HomeMy WebLinkAbout030-182-006A
A.P. 30-182-6
S.T. Combs /�. BULLARD, Allen 2996B
Chico 24"45P524"45P1116 12th St. , Uroville �_
9' 7" r 4
CONTR: Foothills Const., t .
Permit 2991-73 (reroof) . __ _ _ _ _ _ - E
• 91-3924 0-182-6 x
030-18-2-006 1116 12th St., Thermalito-
MCMA I N , •DONNA (addition)
CONTR:',HOUSER,-JAMES
1 1 16 12TH ST, OROV I LLE
REROOF/SF !
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030- 18-2-006 .. Ski•- 91-3924
MCMAIN, DONNA
y CONTR: HOUSER,`JAMES
1116 12TH ST, OROVILLE
REROOF/SF
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.�r „►rtryc ►.^,,.t►a�c�+r."'`??t-`'''`r�r
- COUNTY OF BUTTE -DEPARTMENT OF PUBLIC WORKS-, PERMIT NO.
,%7f County Center Drive - Orovllle. California 95965 - Telephone: 916/538-7541—QI r
APPLICATION AND PERMIT'
ASSESSOR PARCEL NUMBER
-182—Ob
ZONING
AR
BUILDING PERMIT
OWNER yy
DONNA MCMAIN t it 1,
TELEPHONE4.076-
SQ. FT. OCC.1 BUILDING VALUATION
OWNER'S MAILING ADDRESS t t
1116 12th St, Oroville 95965
19 S 1. 40
CONTRACTOR'S NAME
James Houser
TELEPHONE
CONTRACTOR'S MAILING ADDRESS
1749 Eaton Rar #17, Chico 95926
Fireplace
COWSST;�CTION LENDER
UNKNOWN
d�•
Total Valuation .D 140
LENDER'S MAILING ADDRESS
ARCHITECT OR ENGINEER LICENSE NO.
None
Filing Fee $ 15.00
Permit Fee $
Plan Checking Fee $
ARCHITECT OR ENGINEER'S MAILING ADDRESS
C
Energy Plan Checking Fee $
Penalty $
BUILDING ADDRESS
1116 12th St Oroville
Permit fee $
PLUMBING PERMIT Filing Fee 15.00
Each Trap 5.00
Solar or heat pump water heater 20.00
LOT NO. SUBDIVISION NAME
PARCEL MAP
Water piping 7.00
Each qas water heater or vent 7.00
USE OF STRUCTURE
SF iJ'"aDuplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets 5.00
Building sewer 15.00
Mobile Home S I G I W @ 15.00
TYPE OF WORK
New❑ Addition E] Remodel UtilitiesInstallation❑ Other
Describe work: r�r--
Permit Fee $
Contractor
ELECTRICAL PERMIT Filing Fee 15.00
Main service 200A OR LESS 18.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
�I am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. /�1 I�QD Classification G
-'
❑FIXED
I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ .l, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
Main service 200A TO IOOOA) 37.50
NEW CONST./ DWELLING OCCUPM 3.64sq.ft.
OR ADDNS. ( ACC. BLDGS.
NeWC ONSTR ULTI.OUTLET 5.00
NON-RESID BRANCH CIRCUITS @
POWER APPARATUS &
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES 20 @ 76
APPLNS.
Ex. Occup. OUTLETS ((RESID,)REA.) I 3.00
Temporary service 15.00
Mobile Home Facilities 15.00
Misc. byirin 9 -15.00
Permit Fee $
—
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
f Consent to Self -Insure.
shall not employ any person in any manner so as to become subject
���JJJ to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT Filing Fee 1 15.00
Heating
Coolin g
Hood 6.50
Ventilation
it Fee
ee $ -
Contractor -
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities,, judgments, costs, f�8.expenses which may in any way accrue
against said C�,unty in.con que ce of the granting of this permit. /
X Date iiok f1
S' nn re of Applicant — Owne ❑ Contractor Agent ❑
An O5HA
permit is required for excavations over 5'0" deep and demolition or construct-FR-+"11,6!/9ion of structures over 3 stories in height.
Mobile Home Installation Fee S
Energy Inspection Fee $
OCC
CONST TYPE
I
TOTAL FEE $
HAz
DFEES
. .
IMP
FLOoo
J
coF
1
PARCEL
PD
Ho
ISS
This permit is hereby issued under the applicable provi-
Bions of f;e Butte County Code and/or resolutions to do
work )ndi ated gbQb_9IVAV_f.hich fe hivebeen paid.
DIRP BLI ' W� Q' RKS
B ; 7 --ate
PERMI V EXPIRES Date�p?
