21-101117 Adutt Family Home (AFH) Lt)CA�. BUILDING INSPECTION CHECKLIST
+ - Code Ref+ersnces:zo16iRC S@ction it330(WAC 51-51)
APPLIGTION NUMBER: �4�'""' ���l j� T
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_.-_�SECTI�NS'I.2.3.AND A MtlST BE COMPLETED BY A�i1LiCANT 9EFORE INSPECTION WILL 6E PROCESSED
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<;�TE Af}p�ESS:,��._�V_1,__,_�1 T{ /,•C� v �yW'S'7 ASSESSOR'S TAX/PARCELx:yLU1(�L�Q���
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PROPERTY OWNER NAME:.___��.1�11���__�, ,��5. DAYTIME PHONE:�� �a 7l 6 3
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AFH 11(:ENSFE NAME(tr otFFeRErri):_C�'t'7 _ +.A,_ DAYTIME PHONE:.�0��C7s-'��J_'��g
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t�n a separate sheet of papec (8 �/z �c 11) draw a f�oor ptan (including ai!
�t�ors) of your prospective AFH. In�ude atl steeping rooms {bedrooms)
�ndicating which bedroom is: A, B, � D�;E and F.
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i�abe� alt Ctamponents for exiting i.e., stairs, ramps, platforms, lifts and
el+�rr�tors. �
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[ �_��rt fy under penalty of perjury that the informatlon fumished b me is ue and correct to the best of my knowledge, and that I am
:cr;�,eshng or I am authorized by the owner of the aboae premi�s to r�auest ir�spection for the operation of an Adult Family Home
a�?:t��s location. I agree to hold harmless the jurisQiction cond rig suct�mspectfons, at my request,as to any claim(including costs,
�z�enses,and attomeys'fees incurred in the investigation of such aim), which may be made by any person, Inciuding the undersigned,
and f�led ayainst the jurlsdiction, but only where such claim ar�s out of the reliance oi the Jurisdiction, including its officers and
etnpioyees, upon the accuraty of the information supplied to fihe jurisdiction as a part of this application.
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❑�'ROI"E:ft'1'Y OW�IER �APPLICe�NT �LICENSEE
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� " Implementation Date: 2021 February 01
� ' Updated: 2021 February
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� SE� '•�"� MUSf St+;:G:4,F�cT£D BY 7NE$�3t��E�f�[}�#��R�'1�lM�T�l�THE 1tJRtS[}tETION TNE HOIVIE Wlll BE LOCATED.
; pLE:�S�E�HECK ALL APPUCABLE BOXfS,E�rlA�G�THE UST B�L�}t�4fTd THE APPLIGANT'S FLOQR PLAN-tJSING THEiR PROSPECTfVE
Y;
F ::�a'�-9�OR��OM �ES�GNATiQ!�S t�E a B�t►EAfi+lU FA�i��CLAS�[FfCAT10N CODE 5,N5i OR N52.
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�330.3 SJeeping Raom Gassifitatian: Each s�p�n�r' , in an Adult famify Home shall be cfassified as:
i ype S-where the rneans of egress contains sta+rs,elevators�or pla�orm lifts ta evacuate residents to public area.
'�'ype N51-.vhere 1 n�eans of egress at grade level(has no sfairs)or ramp constructed compliant with R330.9 is provided to evacuate
.:�uent�to public area.
Type N52-where 2 means of egress at grade levet(both have no stairs)or ramps constructed compliant with R330.9 are provided tq
�a�uatesasulenis to pliblic area.__T_ ,
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SLEEPING ROOM A , '; `�ype 5 Type NSl Type N52 YES NO �
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, Ciasei door/s are readily openable from the inside Yes �Na' /A Smoke alarm is installed in the bedroom Q
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{ 8edroom door apens easily and quickly from the outside wt�en locked � _�
S Sleeping room window has a net opening of 5.7 SF(minimu�dimensions at least 24"high;at least 20"wide) Q �
� EXCEPT per R310.2.1:at-grade escape windows-may have'net t�earance openi�g S SF
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,�:�-���.' has a ana�rr�um sU{-heigf�C bf � a4�nv+� � rtrr ttear eni •no ste s under w'tndow aUa�dted (�_ Q .�...
