201 4TH AVE N111111111 - 0? 0 / W� P aE- /0
ov E D4f
CITY OF EDMONDS
1215THAVENUENORTH- EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
STATUS: ISSUED 09/22/2016 Pemdt#: BLD20161242
BUILDING PERMIT
Expiration Date: 03/22/2017 Project Address: 201 4TH AVE N, EDMONDS
Parcel No: 00434400500100
VA100PLAT"'WT111K APPLICANT CONTRACTOR
NORTH SOUND CENTER RED HAWK FIRE & SECURITY RED HAWK FIRE & SECURITY
C/O BAPTIST CHURCH OF EDMONDS C/O CHANCE BRUMFIELD C/O CHANCE BRUMFIELD
FIRST 21312 30TH DR SE 21312 30TH DR SE
404 BELL ST BOTHELL, WA 98021 BOTHELL, WA 99021
EDMONDS, WA 98020
(425) 486-2600 (425) 486-2600
LICENSE #: REDHAHF882NH EXP:08/08/2018
JOB ),F-SCWPT1*1,1
RELOCATE FIRE ALARM PANEL
ALL WORK SUBJECT TO FIELD INSPECTION
VALUATION: $0.00
PERMIT TYPE: Commercial
PERMIT GROUP: 79 - Fire Alarm
GRADING. N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD:
FENCE: 0 X 0 FT.)
CODE: 2015
OTHER: ------- OTHER DESC:
IZONE:
INUMBER OF S ORIES: 0
IVESTEDDATE:
INUMBER OF DWELLING UNITS: 0
�LOT 4-
EXISTING ARI.,A
BASEMENT � 0 1 ST FLOOR: 0 2ND FLOOR- 0
PROPOSEI) Alll,A
BASEMENT: 0 1 ST FLOOR: 0 2ND FLOOR: 0
3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
IBEDROOMS:
3 RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
BEDROOMS: 0 BATHROOMS: 0
0 BATHROOMS: 0
FRONT SETBACK SIDESETBACK RFARSLTBACK
REQUIRED: PROPOSED: 17EQUIRED: PROPOSED: IREQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O IREQUIRED: PROPOSED:
SETBACK NOTES:
PERMIT APPROVAL
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOINGTHE WORK AUTHORIZED
THEREBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID.
NJ
ltdrp / 11
Print Name Date Released BV Date
ATTENT70N
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC 109/ IBCI 10/ IRCI 10.
ONLINE APPLICANT ASSESSOR F171 OTHER
L74J
2-0/(0
STATUS: ISSUED BLD20161242
CONDITIONS
• Finalapprovalon a project orfinal occupancy approval must be granted by the Building Official priorto use or occupancy of
the building or structure. Checkthejob card for all required City inspections including final project approval and final
occupancy inspections.
• Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from
adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing
fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable.
• Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been
specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision
of city code or state law does not approve any items not to code specification.
• SoundNoise originating from temporary construction s ites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00arn to 6:00prn on weekdays and 10:00arn and 6:00pm on Saturdays, excluding
Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the
noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
• Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance for this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor hirrit in any way the City's ability to enforce any ordinance
provision.
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT TIME LIMIT. SEE ECDC 19.00.005(A)(6)
I BULDING (425) 771-0220 EXT. 1333 1 04GINIMUNG (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720 1
PUBLIC WORKS (425) 771-0235 PIR&TREATMENT (425) 672-5755 RECYCLING (425) 275-4801
When calling for an inspection please leave the follo-Aing information: Permit Number, Job Site Address, Type of Inspection being
requested, Contact Name and Phone Number, Date Prefereed, and mbether you prefer morning or afternoon.
0 F-Fire Alarm System Acceptance
DEVELOPMENT SERVICES
COMMERCIAL & MULTI -FAMILY BUILDING
PERMIT APPLICATION
121 5h Avenue N, Edmonds, WA 98020
City of Edmonds Phone 425.771.0220 9 Fax 425.771.0221
PLEASE REFER TO THE COMMERCIAL & MULTI -FAMILY BUILDING CHECKLIST FOR SUBMITTAL REQUIREMENTS
PROJECT ADIDRES� (Street, Suite #, City State, Zip):
i � +-h A--� P, K gi
Parcel #:
.-2-n Fj�jA
Subdivision/Lot #:
Project Valuation: $
APPLICANT:2., 1A)k
re Uyl. f2d
Phone
Fax:
I
y,
Address Street, Cit te, i : S r_ qg0j,
71
E-Mail Address:
Rvollhlyq�e�i a Ly u's, com
PROPERTY OWNER: �3 OV�h &)Uy_)� 04,(,,,eL
Phone:
Fax:
Address (Streel, Cit State, Zip):
A UO2 0
E-Mail Address:
LENDING AGENCY:
Phone:
Address (Street, City, State, Zip):
E-Mail Address:
CONTRACTOR:*
Phone:
Address (Street, City, State, Zip):
E-Mail Address
*Contractor must have a valid City of Edmonds business license prior to
doing work in the City. Contact the City Clerk's Office at 425.775.2525
n
Ain #/Ex ate:
992- m H
6ty Business License #/Exp. Date:
") I
DETAIL THE SCOPE OF WORK: K�-_,�occa�p :�ye da tie,
PROPOSED NEW SQUARE FOOTAGE FOR THIS
PROJECT:
I st Floor: sq. ft.
2'd Floor: —sq. ft.
P Floor: sq. ft.
Basement: —sq. ft.
Garage: sq. ft.
Deck/Cvrd Porch: —sq. ft.
Other: sq. ft.
Retaining Wall: YesE] No n
Fire Sprinklers: YesF_1 NoF_1
Occupancy Group(s):
Occupant Load(s):
Type(s) of Construction:
Grading: Cut ------cu.yds. Fill _____cu.yds.
