21108_21120 77TH PL SW.pdfFIRE PREVENTION
';�H Co. Serving Brie�, P-amonds, and 124.25 Meridian Ave S 1�$PECTION REPORT
SNOHOM
rl EDMONDS
% Mozintlake Terrace Everett, WA 98208 0 BRIER
V11 - ( / Phone (425) 551-1200 0 MOUNTLAKE TERRACE
UNINCORPORATED
U3 jLR T www,.--,Fir'eDistrict'l.org Fax (425) 551-1272
21108 77 th Plate W 98026 WA�GCY STAfetp SHIFT'*'
LOCATIOh,�
BUSINESS NAME: Rustic . Manor Condos PHONE: 4257712059 SCHEDULED IVI a r—ZOT7
MAILING 21114 77th Place W, #102, Edmonds, WA � 98026
ADDRESS:
Rose,Ken
428206
LIFIR 0
BUSINESS OWNER: HOME PHONE:
Roppo, Pam .4257712059
EMERGENCY-1: HOME PHONE: U
KEY'ACCESS-2: HOME PHONE: �RRENT YES NO
USI
r�B NESS
EMAIL: LICENSE 0
PERSON CO�TACTED: /JA INITIAL INSPECTION DATE
NAME OF INS' PECTOR:
I= RYSTEMS. Fla Si-e/-PO� , e� (0 1
Date Last Serviced: r
Serving Brier, Edmonds, and 12425 MeridianAve S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
21108 77 th Place W 98026
Annual
16-C
BUSINESS NAME:
Rustic Manor Condos PHONE:
4257712059
SCHEDULED
DATE DUE � Mar2016
MAILING
UFIR 1 428206
ADDRESS:
21114 77th Place W, #102, Edmonds, WA 98026
BUSINESS OWNER:
Rose,Ken HOME PHONE:
.EMERGENCY-1:
Roppo, Paril HOME PHONE:
I
4257712059 "CURRENT
KEY ACCESS-2:
HOME PHONE:
YES NO
CITY
BUSINESS
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
.
.NAME OF INSPECTOR:
FIRE SYSTEMS:
FE 6/13
Date Last Serviced-
t1_
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
4
3
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 orviolations 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.
FIRE PREVENTION
INSPECTION REPORT
E' 61 Y
Serving Briet; dnionds, a2y Heri ian A
,SNOHOMISH C-0. " I)% T;MDMONDS
Mountlake Terrace Everett, WA 98208 5 BRIER
IR El MOUNTLAKE TERRACE
DR I IMAM—, I Phone (425) 551-1200 [3 UNINCORPORATED
IS T www.FireDist'rictl.org Fax (425) 551-1272
FREQUENCY I STATION & SHIF_*�
LOCATION: 21108 77 th Place NA/ -08026 Annual 16-A
42157712,051 SCHEDULED Mar 2014
BUSINESS NAME: Rusk. Marior Candm- PHONE: DATE DUE
MAILING IJIFIRV
ADDRESS: 21114 77h Plai;c W, 4102, Ed(TmndN,'vVA 0,002E
Rrise-, Kwi
BUSINESS OWNER: HOME PHONE:
Roppa. Pam 42677-fe"21350
EMERGENCY-1: HOME PHONE: CURRENT YES NO
KEY ACCESS-2: HOME PHONE: CITY
BUSINESS
EMAIL: LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: 5 3 Ir 7 hv
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
V
2
2
3
z
3
4
4
b
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
Ist RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
I
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
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
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
"I LETTER NEEDED F] YES NO
LETTER NEEDED F] YES El NO
1
8
FIRE DEPARTMENT COPY""
Serving Briei; Edmonds
SNOHOMISH CO.
