HomeMy WebLinkAboutBuilding Fire Damage Report 1991-12-5
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FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
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DATU..?' jJ ~I
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Building'Department
Springfield Fire Department
, FROM:
SUBJECT: '"Structural Damage to Building
Address or location of building
, Name of, m'mer, ' R..., b ev- -+-
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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;
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(7
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(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,
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Dstrictoflncident So ,...~,"'\q..r; ~ \ A
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INCIDENT ADDRESS -+:
OCC!~!.~LuI'Finl'M~ r- '5 '1 ~l~ I n.
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BUSINESS OWNER NAME (Last, Fin.t, Ml)
S~lYlv
County J ~~, r-
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o Wod
o Satur
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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~
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I 'TIMEHACK Il\
SEH\'ICt-:
OIZ 13 13
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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:
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22):suJ ~nnR..qut'~It'd
'(> :~lImt~rof Injuries ,
" Flrt' Sen'i{'f' "
Sumberurrllllllilit'S
Fin,St'lvkt'
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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
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