I Cut/Fill in Critical Area: Yes
No [_J
Ideclare underpenalty ofpejjury laws that the information I h ave provided on this formlapplication is true, correct and
complete, and that I am the properry owner or duly authorized agent of the property owner to submit a permit application to
the City of Eadm n#s.
. bl
Print Name: nce OwnerE1 A t/Other (specify):
M/1
Signature: Date: �T --�C) I �
FORM E LABuilding New Folder 2010\DONE & x-ferred to LBuilding-New drive\Form E 2014.docx Updated: 1/17/2014
FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time ofsysiem acceptance and approval.
11 shall be permitted to modify thisform as needed to provide a more complete andlor clear record.
Insert NIA in all imused lines.
Attach additional sheets. data, or calculations as necessary to provide a complete record.
1. PROPERTY INFORMATION
Name of property: North Sound Center
Address:
Description of property: Community Center
Occupancy type: A-3/13
Name of property representative: John Taylor
Address: Same as Above
Phone: Fax:
Authority having jurisdiction over this property:
Phone: 425-771-0215 Fax:
E-mail:
Edmonds Fire Dept (Snohomish County Fire)
E-mail:
2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION
Installation contractor for this equipment: Red Hawk Fire & Security
Address: 21312 30h Dr SE # 103 Bothell, Wa 98021
License or certification number: REDHAHF8850K
Phone: 425-486-2600 Fax: 425-486-2611 E-mail:
Service organi72tion for this equipment: Same as Installation Contractor
Address:
License or certification number:
Phone: Fax: E-mail:
A contract for test and inspection in accordance with NFPA standards is in effect as of:
Contracted testing company:
Address:
Phone: Fax: E-mail:
Contract expires: Contract number: Frequency of routine inspections:
3. DESCRIPTION OF SYSTEM OR SERVICE
0 Fire alarm system (nonvoice)
* Fire alarm with in -building fire emergency voice alarm communication system (E.VACS)
* Mass notirication system (MNS)
0 Combination system, with the following components:
0 Fire alarm 0 EVACS 0 MNS 0 Two-way, in -building. emergency communication system
0 Other (specify):
NFPA 72, Fig. 10. 18.2. 1. 1 (p. 1 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. it may not be copied for commercial sale or distribution.
3. DESCRIPTION OF SYSTEM OR SERVICE (continued)
,VrPA 72 edition:
3.1 Control Unit
Manufacturer: Notifier
3.2 Mass Notification System
3.2.1 System Type;
In -building MNS—combination
In -building MNS—stand-alone
Other (specify):
3.2.2 System Features:
Additional description of system(s):
Model number: NFS-320
ciThis system does not incorporate an MNS
0 Wide-arca MNS 0 Distributed recipient MNS
0 Combination fire alarm/MNS 0 MNS autonomous control unit 0 Wide -area MNS to regional national
alerting interface
• Local operating console (LOC) 0 Direct recipient MNS (DRMNS) 0 Wide -area MNS to DRMNS interface
• Wide-arca MNS to high -power speaker array (HPSA) interface 0 In-buildingMNS(owide-areaMNS interface
0 Other (specify):
3.3 System Documentation
An owner's manual. a copy ofthe manufacturer's instructions. a written sequence of operation. and a copy of
the numbered record drawings are stored on site. Location:
3.4 System Software C] This system does not have alterable site -specific software.
Operating system texecutive) software revision level: Version 21
Site -specific software revision date:
C] A copy ofthe site -specific software is stored on site. Location:
3.5 Off -Premises Signal Transmission
Name oforgani7ation receiving alarm signals with phone numbers:
Alarm: Alarm Center
Supervisory: Alarm Center
Trouble: Alarm Center
Entity to which alarms are retransmitted:
Method of retransmission:
Revision completed by:
[] This system does not have off-prcmises transmission.
Phone: 866-402-3673
Phone: 866-402-3673
Phone: 866-402-3673
Phone:
If Chapter 26, specify the means of transmission from the protected premises to the supervising station:
If Chapter 27, specify the type of auxiliary alarm system: C1 Local energy 0 Shunt C] Wired [] Wireless
NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. it may not be copied for commercial sale or distriboion,
4. CIRCUITS AND PATHWAYS
4.1 Signaling Line Pathways
4.1.1 Pathways Class Designations and Survivability
Pathways class: B Survivability level: 2 hours Quantity: 1
(See NFPA 72. Sections 12.3 and 12.4)
4.1.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.1.3 Device Power Pathways
0 No separate power pathways from the signaling line pathway
El Power pathways are separate but of the same pathway classification as the signaling line pathway
0 Power pathways are separate and different classification from the signaling line pathway
4.1.4 Isolation Modules
Quantity: 0
4.2 Alarm Initiating Device Pathways
4.2.1 Pathways Class Designations and Survivability
Pathways class: B Survivability level: 2 hours Quantity: 4
(See NFP,4 72. Sections 12.3 and 12.4)
4.2.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.2.3 Device Power Pathways
19 No separate power pathways from the initiating device pathway
• Power pathways are separate but of the same pathway classification as the initiating device pathway
• Power pathways are separate and different classification From the initiating device pathway
4.3 Non -Voice Audible System Pathways
4.3.1 Pathways Class Designations and Survivability
Pathways class: B Survivability level: 2 hours Quantity: I
(See NFPA 72, Sections 12.3 and 12.4)
4.3.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.3.3 Appliance Power Pathways
0 No separate power pathways from the notification appliance pathway
El Power pathways are separate but of the same pathway classification as the notification appliance pathway
[I Power pathways arc separate and different classification from the notification appliance pathway
NFPA 72, Fig. 10. 18.2.1 .1 (p. 3 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or dstnbution,
5. ALARM INITIATING DEVICES
5.1 Manual Initiating Devices
5.1.1 Manual Fire Alarm Boxes
Type and number of devices: Addressable:
Other (specify):
5.1.2 Other Alarm Boxes
Description:
Type and number of devices: Addressable:
Other (specify):
5.2 Automatic Initiating Devices
0 This system does not have manual firc� alarm boxes.
Conventional: 10 Coded: Transmitter:
OThis system does not have other alarm boxes.
