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Home My WebLink AboutBLD2018-00303 Repairs - BLD Application - 3/30/2018 A�oN coU, MASON COUNTY COMMUNITY SERVICES ^� PERMIT ASSISTANCE CENTER: Permit No. 00 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 R E I D Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-77 fe, E I V E p Belfair.(360)275-4467•Phone Elma:(360)462-52D 01Q 83... Y BUILDING PERMIT APPLICATION 61 . Alder Str PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Zee V- �?Liq-CQP LL, NAME: "1 - V\ p .5t-0(rr4-Tk1yJ MAILIN ADDRESS:21 Wwy 3 MAILING ADDRESS: V Lw CITY: L ✓' STATE: ZIP: CITY. rJ STATE: ZIP: 3 Z PHONE#1: ^ 2-2 PHONE: b CELL3l� 6z0(0.SZ _ PHONE#2: EMAIL : Krnatjijr p EMAIL:— �u�-�� LI, M L&I REG# EXP. PRIMABY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑ NAME EMAIL MAILING ADDRESS CITY rVQ STATE ZIP PHONE ?&D Lf - CELL 6 PARCEL INFORMATION: � PARCEL NUMBER(12 Digit Number) 122-� + 19 - 6 a Sb ZONING f Ali S LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT -L SITE ADDRESS 7 ; Q �3- T CITY C3GL--/ I I2 DIRECTIONS TO SITE ADDRESS 1S THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES❑ NOZ IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM ❑ TYPE OF WORK: NEW ❑ ADDITION❑ ALTERATION❑ REPAIR k OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) bzLQ IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS Z NUMBER OF BATHROOMS__ HEATED STRUCTURE? YES(Whole Bldg)W YES(Part[s]of Bldg) ❑ NO ❑ DESCRIBE WORK SQUARE FOOTAGE: (propose+existing) 1ST FLOOR_'� sq.ft. 2ND FLOOR -� sq.ft. 3RD FLOOR sq.ft. BASEMENT sq. ft. DECK — sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq. ft. GARAGE sq. ft. Attached❑ Detached❑ CARPORT -8-- sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTINGZ PLUMBING IN STRUCTURE? YES% NO ❑ If yes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOL4.1 EXISTING SQ.FT. EXISTING BEDROOMS a PROPOSED BEDROOMS D TOTAL BEDROOMS c=-), OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and Inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLIC ON OF 100 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42) X % Iz3)JS Sign ure of OW (Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH >. MASON COUNTY Shelton(360)427-9670 ext. 352 DEPARTMENT OF COMMUNITY SERVICES Belfair(360)275-4467 Mason County Bldg. 8, 615 W. Alder Street Elma (360)482-5269 /'J Shelton, WA 98584 �« www.co.mason.wa.us REQUEST FOR BUILDING PERMIT EXPEDITION p _ Date: 3 Z f��'✓��._... Permit No.:_Jh)1d-2-6 16 - W)0 MAR 3 0 20 Name: K2o MMQO r -;66 39 3-) o1 615 W. Alder Street Mailing Address: G!�12 Oc V spu- Parcel Number: 1 Z20jo BUILDING Site Address: Request due to: ❑Medical Hardship re Damage ElOther Explanation of Hardship: �. L-\Vlm Must include supporting documents.This may be a letter from a doctor, insurance claim report, report of fire damage from appropriate fire district representative or other relevant documentation. I (WE) understand the intention of this form to determine and document justification for expedition of a building permit to alter or reconstruct a ucture o t e bove named property. Signature Owner/Agent: 60 OFFICIAL USE ONLY Request: proved ❑Denied Date: Request denied for the following reasons: Signature: —L-- - ,� �A.w t!< v.,c.