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170 W DAYTON ST BLDGX- �. III - .. .• L. � ,° � - •� •: /7(� Li �Ay' v'� - d(r FIRE PREVENTION' "Serving Brier, Edmorius, Uftu 12425 Meridian Ave S INSPECTION REPORT SNOHOMISH CO. � ❑ EDMONDS �I�, _ Mountlake Terrace Everett, WA 98208 i' ��,r �• ❑BRIER "' • ; a ❑ MOU NTLAKE TERRACE Phone (425) 551-1200 ❑ UNINCORPORATED DICPTR T www.FireDistrict].org Fax (425) 551-1272 170 West Dayton Street Bldg 98020 LOCATION: . BUSINESS NAME: 170 W Dayton Bldg MAILING 170 West Dayton Street, Edmonds, WA 98020 ADDRESS: BUSINESS OWNER: Conner, Jan • Conner, Jan EMERGENCY I: KEY ACCESS-2: EMAIL: PERSON CONTACTED: NAME OF INSPECTOR: C A t /' ^ r 2L t 6Y5TE� 101—FA Ub/1 I 7 : :O 4257741511 PHONE: HOME PHONE: 4257741511 HOME PHONE: HOME PHONE: FREQUENCY STATE &SHIFT Annual I A SCHEDULED Oct 2016 DATE DUE / UFIR / CURRENT CITY BUSINESS LICENSE INITIAL INSPECT YES NO 1 9 �l FIRE PREVENTION ServingBrief, Edmonds, an,�SPECTION REPORT SIVQI3QMISiiCO. f '>& ,h4 Eddd 12425 Meridian Ave S [�A 98208 ❑EDMONDS ' Mountlake Terrace Everett, BRIER FIRE Phone (425) 551-1200 ❑ MOUNTLAKE TERRACE Fax (425) 551-1272 ❑ UNINCORPORATED FREOUENCY STATION $ SHIFT � LOCATION: 170 T West Dayton Street Bldg 98020 Annual 17-D BUSINESS NAME: —170- Dayton Bldg. PHONE: 4257741511 SCHEDULED Oct 2015 DATE DUE / MAILING FFiR / 509 ADDRESS: 170 West Dayton Street, Bldg, Edmonds, WA 98020 BUS`INESS,OWNER: Conner, Jan HOME PHONE: EMERGENCY 1: Conner, Jan HOME PHONE: 4257741511 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO EMAIL: BUSINESS „ a LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: ' -oe r FIRE SYSTEMS: 05/1,5 FE /U/� FD'Lk Box �('u. -3/ /� Date Last Serviced!�� HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS _ _ 1 y .i 2. 2 y 3.. .... 4 4 5 5 6 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: -� GRANTEDTO: DATE DUE- ' CITED: PERSON PERSON ._ .. _ _ __ -.-......_.... = "+INSPECTOR: SON' ----_..._._ ......_ ...........,a_._..._ . _.-._ w. ' CONTACTED: CONTACTED: NTACTED: INSPECTOR: INSPECTOR: s 2 DATE: - DATE: _ _ DATE:3 ___ _ ... VIOLATIONS VIOLATIONS+- PRE -CITATION•-- CITATION ISSUED 1 5 -.... __ 1_.. _.... ._.....5._.._._... _.LETTERSENT NUMBER 4' CODE I S 2 i 6 2 16 DATE: SECTION: RETURN RECEIPT 3 _.r._._ .. I 7 3 17 RECEIVED I s { ..�_._. _... DISPOSITION: {{ ._.....,�_._._.�_..�..®.. � 4 (8 4 8 DATE: _ LETTER NEEDED ❑ YES ❑ NO LETTER NEEDED — — _ ❑ YES ❑ NO 8 AAA FIRE & SAFETY, INC 3013 3RD.-AVE NORTH 7:3 SEAME,. WA,981,09 EDMONDS FIRE DEPARTMENT "THE NORTHWESTS MOST TRqSTEUNAME WFIRE PROTECTION' STEM RREALARM SYSTEM. Statu&,.QiVeh (One Systern, per. Report) RED F I YELLOWF WHITE. CONFIDENCE TEST I FX REPAIRS Sprinkler Mohitoring'P6hel? El OccupAnpy.Address- 170 IN DAYTON ST Occupancy Name: HARBOR SQUARE BLDG Respon-si.01 . e Person . st.';& Last Namd:. Jan Connor Fir Phone Number'. (425) 268-6649: Responsible Person. rs6n Address, City, State; Zip-. Responsible Party nwcihns(a)hoimall.com: &�Mail Address Date of Inspection: '044i6iwit 161:5am PDT-* Annual r'- Inspection• Frequency/Type:. 