Fill - Free fillable STATE OF WASHINGTON FACTORY BUILT HOUSING AND COMMERCIAL (Washington) PDF form

STATE OF WASHINGTON

FACTORY BUILT HOUSING AND COMMERCIAL STRUCTURES

REGULATIONS

Effective: July 1, 2017 to

(Except as Noted)

Factory built housing and commercial structures built to be sited in Washington State are

inspected by the Department of Labor and Industries, Specialty Compliance Services

Division and are to be constructed to comply with the following codes. Factory built

structures WAC rules can be found at the website below. Washington State amendments and

Washington State stand alone codes are available as shown in brackets ( ).

Rules for Factory Built Structures

Chapter 296-150F WAC (Dated 02-04-2020) (Website)

(Note: As new rules become effective they will be published on

our website)

International and Uniform Codes as Adopted per the Washington State Building

Code RCW 19.27

2015 International Building Code

(IBC) and Washington

State amendments to the

2015 International

Building Code

adopted by Chapter WAC 51-50

(WABO)

2015 International Residential Code

(IRC) and Washington(WABO)

State amendments to the

2015 International

Residential Code

adopted by Chapter WAC 51-51

2015 International Mechanical Code

(IMC) and

Washington State amendments to the

2015 International

Mechanical Code

as adopted by Chapter WAC 51-52

2015 International Fire Code

(IFC) and Washington

State amendments to the

2015 International

Fire Code

adopted by WAC 51-54A

2015 Uniform Plumbing Code(UPC

) and Washington

State amendments to the

2015 Uniform Plumbing Code

as adopted by Chapter WAC 51-56

(WABO)

FBS_Regulations_REV

Washington State stand alone codes as adopted under the Washington State

Building Code RCW 19.27 and 19.27A

Washington State Energy Code, 2015 Edition as

adopted by Chapter 51-llC and51-llR WAC

Washington State Electrical Laws, Rules and Regulations:

RCW 19.28; WAC 296-46B (current edition)

2017 National Electrical Code (NEC) as adopted by

RCW 19.28 and WAC 296-46B

Other state agency rules that may be applicable:

(NOTE: List may not be all inclusive)

Primary and Secondary Schools - WAC 246-366

Boarding Home Licensing Rules WAC 388-78A

Also enclosed for your use are:

(WABO)

(L&I Elect.)

(HEALTH)

(DSHS)

"Plan Approval Request" form and instructions for completing.

"Application for Insignia" form and instructions for completing.

"Notification to Local Enforcement Agency" form and instructions.

Procedural bulletins and procedures affecting Factory Built Structures.

Copies of Codes are available as follows:

(WABO)

(L&I Elect.)

(HEALTH)

(DSHS)

The Washington Association of Building Officials

0. Box 7310

Olympia, WA 98507-7310

Telephone: (360) 628-8669

Web Site www.wabo.org

Department of Labor and Industries

Specialty Compliance Services Division

Electrical Section

7273 Linderson Way SW ms: 4460

Tumwater, WA. 98501

Web Site

https://lni.wa.gov/licensing-permits/electrical/laws-rules-policies

P O Box 44460 (

Mailing address)

Olympia, WA 98504-4460

Telephone: (360) 902-5244

Department of Health

Department of Social & Health Services

STATE OF WASHINGTON

DEPARTMENT OF LABOR AND INDUSTRIES

Field Services & Public Safety

Factory Assembled Structures

PO Box 44430 Olympia, Washington 98504-4430

To:

From:

Modular Manufacturers

Shane Daugherty, FAS Program Chief

Subject: Required Inspections

WAC 296-150F-0500 When Is an inspection required?

(1) Before we issue an insignia, each

factory-built house, commercial structure, and component must be inspected at the MANUFACTURING

LOCATION as many times as are required by the codes. (See WAC 296- 150F-0600)

NOTE: Approved design plans; specifications, engineering analysis and test results must be available

during the inspections.

Inspection may include but not be limited to the following codes:

2015 International Building Code: section 110.3

110.1 General. Construction or work for which a permit is required shall be subject to inspection by the

building official and such construction or work shall remain accessible and exposed for inspection purposes

until approved.

