HomeMy WebLinkAboutSpecial Inspection Fire Deferral Submitted 2004-9-20
DISTRICT OF INCIDENT:
0347: SPRINGFIELD FIRE LIFE SFTY 20: LANE
ALARM DATE: 912012004 I ALARM TIME: 15:49:00 I ARRIVAL DATE: 912012004
TYPE OF SITUATIONS FOUND:
111: Building fire
INCIDENTADDRESS: 3506 VIRGINIA AVE
CITYIZIP: SPRINGFIELD, OR 97478-
OCCUPANT/COMPANY: TONI IRISH
0347: SPRINGFIELD FIRE LIFE SFTY
ARRIVAL TIME: 15:52:00 I BACK IN DATE: 9/20/2004
IBACK IN TIME: 16:17:00
CENSUS TRACT: 19.02 ZONE: 2
I DOB: 4/11/1951 TELEPHONE: (541)746-0518
BUSINESS OWNER:
ADDRESS:
DOB:
TELEPHONE:
BUILDING/MOBILE PROPERTY OWNER: MA lTHEW PETZ
ADDRESS: 24029 DODDS ROAD BEND OR 97701-
DOB: 7/15/1977 I TELEPHONE: (541) 312-2623
REPORTED BY:
ADDRESS:
DOB: TELEPHONE:
CAREER FIF:
15 VOLUNTEERFIF:
o I ENGINES:
4 I AERIAL APPARATUS:
o I OTHER VEHICLES:
2
MUTUAL AID: 0: None
ACTIONS TAKEN:
12: VENTILATE, EXTINGUISH, SALVAGE & OVERHAUL 71: INVESTIGATE
METHOD OF EXTINGUISHMENT: 5: WATER ON FIRST ALARM UNITS
~:~;I::;TYUSE: 414: TWO-FAMILY DWELLING, YEAR ROUND USE
MOBILE PROPERTY INVOLVED: 98: NO MOBILE PROPERTY INVOLVED
98: NO ACTION TAKEN
AGENT OF EXTINGUISHMENT:
GENERAL .
PROPERTY USE: 41.1 OR 2 FAMILY RESIDENCE
ROOM/AREA OF ORIGIN:
47: GARAGElCARPORTNEHICLE STORAGE AREA
EQUIPMENT INVOLVED:
9800: NO EQUIPMENT INVOLVED
JUVENILE: COUNT:
No 0
IGNITION FACTOR: 53: SHORT CIRCUIT, GROUND FAULT
FORM OF HEAT: MATERIAL FIRST IGNITED WAS MADE OF: ITEM FIRST IGNITED:
33: SHORT CIRCUIT ARC FROM DEFECTIVEIWO 43: FLEXIBLE PLASTIC ( SOFT, ELA 61: ELECTRICAL WIRE, CABLE INSULATION
BUILDING: CONTENTS MOBILE PROPERTY AND CONTENTS: I OTHER:
ESTIMATED VAlUE $180,000.00
ESTIMATED LOSS $13,000.00
$60,000.00
$5,000.00
$0.00
$0.00
$0.00
1$0.00
DETECTOR TYPE:
1: SMOKE ALARM
DETECTOR POWER SUPPLY:
1: BA lTERY ONLY
DETECTOR PERFORMANCE: REASON FOR DETECTOR FAILURE:
6: OPERATED, NOT FACTOR IN DISCOV 8: NO ALARM FAILURE
SPRINKLER SYSTEM TYPE:
8: NO SPRINKLERS PRESENT
# OF HEADS OPENED: SPRINKLER PERFORMANCE:
o 8: NO SPRINKLER PROTECTION
REASON FOR SPRINKLER FAILURE:
8: NO EXTING. SYSTEM FAILURE
FOLLOW-UP INVESTIGATION REQUESTED:
Y
IF YES, WHO WILL INVESTIGATE: Y: LOCAL FD PERSONNEL OR TEAM
NUMBER OF INJURIES
FIRE SERVICE:
o OTHER:
o
NUMBER OF FATALITIES
FIRE SERVICE:
o OTHER: 0
DATE: 9/20/2004
MEMBER MAKING REPORT: Sweeney, Scott
ADDITIONAL INFORMATION BY: Wicks, Joseph
TITLE: Captain
TITLE: DFM
DATE:
9/23/2004
QA.\n~