Loading...
128 4TH AVE S BLDG (2)SNOR01MISH CO. • • IIII��III 1Z g �� +�, ��� .s Serving Brier, Edmonas, and 12425 Meridian Ave S Mountlake Terrace Everett, WA 98208 Phone (425) 551-1200 www.FireDistrictl.org Fax (425) 551-1272 LOCATION: 128 4 th Avenue S Bldg 98020 BUSINESS NAME: Copperstone Building MAILING ADDRESS: 128 4th Avenue S, Edmonds, WA 98020 BUSINESS OWNER: TGB PHONE: HOME PHONE: FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY STATION & SHIFT Annual 17-C SCHEDULED Jan 2017 DATE DUE UFIR 1, 423 202 EMERGENCY-1: Stevens, Jan HOME PHONE: 2062903313 CURRENT KEY ACCESS-2: HOME PHONE: 17 CITY YES NO BUSINESS EMAIL: LICENSE PERSON CONTACTED: ° �-Z INITIAL INSPECTION DATE NAME OF INSPECTOR: IN- ki—y! (•��I,�� 30. 17 � ���� =IRE SYSTEMS: AS §145 FA 5M �911f' FE 5/15 t}� Date Last Serviced: S t(, q11(.(c., .x. Ov ✓ HAZARDS FOUND AND LOCATIONS / COMMUNI ATIONS ! 1 2 2 3 3 4 4 5 5 6 .............. 6 7 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS DATE DUE: _ DATE DUE: W GRANTEDTO: =DATE DUE' CITED: PERSON '4 PERSON PERSON CONTACTED: CONTACTED: CONTACTED: INSPECTOR: INSPECTOR- INSPECTOR: € 2 DATE: DATE. ;DATE: 13 VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 4 1 ? 5 1 5 LETTER SENT NUMBER• ^ 2 6 2 6 DATE. CODE SECTION: 5 3 17 3 7 RETURN RECEIPT RECEIVED B „�.. DISP6SITION- 4 8 4 8 DATE LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO €8 1. SNOHOMISH CO. FIRE DISman. Serving Brier, Edmonds, and Mountlake Terrace www.FireDistrictl.org LOCATION: 128 4 th Avenue S Bldg 98020 BUSINESS NAME: COpperstone Building MAILING ADDRESS: 128 4th Avenue S, Edmonds, WA 98020 BUSINESS OWNER: TGB 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 PHONE: HOME PHONE: FIRE PREVENTION INSPECTION REPORT A EDMONDS ❑ BRIER ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY I STATION & SHIFT Annual 17-B SCHEDULED DATE DUE ► Jan 2016 UFIR ► 423 202 EMERGENCY-1: Stevens, Jan HOME PHONE: 2062903313 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS mv EMAIL: LICENSE PERSON CONTACTED: IJo INITIAL INSPECTION DATE NAME OF INSPECTOR: It") ( 10 k v kb-, -Z FIRE SYSTEMS: OAS/1 FA 5/13 FE 5/1 D Lk Box HAZARDS FOUND AND LOCATIONS / COMMUNICATION p0 j _� r.1 N O N S� At i ,j-e- 2 2 3 5 3 4 5 6 6 7 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X In our continuing effort to promote fire safety and prevention within the community, your fire department conducts regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the Cities covered by Snohomish County Fire District 1. You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above you will find the item(s) that were noted during. our inspection which require attention to bring them into compliance with the minimum standards adopted by the above jurisdictions. Any overlooked hazards or violations. of the fire regulations does not imply approval of such con di ions of -Violation. If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for Mountlake Terrace or Brier, call (425) 744-6231. '^`\ FIRE PREVENTION i �` ���� `-1 ` J INSPECTION REPORT SNOHOMISH CO. e Serving Brier, Edmonds, and 1 _4..5 Meridian Ave S Mountlake Terrace Everett, WA 98208 ❑ BRIER IRE S F❑RIER :. ❑ TERRACE I Phone (425) 551-1200 ❑UNINCORPORATEDDI wwwFireDistrictl.org Fax (425) 551-1272 FREQUENCY STATION & SHIF f LOCATION: � 128-.%Ith Awnue S Suite 1QLi fl802{] , 2 vpz-;<r i I 17-t3 BUSINESS NAME: ,- {-- PHONE: 42M87211 - DATE DUEED► .Ban 2014 � 1 MAILING , v �' _+ UFIR ► ' ADDRESS: 128 41h Awnuc S, SuUn 100, Ldrrmrv", WA .:38020 B�pp SINESS OWNER: HOME PHONE: EMERGENCY-1: Fianiilt n, I{iYlberi HOME PHONE: 4:}531144t)l1 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS EMAIL: / LICENSE INITIAL INSPECTION DATE ` PERSON CONTACTED: NAME OF INSPECTOR: FIRE SYSTEW,: „ F _1 HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 •�� 1 4 2 2 3 3 v 4 4 c• 5 5 6 6 7 7 I A - REE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st R -INSPECTION 2nd RE -INSPECTION FINAL RE -INSPECTION I EXTENSION VIOLATIONS DATE UE. DATE DUE. GRANTED TO* DATE DUE: CITED: PERS N PERSON PERSON CONTA TED: CONTACTED: CONTACTED: 1 J,NSPE�TOR: INSPECTOR: INSPECTOR: 2 3 ,DATE: , DATE: DATE: • VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED .1 5 1 15 LETTER SENT NUMBER: 4 CODE 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 3 7 3 7 RECEIVED 8 DISPOSITION: 4 8 4 ,p 8 DATE: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO 8 FIRE DEPARTMENT COPY & ,'�'•.:..K ✓ii•�-�.ryy. a. r `. F .r n �' � •, ,.:i t � , yr t•,1, ! *4�.`; - '-'r t..w`�+:.�r '�. ,= e JY� ^wl;: � �:�hL' b•>1.y.a',r =.� +V^.r�sx ;1.,.,.r��Yi- i tt r z^ , f .{i `l. 1 ta; ; c`:� ^�..1�..�+•.;�`.ai.*�i. y�++^��t����`Itt.. �: �..'* .:q,•'Sa'.rSR.{I;r :.7 ' f .....� �-�r:'...`'.p.:,..,,s .h. tp. M-�„ h�� :.o'•l- _=�.. y mWestern States Fire Protection Co. _ �u%Cd Gk2d j�24�trdPJltly �: Fire Protection Systems a subsidiary of API Group, Inc.t} Design • Fabrications • Installation Commercial • Industrial • Residential • Institutional 14690 N.E. 95th Street, Unit 101, Redmond, Washington 98052 Special Hazards • High Tech • Defense • Hangars Retrofit • Service • Inspection • Maintenance 425-881-0100 REPORTTO GOi 0.o. 5-1cwe STREET /2 47' �� A vE S. CITY & STATE ret^ or d S (1d zip ATT _ 12 jA S 7/P `/, rs,� PHONE NO. 'zOfe LOCATION INSPECTED✓"+C INSPECTOR :r Allen, DATE �! - L 1- /O JOB NO. (.GENERAL A. (To be answered by the Owner or Owner's representative) Was owner available? Owner/Rep. Signature YES NA NO 1 1. Have there been any changes in the occupancy classification, machinery or operations since the last inspection? 2. Have there been any changes or repairs to the fire portection systems since the last inspection? 3. If a fire has occurred since the last inspection, have all damaged sprinkler system components been replaced? 4. Has,the piping in all dry systems been checked for proper pitch within the past five years? Date last checked'(Checking is recommended at least every 5 ears 5. Has the piping in all systems been checked for obstructive materials? Date last checked(Checking is recommended at least every 5 ears 6. Have all fire pumps been tested to their full capacity through the use of hose streams or flow meters within the past 12 months 7. Are gravity, surface or pressure tanks protected from freezing? 8. Are any of the sprinklers 50 years old or older? (Testing and/or replacement is recommended for such sprinklers.) 9. Are any extra high temperature solder sprinklers regularly exposed to temperatures near 3001f? B. To be answered by inspector) 1. Have the sprinkler systems been extended to all visible areas of the building? ►! 2. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector? 3. In building areas protected by a wets stem, does it appear to be heated, including its blind attics and perimeter areas, where accessible? 