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AFH Inspection ChecklistSECTION I -PROPERTY INFORMATION SITE ADDRESS: a/o/! � D/�IO�tI�jS O�" _ ASSESSOR'S TAX/PARCEL#:OO SECTION 2- APPLICANT INFORMATION PROPERTYOWNERNAME: �eh� �VIXi? �eof-z& 64iheq DAYTIMEPHONE: oho a3S`L/07U - AFH LICENSEE NAME(IMFFEREur). SECTION 3 -FLOOR PLAN DAYTIMEPHONE:06-3311-3s�o� On a separate sheet of paper (81/2x 11) draw a floor plan (including all floors) of your prospective AFH. Include all sleeping rooms (bedrooms) indicating which bedroom is: A, B, C D, E and F. Label all components for exiting i.e., stairs, ramps, platforms, lifts and elevators. I certify under penalty of perjury that the information furnished by me is true and gorrect to the bestof 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 agreeto 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 againstthe 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 partof this application. NAME/TITLE: /,Elena (2r1Lq,'n j PROPERTY OWNER V APPLICANT DATE: CCU LICENSEE SECTION 5 MUST BE COMPLETED BY THE BUILDING DEPARTMENT IN THE JURISDICTION THE HOME WILL BE LOCATED. PLEASE CHECK ALL APPLICABLE BOXES; MATCH THE LIST BELOW TO THE APPLICANT'S FLOOR PLAN — USING THEIR PROSPECTIVE RESIDENT BEDROOM DESIGNATIONS OF A 8 CD EAND FAND CLASSIFICATION CODE S, NS1 OR NS2. R330.3 Sleeping Room Classification: Each sleeping room in an Adult family Home shall be classified as: Type S — where the means of egress contains stairs, elevators or platform lifts to evacuate residents to public area. Type NS1- where 1 means of egress at grade level (has no stairs) or ramp constructed compliant with R330.9 is provided to evacuate residents to public area. Type NS2 — where 2 means of egress at grade level (both have no stairs) or ramps constructed compliant with R330.9 are provided to evacuate residents to public area. SLEEPING ROOM A 113 Type S 10 Type NS1 10 Type NS2 YES NO Closet door/s are readily openable from the inside [3 Yes [3 No I QN/A I Smoke alarm is installed in the bedroom 1313 Bedroom door opens easily and quickly from the outside when locked Q Q Sleeping room window has a net opening of 5.7 SF (minimum dimensions at least 24"high; at least 20" wide) EXCEPT per R310.2.1: at -grade escape windows — may have net clearance opening 5 SF 0 13 Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed SLEEPING ROOM B [3 Type S [3 Type N51 10 Type NS2 YES NO Closet door/s are readily openable from the inside Yes [3 No I ON/A Smoke alarm is installed in the bedroom Bedroom door opens easily and quickly from the outside when locked 13 13 Sleeping room window has a net opening of 5.7 SF (minimum dimensions at least 24"high; at least 20" wide) EXCEPT per R310.2.1: at -grade escape windows — may have net clearance opening 5 SF 13 13 Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed 13 13 SLEEPING ROOM C Q Type S [3 Type NS1 10 Type NS2 YES NO Closet door/s are readily openable from the inside Yes [3 No [3N/A I Smoke alarm is installed in the bedroom [3 Q Bedroom door opens easily and quickly from the outside when locked 13 Q Sleeping room window has a net opening of 5.7 SF (minimum dimensions at least 24"high; at least 20" wide) EXCEPT per R310.2.1: at -grade escape windows — may have net clearance opening 5 SF 13 13 Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed 13 0 SLEEPING ROOM D 10 Type S [3 Type NS1 10 Type NS2 YES NO Closet door/s are readily openable from the inside [3 Yes [3 No I [3N/A I Smoke alarm is installed in the bedroom0 13 Bedroom door opens easily and quickly from the outside when locked 0 13 Sleeping room window has a net opening of 5.7 SF (minimum dimensions at least 24"high; at least 20" wide) EXCEPT per R310.2.1: at -grade escape windows — may have net clearance opening 5 SF 13 13 Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed SLEEPING ROOM E 0 Type S 10 Type NS1 10 Type NS2 YES NO Closet door/s are readily openable from the inside Yes [3 No I [3N/A I Smoke alarm is installed in the bedroom Bedroom door opens easily and quickly from the outside when locked 13 13 Sleeping room window has a net opening of 5.7 SF (minimum dimensions at least 24"high; at least 20" wide) EXCEPT per R310.2.1: at -grade escape windows — may have net clearance opening 5 SF 13 Q Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed 13 13 SLEEPING ROOM F [3 Type S [3 Type NS1 10 Type NS2 YES NO Closet door/s are readily