap o(the type (N/A)
,0
21 REMARKS WutherConditiona(optional): 11
(' /nl,-I,; {,\.1..-M
22 FoUowUplovatiptionRequated Y_ N-X- 1ft.. O~inV"tipte
23 Number of Injut-ie.
Fi"SPrviee
24 Member Makin&: Repon
a
{
1/ _T'!A
41' ...
2.5 Additional InfolUl8.tioo by
814-440-10 (R-84)
!.J,J;h:A{( r/l/~~_<?
----rJ - ,Below pd. level ~ Undetermined
o NotCIa..ified
,JlO
.OU-
TOTAL
,?,.&( /l 00
/
-'- 1)00
>, _...80
.00
.00
U 13to:0!4ltori.
o 25 to 49 ltofi.-
o 10,0Q0-19,999tq ft LJ 5O.000-99.9991Q ft
o 20ooo.499'l9lO/'1't 0 IQO,0l)0.499999l1C1ft
~ UnplOl.cICt. MllIOnry Eu. & Wood lot. lJ Unprotected Wood Frame.
o Protected "'ood Frame 0 Not Classifwd Above
SPRINKLER PERFORMANCE
I 0 Equipment operated
2 0 Equip. dlould have oper.-did not
3 0 Equip. prnent rift too tmaU to oper.
9 0 Not dusifled above
o 0 Undetermined or not reported
8 ~ No equipment prnent {N/AI
U &olJtone.ofn>ore I
o s.oo.ooolQft
Sprinltlera Controlled Fire:
, or Heada Opened
YES 0 NoD
o coot. on bIIelt
I NumberofJ.'atalitiN
Fire SPrvin
TiU.~ C 0/-;, :'"
Title
Cth"
es
Other
I D...
/')7-N-97
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