'Quarterly Testers Name- Mark, Hagen, Bryce tropper (Plea,se Print); Ni6et Number- — H60040 Identification Number: System r Location Elevator room Cerittal station monitoring?; Yes. 13 No Monitoring Mohitoring.Required . ? . ' Yes No 11' Company,- Name - e; -th System M k-- .120:vac S/d &heats.-wielev..re�calj System Model: FIRE CODEVOLATIONs FOUND: (if additional I room is needed, please add I a - separate .shee - t) Cokktdn6Ns.MA-6t�' Date. Cd'er'0.cted-. Corrected By:; if additional,k)orn'li 660­6'0;'Ph� I a4e, wd , a . separbte.t$46bt N icet Certification, Number:. - This certiftsftt, this -fird and lifd:safety systern has-been properly inspected for reliability to cover the 'siand Itern's. 1'i[itod�;ifi'tis repO-r"t'ais�cohsisten_kvjth`Firo 6epqrtneni FireCode ids'ard1hat' Ois.6tepaincies...-a-re.6 ted and havported 4606,:buildingOwn eir/Manaigier for:porrectiive action. t Signature of, Tester te - jl_ Phone k (?66) 294 7- Building ROpeesent8tive- (sign(atUre)l Fife Alarm S 'te ys ms Page 1 of 2 The items on ;he checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements. Alarm Svstem Functionali 1. Trouble signal with AC power off? (rl r Yes ❑ No j 2. System operates properly on battery backup? Yes ❑ No .3. Battery voltage (no load) volts 4. Battery voltage (full load) volts (signals operating) 5. Charge circuit voltage volts 6. System operates properly on standby power? Yes ❑ No ❑ 7. All signals operate on AC power? Yes © No Di 8. Number of initiating circuits 2 9. Number of signal circuits 0 10. Does alarm system meet audibility standards as accepted? n/4/ Yes ❑ No ❑I 11. All circuits checked for electrical supervision? Yes ❑X No 12. All auxiliary equipment operates (Elevators, fans, dampers)? N/A ❑ Yes ❑X No 13. Ventilation controls operate? N/A © Yes ❑ No ❑ 14. Key to panel available? N/A ❑X Yes ❑ No❑ 15. Materials and equipment needed to restore pull stations are available at the N/A © Yes ❑ No[:] main panel, e.g. glass rods, and plates; keys and allen wrenches, etc? 16. Operating instructions at panel? Yes ❑X No ❑I 17. Trouble indicators function properly? Yes ❑ NoEj 18. Remote Annunciator Panels function properly? N/A ❑ Yes X❑ No❑I 19. Elevator Call Down functions properly? N/A ❑ Yes X❑ No❑ 20. Test record posted at panel? Yes No 21. General alarm automatic time delay (minutes) N/A 22. Was a signal received at the Central Station monitoring company? N/A ❑X Yes ❑ No❑ 23. Other Devices (Specify) YeSEI No El System Devices Total Number of Units in Building Total Number Units Tested Test Results Acceptable I I 24. Bells, Horns, Chimes N/A ❑X Yes ❑ No ❑ 25. Voice Speakers (Voice Clarity) N/A © Yes❑ No [:1 26. Visual Alarm Devices 1 1 N/A ❑ Yes X❑ No❑ 27. Smoke Detectors 3 3 N/A ❑ Yes ❑X No ❑ 28. Heat Detectors 3 3 N/A ❑ Yes ❑X No ❑ 29. Duct Detectors N/A ❑X Yes ❑ No ❑ 30. Sprinkler Flow Switches N/A ❑X Yes ❑ No ❑ 31. Sprinkler Supervisory Switches N/A X❑ Yes ❑ No 32. Manual Pull Stations N/A ❑X Yes ❑ No 33. Annunciator(s) 1 1 N/A ❑ Yes ❑X No 34. Beam Detectors N/A ❑X Yes ❑ No ❑ 35. Automatic Door Unlocks N/A ❑X Yes ❑ No ❑ 36. Automatic Door Release N/A ❑X Yes ❑ No 37. Fire Dampers N/A X❑ Yes ❑ No ❑ Total Number of Units Total Number Units Communication Equipment in Building Tested Test Results Acceptable 38. Phone Sets N/A X❑ Yes ❑ No ❑ 39. Phone Jacks N/A ❑X Yes ❑ No ❑ 40. Call -in Signal N/A ❑X Yes ❑ No ❑ Fire Alarm Systems I Page 2 of;2 AAA FIRE &SAFETY, INC. .R�.......:. 3013 3RD AVE NORTH taoo> zza a�'3 SEATTLE, WA 98109 FIFO®AAAFIRE.LOM EDMONDS FIRE DEP "THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION" ARTMENT MAY 2 2 2815 FIRE ALARM SYSTEM Status Given (One System per Report) RED YELLOW WHITE X CONFIDENCE TEST. X REPAIRS Sprinkler Monitoring Panel? ❑ Occupancy Address: 170 W DAYTON ST Occupancy Name: HARBOR SQUARE BLDG Responsible Person First & Last Name: Jan Conner Phone Number: (425) 268-6649 Responsible Person 120 west Dayton st b-6 Address, City, State, Zip: Responsible Party Nwcinns@hotmail.com E—Mail Address Date of Inspection: 05/05/2015 01:45pm PDT Inspection Annual ❑X Frequency/Type: Quarterly ❑ Testers Name Mark Hagen (Please Print): Nicet H00040 Number: — Identification Number: System Location Bldg 5. Elev room Central station monitoring? Yes ❑ No ® Monitoring Monitoring Required? Yes ® No Company Name: N/a System Make: 120v ac smoke det/with elev recal System Model: FIRE CODE VIOLATIONs FOUND: (If additional room is needed, please add a separate sheet) CORRECTIONS MADE: Date Corrected: Corrected By: (If additional room is needed, please add a separate sheet) Nicet Certification Number: - This certifies that this fire and life safety system has been properly inspected for reliability to cover the Items listed in this report and is consistent ith ire discrepancies are noted and have be rep a partment Fire Code standards, and that the building Owner/Manager for corrective action. Signature of Tester: one # (206) 284-1721 Building Representative (signature) Fire Alarm Systems Page 1 of 2 The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements. Alarm Svstem Functionali 1. Trouble signal with AC power off? 2. System operates properly on battery backup? 3. Battery voltage (no load) volts 4. Battery voltage (full load) volts (signals operating) 5. Charge circuit voltage volts 6. System operates properly.on standby power? 7. All signals operate on AC power? 8. Number of initiating circuits 3 9. Number of signal circuits 10. Does alarm system meet audibility standards as accepted? 11. All circuits checked for electrical supervision? 12. All auxiliary equipment operates (Elevators, fans, dampers)? 13. Ventilation controls operate? 14., Key to panel available? 