HomeMy WebLinkAboutBRN2009-00009 Final - BRN Permit - 2/13/2009 BURN PERMIT
Mason County Dept. of Community Development
PO BOX 186 - 426 W Cedar St, Shelton WA 98584 - 360.427.9670
BRN2009 =00009
Issue Date Expiration Date
Site Address: 3330 E BROCKDALE RD SHELTON
321314100010 31 21 3
Parcel Number Section Township Range Fire District
Applicant: RICHARD HUTCHINS
Address: 1325 WINGWOOD PL SHELTON WA 98584
P H 1: 426-1963
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--
BRN2009-00009 02/13/200!
PERMIT NO.
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) 482-5269 •www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner. �Z ickt rd J4ii.A+Ck;tis Company Name
Mailing Address 13Z5 W0:5WO d PL Mailing Address
City St" I:tcj State_1aLA_ Zip Code City State Zip Code
Phone q?i,- 01",� Other Ph. yqb -- 0l-1-7 Phone Other Ph.
Lien/Title Holder_OUL enno44i,'4v_ 116(d;4- k&,0 Contractor Reg. # _.�_ Exp.
E mail Address -- E Mail Address
Drivers Lic. # PlJTc,N 2LZqLDE DOB__J_28 -'](o Drivers Lic. # DOB
PARCEL NUMBER: - Li 0 Sec._3L Town. 2-1 _Rng. 3 Fire District_L
Site Address (Please include street name, number and city)
Directions to site cxn(-o k. 2 W- Ic s 00-- ?ra JcAale_ V- . o�-) le
Parcel within 200'of Saltwaterp Lakep River/Creek❑ Pond[3 Wetland p Seasonal Runoffp Stream[3 Slopes or Bluffs> 15%
Is property flagged or addressed prior to inspection e�No-Will timber be cut and sold in parcel preparation? Yes /
Reason for land clearing: Q mo i r- In o
Is this site being converted or replanted? Yes / Does site require FPA or 6 yr. Moratorium? Yes/
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/No
Burning is authorized subject to the following conditions:
permit must be on site while burning.
�Palid
he 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.
E3.4II materials must originate from the property on which the burning is to occur.
he fire must not create a nuisance from smoke,obscure visibility on public roads and highways,or endanger life and property.
aximum pile size is twenty(20)feet in diameter, a minimum ten(10)foot firebreak must be constructed around each pile.
ach pile must be at least one hundred(100)feet from any structure, at least fifty(50)feet from standing timber.
o not burn if wind is blowing more than seven(7)miles per hour.
o not burn if wind is blowing from (direction)
A responsible adult and knment shall be required to be on site and in attendance at the fire while burning.
On site water required: ® No
rovide EXCAVATOR/DAZ (with afire extinguisher)on site with qualified operator.
rovide 24 hour fire watch.
ire must be completely extinguished within three(3)days after ignition.
Fan required
Other
13 Upon completion of above conditions,applicant must call(36 427-9670 Ext.262 for spection prior to burning
OWNER/CONTRACTOR Acknowledges submission of inaccurate information ma resu in a stop worts 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
inspection. This permit/application becomes null and void if worts is not completed within 30 days. Permit includes two (2) inspections mvdmum,
additional ins ctio wiq qu a of sixty four(64)dollars per inspection. q
X Date: 2 `
Owner/Owners Re re n tive/Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED A N TES
Fire Marshal ,j _ 1—
FEES
Burn Permit Fee Site Inspection Violation Fee
State Fee Pre-Paid at Submittal Other
EXPIRES: Date: Inspector TOTAL FEES