110.3.2 Concrete slab or under-floor inspection. Concrete slab and under-floor inspections shall be

made after in-slab or under-floor reinforcing steel and building service equipment, conduit, piping

accessories and other ancillary equipment items are in place, but before any concrete is placed or floor

sheathing installed, including the subfloor.

110.3.4

Frame inspection. Framing inspections shall be made after the roof deck or sheathing, all framing,

fireblocking and bracing are in place and pipes, chimneys and vents to be concealed are complete and the

rough electrical, plumbing, heating wires, pipes and ducts are approved.

110.3.5

Lath or gypsum board inspection. Lath and gypsum board inspections shall be made after

lathing and gypsum board, interior and exterior, is in place, but before any plastering is applied or gypsum

board joints and fasteners are taped and finished.

110.3.6

Fire-resistant penetration inspection. Protection of joints and penetrations in fire-resistance- rated

assemblies, smoke barriers and smoke partitions shall not be concealed from view until inspected and

approved.

110.3.8

Other inspection. In addition to the inspections specified above, the building official is authorized

to make or require other inspections of any construction work to ascertain compliance with the provisions

of this code and other laws that are enforced by the department of building safety.

110.3.9

Special inspection. To be made as required by section 1704.

110.3.10

Final inspection. To be made after the building is completed and ready for shipment.

07/20/2020

Page2

2015 International Residential Code: section 109

R109.1 General.

Construction for which a building permit is required shall not be covered or concealed

without first obtaining the approval of the building official.

R109.1.2 Plumbing, mechanical, gas and electrical rough-in.

Rough inspection of plumbing,

mechanical, gas and electrical systems shall be made prior to covering or concealment.

R109.1.4 Frame inspection.

To be made after the roof, all framing, fire blocking and bracing is in place

and all pipes, chimneys and vents are complete and the rough electrical, plumbing, and heating wires, pipes

and ducts are approved.

R109.1.5 Other inspection.

In addition to the listed inspections specified above, the building official

may make or require other inspections of any construction work to ascertain compliance with the

provision of this code and other laws which are enforced by the code enforcement agency.

R109.1.5.1 Fire-resistant construction inspection. To be made after gypsum wallboard is in place but

before joints and fasteners are taped and finished.

R109.1.6 Final inspection.

To be made after the building is completed and ready for shipment.

2015 International Mechanical Code: section 107 (for IBC buildings)

107.1 General.

Mechanical systems for which a permit is required by this code shall be subject to

inspection by the building official and such mechanical systems shall remain accessible and exposed for

rough in and final inspections until approved by the building official.

2015 Uniform Plumbing Code (for IBC and IRC buildings)

105 .1 General.

Plumbing systems for which a permit is required by this code shall be inspected by the

Authority Having Jurisdiction. No portion of any plumbing system shall be concealed until inspected and

approved. Neither the Authority Having Jurisdiction nor the jurisdiction shall be liable for expense entailed

in the removal or replacement of material required to permit inspection. When the installation of a

plumbing system is complete, an additional and final inspection shall be made. Plumbing systems regulated

by this code shall not be connected to the water, the energy fuel supply, or the sewer system until

authorized by the Authority Having Jurisdiction.

2015 International Fire Code (for IBC buildings)

106.2 Inspections.

The fire code official is authorized to conduct such inspections as are deemed necessary

to determine the extent of compliance with the provisions of this code and to approve reports of inspection

by approved agencies or individuals.

106.2.2 Approval Required.

Work shall not be done beyond the point indicated in each successive

inspection without first obtaining the approval of the fire code official.

2015 Washington State Energy Code: section R104 (for IRC buildings)

104.1

General.

All construction or work for which a permit is required shall be subject to inspection by the

building official and all such construction or work shall remain accessible and exposed for inspection

purposes until approved by the building official.

104.2

Approvals Required:

No work shall be done on any part of the building or structure beyond the

point indicated in each successive inspection without first obtaining the approval of the building official.

104.2.1 Wall Insulation Inspection:

To be made after all wall insulation and vapor retarder sheet or film

materials are in place, but before any wall covering is placed.

104.2.1 Final Inspection: The building shall have a final inspection.

07/20/2020

Page3

2015 Washington State Energy Code: section C104

(for

IBC

buildings)

104.1 General: All construction or work for which a permit is required shall be subject to inspection by the

building official and all such construction or work shall remain accessible and exposed for inspection

purposes until approved by the building official. No work shall be done on any part of the building or

structure beyond the point indicated in each inspection without first obtaining the approval of the building

official.

