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Building Fire Damage Report 1997-12-21
. CITY OF SPRINGFIELD Fire & Life Safety }ab. <17/7y 1 1703).7 '-J J o/6tJ"o 5i:;- q 7 - :3 ycf5 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD DATE: (-z...-l..1-9? TO: Building Department FROM: Springfield.Fire Department SUBJECT: Structural Damage to Building Address or location of building L(to IN, ()LyY/Pil Name of owner LL-Av (7 7ru rrls j Type of building DW~LL ;,V"k (Dwelling, Store, Warehouse, etc.) Estimated value of building Si 9 (J 0 DO Estimated loss to building Si 6 D 0 0 0 ( Da te of fi re / L - '- \ ' '"7 7 Location of damage in building 1"JJ.Je.c>V'-+l1?U<j (Roof, Wall, Exterior, Interior, etc.) Structural weakness as a result of the fire (Burned rafters, Beams, Joists, etc.) Additional pertinent information Electrical Hazard :IJ1.<<'O U /z.;fJOlJi, )7~,,"\:.Ii rfCJrl':., P'Vuj-,1) , - , (Wiring, Outlets, etc.) ~ Signed a~ () h-., .- ~ V' r /F~1. . cc: /1.-:2. 3 . (17 ? uJ ~/ ~. -. ,..,,:}{ITY OF SPRn-meLD I Fire & Life Safety ,/ . 5r97 - '3 lftfS FIRE DAMAGE REPORT OR ELECTRICAL HAZARD DATE: 1'-- L 1-9? TO: Building Department FROM: Springfie1d.Fire Department SUBJECT: Structural Damage to Buil di ng Address or location of building L(J'O W, ():,'-I'}1{J); Name of o\'lner LL-f'-v 0 7rv rr ~ j Type of building DN~LL ;:v"k (Dwelling, Store. Warehouse. etc.) , 9 I) 0 '0 0 Estimated value of building ~ L Estimated loss to building $ (; lJ 0 0 {) ( Date of fire I L ~ <-\, '77 Location of damage in building '1"J,Jf:.c>U.(,t-lOJ<l (Roof, Wall, Exterior, Interior. etc.) Structural weakness as a result of the fire (Burned rafters, Beams, Joists..! etc.) Additional pertinent information Electrical Hazard ::L6L!<,OIJ&...NflUi, )7~''(-fr (fGrc~ fJ'l.hJ.....f-JJ - ( - cc: /'1-:B-c17 '?LjJ (Wiring, Outlets, etc.) ~ Signed~~p~ , ' L-d ~ -'iJ ' ,f:..,'-' . DO lfOrWlUTEJN11JIS SPACE CXJN'DUX. ~ I ~, ~ . \ EXP NO. ,.~~"<':'." " .,/l' .... . <4' .' . SI'ATE OF OREGON ' ~ O"{~~ ~.ALARMNO.' ~cwJncident ~q7" 3"/45 . "'~~U~ NO. 0 CbtInl!f to Rcoort , ......~.oF~,..:...~,c'~"ltifll~/H.D , ' ". . .,. COMPLETE FOR Ai:.L _,'........o.NTS __~'u Lane' .. , DEP1'......,.-.~-,~ Snrinofip.ld 1 I f{!."i~~ I~ 'l,D~WEEK'" lA1<Rf~~1J.,-' J ~!l)l,En " I DATE~'1~ 1 ~!t~IN _ . ___ .._ _. -.1-- '1J. _j,!_L~ n I..