Conventional: Coded: Transmitter:
5.2.1 Smoke Detectors 0 This system does not have smoke detectors.
Type and number of devices: Addressable: Conventional: 3
Other (specify):
Type orcoverage: 0 Complete area 0 Partial area 0 Nonrequired partial area
Other (specify):
Type of smoke detector sensing technology: 0 Ionization [I Photoelectric [] Multicriteria [I Aspirating 0 Beam
Other (specify):
5.2.2 Duct Smoke Detectors
Type and number of devices: Addressable:
Other (specify):
Type of coverage:
Type of smoke detector sensing technology
5.2.3 Radiant Energy (Flame) Detectors
Type and number of devices: Addressable:
Other (specify):
Type of coverage:
5.2.4 Gas Detectors
Type of dctcctor(s):
Number of devices: Addrcssable:
Type of coverage:
0 This system does not have alarm -causing duct smoke detectors.
Conventional: 4
0 Ionization 0 Photoelectric 0 Aspirating 0 Beam
oThis system does not have radiant energy detectors.
Conventional:
Conventional:
0 This system does not have gas detectors.
5.2.5 Heat Detectors E] This system does not have heat detectors.
Type and number of devices: Addressable: 1 Conventional:
Type of coverage: [I Complete area El Partial area [I Nonrcquired partial area 0 Linear 0 Spot
Type of heat detector sensing technology: 0 Fixed temperature 0 Rate-of-riie [] Rate compensated
NFPA 72, Fig. 10. 18,2. 1.1 (p. 4 of 12)
Copyright C 2009 National Fire Protection Association This form may be copied for individual use other then for fesale. It may not be Copied for COMMercial sale or distribution.
S. ALARM INITIATING DEVICES (continued)
5.2.6 Addressable Monitoring Modules
Number of devices: 7
5.2.7 Waterflow Alarm Devices
Type and number of devices: Addressablc:
5.2.8 Alarm Verification
Number of devices subject to alarin verification:
5.2.9 Presignal
Number of devices subject to presignal:
Describe presignal functions:
5.2.10 Positive Alarm Sequence (PAS)
Describe PAS:
5.2.11 Other Initiating Devices
Describe:
oThis system does not have monitoring modules.
0 This system does not have waterflow alarm devices.
Conventional: Coded: Transmitter:
6. SUPERVISORY SIGNAL -INITIATING DEVICES
[D This system does not incorporate alarm verification.
Alarm verification set for seconds
Z This system does not incorporate pre -signal.
oThis system does not incorporate PAS.
[9 This system does not have other initiating devices.
6.1 Sprinkler System Supervisory Devices wrhis system does not have sprinkler supervisory devices.
Type and number of devices: Addrcssable: Conventional: Coded: Transmitter:
Other (specify):
6.2 Fire Pump Description and Supervisory Devices This system does not have a fire pump.
Type fire pump: 0 Electric pump 0 Engine
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other (specify):
6.2.1 Fire Pump Functions Supervised
[I Power C1 Running El Phase reversal C1 Selector switch not in auto 0 Engine or control panel trouble 0 Low fuel
Other (specify):
6.3 Duct Smoke Detectors (DSDs)
Type and number of devices: Addrcssable:
Other (specify):
Type of coverage:
Type of smoke detector sensing technology
6.4 Other Supervisory Devices
Describe:
0 This system does not have DSDs causing supervisory signals.
Conventional: 4
C3 Ionization 0 Photoelectric [I Aspirating C1 Beam
0 This system does not have other supervisory devices.
NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12)
Copyright 0 20D9 National Fire Protection Association. This form (my be copied for individual use other than for fesale. It may not be copied for commercial sale or distribution.
7. MONITORED SYSTEMS
7.1 Engine -Driven Generator
7.1.1 Generator Functions Supervised
[I Engine or control panel trouble C3 Generator running
[I Other (specify):
7.2 Special Hazard Suppression Systems
Description of special hazard system(s):
7.3 Other Monitoring Systems
Description of special hazard system(s):
8. ANNUNCIATORS
8.1 Ucation and Description of Annunciators
Location 1: Main FACP
Location 2:
Location 3:
9. ALARM NOTIFICATION APPLIANCES
0 This system does not have a generator.
0 Selector switch not in auto 0 Low fuel
OThis system does not monitor special hazard systems.
0 This system does not monitor other systems.
C] This system does not have annunciators.
9.1 In -Building Fire Emergency Voice Alarm Communication System [] This system does not have an EVACS.
Number of single voice alarm channels: 1 Number of multiple voice alarm channels:
Number of speakers: 13 Number of speaker circuits: 1
Location of amplification and sound -processing equipment: @ FACP
Location of paging microphone stations:
Location 1: @ FACP
Location 2:
Location 3;
9.2 Nonvoice Notification Appliances
1-forns: 1 With visible:
Chimes: With visible:
Visible only: 8 Other (describe):
9.3 Notification Appliance Power Extender Panels
Quantity:
Locations:
0 This system docs not have nonvoice notification appliances.
Bells: With visible:
ED This system does not have power extender panels.