FIREMountlake
Terraceand
DIST RT'Twww.FireDistrict1.org
the Town of Woodway
U LOCATION:
21108 77th Place
BUSINESS NAME:
Rustic Manor Condos
. MAILING
7-1114 77th PI W #102
ADDRESS:
Edmonds
BUSINESS OWNER:
Roppo,Pam
EMERGENCY-1:
Hoa C/O Ken Rose
KEY ACCESS-2:
PERSON CONTACTED:
NAME OF INSPECTOR: 0
FIRE
SYSTEMS:
W
12425 Meridian Ave S
Everett,'' WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257712059
98020
HOMEPHONE: 4257712059
HOMEPHONE: 4257782420
HOME PHONE:
02- c)
FIRE PREVENTION
INSPECTION REPORT
OEDMONDS
0 BRIER
[1WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIFF`�
366 16 D
SCHEDULED
DATE DUE 1' 03f01/13
I U 3206
FIR � 428
ACTIVE
CURRENT
CITY
YES NO
BUSINESS
R 1:1
LICENSE
INITIAL INSPECTION DATE
.90/
FE
I
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE T&CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
11st 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:
I
,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
3
7-
RETURN RECEIPT
RECEIVED
6
14
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES [I NO
rLETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
SNOHOMISH CO. Serving Briet; Edinonds 12425.Mer . idian Ave I S
i ' .. Moun' Hake Terrace, and tt, WA 98208
FIRE
- f
the Town of Woodway Phone (425) 551-1200
DISTR'W1Twww.FireDistrict1.org
I Fax (425) 551-1272
LOCATION: 21108 77th Place W
BUSINESS NAME: Ru ic Manor Condos PHONE: 425771:2059
MAILING 24114 77th PI W #102
Nnnocce
Edmonds 980.20
BUSINESS OWNER: Roppo,Pam HOME PHONE: 4257712059
EMERGENCY-1: Hoa CIO Ken Rose HOME PHONE: 4257782420
KEY ACCESS-2: f HOME PHONE:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE
SYSTEMS:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIFF*)
36,6 16 C
SCHEDULED
DATE DUE 1' 03/01/12
UFIR � 428 3206
ACTIVE
CURRENT
CITY
YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
1113112-
Ft
/
ANNUAL
HAZARDS FOUND AND LOCATIOZN COMM ICATIONS
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
DATE -DUE:
2nd RE -INSPECTION, 4:1
DATE DUE:
EXTEN SION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
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
3
7
RETURN RECEIPT
RECEIVED
6
14
'8
4
'8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
OF EDMONDS
21 5- AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIR DEPARTMENT
41 t
LOCATION: 21108 77th Place w
BUSINESS NAME: Rustic Manor Condos
MAILING 21114 77th PI W #102
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257712059
ADDRESS: Edmonds 98020
BUSINESS OWNER: Roppo,Pam HOMEPHONE: 4257712059
EMERGENCY-1: Hoa C/O Ken Rose HOME PHONE: 4257782420
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION 1, SHIFT
366
16 6
I
SCHEDULED
03/01/11
DATE DUE 11�
UFIR 11, 428
3206
ACTIVE
r- I INITIAL INSPECTION DATE
PERSON CONTACTED: 49 1
NAME OF INSPECTOR:6 �-!n W-c S �flV-.o_ _�q ej 7- 4
FIRE FE
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1 NO C41
6k 1 4 0 LAj vIr
ENTER CODE ONLY ONCE 10
Ira I,'. a 1/
VIOLATION CODE
1
2
2
3
3
4
4
5
5
6
6
7
7
8
8
'Ist 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:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
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
6
7
4
8
4
18
DATE:
DISPOSITION:
8
� LETTER NEEDED D YES NO
WTTER NEEDED 0 YES Ll NO
FIRE DEPARTMENT COPY
CITY OF EDMONDS
.121 5TH AVENUE N. - EDMONDS, WASHINGTON 9W2O (425) 771-0215
FIRE DEPARTMENT
LOCATION: 21109 77th Place w
13USINESS NAME: Arbor Lane Condo's (21109-21)
MAILING
ADDRESS:
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4253391160
