HomeMy WebLinkAboutBRN2011-00014 - BRN Permit - 5/19/2011 Inspection Line (360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext. 352
Mason County Bldg. III 426 W. Cedar P.O. Box 186
Shelton, WA 98584
` BURN PERMIT BRN2011-00014
OWNER: ANDREW TAYLOR RECEIVED: 5/19/2011
CONTRACTOR: LICENSE: EXP: ISSUED: 5/19/2011
SITE ADDRESS: 40 E ADELLE LN ALLYN EXPIRES:
PARCEL NUMBER: 122322290084
LEGAL DESCRIPTION: TR 4 OF W1/2 NW NW EX TR 4 SP#680
PROJECT DESCRIPTION: DIRECTIONS TO SITE:
LAND CLEARING BURN HWY 3 TO MILE POST 19
BURN TYPE: FEES
Land Clearing Type By Date Amount Receipt
Burn Permit GMM 5/19/2011 $160.50 S1201100000000000883
Total $160.50
BRN2011-00014 Please refer to the following pages for conditions of this permit. Page 1 of 4
CASE NOTES FOR
BRN2011-00014
CONDITIONS FOR
BRN2011-00014
1) Permit inclugg ) inspections maximum, additional inspections will require a$73.00 re-inspection fee.
X A
2) Applicants ii� call .427.7761, EACH day to report burning activity. Last 3 numbers of permit required at time of call in.
X
3) Applicants must call 36Q,586.1044 (ORCCA) EACH day to report/request any air quality issues associated with burning.
X
4) Valid per must on-site while burning.
X
5) A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void. After a burn ban has been implemented,
all fires mu e e �shed immediately.
X
6) The following materials may not be burned: Garbage, dead animals, asphalt, petroleum products, paints, rubber products, plastics, paper, cardboard,
treated wood, construction /demolition debris, metal or any substance (other than natural vegetation) that normally releases toxic emissions, dense
smoke cis odors when burned.
X
7) All material must o to from the property on whichthe burning is to occur.
X
8) The fire pN4sj n eate a nuisance from smoke, obscure visibility on public roads and highways or endanger life and property.
X
9) The ma i e size is twenty(20) feet in diameter, with a minimum ten (10) feet firebreak around each pile.
X
10) Each pile m at least one hundred (100) feet from any structure and atleast fifty (50)feet from standing timber.
X
BRN2011-00014 Please refer to the following pages for conditions of this permit. Page 2 of 4
11) Do notd is blowing more than seven (7) MPH.
X
12) Do not burn i# i d is blowing from XX direction. (This will be indicated on the posted permit at the time of site inspection.)
X
13) A minimum of one qualified operator is required to be in attendance at the fire while burning. A burn site/fire shall never be left unattended. MUST
PROVIPZ24 FIRE WATCH.
X
14) On Site Water is required between April 15th and Oct. 15th. The pump truck or trailer must have 300 gallons of water loaded and 200 ft of hose. (Pump
must b bl mping 20 gallons per minute through a one-inch (diameter) 50-foot hose.)
X
15) It is advisable to pump the entire content of the water tank onto the burn site to assure the fire is completely extinguished. Permitted individual is
responsible an dling on the fire/burn site.
X
16) Provid va /dozer with a fire extinguisher at the site with a qualified operator.
X 771
17) Provide a 4-hour fie watch.
X
18) The person in charge of the fire will be liable for the cost of suppression if the fire gets out of control or if becomes necessary to extinguish the fire as the
result of an jpjafor ent action.
X
19) Access st sable with 2 wheel drive vehicle.
X
20) Fire must b
,t_2qmpj0ely extinguished within three (3) days after ignition.
X
21) After the bu�a-i�T7 ete, YOU MUST touch by hand, the earth to make sure the fire has not burned down into the earth.
X `�i%�
22) Fan i it
X
BRN2011-00014 Please refer to the following pages for conditions of this permit. Page 3 of 4
This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any
time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be
occupied. Proof of continuation of work eans o ss inspection. The owner or the agent on the owners behalf, represents that the information provided is accurate
and grants employees of Mason C unty acce h above described property and structure for review and inspection.
