HomeMy WebLinkAboutBuilding Fire Damage Report 1989-6-3
"
1
STATE OF OREGON FIRE REPORT~
STATE FIRE MARSHAL lREDEP..., G).I-' 'KG
ALAHM NO., I) f .....
Dept. Responding ....5p{'iA U; f.'!L Ir.!
--
DO NOTWllITE tN TillS SPACE
CONTHOL EXP.
NO. 1'\0.
/ ;)07
County ~a1f;
, ,
o
o
Sun 0 T_ O Thur ~ Satur ALARM TIME
Mo, 0 W~ 0 Fri /l./':;-U
ZIP I
$7'-177
ARHIVALTIf.,lI.:
TIMfo:nACK IN
SERVICE
1l{f"Cf
ISO CLASS
3
INCIDENT ADDRESS
/4i'{.
CENSUS TRACT
3~
I i,113
DOBloplionall
n:LEPHONE
ADDRESS
j-"O-(; 0
DOB (optional)
'7<11. . f'{ 21-
TELEPHONE
~ OWNERNAME(Lut.Fint,MI)
ADDRESS
DOB (optional)
TELEPHONfo:
N!:."""'--
6 F1REREPORTEDBY(~t.Fin.t.MI)
\&c...U 11 /.((-, I " Gk
7 METHOD OF \ 0 TtltpnJne Direct 0 Rldio
ALARM 0 Municipal Alarm S)'Ittm 0 Verbal
o Prh'ate Alarm S)'It.em 0 No Alarm Rec'd
8 I OF FIRE SERVICE PERSONNEL , OF ENGINES RESPONDED
RESPONDED ~ ?..
ADDRESS
D08(optional)
TEI.EPHONE
:,u. "^-'-
~
o
911 {Tie Line)
Voice Signal Muni Alarm
Not Clauirled Above
Mutual Aid (ntingui. ,or in\'eltipte only)
o Recti\'ed 0 Given 0 N/A
I lOTHER VEHICLES RESPONDED
(donotinclud,PA's) ::z..
I lOF AERIAL APPARATUS RESPONDED
o Other (List)
o 88h....
o Not Clauined
o Undtt.ermined
o Vehicle Fi~
o Bnah. Grau. Leaves
o Truh. Rubbish
~~-Extinguished
~ Make.shiftaids
o Portable Extinguisher
I TYPE OF ACTION TAKEN
o Extinguish 0 Removed Hazard
o Im'estigation 0 Stand By
o Hand.laid hOlJe/h}'drant. standpipe
o Master Stream De\.it-e
o Not Classified Abo\'e
9 TYPE OF SITUATION FOUND
~ructureFire
o Other Prop. w/\'alua
10 METHOD OF
EXTINGUISHMENT
o Automatic Ed. System
o P~.conned. hose/tank only
o Pre.connecthoSC!/hydrant,st.andpipe
11 FIXED PROPERTY USE
d WE.lliN~
M MOBILE J >EAR
PROPERTY
12 ROOM/AREAOFi'IREORIGIN
Ji!lil\'~ f"" E.o\-)\ I",d/
E EQUIPMENT r YEAR I MAKE
INVOLVED
IN IGNITION
13 IGNITION FACTOR
I PROPERTY COMPLEX (lC applicable)
I MODEL
MOBILE PROPERTY (Complete tina M)
SERIAL'
I L1CJo:NSE,
I MAKE
EQUIPMENT INVOLVED IN IGNITION (Complete Line E)
(;r:'Yu/'"/<,O'" Cnrd,
MODEL I SERIAL'
I VOLTAGE
~'I.I."'~~ 1 ON
U FORM OF HEATOF IGNITION
{l J-gf{!~r.Ctj
15 ~\j::LOFFIREORIGIN
IlJ' Grade levelta 9 feet
nu(\.. [0(1& - gf(dii1J~ ~(Q Cm'I'(1)~
] MATERIALFIRSTIGNITfDWASMADEOF ~
(,','rf-. iJ'!4ldcLr-jI'"J~f('
o 10 to 19 feet 0 30 ta 49 feet 0 O\er70feet
o 20 to 29 feet o 50 to 70 feet o Objects in Flight
Contents Vehicle and Contents
.00
.00
.00
ITEM FIRST IGNITED;
wif6 INJulCtdt'il!.l
o Below grd.level 0
o NotClauified
Other
Undtlermined
TOTAL
ll.\~nrm
16
VALUE
Building
1.(0 ,{'jr'Jh
cfJOo
.00
LOSS
.00
.00
.00
.00
~-o
--D-...