=....1J 2 TYPEOFI'IRE nONFOVND(ONETYPBOF:t-'1KJi,foO:tl.MUi!tl:hlRt) . . .a..r.r~u.r V.l.nz.n. ",.............ONF01JND(MARKAll. TIlAT APPLY) ~tructureFire ,O~bitc:.:i..r..,:. Fire DOtherOutsideFire OOvabeat DRescueCall OGoodJntentCall , o FireJn Mobile Property OFireJnNatural,'. WithVolue o Service Call DEMSCalI o HazmatJncident UsedAsAStructure vegetation: . DTIlIShFire OFalseCall.Maliciaus DlliegalBum ONon.fireDamage I DFire JnMDbile Property DFireJnCulti~., \. o OtherFire, Explosion o False Call. UlliDtcltional OLegalBum Rqlart JnA.......:-.. vegetation DExposuIeFire . OSy.1"''' Malfunction DOther J-I:J'J;O~''''tN,.' OcYhP;C':' 1~7'-117 1~5~ 4 OCCUPAN1'N.\MI!(Lool.F....Ml). , DOll . ,DllEPHONE '5~'::~:!JJ~~t.-~vP !:-7- ~-.'-If lM:.c;;.[bki. . ' .': \ I " f=cr/f I 7 BllIUIINGlMOBIlEPll........__ OWNEllNAME(Lal.F....Mi) SAA"... . 8 BuniiINGlMOmLEPROPERTY OWNEllADDRESS . , I DOB l7JP I UUPHONE 17JP , BUSINJlSS OWNEllADDRESS . INaDENra..............BY(Lcl.F....Ml) V N\lI'lO~-tJ 10 mcmENT ~ _..:l.....:....BY ADDRESS <..(frD IAl; ()L'('-d' ,'e 1.1 .0FmlEPEIlSONNELJIESPONDING L.OFENGlNES _1.OFAERIALAPPARAn1S c.rcer I "2-- ~ VelUfttea' ~....~_..... _.....u......~ I . 12 TYPE OF ActION TAKEN (amcKALL lHAT AFPLY) o Fmcib1e Entry' OOnvestigate ' 0 T._r_: 0 Dccon Area ()d" Search Ji(Exbnguish , 0 Rescue 0 Hazmat ID ' 0 Dccon Peop1elEquip 0 Standby &('Ventilate' . 0 ExlriC81e 0 Remove Hazan! 0 Monitor Hazmat 0 Move Up JilIl;elVllltC . 0 EMS 0 Establish Safe Area 0 Evacuate 0 Othcr_ , COMPLETE FOR ALL FIRES I DOB I1ELEPHONE 17JP~7~77 I NOFOtHERFlIUtSERVICE 'I MUlUALAID VEBICIES~...........\.../ 0 GIVEN 0= o Provide Personnel I 13 lu..:-..:..~ 01' ..........'....JISHPdENT o WatL:r From T8DkerITendcr Shuttle o Ground Crews WI Equip And/Or Air Support o UnknownINot Rcportcd o Se1f.Extinguishcd' 0 Automatic ExtiDguishing System OV.~h;ftAids - OWatL:rCarricdOnJnitialApparatlls o Portable ExtitWrishcr ~ From Hvdnmt. Droft Or S:......:..:., .. AGENT OF .O!o...._.'....iism.mNi J(!!}later Only 0 Class A Exting. 0 Class AlBIC Exting. 0 CO2 0 c.,_.~..d Air Foam 0 Class B FoamIAFFF 0 None ODirt ' o Class B1c Extin.<!. OClassDExting.. OHolon .DClassAFoam OW~h:entW/WatL:r OOther ~~.......~ "fZGS1'D~'r.JLE I~~ ReSidel1+:evl l'(~:::::~~_u_,-,'.D " M I YBAR I MAKE I MODEL SERIAL "'AIRCRAFT TAIL' I UCIlNS!lt . 16 J<OO1ol'JAIIEA. EQUlPMIlNTINVOLVEDINIGNmON , OFlIRBORlGlN U V i Nt..:, -Q () H (c.mpI<l<LiocE) I E I YBAR L MAKE fMODEL :~rONFAcrD~ e~. II HUMANFAcrDas I Askq> 0 10 Mde INVOLVED IN ICNmON' 0 Female I I9 FaRMOF '. HEATOFIGNmON?A D I /<IN! 1%0 lEVELOFFlREORlGIN I o Bclow Ground I ". =TED ~rt'5n .00 121 ~TED,_, ..