BUSINESS OWNER: Port Gardener Mg. Co Mgmnt//Cory HOMEPHONE: 4253391160
EMERGENCY- 1: '21113,21117,21121- HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION 11 SHIFT
366
1 16 6
SCHEDULED
0,31101/11
DATE DUE 01
LIFIR P� 428
3206
ACTIVE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: 6v,5 7ct6?-
FIRE AS 8109 1FDLkBx @ AS CABINET DOORS FE —.I—
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
wl_
ENTER CODE ONLY ONCE III,
Uv\-6Lb.(t_ Iravt-
VIOLATION CODE
u, vx
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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
6
PRE-CITAMON
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
13
7
RETURN RECEIPT
RECEIVED
6
7
1'
4
18
4
a
DATE:
DISPOSITION:
8
k' LETTER NEEDED ':] YES NO
LETTER NEEDED ] YES NO
FIRE DEPARTMENT COPY
AAA Fire and Safety, Inc. EDMONDS FME DEPARTMENT Invoice#101702
3013 3rd Ave. No. ConjUence Tesdng Acct#28172
Seattle, WA. 98109 AUTOMATIC SPRINKLER SYSTEM Date 8/10/2010
800.223.3473
Address 21113 77th PL. W. City EDMONDS, WA Zip Code 98026
Occupiej"As ARBOR LANE
Building Owner Same Phone No.425-339-1160
Address Same City Same Zip Code Same
Date of Inspection 8/10/2010 Type Type of inspection ANNUAL
Tester's Name Sample/Mencias NICET Certification # 8620ffO62609/IT128238 SFD CERT # SCPM04506
DRY SYSTEM Location: N/A
L test trip conducted. N/A
2. System tripped in 0 seconds.
3. All flow switches, supervisory switches and alarm bells tested. N/A
4. Alarm bell operates.
N/A
5. Flow test conducted.
N/A
Static pressure 0 psi.
Flow pressure 0 psi.
6 Two inch drain.
N/A
7 Air compressor refills system in thirty minutes or less.
N/A
8 System drained and restored to normal operation.
N/A
9 Heat actuation devices tested on pre -action and deluge systems.
N/A
WET SYSTEM Location: FRONT BLDG. CLOSET
1. Flow test conducted.
YES
Static pressure 67 psi.
Flow pressure 51 psi.
2 Two inch drain.
YES
3- Flow and supervisory switches and bells tested.
YES
System inspected and lubricated.
YES
GENERAL
1. Central station monitoring. WASH. ALARM
YES
Z. Sprinkler heads less than fifty years old.
YES
3. Pumper connections and clapper valves unobstructed.
YES
4. Spare heads and wrench available.
YES
System left in service.
YES
6. Valves sealed and/or supervised.
YES
7. Gauges recalibr�ted or replaced (every five years).
YES
8. Signs provided oh valves.
YES
I it II
9. Static water pressure 67
— psi
1.0._Hydraulically designed Placard YES
system on riser
11. PROBLEMS FOUND. NONE -NOTE NO BELL INSTALLED
CORRECTIONS MADE: NONE
Date corrected — By
This is to certify that the sprinki s s as been properly tested
and inspected for reliability to cover the items
list on this test report.
Signature of tester
NICET License
# 86201TO62609/IT 12823 8/
SFD License # SCPM04506
-j ;
AAA Fire and Safety, Inc. EDMONDS FIRE DEPARTMENT Invoice#101702
3013 31d Ave. No. Confdmce Tesdng Acct#28172
Seattle, WA. 98109 AUTOMATIC SPRINKLER SYSTEM Date 8/10/2010
800.223.3473
Address 21117 77th PL. W. City EDMONDS, WA Zip Code 98026
Occupied As ARBOR LANE
Building Owner Same Phone No. 425-339-1160
Address Same City Same Zip Code Same
Date of Inspection 8/10/2010 Type Type of inspection ANNUAL
Tester's Name Samplefflencias NICET Certification # 8620IT062609/IT128238 SFD CERT # SCPM04506
DRY SYSTEM Location: N/A
L test trip conducted. N/A
2. System tripped in 0 seconds.
3. All flow switches, supervisory switches and alarm bells tested. N/A
4. Alarm bell operates.
N/A
5. Flow test conducted.
N/A
Static pressure 0 psi.
Flow pressure 0 psi.