NFPA 72, Fig. 10. 18.2. 1.1 (p. 6 of 12)
Copyright 0 2009 National Fire Protection Association This form may De copied for individwi use other than for resale. it may riot be copied for commercial sale or distribution.
10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS 0 This system does not have an MNS.
10.1 MNS Local Operating Consoles
Location 1:
Location 2:
Location 3:
10.2 High -Power Speaker Arrays
Number of HPSA speaker initiation zones:
Location 1:
Location 2:
Location 3:
10.3 Mass Notirication Devices
Combination fire alarm/MNS visible appliances: MNS-only visible appliances:
Textual signs: Other (describe):
Supervision class:
10.3.1 Special Hazard Notification
0 This system does not have special suppression predischarge notification.
0 MNS systems DO NOT overr ide notification appliances required to provide special suppression
predischarge notification.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS
11.1 Telephone System oThis system does not have a two-way telephone system.
Number of telephone jacks installed: Number of warden stations installed:
Number of telephone handsets stored on site:
Type ol'tcicphone system installed: [I Electrically powered 0 Sound powered
11.2 Two -Way Radio Communications Enhancement System
0 This system does not have a two-way radio communications enhancement system.
Percentage of area covered by two-way radio service: Critical areas: % General building areas: %
Amplification component locations:
Inbound signal strength: dBrn Outbound signal strength; dBm
Donor antenna isolation is: dB above the signal booster gain
Radio frequencies covered:
Radio system monitor panel location:
NFPA 72, Fig. 10. 18.2. 1.1 (p. 7 of 12)
Copyright 0 2009 National Fire Protection Association. This form may oe copiao for incividual use other than for resale, It may not be coptea for commercial sale or clistribution.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued)
11-3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems
C1 This system does not have an area of refuge (area of rescue assistance) emergency communications system.
Number of stations: Location of central control point:
Days and hours when central control point is attended:
Location of alternate control point:
Days and hours when alternate control point is attended:
11.4 Elevator Emergency Communications Systems
0 This system does not have an elevator emergency communications system.
Number of elevators with stations: Location of central control point:
Days and hours when central control point is attended:
Location of alternate control point:
Days and hours when alternate control point is attended:
11.5 Other Two -Way Communication Systems
Describe:
12. CONTROL FUNCTIONS
This system activates the following control fuctions:
Hold -open door releasing devices C1 Smoke management C3 HVAC shutdown 0 F/S dampers
Door unlocking Elevator recall 0 Fuel source shutdown 0 Extinguishing agent release
0 Elevator shunt trip 0 Mass notification system override of fire alarm notification appliances
Other (specify):
12.1 Addressable Control Modules
Number of devices: 6
Other (specify):
13. SYSTEM POWER
13.1 Control Unit
13.1.1 Primary Power
Input voltage of control panel: 120 VAC
Overcurrent protection: Type: Thermal Breaker
Location (of primary supply panel board): Main Electric Room
Disconnecting means location: Main Electric Room
13.1.2 Engine -Driven Generator
Location of generator:
Location of fuel storage:
0 This system does not have control modules.
Control panel amps: 5 Amps
Amps: 20 Amps
0 This system does not have a generator.
Type of fuel:
NFPA 72, Fig. 10. 18.2. 1.1 (p. 8 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution,
13. SYSTEM POWER (continued)
13.1.3 Uninterruptible Power System [9'1'his system does not have a UPS.
Equipment powered by a UPS system:
Location of UPS system:
Calculated capacity of UPS batteries to drive the system components connected to it:
In standby mode (hours): In alarm mode (minutes):
13.1.4 Batteries
Location: @ FACP Type: Lead Acid Nominal voltage: 24 Amp/hour nating: 12Ah
Calculated capacity of batteries to drive the system:
In standby mode (hours): 24 In alarrn mode (minutes): 5
0 Batteries are marked with date of manufacture 0 Battery calculations are attached
13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System
0 This system does not have an EVACS or MNS system.
13.2.1 Primary Power
Input voltage of EVACS or MNS panel: 120
Overcurrent protection: Type: Thermal Breaker
Location (of primary supply panel board): Main Electric Room
Disconnecting means location: Main Electric Room
13.2.2 Engine -Driven Generator
Location of generator:
Location of fuel storage:
EVACS or MNS panel amps: 1.3
Amps: 20
0 This system does not have a gcnerdtor.
Type of fuel:
13.2.3 Uninterruptible Power System This system does not have a UPS.
Equipment powered by a UPS system:
Location of UPS system:
Calculated capacity of UPS batteries to drive the system components connected to it:
In standby mode (hours): In alarm mode (minutes):
13.2.4 Batteries
Location: SameasFACP Type: Nominal voltage: Amp/hour rating:
Calculated capacity of batteries to drive the system:
In standby mode (hours): In alarm mode (minutes):
0 Batteries are marked with date of manufacture 0 Battery calculations are attached
NFPA 72, Fig. 10. 18.2. 1.1 (p. 9 of 12)
Copyright 0 2009 National Fire Protection Association This form may be copied for individual use other than for fosale, it may not be copied for commercial sale of distribution.
13. SYSTEM POWER (continued)
13.3 Notification Appliance Power Extender Panels
13.3.1 Primary Power
Input voltage of power extender pancl(s):
Ovcrcurrcnt protection: Type:
Location (of primary supply panel board):
Disconnecting means location:
13.3.2 Engine -Driven Generator
Location of generator:
Location of fuel storage:
13.3.3 Uninterruptible Power System
Equipment powered by a UPS system:
Location of UPS system:
0 This system does not have power extender panels.
Power extender panel amps:
Amps:
0 This system does not have a generator.
Type of fuel:
ED This system does not have a UPS.
