20050331.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER AMEINAME OF BUWESS
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TESCP Approved E3
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EXISTING — PROPOSED
Street Use Permit Roq'd 13
Inspection Required Q
Sidewalk Required E3
REQUIRED DEDICATION— Fr
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METER SIZE
LINE SIZE
NO. OF FIXTURES
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YES 13 NO C3
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PROGRESS INSPECTIONS PER UBC108/lSC109/IRC109 FINAL INSPECTION REO'D
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECM— VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
CC
ul PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT' 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
9 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
!3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.O.
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIO��RANCE AND RCW 18.27.
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VALUATION
Description FEE Description FEE
Plan Check
State Surcharge
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Building Permit
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City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Endr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
4
APPLICATION APPROVAL
CALL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees arc paid, and
FOR INSPECTION
receipt Is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
(425)
z61— -2
771-0220
RELEASE6W DATE
ATTENTION LA I I JJJ <�
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
12 1 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: wwwdedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning - Building Engineering
November 8, 2004
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Ms. Erin Doss
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21008 76 Avenue W
Edmonds, WA 98026
RE: Building permit for Code Alert installation at 21008 V11 Avenue W, Edmonds
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Dear Ms. Doss: -
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As I informed you over the telephone, a building permit i s required for the installation of
the Code Alert system. You have advised me that it -would take approximately one
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month to receive the permit fees from your corporate, office. I am enc losing an
plication form, for your convenience. I -orward to your submittal.
ap will look f
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The permit fees based on a $1 7,000.00 bid are as follows:
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Building plan check fee $305.00
Buildin permit fee. $444.00
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Fire review $ 50.00
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Fire inspection $ 50.00
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City and State Surcharge. $ 19.50
Total $868.50,
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Thank you for your prompt attention to this matter. If youhave any questions,. please
don't hesitate to call me at 425-771-0220.
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Sincerely,
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A�ie �Ha
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Senior Pennit Coordinator
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Incorporated August 11, 1890
Sister Citv - Hekinan. Japan
rEdm d Rehabilitation
and �Teashhcare Center ECEI]\1
A- Kindred Community
JAN 3 .1 2005 ID
-1E DEPT.
EDMONDS F11'
01/27/2005
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0876 Ave W Code Alert
kef. Plan Check EF04-626 Edmonds. Rehabilitation 210
System Installation
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1) a. The electromagnetic Codelock is to be used with a Code Alert Wandering System
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and not with a perimeter alarm system. Residents who are identified by nursing as
wandering risks" will be assessed as such and will be given the code alert bracelet to C 2:
wear around their wrist or ankle. When they approach the door with the bracelet on,
the door will lock and the alarm will begin beeping as described in the manufacturer's
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information. This will alert staff to to the door and remove the resident from the
exit.,
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b. Residents who will wear the transmitter will be assessed by nursing on the day of
admission or when the have a change in condition. If the resident is confused 0
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and it is dangerous for them to leave the facility unsupervised, a code alert a
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bracelet will be placed pursuant to a physician's order to have the bracelet placed.
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2) See attached Emergency Evacuation Plan for doors that are installed with Code Lock
Exhibit A.
3) Callout emergency lighting appliances are in the vicinity of affected doors on the
er ase of
plan. Several lights by each exit run on the emergency gen ator, and in c,
power outage those lights will remain on with sufficient lighting to illuminate the.
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code alert box so that staff can continue to operate.
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4) Text for release signage is mounted on each exit door within 12" of release
mechanism on the upstream side of egress path and the maintenance director checks
that the signs are always up. See exhibit B.
.5) See Exhibit C. for signage.
fts at 425-359-6003.
Please contact Ray Zorn if you have any further questio
21008 76th Avenue West Edmonds, Washington 98026
425.778.0107 425,776.9532 Fax www.kindredhealthcore.com
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GARY HAAKENSON
CITY OF EDMONDS
MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: vAmmedmonds.wa,us
DEVELOPMENT SERVICES DEPARTMENT
Planning Building Engineering
February 2, 2005
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Ray Zorn
Edmonds Rehabilitation
And Healthcare Center
21008 716t" Avenue W
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Edmonds, WA*98026
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RE: Plan Check 04-626,,Code Alert Syst em Installation
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Dear Ray':
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Please see. attached letter fTom Ann Bullis to Erin Doss dated December 29, 20W. This
letter describes the process for requesting an Alternate Design. Please note that your
request must be accompanied by a check in the amount of $180.00. Please give me a call
if you have any questions, 425-771-0220.
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Sincerely'.