&C-,e,` Director of Community Services North Mason Regional Fire Authority : 2017-2067 Page 1 of 7 Location: Incident Type: 21756 E State Route 3# b 111-Building fire sh , Belfair WA 98528 FDID: 23D02 Lat/Long: Incident#: 2017-2067 N 470 25'32.93" Exposure ID: 28121699 W 1220 50'44.15" Exposure#: 0 Incident Date: 11/11/2017 Zone: Dispatch Run #: 17-048645 North Mason Regional 74-Downtown Location Type: 1-Street address Fire Authority Map Page: F074 Station: 21 Shifts Or Platoon: A Report Completed by: Ehresman II,Carl E ID: 9156 Date: 11/11/2017 Report Reviewed by: Ehresman II,Carl E ID: 9156 Date: 11/11/2017 Report Printed by: Hicks,Jeromy N ID: 8381 Date:4/2/2018 rime: 07:58 Structure Type: Enclosed building Property Use: 419-1 or 2 family dwelling Automatic Extinguishment System Present: Detectors Present: Cause of Ignition: Unintentional Aid Given or Received: Mutual aid received Primary action taken: 11-Extinguishment by fire service personnel Losses Pre-Incident Values Property: Property: Civilian Injuries: 0 Fire Service Injuries: 0 Contents: Contents: Civilian Fatalities: 0 Fire Service Fatalities: 0 Total: Total: Total Casualties: 0 Total Fire Service Casualties: 0 Total #of apparatus on call: 8 Total#of personnel on call: 15 Narrative from dispatch: smoke coming from under the floor by the chimney.... evacuating 13:51:36 11/11/2017-RifFle,Barbara 2 adults evacuating, ..this is duplex... other have is at work now. 13:53:45 11/11/2017-Clark,Amber-From: E21-Any Unit lock down firel for ops 13:54:28 11/11/2017- Powelson,Aaron kitsap advised will be toning for E16 13:57:44 11/11/2017- RifFle,Barbara PUD ADVISED,AT LEAST 30 TO 40 MINS 13:57:52 11/11/2017-Clark,Amber-From: M27-Any Unit multiple units,smoke sceen, investigating 13:58:41 11/11/2017-Clark,Amber-From: E21-Any Unit laying forward 13:59:53 11/11/2017- Riffle,Barbara WSP ADVISED,WSP SAYING IF NMFA NEEDS TRAFFIC CONTROL 13:59:57 11/11/2017-Clark,Amber-From: E21-Any Unit next arrived engine to supply water 14:03:58 11/11/2017-Powelson,Aaron pud c/b 20 min eta 14:04:13 11/11/2017-Clark,Amber-From: E21-Any Unit small single story dulplex,smoke from crawl space,offensive stradegy cmd post e21 14:07:03 11/11/2017-Clark,Amber-From: E21-Any Unit water supply established 14:09:13 11/11/2017-Clark,Amber-From: E21-Any Unit fire knocked down, rit established,and discontinue timer 14:09:16 11/11/2017- Riffle,Barbara WSP ER TO STURCTURE FIRE 14:28:51 11/11/2017-Clark,Amber- From: E21-Any Unit over hauling stage, realease the channel https://secure.emergencyreporting.com/nfirs/print.asp?printtype=2&printtype... 4/2/2018 North Mason Regional Fire Authority : 2017-2067 Page 2 of 7 15:10:00 11/11/2017- Riffle,Barbara COMMAND TERMINATED.ALL UNITS AVAIL NARRATIVE (2) Narrative Title: Incident Command Report Narrative Author: Ehresman II,Carl Narrative Date: 11/11/2017 18:33:04 Narrative Apparatus ID: E21 Narrative: NMRFA dispatched for report of a structure fire,smoke coming up from the floor beneath fireplace. M27 is first arriving, confirms occupancy and smoke from the crawlspace. E21 arrives,driveway lay. M21 attack team,A57 standby then backup. M27 is RIT. 360 completed. E51 supplies the driveway lay. Access is made to the crawlspace,smoldering fire which is extinguished. Commence overhaul. Less than 10 gallons of water used. Primary and secondary search all clear. Complete overhaul.Air monitor check,CO levels less than 10ppm.Advised Mr.Tygart he should not stay in the residence until repairs are made. We released the building back to him to allow him access to his belongings. https:Hsecure.em ergencyreporting.com/nfirs/print.asp?printtype=2&printtype... 