.r.._,____ SLEEPlNG R�C?M 8 ' ' :�' ' .ype S � Type NSi Typ+e N52 YES NO
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� Closet door/s are readily openable from the inside f lfes N /A Smoke alarm is installed in the bedroom
; Bedroom door opens easily and quickly from the outsi'de w en locked 0
{ Sleeping room window has a net opening of 5.7 SF(minimu dimensions at least 24"high;at least 20"widey � (�
: EXCEPT per R310.2.1:at-grade escape windows-ma�have net c�e�'a�rance opening S SF
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�..t,�Ll�piwg.r.wc��»w�dow has a+�axamum sd!hei ht a�f�i4 ah�cive�fd'r to clear opening;no steps und�r window aDa�,ted Q _Qs ...
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SLEEPING ROOM C ; ype 5 Type N51 , Type NS2 YES NO
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� Clnset door/s are readily open�ble from the inside Yes �lao� ��t/A Smoke alarm is installed in the bedroom �_
� Bedreom door opens easily and quickly from the outside w en locked � Q �___
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' Slnepir,g room window has a net opening of 5_7 Sf(minimulh dimensions at least 24"high;at least 20"wide) � �
i p _ g p y net de�rance opening 5 SF
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EXCEPT er R31C.2.1:at rade esca e win ows-ma Mave v�fl �f to clear Openin ;no steps under window allowed �_ _[l._ =� -
�reen�rwndow has a�ma�nmum sill hei ht of 114 abn
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SLEEPING ROOM D ype S Type NSi Type NS2 YES NO
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' Closet door ,are readil o enable from the inside Yes Q (�N/A ' Smoke alarm is installed In the bedroom� �
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�ed�oom -�ocr open;easily and quickly from the outside w en loclted f Q �_�
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' Sleeping room window has a net opening of 5.7 SF(minimu dimeinsions at feast 24"high;at least 20"wide) �-� � i
' EXCEPT per R310.2.1�at-grade escape windaws-fna�y have net'c�e�arance opening 5 SF �
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> ���inR•�rt►en►windvw has a-m�cimum sill height of A4'"abov"e'ff �r to clear opening;no steps under window allowed Q.
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SIEEPING RC3.OM E � � ' ype 5 Type NSi Type NS2 YES NO
C'�se!�ioorJs are readdy openable�rom the instde (�1�es (,�Mo, �1/A Smoke,alarm+�instal{ed in the bedraoEm
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t-�>cir�am doc+opc ns easily and 4uickiy frorn the outsi�fe loc�Ced ____�. Q_ 0__�
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' ���ep;ng room w�ndow has a net openingaf S"7 SF{minimu dimehsi�xts�`t ieast 24"high;at least 20"wide) Q ❑ ,
` EXLEPT per R310 2.1:at-grade esca�ae windows-�m�y have net d{earance opening 5 SF f
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��+v►�►�eam vw�+c�c►w has a-r�a�imurn sill heighf of 44"above fl0'r ta clear opening;�o sieps under window allo�nred Q._ �,._r....,..�
SLEEPING ROOM F `; �' Type S Type NSI ��T--ype N52 YES NO �
`��.^�set doorJs are readily openable from the iqside Yes �_ -- A Smoke alarm is installed in the bedroom (� �
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� n�oom door opens easily and quick(y from the outside w en locked _ __ . 0 _Q_�
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51��eping room window has a net opening of 5.7 SF(mi�imu'�dimensions at least 24"high;at least 20u wide� � 0
EXCEPT per R310 2.1�at-grade escape windows-rn�y,have:neC dle�arance opening 5 SF
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*�repm�rolrretovr has a-nrrncimum silt height of 44'abovA�Iq�r to cleaz opening;no steps under window allowed _0_ Q �
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� � � � Implementation Date: 2021 February 01
� lfpdated: 2021 February
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GENERAL j I YES NO
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°_ �-•� r�iaihroom doors are easily and quickfy openable from the outside�}rhen locked 1]
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� c.arbon Monuxide alarms are instalied as required inR315 o�each�evel ofthe home. 0
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� Smoke alarms are installed on ait levels of the dwei#ing,in e�ct�resident sleeping room,outside each separate
i sfeeping area in the immediate vicinity of sieeping rooms(R�14}. -� 0
! Smoke and Carbon Monoxide alarms are instalied in suth a rnannet so that the audible waming may be heard in all �, a I
part� af the dwel{ir>g upon activation of a singJe deviCe. ` i
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`� c?����a�and water supply meet local Fre jurisdictional cequirert�ents. � ,
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a ��Y d Jperab'e parts of door fiandles,pu11s, �atches, locks�nd other devices installed in AFH shall be operable � O �
; „r,Tr, one han� and shall nat require iight grasping,pinching�pr twisting.ofthe wrist(lever�typej�_