4. Does it appear that visible exterior openings are protected against the entrance of cold air? ll. CONTROL VALVES A. Are sprinkler system main control valves and other readily visible valves in the appropriate open or closed position? B. Are readily visible control valves sealed or supervised in the proper position? Control Valves No. of Valves Type Size Easily Accessible Signs g Valve O en Sealed? (Sealed?) If yes, how? (Lo Yes No upvd•? Supervision Operational Yes F No Yes I No Yes No Yes No / X X Lt, c/ / mill., i h IA I k III. WATER SUPPLIES S A. Water supply source? City ' toA Waterflow Test Results Made During This Inspection Private Pressure Fire Pump & Tank Pressure Fire Pump & City Pressure Fire Pump & Ponc Other Test Pipe Location Size Test Pipe Static Pressure Before Flow Pressure Static Pressure After Test Pipe Location Size Test Pipe Static Pressure Before Flow Pressure Static Pressure After ., / a / as 10 /oo / /ID IV. TANKS, PUMPS, FIRE DEPT. CONNECTIONS A. Do fire pumps, gravity, surface or pressure tank appear to be in good external condition? YES NA NO B. It appears that gravity, surface and pressure tanks are at the proper pressure and/or water levels? C. It appears that fire department connections are in satisfactory condition, couplings free, caps or plugs in place and check vavles tight? D. Are fire department connections visible and accessible? V. WET SYSTEMS - A. No. of systems Make & Model P e; /r E B. It appears that gravity, surface and pressure tanks are at the proper pressure and/or water evels? If closed, has piping been drained? C. Has the owner or owner's representative been advised that cold weather valves are not recommended by NFPA? D. Have readily apparent antifreeze systems been tested? E. Date antifreeze systems were tested. F. The antifreeze tests indicate protection to (temperature) system 1 2 3 4 5 G. Did alarm valves, waterflow alarm indicators and retards test satisfactory? .� r„ff +-, ,M ,. 1K,�,E���v"4i'•4':1•�l+?.hir•a•4ayi'-ri�,�'�rv.•<S!!+^..��'vhi'�%. , +�$�"%Y !;� �4.v' � Ar �� ih��°.E�y�.. L � .. 9 "j{� '�' �AY,�J�''�'�l" "''fi.-�'kZ 't. � .^Vj'• ,ki K ' m6Western States Fire Protection Co. a subsidiary o/AP/Croup, /ne.0 14690 N.E. 95th Street, Unit 101, Redmond, Washington 98052 / 425-881-0100 Fax 425-881-3030 ADry ❑ Pre -Action ❑ Deluge ❑ Other: A FOR UAr Sr to L COO LI f 0S STREET J .04et� S. INSPECTION NO. t-X78 5-2 % CITY & STATE E�+-f�*�/ C Li✓ C( ZIP 'FM CONTRACT N0. DATE OF TRIP TEST �O INSPECTOR •J Gib/ t"7 DAY WORK NO. VALVES SYSTEM NO. ( �) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) VALVE SERIAL NUMBER MANUFACTURER (NAME) Ze VALVE MODEL VALVE SIZE INCH INCH INCH INCH CONTROLLING SPRINKLERS (LOCATION) (APPROX NUMBER) R a'Q DATE LAST TESTED? - DATE LAST OPERATED? to PRESSURE BEFORE TEST - AIR 3S PSI PSI PSI PSI WATER PSI PSI PSI PSI SIZE AND LOCATION.OF TEST VALVE WAS GATE VALVE BELOW VALVE'OPEN WIDE AT TEST? E NO YES NO YES NO YES NO (IF NOT, HOW MANYTURNS?) LOW AIR SIGNAL RECORD PSI PSI PSI PSI AIR PRESSURE 4r' PSI PSI PSI PSI VALVE ACTIVATED AT WATER PRESSURE PSI PSI PSI PSI TIME MIN SEC MIN SEC MIN SEC MIN SEC IF SYSTEM IS FLOODED, LIST TIME WATER REACHED OPENING MIN SEC MIN SEC MIN SEC MIN SEC PERFORMANCE VALVE CONDITION (Good, Fair, Poor) INTERIOR OF BODY F P G F P G F P G F P MOVING PARTS F P G F P G F P G F P RUBBER FACING F P G F P G F P G F P SEATS F P G F P G F P G F P RESET? NO YES NO YES NO YES NO DID ALARMS OPERATE AT TRIP TEST? 1 E NO YES NO YES • NO YES NO ALL LOW POINT DRAINS BLOWN OUT? E NO YES NO YES NO YES NO WATER CONTROL VAVLE LEFT OPEN & SEALED? E NO YES NO YES NO YES NO ALARM CONTROL VALVE LEFT OPEN & SEALED? YES NO YES NO YES NO YES NO QUICK OPENING DEVICES SYSTEM NO.( ) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) DEVICE SERIAL NUMBER MANUFACTURER (NAME) TYPE AND MODEL AIR PRESSURE IN UPPER CHAMBER QUICK OPENING DEVICE ACTIVATED AT PERFORMANCE QUICK OPENING DEVICE LEFT IN SERVICE AND CONTROL OPEN AND SEALED? LIST ANY UNSATISFACTORY CONDITIONS? 'N . :.;:_��*1'..:. �",:;j;�..:,::fi�,�h�'t�.?�;i`-J���IP^,:; � ' s -�.3• , vL't'gv�y,�Fr.�'#"�ft�.''' r.+:>°`i��;rti�.:i�::�?;�k�1�:..:rfrz.::.,�r�;;:: �8.n;,.�+,wot:,_ •, • -. a �%'so'a"�..,"�.� ".,5.h� W G�:.:r. y-n,��h>.iri�.rv`R �,n �rt�:./„ � � �-oo'.i��.`� n� i� .,,� '4`.: '`•`'`"S a ' ` Western States Fire Protection Co. a aubsldHry o/ AP/ Group, Inc. {} Page 2 of REPORT OF INSPECTION INSPECTION CONTRACT VI. DRY SYSTEMS YES NA NO A. No. of systems Make & Model X G U., Date last trip tested t Partial ull B. Are the air pressure and priming water levels normal? C. Did the air compressor operate satisfactorily? D. Were readily accessible and visible low points drained during this inspection? E. Were dry system trip tests performed? (If yes, see DPV Trip Test Report) F. Do dry valves appear to be protected from freezing? G. Is the dry valve house heated? VII. ALARMS A. Did the water motor(s) and gong(s) operate during testing? B. Did the electric alarm(s) operate during testing? C. Did the supervisory alarm service test satisfactory? VIII. SPRINKLERS -PIPING �[ A. Do sprinklers generally appear to be in good external condition? B. Do sprinklers generally appear to be free of corrosion or loading and visible obstructions? C. Are extra sprinklers available on the premises? D. Does the exterior condition of the firesprinkler system appear to be satisfactory? E. Does hand hose on the sprinkler system appear to be in satisfactory condition? IX. EXPLANATION OF "NO" ANSWERS (FOR SECTIONS IB thru VIII): X. THE INSPECTOR SUGGESTS THE FOLLOWING NECESSARY IMPROVEMENTS. HOWEVER, THESE SUGGESTIONS ARE NOT THE `RESULT OF AN ENGINEERING SURVEY: / r 3 5 O►++t, .� L'd,...e /t f .� (-/n,p, yO r 4r P y -4 XI. ADJUSTMENTS OR CORRECTIONS MADE: XII. LIST CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPMENT, AS ADVISED BY THE OWNER IN SECTION I -A: /YG1'r� XIII. INSPECTION AND SUGGESTED IMPROVEMENTS WERE DISCUSSED WITH THE UNDERSIGNED OWNER OR OWNER'S REPRESENTATIVE: Signature of Owner or Owner's Representative Date: Printed Name: DUPLICATE TO: STREET: CITY & STATE: ZIP: ATTN: -~ Seib ing Briei; Edmonds, and SNOHOMISH CO: FIRE \�hyT /j Mountlake Terrace STwww.FireDistrictl.org LOCATION: 128 Uh Amnue S flSWO BUSINESS NAME: Cappemianc !wilding MAILING ADDRESS: 128 4Lh Avcnuc S, Edinnrx6-, WA 08020 BUSINESS OWNER: 12425 Mei•rdrait Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) SSI -1272 PHONE: HOME PHONE: FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER. ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY STATION & SHIFT A►ntim 17-13 SCHEDULED Ja. n 2014 '! DATE DUE UFIR 10) 01 EMERGENCY-1: Lwe ns, Jan HOME PHONE: "130b"90331Y CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO EMAIL: BUSINESS ❑ LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: FIRE SYSTEMS: X", 51t., FA 5M2 FE9 !RFD Lk Box HAZARDS FOUND AND LOCATIONS / COMMUNICA IONS I 2 2 l 3 3 // 4 4 i 5 i" 5 6 6 7 N, 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION 2nd RE -INSPECTION FINAL RE -INSPECTION EXTENSION VIOLATIONS DATE DUE. DATE DUE. GRANTED TO' DATE DUE: CITED. PERSON PERSON PERSON CONTACTED: CONTACTED: .. CONTACTED: INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 1 5 1 5 LETTER SENT NUMBER: 4 CODE 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 3 7 3 7 RECEIVED 6 DISPOSITION: 4 8 4 8 DATE: LETTER NEEDED ❑ YES ❑ NO LETTER^NEEDED ❑ YES ❑ NO 8 FIRE DEPARTMENT COPY SNOHOMISH CO. FIRE - DISTI Serving Brier, Edmonds Mountlake Terrace,and the Town of'Woodway www.FireDistrictl.org FIRE PREVENTION 12425 Meridian Ave S INSPECTION REPORT ONDS Everett, WA 98208 ❑ IM BRIER ❑ BRR Phone (425) 551-1200 ❑ WOODWAY ❑ MOUNTLAKE TERRACE Fax (425) 551-1272 ❑ UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 128 4th Ave S 366 17 B I I' BUSINESS NAME: Copperstone Building PHONE: DATE DUE SCHEDULED► 01/01/12 MAILING 128 4th Ave S UFIR ► 423 591 1202 ADDRESS: Edmonds 98020 • BUSINESS OWNER: TGI3 HOME PHONE: 4257781530 EMERGENCY-1: Stevens, Jan HOME PHONE: 2062903313 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS LICENSE INITIAL INSPECTION DATE PERSON CONTACTED: NAME OF INSPECTOR:/� L. %� ^'t�l �a1.