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Senior Permit Coordinator
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Incorporated August 11, 1890
Sister City. - Hekinan, Japan
GARY HAAKENSON
CITY. OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website:-www.d.edmonds.wa.us
DEVELOPMENT -SERVICES DEPARTMENT
C. BoQ3 Planning Building Engineering
March 23, 2005
Mr. Ray Zom
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Edmonds Rehabilitation & Healthcare Center
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2 1008 76 Avenue West
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Edmonds, Washington 98026
RE: Code Alert System Edmonds Rehabilitation & Healthcare Center
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Dear Mr. Zorn:
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The City. Fire Marshal has informed my office that the Code Alert System is installed at the
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subject healthcare center. Please note this system is not yet approved by the City and therefore a
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violation of the International Building Code exists. Please refer to the enclosed outstanding
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corrections required by the City Fire and Building Departments. Since exiting systems are
considered a primary life -safety component in a building I shall require that you fully respond to
all outstanding items by April 12, 2005.
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Please be aware, a key element in gaining the City's approval for this system is.t6 submit a
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fori-nal Alternate Design Request (fee $180.00) to the Building Official. The design professional
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that makes the request on behalf of the building owner must have compelling arguments and
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provide sufficient evidence as to how the design is equivalent to the affected prescriptive
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building code(s) provisions. The design professional has the full burden of proof on any claims.
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of code equivalency.
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Failure to completely respond by this established deadline shall result in the issuance of an Order
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to Correct Violation,Notice, the first step in the City's Civil Penalties Ordinance whereby fines
in rder to gain compliance. It is not the City's intent to cause this business undue
are assessed o
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hardship however, compliance to the codes is mandatory for the fair and equal treatment of all
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citizens.
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If you have specific questions about the enclosed plan review corrections contact Ms..Bullis and
Fire Marshal Westfall directly.
Sincerely,
Jeannine L. Graf
Building Official
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Incorporated August 11, 1890
Sister City - Hekinan, Japan
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 STH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: wwwzi.edmonds wa.us
DEVELOPMENT SERVICES DEPARTMENT
C)" Planning Building Engineering
April 12,2005
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Mr. Ray Zom
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Edmonds Rehabilitation & Healthcare Center
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21008 76 Avenue West
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Edmonds, Washington 98026
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RE: Code Alert System @ Edmonds Rehabilitat ion & Healthcare Center
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Dear Mr. Zorn:
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Thank you for responding to my letter dated March 23, 2005. 'Although you have n ow. provided
a letter on the egress door. changes at Edmonds Health Center, the alternate design request is. not
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complete because:
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-or the code deviation,
The request does not explain the reason or necessity f
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The request does not include or explain the over -ride mechanism and pro cedures fo r
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activation, etc.
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Also, as stated in iny last letter, the owner of the building is required to.co-sign the alternate
design with'the design professional. The City highly recommends that the build ing owner
coordinate with their insurance carrier since the special request is a. modification to the
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prescriptive requirements of the code and may expose additional liabilities.
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Please supplement the request with t he additional information requested by April 20, 2005.
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Sincerely,
Jeannine L. Graf
Building Official
ncorporated A ugust 11, 1890
Sister City - Hekinan, Japan
GARY HAAKENSON
CITY OF EDMONDS. MAYOR
121 5TH AVENUE NORTH EDMONDS. WA 98020 (425) 771-0220 FAX (425) 771-0221,
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning* Building - Engineering
Ms. Joann Croot, Director orNursing Services April 29, 2005
Mr. Ray Zorn, Area Maintenance Manager z
Edmonds Rehabilitation & Healthcare Center
21008 76"' Avenue West 0
Edmonds, Washington 98026
RE: Code Alert System @ Edmonds Rehabilitation & Healthcare Center
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Dear Ms. Croot & Mr. Zorn: 10
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-nation o the egress door changes
Thank you for supplementing the request for additional inforl 11
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at the Edmonds Rehabilitation & Healthcare Center, the alternate design request is deemed
complete.
The reason for the request is to monitor residents who are identified by the attending physician as Cn
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wonder risks. These residents may become easily confused or have a medically related delirium n
I -e outside the facility when not supervised. The proposed code alert
that causes them to be ursaf 3: E
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system places a locking mcclianisi
sound an alarm) when a code alert bracelet, worn on a patient, approaches the door. The code 0
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alert system has an override switch that is monitored by the attending nurse and doors, will
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releasewhen pressure is applied for a period of 15 seconds. Lastly, the doors deactivate when mo�
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the fire alarrn system is activated or when electrical power is lost that controls the locks or lock
mechanism. X
I have confin-ned with the State Building Code Council that State Amendments to International
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Building.Codc Section 407.8 entitled, 'Locks on exit doors' will allow approved, listed locks in
I�2 Nursing Homes (WAC 51-50-0407) effective July 1, 2005. The request for Alternate Design
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to install the Code Alert System at the Edmonds Rehabilitation & Healthcare Center is hereby
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approved.
