HomeMy WebLinkAboutInvestigation Report - FIR Inspections - 12/16/2010 MASON COUNTY FIRE MARSHAL
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FIRE
INVESTIGATION
REPORT
Completed by:
MCFD Incident #:
MCSO Case #:
Incident Date:
Address: /8/ w L-,74-�F- RGyPi A4
Mason County Bldg. III — P.O. Box 186— Shelton, Washington 98584—
FAX (360)427-7798— PHONE(360)427-9670 ext. 273
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Fire Investigation Report
By.
MCFD Incident M
MCSO Case M
Incident Date:
Address: 1 / 14" 1-1 M-6 tTGy/�r
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Z. Genera/Incident Information
Date: 1 - )6 Oo1 a
Address: j g/ L./ L /lrl�F- LAG yp?`
Reporting Party:
Call Type:
Time of Call:
Dispatched:
2, Building Information a �3
Building Construction Type:
Building Use:
Fire Alarm System:
Automatic Fire Sprinklers:
Obstructions to Access or Fire Protection Equipment:
Position of Doors & Locks Upon Arrival:
3. Occupant/Owner Information;
Occupant: s7-1y c.,�7 t_ 1-1,0
Occupant Phone: La
Owner:
Owner Phone:
Owner Address:
4, Insurance/Loss Information:
Insurance Company:
Agent:
Agent Phone:
Agent Address:
Policy #:
Policy Amount:
Estimate of Loss Structure:
Estimate of Loss Contents:
5. Origin and Cause ��
Area of Origin: 1°�
Point of Origin: U �yMiNL'�
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Fire Investigation Report
By:
MCFD Incident#:
MCSO Case #:
Incident Date:
Address: ! ��i?L
Incident Narrative;
DESCRIPTION PL
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OBSERVATIONS:
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DOCUMENTA TION:
OPINION:
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12/16/10 SHELTON POLICE DEPARTMENT 2141
23 : 34 FIRE Incident Table : Page : 1
Incident Number: 10-FM0039
Nature : 24B.Vehicle
Addr= 181 W LITTLE EGYPT RD Area : F089 DAYTON
City: Shelton ST: WA Zip : 98584 Contact : cont
Complainant& 143873
Lst : Mounts Fst : Robin Mid: E
DOB : 04/04/60 SSN: - - Adr= 581 W MAPLE ROCK RD
Rac : W Sx: F Tel : (360) 490-1293 Cty: Matlock ST: WA Zip : 98560
Condition Codes : Reported: FIRE Observed:
Circumstances :
Rspndg Officers : E161-Any Unit
Rspnsbl Officer: E161-Any Unit Agency: MCF
Received By: Riffle,Barbara Orig Number:
How Received: T Telephone CAD Call ID: 10-037618
When Reported: 20 : 20 :39 12/16/10 Last RadLog: 23 : 18 : 20 12/16/10 '.,A
Occurrd between: 20 : 20 :39 12/16/10 Disposition: ACT Disp Date : 12/16,1/10
and: 20 : 20 :39 12/16/10 Misc Entry:
MO:
Narrative :
Supplement :
INVOLVEMENTS :
Type Record # Date Description Relationship
NM 143873 / / Mounts, Robin E *Complainant
CA 10-037618 12/16/10 20 : 20 12/16/10 24B.Vehicle *Initiating Calk
FIRE Incident Responder Detail
Responding Officers
Seq Name Unit
1 E161-Any Unit E161
Main Radio Log Table :
Time/Date Typ Unit Code Zone Agnc Description
23 : 18 :20 12/16/10 f FM1400 OA F089 MCF incid#=10-FM0039 DISPATCH all
23 : 17 : 14 12/16/10 f E162 BIQ F089 F16 incid#=10-16F161 Back In Q_:art
23 : 03 : 05 12/16/10 f FM1400 ER F089 MCF incid#=10-FM0039 DISPATCH ,-all
22 :49 : 57 12/16/10 f F16 OS F089 F16
22 :49 : 53 12/16/10 f F1605 RET F089 F01 incid#=10-1F0280 Returning fro
22 :49 : 40 12/16/10 f E161 RET F089 F16 incid#=10-16F161 Returning fro
22 :49 :40 12/16/10 f E162 RET F089 F16 incid#=10-16F161 Returning fro
22 : 30 : 18 12/16/10 f F1100 OS F089 F11
22 : 30 : 04 12/16/10 f R61 OS F089 F06
22 :29 : 56 12/16/10 f E111 OS F089 F11
22 :29 : 00 12/16/10 f F11 OS F089 F11