—� %V / 12'7 /Z011— FIRE AS 5/11 FA 5/11 FD LkBx FIE SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 Z �•: � •i G � 6N i �� � �` �Coc✓L,- /•I C. � ��fa�'�`�.S?� �JOt? �'/_' / ` 1 2 2 3 " 3 I 1 - 4 4 5 5 6 6 7 I 7 I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION DATE DUE: - 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON �� CONTACTED: PERSON CONTACTED: PERSON CONTACTED: 1 INSPECTO (/ INSPECTOR: INSPECTOR: 2 DATE: �� Dr• Z DATE: DATE: 3 VIOLATIONS LA5 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 2 6 2 6 DATE: CODE SECTION: 5 3 7 3 • 7 RETURN RECEIPT RECEIVED 5 Q 6 Q 6 DATE: DISPOSITION: 7 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO g FIRE DEPARTMENT COPY Date: 5/10/12 Time: 10:00 AM Job Number: KI1139 Technician: Paul Ortega & Tim Marsh j� Western States 1 Fire Protection Co. �7atecfusy l�iued a�rd �� a subsidiary of AP/ Group, Inc. r' Annual Annual Fire Alarm, Sprinkler, Extinguisher, and Backflow Inspection Job Site Information Copperstone Condo HOA 128 4th Ave S #500 Edmonds, WA 98020 206-290-3313 Billing Information Copperstone Condo HOA 128 4th Ave S #500 Edmonds, WA 98020 Jan Stevens 206-290-3313 Western States Fire Protection CO. 1485-A Tuskegee Place Clorado Springs, Colorado 80915 Phone Number (719) 578-1822 Fax Number (719) 578-1831 API Group Inc. is a member of the U.S. Green Building Council Western States Fire Protection Albuquerque, NM: Centennial, CO: Fort Collins, CO: Pflugerville, TX: San Antonio, TX: Nampa, ID: Casper, WY: Lakewood, CA: Colorado Springs, CO: Houston, TX: Phoenix, AZ: Spokane, WA: Missoula, MT: Glenwood Springs, CO: Black Hawk, SD: Grand Prairie, TX: Oregon City, OR: Redmond, WA: Sacramento, CA: Upland, CA: El Paso, TX: National Fire Suppression Decatur, IL: Kansas City, KS: Maryland Heights, MO: Statewide Fire Protection Las Vegas, NV Western States Fire Protection Co. 2!ir� .dcaed 44d �WW!0 5/10/12 a subsidiary of AMI croup. Inc. ' KI1139 Copperstone Condo HOA GENERAL' ., YES ': NA'; .NO A. (To be answered by the Owner or the Owner's representative) Was owner available? 1. Have there been any changes in the occupancy classification, machinery or operations since the last inspection? 2. Have there been any changes or repairs to the fire protection systems since the last inspection? 3. If a fire occurred since the last inspection, have all damaged sprinkler system components been replaced? 4. Has the piping in all dry systems been checked for proper pitch within the past five years? Date last checked 5. Has the piping in all systems been checked for obstructive materials? Date last checked 6. Have all fire pumps been tested to their full capacity through the use of hose streams or flow meters within the past 12 months? 7. Are gravity, surface or pressure tanks protected from freezing? 8. Are any of the sprinklers 50 years old or older? (Testing and/or replacement is recommended for such sprinklers.) 9. Are any extra high temperature solder sprinklers regularly exposed to temperatures near 300"F? B. o be answered the inspector) 1. Have the sprinkler systems been extended to all visible areas of the building? x 2. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector9 x 3. In building areas protected by a wet system, does it appear to be heated, including its blind attics and perimeter areas, where accessible? x 4. Does it appear that visible exterior openings are protected against the entrance of cold air? x CONTROL VALVES A. Are sprinkler system main control valves readily visible and in the appropriate open or closed position? x B. If the valve(s) had seals were they broken in order to operate the valves ? C. Was the Owner or the Owner's representative notified that the seal(s) were removed if they could not be replaced? x x Cordrol Valves No. of Valves Typa s.Yes Easity,Accessible Signs. VeIJe Open : Sealed,Supervfsed or Locked Supe vision Operational No. Yes No ; Yes No . Yes` ` NO PIV 1 PIV x x x Supervised x On backfiow 2 OSBY x x x Supervised x Dry system 1 Butterfly x x x Supervised x Wet system 1 Butterfly x x x Supervised x Elevator 1 Butterfly x x x Supervised x WATER SUPPLIES Pressure Fire Pump & Tank N/A A. Water supply source, City or Private? City Pressure Fire Pump & City N/A Pressure Fire Pump & Pond N/A Other N/A Main Drain Flow Test Results Made During This Inspection Test Pi Pipe located , - Slze Test Pipe Static .: Pressure'• Before ... Flow Pressure _ Static • Psi After Test Pipe Located:, , Size Test Pipe Static Pressure : 'Before: ' :; Flow Pressure. Stavri Pressure ;: After Wet riser 2" 115 95 115 Or riser 1" 115 95 115 TANKS, PUMPS, FIRE DEPT. CONNECTIONS :YES " NA': NO. A. Do fire pumps, gravity, surface or pressure tanks appear to be in good external condition? x B. It appears that gravity, surface and pressure tanks are at the proper pressure and/or water levels? x C. it appears that fire department connections are in satisfactory condition, couplings free, caps or plugs in place and check valves tight? x D. Are fire department connections visible and accessible? x 128 4th Ave S #500 Page 1 Fire Sprinkler Inspection Western States Fire Protection Co. 5/10/12 a subs/diary of AW1 G~p, INC. ; KI1139 Connerstone Condo HOA WET SYSTEMS I YES 'NIA "NO,: A. No. of Systems 1 Make & Model Shotgun B. Was the date of the gauge(s) checked, since gauges are required to be tested with a calibrated gauge or replaced every five years? If tested with a calibrated gauge and the gauge was not within 3% over the full scale they must be recalibrated or replaced x C. If applicable, have any dry type heads more than 10 years old had a representative sample tested x D. Where the water flow test(s) performed by flowing water through all appropriate test valves? x E. Have all known and readily apparent antifreeze systems been tested? x F. Date antifreeze systems were tested N/A G. The antifreeze tests indicate protection to temperature: Sys. 1 N/A Sys. 2 N/A Sys.3 N/A Sys. 4 N/A Sys.S N/A H. Did alarm valves, water flow alarm indicators and retards test satisfactorily? x 1. Did all known tamper switches attached to the sprinkler system test satisfactorily? x J. Did all known supervisory switches attached to the sprinkler system test satisfactorily? x DRY SYSTEMS Qtly. A. No. of systems 1 Make 8 Model Reliable D Date last trip tested 2011 Partie 2010 Full 2012 B. Are the air pressure and priming water levels normal? x C. Did the air compressor operate satisfactorily? x D. Were readily accessible and visible low points drained during this inspection? x E. Were dry system trip tests performed? (If yes, see DPV Trip Test