ApplicationHearing Date: May 18, 2017
File No.: H-2017-0054
Project Name: My First Steps Daycare
Request: Request for a group daycare for up to 12 children on 0.15 of an acre in an R-8 zoning
district, by Darya Krautsova.
Location: The site is located at 3545 S. Pompei Ave., in the NE ¼ of Section 30, Township 3N.,
Range 1E.
((IE IDIAN:---
Planning Division
DEVELOPMENT REVIEW APPLICATION
STAFF USE ONLY: , n
Project name: M b t-,0, S� �e'eS Y(�'-`/—Ovy
File number(s): d 1
Assigned Planner: K � Related files:
Tyge-of Review Requested (check all that apply)
WAccessory Use
❑ Planned Unit Development
❑ Administrative Design Review
❑ Preliminary Plat
❑ Alternative Compliance
❑ Private Street
❑ Annexation and Zoning
❑ Property Boundary Adjustment
❑ Certificate of Zoning Compliance
❑ Rezone
❑ City Council Review
❑ Short Plat
❑ Comprehensive Plan Map Amendment
❑ Time Extension:
❑ Comprehensive Plan Text Amendment
Director/ Commission/Council (circle one)
Conditional Use Permit
❑ UDC Text Amendment
❑ Conditional Use Modification
❑ Vacation:
Director/Commission (circle one)
Director/ Council (circle one)
❑ Development Agreement Modification
❑ Variance
❑ Final Plat
❑ Other
❑ Final Plat Modification
Information
Applicant name: V .L\Y (,Xte' U _Q 1—_ JJ
Applicant address: Email:2
City: A State: I D
Applicant's interest in property: ❑ Own Aent ❑ Optioned ❑ Other
er�
Owner name: ,l n � Wn TOU)"I o1i
R o&
K -,a
zip: 94,_)U44?,
Phone:
Owner address: SI (vii/mw Email: L)AQ& l l0riru (_-►i7
city: State: tp Zip:
Agent/Contact name (e.g., architect, engineer, developer, representative):
Firm name: Phone:
Agent address: Email:
City: State: Zip:
Primary contact is: Applicant ❑ Owner ❑ Agent/Contact
Subiect Property Information
Location/street address: W4 5- S,bmm����yAV� �
Township, range, section: lb N1 E 9,
Assessor's parcel number(s): P,�! s V L[ wW Total acreage: Zoning district: _
Community Development ■ Planning Division ■ 33 E. Broadway Avenue, Ste. 102 Meridian, Idaho 83642
Phone: 208-884-5533 Fax: 208-888-6854 www.meridiancity.orgiplanning
-1- (Rev. 06/12/2014)
Project/subdivision name: f t� - '11VD
General description of proposed project/re4 est:yU r� Q lid,. t cam,.,.
Proposed zoning district(s):
Acres of each zone proposed: Q ' /S2
Type of use proposed (check all that apply):
Residential ❑ Office ❑ Commercial ❑ Employment ❑ Industrial ❑ Other
Who will own & maintain the pressurized irrigation system in this development?
Which irrigation district does this property lie within?
Primary irrigation source: Secondary:
Square footage of landscaped areas to be irrigated (if primary or secondary point of connection is City.vater):
Residential Project Summary (if applicable)
Number of residential units: Number of building lots:
Number of common lots: Number of other lots:
Proposed number of dwelling units (for multi -family developments only):
1 bedroom: 2-3 bedrooms: 4 or more bedrooms:
Minimum square footage of structure (excl. garage): Maximum building he
Minimum property size (s.f): Average property size
Gross density (Per UDC 11-lA-1): Net density (Per UDC ll -IA -1): -
Acreage
l-IA-1):Acreage of qualified open space: Percentage of qualified open space:
Type and calculations of qualified open space provided in acres (Per UDC 11-3G-313):
Amenities provided with this development (if applicable):
Type of dwelling(s) proposed: ❑ Single-family Detached ❑ Single-family Attached ❑ Tom-
❑ Duplex ❑ Multi -family ❑ Vertically Integrated ❑ Other
Non-residential Project Summary (if applicable)
Number of building lots: Common lots: Other lots:
Gross floor area proposed: Existing (if applicable) :
Hours of operation (days and hours): Buil ct img height:
Total number of parking spaces provided: Number of compact spaces provided:
Authorization
Print applicant name:
Applicant signature:
Date:
Community Development ■ Planning Division ■ 33 E. Broadway Avenue, Ste. 102Meridian, Id
Phone: 208-884-5533 Fax: 208-888-6854 vvvvw.naeridiancity ori/nlannine
-2-
To the planning division team,
About us: My First Steps Daycare is a high-quality h1 -home daycare, we have been open since
March of 2016 and relocated from Nampa to Meridian as we expand. We focus on providing an
educational, safe, clean, and nurturing environment that fosters creativity and healthy
development to form a strong foundation of lifelong learning and confidence for children.