RCW 19.28.101 & 2014 National Electrical Code (for IBC and IRC buildings).

No electrical wiring or Equipment subject to this chapter may be concealed until the inspector making the

inspection has approved it. If the electrical system exceeds 200 amps or single phase, the manufacturer

must advise the department so that appropriate inspection personnel can be provided.

WAC 296-150F-0510 How do

request an inspection?

(1) You need to contact us, and we will let

you know where your request for inspection should be submitted. Our address is noted in the definition of

department.

(2)

We need to receive IN-STATE inspection request at least seven calendar days prior to the date that

you want the inspection.

(3)

We need to receive OUT-OF-STATE inspection requests at least fourteen calendar days in WRITING

prior to the date that you want the inspection. With your request please submit a map and directions from

the closest commercial airport to your facility. Please include on your map and directions, your

manufacturers name, physical address, city, area code, phone number and contact person.

To request an out-of state inspection you need to contact:

Physical Address:

Shane Daugherty, FAS Program Chief

Department of Labor and Industries

7273 Linderson Way SW (MS: 4430)

Tumwater, WA 98501

Mailing Address: PO Box 44430

Olympia, WA 98504-4430

Phone: 1-800-705-1411 Option 3

Fax: 360-902-5229

Email: FAS1@lni.wa.gov

NOTE: The Department will apply an insignia(s) on the factory built structure(s) at the manufacturing

location after the final inspection.

If you have any question about the inspection process please call 1-800-705-1411 Option 3, Fax at 360-

902-5229 or Email at FAS1@lni.wa.gov.

TO:

FROM:

STATE OF WASHINGTON

DEPARTMENT OF LABOR AND INDUSTRIES

Field Services & Public Safety

Factory Assembled Structures

PO Box 44430 Olympia, Washington 98504-4430

July 20, 2020

All Manufacturers of Factory Built Structures and

Commercial Coaches

Shane Daugherty, FAS Program Chief

SUBJECT: Forms Required for Compliance with 2015 Washington State

Energy Code

Forms for demonstrating compliance with the current energy code are

available on line at www.energy.wsu.edu/BuildingEfficiency.aspx

for

residential buildings and at www.wseccompliancedocuments.com for

commercial buildings and commercial coach trailers. In an effort to

support uniformity of enforcement statewide, the Department of Labor

and Industries will require the use of these forms for all buildings

submitted to the department.

Please note that not all forms contained in the package may be

required for each building, i.e., the envelope UA Calculations (ENV

UA) would no

t be required for a building qualifying under a

prescriptive path.

reciprocity

line:

AP No.

AP No

Renewal

Addendum

FACTORY BUILT STRUCTURES

FOR DEPARTMENT USE ONLY

New plan (Master design) (1 Yr design)

Date

Expiration dateDate approvedAp No.

Application ID

Fee Ledg Sht #

Signature

Fee enclosed

For Non-Postal Delivery (e.g., FedX, UPS)

Department of Labor and Industries

Factory Assembled Structures

7273 Linderson Way SW

Tumwater WA 98501

Contact person's printed name:

Manufacturer

PLAN APPROVAL REQUEST

Phone No FAX No

See

appropriate

WAC

r fees

Check # $ Amount

www.wa.gov/lni (case sensitive)

Plans to be returned to: Address

City/State/ZIP

Mfg No.

Applicant: Fill out completely

AP#

file

Acct #

Carrier

Overnight @ customer's expense Regular mail

F623-006-000 plan approval request 7-04

Structural calculations or test proposals

Truss or rafter drawing(s)

Truss plan if over 3 different trusses

Girder truss or ridge beam drawing

HVAC drawing

Cross section and elevation

Foundation plan

Electrical load demand calculation

Panel box schedule/Electric load calc's

Chassis drawing (CC units only)

Plumbing systems:

Attached/Design

Professional Review

Attached

L&I Review

Operating pressure to

No of fixtures Total developed length

RETURN PLANS

VIA:

N/A

Other:

Note: Identify addendum items on plan!

