201 5TH AVE N (2)Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200'
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
"' DMONDS
KBRIER
0 MOUNTLAKE TERRACE
E3 UNINCORPORATED...
FREQUENCY STATION & SHIFT""
LOCATION:
�01 5 th Avenue N 98020 AnnUal 17-D
BUSINESS NAME: PHONE: SCHEDULED
Towncenter Apartments 3606521178 DATE DUE 0 Apr 2016
MAILING UFIR 0 -422203
ADDRESS:
201 5th Avenue N, Edmonds, WA 98020 __j
BUSINESS OWNER: HOME PHONE:
Dines, Bob
-EMERGENCY-1: HOME PHONE: CURRENT
KE Y ACCESS-2: Appleby, Mike & Debbie HOME PHONE: 3606521176 CITY YES NO
EMAIL: BUSINESS
LICENSE El
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: 1_5-761
FIRE SYSTEMS: FE(!?_As�_
MIbMtWItEATIONS
2
/ COMMUNICATIONS
S
UA/�4AW'
2
3
3
4
4
6-'
5
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:'
1
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
CONTACTED:
INSPECTOR:
DATE:
PERSON
CONTACTED:
INSPECTOR:
PERSON
CONTACTED:
INSPECTO
DATE:
2
3
DATE:
VIOLATIONS
1 1 5
VIOLATIONS:-
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
6_
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
....RECEIVED---
6
4
18
18
DATE:
DISPOSITION:
7
LETTER NEEDED YES NO
.4
LETTER.NEEDED 0 YES []'No
8
Columbia Fire, Inc.
I I I South Findlay Street Confidence Test Report
Seattle, WA 98108
206-232-8569
1 SPRINKLER -WET SYSTEM,
1
1 Certification Given
(One System per Report)
RED C3
YELLOW 0 1 WHITE X
CONFIDENCE TEST PAIRS
201 5th Ave South Old Mill Town Retail
Occupancy Address: Edmonds, WA 98020 Occupancy Name: Center
Responsible Person
First & Last Name: Ulises Phone Number: 425-457-3367
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Date of Inspection: 9-13-16 Inspection Annual
Frequency/Type:
Testers Name SFD Certification
(Please Print).- Nick Przygocki Number: SCP-P-07865
Identification Number
(Required): FSCC-14155 System Location: Loading Dock
Central station monitoring? Yes X No C] Monitoring
Monitoring Required? Yes 0 No 0 Company Name:
System Make.- Shotgun System Model:
SEATTLE FIRE CODE VIOLATIoNs FOUND: (if additional room is needed, please add a separate sheet)
Due for 5 year inspection. 2 water gaug2s replaced,
CORRECTIONS MADE: Date Corrected: Corrected By:
(if adaitionai room is neeaea, please add a separate sheet) SFD Certification Number- SCP -
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 with Seattle Fire Department Fire Code standards, and that
discrepancies are need and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: Phone # 206-232-8569
Building Representative (signature)
Sprinklers - Wet Page 1 oil 2
A
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 NFPA13 Code for inspecting and testing
requirements.
General
1 :MzIin.
Drain' and IhsOpctor's Drain, flow,test.c6nducted7',
Ps�
0
2.
Static pressure: 100 psi Flow pressure: 90 psi
13,
Number of Sprinkler. Heads: �3
4.
2-inch drain? Other
Yes X
No 0
F! 6w* sihitches,: I sup . e I rvisory switches and a-lairm. b e*1ls -tested?
Y s x
e-
6.
Pressure regulating valves tested? N/A
Yes 0
No 0
7
bel[operates.
Ala.rm, N/A
es'O..,
No, 0
8.
System inspected and lubricated?
Yes X
No 0
9.
Valves are sea led.'or.supervised?
�.Yes.x`
NoIS
10.
Signs are provided on valves?
Yes X
No 0
1.1...
Pumper -connections and clapper -valves, Unobstructed and turn freely?.
es-
Y X
N 0 C3
12.
Sprinkler coverage is acceptable?
Yes X
No 0
A 3�
zive 1he sprihklee.headi�, been e6oladiad or- successfully sample test, in he I
t
�Y,
ast: years. -,ate.of]ast'te�t.
14.
Proper number of spare sprinkler heads available with appropriate wrenches
Yes X
No 0
foreach?
15.
Sykem left- in -service?
Yes
No
16.
System gauges repl aced or calibr ated within the last 5 years?
YesO,
No X
Year changed: 5/11
17,
Sprinkler he'.ads.free of-c-orrosion, pain`�', obstructions and/or physical.
es.
6.0 -
damage?
18
Was debris found in the Fire Department Connection (FDC)?
Yes 13
NoX
'19,,.Wa,§�thie�Fi,-e-Deneirtin6nt.C6nr�ection.(rDC).batk-.,flushe'd.'withi'*n'ttie�i*��t.5:
N6�
a' Uate:oflast back flush, 5/11, -
rs
20.
Was an internal pipe and valve inspection performed within 'the last 6 years?
Yes 13
No X
5/11
Is the hydr6ulic �am6la'te: installed, and visible on� riser, if N6. then Yellow'78J.'
