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Home My WebLink AboutBRN2012-00022 - BRN Application - 6/5/2012 BRN2012-QMOIA_ MASON COUNTY BURN PERMIT APPLICATION 426 W CEDAR ST. • PO BOX 196• SHELTON WA 98584 SHELTON 360.427.9670 •BELFAIR 360.275.4467 •ELMA 360.482.5269 APPL CANT INFORMATIQ CONTRA"QR IN O TION- ` Own Owner J O 1 Mailin ddress Mailing Address City State Zip City - State Zip Phone Cell Phone Phone (P'I0-12.r Other Phone Lien/Title Holder Contractor Reg.# Exp. E-mail address E-mail address Drivers Lic.# DOB Drivers Lic.# D.O.B. TAX PARCEL NUMBER 2' 220 L Secr r wn. Fire istrict SITE ADDRESS(please include street name,number&city 7 �— Directions to the site IF Ck Parcel within 200'of: Saltwater❑ Lake❑ River/Creek❑ Pond❑ Wetland❑ Seasonal Runoff❑ Stream❑ Slopes or Bluffs> 15% Yes/NO Will timber be cut and sold in parcel preparation?Yes/No Does Site require FPA or 6 yr.Moratorium:Yes/No Is site being converted or replanted:Yes/No --- Reason For land Clearing 1 Is this application the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No BURNING IS AUTHORIZED SUBJECT TO THE FOLLOWING CONDITIONS: c • Valid permit must be onsite while burning S • 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 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 15t'and Oct..15s'.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 EXCAVATOR/DOZER(with fire extinguisher)on site with gualified 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 360.426.4441,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 fire/bum 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 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 ssion is required from any easement holder or any other party in interest regarding this application or the work proposed in plication,I have obtained permission from them to apply for this permit and conduct the work proposed.The owner or agent on A half,represents that the information provided is accurate and grants employees of Mason County&local fire autho ' ccess to above described property and structure for review and inspection.The person in charge of the fire wi I r th cost of s ression if the fire gets out of control or if becomes necessary to extinguish the fire as the result of an enfo]�9e`e X Date INdicat owner/AVDlicant/ReiDresentative 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 i� BURN PERMIT BRN2012-00022 OWNER: DANIEL FRAZIER RECEIVED: 6/5/2012 CONTRACTOR. JOHN WAYNE TREE SERVICE 360.670.1217 LICENSE: JOHNWWT941 KE EXP: 7/20/2012 ISSUED: 6/5/2012 SITE ADDRESS: 1621 SE ARCADIA RD SHELTON EXPIRES: PARCEL NUMBER: 320281200030 LEGAL DESCRIPTION: TR 3 OF NW NE PROJECT DESCRIPTION: DIRECTIONS TO SITE: BURN PERMIT FOR LAND CLEARING FOLLOW ARCADIA RD TO WALKER PARK RD TO SITE ON THE LEFT BURN TYPE: FEES Land Clearing Type By Date Amount Receipt Burn Permit GMM 6/5/2012 $160.50 S1201200000000000863 Total $160.50 BRN2012-00022 Please refer to the following pages for conditions of this permit. Page 1 of 4 CASE NOTES FOR BRN2012-00022 CONDITIONS FOR BRN2012-00022 1) Permit includ a,two (2) inspectt,o'ns maximum, additional inspections will require a $73.00 re-inspection fee. X ' 4 / 2) Applicants must�pIN'36Q42�4441, EACH day to report burning activity. Last 3 numbers of permit required at time of call in. X 3) Applicants mkt call 36.0: 86.1044 (ORCCA) EACH day to report/request any air quality issues associated with burning. X �. 4) Valid permit ust%be on-site.while burning. X 5) A BURN BAN w h 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 b6'extirl.guished immediately. X I 6) The followi 'materials may not be burned: Garbage, dead animals, asphalt, petroleum products, paints, rubber products, plastics, paper, cardboard, treated w /construction /demolition debris, metal or any substance (other than natural vegetation)that normally releases toxic emissions, dense smok" no us oidors when burned. X i i 7) All materi/1 ;m�L from the property on whichthe burning is to occur. X 8) The fire mtwlrino create a nuisance from smoke, obscure visibility on public roads and highways or endanger life and property. X 9) The maxim,(pi� e is twenty(20) feet in diameter, with a minimum ten (10) feet firebreak around each pile. X 10) Each pile"mu be at one hundred (100)feet from any structure and atleast fifty(50)feet from standing timber. X BRN2012-00022 Please refer to the following pages for conditions of this permit. Page 2 of 4 11) Do not bur Afyvindis-blowing more than seven (7) MPH. X 12) Do not bW ' wind 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 PROVIDE 24 -FIRE WATCH. X 14) On Site Water is fed 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 be capab) pumping 20 gallons per minute through a one-inch (diameter) 50-foot hose.) X �! 15) It is advisablp 4the entire content of the water tank onto the burn site to assure the fire is completely extinguished. Permitted individual is responsib or ny rekindling on the fire/burn site. X 16) Provide exlcav or/.dozer with a fire extinguisher at the site with a qualified operator. X i 41 17) Provide /heuf_fire watch. X '� 18) The perso i arge 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 o a forcement tion. X . 19) Adcess mus assable with 2 wheel drive vehicle. X 20) Fire mus c pletely extinguished within three (3) days after ignition. X17 21) After the bur s om ete, YOU MUST touch by hand, the earth to make sure the fire has not burned down into the earth. X 22) Fan is rewired. X BRN2012-00022 Please refer to the following pages for conditions of this permit. Page 3 of 4 This permit becomes null and void if work or constructer 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. Evidencq of coglin, on 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 wor ss by, s progress inspection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Mason C n�ty.at ss to he above described property and structure for review and inspection. _. OWNER OR AGENT: —�� DATE: BRN2012-00022 Please refer to the following pages for conditions of this permit. Page 4 Of 4