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HomeMy WebLinkAboutBuilding Fire Damage Report 1991-12-5 ,.. .'._i .. . ~t{ II Y?7'6 FIRE DAMAGE REPORT OR ELECTRICAL HAZARD . J~;f~fK~,;::,;:; . . . . . " .... DATU..?' jJ ~I ,'\- ..,.... ...... . <"'.,TO:i..:.,. ... -,- . ,...,.- -', Building'Department Springfield Fire Department , FROM: SUBJECT: '"Structural Damage to Building Address or location of building , Name of, m'mer, ' R..., b ev- -+- S2. 5'tf ?o <"<=r... ~ r-,,;>"f +h:...... Type,Qf building /10'10 h~ 'e... h.".....e. ('S':"',lc -PdW>')'1 dv..><:./' 'I-c.j) (Dwelling, Store, Warehouse, etc.) I Estimated value of building $ So ,00 0 5u c)o D J ',' . E,stimatedloss to building $ Date of fire, 12- 5 - 'j / Location of damage in building C 1-\ -h.'€' ") -+ r- ..... L ~v-e... ,- (Roof, Wall, Exterior, Interior" etc.) Structural weakness as a ,result of the f,ire .f' /00.- , c e; /,...... ,u.J4Ib (7 ;' (Burned rafters, Beams, Joists, etc,) Additional pertinent information El ectri ca 1 Hazard .il/ / e / <=. c. -I ' e"'rL-o..'t.?~+ cb'<:l""'.'lrri cc: (Wirinq, Outlets, etc.) Si,oed 71f~~L~) Df'pt. Respondin~ OA~A~M ~I;E 410 A;~V:L;I~12 ZIP CENSUS TRACT '11:U1Ih8 I 111'7,61 DOB(optionall 1-j~ - 6209 TELEPHONE ,J n() ~OT WRITE 1:01 TillS SPACE CONTROL E.XP, 1\0, NO. ST A TE OF OREGON FIRE REPORT STATE FIRE MARSHAL .l...RE DEPT, _ARM NO, . Dstrictoflncident So ,...~,"'\q..r; ~ \ A II ~~ 16D:~II,;~;,,1 ~~~~F INCIDENT ADDRESS -+: OCC!~!.~LuI'Finl'M~ r- '5 '1 ~l~ I n. Ro ~ ~r+ KO'$C'h BUSINESS OWNER NAME (Last, Fin.t, Ml) S~lYlv County J ~~, r- o Tues o Wod o Satur M," l2i o Fri o Sun o Th.. 5 'I 3- '1 ~ , ADDRESS DOB (optional) ADDRESS DQB(optional) 5 O'WNERNAME(Last,Fint,MI) 3jjY"1~ 6 FIRE REPORTED BY (Last, Fmt, MIl 3aWle, \. pc'!v',~ K05e"t'l I o Tele::lhone Direct 0 Radio o MunK:ipal Alarm S)'5tem 0 Verbal o Private Alarm System 0 No Alarm Rec'd 8 lOFFlRESERVICEPERSONt>."EL I ;OFENGINESRESP07"ffiED RESPONDED IIf .J ADDRESS DOB(optional) Stl~ C' 'f" ( ,) ,;'),-f"c....' ,t- ) I 'TIMEHACK Il\ SEH\'ICt-: OIZ 13 13 ! l IS'3L^,' TELEPHONE TELEPHONE TELEPHONE Muwal Aid (utinguu., or investi;auonl)'} Recel\'td 0 Given ~ N/A ,0..911 (Tie Line) I o Voict'SignaJMuniAlarm 0 o Not Classified. Above . I' OF AERlALA~PARATUS RESPONDE? o Other (List) I TYPE OF ACTION TAKEN ~ Estinguish 0 Remo,'ed Hazard o In\'estigation 0 Stand By o Hand.laidhoae!hydrant.standpipe o MuterStreamne..'~ o Not Classified Above METHOD OF ALARM I ' OTHER VEHICLES RESPONDED (do not indude PA'a) .3 MOBILE PROPERTY (Comph.!.e line M) P1" h;lc:. I MOD~ ,If')( tp ()' SERIAL I I LICENSE I . ~I~MENT IN)\OL\'ED IN IGNITION (Co~}ek Lint' E) . +.s b' J . T.V. ~ 4!u.e.,Sa.y-) Vc...R-1h1 U Isnl. I SERIAL' U 13to24alOrirs o 25 to 49 stories U 10.000.19.999aqft D SO,OOO.99.999sqft o 20.000.4'lJI'lQ 110 ft 0 100.000.499.999 Ict ft U Unprottct. Masonr)" Ext. & Wood Int. ~ Unprotecttd Wood Frame o Proll-'<:ttd Wood Frame 0 Not Classified Abo\'e SPRI:"\KLER PERFORMANCE 10 Equipmentoperaloo o Equip. should have oper.