Calculated capacity of UPS batteries to drive the system components connected to it:
In standby mode (hours): In alarm mode (minutes):
13.3.4 Batteries
Location: Type: Nominal voltage: Amp/hour rating:
Calculated capacity of batteries to drive the system:
In standby mode (hours): In alarm mode (minutes):
0 Batteries are marked with date of manufacture [I Battery calculations are attached
14. RECORD OF SYSTEM INSTALLATION
Fill oul after all installation is complete and wiring has been checkedfor opens. shorts, groundfaulis. and improper
branching, but before conducting operational acceptance tests.
This is a: 0 New system 0 Modification to an existing system Permit number: BL020161242
The system has been installed in accordance with the following requirements: (Note any or all that apply.)
NrPA 72, Edition:
NFPA 70, National Electrical Code, Article 760, Edition:
Manufacturer's published instructions
Other (specify):
System deviations from referenced NFPA standards:
Signed: Printed narne:
w4Ve,-- Date:
Organ izat ion: i t I c: 7 -e c .4,, q Phone:
NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12)
Copyright 0 2009 National Fie Protection Association This form may be copied for Individual Lose other than for resale. 11 may not be copied for commercial sale or distribution.
15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST
0 New system
All operationalfeatures andfunctions of this system were tested ky, or in the presence of the signer shown
below, on the date shown below, and werefound to be operating properly in accordance with the requirements
for thefollowing:
ED Modifications to an existing system
All newly modijied operationalfeatures andfunctions ofthe system were tested by, or in the presence of the
signer shown below. on the date shown below, and werejound to be operating properly in accordance with the
requirements of thefollowing:
NrPA 72. Edition:
NF*PA 70, National Electrical Code. Article 760, Edition:
Manufacturer's published instructions
Other (speciry):
0 Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached]
Signck-'� Printed name:
Date:
Organization: X� /-Jk- Title: Phone:
16. CERTIFICATIONS AND APPROVALS
16.1 System Installation Contractor:
This system. as specified herein, has been installed and tested according to all NFPA standards cited herein.
Signed: Printed name:
Organization: Title:
16.2 System Service Contractor:
The undersigned has a service contract for this system in effect as of the date shown below.
Signed:
Organization:
Printed name:
Title:
16.3 Supervising Station:
This system, as specified herein. will be monitored according to all NFPA standards cited herein.
Signed:
Organization:
Printed name:
Title:
Date: 2XI-,-Zl'7
Phone:
Date:
Phone:
Date:
Phone:
NFPA 72, Fig. 10. 18.2. 1.1 (p. 11 of 12)
Copyright 0 2009 National Fire Protection Association This form may be copied for individual use other than for resale. It may not be copied for 00mmOlMial sale or distribution.
16. CERTIFICATIONS AND APPROVALS (continued)
16.4 Property or Owner Representative:
I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein.
Signed: (f�� Printed name: (�-Z / 0 7- 3 -' M-1 Date: Z - 2- - / 7
Organi7ation: Title: 5,,,p &-P jP7Z7J Oe-,-J 7— Phone: 206 2-
16.5 Authority Having Jurisdiction:
I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly
in accordance with its app7r'D,.cd plans and specifications, with its approved sequence of operations, and with all
NFPA standards cited hom Iff.
Signed- Printed name: Date:
Organi7 Title: 'b Phone:
NFI-A �?. Fig. WI " (11. 0 ":')
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use Other then for resale. It may not be copied for commercial sale or distribution.
NN
FIRE PREVENTION
Serving Brier, Ednionds, and
12425 Meridian A ve S
INSPECTION REPORT.
A 4
SN0HON11SH CO.
F1
Mwintlake Terrace
Everett, WA 98208
OEDMONDS
0 BRIER
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION:1 15 4 th Avenue S Suite A 98020
BUSINESS NAME: AZZ Technology
PHONE: 4257741582
MAILING
ADDRESS: 115 4th Avenue S, Suite A, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
FREQUENCY STATION & SHIFT
2017 17-C
SCHEDULED
DATE DUE 1' Jan 2017
LIFIR 0 549 202
EMERGENCY-1: Wolfe, Mark HOME PHONE: 2064127768 CURRENT
KEY ACCESS-2: HOME PHONE: 17 CITY YES NO
BUSINESS J�71
EMAIL: A-3 LICENSE L2�..j 1:1
r- INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: FE-8rf4*' F C Ili 6,
Date Last Serviced:
1#L___ -
SNOH01141SH CO.
� 11
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistricil.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
,MVDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY STATION & SHIF`�
LOCATION:
201 4 th Avenue N 98020 1
Annual 17-D
I
BUSINESS NAME:
Ed- RA B-14 d_'_ fel t! I I Utlee r
PHONE:
4256401808
SCHEDULED
DATE DUE 0 Apr 2016
00r_V"k
MAILING
UFIR 0 122202
ADDRESS:
201 4th Avenue N, Edmonds, WA 98020
BUSINESS OWNER-
"h'f5f_ (3'& HOME PHONE:.
G 10) I+)
.EM ERGENCY-1:
"88"
HOME PHONE- do 1�0_
CURRENT
KEY ACCESS-2:
HOME PHONE* ---
CITY YES NO
BUSINESS
EMAIL:
LICENSE
oo
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
C?m
FIRE SYSTEMS:
FA 9/15 FE 5/14 FD Lk Box
� I.. -,F.. I -
0 4
_112119 Last So HIP -Y Lia—
NS / COMMUNICATIONS
HAZARDS FOUN 311A'!ND gtEATIO'l f
2
2
—3
4
---- - -
.......
4
5
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 conditions or 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.
RED HAWK
Fire & Security
21312 30th Drive S.E.