What we offer:
-We will be licensed through Idaho Stars for a group day care (12 children) . Idaho Stars
provides government funding for families that need assistance.
-The ages we accept are from 6 weeks old to 6 years. Tuscany Village subdivision is a
newer neighborhood with many young families. We will be a convenient and
affordable childcare option in the area.
-We are required to be Pediatric CPR and First Aid certified, certifications are all current
and updated annually.
Under the Umbrella is a food program our daycare receives funding from. This enusres
children will be provided with healthy and nutritious meals.
-We have pre-school activities, providing basic education. Also we enjoy lots of arts and
crafts.
-When weather pen -nits we do many outside activities and trips to the park.
-The home is clean, organized, and structured.
-Hours of operation are 6:30 AM to 6:30 PM, Parents are instructed to turn music down
once entering subdivision, ensuring the noise level is down. We have a three car driveway that
provides space and prevents traffic, families make quick drop in's and drop off's.
Thank you for taking the time to review the proposed project, please let me know if there is any
further information needed.
Thank you,
Darya Kravtsova
208-371-0019
e • ADA COUNTY RECORDER Christopher D. Rich 2017.009906
PioneerfltleCo. BOISE IDAHO PONDgs=1 BONNIE OBERBILLIG 02/01/2017 12:01 PM
775 S. Rivershore Ln., Ste, 120 PIONEER TITLE COMPANY OF ADA COUNTY $10.00
Eagle, ID 83616
ELECTRONICALLY RECORDED -DO NOT
REMOVE THE COUNTY STAMPED FIRST
PAGE AS IT IS NOW INCORPORATED AS
PART OF THE ORIGINAL DOCUMENT
File No. 613939 TK/PP
WARRANTY DEED
For Value Received Ann Marie Boening, a single woman
hereinafter referred to as Grantor, does hereby grant, bargain, sell, warrant and convey unto
Dallan Taylor and Patricia Mae Taylor, husband and wife
hereinafter referred to as Grantee, whose current address is 565 S. Silvermoon Lane Eagle, TD 83616
The following described premises, to -wit:
Lot 3 in Block I 1 of Tuscany Village Subdivision No. 2, according to the plat thereof, Bled !it Book
92 of Plats at page(s) 10893-10894, records of Ada County, Idaho,
To HAVE AND TO HOLD the said premises, with their appurtenances unto the said Grantee($), and
Grantees(s) heirs and assigns forever. And the said Grantor(s) does (do) hereby covenant to and with the
said Grantee(s), the Grantor(s) is/are the owner(s) in fee simple of said premises; that said premises are
free from all encumbrances EXCEPT those to which this conveyance is expressly made subject and those
made, suffered or done by the Grantee(s); and subject to U.S. Patent reservations, restrictions,
dedications, easements, rights of way and agreements, (if any) of record, and current years taxes, levies,
and assessments, includes irrigation and utility assessments, (if any) which are not yet due and payable,
and that Grantor(s) will warrant and defend the same from all lawfiul claims whatsoever.
Dated:anuary•ft, 2017
AA
Ann M rie Qocning
�2GGCif� �Lvc ��
State of L 9n,AI , Connty of /' 6loYl d ffttl r `
On this day of January in the year of 2011, before me, the undersigned, a Notary Public in and for
said State, personally appeared Ann Marie Boening known or identified tome to be the person/persons
whose name(s) is/are subscribed to the within instrument, and acknowledged to me that he/she/they
executed the same.
esid' gat:t t -ai --
Commission Expires: 1 ! — I " U2t)
OFFICIAL STAMP
KODY ROYCE GROSS
NOTARY PUBLIC - OREGON
COMMISSION NO. 9566M
*SSION EXPIRES NOVEMBER 15, 2020
CVEF
IDIAN
Renter's Addendum
I
k"ick.- 4q- cw StU� do hereby declare
therefore a resident at1')1 f Vit'_ i AVf ,
will be responsible for the payment of the City of Meridian Utility Bill
at the previously stated property during my tenancy.