6 Two inch drain.
N/A
7 Air compressor refills system in thirty minutes or less.
N/A
8 System drained and restored to normal operation.
N/A
9 Heat actuation devices tested on pre -action and deluge systems.
N/A
WET SYSTEM Location: FRONT BLDG. CLOSET
1. Flow test conducted.
YES
Static pressure 67 psi.
Flow pressure 51 psi.
2 Two inch drain.
YES
3- Flow and supervisory switches and bells tested.
YES
System inspected and lubricated.
YES
GENERAL
1. Central station monitoring. WASH. AILARM
YES
2L Sprinkler heads less than fifty years old.
YES
3. Pumper connections and clapper valves unobstructed.
YES
4. Spare heads and wrench available.
YES
System left in service.
YES
6. Valves sealed and/or supervised.
YES
7. Gauges recalibrated or replaced (every five years).
YES
8. Signs provided on valves.
YES
9. Static water pressure 65 psi
I.O.-Hydraulically designed system Placardonriser YES
11. PROBLEMSFOUND. NONE-NOTENO BELL INSTALLED
CORRECTIONS MADE: NONE
Date corrected — By
This is to certify that the s aink7l has been properly tested and
list on this test report.
<-L�
-V11- ?L4 vr4 ue �k
,(..!,VqJTG rL,-
q It Ito kpe�
inspected for reliability to cover the items
Signature of tester NICET License # 86201TO62609/IT128238/
SFD License # SCPM04506
AAA Fire and Safety, Inc. EDMONDS FIRE DEPARTMENT Invoice#101702
3013 3rd Ave. No. Confidence Tesdng Acct#28172
Seattle, WA. 98109 AUTOMATIC SPRINKLER SYSTEM Date 8/10/2010
800.223.3473
Address 21121 77th PL. W. City EDMONDS, WA Zip Code 98026
Occupied As ARBOR LANE
Building Owner Same Phone No. 425-339-1160
Address Same , City Same Zip Code Same
Date of Inspection 8/10/2010 Type Type of inspection ANNUAL
Tester's Name Samplefflencias NICET Certification # 86201TO62609/IT128238 SFI) CERT # SCPM04506
DRY SYSTEM Location: N/A
L test trip conducted.
N/A
2. System tripped in 0 seconds.
3. All flow switches, supervisory switches and alarm bells tested.
N/A
4. Alarm bell operates.
N/A
5. Flow test conducted.
N/A
Static pressure 0 psi.
Flow pressure 0 psi.
6 Two inch drain.
N/A
7 Air compressor refills system in thirty minutes or less.
N/A
8 System drained and restored to normal operation.
N/A
9 Heat actuation devices tested on pre -action and deluge systems.
N/A
WET SYSTEM Location: FRONT BLDG. CLOSET
1. Flow test conducted.
YES
Static pressure 65 psi.
Flow pressure TO psi.
2 Two inch drain.
YES
3- Flow and supervisory switches and bells tested.
YES
System inspected and lubricated.
YES
GENERAL
1. Central station monitoring. WASH. ALARM
YES
2L Sprinkler heads less than fifty years old.
YES
3. Pumper connections and clapper valves unobstructed.
YES
4. Spare heads and wrench available.
YES
System left in service.
YES
6. Valves sealed and/or supervised.
YES
7. Gauges recalibrated or replaced (every five years).
YES
8. Signs provided on valves.
YES
9. Static water pressure 65 psi
10. Hydraulically designtT�ystern Placardonriser YES
11. PROBLEMSFOUND. NONE-NOTENO BELL INSTALLED
CORRECTIONS MADE: NONE
Date corrected — By
This is to certify that the sprinkler sy h bee properly tested and inspected for reliability to cover the items
list on this test report.
