22127 HWY 99 (2)Z.] �z
SNO110N.11SH Co. Serving Brier, Edn�onas, und 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208,
FIRE Phone (425) 551-1200
DIST T www.FireDistrictl.org Fax (425) 551-1272
22127 Highway 99 98026
LOCATION:
Great American Motel 4257760200
BUSINESS NAME: PHONE:
MAILING 22127 Highway 99, Edmonds, WA 98026
ADDRESS:
Kim, Jeff
BUSINESS OWNER:
EMERGENCY-1: Skc Lodging Inc
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: :Z1 e-,(A L LA CA
NAME OF INSPECTOR:
mo ul 1p rM a/ ly rc fl 10
Date Last Serviced:
6 loo
HOME PHONE:
'FIRE P* R*E-V* E'N'TION
INSPECTION REPORT
OEDMONDS
D BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
F E ENrY STA�16tg SHIFT
U
A% a
SCHEDULED Mar 2U-17.
DATE DUE �
443
UFIR
4257760200 -- .
HOME PHONE: CURRENT
HOME PHONE: CITY
BUSINESS
LICENSP
INITI,2�INSVEFZ
NO
*I
Serving Brier, E(Imonds, and
Mountla.ke Terrace
www.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
D BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
22127 Highway 99 98026
I Annual
0.
720-C
BUSINESS NAME:
Great American Motel
PHONE: 4257760200
SCHEDULED
DATE DUE � Mar 2016
MAILING
LIFIR 443
ADDRESS:
22127 Highway 99, Edmonds, WA 98026
BUSINESS OWNER:
Kim, Jeff
HOME PHONE:
EMERGENCY-1:
Skc Lodging Inc
HOME PHONE
: 42577602001 CURRENT
KEY ACCESS-2:
EMAIL:
HOME PHONE:
CITY
BUSINESS
YES NO
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
4
NAME OF INSPECTOR:
C,. 4. f-Al
FIRE SYSTEMS: AS 5/12 FA P/14 FE '5' / I < tirl4r 54&bftN &-AR
, p,
Date Last Servoceda ftS
tal [tip
HAZARDS.FOUND AND LOCATIONS / COMMUNICATIONS
ft --A
-k
2 (3�
'16 6'
Dort, 4,rfc, C
2
3
4
5
5
-6
7
7
I AGREE TO CO RRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSI
ANT
'FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED: 67�
PERSON
CONTACTED:
PERSON
CONTACTED:
LNSPECTOR
INSPECTOR:
INSPECTOR:
2
DATE:
VIO 10
PATE:
DATE:
3
4
69T_ms-
5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
2 �6
3
2
6
DATE:
CODE
SECTION:
5
6
3
7
RETURN RECEIPT
RECEIVED
8
4
18
DATE:
DISPOSITION:
7
�'LETTER NEEDED [] YES NO
LETTER NEEDED 0 YES [I NO
Fire Protection Contractors since 1930
VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., S08tti@, WA 98134, 206.622.4656
WA.: VZ-K1-NA-W73NT LEVEL M 602 California Way, Longview, WA 98632,360,425.7620
Fire Sprinkler Inspection Report Pa9e:1of2
REPORTTO:
JOB NO. i,L, DATE:
STREET:
BLDG./ LOCAMON
CITY/STATE: INSPECTOR:
I.GENERAL
a. Is the building occupied ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Is occupancy the same as previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Are all fire protection systems the sam's, as last inspection ? . . . . . . . . . . . . . . . . . . ....... . . .
9. Is the building completely sprinklered ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Are all now additions and building changes properly protected ? . . . . . . . . . . . . . . . . . . . . . . .
g. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . . . . . . . . . . . .
h. Was property free of fires since lost Inspection ? (Explain any fire on Page 2) . . . . . . . . . . . . . . . . . . .
1. In areas protected by wet systa ms, Is building properly heated, Le.: blind attics, perimeter areas, and are all exterior opening* protected agaii
2. CONTROL VALVES (See Section 17)
a. Are all sprinkler system main control valves open ? . . . . . . . . . . . . . . . I . . . . . . . . . . . .
b. Are all other control valves In proper position ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Are all control valves In good condition and sealed or supervised ? . . . . . . . . . . . . . . . . . . . . . .
3. WATER SUPPLIES (Soo Section IS)
a. Was a water flow test preformed and were the results satisfactory ? . . . . . . . . . . . . . . . . . . . . . .
4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS
a. Are fire pumps, gravity tanks, resevolrs and pressure tanks In good condition and properly maintained ? . . . . . . . . . .
b. Are Fire Department Connections In satisfactory condition, coupling* free, caps In place and check valves tight ? . . . . . . .
s. WET SYSTEM (See Section 13)
a. Are cold weather valves open or closed as necessary ? . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Have antifreeze systems been tooted and left In satisfactory condition ? Temp. ? . . . . . . . . . . . . . .
c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? . . . . . . . . . . . . . . . .