~ 000 .00 I STA'IE Ilh I POWER SOURCE I DFlXED . DI'ORTAllLIl - M~ CUl./U:,Sol~, oi/~~.';"&PI~!-' ~... Iuveoi1e ,(Complete Juvaillc . A8< ] ElderlY ." 1 M>llOpIe- o _ 0 0 wfF""Fonn) : (Age~) 0 0;, . .... ,.10 InYoIved 0 MATERIALFlRSTIGNlTED S'iJ LIrI!:I"''1.l/ IlTEMFlRST WAS MADE or CML'1SlI(l..p.m~ (.l.J6kI~ILT- Cvfl.,r,II'rrV<<-rt. ~ O""""'Ground I DInFligh! 1 iafOrigU>(S"","",Fii6Oo1y) CooIems Mobile _ "'" CooIems I' O<ha 1;pT~ <Q cOO.oo ' .00 .00 I L. Q, 000 ,00 1/' ZO cW.oo ,00 .00 00. DO 0.00 SIlRIAL . , '~MPr:E'n: FOR ALL STRri~. };"::"L:""S.~,~:,,,{~}::~:.~,, . , ',. . . ,. . .":~" : :';-: ,'~i:~,~ .; .,~ '-'~. :: ":1:', ?':;';'~~~:~'_<l';.' "~"~'\ .,.:..t'i;'{~';':';~';~" t'(~~t~!~~?;.1.~ ~.,~.:~~<,:. ~:,.:~~"ir: '~'~;-~;'i:': ;:..... ':...:), JlUiWlNGSIZE(o..a.dF1oorOoly) 0 sooo._SQFr " 0 ~'''~SQ~ ". " . NtIMBEB.'Ol'~~"~" Oo.gggW'loF1' .....~r".:';...\:.'...:..."'., : ~:...Dt"oc.cj.~lll,.~mFT .,...~., ~ OIIW'l"-:.~oDo'Mni'~~::~;'4;":'! '~~~;--I":" C V\( _ ... -.- _' __ . V\( ".'. . . '... ....r:~.. .'. ~. ~ IillooO-4999SQFf '-"f' -' 0 2O.000..~,999~FT :1'. ':. ' (] soo.OOOSQFI'OR1.a:mB ,,~:';. ~~', ,'/~\ 3.~:'.'3-;.::,:':",;-<: ::"",:~ :"~ . ;,. .' mNSIB.UC'DON.~ f2'~':::i{~l~;;.:,~~j'~:~,:Y';;~:/~i:.',~\~~,~ .It.OOjc;o''~k:l'tt=-;;~;-:;i-';'''f::;--~:-'. .~~'-:~'....~.~; ~'t}~'~J:~ i. . Ii' " OSl<dAo..aa..,3-4Hi(t)peIADFll,),,1';,v,:::,,;q: ,0a.s.AOr,B(N~~~~~~.c, ..",::<, i:;;:".fi O_MasoaryEllLAWoocIlIIt.(l)peDlIlI) ",.~" ~c(_,.., ,..", ..,~SbiII&la) ~;,~";:,,.:, . ,,".' ;."",., O'...;:.;;;.;......~:.;.;; .;.:;",.".._......:.:.m-<' 'J'''''''"' O~"'-'c' ~'=-....,:;.l"~.,.:.;,.,;;;;,~,.'~'III.;,,,_C'_;;,. 'i', ~-_J'&OoUo_"UUQWl..\."J""', ..P!:-..:;l.;~~r.. ~'. ,vu_~-.~.~,.....~~J"'~.~~;o:.:.~~J:I.Vb~i~~~~~ OProlected., Sl<dBldg.' C.....m '1 lit) '. .:"" '",."...' o tImroOItd woOd "'-:....r.. ',";"'i""'<" "':-""''''-'';'-'''.1,,' L , _ . ..1......... .~:,:',...~;,\:t.:.;-:_:r-. .. ' _. ~:..~.~....,~'i::JI:'::;:;J~";.:.:.;:':';.-.:.;I~,:~":'<..: 0\:,,, ,.n .JSl<dBldg.(t)pemN) '''', ", ,,":' :.,,' o NomaI<dRoofeo..r;"gCC........PIaili.. HatTar)" :..'4::. o~rllDbc<(l)pe1V) .'t....'.:,. OSlludul.:wilboutRoof .".; '''.'' ',:," ,: :: ." 0~~;S:~~~1ItN)) " ORoofNot,a.ssedAbow: " :: : ::':,!,'. :;.!.Lt.,/:'.""",;:".,', ~'I.' '. "- \"'.1r. """. __ . ,'."..'...',:,:._:...;.~.'.