09-103758 City of Federal Way
• building - Single Family
Community Development Services Permit #: 09-103758-00-SF
P.O.Box 9718
Federal Way.WA 98063-9718
Ph (253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: GEMCARE AFH,LLC a .
Project Address: 30440 11TH AVE S Parcel Number: 091900 0215
Project Description: NEW-Verification of Occupancy for Adult Family Home. ***No construction work
allowed under this permit.***
Owner Applicant Contractor Lender
ROLAND R FIGUERAS MENITO CARING
BEVERLY A FIGUREAS 30440 11TH AVE S
30440 11TH AVE S FEDERAL WAY WA 98003
FEDERAL WAY WA 98003-4120
Census Category: 434 - Residential alt/add - no change in number of units
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq. ft.) 0 0 0 0
.rtlalr ® aa
New/Additional Sq. Feet- 1st Floor 0 New/Additional Sq. Feet-2nd Floor 0
New/Additional Sq. Feet-3rd Floor 0 New/Additional Sq.Feet-Basement 0
Basic Plan? No New/Additional Sq.Feet-Deck 0
New/Additional Sq.Feet-Garage 0 Mechanical to be Included? No
New/Additional Sq.Feet-Other 0 Plumbing to be Included? No
New/Additional Sq.Feet-Total 0 Zoning Designation RS 7.2
z 10 Fixtnir s.Associated With This Permit 1!
1 Y
PERMIT EXPIRES Saturday, March 27, 2010
Permit Issued on Monday, September 28, 2009
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: t` ''om Date: i � '�'Cl
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City of Federal Way • •
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that
at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
Tenant Name: GEMCARE AFH, LLC Permit#: 09-103758-00-SF
Address: 30440 11TH AVE S
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 0 0 0 0
Owner Name: ROLAND R FIGUERAS
BEVERLY A FIGUREAS
Owner Name:
Owner Address: 30440 11TH AVE S
FEDERAL WAY WA 98003-4120
A 14
Building Official te
The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which
experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a
review and inspection as is reasonably possible(within budgetary time and personnel limitations), the City neither guarantees nor
warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every
ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon
which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises.
I
NAME OF AFH: I- C f4 � j (t
SECTION 5 MUST BE COMPLETED BY THE BUILDING DEPARTMENT IN THE JURISDICTION THE HOME WILL BE LOCATED.
PLEASE CHECK ALL APPLICABLE BOXES. PLEASE ALSO INDICATE ON THE FLOOR PLAN DRAWN BYAPPLICAN7'
WHICH BEDROOM IS#1,2,3,4,5,OR 6 AND THE CLASSIFICATION CODE: S, NS1,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 only 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.
SLEEPING ROOMS
Sleeping Room #1 0 Type S ' 0 Type NS1" Z Type NS2 YES NO
Closet door/s are readily openable from the inside YES' NOD Smoke alarm is installed in the bedroom tl 0
Bedroom door is easily and quickly openable from the outside when locked 0
Sleeping room window has minimum dimensions at least 24" high; at least 20"wide—(NETOPENABLE AREA OF 5.7 SF") 0
**EXCEPT PER R310.1.1:AT-GRADE ESCAPE WINDOWS-(MAY HAVE NET CLEAR OPENING 5 SF)
Sleeping room window has a maximum sill height of 44"above floor;no steps under window permitted 0
Sleeping Room #2 0 Type S 0 Type NS1 .R7 Type NS2 YES NO
Closet door/s are readily openable from the inside YES NO 0 Smoke alarm is installed in the bedroom yi 0
Bedroom door is easily and quickly openable from the outside when locked 0. 0
Sleeping room window has minimum dimensions at least 24" high; at least 20"wide —(NET OPEN-ABLE AREA OF5.7SF") [� 0
— _ **EXCEPT PER R310.1.1:AT-GRADE ESCAPE WINDOWS—(MAY HAVE NET CLEAR OPENING 5 SF)
Sleeping room window has a maximum sill height of 44"above floor;no steps under window permitted ZS
❑
Sleeping Room #3 ❑ Type S ❑ Type NS1 cz Type NS2 NO
Closet door/s are readily openable from the inside yap' NO 0 Smoke alarm is installed in the bedroom 0 0
