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HomeMy WebLinkAbout021-190-012FIRE DAMAGE REPORT DATE:- 1-/s-63 21-19-12 2403-89E MITCHELL, Ila 983 Dewsnup, Gridley (upgrade elec ser) 16 9 FIRE DAMAGE REPORT • .u�O"a. L", 1viJ i CONTRACTJ DATE TO INSPECTOR: FOLLOWS: A O o-- Building Description: Commercial/Usage: Residential/# of Units: oma/ Currently Occupied Abandoned/Vacant Electric: / Yes Gas: ) NONE (� AS DATE: l /03 Q :ti A.P. # ZONING: - BUILDING INSPECTOR'S REPORT Condition of Electric C o 0.1 Electric currently On ,. Off Natural Propane /None Currently On Off_ Obvious Problems: tv 0"I C. Sanitation: Plumbing Working c/4-5 Well Working_ yeS Potable Water Y.LS Obvious SewageProblems e, Description of Damaged Area: rj o P Vz,� Estimate Valuation of Damaged Area: Condition of Foundation: cc) ©v Mobile Home: Condition of Utilities: 4,00d Sketch building on reverse and indicate area of damage. Date__ � P � Vi j PLS �����1• �-I-I rt0-037 "'DF/BUTTE COUNTY FIRE INCIDENT LOC DATE 08/28/2003 REPORT TIME 15:12 INCIDENT NUMBER 10009 LOGGED BY LOCAL FIRE NUMBER 10818*_ Mai �•p RO STATE FIRE NUMBER BI CASE NUMBER r J MEDICS LOCATION 995 DEWSNUP AVE RP WONDA PHONE NUMBER WILDLAND FIRES ❑ ESTIMATED ACRES STRUCTURE FIRE IRESIDENTIAL OTHER FIRE MEDICAL AIDS PRA Y10j ECC ❑ 348.4828 I REPORT METHOD 1911 FIRE INFORMATION FIRE INFO SENT HOW EMAIL BYTMJ TO STA 74 7 -DAY LOGGED INITIALS JK INCIDENT. NAME DEWSNIP PSAIOTHER START DATE 08/28/2003 START TIME 15:00 HAZ MAT DIAMOND # 5.0 COMMENTS CAUSE EQUIPMENT LAND USE DOMESTIC ACRES 0 TYPE OF ACRES DIAMOND 5 ONLY $ DAMAGE TYPE ALL OTHER DOLLAR DAMAGE r 1000.00 SAVE 100000.001 INJURIES/FATALITIES ❑ # CIVILIAN INJURIES 0J # CIVILIAN FATALITIES EMD 1:1 DES El# FF INJURIES 0 # FF FATALITIESJO FC -Q INFORMATION Incident ': FC -40 ❑ DATE OF FC -40 INC AGENCY INC # INC P# FC -40 COMP DATE ( FC -40 COMP BY County Notifications ® EARS Hard Copy Recieved ❑ EARS Checked Agenst EARS Computer ❑