HomeMy WebLinkAboutMiscellaneous Fire Damage Report 1986-12-25
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
'1 ,-/0, III
DATE: 1')''d,<;-!0
TO:
FRO~l:
Building Department
Springfield Fire Department
~(j
SUBJECT: Structural Damage to Building
Address or location of building
Name of owner I2...n t e d
qd, .c;
Glum aif!.,
. I
Type of building
[...,...evv, Lll,uhlJr.LM. f-
})w e..U;n g
(Dwelling, store. Warehouse. etc.)
F3-~Lf.<-1
oJ
Estimated value of building $ 40. ()Uu
d ' · &:-"'() 3Z-
Es timated loss to bui 1 1 ng ~ <JV
Date of fire /d - J.S -,fb
Location of damage in building K,'kL.... Q..,iU"'j nhnv-p ~r::,IAlIc..
c.~, (,'he, 1(, 4UI'c. .\Dls1)
(Roof. Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
de" '+ hp,{ iev-f;> oSD
So"",-<- bl.U\...lA...t I~S -c.hw.. Nl9T TO de~~1\
(Burned rafters, Beams. Joists. etc,)
Additional pertinent information
bc..ul'll- -
t.oil'il~~
:DrolJah/e
(Wirinq,
to Ilqltt o...br,\/-e
(7 CU<.W
Outlets. etc.)
,<:;/'/oi/(
Electrical Hazard
Signed
(Ju.",-/0 &-t.:tt....a.r..-c,)
cc:
f
.' I' DO NOT WRITE INTffiS SPACE
"'CONTROL EXP.
NO. NO.
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FIRE DEPT,
ALARM NO,
STATE OF OREGON FIRE REPORT
STATE FIRE MARSHAL
District of lncident S.J)t',/?c~ .;; dd County
JATl II ; I~DI~III~~;~1 DAY OF 0 S~ 0_
WEEK
0 Man o Wod
2 INCIDENT ADDRESS
9cJo (J)!lf m [) /(' S/,
3 OCCUPANT NAME(La~t. Finlt, Mil I /
/JJ() /' r/s :So h(\( L.
BUSINgSS OWNER NAME (Last. First, Mil I ADDRESS
, OWNF.R NAMfo: /I.all,"'inlt., MI) I ADDRESS
LaNG'
tIi:l Th~
o Pri
- Dept. Respondin'j' S,-"')r., IN c;. /,.' ~ I d'
o -;"w'l1 ALAI.ORM.:~E / /1 ~RRO'V~,L~I()E TIMF.8A<;K I~
..< _ IV '" <>'- \ LV I I i'F.i~F., b
i 7', ~~711 I <;ENISUS ~RAl:3,3( 'S3"'SS
DaB 'oplio.." 17 JZ:"6-~~ ?
1>08 (UPliOnall, TELEPHONE
nOB (optional) I
l DOB 'op'"'''' I TELEPHONF.
.\lutu.1 Aid (clti~lSh nr in\l~M~t~onIYI
o fUoceivt'(t 0 Given D Nt"
TE1.EPHON..:
6
FIRE REPORTED BY (La,l, Fint. Mil
i ADDRESS
o Radio
o Verbal
o No Alarm Rt'C'd
[2'i. 9111TieLintJ
o Voice SiJnal Muni Alarm
o Nut ClallSiilPd Abovl!
SC~I1..<-e..
MJ:o.,'1'HOI> Of
ALARM
o Te~hone DirKt
o MunidpIJ Alarm S}'1Item
o Private Alarm S)'lItem
6 lOFrlRESERVICEPERSONNEL
RESPONDED
, ' OF ENGINES :3PONDED
o VehideFire
o Brosh, Gras., L-aves
o Trash,Rubbiah
I' or AERIAL APPARATUS RESPON[\ED
o Other/Liat)
I ' OTHER VEHICLES Rr:SPONDF.D
(do nut include PA'B)
I
9 TYPE or SITUATION FOUND
.81 Structure Fitl!