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epartment per -n
The City shall require that representatives from both the Building and Fire D fori
an inspectio within 30 days date of this letter. Please call 425-771-
n and testing of the systern
0220 extension 1333 to schedule a Mutually agreeable day and time for the inspection.
Sincerely,
Jeannine L. G—ral"'
Building Official, C.B.O.
-all, Fire Ma
Cc: John Westf rshal
Incorporated August 11, 1890
MICROFILM
Hekinan. Japan
Sister Citv
Edmonds Rehabilitation -NOVED
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and. Healthcare Center.
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AR 2 2005
A Kindred Comt unity
PERMIT COUNTER
April 27, 2005
Jeannine L. Graf
City of Edmonds
Development Services Department
RE: Code Alert System @ Edmonds Re hab. & Healthcare
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as stated in rule-makin
1. We are asking for an Alternate Design to 113C 104 .9
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order CR- 103 that will have as effective date of July 1, 2005. The purpose of
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the amendment is to provide approval for appro ved locks in nursing homes.
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2. No structural changes or construction is necessary for the Code.Alert System.
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The nursing facility is a single story wood structure.
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The occupancy group is. 1-2. with 89 beds and anoccupancy load of 89
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10-1
residents.
3. Residents will be identified by nursing upon admission and upon change I
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condition as a "wonder risk". Whe n this identification occurs, the licensed
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call the phy ician and obtain as MD order to place a code alert
nurse will s
bracelet on the wrist or ankle of the resident. These residents are at risk
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because they may be confused or have medically related delirium that dauses
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them to be unsafe outside the facility by themselves. They will wear the
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bracelet so that when they approach the door, the door will. automatically
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lock and an alarm will sound to alert the nurse that they hav e approached the.
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door and are potentially in a hazardous situation.
4. See attached Emergency Evacuation Plan for location of affected doors, exit
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lighting and "Keep Pushing Signs".
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5. This proposal* is for mobile transmitters only.
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6. We are asking for an exemption to the Architectural requirement.
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21008 761h Avenue Wesl Edmonds, Washington 98026
425.778.0107 425.776.9532 Fax www.kin'dredliealthcare.com
MICRORLM
id Rehabilitation
d Me asIthcare Center
A Kindred Coniniunity
be
to per operation of the door locks will
7. The testin procedures verify the pro
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to have a transmitter lock the door and
I- the door lock will open within 15 seconds of a 15 lb. applied p ressure
2-the Emergency Shut Off switch will deactivate the door lock
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.3 -when the fire alarm is activated the door locks will deactivate.
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Joann Croot
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21008 76th Avenue West Edmonds, Washington 98026
425.778.0107 425.776.9532 Fox. wwwkindredhealthcore.com
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R-103 (June 2004)
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NG.ORDER (implements RCW 34.05.360
RULE-MAKI
Agency: State Building Code Council 2g Permanent Rule
Emargency Rule
Effective date of rule: I N I
Effective date of rule: Emergency Rules
Permanent Rules 0 immediately upon filing. JAN 1 0 2615
0 31 days after f iling. s than 1 31 day . s after filing, a E) Later (s'pecify)
!005 (it les
Other (specify) 4&1_2_9�
specific finding under RCW 34.05.380(3) is required and should.be stated
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below). condition to adoption or effectiveness 1&f rul
_Wn_j�other find provisions of law as P Z,
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Yes No if Yes, explain: -4
and Tiend
e_i003 —International 8uilding Code to adopt
Purpose: 0� all,lelld the Washingto tate Amendments Olt homes to IT!
ible and Usable Buildings and Facilities; to provide for approved locks In nursing
ICC Al 17.1-2003 Access tural low
ents for anchored masonry veneer, strUG
for corridors; to amend requirem
amend minimurn ceiling height -n
orcement lap splices and anchor bolt placement; and to amend plumbing fixture req.0 . irer ients.
combinations, steel reint co X
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Citation a g rules affected by this o
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Repealed: 2108, and 2910. 0
s 003, 005. 0407, 1101, 1109, 1208, 1210, 1405, 1.605, 2107 -40
-50, Section 0
Amended: WAG 51 C
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Suspended:
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for adoption: ROW 19.27.020,19.27.031 and 19.27.074 ITI z
Statutoq aut�orlty f(—
and RCW 34.05
Other authority. RCW 19.27
e ed Rule Makin
PERMANE RULE ONLY (Including xP dit g)
Adopted under notice filed as WSR 04-17-019 on August 9. 2004 (date).