Suite 103
Bothell, WA 98021
For Service Call: (425) 486-2600
LICENSE # REDHAHF882NH
Fire Alarm System Report of Inspection
Rev. 10/0112012
Building Owner/Representative: Edmonds Community College
Name of Facility: Edmonds Community College
Phone #: 425-640-1714
Occupied As: School/Office
Address: 201 4th Ave N
County: Snohomish Zip: 98020
Building Designation (if more than one building): Conference Center
Inspection by: Jeff Heighway
Date of Inspection: September 17, 2015
City: Edmonds
Telephone: 425-640-1714
Cert #: SCP-H06814
Low Vol. Lic. #: HEIGHJR95IRT
1. Type of Test: Cert. Monthly E] Quarterly El Semi -Annual E] Annual Z
Other Ej
2. Type of system: Addressable z Conventional El Other E]
3. Local Fire Department: Edmonds Monitored? Yes Z No
4. Monitoring Agency: , Alarm Center Telephone: 1-800-752-2490
5. Test Received at. Monitoring Agency? Yes Z No E] Monitoring Account: 35-401T
6. No. of Initiating Circuits: 3 No. of Signaling Circuits:. I
BATTERY TEST DURATION: 8min
#1
#2
#3
#4
NOTES
7. Static Battery Voltage
25.8
Batteries Dated 2013
8. Battery Voltage Under Load
w/Signal Devices Operating
25.2
9. Change Circuit Voltage
27.0
CONTROLPANELCHECKS
SATISFACTORY
CHECK
NOTES
Yes
No
N/A
10. Trouble Signal w/AC Power Off
0
101
101:11
11. All Circuits Operate Satisfactory on Standby (Battery) Power
Z
[:1
[:1
12. All Circuits Operate Satisfactory on AC Power
Z
El
El
13. All Circuits Checked for Electrical Supervision
z
1:1
1:1
14. Control Panel Checks Made Per Manufacturers Instructions
z
El
F1
15. All auxiliary Equipment Operates
Z
El
n
16. Alarm Delay Function (if installed) Operates Properly
E]
El
Z
-
17. Panel Key Available
Z
El
F1
18. Operating Instructions at Panel
z
E]
1:1
19. Test/Service Record at Fire Alarm Control Panel
z
1:1
1:1
PAGE 1 OF 2
�Iame & Address of Facility: Edmonds Community College (Conference Center) Date: September 17, 2015
EQUIPMENT TESTED
TYPE OF EQUIPMENT
MANUFACTURING
& MODEL #
NUMBER
OF UNITS
TESTED
SATISFACTORY
CHECK
NUMBER
OF UNITS
IN BLDG
Yes
No
N/A
Control Panel
Notifier NFS-640
I
El
El
1
I
Communicators
Fire Watch 411 UDAC
1
0
0
0
1
Annunciators
El
E]
E
Supervisory
Notifier
I
E
I El
El
1
Trouble Indicators
Notifier
I
E]
E]
I
Smoke Detectors
Edwards
3
E
1:1
Ej
3
Duct Detectors
System Sensor
4
El
El
4
Beam Detectors
I E]
E
Heat Detectors
Notifier
I
E
El
0
1
Manual Pull Stations-
Edwards
10
9
o
10
Audible Devices
El
1:1
0
1
Visual Devices
Edwards
8
0
El
8
Audio/Visual Devices
Edwards
13
E
E]
13
Public Address System
El
1:1
0
1
Fireman Phones
I El
I
Elevator Recall
I
El
El
Booster Panels
F1
Auto Door Release
Mag
4
El
4
Fail Safe Door Unlock
Ventilation Controls
Generators
El
E
I
Sprinkler Flow Switches
Sprinkler Tamper Switches
Sprinkler Supervisory Switches
-
El
1:1
Electric Alarm Bell/Motor Gong
El
I
El
E
Other
Ll
I
El
M
I
Signature of Owner or Representative:
Signature of Fire Alarm Representative: 12z4a4W,,
Discrepancies: See Attached Discrepancies Report
Corrections Made: None
Date Corrected: N/A By: N/A Cert # N/A
PAGE 2 OF 2
1 4.
RED HAWK
Occupancy Name: Edmonds Community College
(Conference Center)
Occupancy Address: 201 4th Ave N Edmonds, WA 98020
21312 30th Drive S.E., Suite 103
Bothell, WA 98021
For Service cafl: (425) 486-2600 or (866) 402-3673
Rev. 10/01/2012
Date of Report: September 17,2015
(Fire Alarm)
Discrepancy Report
Problem Found:
It appears that the all of the pull stations are missing the double action protion of the devices which is not in
accordance with the standard. Owner to investigate and make necessary corrections.
Date Corrected: Corrected by: License #:
Problem Found:
It appears that there is no lock out on the A/C breaker which is not in accordance with the standard. Owner to
investigate and make necessary corrections.
Date Corrected: Corrected by: License M
Problem Found:
Date Corrected: Corrected by: License M
Problem Found:
Date Corrected: Corrected by: License M
Problem Found:
Date Corrected: Corrected by: License M
Problem Found:
Date Corrected: Corrected by: License M
Problem Found:
Date Corrected: Corrected by: License M
Page I of I
Wave, Carolyn
Subject: FW: Follow-up from discussion re: Potential Acquisition of Conference Center
Hi folks:
Here is the litany of issues raised this evening by Council during their first "deliberation" about this issue:
Most of the work will by mine to cover, but some of this will need input from some of you, so I'll just itemize everything
requested and highlight with ** where I believe others of you may be able to provide information:
1. Has there been additional damage to the building since last Summer's reconnaissance?
2. What improvements, maintenance or damage corrections have been made over the years? (Diane added that the
roof had been repaired two years ago.)