openable from the inside [3 Yes [3 No I [3N/A Smoke alarm is installed in the bedroom [3 13 Bedroom door opens easily and quickly from the outside when locked [3 13 Sleeping room window has a net opening of 5.7 SF (minimum dimensions at least 24"high; at least 20" wide) EXCEPT per R310.2.1: at -grade escape windows — may have net clearance opening 5 SF Q 13 Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed Implementation Date: 2021 February 01 Updated: 2021 February GENERAL YES NO Bathroom doors are easily and quickly openable from the outside when locked 0 Q Carbon Monoxide alarms are installed as required in R315 on each level of the home. D 13 Smoke alarms are installed on all levels of the dwelling, in each resident sleeping room, outside each separate sleeping area in the immediate vicinity of sleeping rooms (R314). 13 13 Smoke and Carbon Monoxide alarms are installed in such a manner so that the audible warning may be heard in all parts of the dwelling upon activation of a single device. 13 Q Access road and water supply meet local fire jurisdictional requirements. 13 13 R330.4 Operable parts of door handles, pulls, latches, locks and other devices installed in AFH shall be operable with one hand and shall not require tight grasping, pinching or twisting of the wrist (lever -type). Pocket doors shall have graspable hardware available when in the closed or open position. 13 13 R311.8 Ramp I YES NO Inside Ramp I N/A [31 13 13 R311.8.1 Maximum Slope one unit vertical in twelve units horizontal (8.3% slope). (Exception R311.8.1 Not allowed in 13 13 R330.9) R311.8.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto ramps, and where ramp changes directions. 13 13 R330.9.1 Handrails required on both sides of ramp. 13 13 Outside Ramp I N/A [3 1 YES NO R311.8.1 Maximum Slope one unit vertical in twelve units horizontal (8.3% slope). (Exception R311.8.1 Not allowed in j 13 13 R330.9) R311.8.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto ramps, and where 13 13 ramp changes directions. R330.9.1 Handrails required on both sides of ramp. 13 13 R312.1.1 Guards shall be located along open -sided walking surfaces, that are located more than 30 inches measured 13 13 vertically to the floor or grade below at any point within 36 inches horizontally to the edge of the open side. Guards below are depicted vertically as an example only. Guard 36" mii minimum is an 8.3% slope all along surface of the ramp. minimum Implementation Date: 2021 February 01 Updated: 2021 February R311.2 Means of Egress YES NO R311.2 Door must be side -hinged with min. width of 32 inches between face of door and stop. Height not less than 78 inches. R330.4 Operable parts of door handles, pulls, latches, locks and other devices installed in AFH shall be operable with one hand and shall not require tight grasping, pinching or twisting of the wrist (lever -type). Q 0 R330.4 Required exit door hardware shall unlock inside and outside mechanisms when exiting the building allowing re-entry Q 13 without use of key, tool or special knowledge. R311.7 Stairways N/A [:I YES NO R311.7.5.1 Riser Height: Max riser height shall be 7 % inches (8 inches in structures built prior to July 1, 2004) R311.7.5.2 Tread Depth: Min. tread depth shall be in 10 inches (9 inches in structures built prior to July 1, 2004) 13 13 R330.10.1 Handrails for Treads and Risers shall be installed on both sides of treads and risers numbering from one riser to multiple 13 13 risers. Handrails shall be installed in accordance with R311.7.8.1— R311.7.8.4 R330.8 Grab Bars in Bathrooms I N/A 131 YES NO Grab bars shall be installed for all water closets (toilets), bathtubs and showers according to R330.8. 13 13 Water Closets (toilet) shall have grab bars installed on both sides according to R330.8.3 1:1 13 Bathtubs shall have two vertical and three horizontal grab bars installed according to R330.8.4 13 Shower stalls have two vertical and horizontal grab bars mounted on all sides of shower according to R330.8.5 Q 13 Shower stalls must be minimum size of 30 inches deep by 48 inches long (R330.11) Q 13 PASSED NAME OF AFH: Adult Family Home Project Address BUILDING DEPT. INSPECTOR'S NAME (PRINT) BUILDING DEPT. INSPECTOR'S SIGNATURE DATE: BUILDING DEPT. OFFICE ADDRESS OFFICE PHONE NUMBER: 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 in accordance with WAC 388-76-10700. Implementation Date: 2021 February 01 Updated: 2021 February