Report) x F. Do dry valves appear to be protected from freezing? x G. Is the dry valve house heated? I x SPECIAL SYSTEMS Qtly. A. No. of systems NA Make & Model N/A Type N/A B. Were all known valves tested as required? X C. Did all heat responsive systems operate satisfactorily: X D. Did the supervisory features operate during testing? X Heat Responsive Devices Type Type of Test Valve No. 1 N/A 2 N/A 3 N/A 4 N/A 5 N/A 6 N/A Valve No. 7 N/A 8 N/A 9 N/A 10 N/A 11 N/A 11 N/A Valve No. 12 N/A 13 N/A 14 N/A 15 N/A 16 N/A 17 N/A Valve No. 18 N/A 19 N/A 20 N/A 21 N/A 22 N/A 23 N/A Valve No. 24 N/A 25 N/A 26 N/A 27 N/A 28 N/A 29 N/A Valve No. 3o N/A 31 N/A 32 N/A 33 N/A 34 N/A 35 N/A Auxiliary Equipment No. N/A Type Location N/A Testing Results N/A ALARMS YES NiA NO O A. Did the water motor(s) and gong(s) operate during testing? x B. Did the electric alarm(s) operate during testing? x C. Did all of the supervisory alarms test satisfactorily and signals verified ? x D. Was the alarm panel free of alarm and trouble signals upon your arrival If no, please explain below x E. Where alarm signals verified by alarm monitoring company? x F. Was the alarm panel clear of alarm and trouble signals upon your departure If no, please explain below x SPRINKLERS - PIPING A. Do sprinklers generally appear to be in good external condition? x B. Do sprinklers generally appear to be free of corrosion or loading and visible obstructions? x C. Are extra sprinklers available on the premises? x D. Does the exterior condition of the fire sprinkler system appear to be satisfactory? x E. Does hand hose on the sprinkler system appear to be in satisfactory condition? x Page 2 Fire Sprinkler Inspection Western States Fire Protection Co. 2 ,.L4w 44d 5/10/12 a subsidiary of JW1 r.Faup, Ine. KI1139 Copperstone Condo HOA 128 4th Ave S #500 EXPLANATION OF ANY PREVIOUS ANSWERS .ABOVE THAT MAY. REPRESENT A PROBLEM; OR COMMENTS FROWTHE ' INSPECTOR. THE INSPECTOR SUGGESTS THE FOLLOWING IMPROVEMENTS. HOWEVER. THESE SUGGESTIONS ARE NOT THE RESULT'OF AN ENGINEERING SURVEY: ADJUSTMENTS OR CORRECTIONS,MADE. ALL LISTED CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPMENT, AS ADVISED BY THE OWNER IN SECTION: Signature of Owner or Owner's Representative Printed Name Jan Stevens Date: 5/10r12 Does the owner/owners representative want a copy of this report sent to another location? (i.e. Insurance. Main Office. etc.) DUPLICATE TO: STREET: CITY & STATE: ATTN: ZIP: Page 3 Fire Sprinkler Inspection Western States Fire Protection Co. .d4wd tad 5/10/12 a subsidiary of "I crow,, ifne.:,: KI1139 Copperstone Condo HOA Owner A. Has the owner/owner rep. been notified that the low point drains need to be maintained all year long? YES NA:; NO;.' x Valve. information A. Valve Serial Numbers B. Manufactures Name C. Manufacturers Date (year) D. Valve Model E. Valve Size F. Location? G. Area protected by Dry system? Heliable 2004 D 4" In riser room Garage Before Test ; YES NA' NO A. Does Air compressor appear to be free of physical damage and be operating properly at the time of the inspection? B. Does the exterior of valve appear to be in good condition and both gauges operable at the time of inspection? C. Record the pressure (psi) shown on the Water Supply pressure gauge. D. Record the pressure (psi) shown on the System side (air) pressure gauge. E. Is system control valve in OPEN position? F. Do the trim valves appear to be in their appropriate open or closed positions at the time of inspection? G. Does the exterior of QOD appear to be in good condition and gauge operable at the time of inspection? H. Record the pressure (psi) shown on the QOD pressure gauge. G. Is the pressure gauge on QOD indicating the same pressure as the air gauge on the system side of the dry pipe valve? H. Does the QOD appear to be free from leakage at the time of inspection? I. Does the intermediate chamber appear to be free from leakage at the time of the inspection? -. Main Drain"Test A. Record system static pressure (psi) before opening main drain valve. B. Record system residual pressure (psi) with main drain valve open. C. Record system static pressure (psi) after closing main drain valve. Partial Trip Test %:.. A. Was partial trip test of the dry pipe valve conducted with control valve partially opened? B. Record the pressure (psi) shown on the Air Pressure gauge When Supervisory Signals Occurred. C. Record the pressure that the QOD operates. D. Record air pressure (psi) at trip of dry valve. E. Record the time in seconds between the start of test and trip of valve. 3rd Year Full Trip,Test_ ` Date last Full trip Test was performed? A. Was a full flow trip test of dry valve conducted with control valve opened fully? B. Record the pressure (psi) shown on the Air Pressure gauge When Supervisory Signals Occurred. C. Record the pressure that the QOD operates. D. Record air pressure (psi) at trip of dry valve. E. Record time in seconds between the start of test and trip of valve. F. Record time in seconds that it took for the water to reach the inspectors test. G. Record time in seconds between the start of test and trip of valve. rJ Yeaf. Internal InSpeCtlOn Date last Internal inspection and cleaning was performed? A. Was internal inspection of dry pipe valve conducted this year? B. Do all components appear to operate property and move freely? C. Has valve been cleaned and appear to be in good condition? After Test ` Is priming water level correct at the time of inspection? A. Does the air pressure maintained appear to be at proper setting for system? B. Have all known drum drip/low point drain been drained and inspected during the inspection? x X 110 PSI 33 Psi x X x NA Psi x x X 115 Psi 95 Psi 115 Psi YES NA NO" X NA PSI NA PSI NA I PSI NA I Sec. 6/10/12 X 20 PSI NA Psi 10 Psi 17 Sec. 21 Sec. 17 Sec. 611N0 X X X x X X 128 4th Ave S #500 Dry Valve Inspection BACKFLOW PREVENTION ASSEMBLY TEST REPORT ACCOUNT #: NAME OF PREMISE Copperstone Condos SERVICE ADDRESS 128 4 h Ave S CUSTOMER PRINTED NAME Jan Stevens LOCATION OF ASSEMBLY In riser room TYPE OF HAZARD ISOLATED Domestic NEW INSTALLATION ❑ EXISTING ® REPLACEMENT ❑ MAKE OF ASSEMBLY Watts MODEL 007MIQT AIR GAP INSPECTION: Required minimum air gap separation provided? Yes ❑ No ❑ CITY Edmonds PHONE 206-290-3313 Commercial ❑ Residential zip 98020 FAX DCVA ® RPBA ❑ OTHER ❑ LINE PRESSURE: 115 PSI SERIAL # 134429 SIZE,, 2" PROPER INSTALATION? YES® NO ❑ DCVA/RPBA DCVA/RPBA INITIAL TEST CHECK VALVE #1 CHECK VALVE 0RPBA PVBA / SVBA PASSED ® LEAKED ❑ LEAKED ❑ OPENED AT PSID AIR INLET CLOSED TIGHT ® CLOSED TIGHT ® #] CHECK PSID OPENED AT PSID FAILED ❑ 1_5 PSID 1_4 PSID AIRGAP OK? DID NOT OPEN ❑ CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID NEW PARTS AND ❑ ❑ ❑ ❑ ❑ Cl LEAKED ❑ REPAIRS ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ ❑ ❑ ❑ ❑ ❑ ❑ REPAIRED ❑ TEST AFTER REPAIRS CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT PSID AIR INLET PSID PASSED ❑ FAILED ❑ PSID PSID #1 CHECK PSID CHECK VALVE PSID LINE PRESSURE 115 PSI REMARKS: TESTER'S SIGNATURE: CERT #: B 4996 a •�—f�i TESTER'S NAME PRINTED: f� a REPAIRED BY: LIC. #: FINAL TEST BY: CERT #: CUSTOMER'S SIGNATURE: Detector Meter Reading: CONFINED SPACE? ❑ YES ® NO DATE: 5-10-12 TESTERSPHONE# 425-881-0100 DATE: DATE: DATE: CALIBRATION DATE: 11-11 GAUGE to: 357630 SERVICE RESTORED? YES 0 NO ❑ BACKFLOW PREVENTION ASSEMBLY TEST REPORT ACCOUNT #: NAME OF PREMISE Copperstone Condos SERVICE ADDRESS 128 4`h Ave S CUSTOMER PRINTED NAME Jan Stevens LOCATION OF ASSEMBLY In riser room TYPE, OF HAZARD ISOLATED Fire Sprinkler NEW INSTALLATION ❑ EXISTING ® REPLACEMENT ❑ MAKE OF ASSEMBLY Ames MODEL 2000E AIR GAP INSPECTION: Required minimum air gap separation provided? Yes ❑ No ❑ CITY Edmonds PHONE 206-290-3313 Commercial ❑ Residential zip 98020 FAX DCVA ❑ RPBA ❑ OTHER ED LINE PRESSURE: 115 PSI SERIAL # 35653 SIZE,, 3/4" PROPER INSTALATION? YES® NO ❑ DCVA/RPBA DCVA/RPBA INITIAL TEST CHECK VALVE #1 CHECK VALVE #2 RPBA PVBA/SVBA PASSED ® LEAKED ❑ LEAKED ❑ OPENED AT PSID AIR INLET CLOSEDTIGHT ® CLOSED TIGHT ® OPENED AT PSID #1 CHECK PSID FAILED ❑ 1_9 PSID 1_S PSID AIRGAP OK? DID NOT OPEN ❑ CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID NEW PARTS . AND ❑ ❑ ❑ ❑ ❑ Cl LEAKED ❑ REPAIRS ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ ❑ ❑ ❑ ❑ ❑ ❑ REPAIRED ❑ TEST AFTER REPAIRS CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT PSID AIR INLET PSID PASSED ❑ FAILED ❑ PSID PSID #1 CHECK PSID CHECK VALVE PSID Detector Meter Reading: LINE PRESSURE 115 PSI CONFINED SPACE? REMARKS: None TESTER'S SIC;NA1'URE: CERT #: B 4996 TESTER'S NAME PRINTED:' REPAIRED BY: LIC. #: FINAL TEST BY: CERT #: CUSTODIER'S SIGNATURE: CALIBRATION DATE: 11-11 ❑ YES ® NO DATE: 5-10-12 TESTERS PHONE # 425-981-0100 GAUGEiv: 357630 DATE: DATE: DATE: SERVICE RESTORED? YES® NO ❑ BACKFLOW PREVENTION ASSEMBLY TEST REPORT ACCOUNT #: NAAIE OF PREMISE Copperstone Condos SERVICE ADDRESS 128 4`h Ave S CUSTOMER PRINTED NAME Jan Stevens LOCATION OF ASSEMBLY In riser room TYPE OF HAZARD ISOLATED Fire Sprinkler NEW INSTALLATION ❑ EXISTING ® REPLACEMENT ❑ MAKE OF ASSEMBLY Ames MODEL 3000SS AIR GAP INSPECTION: Required mininmm air gap separation provided? Yes ❑ No ❑ CITY Edmonds PHONE 206-290-3313 Commercial ❑ Residential ZIP 98020 FAX DCVA ❑ RPBA ❑ OTHER El LINE PRESSURE: 115 PSI SERIAL # 131230 SIZE " 4" PROPER INSTALATION? YES ® NO ❑ DCVA/RPBA DCVA/RPBA INITIAL TEST CHECK VALVE 91 CHECK VALVE #2 RPBA PVBA / SVBA PASSED ❑ LEAKED ❑ LEAKED ❑ OPENED AT PSID AIR INLET CLOSED TIGHT ® CLOSED TIGHT ® #I CHF,CK PSID OPENED AT PSID FAILED ® 2_0 PSID 0_0 PSID AIRGAP OK? DID NOT OPEN ❑ CLEAN REPLACE PART CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE ❑ ❑ ❑ ❑ ❑ ❑ HELD AT PSID NEW PARTS AND ❑ ❑ ❑ ❑ ❑ ❑ LEAKED ❑ REPAIRS ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ ❑ ❑ ❑ ❑ ❑ ❑ REPAIRED ❑ TEST AFTER REPAIRS CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT PSID AIR INLET PSID PASSED ❑ FAILED ❑ PSID PSID #I CHECK PSID CHECK VALVE PSID REMARKS: None Detector Meter Reading: CONFINED SPACE? ❑ YES ® NO TESTER'S SIGNATURE: C'ERT #: B 4996 DATE: 5-20-11 TESTER'S NAME PRINTED: t`I tZt^�e�4 TESTERS PHONE# 425-881-0100 REPAIRED BY: LIC. #: DATE: FINAL TEST BY: CERT #: DATE: CUSTOMER'S SIGNATURE: DATE: CALIBRATION DATE: 11-11 GAUGE #: 357630 SERVICE RESTORED? YES 0 NO ❑ LINE PRESSURE 115 PSI v FIRE PREVENTION CITY OF EDM_ONDS'! SAFETY SURVEY 121 5TM AVENUE N. • EDMONDS, WASHINGTON Two (425) 771-021SJ --FIRE-DEPARTMENT.a 4S' Q z 1 1 LOCATION: 128, 4th Ave S t BUSINESS NAME: CopperStonD Building 1 PHONE: MAILING 128 4th Ave c ADDRESS: Edmonds 98020 BUSINESS OWNER: TGB HOME PHONE: 4257781530 EMERGENCY-1: Stevens, Jan HOME PHONE: 2062903313 KEY ACCESS-2: HOME PHONE: FR STATION & �CLU6ENCY SHIFT SCHEDULED 01t01l11 DATE DUE ► UFIR ► 423 591 1202 PERSON CONTACTED: IINITIAL INSPECTION DATE. - `1f NAME OF INSPECTOR: FIRE jAS 7109 FA 1109 FD LkBx� FE _I SYSTEMS: �f/gyp Ill4 � ANNUAL HAZARDS FOUND AND LOCATIONS / /COMMUNICATIONS ENTER CODE ONLY ONCE ► VIOLATION CODE 2 e/-<►� 1�1 4 4 O L � „� o -r- ., V J 6 S-t Ia �- f 2 3 �" 1 13 c 4 4 5 5 6 6 k 7 tyr .I 8 8 1st RE -INSPECTION DATE DUE: 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: 1 INSPECTOR: 1 INSPECTOR: Z INSPECTOR: 2 DATE: // ^^�� VIOLI!!I NS 1 V� 5 DATE: DATE: _ 3 VIOLATIONS 1 5 PRE -ORATION LETTER SENT CITATION ISSUED NUMBER: 4 C 2 j 6 2 6 DATE: CODE " SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED 6 -- 4 8 4 8 DATE: DISPOSITION: 8 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES ❑ NO FIRE DEPARTMENT COPY LETTER OF TRANSMITTAL I Date May 24, 2011 TO. Re: Job: City of Edmonds c Delpoz Fire Prevention tion Qi 250 5`" Avenue N FROM. Western States Fire Protection Co. Edmonds, WA 98020 14690 NE 95`" St #101 Fire Sprinkler Inspection Report Copperstone Condos-2011 Redmond, WA 98052 Phone 425-881-0100 Fax Phone 425-881-3030 We are sending you: ® Attached ❑ Under Separaie.Cover via the following items: ❑ Shop Drawings ❑ Copy gf'Letter ❑ Prints ❑ Calculations ❑ Plans ❑ Submittals ❑ Other Copies Date Description . 1 0512012011 Fire Sprinkler Inspection Report These are transmitted as checked below: ❑ For Approval ® For Your Use ❑ As Requested ❑ For Review and Comment ❑ Approved as Submitted Comments: CC. Customer, File Signed: harone Larson, Se vice Administrator sharonedarsonCa>wsfn. us ❑ Returned. for Corrections ❑ Resubmit Copies for Approval ❑ Submit Copies for Distribution ❑ Return Corrected Prints ❑ Approved as Noted r 5/20/11 1r Western States Il Fire Protection Co. �aolecticrg .G�cued and p�ra�t�y a subsidimy of Aar r Lqk me Copperstone Condo HOA I7R Ath A— S HSnn ACTION T I LOCATION BUILDING, DATE of- INSPECTION DUEEXTINGUSHER NEXT DUE PASS OR Agent AREA MANUFACTURER SIZE SERIAL NUMBER.ERNALFLOOR, MANFACTURE ANNUAL OR [NEXT HYDRO TEST FAIL TypeINTERNAL[AINT By FACP room Kidde 10 2004 Annual Fail By elevator Machine room Kidde 10 2004 Annual Fail Lobby Amerex 5 2004 Annual 2016 Pass By unit 303 Amerex 5 2004 Annual 2016 Pass By unit 304 Amerex 5 2004 Annual 2016 Pass By unit 203 Amerex 5 2004 Annual 2016 Pass By unit 203 Amerex 5 2004 Annual 2016 Pass In salon Amerex 5 2005 Annual Fail Garage Amerex 10 2006 Annual Fail Elevator Machine room Amerex 5 2004 Annual 2016 Pass Fire Extinguishers Page 1 KI0712 Due 6yr Needs recharge. Lost pressure Fire Extinguishers Page 2 W Date: 5/20/11 Time: 9:00 AM Job Number: K10712 Technician: Paul Ortega \\ �N u Western States 1 Fire Protection Co. acsd Pw a subsidiary of APi GrOUP, /IOC. — — --Annual Annual Fire Sprinkler Inspection Job Site Information Copperstone Condo HOA 128 4th Ave S #500 Edmonds, WA 98020 206-290-3313 Billing Information Copperstone Condo HOA 128 4th Ave S #500 Edmonds, WA 98020 Jan Stevens 206-290-3313 Western States Fire Protection CO. 1485-A Tuskegee Place Clorado Springs, Colorado 80915 Phone Number (719) 578-1822 Fax Number (719) 578-1831 API Group Inc: is a member of the U.S. Green Building Council Western States Fire Protection Albuquerque, NM: Centennial, CO: Fort Collins, CO: Pflugerville, TX: San Antonio, TX: Nampa, ID: Casper, WY: Lakewood, CA: Colorado Springs, CO: Houston, TX: Phoenix, AZ: Spokane, WA: Missoula, MT: Glenwood Springs, CO: Black Hawk, SD: Grand Prairie, TX: Oregon City, OR: Redmond, WA: Sacramento, CA: Upland, CA: El Paso, TX: National Fire Suppression Decatur, IL: Kansas City, KS: Maryland Heights, MO: Statewide Fire Protection Las Vegas, NV r r Western States it 6 Fire Protection Co. P� d&" aid 2nke 5/20/11 a subsidiary of API C rOUP, iec. K10712 Copperstone Condo HOA .. YES NA A. (To be answered by the Owner or the Owner's representative) Was owner available? 