Floor Walls Roof (Flat) Roof (Vault)

Yes No

Electric Natural gas Propane Oil Other:

Insulation

values:

Type construction: Use:

orced

air Hyd

roni

cs Baseb

oard

om h

eater Oth

UPC: NEC: WSEC,VIAQ: IFC:

Code cycles (month/year):

IBC, IRC, IMC

Size of building::

ind load MPH - EXP:

Energy calculations:

Floor load PSF:

Plot plan submitted?

Yes No

If “No”, provide distance from farthest projection to nearest building/property

Fron

t: Rear: Lef

t side

: Rig

ht side:

WSEC compliance chapter:

On file - AP#Attached

SUB yr SEC yr

No of

modules:

Occupancy

group:

Component

Performance

Systems

Analysis

Prescriptive

Heat Pump Yes No

Width: Length: Area (Sq Ft):

Roof live load PSF

Type heat:

Type of fuel:

Heating zone: Zone 1 Zone 2

Seismic

Electrical service:

Phase 1 3

Air conditioning

Fan powered

Central

N/A

Amps

WA Only

WA Rev/____Courtesy

____Rev/WA Courtesy

_______ Other state

State ID

For Postal Delivery

Department of Labor and Industries

Factory Assembled Structures

PO Box 44430

Olympia WA 98504-4430

Initial MFG filing

Resubmittal

Plans review by L&I listed professional

F623-006-000 plan approval request - fee worksheet 7-04

For fee schedules see WAC 296-150F-3000

Initial filing fee (One time only)

Through which service should the plans be returned? Please fill out overnight carrier (Federal

Express, UPS, etc.) and account number if you wish to have your plans returned by overnight mail.

Department of Labor & Industries

Factory Assembled Structures

PO Box 44430

Olympia WA 98504-4430

FEE WORKSHEET

TOTAL

AMOUNT

Please fill out fee worksheet for each plan or each insignia request.

www.wa.gov/lni

(case sensitive)

This is for beginning mfg. only

FAS FEE SCHEDULE

Initial fee-Master Design

Initial fee-one year design

Addendum fee

Renewal fee

Resubmittal fee

Extra copies of plans $ X Quantity =

Reciprocal plan review

Courtesy review fee

Plans approved by design professionals

Total of insignia and NLEA fees paid (If applicable)

Total of electrical fees paid (if applicable)

List other plans the enclosed check applies to:

Total Fees Paid $

Serial or Model #

INSTRUCTIONS

FOR "PLAN APPROVAL

REQUEST"

FORM

FOR FACTORY BUILT STRUCTURES

Provide Manufacturer or applicant name, address, and telephone number.

Manufacturer ID number is assigned upon receipt of the first plan (e.g. M-22), If you already

have an assigned number then fill this space in.

3. Indicate

this plan is submitted under the terms of a reciprocity agreement with another state.

Indicate this in one of the last three boxes, otherwise check WA only.

4. Print and sign the name of the contact person responsible for this plan should questions about this

submittal arise. Include on this line the date this plan was sent

the Department and the fee

enclosed for this building. See WAC 296-150F-3000 for fee schedules. Provide an extension

number or direct line, email address and FAX number if available for the contact person.

Use this line

this is a new plan submitted for the first time. Indicate the appropriate fee paid for

a plan to be approved for the duration of the code cycle (Master Design) or for a plan to be

approved for one year.

Use this line only if this is the first application from a manufacturer. This is a ONE TIME ONLY

FEE for new FBS manufacturers. See WAC 296-150F-3000 for the current fee.

7. Use this line only when you wish to renew a previously approved plan Indicate the fee for renewals.

Use the AP No. line to show the approved plan number you wish

renew.

8. Use this line only

this is a resubmittal response

a previously reviewed and rejected plan.

Indicate the fee required for resubmittals.

Use this line only if the submittal is an addendum to a previously approved plan. Indicate the fee

paid and the approved plan number that you wish to amend.

10.

your plan was reviewed by a department approved Design Professional firm; indicate the

appropriate fee from the current WAC's on this line.

11. Use this line to indicate the effective dates of the codes under which this plan is being submitted.

As of July 1, 2013 these would be: IBC, IRC, IMC: 2012; UPC: 2012; NEC: 2008; WSEC: 2012;

IFC: 2012. Please note that the date for each code indicates the year for the beginning of

enforcement of that code or the latest amendment enforced for that code by the Department, not the

year of the code publication.

