HomeMy WebLinkAboutSpecial Inspection Fire Damage Report 1988-3-22
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE: OYJ~/J-,Y
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location of building ,1-70 ~'---'"
v
r:f2~~f}
ft~ ,{)_u~.fJa':'~1~
- (Dwelling, Store, l~a~eh6'Use,
Name of O\'mer
17/~~
/
Type of building
etc. )
Estimated value of building $ !< ?;Ooo
Estimated loss to building $ g{ I 00 0
Date of fire 0 3/ ~ ~/ :i-,V
Location 0' d~mag/;n b~lding ~hfl- ~j} Dr! Il:fh:--'{'~A~L)
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire -A/L) SlA?IA~f7./A!.~
MYrJM6 /~
, (Burned rafters, Beams, Joists, etc.)
~.dditional oertinent information ,lCJ ~_ _~ ~
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(~Jirinq, Outlet~, etc.)
Electrical Hazard
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CONTROL ' EXP,
NO, NO,
District of Incident ~ ' A ~ ~ /. ~ tJ --'.J
, ~, ~-~
(-I MO DAY YEAR DAY OF ,0
"u- 03 ~~ g-y WEEK 0
,2 INCIDENT ADDRESS
, IJJC7 ~ '
3 ~CCUPANTNAME(Last,First,MI) () ;, .A ",/I J
e.~, /yrl A..-l".A
4 BUSINESS OWNER NAME (Last, First, MIl ADDRESS
I) OWNER NAME (Last, First, MI)
....~4
6 FIRE REPORTED BY (Last, First, MI) p.
~r.r'1~- /(.,6d,;', .r'_
(}METHQltOF ' 0 Tel~bone Direct 0
ALARM 0 Municipal Alarm System 0
o Private Alarm System 0
8 , OF FIRE SERVICE PERSONNEL
RESPONDED 9
9 TYPEOFSITUATIONFOUND
~truct"'" Fire
o Other Prop, w/value
10 METHOD OF
EXTINGUISHMENT
STATE OF OREGON FIRE REPOR'
STATE FIRE MARSHAL
Sun
:J;:!K.Tues
o Wed
J ~tJ3
o Satur
) 7.;1
ZIP
97'177
9' ~J?~
MOD
CENSUS TRACT
"":11....
DOB (optional)
,DOB (optional)
---
ADDRESS
DOB (Optional)
TELEPHONE
,,--
ADDRESS
S-7:J
I?
~
DOB (optional)
TELEPHONE
7 i../ 7-'-11 ~ 1-
Mutual Aid (extinguisb or investigate oniy) ,
;e Received 0 Given 0 N/A
Radio
Verbal
No Alarm Rec'd
Q, 911 (Tie Line)
o Voice Signal Muni Alann
o Not Classified Above
, OF ENGINES RESPONDED
~
o
o
o
Vebicle Fin!
Brusb, Grass, Leaves
Trash, Rubbish
o Self-Extinguished
o Make-sbift aids
o Portable Extinguisher
I OF AERIAL APP AHA TUS RESPONLED
# OTHER VEHICLES RESPONDED
(do not include PA's)
(
o Otber (List)
TYPE OF ACTION TAKEN
8: Extinguish
o Investi~ation
o Salvage
o Not Classified
o Removed Hazard
o Stand By
o Automatic Ext, System
::a::: Pre-connect hose/tank only
o Pre,connect hose/bydrant, standpipe
PROPERTY COMPLEX (If applicable)
o Hand.laid hose/hydrant. standpipe
o Master Stream Device
o Not Classified Above
MOBILE PROPERTY (Complete line M)
o Undetermined
11 FIXED PROPERTY USE C /J 17 ,
I ~ rV~~/
M MOBILE YEAR MAKE ~
PROPERTY
17 NUMBEROFSTORIES B 2stories B 5to60tories
~ 1 story 3 to 4 stories 7 to 12 stories
18 BUILDI~'9~GE(lnYears) I BUILDING SIZE (GmdFlrOnly) g 1000-49998Qft
~ V 0 (}'999 8Q ft 0 5000,9999 SQ ft
19 CONSTRUCTION TYPE 0 Heavy Timber 0 Unprotect. Steel Bldg
o Steel & Concrete. 3-4 hr, Drot, 0 Protect, Steel Bldg 0 Protect, Masonry Ext, & Wood Int,
EXTENT OF DAMAGE CONFINED TO: Flame Smoke DETECTOR PERFORMANCE
-
~2 ROOM/AO~~IN
E EQUIPMENT YEAR
INVOLVED
IN IGNITION
13 IGNITlONFACTOR '/J ()
,~/ o..t'~y ,
14 FORM m' HEAT OF IGNITION
O~~
15 LEVEL OF FIRE ORIGIN
o Grade level to 9 feet
, 16 VALUE ~ ~ Building
o(fl,OC'd
LOSS
(~,OOO
1
2
20 3
4
5
6
7
The object'of origin
Part of room or area of origin
Room of origin
Fire-rated compo of origin
Floor of origin
Structure of origin
Extended beyond structure of origin
9
No damaltOoCthe type (N/A)
21 REMAliKS Weather Conditions (optional):
~2 Follow Up Investigation liequested
<.. ( \ <: -L..L I ". i;?" J. /J.
