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Home My WebLink AboutBLD2015-00240 Replacement MFG Home - BLD Permit / Conditions - 4/23/2015 Inspection Line(360)427-7262 #18W " MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352 Mason County Bldg. III 426 W. Cedar Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2015-00240 OWNER: JOHN KLEUTSCH CONTRACTOR: LICENSE: EXP: RECEIVED: 4/3/2015 SITE ADDRESS: 974 W LITTLE EGYPT RD SHELTON ISSUED: 4/23/2015EXPIRES: 10/23/2015 PARCEL NUMBER: 420184300000 LEGAL DESCRIPTION: N1/2 N1/2 SW SE PROJECT DESCRIPTION: DIRECTIONS TO SITE: REPLACEMENT MFG HOME (EXISTING WAS DESTROYED BY FIRE) DAYTON AIRPORT RD, CROSS SHELTON MATLOCK RD TO LITTLE EGYPT RD TO SITE ADDRESS ON THE RIGHT SIDE, SHARED UNNAMED EASEMENT(970,972) General Information Construction&Occupancy Information Square Footage Information No. of Bedrooms: 2 Type of Constr.: Type of Use: MH Insp.Area: No. of Bathrooms: 2 Occ. Group: Lot Size: Deck: Type of Work: NEW Fire Dist.: 16 No. of Stories: Occ. Load: Building: Valuation: Building Height: Occ. Status: Basement: Manufactured Home Information Setback Information Shoreline& Planning Information Make:palm harbo Length: 61 Ft. Front: S 101.0 Ft. Shoreline: 400.0 Ft. Water Body: NORTH FORK GOLD Rear: N 130.0 Ft. Slope: Ft. SEPA?: No Model:prow Width: 27 Ft. Side 1: E 320.0 Ft. Shoreline Desig.: Rural Year:2009 Serial No.: Side 2: W 400.0 Ft. Comp. Plan Desig.: Rural Plumbing Fixtures Mechanical Fixtures FEES Type Qty. Type Qty. Type By Date ' Amount Receipt Manufact. Home Submittal GMM 4/3/2015 $264.25 S1201500000001 EH Minor Plan Review GMM 4/3/2015 $ 100.00 S1201500000001 Planning Review Fee GMM 4/3/2015 $205.00 S1201500000001 Manufact. Home Issuance RTB 4/22/2015 $264.25 S2201500000001 Total $833.50 BLD2015-00240 Please refer to the following pages for conditions of this permit. Page 1 of 6 10) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-80 - 47- 98 . The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X 11) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour) will be charged and must be collected by the Building Departmentprior to any further inspections being performed or approvals granted. x ncn 12) Owner/A ent is responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X 13) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal of approved documents will result in failure of required building inspections. X 14) The "approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the "approved" site plan is not on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building De artme t for to any further inspections being performed or approvals granted. X 15) Any retailer, manufacturer or contractor who installs a manufactured home warrants that the manufactured home is installed in accordance with the State Installation code, chapter 296-150M WAC. All installers hired to do installation work shall be certified manufactured home installers and shall be present to supervise the installation of all on-site work. An Installer Tag shall be posted on site giving the certification number and signature of the certified installer responsible for each major part of the installation. RCW43-63B.090 An approved Installer cerification tag shall be placed on the end of the manufactured home directly above or below the HUD certification tag or temporarily located in plain site within three of the home's front entry. There shall be one certification tag for each certified installer accounting for the work that each installer performed st I certification number and signature of the certified installer responsible for each major part of the installation. WAC365-210 X 16) If you are installing a anufacturing home and no longer have the installation manual for the home, you must use the instructions of the American National Standards Institute (ANSI). To order the ANSI instructions you may either get an order form from the Mason County Building Department or you can contact the.Offfice of Manufacturing Housing (360) 725-2800. X 17) A concrete encased grounding electrode must be installed and used at each new building or structure that is built upon a permanent concrete foundation. In Mason County the electrical code is regulated by Washington State Department of Labor& Industries (L&I). For more information contact L&I for additional information. In Olympia call (360)902-6350 and in Bremerton call (360)415-4000. X BLD2015-0024 Please refer to the following pages for conditions of this permit. Page 3 of 6 18) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of Washington. Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit v ati X 19) REQUIRED INSPECTIONS (Footing Inspection-prior to pour, Set-up Inspection-prior to skirting, Final Inspection-prior to occupancy). I hereby assume all responsibility for the scheduling of my required inspections. If the required inspections are not requested, inspected and signed off(approved) by the inspector in the prescribed order, I understand that reinspection fees and an hourly investigation fee pursuant to the current fees adopted by the Mason County Building Dept., and will be assessed in addition to my original permit fees to resolve any questionable practices or problems that have been discovered. I further understand that this investigation will be scheduled as time allows. Until resolution of any/all problems no occupancy (Final Inspection)will be granted for the residence. OWNER/CONTRACTOR(indicate which) Signature X 20) This permit is for the-DI t and installation of the manufactured ome only and does not imply approval or review for any other items indidcated on the plot plan. X 21) Applicant has indicated this is a replacement unit. Prior to Mason C a i any occupnacy of the new proposed unit, the existing unit which is on-site and is being replaced MUST be removed from the parcel. BLD2015-00240 Please refer to the following pages for conditions of this permit. Page 4 of 6 25) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the international codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Inspect g b made prior to requesting additional inspections. X 26) The installation permit shall be displayed in clear view of the site access road. The approved site plan and other applicable instructions, including installation instructions, shall be available in this location OR placed in the location specified by WAC 296-150M-655. Support configuration shall be clearly mar ed i the installation instructions. X 27) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason u �o ances and building regulations. X 28) All per Xtsexpire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a period not exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit hold a ted action from being taken. No more than one extension may be granted. X er 29) Pressure treated wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors d I ping. Install metal connectors approved for contact with the new types of pressure treated material. X 30) ALL SURFACE WATER AND POTENTIAL RUNOFF WILL BE CONTROLLED ON SITE AND SHALL NOT ADVERSLY AFFECT ANY ADJACENT PROPERTIES NOR INCREASE THE VELOCITY FLOW ENTERING OR ABUTTING TO ANY STATE OR COUNTY CULVERTING/DITCHING SYSTEM OR ROAD W Y X OWNER/ BUILDER acknowledges 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, owners legal representative, or contractor. 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 authorized agent 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 IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. nature Date Z'/a `YI• .I�LL� OWNER REPRESENTATIVE - CONTRACTOR Print Name (Circle one to indicate) BLD2015-00240 Please refer to the following pages for conditions of this permit. Page 6 of 6 co o CONCRETE MECHANICAL MANUFACTURED HOME N r Footings I Setbacks Date By Ribbons C: Gas Piping o Interior Date By Interior-Date By Date By fA O Exterior Date By Exterior-Date _ B Set-w _ INSULATION Point Load I Isolated Footings Date -4 H I-3 By (�� C_ Date By BG I SLAB INSULATION — Date By FIRE DEPARTMENT = Foundation Walls Floors Date By Z Date By Data By DECKS FRAMING Walls Date By Date By Data By PROPANE TANKS PLUMBING