HomeMy WebLinkAboutPermit Correspondence 2004-11-21
DISTRICT OF INCIDENT:
te Fi.allnCident Report
COUNTY:
0347: SPRINGFIELD FIRE LIFE SFTY
20: LANE
DEPT, RESPONDING:
0347: SPRINGFIELD FIRE LIFE SFTY
ALARM DATE: 1112112004 i ALARM TIME: 1 :32:00 I ARRIVAL DATE: 1112112004
TYPE OF SITUATIONS FOUND:
111: Building fire
INCIDENTADDRESS: 2212 BEVERLY ST
CITYIZIP: SPRINGFIELD, OR 97477
OCCUPANT/COMPANY: DANIEL WALKER
,
ARRIVAL TIME: 1:36:00 I BACK IN DATE: 11/2112004 IBACK IN TIME: 3:13:00
CENSUS TRACT: 21,02 ZONE: 5
DOB: 6/22/1968 TELEPHONE: (541)747-5869
BUSINESS OWNER:
ADDRESS:
DOB:
TELEPHONE:
BUILDING/MOBILE PROPERTY OWNER: DANIEL WALKER
ADDRESS: SAA 97477-
DOB: 6/22/1968 I TELEPHONE: (541) 747-5869
REPORTED BY:
ADDRESS:
DOB:
TELEPHONE:
CAREER FIF:
18 VOLUNTEERF/F:
o I ENGINES:
3 I AERIAL APPARATUS:
! OTHER VEHICLES:
5
MUTUAL AID: 2: Received
ACTIONS TAKEN:
15: EXTINGUISH
16: VENTILATE
14: SALVAGE & OVERHAUL
METHOD OF EXTINGUISHMENT: 6: WATER FROM HYDRANT,DRAFT,STANDPIPE
~:~;~~~ USE: 41: SPECIFIC PROPERTY, UNCLASSIFIED GO TO 097 - 099
MOBILE PROPERTY INVOLVED: 98: NO MOBILE PROPERTY INVOLVED
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: 'I'
No 0
IGNIT10N FACTOR: 00: IGNITION FACTOR UNDETERMINED
FORM OF HEAT:
MATERIAL FIRST IGNITED WAS MADE OF:
ITEM FIRST IGNITED:
C: FORM OF HEAT OF IGNITION UNKNOWN 00: TYPE OF MATERIAL, UNKNOW 00: FORM OF MATERIAL NOT KNOWN/NOT REF
I
BUILDING: CONTENTS MOBILE PROPERTY AND CONTENTS: I OTHER:
ESTIMATED VALUE $140,349,00 $50,000,00 $0,00 $0,00
ESTIMATED LOSS
$20,000,00
$0,00
1 $0,00
DETECTOR TYPE:
1: SMOKE ALARM
I DETECTOR POWER SUPPLY:
! 1: BATTERY ONLY
I DETECTOR PERFORMANCE:
1: IN ROOM OF ORIGIN, ALERTED OCCU
REASON FOR DETECTOR FAILURE:
8: NO ALARM FAILURE
SPRINKLER SYSTEM TYPE: # OF HEADS OPENED: SPRINKLER PERFORMANCE:
0: SPRINKLER SYSTEM UNKNOWN/N 0 0: UNKNOWN/NOT REPORTED
REASON FOR SPRINKLER FAILURE:
0: REASON FAILURE UNKNOWN/NO
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:
o
MEMBER MAKING REPORT: Little, Le/don
ADDIT10NAL INFORMATION BY: Gordon, Gilbert
TITLE: Captain
TITLE: DFM
DATE:
11/21/2004
DATE:
~4..\~~