2010, 08-27 Permit App: 10002681 Adult Family HomeAdult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST
Code References: 2009 IRC Section R325 (WAC 51-51)
APPLICATION NUMBER:
SECTIONS 1, 2, 3, AND 4 MUST BE COMPLETED BY APPLICANT BEFORE INSPECTION WILL BE PROCESSED
SECTION 1 - PROPERTY INFORMATION
SITE ADDRESS: 7 O O k"5.52 . `"NV\c•rt, V4-\S\nt `'kCl'?.,1 A.„, ASSESSOR'S TAX/PARCEL#: IS _ a
SECTION 2 - APPLICANT INFORMATION
PROPERTY OWNER NAME: C_+c'- `' \t \Z • \\--\‘'')a-�'���C `, • 5
)n /� / ,
AFH LICENSEE NAME (IF DIFFERENT): CA 1- ]✓ `/ f� �� `/f !u 7 DAYTIME PHONE: 5.-0 '7 C,06_5
DAYTIME PHONE:
SECTION 3 — FLOOR PLAN
APPLICANT MUST DRAW COMPLETE FLOOR PLAN/s ON THIS FORM (ALL FLOORS). PLEASE INCLUDE ALL SLEEPING ROOMS (BEDROOMS).
ON THIS DRAWING, INDICATE WHICH BEDROOM IS A, B, C, D, E, AND F. LABEL ALL COMPONENTS FOR EXITING i.e.: STAIRS,
RAMPS, PLATFORM LIFTS & ELEVATORS.
SECTION 4 — DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and that I am requesting or I
am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I agree to hold
harmless the jurisdiction conducting such inspections, at my request, as to any claim (including costs, expenses, and attorneys' fees incurred in the
investigation of such claim), which may be made by any person, including the undersigned, and filed against the jurisdiction, but only where such
claim arises out of the reliance of the jurisdiction, including its officers and employees, upon the accuracy of the information supplied to the
jurisdiction as a part of this applicatio
NAME/TITLE:
❑ PROPERTY OWNER APPLICANT
/O
DATE:
08/01/10
NAME, OFAFH:
SECTION 5 MUST BE COMPLETED BY THE BUILDING DEPARTMENT IN THE JURISDICTION THE HOME W ILL BE LOCATED.
PLEASE CHECK ALL APPLICABLE BOXES. PLEASE ALSO INDICATE ON THE FLOOR PLAN DRAWN BY APPLICANT.
WHICH BEDROOM IS #1, 2, 3, 4, 5, on 6 AND THE CLASSIFICATION CODE: S, NSI, OR NS2 (TO MATCH THE LIST BELOW)
SECTION 5 - BUILDING INSPECTOR'S INSPECTION CHECKLIST
R325.3 SLEEPING Room CLASSIFICATION. Each sleeping room in an adult family home shall be classified as:
Type S - where the on)ly means of egress contains stairs to evacuate.
Type NS1 -where one means of egress does not have stairs to evacuate.
Type NS2 -where two means of egress do not have stairs to evacuate.
V Sleeping Room #1. I • Type Si • Type NS1 • Type NS2
YES
•
NO
•
Closet door/s are readilyopenable from the inside YES • NO • Smoke alarm is installed in the bedroom
■
■
Any smoke alarm must be audible throughout the home when activated.
Bedroom door is easily and quickly openable from the outside when locked
•
•
Sleeping room window has minimum dimensions at least 24° high; at least 20" wide -(NET OPEN-AOLE AREA OF 5.7 SF ")
•
■
"EXCEPT PER R310.1.1: AT -GRADE ESCAPE WNWAS -(MAY HAVE NET CLEAR OPENING 5 SF )
Sleeping room window has a maximum sill height of 44" above floor, no steps under window permitted
•
•
Sleeping Room #2 r • Type S 0. Type NS1 • Type NS2
YES
•
NO
■
,I
Closet°door/s are readilyopenable from the inside yES • NO • Smoke alarm is installed in the bedroom
Bedroom door is easily and quickly openable from the outside when locked
•
•
Sleeping room window has minimum dimensions at least 24" high; at least 20' wide-(NETOPEIMBLE AREA OF5.7sr ")
•
IN
" "EXCEPT PERR310.1.1: AT -GRADE ESCAPE WNDOWS - (MAY HAVE NET CLEAR OPENING 5 sF)
Sleeping room window hese maximum sill height of 44° above floor, n� steps under window permitted
•
■
Sleeping Room #3 I 0 Type S I • Type NS1 • Type NS2
YES
NO
Closet door/s are readilyopenable from the inside yEs • NO • Smoke alarm is installed in the bedropm
•
■
Bedroom door is easily and quickly openable from the outside when locked
•
•
Sleeping room window has minimum dimensions at least 24' high; at least 20° wide-(NETQPENABLE AREA OF 5.7 SF")
•
•
"EXCEPT PERR310.1.1: AT -GRADE ESCAPE WNDOWS -(MAY HAVE NET CLEAR OPENING 5 SF )
Sleeping room window has a maximum sill height of 44° above floor; no steps under window permitted
•
•
Sleeping Room #4 ` I ❑, Type S I • Type NSI. ■ Type NS2
YES
140
Closet door/s are readily openable from the inside yEs ■ NO • Smoke alarm is installed in the bedroom
•
■
Bedroom door is easily and quickly openable,from thebutside when locked
•
•
Sleeping room window has minimum dimensions at least 24° high; at least 20' wide -(NET OPEN -ABLE AREA OF 01 SF "")
•
•
"EXCEPT PER R310.1.1: ATGRADE ESCAPE wNOOWS 7(MAY HAVE NET GEAR OPENING 5 sF )