Descri posed to adopted version: For 1101.2.11 the automatic do )r
-50-1707 is not adopted. Tt 3
be any changes other than editing from pro 0 -n
control switch height is changed from "36 inches" to "32 to 40 inches". WAG 51 -n
an column of Table 2902.1 is amended for clarity, including the addition of footnote 8.
occup cy
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If a p liminary cost -benefit analysis was prepared under RCW 34.05.328, a final co.st-benetit analysi is avE lable 0 co
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tacting: NIA ITI
by can C ca; J
Name: phone M 0
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Address: Z r-
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EMERGENCY RULE HLY -4
Under ROW 34.05.350 the agency for good cause finds:
servation of the pUbli >
E] That immediate adoption, amendment, or repeal of a rule is necessary for the pro tice and opportunity t z
health, safety, or generalwelf.are, and that observing the time requirements of no -1
ic interesL X
comment upon adoption of a permanent rule would be contrary to the publ r
r federal rule or a federal deadline for state receipt of federal funds equires
El That state or federal law o z
immediate adoption of a rule. 0
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Reasons for this finding. M
Date adopted: November 12, 2004 KUSE ONLY.
--.CODE,REVISE 7"ON
NAME (TYPE OR PRINT)
Stan Price
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SIGNATURE
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TITLE
Council Chair
(COMPLETE REVERSE SIDE) DORI �A
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"LE -MAKING ORDER
nq ode council P
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Effective 6
Emerg,
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Facility ED: 007702
Facility N ame*. Edm onds Rehabilitation
Sitekddress: 21008 76th Avenue west
E nionds� WA 98026
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Facility Data:
1-2 Construction Type:
Ap licable Code: 03 IBC
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Occupancy Group:
NA PrivMe occupancy: NA
Two person occupancy* NA
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Number of Apartment units:
E]13D
Not A licable
pp
Automatic Fire Sprinkler Sy stem: 013 013R
Automat ic Fire Alarm.System: Yes Not A pplicable
gy, ONot
Compailmentation. on all floors requ ired: es.
App licable
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-40,
Special Egress Control Devices: Yes
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Approved Smoke Con trot System: nYes No
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Maximum allowable licensable Beds: NA
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used for slee NA Residents
Based on size of rooms ping
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Based on size of common rooms NA Residents
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h e Departmen t of tlealth Construction Review Services.
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sented tot
sed on the info rmation pre ation to be incorrect is Subject to
The data above is ba that uses the above inforin
ility or facility Program ca
in the fac approval for licensure- A copy, of
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Any change on is not
D011 Construction Revi ew Services. Approval for constructi
review by
this certi ricate will be sent to the licensing agency*
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STATE OF WASHINGTO
DEPARTMENT Or HEALTH
APPROVED
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OCT 0 8 2004
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--�-SECT —TO ACCOMPAN ING LETTER
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AND APPLICABLE REGULATION
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plan Re. view Comments for Project 7737
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page 3 of 4'
�:NOTiCE: IF THE DOCUMENT: IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE,TO'THE QUALITY OF THE DOCUMENT.
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EDMONDS REHABILITATION & HEALTH CARE CENTER
EMERGENCY EVACUATION PLAN
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FINAL PROJECT APPIROVAL FORM
TO:
DATE:
MEMO TO: PE
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BUILDING DIVISION
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7VO40RI
DATE
FROM: FIRE DEPARTMENT
H A S, 1: SIGN
ENGINEERING DIVISION DATE
PIXASI: SIGN
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PLANNING DIVISION DATE
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PLEASE SIGN
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PROJECT 6EO/`��S
SITE. ADDRESS Z foo cb -7 G T1,_ 4V
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PERMIT # ADB# DATEINSPECTED
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DESCRIPTION OF WORK TO BE INSPECTED— 6,r
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A field inspection was conducted to determine compliance with -approved plans. Final approval
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denotes that there are' no objections from the above signed Department. to the release of
PERFORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS givcn to owner/contractor by inspecior
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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0 Copy of CORRECTION NOTICE givcil to owncr/contractor by hipector
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RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
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ate Sign,
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1,:tciiip:.[)I(lg:foriiis:ocal)r%,I 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ..................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...............
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Commercial Final ......
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HEATING:
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Gas Test .....................
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Gas Piping .................
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Equipment ...............
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ................. I ...........
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FRAMING ... .....................
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FIRST FLOOR FRAMING...
INSULATION ...................
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Floor Insulation .........
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Wall. Insulation ............
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
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MISCELLANEOUS ....
FINAL APPROVAL FOR L13,
OCCUPANCY ..................
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