12. List the width and length of the building. For irregular buildings, give the longest dimensions.

Include the square foot area of the building.

13.· Use this space to show the total number of modules required to construct one whole building.

14.

Use this space to show the occupancy group of the building from IBC Chapter 3. For mixed

occupancy building, show the largest occupancy first, the next largest occupancy within the

building second, etc. (e.g. B/M/H-2).

15.

. Use this line to indicate the type of construction of the building from IBC Chapter 6. Also indicate·

the sub category behind the appropriate Roman numeral (e.g. II-A).

16.

Describe the primary use of the building (e.g. classroom, church office, etc).

17.

Indicate the edition of the International Building Code and the National Electrical Code being

used in the spaces marked SUB yr and SEC yr.

18.

Indicate the value of the seismic acceleration factor Ss and the site classification used in the seismic

design from IBC figure 1615.1.

19.

List the roof live load capacity in pounds per square foot.

20.

Indicate the wind load for which the building is designed in miles per hour/exposure class.

21.

List the floor live load in pounds per square foot.

22.

Indicate "yes"

a plot plan is included in the submittal. If "no" you must provide distances from

the building to property lines and adjacent buildings.

23·.

Check the type of heating to be installed in the building. Use "other" to describe systems not shown

or indicate N/A if there is no heating or cooling system.

24.

Check the type of fuel used in the heating or cooling system.

25.

List the

"R"

value of the insulation being installed in the floors, walls and roof of the building.

26.

Indicate whether the building is to be located in Zone 1 or Zone 2 as defined by the energy code.

27.

Mark the appropriate box if the energy code compliance 'is obtained by the systems analysis

approach; the component performance approach; or

the prescriptive paths are used. If energy

code compliance is obtained by calculations, indicate whether the calculations are attached with

the submittal or whether they are on file with a previously approved plan. Provide the referenced

approved plan number. Mark the boxes 'yes' or 'no' indicating whether a heat pump and/or air

conditioning are installed in the building.

28.

Show the calculated KVA load of the electric service for the whole building. Also indicate whether

this is a single or three phase system. ·

29. .

This section is meant

act as a checklist for some of the information that will be necessary in order

to approve the plans. Not all elements may be applicable

your plan and as such may be

'NI

A' ed.

If the element is

be reviewed by L&I approved Design Professional, so indicate in the third

column. If the element or system is already approved as part of another plan and is identical to this

plan, you may reference the approved plan number that is "on file" in the fourth column.

30. Provide the plumbing system design operating pressure whenever plumbing fixtures are installed in

the building. Provide the number of fixtures (not fixture units) that are installed in the building.

Provide the total developed length of the water supply system.

31. Indicate how you wish to have the plans returned to you, FedEx is the only overnight service

available unless you provide the overnight label and envelope from another carrier.

FB_planApplnst

DEPARTMENT OF LABOR AND INDUSTRIES

INSTRUCTIONS FOR COMPLETING APPLICATION FOR INSIGNIA

FOR FACTORY BUILT STRUCTURES

(form F623-014-000)

Provide the Manufacturer name, address, phone and fax number if available.

2. Provide the Manufacture Identification number that was assigned by the Department upon

approval of the manufacturer's first plan. i.e.: M-222.

Check the box appropriate for your type of unit. Permanent is first time labeled. Alteration is a

label showing an alteration was performed on a previously labeled unit. Replacement is for

ordering a replacement label for one that was removed.

Indicate which state's insignias will be affixed to your structure.

5 Provide the name of the contact person requesting these insignia(s) should any questions arise.

Also provide date the application was sent to the Department, sign, and provide a contact

person, and phone number.

Enter the total fee for all insignias ordered on this form.

The department will generate this number. Each module will have q different number.

Enter the unique manufacturer serial number for each module.

If submitting this form with a new plan, leave blank and the department will complete it

after your plan is approved. If submitting this form to he used with a previously approve

an, enter the plan approval number.

10.

Indicate which module of the total number of modules required in the building configuration

s being requested. ie:1 of 1 or 3 of 6.

11.

Show the fee for each module. (See WAC 296-150F-3000).

12.