1. Have there been any changes in the occupancy classification, machinery or operations since the last inspection? 2. Have there been any changes or repairs to the fire protection systems since the last inspection? 3. If a fire occurred since the last inspection, have all damaged sprinkler system components been replaced? 4. Has the piping in all dry systems been checked for proper pitch within the past five years? Date last checked 5. Has the piping in all systems been checked for obstructive materials? , Date last checked 6. Have all fire pumps been tested to their full capacity through the use of hose streams or flow meters within the past 12 months? 7. Are gravity, surface or pressure tanks protected from freezing? 8. Are any of the sprinklers 50 years old or older? (Testing and/or replacement is recommended for such sprinklers.) 9. Are any extra high temperature solder sprinklers regularly exposed to temperatures near 300°F? B. 0 e answere a ins ec or _ x 1. Have the sprinkler systems been extended to all visible areas of the building? x 2. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector? 3. In building areas protected by a wet system, does it appear to be heated, including its blind attics and perimeter x areas, where accessible? x rio 4. Does it appear that visible exter openings are protected against the entrance of cold air? A. Are sprinkler system main control valves readily visible and in the appropriate open or closed position? - B. If the valve(s) had seals were they broken in order to operate the valves ? C. Was the Owner or the Owner s representative notified that the seal(s) were removed if they could not be replaced? Easily Accessible Signs Valve Open Sealed, Supervised or No. of . Type Locked Control Valves Valves Yes No Yes No Yes No x Supervision Operational Yes NO PIV 1 PIV x On backflow 2 OS&Y x Dry system 1 Butterfly x Wet system 1 Butterfly x Elevator 1 Butterfly x x x Supervised x x Supervised x x Supervised x x Supervised x x Supervised x x x x x Pressure Fire Pump & Tank N/A WATER SUPPLIES A. Water supply source, City or Private? City Pressure Fire Pump & City Pressure Fire Pump & Pond N/A N/A Other N/A Vlain Drain Flow Test Results Made During This Inspection Static . Static Size Test Flow Test Pipe Located Pressure Pressure Psi Pie p Before After Static static Flow Test Pipe Located Size Test Pipe Pressure, pressure Pressure Before After , Wet riser 2" 110 100 110 Dry riser V. 120 100 110 A. Do fire pumps, gravity, surface or pressure tanks appear to be in good external condition? B. It appears that gravity, surface and pressure tanks are at the proper pressure and/or water levels? C. It appears that fire department connections are in satisfactory condition, couplings free, caps or plugs in place and check valves 128 4th Ave S #500 YES :NIA NO WET SYSTEMS Page 1 Fire Sprinkler Inspection Western States Fire Protection Co. z4w'd a.4d 5/20/11 a subsidiary of API Group, Inc. K10712 Copperstone Condo HOA A. No. of Systems 1 Make & Model Shotgun B. Was the date of the gauge(s) checked, since gauges are required to be tested with a calibrated gauge or replaced every five years? If tested with a calibrated gauge and the gauge was not within 3% over the full scale they must be recalibrated or replaced x C. If applicable, have any dry type heads more than 10 years old had a representative sample tested x D. Where the water flow test(s) performed by flowing water through all appropriate test valves? x E. Have all known and readily apparent antifreeze systems been tested? x F. Date antifreeze systems were tested N/A G. The antifreeze tests indicate protection to temperature: Sys. 1 N/A Sys. 2 N/A Sys.3 N/A Sys. 4 N/A Sys.5 N/A H. Did alarm valves, water flow alarm indicators and retards test satisfactorily? x Did all known tamper switches attached to the sprinkler system test satisfactorily? x J. Did all known supervisory switches attached to the sprinkler system test satisfactorily? x DRY SYSTEMS Qtly. A. No. of systems 1 Make & Model Reliable D Date last trip tested 2010 Partic 2009 Full 2010 B. Are the air pressure and priming water levels normal? x C. Did the air compressor operate satisfactorily? x D. Were readily accessible and visible low points drained during this inspection? x E. Were dry system trip tests performed? (If yes, see DPV Trip Test Report) x F. Do dry valves appear to be protected from freezing? x G. Is the dry valve house heated? I x SPECIAL SYSTEMS Qtly. A. No. of systems NA Make & Model Type N/A N/A B. Were all known valves tested as required? X C. Did all heat responsive systems operate satisfactorily: X D. Did the supervisory features operate during testing? X Heat Responsive Devices Type Type of Test Valve No. 1 NIA 2 N/A 3 N/A 4 N/A 5 N/A 6 N/A Valve No. 7 N/A a N/A s N/A 10 N/A 11 N/A 11 N/A Valve No. 12 N/A 13 N/A 14 N/A 15 N/A 16 N/A 17 N/A Valve No. 18 N/A 19 N/A 20 N/A 21 N/A 22 N/A 23 N/A Valve No. 2a N/A z5 N!A 26 N/A 27 N/A 2s N/A z9 N/A Valve No. 3o N/A 31 NIA 32 N/A 33 N/A 3a N/A 35 NIA Auxiliary Equipment No. N/A Type Location NIA Testing Results N/A ALARMS YES N/A NO A. Did the water motor(s) and gong(s) operate during testing? x B. Did the electric alarm(s) operate during testing? x C. Did all of the supervisory alarms test satisfactorily and signals verified ? x D. Was the alarm panel free of alarm and trouble signals upon your arrival If no, please explain below x E. Where alarm signals verified by alarm monitoring company? x F. Was the alarm panel clear of alarm and trouble signals upon your departure If no, please explain below f x SPRINKLERS - PIPING A. Do sprinklers generally appear to be in good external condition? x B. Do sprinklers generally appear to be free of corrosion or loading and visible obstructions? x C. Are extra sprinklers available on the premises? x D. Does the exterior condition of the fire sprinkler system appear to be satisfactory? x E. Does hand hose on the sprinkler system appear to be in satisfactory condition? x 128 4th Ave S #500 Page 2 Fire Sprinkler Inspection KI Western States it 6 Fire Protection Co. a subsidiary of API GTOUP, rnc. K10712 5120/11 Copperstone Condo HOA ALL LISTED CHANGES IN THE UC:GUt AN1, r-- Signature of Owner or Owner's Representative Date: 5/20/11 Printed Name Jan Stevens Does the owner/owners representative want a copy of this report sent to another location? (i.e Insurance Main Office, etc.) DUPLICATE TO: ZIP: STREET: CITY & STATE: ATTN: 128 4th Ave S #500 Page 3 Fire Sprinkler Inspection Western States Fire Protection Co. 5/20/11 a subsidiary of avi croup, ifne. K10712 C000erstone Condo HOA Owner A. Has the owner/owner rep. been notified that the low point drains need to be maintained all year long? IYESINA INO IX Valve Information A. Valve Serial Numbers B. Manufactures Name C. Manufacturers Date (year) D. Valve Model E. Valve Size F. Location? G. Area protected by Dry system? Reliable D 4" In riser room Garage Before Test NA