77;
Signature of tester NICET License # 86201TO62609/ITI 28238/
SFD License # SCPM04506
FIRE PREVENTION
SAFETY SURVEY
CITY OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
-_�It. Isla FIRE DEPARTMENT
LOCATION: 21109 77th Place w
BUSINESS NAME: Arbor,'Lane Condo's (21109-21) PHONE: 4253391160
MAILING
ADDRESS:
BUSINESS OWNER: Port Gardener Mg. Co Mgmnt//Cory HOMEPHONE: 4253391160
EMERGEN C Y-1: -21 -113, 21117, 21121 HOME PHONE:
KEY ACCESS-2: HOME PHONE:
FR EQUENCY
STATION 1, SHIFT
16 A -
I
SCHEDULED
DATE DUE 0-
LIFIR 1, 428
3206
ACTIVE
01 . INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OFIINSPECTOR: &/ // "s
I
FIRE - - AS 8/07 I'D LkBx @ AS CABINET DOORS
SYSTEMS:
FE I
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICAT17NS
z2 ez 617,
ENTER CODE ONLY ONCE lo
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:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE-CITAT10N
LETTER SENT
CITATION ISSUED
NUMBER:
4.
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
7
14
18
4
8
ATE:
DISPOSITION:
1 8
LETTER NEEDED 0 YES [3 No
LETTER NEEDED I] YES NO
1
FIRE DEPARTMENT COPY
CITY OF EDMONDS
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
t
LOCATION: 21108 77th Place w
BUSINESS NAME: Rustic Manor Condos
MAILING 21114 77th PI W #1'02
FIRE PREVENTION
SAFETY SURVEY
PHONE: 4257712059
ADDRESS: Edmonds 98020
BUSINESS OWNER: Roppo,Pam HOMEPHONE: 4257712059
EMERGENCY-1: Hoa C.10 Ken Rose HOME PHONE: 4257762420
KEY ACCESS-2: HOME PHONE:
FREQUENCY
STATION & SHIFT
366
16 A
SCHEDULED
03/042/10
DATE DUE
LIFIR o� 428
3206
ACTIVE
INITIAL INSP CTION 7DE
PERSON CONTACTED:
NAME OF INSP�CTOR: 71
FIRE AS 8/07 FD LkI3x @ AS CABINET DOORS FEr 10_�
SYSTEMS:
ANNUAL
i
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE I�
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
'Ist 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:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 1 5
VIOLATIONS
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
14
18
4
8
DATE:
DISPOSITION:
8
LETTER NEEDED C-] YES E] NO
LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
V.
April 4, 2003
Attn: Inspector Mike Smith
Edmonds FireDepartment
Rustic Manor Condominium Owner,s Association is now in compliance with the order for the association
to provide proof of annual fire extinguisher check test.
Attached find invoice dated April 4,2003 from All City Fire & Safety Corpoation
Pamela A. Sanders,Treasurer
Rustic Manor Condominium Owner's Association
3
ALL CITY
FIRE & SAFETY CORP.
206-628-2963
P.O. Box 2245 Fax 425-347-7209
Everett, WA 98203-0245 1-800-386-5023
TO
15"
I N V 0 1 C E
DATE ORDER NO
SHIP TO
20950
SALESPERSON
CONTACT
PHONE#
TERMS
Service charge of 11/2% per month on
all accounts 30 days or more past due.
QUANTITY
DESCRIPTION
UNIT PRICE
TOTAL
-�77
RECEIVED BY: SUBTOTAL
TAX
Please Pali This Amount TOTAL
E-b4lGJJDS,, L-U4, 9902-Co
Plusr),C, MAQOIZ Cokil..)O's
. .................
(102.)
oq)
-7 -7
7717 2,12th S.C. RUSTIC RAMOVAter.'
LIV
175 16 117 __FT9
PARKIN G
4 3
2T
H J K I L .0
PARKING C-)
F
E
C =B
21.2th.St. S.W.
HYDRANT: N.E.corner of 78th.Ave. and acro.ss,the st*reet
at High School
STANDPIPE CONN: None
FIRE DEPT CONN: None
UTILITY 'SHUT OFF: elect: by units C, FIJ,3210,17
HAZARDS: None
r
CITY OF EDMONDS LAURA M. HALL
CIVIC CENTER - EDMONDS, WA 98020 - (206) 771-0215 - FAX (206) 771-0208 MAYOR
FIRE DEPARTMENT
890 . 1 99 -
DATE: April 14, 1994
TO: Attn-Ken Rose
Rustic Manor Condominium-'
21114-77th Place W., #104
Edmonds, WA 98026 -
SUBJECT: RUSTIC MANOR CONDOMINIUM
PERSON CONTACTED:
In our continuing effort to promote Fire Safety and Prevention
within the community, your Fire Department conducts regularly
scheduled "Fire Safety Inspections" of all businesses and
multi -family occupancies in the City of Edmonds.