3. The report itemizes repair of the damage, but would one really just replace the entire exterior cladding system
and/or repair all windows rather than just repair identified damage? **
4. Could we have previous and/or earlier years' Profit/Loss statements?
5. What would be the potential uses of the building?
a. Conference Center?
b. Business incubator (and is that still something desired by EDC or others?)?
c. Art Museum? (Kristiana referenced the CFP/Comp Plan.
d. Indoor Farmers Market?
e. Some of the uses in the old PW Building (including Artworks)? (Lora and loan had several versions of what
uses could potentially move here; i.e., parks staff, parks maintenance, Artworks, Theater rehearsal space, other arts
groups, etc.) **
f. What other uses in our CFP or Comp Plan "wish list" could be housed or sited here?
g. Would it be a useful site for "surge space" for the Senior Center during its reconstruction?
h. Shared use of the building? **
6. Regarding the potential price offer, do any of the following relate and/or can we get more information about any of
the following vis-a-vis the price?
a. Would our potential correction of water damage be a potential deal term?
b. Does the fact that it was gifted to EdCC affect the price? **
c. Does the assessed value have any bearing on the price? What is the assessed value, including break -down
between land and improvements?
d. What would other "mutual and offsetting benefits" be to include in deal terms?
7. In addition to the 27 on -site parking spaces, are there any other spaces associated with the Center, such as through
shared -parking arrangements on near -by properties?
8. What is the Center's capacity for meetings, gatherings, conferences, etc.? tsawR< L,111q
9. Is the College maximizing its efforts to develop business and usage of the Center? What are their marketing efforts?
10. If the City were to take over the Conference Center and use it as such, how we would we manage it? City staff.?
Management contract? **
11. Would the PFD be interested in either a) our acquisition of the Center and/or b) in any affiliated usage and/or
operations with the Center? **
I think that's it ... whew! If anyone caught something else, please let me know! Also, as noted above with the **, I will
need particular assistance with those issues. Please send me any thoughts you may have on those issue and/or I may
chat with those of you I think would be involved.
Thanks ;-)
Patrick
7 P`
FIRE PREVENTION
INSPECTION REPORT
S�rving Brier Edmonds, and 12425 Meridian Ave S
SNOHOMISH CO. Mountlake Terrace Everett, WA 98208 El EDMONDS
,4, 0 BRIER
FIRE Phone (425) 551-1200 0 MOUNTLAKE TERRACE
[I UNINibORPORATED
DISTR wwwFireDistrictLorg Fax (425) 551-1272
LOCATION: FREQUENCY I STATION&SHIFT
2D I I th Avexe N WD21) ROG Atimol 17-B
PHONE: SCHEDULED
BUSINESS NAME: Edmrx6-i::mdcrcmmCbnLcr �422266401 DATE DUE *r 2014
MAILING UFIt
ADDRESS: 2 1 Y21
201 4h A\mnLc N, F-damindIs. WA 08020
.N w'-'
BUSINESS OWNER: b-nny, Rnm N�_-M �EPH6�E
EMERGENCY-1 .- EdmixisCC HOME PHONE: 42GE401WO 'CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS
EMAIL: LICENSE
INITIAL 7INPECTION DATE
PERSON CONTACTED: 1-0-so.\ r—mmi-ev,
NAME OF INSPECTOR: s
I-fl-1_-9VSENZ. FAQlICFE_�el_X FDLkRaw
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1�!L_ce_JQ�fj- 0 OL 59"WC-C.
i
2 6
2
3
Ag T4j,141
3
4 rfT-1
4
5 FA
v,!)
5
6
:5,tVV'jCr
CdLr_& OtA4_ 0-f-
6
7-
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
X!�
lst RE -INSPECTION
DATE DUE: �0
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO,
FINAZ��fl__NSPqp N
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
MOTOR MOO
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTIOU:,.
5
3
7
3
7
U N I
RECEIVED
6
14
�8�
4
8
DATE:
DISPOSITION:
7
LETek'IEF�LED _
I LETTERNEEDED [] YES El NO
a
FIRE DEPARTMENT COPY
J
FIRE PREVENTION
Set-ving Bilet: Edmonds
124-25 Metldial7.4ve S
INSPECTION REPORT
SNOHOMISH CO. -e T -i-aceand
Mountlak et
FIRE
-ett, W
Evet A 98208
EIEDMONDS
El BRIER
the Town of Woodway
DISTR T
Phone (425) 551-1200
EIWOODWAY
0 MOUNTLAKE TERRACE
wwwFireDistrictl.org
Fax (425) 551-1272
UUNINCORPORATED
FREQUE�CY
STATION & SHIFT-')
LOCATION: 201 4th Avenue
N
365
17 D
BUSINESS NAME: Edmonds Conference Center
PHONE: 4256401808
SCHEDULED 04/01/12
DATE DUE
MAILING 201 4th Ave N
LIFIR 1, 122 5094202
ADDRESS: Edmonds
98020
1., T�_j
B USINESS OWNER: Edmonds CC
HOME PHONE: 4256401500
ACTIVE 999
EMER - GENCY-1: LePAay, Pam
HOME PHONE: 2062764343
KEY ACCESS-2:
HOME PHONE: 4257540154
ITY YES NO
[-�U-RRENT
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSP ECTION DATE
NAME OF INSPECTOR: n97Z!;_iE_ �L'44 L_
5T.,
- / "� - / _-"
FIRE FA 9110 FD LkBx
FE e
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
'-s
1
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEX_�30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
-DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
PATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VI LATIONS'
1 5
VIOLATIONS
5—
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
—
6
4
18
4
18
DATE
DISPOSITION:
7
LETTERNEEDED [] YES NO
LETTERNEEDED E] YES [:1 NO
8
FIRE DEPARTMENT COPY
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
mc k\o39
Name of Company (DBA):
Edmonds Conference Center
Edmonds Location
201 4th AveaveWAvenue N
In conformity with the
terms of the International
Fire Code, application is
hereby made to store, use
Places of Assembly - Occupant Load: 750
or maintain the following
activity, storage or pro-
cesses:
Mailing Address:
201 4th Ave. N.