/L~ IV- 2, ~ I"~-v-.... ~U1-.J--/<.-vVI-
M~ERlAL~IRSTIGNITE6WASMADEOF I~~FIRSTIG~D:" - l
~~IU)~ 'tJ~~dt~ '
o 30 to 49 feet 0 Over 70 reet [j Below grd, level
o 50 to 70 feet n Objecta in Flight 0 Not Classified
_.r- Contents Vehicle and Contents r Other
<:J,I 0 (J 0 ,00 ,00
,00 I
MAKE
-B
10 to 19 feet
20 to 29 Ceet
--
, MODEL
SERIAL #
LICENSE #
-
,00
,00
10
:~
4 0
5 0
6 0
7 0
Y_ N V-
-
EQUIPMENT INVOLVED IN IGMTION (Complete Line E)
-1 ,'.. J,~~ ~ k~
MO~1 's!;:RIALI
, VOLTAGE
-
o Undetermined
,00
'9? TOTAL
,) lrOOd
" 9..,-00 t7
,00
.00
10
2 0
3 0
4 0
52l.
6 0
7 0
9 0
B 13 to 24 stori..
25 to 49 otori..
o IO,OOO-19,9998Qft 0 5O,ooo-99,9998Qft
o 20,000-49,999 SQ ft 0 100,000-499,999 8Q ft
o Unprotect, Masonry Ext, & Wood Int. .&. Unprotected Wood Frame
o Protected Wood Frame 0 Not Classified Above
SPRINKLER PERFORMANCE
10
2 0
3 0
9 0
o 0 Undetermined or not reported
8 'C>l. No equipment present (N/A)
o 50 atories or more
o 500,000 8Q ft
01
o 2
o 3
o 4
o 5
o 6
o 7
o 8
~9
In room of origin -oper.
Not in room of origin-oper.
In rm of origin-not oper-fire too small
Not in rm of origin-not oper. fire too small
In room of origin-not oper. power disconnect
Not in rm of origin-not oper. power discon.
In room of origin-notoper, dead battery
Not in room of origin-not oper. dead battery
No detector present 0 10 Undetermined
Equipment operated
Equip, sbould have oper,-did not
Equip, present fire too small to oper,
Not classified above
Sprinklers Controlled Fire:
# of Heads Opened
YES 0 NO 0
o cont, on back
ffyes. who will investigatp
,..---
23 Number or Injuries
Fire Serv;('e -- Other
24 Member Makin~ H.ePOr2~ r.J..k'~
25 Additional Information by
01 A "'An 1n ID at:'\
I Number of Fatalities
Fire Service
-
Other
!.-
I TitJe,-o~~
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Date
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Date OJ/:)..,:1../ rX-
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88 o.;;5~..-.I.u
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DATE: O~/JYJ-,Y
TO: Bu il ding Depa rtmen t
FRor., :
Springfield Fire Department
L1li ()
SUBJECT: Structural Damage to Building
'-'.,
"
<:.
Address or location of building j-7o {2~,-",
171 ~J r:t~pj-C~f} v
Type of bu i 1 ding ____I ~~,~ rJfJ ~\H'.-fL-1 _~
- (Dwelling, Store, \~areh6Dse,
Name of O\'mer
etc.)
Estimated value of building $ 1< S;ooo
Estimated loss to bu"ilding $ g( J Oc" 0
Date of fire 0 3/ g( a../ :i-/V
/ /) _I//J-,
Location of damage in building 1./.~AJJ-f)~"VfJ o;}_ (Lu~.J~~~.t._)
0- -
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire
(Burned rafters, Seams, Joists, etc.)
Additionai oertinent information rl(!JJ ./~'\..o ":;;_ ~ o:ii~
~~- lld~JJLd--6~
Electrical Hazard
~) ~lc~'-<:1_. ~., oXf~j Cl~~-z~-eg~/
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)2lo ,A.if{"'-t.,~...... '\..L,.' /J/l..<.....('t. ~u, (I!..-,~~~__
(\-Jirinq, Outlet~, etc.)
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