Bedroom door is easily and quickly openable from the outside when locked 0
Sleeping room window has minimum dimensions at least 24" high; at least 20"wide —(NET OPEN-ABLE AREA OF 5.7 SF") ❑
"EXCEPT PER R310.1.1:AT-GRADE ESCAPE WINDOWS—(MAY HAVE NET CLEAR OPENING 5 SF)
Sleeping room window has a maximum sill height of 44" above floor; no steps under window permitted P 0
Sleeping Room #4 0 Type S 0 Type NS1 0 Type NS2 YES NO
Closet door/s are readily openable from the inside YES NO 0 Smoke alarm is installed in the bedroom ❑-
Bedroom door is easily and quickly openable from the outside when locked fZ] 0
Sleeping room window has minimum dimensions at least 24" high; at least 20"wide —(NET OPEN-ABLE AREA OF 5.7 SF") 0 0
*"EXCEPT PER R310.1.1 AT-GRADE ESCAPE WINDOWS—(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 #5 ..............0 Type S ❑ Type NS1 Type NS2 Y✓ •
C os- :•• s are readily openable from the inside YES : 1 NOD Smoke alarm is installed in the bedr 0 0
Bedroom door is easi y a • ••• . ..enable from the side, when locked 0 ❑
Sleeping room window has minimum dimensions at lea 'lie —(NET OPEN-ABLE AREA OF5.7SF**) 0 D
XCEPT PER R310.1.1:AT-GRADE ESCAPE WINDOWS— '• , •R OPENING 5 SF)
— _-- ——_-..-_...-..------...Sleeping room window h. urn sill height of 44" above floor; no steps under window permitted ! ❑
Sleeping Room #6 0 Type S 0 Type NS1 ❑ Type N ' S NO
Closet door/s are -•. , •. -:- • the inside YES ❑ NO 0 Smoke alar.. ' : - -. in the bedroom 0 0
Bedroom door is easily and quickly openable r. •- .utsi•• • •c ed 0 0
Sleeping room window has minimu - east 24" high; • •" . .e —(NET OPENABLEAREA OF 5.7 SF") 0 0
"EXCEPT PER R310.1.1:AT-GRADE ESCAPE WINDOWS— MAY ,' ' •:•PENING 5 SF
Sleep' • •• window has a maximum sill height of 44" above floor; no steps under window permitted 7 ■
GENERAL YE NO
Bathroom doors are easily and quickly openable from the outside when locked 0
Smoke alarms are installed on all levels of the dwelling, in each bedroom and common areas 0
Any smoke alarm must be audible throughout the home when activated. fjj 0
Access road and water supply meet local fire jurisdictional requirements 0
8/1/09
1110 • '
R311.6 Ramps
Inside Ramp If N/A E here YES NO
R311.6.1 Maximum Slope one unit vertical in twelve units horizontal L8.3% slope). ❑ 0
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). 0 ❑
Outside Ramp if N1 r A YES NO
R311.6.1 Maximum Slope one unit vertical in twelve units horizontal (8.3% slope). 0 0
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 i•th sides of ram.: •er state licensin. re! ir-men WAC 388-76-1p730) ❑ ❑
**Guards below are depicted vertically as an example only. ///
Less than 4" / `O
_�.. .......
Handrail both sides „ n`
7 34"—36" ( c/fJ/J�/
__ f \F!/?
Guard
36"min I ✓
warm mourmilliimum /
1.1" +wrn�,�yrw�rwar 1 3'x 3'min
in
x 3'min �r��,y I landing
landing — --
1:12 max slope
8.3% 3'
min min
AD T FAMI!;_Y HOME RAMP
per 20.• IRO with WA. ST. AMENDMENTS
*ALL AMPS REQUIRE A BUILDING PERMIT*
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 = _ YES NO
R311.5.3.1 Riser Hei t: Max riser height shall be 73/4 inches (8 inches in structures built prior to July 1,2004) 0 0
R311.5.3.2 Trea70//
epth: Min. tread depth shall be 10 inches. (9 inches in structures built prior to July 1,2004) ❑ 0
R311.5.6 Handrails required on both sides of one riser or more(per state licensing requirement WAC 388-76-10730) ❑ 0
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
needsof r sidents in: CI
Bathin facilities such as tubs and showers; and
0 0
On both sides of the toilet (if structurally not feasible use type that affix to toilet seat) ❑ ❑
AG101 Swimming Pool,Spa, Hot Tub If N/A RI here YES NO
AG105 Must be surrounded by a barrier that is 48 inches high, may have doors and or gates that ❑ ❑
must have audible alarms when opened.