15. Materials and equipment needed to restore pull stations are available at the main panel, e.g. glass rods, and plates; keys and allen wrenches_, etc? 16. Operating Instructions at panel? 17. Trouble indicators function properly? 18. Remote Annunciator Panels function properly? 19. Elevator Call Down functions properly? 20. Test record (posted at panel? 21. General alarm automatic time delay (minutes) 22. Was a signAreceived at the Central_ Station monitoring company? 23. Other Devices (Specify Yes NoU YesH NON, Yes ❑ No j Yes No ❑ Yes X❑ No❑, Yes ❑X No ❑ N/A ❑ Yes ❑X No ❑; N/A ❑X Yes ❑ No ❑ N/A ❑X Yes ❑ No[:], , N/A X❑ Yes ❑ No ❑ Yes n No ❑. Yes ❑ No ❑ N/A ❑ Yes O Non N/A ❑ Yes Z No I. Xes X No N/A N/A ❑X Yes ❑ No❑ Yes ❑ No ❑ System Devices Total Number of Units in Building Total Number Units Tested Test Results Acceptable 24. Bells, Horns; -'Chimes 1 1 N/A ❑ Yes Q No 25. Voice Speakers (Voice Clarity) N/A Yes ❑ No❑ 26. Visual Alarm,Dev ices 1 1 N/A ❑ Yes X❑ No [I 27. Smoke Detectors 3 3 N/A ❑ Yes ❑X No ❑ 28. Heat Detectors 3 3 N/A ❑ Yes ❑X No ❑ 29. Duct Detectors N/A ❑X Yes ❑ No ❑ 30. Sprinkler Flow Switches,,' . N/A ❑X Yes ❑ No 31. Sprinkler Supervisory Switches N/A ❑X Yes ❑ No 32. Manual Pull Stations N/A ❑X Yes ❑ No ❑ 33. Annunciator(s) N/A ❑X Yes ❑ No ❑ 34. Beam Detectors N/A X❑ Yes ❑ No ❑ 35. Automatic Door Unlocks N/A X❑ Yes ❑ No ❑ 36. Automatic Door Release N/A ❑X , Yes ❑ No 37. Fire Dampers N/A ❑X Yes ❑ No ❑ Total Number of Units Total Number Units Communication Equipment in Building Tested Test Results Acceptable 38. Phone Sets N/A ❑X Yes ❑ No ❑ 39. Phone Jacks N/A ❑X Yes ❑ NO ❑ 40. Call -in Signal N/A ❑X Yes ❑ No Fire Alarm Systems Page 2 of 2 y� 3013 3rd AVE NORTH R R R (206) 284-1769 FAX FWE a SAFETY m • AAA.FIRE.COM INVOICE # Confidence Testing ACCOUNT # c40991 FIRE ALARM DATE FIRE DEPARTMENT '7_6 Address %6 V-� ' "ti City: Zip Code '30-3 Occupied as:r Building Owner: Ph. # Address: A� "" �"'`R �'City: "`^� Zip Code:c�i_6 Date of Inspection: S'a1 " T1ylpe of Inspection: Quarterly Annual Acceptance . Other Z(�� Tester`s Name (PLEASE PRINT) ��` Gam` SFD Certification #a1 1 Control Panel �ZD U �'�" ( W Model #'74- No. of Initiating Circuits No. of Signal Circuits Battery Voltage Volts ge Circuit V ge Volts Battery Voltage Under Full Load Volts (sls ope ' narating) 1. Trouble Signal With A/C Power Off Yes No N/A 2. System Operates Satisfactorily on Stan Power Yes o N/A� 3. All auxiliary equipment operates: ( va , fans; dampers) Yes —N N/A 4. All Signals Operate On AC Power Yes °' No 5. Have All Alarm Notification Appliances been checked for proper operation Yes No 6. All Circuits. Checked For Electrical'Supervision Yes No %N/A r� N/A 7.:-_Control panel checks made per manufacturer`s instructions __.. . Yes No No /% N/A 8. Central station or remote connection Name of monitoring company/ Yes 9. Key to panel available Yes , No N/A TYPE OF EQUIPMENT # OF UNITS TESTED SATISFACTORY # OF UNITS IN BLDG YES NO N/A BELLS, HORNS, CHIMES VOICE ALARM SPEAKERS VISUAL