4/2/2018 North Mason Regional Fire Authority : 2017-2067 Page 3 of 7 NARRATIVE (3) Narrative Title:Investigation Narrative Author: Ehresman II,Carl Narrative Date: 11/11/2017 18:33:42 Narrative Apparatus ID: E21 Narrative: Interview renter/occupants who tell me they were burning wood in the fireplace. Mr.Tygart was asleep on the couch when his girlfriend alerted him to smoke coming up around the fireplace pad. She attempted to pour water on it, with no success. Smoke detector activated, he grabbed it off the wall and called 911. He was advised to evacuate the building. The floor in front of the fireplace was covered with a framed pad covered in a non-flammable masonry/tile.There was charring midline on the underneath.This was removed during fire attack and placed outside. Significant charring of the floor joists and sill joist was noticed midline to the front of the fireplace in the crawlspace.There is metal flashing present along the front of the fireplace which has evidence of high heat midline along the edge which would indicate direct conduction of heat to framing members. I am unsure if this is due to conduction from the coalbed of the fire or from embers that had found their way down the flashing. Cause determination:Accidental. Likely due to construction deficiency, it is unclear if the design was faulty or there was damage. Given the age of the building and several other buildings next door of the same design, it is reasonable to assume there had been some damage to the fireplace pad to allow for conduction to framing members. Carl Ehresman Fire Captain https://secure.em ergencyreporting.com/nfirs/print.asp?printtype=2&printtype... 4/2/2018 North Mason Regional Fire Authority : 2017-2067 Page 4 of 7 APPARATUS Fire Controlled Date/Time: 11/11/2017 2:09:16 PM Unit E21 Unit M21 Type: _ Engine Type: ALS unit Use: Suppression Use: EMS Response Mode: Lights and Sirens Response Mode: Lights and Sirens # of People 2 #of People 2 _ Injur_y Or Onset - /-/- - --: - _Injury Or Onset - Alarm 11111/201713:50:31 Alarm 11/11/2017 13:50:31 Dispatched it/1112017 13:51:52 Dispatched 11/11/2017 13:52:22 Enroute 11/11/2017 13:51:52 __ Enroute 11/11/2017 13:52:22 _Arrived 11/11/2017 13:58:17 Arrived 11/11/2017 13:58:17 Cancelled - /-/- - -- - Cancelled -_L-/- - - Cleared Scene 11/11/2017 15:10:10 Cleared Scene _ 11 it 2017 15:10:10 In uarters - / -: -: - _In Quarters - - - -- - In : - In Service 11/11/2017 15:10:10 In Service 11/11/2017 15:10:...................... .................. ............. ............_......_......... _.. Unit M27 Unit A81 _Type: ALS unit _._Type: BLS unit Use: EMS Use: EMS Response Mode: Lights and Sirens Response Mode Lights and Sirens # of People 2 #of People 1 __ .... _ _. _- Injury Or Onset - -- Injury Or Onset Alarm 11/11/2017 13:50:31 Alarm _ 11L1/2017 13:50:31 Dispatched 11/11/2017 13:53:16 _Dispatched 11/11/2017 13:53:53 Enroute 11 11 2017 13:53:16 Enroute 11/11 2017 13:53:53 Arrived 11 11201713:57:05 Arrived 11 11201714:15:48 Cancelled - /-/- -: - : -- Cancelled -- Cleared Scene 11/11/2017 15:10:10 Cleared Scene 11/11/2017 15:10:10 In Quarters - In Quarters In Service 11 11 2017 15:10:10 In Service it 11 2017 15:10:10 Unit C201 Unit M Aid -_Type: Chief officer carType: Other apparatus/resource Use: Other Use: Other _.. Response Mode: Lights and Sirens _Response Mode: _Lights and Sirens ___ ___ __ -# of People 11 1 #of People _ 2 Injury Or Onset - -:- -- Injury Or Onset Alarm 11/11/2017 13:50:31 Alarm 11 11/2017 13:50:31 Dispatched 11/11/2017 14:05:48 Dispatched 11/11/2017 14:05:48 _ Enroute 11111/2017 14:05:48 -Enroute 11/11/2017 14:05:48 _ Arrived 11�/11/201714:10:10 Arrived 11/11/2017 14:10:10 Cancelled -- - - -: - : - Cancelled —�1-_ -Cleared Scene 11/11/2017 14:28:19 `Cleared Scene 11/11/2017 15:10:10 In Quarters - Quarters ______ In Service 11 1112017 14:28 19 In Service 11/11/2017 15:10:10 Unit E51 Unit E16 _...... .. ...._._........