vault Data By Date By OTHER Groundwork Attic Type- Date By Date By Date By D.W.v DRYWALL Type- Date Brace Wall Date By Date By Date By v FINAL INSPECTION 0 Water Line Fire Separation N CD CD By Date By Date S" / i By [/ CD m Cn s Pass or Request Inspect. c Type of Insp. Fail Date Date Done By Comments M ,1�II� l� �V o '0 >�allt �— 0 f 0 0 _a 0 :3 Cn 0 m 3 v co m 0 CA PLANNING : PLANNING ALL SETBACKS ARE MEASURED FROM THE FURTHEST PROJECTION OF THE BUILDING RECEIVED i APR 0 3 2015 426 W. CEDAR ST M 40 MC APPROVED COU111TY DCD PLANNING SITE PLAN REQUIIEa TO BE ON SITE CHANGES SU."J',}ECT TO APPROVAL ��,,� i BY --- — Date w 13bA15A IDA 14 , o � �-0 IN -246A � i a� RECEIVED APR 0 3 2015 �f . CEDAR ST l \ am CD , � ,ply fz,a,C�O 1/YA� �� 1 ��r✓J yH'Y. l b i LV_ o z cr- 4n o M1 o � S a R 4 Q N Y9 �J l lk � � Q s ` i owls�� „0—.CZ Y REVIEWED FOR CODE COMPLIANCE MASON COUNTY B ILDING DEPARTM Date Documenis attached w approved plans,: Site Plan Plan review checkli t: --�2 Pages Engineering: Y V�Lateral Vertical Plumber of pages— THESE PLANS MUST BE ON THE JOB SITE FOR INSPECTION CHANGES MUST MEET ALL CURRENT SUBMIT CIIANGI ti I OR APPROVAL PRIOR TO PLRI(MIMING WORK WASHINGTON STATE CODE f t MASON COUNTY PERMIT N0.FJCJ 2015 -002-'-1v DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING•PLANNING•FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 Mason County Bldg. III,426 West Cedar Street (360)275-4467 Belfair ext (' n)W PO Box 279,Shelton,WA 98584 (360)482-5269 Elma ext� BUILDING PERMIT APPLICATION APR 0 3 2015 OWNER INFORMATION: CONTRACTOR INFORMATIO : NAME: -'U�.� V NAME: CA( MAILING ADDRESS: MAILING ADDRESS: col CITY: STATE: LJ r�, ZIP: CITY: STATE: (,_)4;N IP: PHONE: 22,O 17, Z CELL: PHONE: C LL: EMAIL: W4,n 4,(,A, EMAIL : L&I REG# EXP. PARCEL INFORMATION: ,++� Ifo PARCEL NUMBER(12 DIGIT NUMBER) AIM(A43— 0000 V FIRE DISTRICT LEGAL DESCRIPTION(ABBREVIATED) SITE ADDRESS 0\ CITY Qx\ DIRECTIO`k O SITE ADDRESS — v ��:i-<!s &n\\OZZ �Za 45, -\-.\C�ONA a 0 C \\pa SN lt64 IS PROPERTY WITHIN 200 FT: SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO❑ TYPE OF JOB: NEW e ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER P C USE OF STRUCTURE( ID %ENCE,GARAGE ETC.) e \ n IS USE: PRIMARY-rr SEASONAL❑ NUMBR OF ekDROOMS NUMBER OF BATHROOMS DESCRIBE WORK \,LN SQUARE FOOTAGE: 1ST FLOOR 1 _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 sq. ft. ATTACHED❑ DETACHED❑ MANUFACTURED \\HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN MAKE�Q�� i Ook MODEL ( C� YEAR LENGTH r WIDTH `Z'1 BEDROOMS BATHS SERIAL NUMBER OWNER/BUILDER acknowledges 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,owners legal representative,or contractor. 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 authorized agent 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 IS BY MEANS OF INSPEPTION.IN M OF THIS PERMIT APPLICATION OF 180 DAYS WIL�INVALIDATE THE APPLICATION. Signature of Xpplicant Dat— x OWNER/ REPRESENTATIVE/CONTRACTOR Print Name (CIRCLE TO INDICATE) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL RECEIVED A APR 1 5 2015 426 W. CEDAR ST. Fire: 974 W Little Egypt Rd. Shelton, WA 98584 Date: 3/19/15 Time: 1200 Case Number: 15-FM0008, 15-11F144 Weather: Overcast and 55 degrees F, no rain Units on Scene: F1600, E161, E162,T161,T163, E111,T46,T121, E92,T92, F500, E58, FM1407, M152 Investigation Units: FM1407 (F1102), F500 Possible Causes Ruled Out: ❖ Lightning: None per owner and weather report ❖ Electrical: Breaker panel found intact and no breakers tripped ❖ Appliances: No appliances on in residence. ❖ Furnace: No fire seen near furnace per owner,and no extension of fire into other rooms except for living room. Living room fire believed to be from furnace sucking fire into fan and pushing it through main duct to living room vent fore burning the furnace motor. ❖ Arson: No signs of foul play found and no purpose for burning home found. No suspicious causes found in property. No signs of accelerants. Narrative: District 16 toned for a possible structure fire. On arrival M152 found mobile home fully involved and encroaching on a small cabin