.Sleeping room window has a maximum sill height of 44" above floor; no steps under window permitted
•
•
Sleeping Room #5 I • Type S I 0 Type NS1 ■ Type NS2
YES
140
Closet door/s are readilyopenable from the inside yEs • NO • Smoke alarm is installed in the bedroom,
■
■
Bedroom door is easily and quickly openable from the outside when locked
•
■
Sleeping room window has minimum dimensions at least 24°high ; at least 20" wide -(NET OPEN.ABLE AREA oF5.7 SF")
•
•
e'EXCEPTPER R310.1.1: AT -GRADE ESCAPE WINDOWS -(MAY HAVE NET GEAR OPENING 5 SF )
Sleeping room window has a maximum sill height of 44" above floor; no steps under window permitted
•
•
Sleeping Room #6 ■ Type S I ■ Type N51, 0 Type NS2
YES
NO
_I
Closetdoor/s are„reedilyopenable from the inside yES • NO p Smoke alarm is installed in the bedroom
■
•
Bedroom door is easily and quickly openable from the outside when locked
■
•
Sleeping room window has,minimum dimensions at least 24” high; at least 20" wide —(NET OPENy1BLEAREA OF5.7SF j
■
•
"EXCEPT PERR310.1.1: AT -GRADE ESCAPE YWPDOWS -(MAY HAVE NET GEAR OPENING 5 sF )
' Sleeping room window has a maximum sill height of 44° above floor; no steps under window` permitted
■
■
YES NO
Bathroom doors are easily and quickly openable from the outside when locked
■
•
Smoke alarms are installed on all levels of the dwelling, in each bedroom and common areas
■
■
Any smoke alarm must be audible throughout the home when activated.
•
■
Access road and water supply meet local fire jurisdictional requirements
•
■
811109
e.
R311.6 Ramps
Inside Ramp
YES
NO
R311.6.1 Maximum Slope one unit vertical in twelve units horizontal (8.3% slope).
•
•
R311.6.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto
ramps, and where ramp changes directions.
•
•
R311.6.3 Handrails required (on both sides of ramp: per state licensing requirement WAC 388-76-10730).
•
•
Outside Ramp, , ��
„YES
NO
R311.6.1 Maximum„'Stop one unit vertical in twelve,uriits horizontal (8:3% slope). „
•
•
R311.6.2'Landing Requirements}"min.•3X31oot„landing att op/botfom,'where doors"open onto
iamps,,and,where ramp changes`directlons. , KK s
■
■
■
•
NO
WAC 388-76-10730 The AFH must install and securely fasten grab bars (not suction cup style) to meet
the needs of residents in:
R311.6.3471andrails required (on both sides dfaamp: per state"licensing regOfremelit WAC 388-76-10730)
•
•
.*,Guards,below ar`e depicted vertically as"an;exarnple only:
Guard
36" min
Less than 4"
Handrail both sides
34-- 36”
_,,1111rarwrraw..+,.- 'a
' x 3' min 114
landing a 1:12 max slope
8.3%
min
ADULT FAMILY HOME RAMP
per 2006 IRC with WA. ST. AMENDMENTS
*ALL RAMPS REQUIRE A BUILDING PERMIT*
3' x 3' min
landing
3'
min
R311 Means of Egress
YES
NO
R311.4.2 Door Type and Size' Side -hinged not less than 3 feet in width and 6 feet 8 inches in height.
•
•
R311.4.4 Type of lock or latch: readily openable from the side from which egress is to be made
without the use of a key or special knowledge or effort.
•
•
R311.5„Stairways,, „ - ..aKsKL, .„
YES
NO
R311 53 1Rser F4eigh Max hser height shall be 734 rnches (81nchpsirshucturesbuilt priori°Jay 1,2004)'
■
■
R311; 3,27read Deafif Min. tread.depth shalrbe 10'inches? (9 inches lrl s)ructures„bujlt priczto July 1, 2004)
•
■
,
R311 5.6 Handfrailslrwquired on both sides ofarieriseror more (per'state ricer tnq°requifeiiient WAd388-76110/30)
■
■
Grab Bars in Bathrooms
YES
NO
WAC 388-76-10730 The AFH must install and securely fasten grab bars (not suction cup style) to meet
the needs of residents in:
•
•
Bathing facilities such as tubs and showers; and
■
■
On both sides of the toilet (if structurally not feasible use type that affix to toilet seat)
1
■
.AG101xSwimming Pool,'Spa, Hot Tar; . 66,6 06„ „h r p
YES'
NO
AG10y>Must°be t ripunded by a:liarrier that is 4i nciies high,maj%fi0e doors „and or gates that
' ' : , ,” ,
mdst have audible'alarmn wwhenopened) ., , , ,, A:),
4-71.
■
AG1O5.5"Ef(CEPTIONY Spes or tot tuts with a safety coverlw"hich complies' with AStM F 1346 „. '
• -`
■
❑ PASSED
❑ CORRECTIONS REQUIRED
Tncorr rng •C Cir]N ATI ID F •
INSPECTOR'S ADDRESS:
❑ PERMIT REQUIRED
DATE.
PHONE.
Application and Inspection Checklist developed by Washington Association of Building Officials (WABO),
in cooperation with Department of Social and Health Services (DSHS) for use by both departments and licensors.
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