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' �oc:et�aQrs shall have graspable hardware available when:in the closed or open pasition. (� �
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i fF3I1'.�tt�rttp5�` �„t , .......�,..___._. YES �NO
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. �,311.8.1 Maximum Siope one unit vertical in twelve units horizontai{8.3%sfope).�ExCeption R311.8.1 Not allowed in Q �
I R330.9)
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; R311 8 2 Landing Requirements:min.3X3 foot landing at top/bottqm,where doors open anto ramps,and where
� ramp_changes directions. �� 4 b � � 0
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,:: :: �Fi3.iD.9.1k1�a�lsr.e4u'ued.op hoth sides of ram . � ' '
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Outsfde Ram / � � p , � YES NO
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'• k312.8.1 Maximum Slope one unit vertical in twefve units h riEontal(8.3%slope).(Exception R311.8.1 Not aliawed in fl [� ;
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; R330.9
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i H3i1.8.2 Landing Requirements:min.3X3 foot ianding at t b ttom,where doors open onto ramps,and where � � �
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, ramp changes directions. • ; i
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��30.9 1 Handrails re uired on both sides of ramp. '
R312.1.1 Guards shalf be located along open-sided walking s#�rfac� ,that are located more than 30 inches measured 0 �
verticaE{y to the floor or grade below at any point within 36 i ches i�orizontally to the edge of the open side.
i e�uards belaw are depic_ted vertically as an example only. � ' � '
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�--Hand�il both sides
_: I.• I.ess than 4" / 34" -,8" �
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3 -- -= �- One unitvert7c{al,in twehreuni�.s horizontal �..----- 3'-----;
, _ ;nin�mum is an 8.31 slope aFl al,oi�g sur'�aFe of the ramp. n�inimuin
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„ ., � , , . Impiementation Date: 2021 February 01
�� �� Updated: 2021 February
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R311.2 Means of Egress ' � i YES � NO�
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� �t311.1 Dvor must be side hinged with mm width of 32 inches betweer�face of door and stop.Height not less than 78 inches.
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R330.4 Ope-ab!e parts af dt�or handles,puils,latches,locks and�ther dlvices ittstailed in AfH shail be operabte with nne hand
a�id shaN ro_recuire tight graspin , inching or twistin of the `ist(lever-type}. �
! R33C.�Required exit door hardware shall unlock inside and ouc dP R�erFtaniSmS whPn exiting the huilding allt�wing rw_Rntry �J j�
w tnc � e cf�ce�,too!or eciai knowiedge. ` �
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R311.T Stairways i N/A �^� � � YES NO
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� '_., 5 Pise HPi�ht Max riser height shal!be 7% inChes(8 inchRs id structures built priorto July 1,2004� � �
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� �t��3.7 5 P Tread Oepth Mm tread depth shall b2 in 10 inches�9 inche;in structures built prior to July 1,2004) � ^l_,
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?.i?Ci.10.i Nardrzii5 foi Treads and Risers shail be installed an bbth sides of treads and risers numbering frorn one riser to rnultiple a i �
nsen.iiandrails shall be installed in accordante with R311J.8.1►-R311.7.8.4
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R330.8 6�ab Bars in Bathrooms N A �- � YES NO
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Grab bars shall be installed for all water closets(toilets),bathtub�and showers according to R330.8. �
wair�elu��c�(wile�)5��a11 I�ave grab bars Inscolleb on boet7�lara ac.cor ng io Ry3U.25.3 _Q_�
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E��th+.ubs shall have two vertica!and three horizontal�rab bars instalied:according to R330.8.4
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+ Shower stalls have iwo verticaf and horizontal grab bars mounteEt on all sides of shower according to R330.8.5
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��ower s�alls must be minimum size of 30 inches deep by 48 incl�es lon�(R330.11} ,, Q
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BUf1.DING DEPT.INSPEGTbR'S 111AME(PRINl') � + }
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BUILDIN6 DEPT.INSPECTOR551GNATURE pATE:
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' " . A'DDRESS'" " � OFfICE VHONE NUMBER. V � t
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=app��catien and inspF�ction checklict developed by Washington Associatio�ot BuFlding Officials(WABO),i�cooperalion with Department ot Social and �
ri_�,,Ir� �i�_ <jn c,c,�(n�,�tie h��both�i��7r2ments and licensors in accc�dance With WAC 38&-76107W. f
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, Imptementatian Date:2Q21 February 01
' Updated: 2021 February
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