style home next to it. F1600 arrived and took command. F1102 arrived for attack on E111 and fought fire (see ERS report). F1102 reassigned to investigation after fire knocked down. F500 assigned to assist in investigation. F500 took witness statement, received consent to search form, and building/insurance information from owners. F500 took photos of the scene with cell phone due to no camera on scene. F1102 transitioned to investigation and met with F500 to discuss paperwork and owner statements. Firefighter observation report was also given to M152 due to first unit on scene. Scene was investigated and origin found to be in the living room near the wood stove. This was determined based on owner statement and burn patterns to the living room. Living room had the most burn and trusses were completely burnt. Crews were allowed to overhaul the rest of the structure. Once house was cooled the origin was investigated for the cause.A large hole was found in the living room and was determined to be caused by the furnace pumping fire through the vent into the living room. Electrical panel was located on partition wall on the back side of the wood stove. Wood stove pipe was removed and inspected. Pipe was clean and no build-up of creosote found. Wood stove was dug out around and masonry brick pedestal was found.After char debris was removed there was found to be gold colored metal from the stove door melted to the pedestal.The glass in the door was found broken in a corner. Small broken piece of glass was on the lip of the stove and the rest of the large glass was in the fire box of the stove.The fire box of the stove was completely burnt and empty of its contents.All pieces of the stove were located and put back in the location they were found.The stove showed that something broke out a piece of the glass and allowed fire to escape to the partition wall.The partition wall had a bookshelf on it that was well burnt on the side closest to the stove. Owner also advised that both fans attached to the back of the stove were on and blowing into the fire box at time of fire. Photos were taken of stove and pedestal washed off to evaluate burn patterns. Fire turned over to command and advised of findings. F1102 cleared and returned to station to complete report. Re �TT gathered from F500, F1600, and M152. APR 15 2015 426 W. CEDAR ST, Cause Hypothesis: From owner statements, burn patterns, and stove findings I feel this fire was caused from something causing the glass on the bottom corner of the stove door to break and fall out.This allowed heat and fire to escape the box and catch nearby items on fire (bookshelf).The fire then spread to the wall and through the house.This fire caused the cabin next to it to catch fire and fire was stopped at the outside wall and eves of the cabin. *Copies of this report are being forwarded to F500, F1600, and Insurance Company. Matt Heinrich Captain/CFEI MCFD#11 360-701-6017 Mason ounty Fire District# 11 : 2015-145 Page 1 of 2 1 ECEIVED 1 52015 Location: Incident Type: 426 W. 974 W LITTLE EGYPT RD 111-Building fire CEDAR ST. Shelton WA 98584 FDID: Lat/Long: Incidentt#:#: 2015-145 N 470 12153.3111 Exposure ID: 11254310 W 1230 13142.6111 Exposure#: 0 ��R�rD151T}R� Incident Date: 03/19/2015 Zone: Dispatch Run #: 15-009088 Mason County Fire MA16-Dayton District 16-Mutual- aid District # 11 Location Type: 1-Street address Station: 11 Map Page: F089 Report Completed by: Heinrich, Matthew E ID: 1102 Date:03/19/2015 Report Reviewed by: Heinrich, Matthew E ID: 1102 Date:03/19/2015 Report Printed by: Heinrich,Matthew E ID: 1102 Date:3/19/2015 Time: 20:49 Structure Type: Property Use: - Automatic Extinguishment System Present: ❑ Detectors Present: Cause of Ignition: Aid Given or Received: Mutual aid given Primary action taken: 11-Extinguishment by fire service personnel Mutual AID Their FDID: 23D16 Their State: WA Their Incident#: 064 Additional actions: 86-Investigate,- 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: 1 Total#of personnel on call: 2 NARRATIVE District 11 requested mutual aid by F1600 for a fully involved