22 :28 : 57 12/16/10 f F1105 OS F089 F11
22 :28 : 56 12/16/10 f T111 OS F089 F11
Time/Date Typ Unit Code Zone Agnc Description
22 :20 :48 12/16/10 f E111 RET F089 F11 incid#=10-11F366 Returning fro
22 :20 :42 12/16/10 f F11 RET F089 F11 call=94f
22 :20 :42 12/16/10 f F1100 RET F089 F11 call=94f
22 :20 :42 12/16/10 f F1105 RET F089 F11 call=94f
22 :20 :42 12/16/10 f T111 RET F089 F11 call=94f
22 : 14 :26 12/16/10 f R61 AR F089 F06 incid#=10-6F0304 Arrived cA Sc
22 : 07 : 39 12/16/10 f FM1400 AR F089 MCF incid#=10-FM0039 Arrived w Sc
21 :41 :20 12/16/10 f T111 CL F089 F11 incid#=10-11F366 Clear, ba7k i
21 : 15 :23 12/16/10 1 1P49 CM L089 MCS incid#=10-17607 Completed :all
21 : 04 : 56 12/16/10 1 1P49 ASN L089 MCS incid#=10-17607 Assigned to Ca
21 : 04 :47 12/16/10 f 1P49 ER F089 MCS incid#=FIX-084 Enroute to Call
20 : 53 : 50 12/16/10 f FM1400 ER F089 MCF incid#=10-FM0039 Enroute to Ca
20 : 51 : 34 12/16/10 f F16 NOTE F089 F16 incid4=10-16F161 fire marsnall
20 :42 : 53 12/16/10 f F16 NOTE F089 F16 incid#=10-16F161 fire knoc: ed
20 :42 : 31 12/16/10 1 MCS OS L089 MCS
20 :42 : 27 12/16/10 f E162 AR F089 F16 incid#=10-16F161 Arrived of Sc
20 :42 : 03 12/16/10 1 MCS ASN L089 MCS incid#=10-17607 Assigned t . Ca
20 : 37 : 46 12/16/10 f F1105 AR F089 F11 incid#=10-11F366 Arrived c. Sc
20 : 34 : 33 12/16/10 f E162 ER F089 F16 incid4=10-16F161 Enroute t _ Ca
20 : 31 :46 12/16/10 f E161 AR F089 F16 incid#=10-16F161 1 veh and 1 m
20 : 28 :28 12/16/10 f E161 ER F089 F16 incid#=10-16F161 Enroute t:: Ca
20 :25 : 58 12/16/10 f E111 ER F089 F11 incid#=10-11F366 Enroute t . Ca
20 : 25 : 58 12/16/10 f F1100 ER F089 F11 incid#=10-11F366 Enroute to Ca
20 :25 : 58 12/16/10 f T111 ER F089 F11 incid#=10-11F366 Enroute t ,, Ca
20 : 25 : 01 12/16/10 f F16 ER F089 F16 incid#=10-16F161 1625/1640 cal
20 : 24 : 48 12/16/10 f F11 ASN F089 F11 incid#=10-11F366 Assigned za C
20 :22 :46 12/16/10 f F1605 ER F089 FO1 incid#=10-1F0280 Enroute to Ca
20 :22 :37 12/16/10 f F16 ASN F089 F16 incid#=10-16F161 Assigned '-o C
20 : 22 : 37 12/16/10 f F1605 ASN F089 F01 incid#=10-1F0280 Assigned - o C
12/16/10 SHELTON POLICE DEPARTMENT 2141
23 : 32 CAD Master Call Table : Page : 1
Long-Term Call ID: 10-037618
Active Call : 94 Nature : 24B.Vehicle Type : if Priority:
Address= 181 W LITTLE EGYPT RD City: SHE Shelton
Between: W PYRAMID CT & W SHELTON MATLOCK RD
Zones : f& F089 & & Determinant : Alarm:
Directions :
Complainant& 143873
Lst : Mounts Fst : Robin Mid: E
Adr= 581 W MAPLE ROCK RD DOB : 04/04/60
Cty: Matlock ST: WA Zip : 98560 SSN: - -
Tel : (360) 490-1293 Race : W Sex: F Prev Calls& Wants& Adr&
Alrt :
Contact : cont Tel : (360) 490-1293
Address : c jenson /owns property
Info: (See below)
License Plate : State :
Calls& 7 Dupl& 0 Names& 4 w/Alrts& 1 Wants& 0 Prem& 0 Adr& 0
How Rcvd: T Telephone Occurred between: 20 :20 : 39 12/16/10
Rcvd by: Riffle, Barbara and: 20 :20 : 39 12/16/10
Hld Until : / / When Rptd: 20 :20 : 39 12/16/10
INVOLVEMENTS :
Type Record # Date Description Relationship
LW 10-17607 12/16/10 24B.Vehicle *Initiating Cali
FR FIX-084 / / <No access allowed> *Initiating Call
FR 10-11F366 12/16/10 24B.Vehicle *Initiating Call
FR 10-16F161 12/16/10 24B.Vehicle *Initiating Cali
FR 10-1F0280 12/16/10 VOID NUMBER *** *Initiating Call
FR 10-6F0304 12/16/10 VOID NUMBER *** *Initiating Call
FR 10-FM0039 12/16/10 24B.Vehicle *Initiating Call
NM 143873 / / Mounts, Robin E *Complainant
Call Taker Comments :
camper on tire . .