-Yes
Re: NFPA 25
22.
Was a signal received at the Central Station monitoring NIA I
Yes X
No M
company?
Sprinklers - VVet Page 2 of 2
Columbia Fire, Inc.
111 5outh Findlay 5treet Confidence Test Report:
Seattle, WA 98108
206.232.8569
I —_
iSPRINKLER -DRY SYSTEM
I
1
i Certification Given
(One System per Report)
RED 0 1 YELLOW_C3__] WHITE X
CONFIDENCE TEST X
Foccupancy Address: 201 5th Ave South
Occupancy Name: Old Mill Town Retail
Edmonds, WA 98020
Center
Responsible Person
First & Last Name: Ulises
Phone Number: 425-457-3367
Responsible Person
Responsible Party
Address, City, State, Zip:
E-Mail Address
Date of Inspection:
Inspection Annual
9-13-16
Frequency/Type-
Testers Name
(Please Print): Nick Przygocki
SFD Certification
Number: SCP-P-07865
I
I
Identification Number
(Required): FSCC-14155
Systern Location: Loading Dock
Central station monitoring? Yes X No 0
Monitoring
Monitodng Required? Yes 0 No 13
Company Name:
1 System Make: Viking
System Model'. F-2
SEATTLE FIRE CODE VIOLATIONs FoUND: (if additional room is needed, please add a separate sheet)
Due for 5 year inspection; 1 water, 1 air g uge.
CORRECTIONS MADE: Date Corrected:
Corrected By -
,If additional room iss -needed, please add a separate. sheet) SFD Certification Number- SCP -
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 with Seattle Fire
Department Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester:
Phone # 206.232,8569
Building Representative (signature)
Sprinklers - Dry Page I of 2
6 1
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 NFPA13 Code for inspecting and testing
requirements.
General
1.
Trip test co nducted? DT
Yes X
No 0
.-System tripped in 15. seconds.*
3.
Main Drain and Inspector's Drain flow test conducted?
Ye s X
No 0
4.
St6tic pressure: 100.-psi.;
5.
Number of Sprinkler Heads? 25
6.
2-inch drain?, Other C3
Yes X
No. 0
7.
Flow switches, supervisory switches and alarm bells tested? N/A 11
Yes X
No n
:.8;
Alarm bell. operiates? N/A X
Yes
No
9.
Air compressor refills system in 30 minutes or less?
Yes X
No 0
16.
.-,-Heat actuation devices't�sted on'pre-action and -deluge system I s? N/A X:
Ye s 0-*
No
11.
System inspected and lubricated?
Yes X
No 0
111
Valves are seated or -supervised?
Yes X
No
13.
Signs are provided on valves?
Yes X
No 0
q14.
Pumper connections and clapper valves unobstructed and turn freely?
Yes X
No 0
15.
Sprinkler heads replaced or successfully sample tested in last 10 years?
Yes X
No M
Date of last test:
16.
Sprinkler coverage is acceptable?
Yes X
No 0.
17.
Proper number of spare sprinkler heads available with appropriate wrench for
Yes X
No 0
each?
18.
System left in service?
Yes X
N o
19.
System gauges replaced or calibrated within the last 5 years?
Yes 11
No X
Year changed: 5/11
:20.
Sprinkler heads free of corrosion, paint, obstructions and/or physical damage?
Yes X
No 0
21.
System drained and restored to normal operation?
Yes X
No 0
22.
Was debris, found in the Fire Department Connection (FDC'?
Yes 11
No X
23,
Was the Fire Department Connection (FDC) back flushed in the last 5 years?
Yes C3
No OX
Date of last back flush 5/11
24. Was a signal received at the.-Central.Station monitoring company? N/A C] Yes X No 0
25. Is the hydraulic nameplate installed and visible on riser, if No then Yellow Tag. Yes X No 0
(Ref: NFPA 25 5.2�7)
26. Was an internal pipe and valve inspection performed within the last 5 years? Date Yes 0 No X
Performed 5/11
Sprinklers - Dry
Page 2 of 2
CITY OF EDMOND
121 5T" AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
LOCATION: 201 5th Avenue N
BUSINESS NAME: Towncenter Aparlments
MAILING 210 5th Ave N
FIRE PREVENTION
SAFETY SURVEY
PHONE: 3606521178
ADDRESS: Edmonds 98020
BUSINESS OWNER: Appleby, Mike & Debbie HOMEPHONE: 360652117,8
EMERGENCY-1: Dines, Bob HOMEPHONE: 42577587§4
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
365
17 C
I
SCHEDULED
DATE DUE 1�
04/01/11
UFIR � 422
4201
ACTIVE
I- INITIAL INSPECTION DATE
PERSON CONTACTED: t (
NAME OF INSPECTOR: K& 0 (,0 &,- k LAj,
FIRE
SYSTEMS:
FE
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
A,,- rJ
ENTER CODE ONLY ONCE
4
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
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:
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
7
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE:
DISPOSITION:
8
LETTER NEEDED [] YES NO
LETTER NEEDED [_
j YES E] NO
FIRE DEPARTMENT COPY