~','~:(:~.: _ # . _ . .C'I'YDeNota.ssedAbo\llC .. ,:,>,:'I....l; -~; ..... :. .~~-' . .~-:. ..... \'.: ~ ." - ~._~ .... ;,;,:,.... (t'~",t .';': v".,.:.<t'. SPRINKU:RPJl:RFORMANCE _' . ~.' ~N_J!'OB..-:_.~.lAILtIRE :~EE$~~~~;t~~ .~SFf;~~~J~~:,': o Should 11m: <>i>c<-vDid Not "."', :::,'i;: ,D SyItaD Pipiog 1lamapI; '.C;, ,.,: OSystemPr=dlF""TooSmall...e",'""..,; 'DNo~H..dsJnRDQ;;;'.;r' '. itf;~~:~i~If.~~~~,~rfiiJ~!J%f~~y~:"}j.:,., .';iJi~.,;, ~~;" .', ';.;~:;;f0~~Sj,;&j~ii:~ii~L~~:~1' ;~\~i;~~;\~~;G~l!~{~~t*;Jt~~;~~4::f;~:;~;{i~ji:~,::' ~ ' ..: %, FO~W.t1P .,H,_....I2~n~NR,EQUESTm .,' .'~~t.TJ ~:' . ....~'_.-"JF WHO WIlL~.c..>u~u:.: ...... ".:,' '\~'.. .'" : ',<I'P : l'~-'-;;>?,~sn~; "';~'~~5~.:_::~:~:~~~;~t\.~.,:;,:-,:~,.~rf:~" . .\=.",,,,ltd ll!~ ,..,../JifYEJ' ..., OND '....,. ' FIlE MARSHAL.., nSPf\DPOUCE..,.nOTHER..,..;.,~..-"',..._.,'~,.....,--,....,...... , .. NUMIIIl:ROl' .[,F.mE,SEi<.VrCE' '., 1,~tHER<, ;;;.;;;,>,;,,~:::;,,'I NtlMBEROF "", I F.mE~,~';/~;~":' '~"..,;", ..:";:.,,"':, ' :.' ,', _..~ "',' . -', () ...:~.:: .~:,~~.~S~~:;:,~.~;~;-~~O(~.:;p.:: .~~~~,O') .~.-:::~.f:::~~-';.-(./.;...~~~;f'i:K':5.~:-. ':F~?:~~~;LI~'?"'-"""::""::C:~~:;"'""::'" 31~~~:r~,UrY~; ", ~iAlPq-'.a;~X, ..~;:.:' .:(::f, 31jQ:ONALINFORMAllONBl' .'.' :- 111'I;l1o. -r .~. ' ... DA'IE.' , ..' ,,;' I 'J~ (Z'jM~ ' :".~::;:.~,< ':L..\)):~'~-rv:~":'" ~":",.. :r;' .~.i:<:::(,,~';~'~~\S:;j.,;:;,<';.:,,'. .....--1,.. 1:,; ~'_.. . .. ,_ .~" ,....- -~::.t".. ~_ ~.../,._..._, .~,I... '".' ~..,~.,~ ....,...,."..,.,.">",...;. :~-'~ , - --;-..-;i!"j::'"~...''''' -f! ", ..... ~... ,.., ._r,......o,i~"'.~..~.,;....... "'1-" ~.T\1;,._....... ,~,...v....."-<.:>... -4J.'~~F";;.~;;......,,;"'4'-"'(;1d'~i.~. 1 ..i".';:)'t,t"..'t<;~,.~r . '."' ... ..... :t;r;iTy~J.i~~:t~.:\~~1?Y~;.2 ... ."\A;;~t!J~;"~f~~~~~:~f!~~1~~f' , 23 Al'PBOXIMA'IE lItlIUIINGA<;E(ID Y....) i.O ' U smucruRETYPE ~_...,.... O~....u,.:. . o Air ~~'V.., 'h'Stzucturc o Opca~ ' O\:,I.,......! :A.._, , o tWe ofS1nu:lure Not CIuscd AbOve '_ . I ~ I'ACl'OIUlONIlWlu=1Grol'L\ME~VEL U L n.um o Object ofOrigjn o PIlt r4_Are&ofOrigjn OhemofOrigjn o FUenicd Comp. of Origin o _afOrigin (MWli-&oc Slru"""") ~afOrigin' o Bc:yoad S1nu:lure afOrigin ONoa-fireDamaocReoM ,"{ "': ..,: ~.~ ElCIENI Ol'DAMAGECWSED BY , .' ',- '.,;..,:..: c SNOkE', ..... o Object r40rigin , OPlltaf_Are&afOrigin > _' O~afOrigin' . O:':.._.~Comp.afOrigin . . o _afOrigin(Mu1lHloor Slruclure) ~afOrigin {.'