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR. GOLDENROD -APPLICANT
.r
COUNTY OF BUTTE - DEPARTMENT OF PUBLIC WORKS PERMIT NO.
7 County Center Drive - Orovllle, Cellfornla 95985^- Telephone: 916/538.7541
APPLICATION AND PERMIT
A9ESS R RC NU _.
30-182-06
SONING
AR
BUILDING PERMIT
OWNER
DONNA McMAIN
TELEPHONE
534-8763
SQ. FT. OCC. BUILDING VALUATION
19 s co RD 1,140
OWNER'S MAILING ADDRESS
1116 12th St, Oroville 9596.5
CONTRACTOR'S NAME
James Houser
TELEPHONE
CONTRACTOR'S MAILINGADDRESS
1749 Eaton Rd, #17 Chico 9.5926
Fireplace
CONSTRUCTION LENDER
None
UNKNOWN
Total Valuation $ 1 140
LENDER'S MAILING ADDRESS
Filing Fee
$ 15.00
Permit Fee
$
ARCHITECT OR ENGINEER
None
LICENSE NO.
Plan Checking Fee
$
Ener Plan Checking Fee
Energy fd
p
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
1116 12th St Oroville
Permit fee
$
PLUMBING PERMIT
Filing Fee 15.00
Each Trap
5.00
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
�r
SF ❑KXDuplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.00
Mobile Home S I G I W
@ 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities ❑ Installation❑ Other fg
Describe work: reroof
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 200AORLESS
1 18.50
Main service 200A TO 1000A)
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
;elam licensed under provisions of Chapt. 9, Div. 3 of the BUSIneS$
and Profess ns Code and my license is in full force and effect.
License No. O® Classification Iff 3
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
El 1, as the owner, am exclusively contracting with licensed contract -
ors. (Sec. 7044)
❑ I am exempt under Sec. , Business and Professions Code
for this reason
NEW CONST. OR AODNS. DWELLING OCCUP-82ACC. SLOGS. )
I
3.64 sq.ft.
NEW CONSTR.ULTI.OUTLET
NON-RESID BRANCH CIRCITS
@ 5.00
/POWER APPARATUS 8
(SINGLE OUTLET CIR. /
EX. OCCUp(OUTLETS OR FIXTURES
20 76
20cl
Ex. Occup. OUTLETS (RE 51D )RE
3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. Wiring
-15.00
Permit Fee
$
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
�f Consent to Self -Insure.
I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
Contractor
MECHANICAL PERMIT
Filing Fee 15.00
Heating
Cooling
g
Hood
6.50
Ventilation
Permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabili judgments, costs, expenses which may in any way accrue
agai said lunty in con e c of the granting of this permit.
X Date �!'o
$' n re of Applicant — Owna
pp ❑ Contractor Agent ❑
n O5HA permit is required for excavations over 5'0" deep anddemolition or construct-
of structures over 3 stories in height.
Mobile Home Installation Fee S
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $
HAz
DFEES
IMP
FLOOD
COF
PARCEL
PD
H
I E
This permit is hereby issued under the
sions Butte County ode and/or
wor indi ted Ja f hich fe
DIR B I
B fff
PE EXPIR Date 11/6/92
ap IIcable provi-
r olutions to do
ve been aid.
pon
RK$ 11/6/9
Date
103062
Receipt No.
WHITE-D.P.W., YELLOW -ASSESSOR, PINK -INSPECTOR, GOLDENROD -APPLICANT
COUNTY OF BUTTE - DEPARTMENT. QF PUBLIC WORKS
7 County Center Drive - Oroville. Californi& 95965 - Telephone: 916;'538-7541
APPLICATIA AND PERMIT
PERMIT NO.
ASSESSOR PARCEL NUMBER
30 -_ �jd2 _QQ
ZONING
BUILDING PERMIT
OWNE
TELEPHON,6
O ((!/
SO OCC. BUILDING VALUATION
OWNER'S/ A LING AC RE S
-� ,
01
CONTRACTOR'S NAME�/j• 46W y�
\Il
TELEPHONE
'a
CONTRACTOR'S MAILING AD RESS
^TftT�_ ��
Fireplace
CONSTR TIO, ENDER
/VC
UNKNO N
Total Valuation $
Filing Fee
$ 15.00
LENDER'S MAI/LING ADDRESS
Permit Fee
$ Xj,5ZF
ARCHITE T OR ENGINEER
e
LICENSE NO.
Plan Checking Fee
$
Energy Plan Checking Fee
$
ARCHITECT OR ENGINEER'S MAILING ADDRESS
Penalty
$
BUILDING ADDRESS
Permit fee
$
PLUMBING PERMIT
Filing Fee 15.00
Each Trap
5.001
Solar or heat pump water heater
20.00
LOT NO.