mobile home fire threatening a cabin. El I I on scene parked at driveway and F1100 and F1102 walked to scene.On arrival at structure it was found fully involved and the cabin was involved on the outside bravo wall and the eves. F1100 assigned to operations. F1102 put on nozzle and placed on Charlie side of cabin to extinguish and protect cabin.Cabin extinguished and ten gallon propane was found venting near mobile home. F1102 cooled propane tank while it vented. Fire knocked down and F1102 switched to investigation mode. (See investigation report for details). F1102 investigated and units cleared scene. No injuries to fire personnel. Matt Heinrich Captain/CFEI MCFD#11 Narrative from dispatch: 12:02:10 03/19/2015-Early,Allison RP STATES SOMEONE RAN UP TO THEM SAYING THERE IS A STRUCTURE FIRE.. IT IS A RESIDENCE... 12:02:38 03/19/2015-Early,Allison UNK IF ANYONE IS INSIDE AT THIS TIME... 12:02:57 03/19/2015- Early,Allison TOTALLY ENGULFED, 1 STORY MANUFACTURED HOME 12:03:14 03/19/2015-Early,Allison NO ONE IN HOME, DOGS ARE IN RPS CAR. 12:03:25 03/19/2015-Germain,Kim pud advsd 12:03:31 03/19/2015-Early,Allison NO FLAMES, JUST A LOT OF SMOKE SO FAR COMING OUT OF THE EVES. 12:04:39 03/19/2015-Early,Allison CABIN SITS VERY CLOSE TO HOME- 16X20FT. MOTORCYCLE IS CLOSE.. 12:04:40 03/19/2015-Kingery,Kristin third caller sees alot of smoke.... states she can hear yelling and its a huge fire... pat robertsdon 360 432-7921 12:04:46 03/19/2015-Early,Allison HOMEWONER IS FIRST OF JULIA 12:04:54 03/19/2015-Early,Allison PROPANE TANK ATTACHED TO BBQ 12:05:37 03/19/2015-Early,Allison HOMEOWNER IS VERY VERY FRANTIC 12:09:08 03/19/2015-Kingery,Kristin-From: Medic 15-2 large plume of smoke 12-.11:31 03/19/2015-Early,Allison HOMEWONER/KLEUTSCH,JULIA MARIE KELTNER DOB/04-22-1966 12:15:22 03/19/2015-Kingery,Kristin-From: Medic 15-2 FULLY INVOLVED STRU A B SIDE NARROW DRIVEWAY 12:18:36 https:Hsecure.emergencyreporting.com/nfirs/print.asp?printtype=2&printtype=3&printtype... 3/19/2015 Mason -ounty Fire District# 11 : 2015-145 Page 2 of 2 03/19/2015-Kingery,Kristin-From: Medic 15-2 HOUSE NEXT TO FIRE ISNOW ON FIRE IN ATTIC 12:22:09 03/19/2015- Kingery,Kristin-From: McKern,Tim(F05 DISPATCH 214,AND FM1402 12:26:50 03/19/2015-Kingery,Kristin PUD ARRIVING 12:27:34 03/19/2015-Germain,Kim per cooper 214 is not avail 12:42:40 03/19/2015-Earty,Allison PER COMMAND ALL OPERATIONS NOW ON REDNET 13:00:02 03/19/2015- Kingery,Kristin 13:26:29 03/19/2015-Kingery,Kristin CH4 F IS HANDICAPPED 13:26:39 03/19/2015-Kingery,Kristin CH4 CONT RED CROSS 2 ADULTS 1 MALE 1 FEMALE 13:26:44 03/19/2015-Kingery,Kristin CH4 CONT RED CROSS 2 ADULTS 1 MALE 1 FEMALE 13:43:16 03/19/2015-Kingery,Kristin RED CROSS WILL BE CALLING HIS CELL 15:26:41 03/19/2015-Early,Allison BROTHER IN SEATTLE REQ A CALL FROM JULIA 206 459 1123 CURTIS AELTNER 15:42:30 03/19/2015-Eady,Allison PER CH5 NO CELL SERVICE TO GET OUT AT THIS TIME....... 15:44:44 03/19/2015-Kingery,Kristin F502 CONT 1102 HAVE HIM CALL 15:48:32 03/19/2015-Morrison,Tiff per ch4,ch5 remain on scene,red cross on scene 16:06:25 03/19/2015-Evans,Hillary-From: Rooks,Donnie OVERHAUL COMPLETE COMMAND DISOLVED Call type f reopened by Monison,Tiff at 18:50:15 03/19/15 APPARATUS Unit E11-1 Type: Engine Use: Suppression Response Mode: Lights and Sirens RECEIVED #of People 2 Injury Or Onset -- Alarm 03/19/2015 12:00:09 205 Dispatched 03/19/2015 12:07:25 Enroute 03/19/2015 12:08:46 426 W. DEDAR-ST.— Arrived 03/19/2015 12:17:10 Cancelled Cleared Scene 03/19/2015 15:30:57 In Quarters -- In Service 03/19/2015 15:30:57 Number Of People not on apparatus: 0 CUSTOM FIELDS FORM Out of District Patient? No HIPPA Signature/Exception acquired? No Starting Mileage 0 Ending Mileage 0 BLS Transport Flat Fee? $0.00 Mileage billed at$15.50 a mile 0 Total Billable 0 INCIDENT IMAGES PERSONNEL ON CALL Name Personnel Rank Apparatus Heinrich,Matthew E Captain E11-1 Searles,Brandon Chief E11-1 Member Making Report(Captain Matthew E Heinrich): Supervisor(Captain Matthew E Heinrich): , https://secure.emergencyreporting.com/nfirs/print.asp?printtype=2&printtype=3&printtype... 3/19/2015