?" "','.'::,Y," o Bc:yoad~,.....". afOrigin o No Damage af1bis tWe -, ~ ~" . '~"'''''.~ " 27 DXmCIOR TYPE ~Smob: OHal DC, ,...:....:., Smo1odfIat o SpiakkdWatcr Flow Dctcclioa o Specia1111z1n1 System _ Da>ia: ' Ii c:..bclIl )I.......... Delecf<< ' OMcn1bmOoetWe_ OOCbortWe afDelecf<<_ o No Delecf<< pr<s<ul o Detectm lIIIkDowIlIIIot ~ 28 lIPIlINXIEIl.S1'STEMTYPE o Wd Pipe Syil= o Illy Pipe Syil= o De1.&o Syil= , or", ,.:,.. Syil= o CaIIb. Illy Pipe A, ,,: , , Syil= o "OI>()fi" SpriIIkIer Holds' ' OOpca~Syst=.~C<lIIlroI. .' ~Sprilllddrotodi..,," '. 01'-~L......~Un~,,-_"":'.J IIEIECIOlll'OWERliVP1'Ll' ~0IIIy ~ :;:~h:o.;{2;::':'"'::'~"<' g;;~~~:'~<~:'2;"'" o Multiple Detedoi. A "- Supplies '.;,. i,",. ..... :'(l~:~".r:~~~~:,!(~ ", """'-1<)(R-96) .' , ..r'-:'.~~:,\~~' ':.:--' ,:'-5'':..>...~ ".:.[!,. 1 . '. ~ . '. .. I AVENllIlOl'SMOKB1RAVEL' ..",' ,. .,'.'1",...,.,. -".,..,." ,-,'. '....,' f . .. ~' ':'\':.'.' :':;~:.'::7~-...{:..:.';,/~:;..'~~',.-~..>~; ~"":' IIRE~EWOlmlCONnNIIDro ",,;, ' _''','' .:. "~-,. .-(... ."\,' ~", ~.' ,.... " ...I.:;,' "..:':" .... "t :.' , EXTINGllISIIINGAGENr..' '.'n "'. o Objod of Origin o PIlt af_Ana afOrigin bhemofOrigin , ' 0:':. ._.:Comp.ofOrigin o FIoar ofOrigin(Mull!-ftoor ~), ~afOrigin '. '. ,".': '. Y'}''',' o IleyDad Slruclure of Origin . o No Adioo af1bis tWe . . iDUtCONtROL:!~.:;I.-...,.~; 11 ~.:- o Object of Origin , o PIltafRoomlAre& afOrigin.. o hem of Origin, .. < ' o f"-med Comp. afOrigin o _afOrigin(Vn'u.- S1nu:lure) ~:,";;.,..afOrigin'!::F,- "': "',' o Bc:yoad_afOrigin .0 No Adioo af1bis tWe " DEIECrolll'li1lrollMANCE. ',' i-afOrigilllAkot.d""'"'P-' ',:' Not ill hem afOrigilllAl<rl<d C .. ", """ o ~cir~NotClpcnlOi:'~'f ONotmllDamlDidNotOpenle '."'?:..' ..~: O_'iIlRoamlF""TooSmall..':""":. o Delecf<<0pcnlcdIN0t FadM ill ' DisccM:ly , o Delecf<<0pcnteclI~ :...' ...., FaiJod to Ad I. 2;~;: :;;~..;~'~~. ;".,:., ~:: - ~,i:"-":,:, . ~ .'.~'.' .;" ~;:.~:, .'. ..' '.' REASONJ'OB._.-.......aJl'AlUlBE O_"-SupplyFail<d.~.: OL,,,,..r.....lIatioo....~.' .~t;-.~'~.~~;~:~\:'~tlTf~;t> . OIllllcry,Miaiug..D....:.., ,.;.J;. .DBIUay'r-..!.. ,,~'.1 :-:"i:'--i.t.!~: {,;,,;;- . ,ONoDdOcrorFanun;',. " .,.. OF_U,!......:....l,<' ,... . ;.- .D4'IE.\,"~.>:q.....' ....'.~ :.': ";'/ ~ : ~ ,,' '"L!2 -:7.., :: '.. '~ ,.,,,",,-'(.;. - -. .--:-7,:'/..." .'. ',I'. .., '~. "."....-.:._.( .~:~-" ~ .~{- , . ." -;.' . ...... .... '-~:;A; r.~~i; .~.:: ..<;', ",f ..: ~'i:):::t,~,:~ '