20 :21 :29 12/16/2010 - Riffle, Barbara
motor home next to it . .w/no way of moving it . . camper engolfed w/flames and
explotions . . . .
Thu Dec 16 20 : 21 : 58 PST 2010
8 to 10 ft from a structure . . no one shud be in the camper
20 :41 :26 12/16/2010 - Jensen, Kelly
per fire would like le to respond to location as there has been many incidents
there
Mason County Fire Marshal's Office
CONSENT TO SEARCH AND SEIZURE
Name of Person Giving Consent
of
Address
Give consent to the Mason County Fire Marshal's Office
To enter the entire premises / property described as
Without a search warrant and determine the origin and cause of the fire and/or explosion
which occurred on or about ;to enter all areas of the premises and or
property even those where the fire and/or explosion did not cause damage—and to search and
seize evidence which may be relevant to the investigation.
I agree to allow investigators from the Mason County Fire Marshal's Office (and others
assisting them)to take photographs and videos of the premises and or property,to remove
debris, materials, documents or other property, knowing that they may be submitted for
examination, analysis and testing.
I understand that this examination of the premises and or property may take more than one
day and agree to allow the entering and remaining in or on the entire premises or property for
as long as necessary.
I understand that if I do not give consent, no one may enter the premises and or property
without a search warrant. I give my consent voluntarily, without threats or promises of any
kind.
Signed Date � � _Time ����
FIREFIGHTER OBSERVATION REPORT
Incident Location �!/ �,J ,�� e
Incident Number Shp/ Date of Fire
Report Writer �j �i�c��/I/�l/7.���5 Date %at/,6-/U
RESPONDING
Vehicle responded with,= / Position of apparatus I"-'-IR5%
rivate, engine or truck) (first, second, third)
Final approach route
Were you first to arrive at scene? -e-5 If not, who was?
(first, second, third)
Obstruction to response or building access? ✓�.��
APPROACHING THE SCENE
Visible flame? -oS From where? ,�, /� �-,Tye- �Z� Color D-1.a fTf
Visible smoke? YZ 5 Color w
Locations from which smoke was emitting Gov
Persons or vehicles leaving scene
(Windows, doors, chimney, roof, etc.)
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(Color, type, model, license, or physical description of persons)
ARRIVAL AT SCENE
Approx. number of spectators l Recognize anyone acting unusual?
(Name, address, sex, race, age, height, build, complexion, hair color, etc.)
Did anyone offer their help? Who?
Police Officers on scene? (i/u _Who? (Description of individual)
Hydrant Problems? /V/sue}
(Broken stem, tight cap, stripped threads, parked cars)
Siamese or P.I. problems? /V 4
(Plugged, tight cap, stripped threads, etc.)
MASON COUNTY FIRE MARSHAL
P. O BOX 186
SHELTON, WA 98584
SECURITY OF BUILDING
Where did you initially gain entry? 7'--
Was forcible entry necessary? �`'� Was door (window) damaged?
Location of window and doors you entered or opened for access or ventilation (were they
locked, standing open? broken?, etc. ;,0 7` .yoTic«f � �✓�✓v/% .2
Location of glass from broken windows (which window and was it inside or outside?
Usual openings in wall, floor or ceilings? Where?
Inoperative sprinkler heads or fire doors? /' Zz. Where? /V-*
OTHER FACTS
Describe any unusual odors and in what areas strongest �'U ✓��
Describe any unusual flammables or combustibles you suspected and their location
EXTINGUISHMENT
Describe area first extinguished to area last extinguished c f
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Was/the fire unusually easy or difficult to extinguish? Explain. jv
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Was there anything unusual about this fire? Explain. 7—,eG5&
NARRATIVE
Very briefly describe: What did you do during the fire? Use this space also to note any other
observations you feel are important which are not noted above. This material will be kept for
your information in the future and as an aid in the investigation of this fire.
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tignat&6 Date