Indicate the occupancy classification of the building from IBC chapter 3. For mixed occupancy

buildings list the largest first followed by the next largest in descending order.

13.

Show the "Type of construction". See IBC chapter 6 for construction types.

14.

Indicate which incomplete systems beyond normal set up are required to be completed on

site. Enter 'S' for structural items; 'M' for mechanical items; 'P' for plumbing; 'E' for electrical.

15.

Show the edition of the building codes applicable to the building.

16.

Show the edition of the electrical code applicable to the building.

17.

Show the calculated KVA load of the electrical service to the whole building.

18.

Indicate the live roof load in the pounds per square foot for which, the building was designed.

19.

Indicate the wind load/or which the building was designed to in miles per hour/class exposure.

i.e. 80-C .

20.

Indicate the seismic acceleration (SS) and the site classification for which the building was designed.

21.

Indicate the temperature differential or energy code zone that the building was designed for.

22.

Indicate type of heating in the building (heat pump, electric furnace, wall heaters, etc.).

23.

Indicate yes' or 'no' regarding air conditioning installed in the building.

24.

Indicate the number of plumbing fixtures (not fixture units) in the building.

25.

Show the total number of insignias on both the front and back of this request. Indicate how

you wish insignias to be forwarded to the inspector. If requesting overnight delivery service,

FedEx is the only carrier available and your account number needs to be provided.

FB_InsigAppinst

Specialty Compliance Services

Department of Labor and Industries

Section:

FAS Procedure

Procedure:

99-7

Subject: Notification of Local

Enforcement Agencies

Effective Date: December 15, 1999

(NLEA) Contact:

Chief, Factory Assembled Structures

PROCEDURE:

The department will notify the local enforcement agency after the final inspection of factory built structures at a

manufacturing location. After a final inspection is performed on a factory built, commercial structures, or

component, the department will send a notice to the local enforcement agency (NLEA) that:

(1)

Specifies what connections, standards, and incomplete items the local enforcement agency must check

when the unit is installed; and/or

(2)

Estimates the expected time of arrival of the factory built house or commercial structure to the site.

A photocopy of the NLEA must be placed (taped) in a window closest to the electrical panel box so it may be read

from th

e exterior of the building. If the building has no windows, then the photocopy of the NLEA must be placed

(taped) on the electrical panel box cover.

NOTE:

A COMPLETED NLEA AND FEE MUST ACCOMPANY THE APPLICATION FOR INSIGNIA.

ADDITIONAL ITEMS MAY BE ADDED AT FINAL INSPECTION.

EXCEPTION: For stocker units the installation address or the building department address

will not need

be filled out when the insignia is placed on the structure. The NLEA will be

placed on the window closest. to the electrical service. When the structure leaves the yard to

be sited, the installation address and building department address will need

be completed.

Place a photocopy of the completed NLEA back in the window and return the originals to the

Department of Labor and Industries, State of Washington.

WHAT ARE THE INSIGNIA APPLICATION REQUIREMENTS?

1. If the manufacturer is requesting insignia for units they are intending to manufacture under a new design

plan, the completed application must include:

a. A complete design plan approval request form; and

b. Two complete sets of design plans, specifications, engineering analysis, test procedures and

results, plus one additional set for each manufacturing location where the design plan will be

used; and

c. At least one set of design plans must have an original wet stamp from a professional engineer or

architect licensed in Washington. The department will retain the set with the original wet stamp;

and

d. A one-time initial filing fee, the design plan fee, if the department approves the design plan for

fees (See WAC 296-150F-3000); and

e. A completed application for insignia form; and

f. A completed Notice to Local Enforcement Agency (NLEA) form. NOTE: Items may be added to

the NLEA at final inspection; and

g. The fees for each insignia and NLEA requested. (See WAC 296-150F-3000)

FAS Procedure 99-07Rl

Page Two

2. If the insignia is being requested under an

approved design plan,

the completed application

must include:

completed application for insignia form; and

b. A co

mpleted Notice to Local Enforcement Agency (NLEA) form

(NOTE: Items may

e added to the NLEA at the final inspection)

and

The fees for each insignia and NLEA requested (See WAC 296-150F-3000).

