HomeMy WebLinkAbout022-220-014P
22-22-14
R. WOMACK OMACK, W.L. 568/,B
2263 W Biggs Gridley Rd 99-66E
(FIRE DAMAGE REPORT) 99-66P
2-22- - }
s/s W. Biggs -Gridley Rd., Gridley
(addition, repairs & siding)
if -20 % r- ,
I
t+ 4
.�]�1�Z"I[. AIDS. �L.:.r 't:L
Owner:
Addres
Tenant.
Building Location: (0
Type of Inspection requested:
SPECIAL INSPECTION REPORT
r IP--
A.P. #
Date of Inspection
Inspector
/ / 1. Housing / / 2. Finan ing L -/A- Change of Occupancy to
4. Other (specify)_ ,
Present use of building: _
A. Sanitation (Housing)
1. Water closet:
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
B. Struc
1.
2. rloor consrrucrion:
3.• Wall construction:
4. Ceiling and roof construction:
5. Fireplaces:
' 6. Comments:
C. Electrical
1. Service and ground:
2. Receptacles:
3. Fusing:
4. Comments:
103
E.
F.
Plumbing
1. Fixtures connected and vented:
2. Gas water heater:
3. Gas heating vents:
4. Comments:
Other
1. Maintenance and repair:
2. Fire hazards:
3. Safety hazards:
4. Weather protection:
5. Underfloor and attic ventilation:
6. Comments:
Commercial Buildings
1. Roof covering:
2. Distance to property lines:
3. Physically handicapped: _
4. Restroom floors and walls:
5. Exits:
6. Improvements:
7. Zoning:
8. Comments:
G. Field Problems or Violations
1. Problem or violation (give complete description):
2. What action taken (give complete description):
3. What action recommended:
A.
B.
C.
Information only - file.
Hold for ten days, then write letter.
Write letter.
Other:
'AN
FC -18 (1/80)
OpIrUM I OCATInlkl
DORDER 176MITEF1
R4 R.U. INCIDENT NO. START MO. DATE YEAR
COUNTY
jnL
FIRE NUMBER FIRE NAME:
REG.1 R.U. I NO. thru
SEC.
TOWNSHIR
[KN
RANGE
[KE
�2
_L B Os
Ow
MILES
IRECTION
[KFROM C3IN NATIONAL FOREST, FIRE DIST, CITY 8 STREET NO,
. ........
............
iETC.
�b 3
P.INIDENT TYPE
IRC] FALSE ALARM
Top GOT 10OO
0
RESPONSIBILITY (AT ORIGIN) K, �n
C)DIRECT PROT. RESP.('D.P.R') \L/ STATUTORY
Ref. V STATE ZONE RESPONSIBILITY
A, WILDLAND BURNED OR THREATENED
SCHEDULE A D.P.R. ❑STATE
03 UNPROTECTED ❑DISTRICT
��FIOTHER AGENCY D.P.R. CITY'
LOCAL ZONE OCOUNTY_
LN SCHEDULE A D.P.R. 1:1 U.S-F.S.
❑ OTHER AGENCY D.P.R. (Unincorp) ❑ B.L.M.
FEDERAL ZONE ❑ B.I.A.
Q
7� " FEDERAL(except Military) D.P.R. ❑ N.P.S.
8[] SCHEDULE A D.P.R. E] OTHER FEDERAL
EJ MISCJOTHE8
('ZONE' ❑
OTHER
5 CAUSE (STARTS IN01>1&R0ONLY)*
Did not start in 1 2 o*E1 SMOKING ❑ EQUIPMENT
❑ LIGHTNING - 0 DEBRIS PLAY W/FIRE
❑ CAMPFIRE WARSON ❑ OTHER/MISC.
e:NLAND USE(STARTS IN 10"OROONLY)
�-�Ej Did �r-t -Mt ino<2�5o8 - [] FOREST INDUSTRY
X -
DOMESTIC
[DRECREATION
E] RANCH -FARM [:30THER INDUSTRY- COMRCL.
E]DUMP [:]WILDLAND
[]ROAD - [:]NON
-WILDLAND
F-1 UTILITY. RAILROAD OOTHER
n UTILITY. ELECTRIC
—\DAMAGE ( 1 "ORO ONLY)
Number $ DAMAGE
NO DAMAGE IN of I (Nearest $100)
10055 OR 80 1 Veh/DwIg 1 10 1<2 &/or 08 1 65
TIMBER &/OR
YOUNG GROWTH
WILDLAND VEGETATION
(Other than T& Y G)
AGRICULTURAL PROD
(Other than T & Y G)
DWELLINGS
&/OR CONTENTS
OTHER STRUCTURES
&/OR CONTENTS
VEHICLES & CONTENTS
OTHER
TOTAL
..................
n8A AUKI:_-5 OF VEGETATION BURNED
DIRECT
AGENCY PROTECTION
1ACRES BURNED
............ . . . . . . . . . . . . . . . ..... z
.. ...... . . . . . . .
U
ZERO
GO TO @
. .. . .... .
%ON ARRIVAL
[] I& VEGETATION FIRE ❑ OTHER, GO TO 10
ISIZE DISTANCE (Origin to head)
ACRES FEET
WEATHER (ESTIMATE AT SCENE)
WIND I DIRECTION FROM ITEMPERATURE
M.P.H. 1 .1 OF I
10
OVER PLEASE
CDF 7540-130-0118
8C
. ........
............
COF
....
ACRES BURNED
VEG.
. T
TIMBER
OTHER
WOOD
TOTAL
LAND
BRUSH
...........
...... ----------
GRASS
q17F CLASS
PROD'
CDF
❑ A .25 ACRE OR LESS
TOTAL
B 2" ACRES
U80D
❑ C 10-99 ACRES -.-XX`-
TA
STATUT.
UT
TT
RESPON.I.,
RESP
E 0
S
ACRES BURNED
❑ D 100-299 ACRES
OF
0 F
-
❑ E 300-999 ACRES
STATE
STATE
OF 1000-4999 ACRES.
U.S.F.S.
❑ G 5000 ACRES OR MORE
B.LM.
B.LA.
....... .......
W.P.R.S.'
(EX -BOR)
OTHER
FED.
K OTHER
....... .........
... ... . .....
.... .... . .
TOTAL
............
%ON ARRIVAL
[] I& VEGETATION FIRE ❑ OTHER, GO TO 10
ISIZE DISTANCE (Origin to head)
ACRES FEET
WEATHER (ESTIMATE AT SCENE)
WIND I DIRECTION FROM ITEMPERATURE
M.P.H. 1 .1 OF I
10
OVER PLEASE
CDF 7540-130-0118