HomeMy WebLinkAboutStructural IRQ Permit#FP1505176 - BLD Inspections - 9/13/2007 _ RECEIVED
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DEFT OF IAi
-structural Inspection Request Questionnaire
Please fax this questionnaire to Plan Review at (360) 9,02-5229-
You also may want to contact plan review at (,360) 902-5228 to
discuss vour structural-alteration and to expedite the process..
Name:
(The contractor or person doing the work)
Site Address:
(The physical address where the alteration is being done) (Also include the city)
Daytime Phone#: t
(The contractor or person doing the work) - ``M
FAS Alteration Permit#:FP /c Q 5 7(D -
(you 1417 find this 4 on the permit that you are to postn jobsite prior to beginning�4ork)
Who is the Manufacturer of the Manufactured•Home? � �
(You will find this on the compliance certificate in the manufactured home)
What vear was the home manufactured?
(You will find this on the compliance certificate in the manufactured
home)
What is the roof load of your home? N—�
(You will find this on the compliance certificate in the manufactured home)
What is the structural alteration you want to perform? (Be very specific)
What other types of alterations are you making?
�FN
8 DFpT 7 3?DOI
ROOFING AFFIDAVIT % vfty �
Homeowner
Address_ �� I �-, L6 Csv, k.
City WL Zip Code Phone No. ( A-0 -l0
Manufacturer of home (if known) � Roof load of home �
Serial number of home (if known) ? L&I Permit Number
Year of home (if known)
Singlewide Doublewide _Triple wide ```''`"
•'`i'_ .� " i !t.;_'::;Sidi
p -ir t F r rt =a
am authorized to certify on bify'='_}
rr
(Print Name) 11 II
of '� �I�, , that on _
(Company Name)
Please identify if any of the following structural repairs were performed to the roof- (if any
of the answers below are marked YES please fill out the Structural Questionnaire for plan
review screening on the back of this form.)
1) The removal and repair of any trusses or rafters. Yes No /Y
2) The replacement of more than (4) 48 pieces of sheathing. Yes_No
3) A second layer of asphalt roofing was applied over existing roofing without
it being removed. Yes No
4) Applying metal roofing with or without insulation board over existing
asphalt shingles. Yes No A
5) Remove and replace metal roof with asphalt roofing. Yes No
Note: L&I Plan Review in addition to inspection and approval are required for any
of the above items. Please omplete the back side of this form.
Signature of contractor
Other witness_signature(s) [when available]:
Homeowner
Contractor Representative
The original of this affidavit must be available for the inspector prior to when the inspection is
made.
Page 2 of 2
DO NOT POST THIS AT THE WORKSITE
SUBSCRIBERS of the EPIS system do not need to use this code to request or view inspections
through Secure Access Washington.
This is your permit number: FP1505176
Use this authorization code: 99972
The authorization code enables customers who are not subscribed to our online permitting
system (EPIS) to request inspections and view their inspection results online through the
"Request and Inspection" website.
Use your authorization code and permit number at:
The Department of Labor and Industries FAS Homepage: www.Ini.wa.gov/tradeslicensingZfas
Close
http://scsd.apps-inside.lni.wa.gov/pairspermit/rptFASPennit.aspx?AppID=109 9/13/2007
Page 2 of 2
DO NOT POST THIS AT THE WORKSITE
SUBSCRIBERS of the EPIS system do not need to use this code to request or view inspections
through Secure Access Washington.
This is your permit number: FP1505176
Use this authorization code: 99972
The authorization code enables customers who are not subscribed to our online permitting
system (EPIS) to request inspections and view their inspection results online through the
"Request and Inspection" website.
Use your authorization code and permit number at:
The Department of Labor and Industries FAS Homepage: www.Ini.wa.P-ov/tradeslicensing(fas
Close
http://scsd.apps-inside.lni.wa.gov/pairspertnit/rptFASPermit.aspx?AppID=l 09 9/13/2007
Page 2 of 2
DO NOT POST THIS AT THE WORKSITE
SUBSCRIBERS of the EPIS system do not need to use this code to request or view inspections
through Secure Access Washington.
This is your permit number: FP1505176
Use this authorization code: 99972
The authorization code enables customers who are not subscribed to our online permitting
system (EPIS) to request inspections and view their inspection results online through the
"Request and Inspection" website.
Use your authorization code and permit number at:
The Department of Labor and Industries FAS Homepage: www.Ini.wa.gov/tradeslicensin fas
Close
http://scsd.apps-inside.lni.wa.gov/pairspermit/rptFASPermit.aspx?AppID=109 9/13/2007