~2storin 8' 5to6slories
to 3lo4.lorin 7tol2slories
'I BUILDING SIZE (Grnd Fir Only) [J 1000.4999 ~ ft
cr"O-999~ft 0 50Q0-9999sql\
19 CONSTHUCTIONTYPI-: U HeavyTimber U Unprotect.SteelBldg
o Steel&'Concrek',3.4hr.proL 0 Prot.ect.SteeIBldg 0 Prole<:L Masonry F.xl. & Wood Int.
F..xTfo:NTQio' DM..fAGECOr\FINED TO; Flame Smoke DETECTOR PERFORMANCE
-so
o 5O.toriesormoA
17 NUMBEROFSToRIF.8
o Istory
18 BUILDING AGE (In Years)
B 13lo24stories
2Sta49slories
o IO.OOO,19,999sqCt 0 5O,OOO.99.999sqCt
o 20,OOO.49.999sqft 0 IOO.OOO,499,999sqft
U Unprole<:t. Masonry Ext. & Wood Inl. g} Unprotected Wood Frame
o Prol<<ted Wood I-'rame 0 Not Cla..ified Abc)\'a
SI'RINKLgR PERI-'ORMANCI-:
o SOO.OOOsqft
I Theobje<:loCoriJjn I 0 I 0 ~Inroomofori(in-oper.
2 Part of room or area of origin 2 ~ 2 0 2 NotinroomoforilCin-oper.
20 3 RuomoCorilCin 3 0 3 0 0 3 Inrmoforigin-notoper-firetoosmllll
. Fire.ratedromp.oforigin . 0 . 0 0 . Not in rm of origin-not oper. fire too small
, I-'oorofnrigin , 0 , 0 0 , In room of origin-not oper. power disconnect
6 Structureofodgin 6 0 6 0 0 6 Not in rm oC origin-not oper. power discon.
7 Extended beyond structure of origin 0 7 0 0 7 In roomoforigin-notoper.dead b.atttry
0 6 Not in room oforill'in-notoper.dead battery
6 Nndamageofthetype (N/A) 9 l3 0 9 Nodeteclorprellent 0 10 Undetermined
21 REMAHKS Weather Conditions (optional):
I 0 F..quipment operated
2 0 I-:quip..houldh.....eoper....:didnot
3D I-:quip.prellentfiretoosmallwUpC!r.
9 0 Notclauirl('(Jabove
o 0 ~rmined or not reported
8 W"Noequipmentpresent(N/A)
Sprinklers Controlled Fire:
lofHeadsOpened
,,:so NOD
o (t)llt.llnback
22 I-'olluw Up In....esliption Rc.quested
Y_ N_
Ifyes.who....,iIIinvestigate
2:1 Num~r{Jrlnjuril'l
Fire Servire Other
24 Membt'r Making RI'Port~..lhlllJ Q J1 UVf (,
7!i Additiunallnf"rmalilln by I
J Nurnlll'ro!lo'lItalities
Fire Service
Title r <-I
.c..ftICtiN
G - 3, \!<)
OthH
Date
Title
D...
814,440.10 (R-86)
(")
:to
0:::
en'"
..,1.""'
~~
."."
-0
"''''
f)l>
I.""'
I.""'
(")
:to
0:::
en'"
..,1.""'
~~
."",
-0
~~
I.""'
I.""'
.00
(")
o
;::
'"
I.""'
~
t'l
."
o
'"
>
I.""'
I.""'
:t
o
en
..,
;:::
t'l
~
.00
en
--l
'"
c:
Q
c:
'"
t'l
."
~
en
o
Z
I.""'
-<
,.
.
.
aQOSI)&
FD-16
FIRE DAMAGE REPORT
OR
ELECTRICAL HAZARD
DA TE : r. - ~ . p, c,
TO: Building Department
FROM: Springfield Fire Department
SUBJECT: Structural Damage to Building
Address or location' of building I ~q ,~
Ra.-,iJ. !b0
Name of OI'mer Ll4rr'l Q~ij/u."
Type of building rlwr,t!iM'
I (Dwelling, Store, Warehouse, etc.)
Estimated value of building $
Estimated loss to building $
t..{O,OdO
~o
Date of fire
r.. ~ . ~ <;
Location of damage in,building
riLe Iki e (HI lAJCdl
) ,
(Roof, Wall, Exterior, Interior, etc.)
Structural weakness as a result of the fire )Q
(Burned rafters, Beams, Joists, etc.)
Additional pertinent information ~
El ectri calHazard 'A...
(Wiring, Outlets, etc.)
cc: j1J~ 0-.e. ~}(;LFLc),_
Signed ~'!"'" (2. MLW,rJfl,