OWNER OR AGENT: DATE:
BRN2011-00014 Please refer to the following pages for conditions of this permit. Page 4 of 4
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Date By Data By DECKS
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PLUMBING Vault Date By
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BURN PERMIT
Mason County Dept. of Community Development
of PO BOX 186 - 426 W Cedar St, Shelton WA 98584 - 360.427.9670 ext 352
www.co.mason.wa.us
B RN201 1 =000 14
Issue Date Expiration Date
Applicant: ANDREW TAYLOR Contractor:
Address: PO BOX 488 BELFAIR WA 98548 Address:
PH 1: 360-275-6499
Contact Number(s) - Must be a 24 hour number Reg #:
Parcel Number: 122322290084 Section: 32 Township: 22 Range: 1 Fire District:
Legal Description: TR 4 OF W1/2 NW NW EX TR 4 SP#680
Site Address: 40 E ADELLE LN ALLYN
1. Valid permit must be onsite while burning
2. The following materials are prohibited and must not be burned: garbage, dead animals, asphalt, petroleum products, paints,
rubber products, plastics, paper, cardboard, treated wood, construction/demolition debris, metal or any substance (other than
natural vegetation)that releases toxic emissions, dense smoke, or obnoxious odors when burned.
3. All materials must originate from the property on which the burning is to occur.
4. The fire must not create a nuisance from smoke, obscure visibility on public roads and highways, or endanger life and property.
5. Maximum pile size is twenty (20) feet in diameter, a minimum ten (10) feet firebreak must be constructed around each pile.
6. Each pile must be at least one hundred (100) feet from any structure and at lease fifty (50) feet from standing timber.
7. Do not burn if wind is blowing more than seven (7) miles per hour.
8. Do not burn if the wind is blowing from
9. A responsible adult and equipment shall be on site and in attendance at the fire while burning. Must provide 24 hour fire watch.
10. On Site Water is required between April 15th and Oct. 15th. An pump truck or trailer with 300 gallons of water loaded and 200
ft of hose. (The pump must be capable of pumping 20 gallons per minute through a one- inch (diameter) 50-foot section of hose.)
11. Provide EXCAVATOR/DOZER (with fire extinguisher) on site with qualified operator.
12. Fire must be completely extinguished within three (3) days after ignition
13. Fan required.
14. Upon completion of above conditions, applicant must have inspection & approval before ignition. Call (360)427-9670, ext. 262
15. Applicants must call 360.427.7761, EACH day to report burning activity. Last 3 numbers of permit required at time of call in.
16. Applicants must call 360.586.1044 (ORCCA) EACH day to report/request any air quality issues associated with burning.
17. After the burn is complete make sure the fire has not burned down into the earth by checking the fire location for hot spots.
18. It is advisable to pump the entire content of the water tank onto the burn site to assure the fire is completely extinguished. The
permitted individual or party is responsible for any rekindling on the burn site.
19. A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void. After a burn
ban has been implemented, all fires must be extinguished immediately.
20. Permit includes two (2) inspections maximum, additional inspections will require a re-inspection fee. (at current rate)
21. The person in charge of the fire will be liable for the cost of suppression if the fire
gets out of control or if becomes necessary
to extinguish the fire as the result of an enforcement action.
22. Access must be passable with 2 wheel drive vehicle.
Official Use Onl
72 Inspector:
Date: �-L"� - /
� � om,
Sketch of Site/Comments T� �iqC_ J't v'
BRN2011-00014 05/19/201 '
MASON COUNTY BURN PERMIT APPLICATION
426 W CEDAR ST. • PO BOX 186 • SHELTON WA 98584
SHELTON 360.427.9670 • BELFAIR 360.275.4467 • ELMA 360.482.5269
APPLICANT I1,1FORMATION: , CONTRACTOR INFORMATION:
Owner Kw R F_Q L 1 19,1 6,4- Owner
Mailing Address -o bow a1CI S Mailing Address
City_ P �M(( State Zip G@b City State Zip
Phone360 M0 j460 Cell Phon 3 �a (bsO Phone Other Phone
Lien/Title Holder Contractor Reg. # Exp.