ALARM DEVICES TROUBLE INDICATORS SUPER SWITCHES (AUTO SPR.) SMOKE DETECTORS(S) HEAT DETECTOR(S) MANUAL PULL STATIONS VENTILATION CONTROLS OPERATE CENTRAL STATION ANNUNCIATORS ELEVATOR CALL DOWN FIRE DAMPER/SMOKE DAMPERS PHONE JACKS AUTO, DOOR UNLOCKS (FAIL SAFE) AUTO; DOOR RELEASE OTHER PROBLEMS FOUND: CORRECTIONS MADE: Date. corrected By THIS IS TO CERTIFY THAT THE FIRE ALARM SYSTEM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY TO COVER THE ITEMS LISTED IN THI SIGNATURE OF TESTER n7 ELECTRICAL LICENSE # Atl-kA Fire & Saf cIcy,, inc -) j rd ,"C ISeattie, Wa 98i09 �206-284-1721 ,info@aaafire.com w5u95 F}cc. -r �w a0 ►ter �7 tn� Fre DePC-1 t.mer tt_ Confi nnrin TC Sf- [ npporf- d�, 1� L I I Confidence Testinn nfflcer (fax) Red Tag Hotline Ir- (One System per Report) Certification Given `✓ELLOVV EY I WHITE CONFIDENCE TEST REPAIRS j 171 Occupancy Address- ti1_0 b& � Occu Dncy N am — ` i. City, State, Zip Responsible Person First & Last Name: st*:4-4, lv,� 4�-a�Y, Phone Number: �?�' _�� �(- QS��- Responsible Person 3� �� O'>< I Responsible Party Address, City, State, Zip: D �,x.. �(-d E-Mail Address Date of Inspection: Inspection Quarterly® (High-rise only) S .� q ncy/Type: . Fre ue Annual (' Testers Name . SFD Certification (Please Print): 'rc�vt�Gs�►� Number: Central station monitoring? Yes O - No Cr-monitoring Monitoring Required? Yes O. No Er Company Name: System Make: \IcO StQS w Ekes System Model: System Locafiori Identification Number: PROBLEMS FOUND' (If ^�' + .fir^I -gin nr,r + c•'e c ; - _ LORrtECTIONs MADE: Date Corrected- Corrected By: (if additional room is needed, please add a separate shee.l) SFD Certification NUrnber: SCP - SCP--o�ey� V\ r — This certifies that this fir--anU1_life-safety system fins Seen prcpedy. iilspcCtcU-IGI rcriabi1:[y''Iv cover ihC Items listed in this report and is consistent with Seattle Fire Depwhment; Fire Code standards; and that discrepancies are noted and have been reported to the building'Owner/Manager for corrective action. Signature of Tester: A��6 4!,5, Phone 8 Testing Agency: P, A Fire & Safety, Inc Mailing Address: 3013 3rd Ave N Seattle Wa 98109� Buildinq Representative (sianature) )4 I The items on the checklists below shall be inspected and tested. This list does not constitute all of the ran�iiirarl increrting anc!-testing r)f Fhe fire and !ife safe y'.systern. RefFr tJ the Seailie Fire Di_--p lilciii Fire Code for inspecting,and testing requirements. Alarm Svstem Functionali 1. Trouble signal with AC power off? 2. System operates properly on battery backup? 3. Battery voltage (no load) volts `i. Bttery voltage (full load.)` volts (signals operating) S. Charge circuit voltage volts G. System operaproPe:rly`on standby.power? �. A yi-1als operate VII :,C 3. Nbrriber of initiating circillts 9. Number of signal circuits jr)lzk Yes ❑ No C] tA(A i Yes; ❑' No ❑ 10: Does alarm system; meet audibility standards as accel;ted� Yes, No. No: ❑..... 