Telephone number for account: C 2 QRZ
Complete this section only if you want
Mailing address:
City a`�=
bills to be sent to
State:
Phone: 208-888-4439
Fax: 208-887-4813
bdavidsonod meridiancity. org
I am tenant and
ridian Idaho, 8364 1- and
water, sewer, and garbage
9
at a different address:
Zip Code:
I acknowledge that, during my tenancy, I will receive a monthly statement from the City of Meridian
with a balance due each month. I agree that I will submit payment for that balance promptly on time
each month. If payment is not received each month I acknowledge thatmylandlord will receive a
copy of the delinquent notice sent to my residence. Tenant's Initials 1�.
By signing this form I permit.the City of Meridian to release any information requested about this
account to my landlord. The information released may be, but is not limited to; the account balance,
payment history, or delinquency status. Tenant's Initials
Signed: r Dated:';
7
U tj
* * NOTARY USE* -------------------------*NOTARY USE* -------------- --------*NOTARY USE*
STATE OF Idaho
County of Ada
I HEREBY CERTIFY that on this —� day of , 2017, before me, the undersigned,
a Notary Public in and for the said State of Idaho, personally appeared
to me to be the person(s) who executed the foregoing instrument
he/she executed the same.
known or proven
acknowledged to me that
IN WITNESS WHEREOF, I have hereunto set my hand and axed my official seal, the day and
year in this certificate first above written.
Pg'X N
cy. OTS`
Notary Public for the State of Idaho
o
My Commission Expires: 4/24/18
07
o
Identification Verified
ID Type: ID State: :TD
STATE OF IDAHO )
COUNTY OF ADA )
(name) (address)
(city) (state)
being first duly sworn upon, oath, depose and say:
That I am the record owner of the property described on the attached, and I grant my
permission to:
Vx _ p ' a r/`1!
s -
(nam) (address)
---
to submit the accompanying application(s) pertaining to that property.
2. I agree to indemnify, defend and hold the City of Meridian and its employees harmless
from any claim or liability resulting from any dispute as to the statements contained
herein or as to the ownership of the property which is the subject of the application.
3. I hereby grant permission to City of Meridian staff to enter the subject property for the
purpose of site inspections related to processing said application(s).
Dated this t� day of i%�'''!� , 20 ✓� /�
(Signature)
SUBSCRIBED AND SWORN to before me the day and year first above w i n.
0%%%04110111 e
41, all
(No ry Public for Idaho)
'O�800
0 4.41
F®
O
Residing at:���8:\
My Commission Expires: K) 0 ~�;k
Community Development ■ Planning Division ® 33 E. Broadway Avenue, Ste. 102 Meridian, Idaho 83642
Phone: 208-884-5533 Fax: 208-888-6854 NN «,\\..meridiattcit\ .ora/planning
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3/21/2017 In-home daycare - daryakravtsova2@gma7il.com - Gmail
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ACHD will not require a traffic impact study for an application for an in-home daycare
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E IDIAN
Community Development
Department
Date: 3/21/17
Meridian City Hall, Suite 102
33 E. Broadway Avenue
Meridian, Idaho 83642
'7nO00-7 ')')i 1
LV V. VV / .LL J.l
Address/Parcel Verification
The address and parcel information below has been researched and verified as correct by the City of
Meridian Community Development Department.
Project Name:
Address:
Par cel 11,141uim10er
Lot/Block/Sub:
Property Owner:
My First Steps Daycare
3545 S. Pompei Ave.
no.�ivv22v63v
3/11/Tuscany Village #2
Dalian Taylor
756 S. Silvermoon En=
Eagle, ID 83616
Address Verification Rev: 04/23/12
3/21/2017 20170314_181212.jpg
https:Hm ai l.google.com/m ai I /u/OIM nbox/i 5af43fl 2dl7e343?projector= l 1/1
I'
CITY OF MERIDIAN, IDAHO
i
IiCn"�) Nubo/7ic —Valley
LEGAL NOTICE
OF PUBLIC HEARING
I
In the Meridian City Hall
Council Chambers
Fnr mor—nlnr—t.nn �wtact
CITY PLANNER
(208)884-5533
https:Hm ai l.google.com/m ai I /u/OIM nbox/i 5af43fl 2dl7e343?projector= l 1/1
3/21/2017 20170314_142603jpg
https://mail.google.com/mail/u/Ognbox/15af432753e16a27?projector=1 1/1
sAm
3/21/2017
20170314_142546jpg
https://mail.google.rom/mail/u/O/Mnbox/1544326013062?projector=l 1/1
}
https://mail.google.rom/mail/u/O/Mnbox/1544326013062?projector=l 1/1
COMMITMENT OF PROPERTY POSTING
Per Unified Development Code (UDC) 11 -5A -5D, the applicant for all applications requiring a
public hearing (except for a UDC text amendment, a Comprehensive Plan text amendment
and/or vacations) shall post the subject property not less than ten (10) days prior to the hearing.
The applicant shall post a copy of the public hearing notice of the application(s) on the property
under consideration.
The applicant shall submit proof of property posting in the form of a notarized statement and a
photograph of the posting to the City no later than seven (7) days prior to the public hearing
attesting to where and when the sign(s) were posted. Unless such Certificate is received by the
required date, the hearing will be continued.
The sign(s) shall be removed no later than three (3) days after the end of the public hearing for
which the sign(s) had been posted.
I am aware of the above requirements and will comply with the posting requirements as stated in
UDC 11-5A-5.
signature
Date
ILLI t-7
Community Development ■ Planning Division ■ 33 E. Broadway Avenue, Ste. 102 Meridian, Idaho 83642
Phone: 208-884-5533 Fax: 208-888-6854 www.meridiancit�or&lanning
CITY OF MERIDIAN
PRE -APPLICATION MEETING NOTES
Project/Subdivision Name: Krautsova Group Daycare
Date: 2/27/17
Applicant(s)/Contact(s): Darya Krautsova
City Staff: Sonya Bill P2rru T
❑
Location: 3545 S. Pompei
Size of Property: 0.15
Comprehensive Plan FLUM Designation: MDR
❑
Existing Use: SFR
Existing Zoning: R-8
Proposed Use: Group Daycare (6<12 kids)
Proposed Zoning: NA
Surrounding Uses: SFR
❑
Street Buffer(s) and/or Land Use Buffer(s): NA
❑
Open Space/Amenities/Pathways: NA
❑
Access/Stub Streets: Access via S. Pompei Ave.
❑
Waterways/ Floodplain/Topography/Hazards: None
❑
History:
❑
Additional Meeting Notes:
❑
• A conditional use permit is required for a group daycare in an R-8 zoning
district; comply with specific use standards listed in UDC
CUP is
Note: A Traffic Impact Study (TIS) will be required by ACHD for large commercial projects and any residential development with over 100 units. To
avoid unnecessary delays & expedite the hearing process, applicants are encouraged to submit the TIS to ACHD prior to submitting their application
to the City. Not having ACHD comments and/or conditions on large projects may delay hearing(s) at the City. Please contact Mindy Wallace at 387-
6178 or Christy Little at 387-6144 at ACHD for information in regard to a TIS, conditions, impact fees and process.
Other Agencies/Departments to Contact:
❑
Ada County Highway Dist. (ACHD)
❑
Nampa Meridian Irrigation Dist. (NMID)
❑
Public Works Department
❑
Idaho Transportation Dept. (ITD)
❑
Settler's Irrigation District
❑
Building Department
❑
Republic Services
❑
Police Department
❑
Parks Department
❑
Central District Health Department
❑
Fire Department
❑
Other:
Application(s) Required:
❑
Administrative Design Review
❑
Conditional Use Permit Mod ification/Transfer
❑
Rezone
❑
Alternative Compliance
❑
Development Agreement Modification
❑
Short Plat
❑
Annexation
❑
Final Plat
❑
Time Extension - Council
❑
City Council Review
❑
Final Plat Modification
❑
UDC Text Amendment
❑
Comprehensive Plan Amendment- Map
❑
Planned Unit Development
❑
Vacation
❑
Comprehensive Plan Amendment - Text
❑
Preliminary Plat
❑
Variance
X
Conditional Use Permit
❑
Private Street
❑
Other
Notes: 1) Applicants are required to hold a neighborhood meeting in accord with UDC 11 -5A -5C prior to submittal of an application requiring a public
hearing (except for a vacation or short plat); and 2) All applicants for permits requiring a public hearing shall post the site with a public hearing notice
in accord with UDC 11 -5A -5D.3 (except for UDC text amendments, Comp Plan text amendments, and vacations). The information provided during
this meeting is based on current UDC requirements and the Comprehensive Plan. Any subsequent changes to the UDC and/or Comp Plan may
affect your submittal and/or application. This pre -application meeting shall be valid for four (4) months.