E-mail address GJDI e w( E-mail address
Drivers Lic.#'Tf to L' C /n,k DOB "7-la-IF?3 Drivers Lic. # D.O.B.
TAX PARCEL NUMBER Sec. Twn. Rng. Fire District
SITE ADDRESS(please include street name, number&city W 0 F_ash 6,e11P_ L N ►A ih y\) G S
Directions to the site
Parcel within 200'of. Saltwater❑ Lake❑ River/Creek❑ Pond ❑ Wetland❑ Seasonal Runoff❑ Stream ❑
Slopes or Bluffs> 15/o Yes Will tuber be cut and sold in parcel preparation. Yes/ o
Does Site require FPA or 6 yr. Moratorium Ye IQ- Is site being converted on eplante Yes o
Reason For land Clearing r G�SS C k� n vs a� �
Is this application the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye
Burning is authorized subject to the following conditions:
• Valid permit must be onsite while burning
• The following materials are prohibited and must not be burned: garbage, dead animals, asphalt, petroleum products, paints, rubber
products, plastics, paper, cardboard, treated wood, construction/demolition debris, metal or any substance (other than natural
vegetation)that releases toxic emissions,dense smoke,or obnoxious odors when burned.
• All materials must originate from the property on which the burning is to occur.
• The fire must not create a nuisance from smoke,obscure visibility on public roads and highways,or endanger life and property.
• Maximum pile size is twenty(20)feet in diameter,a minimum ten(10)feet firebreak must be constructed around each pile.
• Each pile must be at least one hundred(100)feet from any structure and at lease fifty(50)feet from standing timber.
• Do not burn if wind is blowing more than seven(7)miles per hour.
• Do not burn if wind is blowing from
• A responsible adult and equipment shall be on site and in attendance at the fire while burning. Must provide 24 hour fire watch.
• On Site Water is required for permits between April 15`h and Oct. 15`h.A pump truck or trailer with 300 gallons of water loaded and
200 ft of hose. (The pump must be capable of pumping 20 gallons per minute through a one inch(diameter)50 foot section of hose.)
• Provide EXCAVATORIDOZER(with fire extinguisher)on site with qualified operator.
• Fire must be completely extinguished within three(3)days after ignition
• Fan required.
• Upon completion of above conditions,applicant must have inspection&approval before ignition. Call (360)427-9670,ext.262
• Applicant's must call 360.427.7761, EACH day to report burning activity. Last 3 numbers of permit required at time of call in.
• Applicants must call 360.586.1044(ORCCA)EACH day to report/request any air quality issues associated with burning.
• After the burn is complete make sure the fire has not burned into the earth by checking the fire location for hot spots.
• It is advisable to pump the entire content of the water tank onto the burn site to assure the fire is completely extinguished. The
permitted individual is responsible for any rekindling on the fireibum site.
• A BURN BAN when implemented by Fire Marshal will take effect as noted and all permits become null and void.After a burn ban
has been implemented,all fires must be extinguished immediately.
• Permit includes two(2)inspections maximum,additional inspections will require a re-inspection fee. (at current rate)
• Access must be passable with 2 wheel drive vehicle
OWNER/CONTRACTOR: Acknowledges submission of inaccurate information may result in a stop SITE SKETCH/NOTES
work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am
the owner,owner's legal representative, or contractor. I further declare that I am entitled to receive this
permit and to do the work as proposed in the application. I declare that I have obtained the permission
from all the necessary parties. If permission is required from any easement holder or any other party in
interest regarding this application or the work proposed in the application, I have obtained permission
from them to apply for this permit and conduct the work proposed.The owner or agent on owners
behalf, represents that the information provided is accurate and grants employees of Mason County&
local fire authorities access to the above described property and structure for review and inspection. The
person in e f(in%Wahe
ill be liab e r the cost of suppression if the fire gets out of control or if APPROVED DENIED
becom necess o s -fire as the result of an enforcement action.
XCN - Date s- INTIALS
Owner/Owners Representative/Contractor(indicate which one) DATE