NO A. Does Air compressor appear to be free of physical damage and be operating properly at the time of the inspection? B. Does the exterior of valve appear to be in good condition and both gauges operable at the time of inspection? C. Record the pressure (psi) shown on the Water Supply pressure gauge. D. Record the pressure (psi) shown on the System side (air) pressure gauge. E. Is system control valve in OPEN position? F. Do the trim valves appear to be in their appropriate open or closed positions at the time of inspection? G. Does the exterior of QOD appear to be in good condition and gauge operable at the time of inspection? H. Record the pressure (psi) shown on the QOD pressure gauge. G. Is the pressure gauge on QOD indicating the same pressure as the air gauge on the system side of the dry pipe valve? H. Does the QOD appear to be free from leakage at the time of inspection? I. Does the intermediate chamber appear to be free from leakage at the time of the inspection? Main Drain Test A. Record system static pressure (psi) before opening main drain valve. B. Record system residual pressure (psi) with main drain valve open. C. Record system static pressure (psi) after closing main drain valve. Partial Trip Test A. Was partial trip test of the dry pipe valve conducted with control valve partially opened? B. Record the pressure (psi) shown on the Air Pressure gauge When Supervisory Signals Occurred. C. Record the pressure that the QOD operates. D. Record air pressure (psi) at trip of dry valve. E. Record the time in seconds between the start of test and trip of valve. 3rd Year Full Trip Test I Date last Full trip Test was performed? A. Was a full flow trip test of dry valve conducted with control valve opened fully? B. Record the pressure (psi) shown on the Air Pressure gauge When Supervisory Signals Occurred. C. Record the pressure that the QOD operates. D. Record air pressure (psi) at trip of dry valve. E. Record time in seconds between the start of test and trip of valve. F. Record time in seconds that it took for the water to reach the inspectors test. G. Record time in seconds between the start of test and trip of valve. 5 Year Internal Inspection Date last Internal inspection and cleaning was performed? A. Was internal inspection of dry pipe valve conducted this year? B. Do all components appear to operate properly and move freely? C. Has valve been cleaned and appear to be in good condition? After Test Is priming water level correct at the time of inspection? A. Does the air pressure maintained appear to be at proper setting for system? B. Have all known drum drip/low point drain been drained and inspected during the inspection? ii 0 Psi 40 Psi x x x NA Psi x X x 120 Psi 100 Psi 110 Psi YES1 NA NO X 25 Psi NA Psi 20 Psi 17 Sec. 7/21110 Psi Psi Psi Sec. Sec. See. Unknown x x x 128 4th Ave b 7fbuo Dry Valve Inspection �3�i Is , . iltm : .I1Ii I i�1I(LI�' �• i 1jf •i��C u • - - .m 05/18/2011 10:26 FAX 4253538934 Evergreen Security 0 002 ;aal" I S FIRE PROTECTION BUREAU -FIRE AND IiFE SAFETY INSPECTIONS P (360�596-390042600 IYFAX: (380)598- 934Mpla. WA 00 FIRE ALARM SYSTEM INSPEG 11Vn mr'r%ow% ......0 rrinv nN PREMISES M:Z��- W- Ia �Fig MACo IIMMMai - i - . . ■ 05/18/2011 10:26 FAX 4253538934 Evergreen Security Iaj001 dWWEMERGREEN Security Systems A DIVISION OF EVERCREEN SECURITY INC FAX we area U0company. _. { ) FAX: (425) 353-8934 VOICE,;, 425 348-3850 or 1.-800-466-3�850 To: Edmonds Fire Department Fax: 425-775-7721 From: Lisa Sieloff, Service Coordinator Date: Re: Confidence Testing Reports Pages: CC: ❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply 13 Please Recycle • Attached please find completed confidence testing reports. If you have any questions, or tf this L j report should be forwarded to another department, please contact me. Lisa L. Sieloff, Service Coordinator Evergreen Security Systems LisaS@evergreensecurity.com (425) 348-3850; (800) 466-3850 ..jTICE: This is a CONFIDENTIAL facsimile transmission and is intended for the addressee only. Dissemination of the contents herein and of the accompanying page(s) to any other person or persons is strictly prohibited. If you have received this transmission and are not the addressee, return all pages to EVERGREEN SECURITY, Inc„ 8115 Broadway Suite 101, Everett, WA 95203. Your cost of postage will be reimbursed. Evergreen Security, Inc. Is the lawful owner of this facsimile and the accompanying page(s) and by transmitting same does not relinquish that right of ownership. a. ^ tyr-IfEaR. t•'llt4 441�1�N:S■J IY YR ��ie•.■sa.■��� 01426/2010 11:41 FAX 4253538934 Evergreen Security 0002 Washington State Patrol '�Flre Protection Bureau eneral Administration Building Post Office Box 42600 Olympia, WA 96504-2600 Name of Facility: Occupied As: _ Address: County: Inspection Contract No. File Number Fire Alarm System Report of Inspection Building Designation (if more than one building): Inspected By: Date Of Inspection: � -'1'7 \ 0 Title: Date: 0 1. Type of Test: Monthly ❑ Quarterly ❑ Semi -Annual ❑ Annual 2. Type of System: Noncoded Mommon Coded ❑ Selective Coded ❑ Dual Coded ❑ 3. Local Fire Department: 4. Fire Department Official Contacted: 5. Test Received at Fire Department: ❑ Yes Flo 6. Master Box Reset A.M. P.M. 7. Comments, explanation of unsatisfactory results, action taken, etc...: � ■:�1hfs.■ •.F1it'�:'�'�I)[r'ifRff:1u���•`iT%�Ti]iliillit�/s'Lrlra�lll[�1u�.ti»�ra•�a•, .••—�-••• 01i 6/2010 11:41 FAX 4253538934 Evergreen Security 0003 i. r� .n. �► Ywn►ed TVDe of Equipment C 4t �ncna Number of Units Listed ec�«v Test Date Satisfactory Check Yes No NIA TvDe and Manufacturer 8. Control Panel Cl c✓� 9. Manuel Station 10. Heat Detectors 11. Smoke Detectors 12. Audible Alarms 13. Visual Alarms 14. Code Transmitters 15. Auto Door Releases 16. Trouble Indicators 17. Master Alarm Box 18. Batteries 19. Charger 20. Generator 21, Ventilation Control 22. Fire Department Interconnection �✓j G �� JkJ`, 23. Central Station Interconnection 24. Exterior Sprinkler Electric Alarm Bell 25. Sprinkler Water Flow Switch. � A,%V v 26. Sprinkler Gate Valve Tam r Switch 27. Enunciators 28. Automatic Time Delay of General Alarm Minutes None Installed 29. Test of alarm system on emergency power satisfactory? YesyNo D 30. This Is to certify that this fire alarm system has been properly inspected for reliability covering the times listed in this report, and is consistent with NFPA Fire Alarm Maintenance Standards. A. Signature of Owner or Representative B. Signature of Fire Alarm Firm Representativ C. Name of Firm Evergreen c&curily Systems,Inc D. Mailing Address 8115 Broadway Ev ett WA 98203 E. Electrical Contractors License# F. Specialty Electricians License# „_ CITY OF EDMONDS 121 5TM AVENUE N. • EDMONDS, WASHINGTON 98020 • (425) 771-0215 FIRE DEPARTMENT 4�St, 1S90 LOCATION: 128 4th Ave S BUSINESS NAME: Copperstone Building MAILING 128 4th Ave S -ADDRESS: Edmonds BUSINESS OWNER: T(''B EMERGENCY-1: Stevens, Jan KEY ACCESS-2: FIRE PREVENTION SAFETY SURVEY PHONE: 98020 HOMEPHONE: 4257781530 HOMEPHONE: 2062903313 HOME PHONE: FREQUENCY STATION & SHIFT 366 17 D SCHDATEEDUEE 01/01/10 ► UFIR ► 423 591 1202 INITIAL INSPECTION DATE PERSON CONTACTED: VA . s-f'�µpvt NAME OF INSPECTOR: v N TLG F-D a tg / b 3 1 t It? FIRE AS 7/09 FA 1109 FD LkBx FE 1p5r S-t STEMS: (?l l o q of h o ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS ENTER CODE ONLY ONCE ► VIOLATION CODE 2 2 3 3 r 4 4 5 5 6 6 7 7 8 8 1st RE -INSPECTION DATE DUE: t, 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: _ 3 VIOLATIONS 1 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 2 6 2 6 DATE: CODE SECTION: 5 3 i 7 3 t 7 RETURN RECEIPT RECEIVED 6 7 4 8 i 4 8 DATE: DISPOSITION: 8 LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED ❑ YES, ❑ NO t FIRE DEPARTMENT'COPY �' j FAX NO. : 425 486 4449 Auo. 02 2006 09:10AM P1 FROM : Jan Stevens b D T of E ul ment F Number of Units Listed Test Date Satisfactory Check Yes No NA T and Manufacturer 8. Control Panel 5 �� L f c �1© 9. Manuel Station 10. Beat D2teftm 11. Smoke Detectors 12. Auclible Alarms Q S' 13. Visual Alarms 14. Code T i smitbers 15. Auto Doan Ises 16. Trouble Indicators 17: MasterAlum 1Box 18. Batteries.. 