-did nOI o Equip. preM'nt fin" 100 small to oper. o Sotdassifil"liabo\'e 00 lInd{'\t'rrnint'do: nul reported S~'\<'Kluil'mt'nIPrf'st'nt\S!Al 9 TYPE OF SITUATION roUND RStructureFire D' Outside Strucl. wf,'alue o Vehicll'Fire o Brush,Grass,Leaves o Trash, Rubbish 10 METHOD OF EXTINGUISHMENT o Se1f-Eninguishtd o Maltl'-,hift aids o Portable Extinguisher o Automatic En. System o Pre-connKt hose/tank oni)' t)i{ Pre-connect hoae/hydrant, s~ I PROPERn' COMPLEX (If applicable) I~""'c.. 11 FIXED PROPEF1' USE :;:jn<; It' ,h-',).... d""...1 j,!'I M MOBILE I 'I'EAR I I MAKE G PROPERTY t 7- CDr-, 1'\ 'hc...v- "'~2 ROOM/AREAOFFlRE~IGIN ) S, OS ;J.. 0+ /, 'u 10--J Y'OO1"1'j E EQUIPMENT I YEAR I Mi)C'E INVOL\'Ef) IN IGNITION 13 IGNITION FACTOR 'fY\ O:::.t 'e v-olo a.. \0 Le. 14 FORM OF HEATOFIGl"TTION ..... I MATERIAL FIRST IGNITED WAS MADEOt _ J II lITEM FIRSTTGNTTED: 5''''M--t~<DV~~ \~r>1- \P,.."lor...lol......V\Q.s~LG ~k:. 15 LEVELOFFIREORIGIl" U 10toItfeet U 30to49ftet U (h'er 70 feet ~ Gradl'Il"'elto9feet 0 20to~feet;. o 50 to 70 feel DObje(uinFlight 16 \'ALUE Building :2' ContenU Vl'hiclrandContents ,1)0 {)O 0 ,00 :.I 'f 000 ,00 / {) 000 .Jd o~ () MODEL ~hc.J- O"C.. ()ll~~-f'v-c. rri t: II. lib If e tr._ U BeIoVlgrd.lm'el o NOIClassified Other ,00 ,00 LOSS ,00 :;. 5,ooe) ,00 ....e-- ,00 ,00 , 1 i NUMBER OF STORIES ~ lato~. 18 BUJLDINGAGE(lnYean) U 50 fitories or more U2SWri5 U 5to6stories o 3tohtories 0 itn12stories I BUILDING SIZE IGmd Fir Only) ~ 1000-4999 sq ft I] 0.999.aqft 0 5000-9999~ft 19 CO:\STRUCTIo=--n'PE U HeavyTimber U Unprottct,SteelBldg o St.eel&Conc~u,,3-~hr.~rol. 0 Prott'Ct.StteIBld2 0 Protect. MalOnn' Elt. & Wood Int. EXTEl"T OF DAMAGE CONFINED TO: name Smoke DETECTOR PERFORMANCE I Thl'objKloforigin 1 0 I 0 ~ 1 In room oforigin-oper. ! Pa"ofroomorareaoforigin 2 0 0 0 2 Notinroomoforigin~oper. I Roomoforigin 3 0 3 0 0 3 Inrmoforigin-notoper-fitt'lOOamall 20 I Fin".raledoomp.ofonpn 4 0 4 0 0 4 Not in nn of origin-not oper. fire too small Flournfuri",in 5 0 5 0 0 5 Inroomorurigin-notopt'r.puwerdi~cnnnert SlnlCIUreofori",in 6 0 6 0 0 6 :-:ot inrm<lforiRin-nOI oper, po,",'t'r discun. Exlended beyondslructUn' nforij;:in ~ i)Sl 0 Inroomoforij:in-n(llopeT.deadball.e~' 08 =--ot in room uforipn-no(oper. dud balt.t'f)' o 9 :0;0 dt'lecwrprt'St'nt 0 10 l1ndelt~rmin\'d ~prinkler~Conlrullt'd fift': , 01 Head~ (l~lt'nt'd I, S"dllmllRe of the 1)'Pe (N/Al 90 21 IlEM!\RKS WelltherConditi(ln~lnplion8n: cI"1 ..j..... Cc'" / Y..,},;:.... N Ifyt's,who,",'iIlinnslij;:8te .s::' uc:"v\. c..:.,.. ~ j'\.. ,~ 22):suJ ~nnR..qut'~It'd '(> :~lImt~rof Injuries , " Flrt' Sen'i{'f' " Sumberurrllllllilit'S Fin,St'lvkt' Titlt, ~ ._ L41' I., " T;," D F (Jl 1f,Z o C> ... Olhf'r ," " ...,.n;m",......., '';"'''--7;)1, l' '-;7-- ,;, '",;;/ //I~I ./~' 7....-u.t..d.c "../?~ 2[, }rldili,,"al1nf,'rmHli,,nb)O(~O dL ~.,.::..e-,'\... o Salvage o NotClassifitd o Undetermined I VOLTAGE Surd-eM<\", . U Undetermined TOTAL 1:1 .,),00 11 ,00 '7 ~ ()O't) ,00 U 5OO.000aqft YES 0 NoD o nont.unbal'k Olh!'r \..I'~ ~/ .-- j (') :to 0::: en'" ..,t'" t==~ "'''' ..,.., -0 "'''' "'> ent'" t'" (') :to 0::: en'" ..,t'" t==~ ",,,, ..,,,, -0 "'''' "'> ent'" t'" (') o ::: ", t'" ~ '" .., o '" > t'" t'" :t o en .., t== '" .., ;;; '" en 7 en .., '" c: Sl c: '" '" ::a '" '" en o Z ~