Approved By:

Department of Labor and Industries

Factory Assembled Structures

PO Box 44430

Olympia WA

98504-4430

F623-013-000 notification to local enforcement agency 03-2009

Date

Mfg

NOTIFICATION TO LOCAL ENFORCEMENT AGENCY

The Factory-Built unit identified below requires completion work at the

site as specified.

Owner's name

Installation address

City County

State ZIP+4

Mfgr's serial no. Dept insignia no.

Type of construction Occupancy

ETA at site

DESCRIBE ITEMS REQUIRING COMPLETION WORK AT THE SITE

To: To:

Inspector's name (print/type)

Office location

Phone: (8 am to 5 pm)

Manufacturer's signatureDate

Installation site is in:

City County

Phone number

Manufacturer's name (print/type)

Fee

CheckColumn

Paid date

INSERT NAME AND ADDRESS IN SHADED AREAINSERT NAME AND ADDRESS IN SHADED AREA

www.wa.gov/lni/FAS/

(case sensitive)

www.wabo.org/ www.wa.gov/lni/electrical/

BUILDING DEPARTMENT ELECTRICAL DEPARTMENT

RESET

DEPARTMENT OF LABOR AND INDUSTRIES

INSTRUCTIONS FOR COMPLETING "NOTIFICATION

TO LOCAL ENFORCEMENT AGENCY"

(form F623-013-000)

Provide the date and the name of the Manufacturer.

Provide the Manufacture Identification number that was assigned by the Department upon

approval of the manufacturer's first plan. i.e.: M-222.

Fill in the owner’s name and the installation address of the building.

Indicate the manufacturers serial numbers of the building. NOTE: each building must have a

separate NLEA.

The department insignia numbers will be filled in by the inspector who completes the final factory

inspection.

Show the "Type of construction". See IBC chapter 6 for construction types.

Show the occupancy classification listing for the building. See IBC chapter 3 for occupancy

groups.

Enter the approximate date that the building will arrive on site.

Fill in the phone number of the owner or other contact person for the site installation.

10.

Indicate if the building installation site is within city or county jurisdiction.

11.

Fill in the office name and address of the local building official who will do the on site inspections

of the building when it is installed. A list of names by county and city can be found at the

www.wabo.org web site..

12.

List all of the non electrical items which are being completed on site and require inspection by the

local building official. If all items are standard to a normal modular building installation then this

should he noted.

13.

Fill in the office name and address of the local electrical inspector who will do the on site

inspections of the building when it is installed, A list of city inspectors can be found at the

www.lni.wa.gov web site. Locations which do not have a separate electrical inspection program

use the L&I electrical inspectors from the closest L&I field office. ·

14.

List all of the electrical items which are being completed on site and 1·equire inspection by the local

electrical inspector. If all items are standard to a normal modular building installation then this

should be noted.

15.

Sign and date the form.

FB_NLEA_Inst

STATE OF WASHINGTON

DEPARTMENT OF LABOR AND INDUSTRIES

Field Services & Public Safety

Factory Assembled Structures

PO Box 44430 Olympia, Washington 98504-4430

MEMORANDUM

TO: Modular Manufacturers

FROM: Shane Daugherty, FAS Program Chief

SUBJECT: Manufacturer's Contact Personnel

In order that we may serve you better we are requesting you complete the enclosed form and return it to us. By

having contact persons on our mailing labels and faxes the information we are sending to you should be

received by those who need it. We thank you in advance for your assistance.

If you have any questions, please feel free to contact us at 1-800-705-1411 Option 3, FAX (360) 902- 5229

or email FAS1@lni.wa.gov

Return to: Shane Daugherty

Dept. of Labor & Industries

PO Box 44430

Olympia, WA 98504-4430

Corporate Name: _____________________________________________________________

Mailing Address: ____________________________________________________

City: _________________________ State: ______ Zip: ______________________

Physical Address: ____________________________________________________

City: ________________________ State: ______ Zip: ______________________

Phone No: (_____) ____________ Ext: ________ Fax No: (____) _____________

Web Address: ______________________________________________________

Contact for Plan Review: ______________________________________________

Phone No: (_____) ____________ Ext: ________ Fax No: (____) _____________

Email Address: ______________________________________________________

Contact for Plant Audit: _______________________________________________

Phone No.: (____) _________________ Fax No.: (____) _____________________

Email Address: ______________________________________________________

Plant 1 Name: _____________________________________________________________