19. charw 20. Generator 21. Ventilation Control.... , : 2.L Face Dirrt %ntemonnectim 23. CenW-Statdon neCtion 24: Extertor Wnldar Electrle Alarm Sell 25. Sprin1der Water Flow Switch G' 26. SprrnMr Gate Valve Tamper Switch C/r' 27. 'Annundators 28. Automatic Time Delay of General Alarm Minutes Worie Instaile 29. Test of alarm system on emergency power: satisfactory? .,Ye . No 0 . . .::..:...: . 30.7his is -to certify that this fire alarm systwn has been properly inspected for.reliability covering the Imes listed In this report and Is cansmsnt 4th WFPA fire Alarm Maintenance Stan&r+ds., A. Slgratum 6F Owner' or RepreWtad've=*z&.^, 94 S..Signat ure of Flee 'Aiarm Firrn Repr�ntative C. blame ot` Frttt eer D.' MailIngAddress ' .115' broad v' WB= Tel#:-(425)348-3850 E. Electrical Contractors -Uce=* EX F. ' SPedallyy Electridarrs Ucmnse* E 5- 7-03: 1:27PM;T8y1or / Gregory ' FROM : 6WIR0VBffAL ASSOCIATES INC PINE NO. : 1 425 455 2316 'Feb. 21 20M 1i:55AM Pi ENVIRONMENTAL ASSOCIATES, INC. 1380 -112th Avenue Northeast, Su1te 300 Bellevue, Washington M04 (425)45"025 (425)455,2316 Fax FAX MEMORANDUM DATE: wary 2112003 FROM: Diane Spahr TO: Mr. Colin Winters FAX NO: 42S-7?o-5746 TOTAL PAGES muemecowmamrs if you have difficulty receiving this lnfonmation, please contact us at (425) 455-9025. SUBJECT: Here is a copy of the second report regarding the excavation of the contominated soil and subsequent besting. if you have any questions, please feet fhee to call. Fm-2i-2003 - Rr Ii.49AM 10: C%mr-c- 4 FROM : ENUIF041BMAL ASSOCIATES INC PHM NO. : 1 425 455 2316 Feb. 21 2M 11:56AM P2 u " ENVIRONMENTAL ASSOCIATES, INC. 1380 - 11216 Avcm Northeast, Stifte 300 Bdlewe. Wnbb*m 98004 (425) 43MMS Ofte (US) 453-5394 Tot, Fix (425) 455-2316 Fax October 9, 2002 W. Kirby Owens Hammerworks 400 Dayton Street, We C Fdmonds, Washington 98020 Subject: UNDERGROUND STORAGE TANK SITE ASSESSMENT Residential Property 130 Fourth Avenue South Edmon4 WasWngton Aar Mr. Owens: JN 22045-1 Envuunmental Associates, Inc. (BAI), has completed art assossmentof soil conditiow in the vicinity of an unde Wound heating oil tank which was removed fi*m the site by others in the summer of 2001. In addition. we conducted sampling.end testing of soil from an area to the south of the fixer UST whore approximately ten (10) gallons ofheadng oil was reportedly spilled in the course of the UST removal. This report, prepared in accordant with the tams of our proposal dated October 1, 2002, summarizes our Approach to the, project along with results old conclusions. The contents of this report am confidential and are intended solely for your use sad the use of your repa . Four (4) copies of this report are being distributed to you. No oflur distribution or discussion of this report will take place without your prior written approval. EXECUTIVE SUMMARY On Februazy S, 2002, Mr. Ryan Bixby ofEAI observed the excavation of soil from the sidewalls and floor of the farmer UST bold and from the area to the south of the UST Mold whew soil appeared to have been inpacted by the leaking tank after it was removed by others. Results of sampling and testing of soil conducted at that time indicated that potrolcum-contaminated soil remained beneath the floor of the farmer UST hold and to the south of the fotmCr UST in the vicinity of the =&cW release. Aumde OFiiew. Omegop / Sea Fnw ino E* Moe FES-21-c-M FRI 11: 50AM rOc . Dort - = 5- 7-03; i :27PM;T8Y IOr / Gregory •-��""vv� .. FROM EW t F044ENTAL ASSOCIATES INC. PHONE NO. 1 425 455 2316 Feb. 21 20M 11: 56M P3 i gvasrnerwerka JN 22045--1 Odeber.0, 2002 Page - 2 _ On Oootober 2"d and 31 2002, EM returned to the site and observed the excavation of approximately one hundred and twenty-five (125) tons of petroleum -contaminated soil (PCS) tkom the subject site. The PCS was excavated from the floor of the former heating oil tank hold and from an area to the south of the former UST where the surScial release reportedly occurred. 'Me tank hold excavation extended to a depth otopproximately ten (10) feet beneath ground surface -- and was approximately fifteen (IS) feet by twelve, (12) feet wide at the ground snrihce. Petroleum - son was removed to a depth of apprvsimately seven (7) feet beneath ground =face in the southem excavation The contaminated soil was stockpiled on visqueen and later loaded into trucks and transported to a thermal desorption treatment facility in Everett. Washington. No OF Results of sampling and testing of selected soil earnples collected from the floors and sidewalls of the former tank hold and the southern excavation confirmed that soil in these areas is now compatible with current WDOE Method A cleanup levels for diesel -range petroleum oontaainants. Relying upon the results of sarnpiing and testing completed thus far, it would appear that no additional action with regard to soil would be required by local, state, or fedmal agencies. i We appreciate the opportunity to be of service on this assignmea L If you have any questions or if we may be of additional service, please do not hesitate to contact us. Raespectful]y submitted. Don W. Spencer, M.�, P.G., R.E.A. opal Registered Site Asseem/Lieensed UST Supervisor State Certification #947458636 Licotm 604 Licx m 11464 License: 876 License.. 5195. License: 0327 (Washimgtcn) (Oregon) (California) (filinois) (Mississippi) ENVIRONMENTAL ASSOC,GITES, INC. f EB-21-c2003 FRI 11: 50AM M : onrr • i FRAM B#UIRONMENTAL ASSOCIATES INC PHMNE NO, 1 425 455 2316 or Feb. 21 2003 11.57AM P4 Itesidenthd Properly 130 Fourth Avenue South Edmonds, Washington Prepared tor: Mr. Kirby Owens HAmmerworks 400 Day&n Street, Suits C Edmonds, Wasbington 98M Questions regarding this investigation, the conohoons rea hed and the rocommwdatiaa►s given should be addressed to one of the following undmigaed. ltyaa K. ixby iydrogeotogist/projeat Mamager WD0&RegisWrod Site Assessor Don W. Sperber, P.C., ILEA Ptincipal Registered Site AaseworlLicensed UST Sq visor Stele Certification #947458636 .� License:604 (Washington) License:11464 (Oregon) :. Liceaso:876 (California) 1AGa ..519S (illinois) Ucam.0327 {Misaisaippi) Reference Job Number. JN 2204S-1 FO-21-2003 FRI 1i:SiAM ID: October 9, 2002 CKW=- d