3/21/2017 Ada County Assessor
Ada County Assessor
Land Records/GIS
Home
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2017 Property Details for Parcel R8560220630
2017 Change Yea Need Help? Email the Appraiser Assigned to this Parcel!
(Back to Parcel Searchl [Print Viewl
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r
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--a
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Interactive Map
First Floor
1454 sf 128.6'
52.5'1 1 10.0'
21.0'
Sketch
Ada County appraisers follow American National Standards Institute (ANSI) building measurement standards for
square footage calculations. This information is to be used ONLY for reference purposes and Ada County is not
responsible for any inaccuracies. If you have questions concerning the accuracy, please use the "Need Help" button
at the top of the screen.
Contact Us I Disclaimer
http:l/www.adacountyassessor.org/propsysIViewParcel.do?yearParcel=2017R856022O630 1/1
4.0' 4.5'
(mat -age
Bonus
71 q sf 22.0'
s.a
Room
2.0' 8.5'
277 sf
22.5'
12.0'
21.0'
Sketch
Ada County appraisers follow American National Standards Institute (ANSI) building measurement standards for
square footage calculations. This information is to be used ONLY for reference purposes and Ada County is not
responsible for any inaccuracies. If you have questions concerning the accuracy, please use the "Need Help" button
at the top of the screen.
Contact Us I Disclaimer
http:l/www.adacountyassessor.org/propsysIViewParcel.do?yearParcel=2017R856022O630 1/1
AMERIaa4' to
SAFETY&
HEALTH
6'HSTi T iDTE
ASHI-Approved Certification Card
t
Authodz�nsttrucCtor(PrintName) ----.
_ Suss COM oonte pa
- l Expiration Date
Training Center Phone a No,"�ti/C1.r�,
Training Center 1.1). "'
This card cedrBes the holder has demonstrated the required knowled a and <_
renty authorized ASH) Instructor. C It-Mstial does nor u
sura Or- r:redennalin 9 kill oh)eatr�es to a cam-_
for CPR g' Courea content covers all age g arentee future performance or imply licen-
andECC,andotlass Bence-basedfreatm re ommendandconforms to he 2010gy Guidegnes
exceed 24 months fmm class completion. More fr
equent reinforcement of skills its tion period may not
-^^--•�---.-..�._,_.�,._�,� _ _ recommended.
IlkIDAHODEPARTMENT OF
Iff
HEALTH& WELFARE
C.L. `BtdctY" Otter- Governor
RICHARD M. ARMSTRONG — Director
Darya Kravtsova
2630 sweet dr
nampa, ID 83687
Applicant: Darya Kravtsova
DKWD TAYLOR — Deputy Director
Bureau of Audits & investigations
Criminal History Unit
1720 WestgateDr., Ste A
Boise, ID 83704
PHONE 208-332-7990
TOLL FREE 1-800-340-1246
FAX 208-332-7991
Verification Number,982215
The Department has completed its background check and the applicant has passed effective
03102/2016. No disqualifying crimes or relevant records Were revealed. The agency issuing your
license or certification may request.that you provide them with the specifics of any information
here revealed. if the area immediately below is blank, there is nothing to report.
03/04/2016
nate source uescription
04/26/2013
Self Disclosed
(M) Driving Under the Influence
01/15/2014
Court. Records
(M) Driving Without Privileges
10/17/2003,
Court Records
(M) Theft -Petit
06/25/2003
Court Records
(M) Battery AMENDED (M) Beyond Control
06/251,2003
Court Records
(F) Assault -Aggravated AMENDED (M) Assault
06/25/2003
Court Records
(F) Assault -Aggravated AMENDED (M) Beyond
Control
06/25/2003
CourtRecords
(M) Runaway
02/I0/2003
Court Records
M Battery AMENDED M Beyond Control
The background check is fingerprint based and includes: information obtained front the state and
national criminal databases, Idaho Driving Records, Idaho Child Abuse Registry, Idaho Adult
Protection Registry, Sex Offender Registry, Idaho, Nurse Aid Registry and state and national
MedicaraMAdicald Provider ExrJusinn Lists.
