2001, 09-06 Permit: 00004866 C of O WorksheetsCertificate of Occupancy Worksheet
Last Update: 9/6/01 Updated by: J.D. LARSON
Address: 1423 S BURNS RD
Parcel #: 45234.1603
Owner: FIEBELKORN, BRE
Address: 1423 S BURNS RD
VERADALE, WA 99037
Project #: 00004866
Site #: 39013
Contact: FIEBELKORN, BRE
Architect:
Contractor: OWNER
Occupant:
Permit Use: CHANGE OF USE FROM RESIDEENCE TO LICENSED CARE FACILITY
CO Use: 44461/-4-44.1 "31-7t/
Occupancy: LC -Ii Construction Type: ` Fire Sprinlder 0 FireAlarm ❑
(509) 228-0969
( ) - 0
Assembly Area
Room # / Location
Occupant Load
Special Inspection Agencies:
APPROVED FOR " 4 " GROUND FLOOR SLEEPING
ROOMS WITH " 4 " TENANTS WITH CLASS # 1
EVACUATION CAPABILITY AND A MAX. OF " 2 "
TENANTS WITH CLASS " 2 " EVACUATION CAP.
HS Bolts/ Soil /
NREC Concrete Masonry Steel Welding Drainage
❑ 0 0 0 0 0
❑ 0 0 0 0 0
❑ 0 0 0 0 0
❑ 0 0 0 0 ❑
Final Report
Received By
Inspector : HOWARD, DAN
Coordinator : BURRIS, ROBIN
Date Complete Intials
Date Complete Intials
❑ Mechanical
❑ Drainage
❑
❑ Landscaping / Irrigation
❑
❑ Parking / Paving
❑ Plumbing
dam:eking
ssability
�'' y..G'9
4-s/r
❑ Fire Sprinkler
REQUIRED APPROVALS
❑ FireAlarm
❑ Fire District FD 01
❑ Fire Iiydrants / Lock box
❑ WA DOT
❑ Critical / I-Iazardous Materials
❑ Special Inspection
❑ Grading
❑ Record drawings/Stormwater
❑ Demolition
❑ Utilities / Liberty Lake Sewer Dist.
❑ Free Standing Signs
❑ SRHD: Schools / other
❑ On Building Signs
❑ SRHD: Food Handling
❑ NREC
❑
❑ Special Inspections
❑
Certificate of Occupancy Worksheet
Last Update: 9/6/01 Updated by: J.D. LARSON
Approved for TEMPORARY CO - Field Inspector: Date: Code Coordinator:
Conditions:
Expiration Date: Fee:
Approved for FINAL CO - Field Inspector: .{/ Date:
Conditions:
Code Coordinator:
MAIL CO TO:
ADDRESS:
i c" /iP�c,l�/ar4/
J7 3 _ 5 /34./,',1/5
Date Comments
PI IONE:
Certificate of Occupancy Worksheet
Last Update: 10/24/00 Printed: 10/24/2000
Address: 1423 S BURNS RD Project #: 00004866
Parcel #: 45234.1603 Site #: 39013
Owner: FIEBELKOM, BREA Contact: FIEBELKOM, BREA-
Address:
RE-Address: 1423 S BURNS RD Architect:
VERADALE, WA 99037 Contractor: OWNER
(509) 228-0969
() - 0
Occupant:
Occupancy: LC -1 Construction Type: VN Fire Sprinkler 0 FireAlarm Fes'
-Use:---CHANGE--OF-USE FROM -RESIDENCE TO - * - - f' j
Special Inspection Agencies:
HS Bolts/ ' Soil /
NREC Concrete Masonry Steel Welding Drainage
Agency: APPROVED FOR #4 GROUND FLOOR 0 0
Agency: SLEEPING ROOMS FOR #6 TENANTS WITH ❑ 0
Agency: CLASS #1 & #2 EVACUATION CAPABILITY ❑ 0
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
Final Report
Received By
Date Complete Intials
Date Complete Intials
Approved for TEMPORARY CO - Field Inspector
Conditions:
Expiration Date:
Date:
Fee:
Code Coordinator.
Approved for FINAL CO - Field Inspector:
Conditions:
' _ Le: /e m cyCode Coordinator.
❑ Drainage
• Mechanical
•
❑ Landscaping / Irrigation
❑
❑ Parking / Paving
❑ Plumbing
❑ Smoking
❑
Accessability
❑ Fire Sprinkler
QUIRED APPROVALS
/
..------------
❑ Fire District FD 01
•
• FireAlarm
❑ Fire Hydrants / Lock box
❑ WA DOT
❑ Special Inspection
• Critical / Hazardous Materials
❑ Grading
❑ Record drawings/Stormawater
❑ Demolition
❑ Utilities / Liberty Lake Sewer Dist.
❑ SRHD: Schools / other
• Free Standing Signs
• SRHD: Food Handling
• On Building Signs
■ NREC
•
•
• Special Inspections
Approved for TEMPORARY CO - Field Inspector
Conditions:
Expiration Date:
Date:
Fee:
Code Coordinator.
Approved for FINAL CO - Field Inspector:
Conditions:
' _ Le: /e m cyCode Coordinator.
Certificate of Occupancy Worksheet
4 .
Last Update: 10/24/00 Printed: 10/24/2000
MAIL CO TO:
ADDRESS: / s,'23 _,...5- Zz....,..4
PHONE:
f_)A its491/ e ji. 7,0 2
Date Comments
AREA
. SPOKANE COUNTY
NOTICE OF INSPECTION
PROPERTY ADDRESS:
4/1.2S 5. / afi&n/S
PROJECT NO. weo {
OWNER
CONTRACTOR
INSPECTION TYPE:
.1/70.0<r- C.42.ent
STATUS OF WORK LISTED ABOVE:
NC oS
NOTES: Yys Y -1
BY:
INSPECTOR DATE
QUESTIONS? CALL OUR OFFICE:
DIVISION OF BUILDING AND CODE ENFORCEMENT
(509) 477-3675
CALLED IN:
DATE
TIME
SPOKANE COUNTY
DIVISION OF BUILDING AND CODE ENFORCEMENT
Legal Description: Parcel .No.. 45234.1603.
Owner: Bre Fi ebelkcsn
Occupancy Group: l,l
Construction Type:
Occupied As: .... C aarkge. of. Use .frau. Res
Additional Information: .. Approved or 4 g
evacuation capabil ' Cy
43)-gteptog. ...r.. .ternoftto tit .flow. 1. A .11
This Certificate is issued pursuant to Se •n 109 of the Uniform Building Code and is to indicate the above
described structure is approved for occupancy.
Building Official's Signature
THIS CERTIFICATE MUST BE PERMANENTLY MAINTAINED IN THE BUILDING OR STRUCTURE REFERRED TO ABOVE
If the building or structure is used for any occupancy other than that listed, an application for change of use shall first be made to the Division
of Building and Code Enforcement
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