APPROVED FIR BLD2024-0523+Adult_Family_Home_Checklist+4.19.2024_12.05.49_AM+4206540Adult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST
Code References: 2M IRC Section R330 (WAC 51-51)
RECEIVED
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APPLICATION NUMBER: BLD2024-0523
SECTIONS 1. 2. 3. AND 4 MUST BE COMPLETED By APPLICANT BEFORE INSPECTION WILL BE PROCESSED
SECTION IV PROPERTY INFORMATION
SITE ADDRESS: 130176 � � W tdrvA
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ASSESSOR'S TAX/PARCEL#.20'43
re W�= SECTION 2 -APPLICANT INFORMATION
PROPERTY OWNER NAME: " t- �( m um ` ` / ' T `g
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AFH LICENSEE NAME (IF DIRENT):
r*,Xctt MZE_ A WILT VfttW 11W5
ECTION 3 ,.FLOOR PLAN;
DAYTIME PHONE: `tA 7 �� / 31
DAYTIME PHONE: ��
On a separate sheet of paper (8 1/2x 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.
SECTION 4 7 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
Moff�the
i7information supplied to the jurisdiction as a part of this application. J
NAMFJTITLE' .._. � II v`' 1`� (-'ar Ion DATE41
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QPROPER"ry OWNER C APPLICANT Q LU'ENSEE
Implementation Date: 2021 February 01
Updated: 2021 February
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 C D E AND F AND CLASSIFICATION CODE S, NS1 OR NS2.
SECTION 5 - BUILDING INSPECTOR'S INSPECTION CHECKLIST
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 NSI — 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
Type S Type S1 10
Type NS2
YES
NO
Closet door/s are readily openable from the inside T3 Yes (Q No N/A I Smoke alarm is installed in the bedroom
13
13
Bedroom door opens easily and quickly from the outside when locked
[3
0
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
E3
El
Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed
13
0
SLEEPING ROOM B
Type S
10 Type NS1
Type NS2
YES
NO
Closet door/s are readily openable from the inside [3 Yes Q No N/A I Smoke alarm is installed in the bedroom
13
Q
Bedroom door opens easily and quickly from the outside when locked
13
0
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
0
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 JE3
Type S 113 Type NSi 1
E3 Type NS2
YES
NO
Closet door/s are readily openable from the inside 113 Yes 0 No ON/A I Smoke alarm is installed in the bedroom
Q
Q
Bedroom door opens easily and quickly from the outside when locked
93
0
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
0
Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed
0
13
SLEEPING ROOM D
113 Type S 113 Type NSl 10
Type NS2
YES
NO
Closet door/s are readily openable from the inside 113 Yes 113 No I [3N/A I Smoke alarm is installed in the bedroom
13
1:1
Bedroom door opens easily and quickly from the outside when locked
0
0
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
Sleeping room window has a maximum sill height of 44" above floor to clear opening; no steps under window allowed
0
E3
SLEEPING ROOM E JUType
S Type NS1
113 Type NS2
YES
NO
Closet door/s are readily openable from the inside I E3 Yes 1 E3 No I [3N/A I Smoke alarm is installed in the bedroom
a
a
Bedroom door opens easily and quickly from the outside when locked
0
0
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
o
a
SLEEPING ROOM F
10 Type S Type NSi
113 Type NS2
YES
NO
Closet door/s are readily openable from the inside [3 Yes 0 No N/A Smoke alarm is installed in the bedroom
0
Bedroom door opens easily and quickly from the outside when locked
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
E3
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
13
13
Carbon Monoxide alarms are installed as required in R315 on each level of the home.
[3
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 (11314).
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.
O
1:1
Access road and water supply meet local fire jurisdictional requirements.
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).
D
0
Pocket doors shall have graspable hardware available when in the closed or open position.
1:1
0
R311.8 Ramp
YES
NO
Inside Ramp ' N/A
[]
0
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 N/A 01
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
o
a
R330.9
R311.8.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto ramps, and where
0
a
ramp changes directions.
R330.9.1 Handrails required on both sides of ramp.
Q
R312.1.1 Guards shall be located along open -sided walking surfaces, that are located more than 30 inches measured
0
E3
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" mir
— a. �
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).
p
13
R330.4 Required exit door hardware shall unlock inside and outside mechanisms when exiting the building allowing re-entry
Q
Q
without use of key, tool or special knowledge.
R311.7 Stairways I N/A C1 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)
R330.10.1 Handrails for Treads and Risers shall be installed on both sides of treads and risers numbering from one riser to multiple
risers. Handrails shall be installed in accordance with R311.7.8.1— R311.7.8.4
0
Q
R330.8 Grab Bars in Bathrooms I N/A MJ
YES
NO
Grab bars shall be installed for all water closets (toilets), bathtubs and showers according to R330.8.
Water Closets (toilet) shall have grab bars installed on both sides according to R330.8.3
Bathtubs shall have two vertical and three horizontal grab bars installed according to R330.8.4
Shower stalls have two vertical and horizontal grab bars mounted on all sides of shower according to R330.8.5
Shower stalls must be minimum size of 30 inches deep by 48 inches long (R330.11)
13
0 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 389-76-10700.
Implementation Date: 2021 February 01
Updated: 2021 February