You are to be congratulated on the relative good condition of
your occupancy in regards to fire safety. Attached you will
find, the item(s) that were noted during our inspec ' tion which
require attention to bring them into compliance with the mini-
mum standards adopted by the City of Edmonds.
A re -inspection will be conducted after 30 days to confirm
that the listed item(s) have been corrected.'
Any overlooked hazard or violation of the fire regulations
does not imply approval of such condition or violation. If
you require additional information or assistance, -please con-
tact this office by calling 771-0215, Ext. 301, between the
hours of 8 a.m. and 5.p.m., Monday through Friday.
With your cooperation we can have a safer community through
fire prevention.
S. cere
hn WestJ'all
Inspe or
Enclosure
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CITY OF EDMONDS
CIVIC CENTER - EDMONDS, WA 98020 - (206) 771-0215 - FAX (206) 771-0208
FIRE DEPARTMENT
� 8 9 0 . 1 9 Z) -
DATE: March 8, 1994
TO: Rustic Manor 0 'ers' Assn.
Rustic
Manor
ondominium
W2'
SUB,TECT:
r, n I I
RUSTIC MANOR CONDOMINIUM
PERSON CONTACTED:
LAURA M. HALL
MAYOR
In our continuing effort -to promote Fire Safety and Prevention
within the community, your Fire Department conducts regularl y
scheduled "Fire Safety Inspections" of all businesses and
multi -family occupancies in the City -of Edmonds.
You are to be congratulated on the relative good condition of
your occupancy in regards to fire -safety. Attached you will
find the item(s) that were noted during our inspection which
requite' -attention to bring them into compliance with the mini-
mum standards adopted by the City of Edmonds.
A re-.ipspection will be conducted after 30 days to confirm
thatthe listed item(s) have been corrected.
Any overlooked hazard or violation of the fire regulations
does not imply approval of such condition or violation. If
you require additional information or assistance, please..con
tact this office by calling 771-0215, Ext. 301, between the
hours of 8 a.m. and 5 p.m., Monday through Friday.
With your cooperation we can have a safer community through
fire prevention.
S ce
hn.. '-�Wejst all -
Inspe or
Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
4?A(- OJ3-005
CITY OF EDMONDS HARVE H. HARRISON
MAYOR
CIVIC CENTER - EDMONDS, WASHINGTON 98020 - (206) 775-2525
FIRE DEPARTMENT
March 30, 1932
Attention - Jess Linton
Rustic Manor Apartments
13505 Seattle Hill Road
Snohomish, WA 98290
Dear Mr. Linton,
SUBJECT: REVISION IN THE FIRE AND LIFE SAFETY CODE
Due to recent changes in the new Edmonds CoTmunity Development
Code and the Life Safety Code-, the Fire Marshal's Office will
1 2
be enforcing the following requirements.
The following will effect all apartments and condominums within
the limits of the City of Edmonds.
1. Smoke detectors in each living unit. W.A.C. Chapter
212-10
The following will effect all apartments and condominums with
two or more doors that open on a common area/corridor.
2. Self -closures on all living unit/corridor doors.
Life Safety Code 19-3.6.2.
3. Fire rating on living unit/corridor door:
a. Minimum 20 minute door (label on hinge side of
the door)
b. 1 3/411 solid bonded woodcore door. Life Safety
Code 19-3.6.3
We request that the above items be checked by vou for compliance
and noted on the attached form. Your reply verifying compliance
or current status is to be received by this office within thirty
(30) days.
If we may be of any assistance, Dlease contact this office at
775-2525, Ext. 231', between the hours of 8 a.m. and 5 p.m.,
Monday through Friday.