If there are any questions about the process or results, contact the criminal history unit at (208)
332-7990, 'or toll free at 1-800-340-1246. Additional information about the criminal history background
check process and applicant status is available at the web site. htfps:fchu.dhw.idatio.gov,
Sincerely,
Robyn
Robyn Pedraza
e
IDAHO DEPARTMENT OF
Oil HEALTH& WELFARE
Idaho Department of Health and Welfare
Fire Safety Inspection for State Daycare Licensing
Date:
Name of Facility:__
Operator: 64P 1V Owner:
Address• 3 S3L3 .2e,e-i rul-**
Facility Phone Number.,ZM
City:
Land Lineelr 1 1 Phone
Note: This inspection forin was drafted within the confines of the legislated fire Safety standards for
daycare facilities and does not mean to infer that the provisions within provide for a level of fire safety
that ivould meet nationally recognized standards. Nor does it mean that it would provide a level offare
safety that ivould meet our own adopted fire safety standards for other occupancies in Idaho.
I. DEFINITIONS:
1. Daycare: Daycare means care and supervision provided for compensation during part of a twenty-
four (24) hour day, for a child or children not related by blood, marriage, adoption, or legal
guardianship to the person or persons providing the care, in a place other than the child's or
children's own home or homes.
2. "Child" means a person less than thirteen (13) years of age.
3. "Daycare Center" means a place or facility providing daycare where thirteen (13) or more
children, regardless of the relationship to the person or persons providing the care, are in
attendance.
4. "Group Daycare Facility" means a home, place, or facility providing daycare where seven (7) to
twelve (12) children, regardless of the relationship to the person or persons providing the care, are
in attendance.
"Family Daycare Home" means a home, place or facility providing daycare where six (6) or
fewer children, regardless of the relationship to the person or persons providing the care, are in
attendance.
Note: Family daycare homes caring for four (4) to six (6) children may be rewired to have a
fire inspection but not a license. Those caring for three (3) or less children are not required to
have afire inspection or be licensed.
6. "Licensing Authority" is the Idaho Department of Health and Welfare.
Note: The minimum standards as outlined in the state daycare licensing act will not
preempt any local ordinance that is more stringent.
II. GENERAL REQUIREMENTS FOR ALL DAYCARE OCCUPANCIES
Standard IT Ie I Meets Notl
Standard Meet Standard
Exiting Requirement
Are the required exits located to provide an unobstructed path
outside the building to a public way or area of refuge?
Can exit doors be opened from the inside without the use of a
key or any special knowledge or effort?
Are there at least two exits (travel distance between not to
exceed 75 feet) located a distance apart, not less than one-half
the diagonal dimension of the building or portion used for
daycare?
v
Exception: lit buildings with automatic fire sprinkler systems, the
distance may be increased to 110feet.
Are the required exits not less than 32 inches of clear exit width
and not less than six feet, eight inches (68") in height?
Exception: Sliding patio doors will be accepted as a required second
exit in "Family an Group Daycare Facilities" only,
Are sleeping rooms provided with at least one emergency egress
window having at least a minimum single net clear opening of
5.7 square feet, minimum height 24 inches, minimum width 20
inches, and maximum finished sill height not over 44 inches?
Note: An approver) exit door is acceptable in lieu of egress windows.
Also, cut approved piece of furniture or platform, if anchored in
place, can be approved to sit in front of a window, if the sill height is
over 44 inches
Are approved egress windows from sleeping areas operable
from the inside without the use of separate tools?
Where children are located on a story below the level of exit
discharge (basement), are there at least two exits provided, one
of which is directly to the outside?
Note: More than one exit front the basement opening directly to the
outside may be required, depending on the structure of the building,
Daycare is prohibited on any upper floor beyond the first floor.
Exception: Daycare is permitter) at the second floor level, provided
that the building has two (2) exits, one (1) of which must open
directly to the outside and be in compliance with building codes.