SUBDIVISION NAME
PARCEL MAP
Water piping
7.00
Each qas water heater or vent
7.00
USE OF STRUCTURE
SF Duplex❑ Mobilehome❑ Other
SPECIFY
Gas piping system 1 - 5 outlets
5.00
Building sewer
15.001
Mobile Home S I G W
@ 15.00
TYPE OF WORK
New ❑ Addition ❑ Remodel ❑ Utilities u Installation❑ Other ❑
Describe work: 1"14- roop
_
Permit Fee
$
Contractor
ELECTRICAL PERMIT
Filing Fee 15.00
Main service 600VORLESS
200A OR LESS
18.50
Main service 200ATO1000AI
37.50
CONTRACTORS LICENSE LAW
I declare under penalty of perjury (check one):
❑ 1 am licensed under provisions of Chapt. 9, Div. 3 of the Business
and Professions Code and my license is in full force and effect.
License No. Classification
❑ I, as the owner, or my employees with wages as their sole compen-
sation, will do the work,and the structure is not intended or offered
for sale. (Sec. 7044)
❑ I, as the owner, am exclusively contracting with licensed contract-
ors. (Sec. 7044)
❑ 1 am exempt under Sec. Business and Professions Code
for this reason
NEW CONST.( DWELLING OCCUP.&\
OR ADONS. ACC. BLDGS. //
3.56 sq.ft.
NEW CONSTR. ` ULTI-OUTLET
NON.RESIO. BRANCH CIRC 'ITS
@ 5.00
POWER APPARATUS e
(SINGLE OUTLET CIR.
Ex. Occup(OUTLETS OR FIXTURES
AIFIXED 76d
R (a 4ro
Ex. OCCUp. OUTLETS IRESIC.)RErb .�
I 3.00
Temporary service
15.00
Mobile Home Facilities
15.00
Misc. �yirin 9
15.00
Permit Fee
$
Contractor
—
WORKMEN'S COMPENSATION INSURANCE
I declare under penalty of perjury (check one):
❑ The permit is for $100.00 (valuation) or less.
❑ I have placed on file with the County of Butte Building Department
a Certificate of Workmen's Compensation Insurance or a Certificate
of Consent to Self -Insure.
❑ I shall not employ any person in any manner so as to become subject
to the W. C. laws of California.
Notice to Applicant: If after making this statement, should you become subject
to the W. C. provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked.
MECHANICAL PERMIT
Filing Fee 15.00
Heating
Cooling
Hood
6.50
Ventilation
permit Fee
$
Contractor
I certify that I have read this application and state that the above information
is correct. I agree to comply to all County Ordinances and State Laws relating
to building construction, and hereby authorize representatives of the Countyot
Butte to enter upon the above-mentioned property for inspection purposes.
I also agree to save, indemnify and keep harmless the County of Butte against
all liabilities, judgments, costs, and expenses which may in any way accrue
against said County in consequence of the granting of this permit.
X Date
Si nature of Applicant - Owner
g pp ❑ Contractor ❑ Agent ❑
An OSHA permit is required for excavations over 5'0" deep and demolition or construct -
ion of structures over 3 stones in height.
Mobile Home Installation Fee S
Energy Inspection Fee $
OCC
CONST TYPE
TOTAL FEE $ .
HAz
1 DFEES I
IMP
I FLOOD
CDF_p ARCEL
PD HD
ISSUE
This permit is hereby issued under
sions of the Butte County Code and/or
work indicated above for which fees
DIRECTOR OF PUBLIC
By
PERMIT EXPIRES Dare
the applicable provi-
resolutions to do
have been paid.
WORKS
Date
Receipt No. L�_�V(l/
/ �
PERMIT NUMBER B 2991-73B
P
E
PERMIT EXPIRES
OWNER S.T. Combs
Foothill Const., Paradise
CONTR:.
LOCATION (A.P. .30/182/6
1116 12th. St., Orovill e
0
r
COUNTY OF BUTTE
Department. of-'PtilAic Works"
BUILDING INSP,ECT•ION RECORD
Zoning
Setback
Forms
Foundation
Piers & Girders
Fireplace
Rgh. Plumbing.
Bond Beam
Lath & Plaster
Rein. Steel
Gas Piping & Test
Found. Vents
Framing
Plmg. Topout
Rough Elec.
Wtr. Htr.
Furnace
Kitchen Vent
Firewall
Garage Vents
Sanitation & Water
ELECTRIC
GAS
BUILDING 4
Temporary _
Temporary
Cert. of Occup.