Sincerely,
FW,
t__�
�i, 01104—
Stan A. Olsen
Senior Inspector
R E C E I V E D
APR 12 11982
VERIFICATION OF COM?LIANCE FORM EDMONDS FIRE DEPT.,
# 424-023-003
This form must be completed and returned to the Edmonds Fire
Department within thirty days.
1. Smoke dete ctor installed .............. Yes )( No
2. Self -closures installed ............... Yes No
3. Fire rating on doors:
a. 20 minute label .................. Yes No
b. 1 3/4" solid core ................ Yes- No
FN-rV_y
Not APPlicable; All unitAdoors open to the outside at ground level
In addition, it has been noted that stated item(s) need to
be corrected to be in compliance with current City Ordiances
or Fire Codes:
Service fire extinguisher - to be done annually.
Servic ' has been jorde;�eid 8 Apr 82
Correction made ....................... .... es- No
Rustic Manor Apts. Jess W. Linton
Apartment Name Owner's Signature
Ms Mary Bricksong Mgre
7717 212th SW9 Edmonds 778--(M5
Address Phone Number
We wish to thank you for your time and attention in completing
this form.
VERIFICATION OF CT11PLIANCE FORM
# 424-023-003
This form must be completed and returned to the Edmonds Fire
Department within thirty days.
1. Smoke detector installed .............. Yes No
2. Self -closures installed ............... Yes No
3. Fire rating on doors:
a. 20 minute label .................. Yes No
b. 1 3/4" solid core ................ Yes No
In addition, it has been noted that stated item(s) need to
be corrected to be in compliance with current City Ordiances
or Fire Codes:
Service fire extinguisher - to be done annually.
Correction made ......................... Yes No
Apartment Name Owner's Signature
Address Phone Number
We wish to thank you for your time and attention in completing
this form.
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2133 FIFTH AVENUE, SEATTLE, WASHINGTON 98121 - MUTUAL 2-8444
COAST
INVESTMENT CO.
arealtorso
October 8,, 1968
Fire Department
City of Edmonds
Edmonds, Washington 98020
Attention: Ralph H. Klein., Asst. Chief
Rer Rustic Manor Apartments
Gentlemen:
We acknowledge with thanks your letter of September 26 last in regard
to replacements of thermostats., and relocation of vent ducts in the,
subject building.
We have been advised by the owner that an accredited electrician has
surveyed each unit with a view to the necessary correction of thermo—
stats, and the problem of the vent ducts will also receive attention.
On comp I et ion of the work we wi I I so a dvise you i n order that a re —
inspection may be made,
Yours. very tru I y,,
COAST INVESTMENT COMPANY
By
CB: jc
cc: Mr. Linton
cc: Manager
S A L E S I N S U R A N C E M A N A G E M E N T D E V E L 0 P M E N T
2133 FIFTH AVENUE, SEATTLE, WASHINGTON 98121 - MUTUAL 2-8444
COAST
INVESTMENT CO.
orealtorse
November 29., 1968
City of Edmonds
250 Fifth Avenue North
Edmonds, Washington 98020
Attention: Mr, Ralph H. Klein, Assistant FireChlef
Re: Rustic Manor Apts., 2311 Fifth Avenue S. E., Edmonds, Washington
Gentlemen:
This is to advise you that the replacement of thermostats and relocation
of vent ducts., etc. at the above captioned address have been completed
as outlined in your communication addressed to the owner of Rustic Manor
Apartments on September 26, 1968*
The resident manager of the Rustic Manor Apartments# Mr. Ray Erickson#
has been authorized to show your representative through all areas of the
various units in this building to enable you to complete your safety
inspection as requested in your letter of September 26, 1968e
We are confident that your re —inspection of this building will show that
the building owners have complied with your requests.
Please accept our appreciation of the courtesy and consideration you have
extended to our clients relative to the foregoing.
Yours very truly,
COAST INVESTMENT COMPANY�/
" B Y,
y
JJF: jc
cc: Manager
S A L E S I N S U R A N C E M A N A G E M E N T D E V E L 0 P M E N T .