_...__.._...---.._. ........_.. _.._..__—_ _... _.._.._... Type _ _ Engine _Type Engine Use: _ry Suppression Use. Suppression Response Mode:- Lights and Sirens Response Mode: U hts and Sirens #of People 2 _# of People 3 Injury Or Onset Injury Or Onset - _ - Alarm 11 Zi1/2017 13:50:31 _ Alarm _ 11 11 2017 13:50:31 Dispatched _ 11 11/2017 14:05:48 Dispatched 11 LJZO 14:05:48 _ _Enroute it/11/2017 14.05:48 Enroute 11/11/,2017 14:05:48 Arrived 11 11 2017 14:10:10 Arrived - /-/- - - - Cancelled - /-/-- - - : -- Cancelled 11 it 2017 14:10:10_ _ _ _.. _._._ Geared_Scene _ 11/11/2017 15:10:10 - In In Quarters In Service 11/11/2017 15:10:10 In Service _ 11/11/2017 14:10:10 Number Of People not on apparatus: hops://secure.em erg encyreportin_.com/nfirs/print.asp?pr'nm-pe=2&printtype... 4/2/2018 r North Mason Regional Fire Authority : 2017-2067 Page 5 of 7 FIRE Acres Burned None or Less Than One Acres Burn From False Wildland Form Area Of Fire Origin Common room, den,family room, Heat Source Hot ember or living room, lounge ash Item First Ignited Structural member or framing Fire Is Confined To TRUE Object Of Origin Type Of Material _ Sawn wood, including all finished Cause Of ignition Unintentional lumber Factor Contributing To Operational deficiency, other Ignition Human Factors None Contributing STRUCTURE FIRE Structure Type Enclosed building Building Status In normal use # Of Stories At Above Grade 1 #Of Stories Below Grade 0 Square Feet._...._._`--_ 800_-- Length_,_—_._ Width Fire Spread Confined to object of origin Minor Damage 0 Significant Damage 0 Heavy Damage--_ 0 Extreme-Damage 0 Presence Of Detectors Present _ Type Of Detection Smoke - ----- .. ...__._.....__....----------.._...._.._._..._......---.— ....---._._.—.._—_.__........SYm ._.._............. Detector Power Suppiy Battery only Detector Operation Detector operated Detector Effectiveness Detector alerted occupants, Detector Failure Reason occupants responded PEOPLE -- PERSON 1 Telephone Number —__ �360)710-1980 Involvement CONTACT _ Name yes Date of Birth Address PEOPLE -- PERSON 2 Telephone Number (360)801-9284 Involvement COMPLAINANT Name Brock Allen P Tygart Date of Birth Address 21756 E State Route 3 B Belfair,WA 98528- CUSTOM FIELDS FORM HIPAA/Consent,signature obtained or exception filled out properly? - Not Applicable ALS II procedures performed N/A BLS procedures performed N/A NSA-.._... Mileage at$1 per 1/10 mile 0.... Total Billing _— _ _ 0 Smoke Detectors)Checked? Yes, Full Check Was this call a result of NMRFA Auto Dialer Activation? NO htto s://secure.emerizencyreDortin 2.com/nfirs/print.asp?printtype=2&printty pe... 4/2/2018 North Mason Regional Fire Authority : 2017-2067 Page 6 of 7 INCIDENT IMAGES ti.. ?1 -rsyy 6 W PERSONNEL ON CALL Name Personnel Rank Roie(s) Apparatus ............... .................. ........ Cloud, Ryan D PM/FF M27 Cooper,Scott Assistant Chief/EMT C201 Ehresman II,Carl E Captain/EMT E21 Friese, laura FF/EMT M21 Hasbrook,Joshua J FF/EMT E21 Klahr, Deric J FF/EMT M27 Piety,John FF/EMT A81 Pinero,Crystal M PM/FF M21 Member Making Report(Captain/EMT Carl E Ehresman II): httos://secure.emergencvrenorting-com/nfiirs/nrint_asn?nrinm,ne=2&nrinttx-ne _ 4/7001 R North Mason Regional Fire Authority : 2017-2067 Page 7 of 7 Supervisor(Captain/EMT Carl E Ehresman II): httt)s:Hsecure.em er2en cvre-Dortinp-.com/nfirs/print.aso?DrinttvDe=2&t)rinttvDe... 4/2/2018 ~ .p. ♦` y. r oo yk�+ ., .11 'f�• '� " �� r��u ' Nam'. ,tA : rat e t'w p -his WV . , . . s c' t •