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HomeMy WebLinkAboutBRN2009-00018 - BRN Permit - 3/25/2009I BURN PERMIT Mason County Dept. of Community Development PO BOX 186 -426 W Cedar St, Shelton WA 98684 - 360.427.9670 RN2009 =0001 8 Issue Date Expiration Date Site Address: 240 NE CHINOOK DR BELFAIR 123303290270 30 23 1 2 Parcel Number Section Township Range Fire District Applicant: JIM JESFIELD Address: P O BOX 159 BELFAIR WA 98528 PH1: 1.360.275.7462 Contact Number(s) - Must be a 24 hour number Conditions: 1.Valid permit must be on-site while burning. 2. 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 or obnoxious odors when burned. 3.All material 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. The maximum pile size is twenty (20) feet in diameter, with a minimum ten (10) feet firebreak around each pile. 6. Each pile must be at least one hundred (100) feet from any structure and at least fifty (50) feet from standing timber. 7. Do not burn if wind is blowing more than seven (7) MPH. 8. Do not burn if wind is blowing from direction. 9. The minimum people required to be in attendance at the fire while burning: 1 10. On site water required? 11. Provide excavator / dozer with a fire extinguisher at the site with a qualified operator. 12. Provide a 24-hour fire watch. 13. Fire must be completely extinguished within three (3) days after ignition. 14. Fan is required. 15. Other: Fire Warden: Signature Date **YOU MUST CALL (360) 427-7761 EVERY MORNING TO REPORT IN** BRN2009-00018 1� can. �.o �] `l�� PERMIT NO .�I %t (�(.XJ I MASON COUNTY BURN PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair(360) 275-4467 - Elma (360)48275269 -www.co.mason.wa.us APPLICANT I FORMATION CONTRACTOR INF R A'rrl N Owner. 1ii Company Name L-U Mailing Addre s State S Mailing Address City Zip Code �' City State Zip Code Phone '7�5 ' 7�1v K--- Other Ph. Phone Other Ph. Lien/Title Holder Contractor Reg. # Exp. E mail Address E Mail Address Drivers Lic.#-JTeJa r/Jp2S7Y60 DOB 0, Drivers Lic.# DOB PARCEL NUMBER:1d-dV9�,9®,d-70 Sec.-WTown. ' -7 Al Rng. Fire District Site Address(Please in Jude street name, number and city) ®r✓,� �• �� Directions to site Z� F / �� - .fG+ocJ -ru I� /-ST' as 4!KZ rJl�/� Parcel within 200'of SaltwaterQ Lakep River/Cre,e�Z Pondp Wetland[3 Seasonal Runoffp Streamp Slopes or Bluffs> 15% Is property flagged or addressed prior to inspection 'l �No-Will timber be cut and sold in parcel preparation? l / No Reason for land clearing:^PA6LaQX 77Z ,Q F' 6/0"" -117--=-- Is this site being converted or replanted? Yes / Does site require FPA or 6 yr. Moratorium? Ye / The person in charge of the fire may be liable for the cost of fire supression if the fire gets out of control or,if it becomes necessary to extinguish the fire as a result of enforcement action.Open burning shall be prohibited during any period of impaired air quality as designated by the Olympic Region Clean Air Agency, or during extreme fire danger due to dry weather conditions as designated by the Mason County Fire Marshal's Office.Information hotline(360)427-7799 Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action? Yes/ Burning is authorized subject to the following conditions: Valid permit must be on site 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 normally 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)foot firebreak must be constructed around each pile. ®Each pile must be at least one hundred(100)feet from any structure,at least fifty(50)feet from standing timber. 113 o not burn if wind is blowing more than seven(7)miles per hour., Do not burn if wind is blowing from (direction) ®A responsible adult and equipment shall be required to be on site and in attendance at the fire while burning. On site water required: [3Yes ® No Provide EXCAVATOR/DOZER(with a fire extinguisher)on site with qualified operator. ©Provide 24 hour fire watch. M Fire must be completely extinguished within three(3)days after ignition. IM Fan required 13 Other C@ Upon completion of above conditions,applicant must II(360)427-9670 Ext.262 for nspection prior to burning OWNER/CONTRACTOR Acknowledges submission of inaccurate in It' to work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or the 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 neces- sary 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 access to the above described property for review and ins p 'on.This permit/application becomes null and void if work is not completed within 30 days. Permit includes two(2) inspections ma)amum, addZ'01 inspe 'ons will require a fee of sixty four(64)dollars per inspection. X Date: D� --�ne`r-F'0'wnU Re resentative/Contractor indicate which one FOR OFFICIAL USE BEYOND T OINT Accepted b (.2J Dat 1,L n EreM RTMENTAL REVIEW APPROVED DENIED NOTES rshal -zS FEES Burn Permit Fee Site Inspection Violation Fee State Fee Pre-Paid at Submittal Other EXPIRES: Date: Inspector TOTAL FEES