Is thefiacility in compliance?
Fire Extinguishers
Note: Fire extinguishers shall be maintained ro err .
For Daycare Centers: Is there a portable fire extinguisher
(minimum 2A -)013C) mounted securely in the kitchen area and
one other approved location that is visible, does not to exceed
five (5) feet from the floor to the top to the extinguisher, and not
more than seventy five (75) feet travel distance, and is it
maintained properly?
For Group Daycare Facilities and Family daycare Homes: Is
there a portable fire extinguisher (minimum 2A -1013C) mounted
securely in the kitchen area that is visible, does not to exceed
five (5) feet from the floor to the top to the extinguisher, and not
Standard ss
Standard Meet Standard,
s
Occupant Load
Note: Only those areas used or da care purposes will be used when determinin occupant load.
To determine occupant load, calculate the square footage of the
space between the interior face of the exterior walls, assigned to
daycare use, and divide by the occupant load factor of 35.
Allowances for interior walls or partitions and furnishings have
been taken into account in the occupant load factor, except
fixed seating. The occupant load for fixed seating is determined
by counting the seats.
Enter Occupant Load: W-0
Is the facility in compliance?
Note: This inspection is for the purpose of meeting only the requirements of the Department of Health
and Welfare. The operator/ owner may also be required to meet; zoning, building code, fire code or
other agency regulations within their local jurisdiction to conduct this type of business. In addition a
separate Health and Safety inspection is required on all facilities that are required to be licensed.
REMARKS:
Facility passes fire inspection:Yes. No Type: Family Group Center
INSPECTION MADE BY:k 0/9 C11
TITLE AND AGENCY: ;E _ r
Signature of Inspector: `�` �' --' Date: /
Name of facility operator/owner (please print):J j(rl:nL6p , )K' -z? .j&WL
Signature of facility operator/owner: (,�lL/jQd,J t' Date: `�! 1� -7
Fire Inspection Fee Collected*: 01
*Tlte fee collected for a State Daycare Licensing Fire Inspection must not exceed $25 and will
be deducted from the Licensing fee paid by the provider prior to the Health & Safety
Inspection.
Idaho Department of Health and Welfare Daycare Licensing Fire Safety Inspection Form -Revised June 3, 2010
Standard Facility Meets Facility does Not
Standard
more than seventy five (75) feet travel distance, and is it
maintained properly?
1s there a hood -type fire suppression system installed in the
kitchen area if required?
Fire Extinguishers (cont.)
In facilities over three thousand (3,000) square feet are
additional fire extinguishers present and approved by local fire
official or designee?
In Facilities greater then twenty thousand (20,000) square feet
in area or when the number of children under the age of
eighteen (18) month exceeds one hundred (100) is there an
automatic sprinkler system?
Telephone
Is there an operable telephone on the premises?
Smoke Detectors
Is there a smoke detector installed in the basement having a
stairway which opens from the basement into the facility (such
detector shall be connected to a sounding device or other
detector to provide an alarm which will be audible in the
sleeping area)?
Are approved smoke detectors provided on the ceiling or wall
outside each separate sleeping area or in the immediate vicinity
of bedrooms?
Is there a smoke detector in each room used for sleeping
purposes?
Is there a smoke detector in each story within the facility
including the basement?
Fire Safety and Evacuation Plan
Note: Each daycare center, group daycare facility or fancily daycare home voluntarily licensed by the
Department, must have an approved fire safety and evacuation plan prepared. Fire evacuation and
safetyplans must include the elements listed below.
Procedures and policies that accounts for all employees and
children after an evacuation is completed.
Identifies evacuation routes, locations of facility exits, and
assembly point for an evacuation.
Includes location of smoke detectors, fire alarm appliances and
fire extinguishers.
A schedule of fire and emergency evacuation drills and annual
/r
reviews that all employees and children participate in with
records of those drills available for reference and review.
For facilities with over 50 children
Note: In addition to the requirements above, those facilities with over fifty (50) children must also meet
the criteria outlined below.
Do exit doors swing in the direction of egress?
Do exit doors from rooms having an occupant load to fifty (50)
or more, if provided with a latch, have panic hardware?
Are Exit signs installed at required exit doorways and where
otherwise necessary to clearly indicate the direction of egress?
Is an approved fire alarm system installed?