11. All circuits checked for electrical supervision? L� -- 12. All a'u�;lia ;y Yes No O ry. cgwpment operates (EI v rs;. fans, dampers)? N/A ❑ Yes IX No O 13. Ventilation controls operate? N/A Yesf] No O 14. I<ey Co panel available'' 15. Operating instructions at panel? es .. NO Yes No O 16. Trouble indicators function, properly? Yes No ❑ 17. Remote Annunciator Panels function properly? N/A ❑ � Yes 17No O 1 . Elevator Call: Down functions properly.- N/� U Yes,• l No ❑'. ' 19. Test record posted at panel? 20. General Ell alarm aUtomahc time delay (minutes) rCs No 21. Was a signal received at the Central Station monitorin cone an (1 A ..77 g p Y'. _ N/r, iJ .. .. Yes Nn ❑ ,•. _�. Otlier Devices (Specify).: - Ya Stern Devices 23. Bells, Horns; Chimes 24. Voice Speakers (Voice Clarity) 25. Smoke Detectors 26. Heat Detectors 27. Dcict Detectors 28. Sprinkler Flow Switches 29. Sprinkler SupervisorySwitches 30. Visual Alarm DevicOes 31. Mahual;PUll:Stations 32. Annunciator(s) 33. Beam Detectors 34. Automatic Door Unlocks 3.5. Automatic Door Release 36. Fire Dampers. every 4 vrs. Communication Eouiornent 37. Phone Sets 38. Phone Jacks 39.'Call-in Signal Total Total Number Number of Units in Units Building Tested Test Results vpc N/A Yes ❑ Yes N/A Yes ❑ Yes d N/A 1� Yes ❑ N/A Yes N/A Yes ❑ N/A Yes N/A ❑ Yes V N/A Yes ❑ N/.A Yes r-t Yes ❑ N/A Yes ❑ Total Number of I Total Number Units in Buildin !nits Tested N/A I N/A AI/A Test Resuits Acc Yes ❑ Yes 0 .. P•1 tad ble -- w-. "7 No ❑ .No ❑ .. No ❑ No. O. No ❑ No ❑. . No ❑ No No ❑ No ❑ No ❑ No No ❑ ble No ❑. No f-1 Serving Brier, Edmonds SNOHOMISH CO. FIREMountlake Terrace,and DISTRI%*'T the Town of Woodway FireDistrictl. www org LOCATION: 170 W Dayton St BUSINESS NAME: 170 W Dayton Bldg MAILING ADDRESS: BUSINESS OWNER: Conner, Jan EMERGENCY-1: KEY ACCESS-2: PERSON CONTACTED: H (� F p1 J ti J Jr—_ NAME OF INSPECTOR: 1 I t w n /\ o 6 11 FIRE SYSTEMS: r% LI) DA 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 PHONE: 4257741511 HOME PHONE: 4257741511 HOME PHONE: HOME PHONE: .FIRE PREVENTION INSPECTION REPORT ❑ EDMONDS ❑ BRIER ❑ WOODWAY ❑ MOUNTLAKE TERRACE ❑ UNINCORPORATED FREQUENCY I STATION & SHIFT 365 17 B SCHEDULED 10/01/11 DATE DUE UFIR ► 509 1(202 PREFIRE CURRENT NO CITY El LICENSE 2 INITIAL INSPECTION DATE f cG 1� FED/ It ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 1 I... O(/VCc7M,5,J1 2 2 3 3 4 4 5 5 6 6 7 7 1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X In our continuning 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 items) that were noted during our inspection which require attention to bring them into compliance with the minimum standrads adopted by the above jurisdictions. Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions or violation. If you require additional information or to schedule a re -inspection for Edmonds or the Town of Woodway, call (425) 775-7720; for Mountlake Terrace or Brier, call (425) 754-0434. BUSINESS COPY