Final
Final
Final
f
DATE
REMARKS OR CORRECTIONS
r
COUNTY OF BUTTE — DEPARTMENT OF PUBLIC WORKS
J'7 County Center Drive -t:Oroville, California 95965 �9�
Telephone: 534-4541
APPLICATION AND PERMIT
Signature of Permitee or A ent /
By - � Date 6
Receipt No.
oe
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Building permit expires Date . ���
BUILDING
Owner
SQ. FT. OCC. BUILDING VALUATION
Mailing Address
-
Telephone No.
Fireplace
Contractor
Total Valuation
Mailing Address '
Permit Fee
Plan Checking Fee &/or Penalty
e,
Ls
Telephone No.
7
Permit Fee $
—
Building Address
PLUMBING No. @ FEE
PERMIT FILING FEE $2.00
Each Trap 1.50
Repair drainage or vent piping 1.50
Water piping 1.50
Each gas water heater or vent 1.50
A. P. No.
Zoning & Planning
Gas piping system'1 - 5 outlets 1.50
Each additional outlet .30
FOebr
W.e-
Sa '
Fire Dept.
Fire Zone
Use Permit
Building sewer 5.00
EQA
Parking
Plans
I Parcel
Declaration
Parcel Ma P
60' R/W
Im rovements
P
Lawn sprinkler system 2.00
d
Parcel Approval
Plans Approval
Permit Fee $
$
NEW ADDITION ❑ UTILITIES ❑ OTHER ❑
ELECTRICAL No. @ FEE
PERMIT FILING FEE $3.00
Main service incl. 1 meter
Additional meters, each 1.00
Sub -panel (12 or less) (more than 12)
Single Family Duplex ❑ Mobil Home ❑ Others ❑
Range, Cook -top or Oven 1.00
Water Heater or Space Heater 1.00 ,
Light fixtures 21) 130010
Receps., switches & fix outlets 20 (a 25
CONTRACTORS LICENSE LAW
I am licensed under the provisions of Chapter 9, Div. 3, of the
State of California Business & Professions Code under the name
style of:/f
'l r¢
Hood, Ex. Fan or F.A. Furn. Motor 1.00
Evap. cooler, gar. disp. or D.W. 1.00
Air conditioner or heat pump
Water pump
Mobil Home Facilities 5.00
Temp. Power Pole 5.00
fa
License No S d Classification
Misc. wiring
❑ I am exempt from the Contractors License Laws of the State of California.
Permit Fee $
$
WORKMEN'S COMPENSATION INSURANCE
I am aware of the provisions of Section3700 of the California Labor
Code which requires every employer to be insured against liability
for Workmen's Compensation.
❑ I have placed on file with the County of Butte a certificate of
Workmen's Compensation Insurance.
certify that in the performance of the work for which this
❑ piermit is issued I shall not employ any person in any manner
so as to become subject to the Workmen's Compensation Laws of
California.
r
MECHANICAL No. @ FEEPERMIT
FILING FEE $3.00
Heating
Cooling
Ventilation
Hood 2.00
Permit Fee $
$
I certify that I have read this application and state that the above
information is correct. I agree to comply to all County Ordinances
and State Laws relating to building construction, and hereby
authorize representatives of the County of Butte to enter upon the
above-mentioned property for inspection purposes.
XDate .—
-�
TOTAL PERMIT FEE
$
This permit is hereby issued underthe applicable provisions of
the Butte County Code and/or resolutions to do work indicated
above for which fees have been paid.
DIRECTOR OF PUBLIC WORKS
Signature of Permitee or A ent /
By - � Date 6
Receipt No.
oe
White-D.P.W. — Yellow -Assessor — Pink -Inspector — Goldenrod -Applicant Building permit expires Date . ���
0
State o! California %P' *10'3 O
RESOURCES AGENCY
Der,qrtsnent of Conservation
Division of Forest RURAL FIR pGpOpT JJ'
ry
/C\
FIRE NUMBER: R2- RANGER UNIT (OR AGENCY) :
FIRE NAME:—/'Y, DATE FIRE TARTED:
If Fire Started in Another Jurisdiction, or Zone I or II, Name It: 200 "
i ---
MEMO NONE,
ZEN
SEMMON .
■■.■■■..
■.■■.
C. LOCATION. Spot fire origin. Always give section location where possible.
Otherwise give sub -division lot; R.F.D. box; cte. Sketch boundary of large fires,
roads, railroad, zone line, etc.