'0 Outaide Struct. w/value
I TYPE OF ACTION TAKEN
~ ExtinltUish 0 Rtm"...Pd Haurd
o Inves!illlltiun 0 StandRy
o Hand.laid hllse/h~'drlnt, ltandpi~
o :\1as!erS!tI!llmDt'\'irt
o Not Clauilird Abo\'e
o &1\'11111'
o NlIlCllIuilil'd
o Undetermined
10 MF.THOD OF
EXTINGUISHM8NT
o &!If.Extinguished
o Make-8hiftaidll
o POr1.llble ExtinlNisher
o Automatic Ex!. System
~Pre'omnl!{'th08fl/tankllnly
o Prl'.rnnnerthOllt'-/hydrant.standpipe
II "L};;I;;;;~
M MOBIU: I Yf!AR I MAKE
PROPERTY
----'2 RooMIAREA OF FIRE ORIGIN
K:J.c..I~N
I PROPERTY COMPLEX (If applicable! I MOBILE PROI't:RTY ICumpleLe line Ml
I MODF.l I SERIAL, I J.I<;ENSE,
EQUIPMENT INVOL\'ED IN IGNIT.ON /Complm Line El
E
EQUIP!\U:NT I Yfo::AR
IN\'OJ.\'ED
IN IGNITION ,
13 IGNITION FACTOR
I MAKE
MODEL
I SERIAL,
I \'OLTAGE
IN st.<..la. f.'"", over
14 FORM OF HEAT OF IGNITION
e/ec.lr/r!. //9IJf
15 LEVELOFFIREORIGiN ~10tol9feet
o r.radelevelto9feoet o 20 to 29 feet
16 VALUE l.ij 0 ~~~OnO .00
J $0000 -f:)
17 ~f8ERm'STORIES U :.!stoties U 5to68tmin U 13to24swries
p I story 03tohtotiea 0 ;lol2atotin D25to49swrirs
18 BUILDING AGElln Yea,.., I BUILDING SIZE IGmd FIr Only; ~ 1000.4999aq ft 0 10,000-19,999 aq ft U 50.000.99.999 aq It
d V n 0.999!~~: ' 05000.99998(1ft D20.ooo_.t9_999-"f! 0 IOO.OOO.499_9995f1fl
19 CONSTRUCTION TYPE 0 HeavyTimbrr L] Unpmll!ct. Stt'l'l Bldg U Unprotecl. Mas.-lnry Ex!. & Wood Int. _...iT Unpmtectf'd Wo<ll:! FrllM
o SlHl&C"nc",I..;l'4hr.~rol. [1 ProLeCt.SteelBldg 0 Pmtect.Ma~nl'\-'E~t.&Woodlnt. 0 PmtffUod\"oodFrllme '.q :>/ot ChlPifif'd Abn...e
E.XTENTOF OAMAt;ECONfINED TO: Flame Smoke DETECTOR f'ERt'ORMANCE SPHI:-:KLER PERt'ORMA:-;CE
1 Theobjectnforigin I 0 I 0 0 I Inroomofor~n_o~r. I 0 EQllipmrntoperated
2 Pnrtufroomurareloforigin 2~ 20 0 2 Nntin rrlQmofori!fin-oper. :.! 0 f.quip,~huuldhn..enper._didnut
3 Huumororigin 3 0 3,g1 0 3 InrmofOtill"in-noto~r_fil'etoollmalJ :I 0 ~:.quip'Pll'lt'ntliretullsmaUtnllpt'r,
20 " Fill!-rnttdcomp.oforigin .. 0 40 '6ZL 4 Nntinrmur(Jr~n-notoptr.fill!tno8mnll 9 0 ~ntfla!lSiliedabu..e
Ii FloClroforigin 5 0 50 b;l Inroomoforigin-notopl!r.powerdi3cnnnect U 0 UndetenninedornOlrl'pClrtt'd
6 Structutl!uforigin 6 0 60 0" N'llinrmoforiltin-notoper.powerdiacon. iI 0 ~o"lllipmenlpl'l'r.ent(N/AI
7 Extendedbl'....ond8tnlcIUrl'ofori(in 0 70 0 7 Inroomuforiltin-notopl!r.deadbattery
o 8 Not in room oforiain-notoper. dead battery
o 9 No del<<'torp/l!llent 010 Undetermined
,
..
MATr:RIAL fiRST IGNITED WAS MADE OF
de/I'-<.Nse
t
C!1JLI.k.. {; 'I, ceSS i 1/ e A... 'X.-T -I iCl ht &)1t/1J:i &..
II'IE; :!;~;:I:'I;~tf"rV
U Helowl{Td,ll'Vel
o ~<ltCI8I1llified
00 I
,00 I
U 30to"9fl'tt
o IiOto70feet
'r- Contenu
la ,DOO ,00
[J Over 70 feet
o ObjectsinFJi.rht
CJ Undetermined
\'ehicJellndContenu
Olher
.<C'<" TOTAl.
~,OOO
,00
LOSS
,00
,00
ow
L.J 5Osloril'llorruotl!
o :'lOO,OOOilqft
9 NodamaRofth~Ivpf'/N/AI
Sprinklo:onColltrolledJ-'il?:
,....sONOO
90
I ofHrads()pent'd
21 REMARKS Wo:oatherConditionsloptionall:
o cont.<lnback
2:? Follow Up In...eSli,ration Rtqueatf>d
N ",..-- Ifyn..whowillinvl'll'~to:'
,.
:?3 Nomberu{lnjllril'll
Fill! Servire
24 Member Mll.killll Report /J. ./_ .
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2~ Additiumd Int<lrmlltinn by --
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