Edmonds, WA 98020
EFD UFIR #:
509750�413202
(for office use)
Your Signature
9
/
Your Name (print)
G7- �\ V \A
Your Title
Please make corrections, attach $40 payable to the City of Edmonds and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
FOR OFFICE USE ONLY
Rec'd
Check7#
APPLICATION FOR PERMIT EC
FOR MATERIALS OR PROCESSES
2 5
March 7, 2011 e��
Please verify and correct the following information:
Name of Company; DBA
Edmonds Conference Center
Edmonds Location
201 4th Avenue
In conformity with the terms of
Places of Assembly - Occupant Load: 750
the International Fire Code,
application is hereby made to
store, use or maintain the
following activity, storage or
processes:
Mailing Address:
201 4th Ave. N.
Edmonds WA 98020
EFD UFIR #:
5097500413202
(for office use)
n
Your Signature
Your Name (print)
OAT � VIA +V14
Your Title
Please make corrections, attach $40 payable to the City of Edmonds, and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
PERMIT
January 1, 2011 509-750-0413-202 December 31, 2011
Date of Issue UFIR Number Date of Expiration
I This PERMIT is issued to: I Edmonds Conference Center I
I located at: 1201 4th Avenue N I Edmonds, WA I
I To engage in the business, occupation or pr cess of: I I
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly - Occupant Load: 750
I Allowed Occupant Load: 1 750
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds for the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
This Permit Must Be Posted At All Times in The Premises Identified Above
City of Edmonds Community Development Code 19.25.020
3
CONFIDENCE TESTING
FIRE ALARM REPORT
ADDRESS: 201 4'h Ave. XCITY: Edmonds STATE: WA 23P: 98036
OCCUPIED AS: Edmonds C.C. - Conference Center
BUILDING CONTACT: Phitfij)Tutt PHONE: 425.754.5668 EXT:
NAME OF TESTER: Demari Brown CERTMCATION NO.
DATE OF INSPECTION: 9/17/2010
TYPE OF INSPECTION: QUARTERLY 11 ANNUAL NACcEPTANcE F] OTHER n
CONTROL PANEL MFG: Edwards MODEL NO.: LSS4/36
1. TROUBLE SIGNAL WITH A/C POWER OFF:
YES ED NO [I N/AE1
2. SYSTEM OPERATES SATISFACTORY ON STANDBY POWER:
YES 0 NO [I N/A El
3. ALL SIGNALS OPERATES ON A/C POWER.
YES 9 NO 0
4. HAVE ALL NOTIFICATION APPLIANCES BEEN CHECKED FOR PROPER OPEIL:
YES Z NO 0
5. ALL CIRCUITS CHECKED FOR ELECTRICAL SUPERVISION:
YES [I NO [I N/A
6. CONTROL PANEL CHECKS MADE PER MANUFACTURE'S INSTRUCTION:
YES 0 NO [I N/AE1
7. ALL AUXILLARY EQUIPMENT OPERATES (ELEVATORS, FANS, DAMPERS):
YES 0 NO [I N/A [I
8. CENTRAL STATION OR REMOTE CONNECTION:
YES 0 NO [I N/A El
NAME OF MONffORING COWANY: Alarm Center
9. KEY TO PANEL AVAILABLE: YES 0 NO F1 N/A 0
10. OPERATING INSTRUCTIONS AT PANEL: YES 0 NO [I N/AE1
11. SERVICE LABEL OR TAG (REQUIRED): YES 0 NO [I
(Page I of 2)
(Page 2 of 2)
EQUIPMENT TESTED
TrP OF EQULPMENT
NO. OF
flFM TF"ED
By
IVO. OF U]VrFS
IN BUILDNG
YES NO NIA
BELLS, HORNS, CMMES, VOICE ALARM SPEAKERS
13
13
VISUAL ALARM DEVICES
26
�
26
TROUBLE INDICATORS
1
1 1
DUCT DETECTORS
5
0
1 5
SMOKE DETECTORS
3
Q
1 3
REAT DETECTORS
RX
AL4NUAL PULL STA71ONS
11
0
11
VENTRATION CONTROLS OPERATE
5
5
CENTRAL STATION
1
IRE
u
1
ELEVATOR CALL DOWN
1
m
11
11
1
FIRE DAMPERS)SMOKE DAMPERS
0
1
PHONEJACKS
-0
13
70
1
AUTO DOOR UNLOCKS (FAILSAFE)
-0
1
0
AUTOMATIC DOOR RELEASE
4
m
I
ET . . .
......
4
AUTOMATIC SPRUQ(LER FLOW SWITCHES
SUPERVISORY SWITCRES (AUTO SPR)
ANNUNCIATORS
PROBLEMS FOUND: No problems found durine this inspeeflon
161W1
DATE CORRECTED: - BY:
THIS IS TO CERTIFYTHAT THE MEALARMSYSTEMHASBEElVPROPERLY TESTED&
LYSPECTED FOR RELUBILITY TO CO, THE S LISTED RV TWS REPOR
SIGNATUM OF OWNER 07)R . ESENTATIVE: X 1 16
DATE:
SIGNATUREOF
NO. SIMPLL * 981SG
AGENCY: SEVIPLEXGRENNELL PHONE: (206) 291-1400 FAX: (206) 291-1500
ADDRESS: 9520 16M AVE SO. SUM 100 SEATTLE, WA 98108 Elect. License No. SBMTROMM6