///6 /,� 7- 57- f1 tt zc_
0 (1-6 V I L. L C_ C- A
D. CLASS OF FIRE
Vegetation
Structural
Vehicle
Improvement
Ref use"
False Alarm
Permit Escape
SEC. TWN.1J_1lGE3 �� -0 • Includes weed burning
Fire occurred 2 A ASi�IeC—(a—) in �" � Direction from Town of '7� V /.1/`r
give number, kind, c G. DAMAGE (Do not make duplicate
F. WHAT BURNED? (a) If structure
g type of construction, acoria, size. ,(b) If � entries below)
vehicle give make, model, year, license, driver's name and address. (c) If vegetation give type and aiea..(d) If Range
other, describe fully. Standing Grain
fire-. F. , ' Harvested Crop
/.I&.5 ec ac% Industrial Bldg (s). .
lfl j3 v,-) �,tJA Non-Indust.Bldg(s). .
n/� 00 [ / Building Contents f p 0
Z l'A�t�`iti�A AT f2F�r1� Vehicle(s) ?DU
Z Vehicle Cargo
Oil or Oil Products
Vegetation Area Burned Acres TOTAL $ ? �`
H. CAUSE OF FIRE: t S C • , Known'[]; Log. 0
Fire started in/on: Known 0; Log. 0
Material First Ignited: Known[]; Log. ❑
Was "first aid" extinguisher used before crew arrived? VE/'=, 9,4,/2d ^iv
/VGvs E uf� �a r/
Did Injury or Death occur? Explain: '' }} O 7.ENHnfr
K. NAME AND ADDRESS OF OWNERS OF DAMAGED PROPERTY:
Tenants Name and Address:
L. INSURANCE CARRIER(S)
Address: IJIA
M. DESCRIBE PROPERTY SAVED AND ESTIMATE VALUE:
D"), //,;,, f foo o c?
N. HOW MUCH INSURANCE WILL PROBABLY BE PAID?
J. WEATHER
WHEN FIRE STARTED
Wind Velocity M.P.H.
Wind Direction
TemDerature
IFuel Moist.
REMARKS
--�% 2._Z�)111
Signature of(` ' . 1REPORT MADE BY: �`'��— -�-'w<Offcer in charge ` 10AA,c.-•'Ow.9.C� -V+'�
P. RECORD OF ACTI,ON ON FIRE
,LAPSED TIMES
ITEM
MO. 6- DAY
TIME
ITEM
HOURS
MINS.
TIME FIRE STARTED
7 „r
(•
- -
'DATE Time
DISCOVERY
(2.1) TIME
v_
✓ P
FIRE DISCOVERED BY INAMEI �l l ����� AT (LOCATION! �C
/'
FIRST REPORT BY (NAME) AT ILOCATION I�(J �•A
697 vz� 4r LG
Z' Z % (/�//
REPORT TIME
(3.2)
/ ;' — 7_y ,0Jw/' 7 (,
SECOND REPORT 8Y (NAMEI � � � k,) ;AT ILOC ATIONI fs,�A-
FIRE REPORTED - AT %%�/).1 I- r
DISPATCH!!
TO NAME TITLE LOCATION
,j
GETAWAY TIME
(6-5)
/>U
(J
WAS FIRST ON
OFFICER. CREW OR PATROLMAN LOCATIONv WAY TO FIRE
ATTACK TIME
O/
FIRST SUPPRESSION .oKJ"l!-I(%A�•- �!' AND/OR try�f'?/"Y• CREW•
WORK:B EGUN BY NAME TITLE � NAME
/'
(/V 17
CON TOL TIME
.. FIRE UNDER CONTROL
+�
WORK FINISHED AND LAST MAN LEFT FIRE
2
MOP-UPYIME
(9.9)
/
Q. OVERHEAD ACTIVITY (ALL MEN NOT ASSIGNED TO REGULAR CREW DUTY)
NAME 2. TITLE S. ORGAN!-
4. LOCATION
6. DISPATCHED
6. ARRIVED
7. R[T.'HOMfi B. MAN•MOU RS
Z^'ION
HOME BAS[
DAT[ TIME
- -
'DATE Time
.DAT[ � TIME CHARGEA6L[
697 vz� 4r LG
Z' Z % (/�//
/2 2i . UL)7�-
/ ;' — 7_y ,0Jw/' 7 (,
` •� TOTAL OVERNEAD TIME O ZZ6
MHO WAS RESPONSIBLE FIRE BOSS?
R. CREW ACTIVITY (ORGANIZED CREWS ONLY)
9. MAN.HOIIRR
n
r
'. VEHICLE SUMMARY
REMARKS:
6. ORGANI.
TYPE ZATtON C. NO. -
D. TOTAL E PUMPING
MILES OR WORK.
I N G HOURS
s
l
L S
osr