AG105.5 EXCEPTION: Spas or hot tubs with a safety cover which complies with ASTM F 1346 0 ❑
❑ PASSED 0 CORRECTIONS REQUIRED ❑ PERMIT REQUIRED
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INSPECTOR'S SIGN URE: YDATE:�i�V
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INSPECTOR'S ADDRESS: PH ONE: 1` 2C
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.
8/1/09
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APPLICATION AND INSPECTION CHECKLIST - Adult Family Home
Code References: 2006 IRC Section R325(WAC 51-51)
APPLICATION NUMBER:-1°13
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SECTIONS 1,2,3,AND 4 MUST BE COMPLETED BY APPLICANT BEFORE INSPECTION WILL BE PROCESSED
,�`/
� �1 SECTION 1 - PROPERTY INFORMATION
SITE ADDRESS:B�//��`�Y"d /,)/ A"'L S gPern 1 /I4/ 10,4 e'Re'73 ASSESSOR'S TAX/PARCEL#: -
SECTION 2 -APPLICANT INFORMATION
PROPERTY OWNER NAME: gL lf1v' }/ tiet/67---iif DAYTIME PHONE: 1573`G.fC 9/F0
LICENSEE NAME(IF DIFFERENT): ,' 1/ A'/7 ' .12'W` DAYTIME PHONE: 4''..2_3•S' -3 y:1•6'
SECTION 3— FLOOR PLAN
APPLICANT MUST DRAW A COMPLETE FLOOR PLAN ON THIS FORM. PLEASE INCLUDE ALL SLEEPING ROOMS(BEDROOMS).
**ON THIS DRAWING,THE BUILDING INSPECTOR MUST THEN IDENTIFY WHICH ROOM IS SLEEPING ROOM#1, 2, 3,4, 5,AND 6 AND
LABEL ALL COMPONENTS FOR EXITING i.e. STAIRS, RAMPS, PLATFORM LIFTS&ELEVATORS.(USE BACK OF THIS PAPER IF YOU NEED MORE ROOM)
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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 further certify that I
have made application to the Department of Social and Health Services for an adult family home license and that I have also made application to the
applicable jurisdiction for the appropriate license(s) to conduct such business at this location. I further 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 application.
NAME/TITLE: ` /T' ,—c,,'r /� % DATE: L�%/2 ��'� ' �%
0 PROPERTY OWNER LTJ APPLICANT Er LICENSEE
8/1/09
cm.. ERMIT SF W CO ME EL PL DE EN FP
Federal Ways—�ELVES!
COMMUMTY DEVELOPMENT SERVICES APPLICATION / /
253-835-2607•FAX 253-835-2609
www.dtuoffederalwau.com SEP 2 8 200S
SITE ADDRESS II or
0y / 7 // 7/ AiresD f— 0 c_ i_' i/, t 4 '/goo a
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
�¢,�q v 1 / p .0 _ 0 G. / 5
NAME OF PROJECT / t/-1 4 p �
(Tenant or Homeowner Name) ( C/4 leL /-t /` if
❑BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
---t) i/t p-/C rt.)y7_ 0 A— 0cC i .' .-)►-
PROJECT DESCRIPTION /d- r—o„yy l y /' /
n
Detailed descriptioof work to ��"
be included on this permit only
; rod ' , �s . T� 1•'i
NAME PRIMARY PHONE
PROPERTY OWNER i.:3 f/,z C y/ f-/6 U /Z-rt_f' ( 3-3) 'c f - q/`I.0
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
3 606 ss-?> .s`7 /J6," 7l1-& 0,4 , t-;/4-
OWNER IS ALSO: El CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE ------
( )
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
( ) -
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
APPLICANT A4611/,Th (a r Al d ( )00 ).23s--)51 /-6
MAILING ADDRESS,/ CITY,STATE,ZIP FAX
3 0 Y 0 //,;)-/ 4h t S 1'421..-=,141-1_ t6 fi c/� t'',4-/ - ( )
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095)
( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplid to the city as a part of this application.
' SIGNATURE:glix
' - DATE i/,
/ gb"4/74
Y PRINT NAME: Mel-Ai'' //Ala
Bulletin#100-4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
MECHANICAL FIXTURES
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/shower Combo) LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes s No
.. 3*f1'1 6 - �..�-K\'�,� off"
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT ' ------------.�.---- —
FIRST FLOOR(or Mobile Home)
SECOND FLOOR :' --
COVERED ENTRY — —
DECK
GARAGE 0 CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL -
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
�..,- �; yes
s COMMERCIAL-NEW/ADIITION
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application