6. DRY SYSTEMS (Sao Section 14)
a. Are dry valve(s) In service and In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Are pressure and priming water levels normal ? . . . . . . . . . . . . . . . . . . . . . I . I . . .
c. Is air compressor In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Were low points drained during fall and winter Inspection* ? . . . . . . . . . . . . . . . . . . . . . . . .
a. Are Quick- opening devices In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Has piping been chocked for stoppage within the past ton (10) years ? . . . . . . . . . . . . . . . . . . . . .
g. Has piping been chocked for proper pitch within the past five (5) years ? . . . . . . . . . . . . . . . . . . . .
h. Have dry valves been trip tested satisfactorily as required ? . . . . . . . . . . . . . . . . . . . . . . . . .
1. Are dry valves adequately protected from freezing ? . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Are valve house and heater conditions satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. SPECIAL SYSTEMS (Sea Section 16)
a. Wore valves tooted as required ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Were all hent-responsive systems tested and were the results satisfactory ? . . . . . . . . . . . . . . . . . . .
c. Were supervisory features tested and were the results satisfactory ? . . . . . . . . . . . . . . . . . . . . . .
S. ALARMS
a. Is the water motor and gong test satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Is the electric alarm test satisfactory ? . . . . . . . . . . . . . . . . . . . . . - - - - - -
c. Is the supervisory alarm service test satisfactory ? Monitoring Co. Ph.-- Code:-"-
9. SPRINKLERS - PIPING
a. Are all sprinkler heads In good condition, not obstructed and fr" from corrosion Or loading ? . . . . . . . . . . . . .
b. Are ail sprinkler heads less than fifty (50) years old ? Head Manufacturer: Date of head : -;44L
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
ING AUTOMATIC SPFNNKLER COMPANY
WAL: VAWWA413731VT LEVEL IN
I
�ontrsctors since 1930
Ion
~Av&ScL,SWftWAW134,206. W.4W
602 Caftmis WW, LaVvilip; WA MW, 360.42S. MV
Fire Sprinkler Inspection Report Page:W2
9. SPRINKLER I PIPING (Continued)
YES N.A. NO
i, c. Are extra sWk*W heads medify WaMbb ? . . . . . . . . . . . . . . . . . . . .
d. Is condition at piping, drain valves, valv luingem Pressure gauges, open sprinklers, andstralners sadiectory ? - - - - - - - - -
a. Are all sprinklers of proper tempenature'Irsting? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
t. Are portable fire extinguishers In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
,9. Is hand hose on sprinkler system satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
J*R
10. Date Dry System Piping last chocked for stoppage .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....
11. Daft Dry System Piping last chocked for Proper pfth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Dow Dry Pipe Valve Mot trip tested .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Wetaystame: Number-4—meksim - /Yes, eiL,) Azu--
14. My Systems: Number: Model Vast,;
15. Accelerator. Make I Model Yew:
Is. Special Systems: Numbw: — Type:
Make Model Year: Condition:
17. CONTROLVALVES
a. City Connection Control Valves . . . . . .
b. Tank Control Valves . . . . . . . . .
c. Pump Control Valves . . . . . . . . .
d. Sections! Control Valves . . . . . . . . .
a. System Control Valves. ; . . . . . . .
It WATER FLOW TEST
a. Water Pressure Source: 041ty. OTank. 0 Fire Pump. Water Flow 71ast taken ?WO-01� If naL namann-
E
Condition
Tog Pipe Location
Sto Tom Pipe
Pressure OWN"
Flow Pressure
Pressure After
A Ri
A6
Ive
19. Explanation of any "No" answers:
71 ..... 77
20. RqWt changes In building occupancy or fire protection equipment:
21. Adjustments or corrections made:
22. Desirable Improvements:
23. Has building owner/ representative been notified of any deficiency to the firs, protection system? 13 Yes 0 No, Person notif led:
If answer Is "No",explain:
24. Inspector's Signature:
WHITE: VIKING COPY
VOtness (property owner / lose") and date:
YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
5
'Fire Protection Contractors since 1930
VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656
WA.: VI-KI-NA-S373NT LEVEL N 602 California Way, Longview, WA 98632,360,425.7620
Fire Sprinkler Inspection Report Pclge:lof2
REPORT TO: JOB NO.- 44121 DATE: _6
STREiT: 8JL*1 W11�4,v 49 BLDG. / LOCATION',
CITY / STATE: INSPECTOR:. ?�viz "qneq ipcee
1.GENERAL
a. Is the building occupied ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f b. Is occupancy the -same as previous Inspection ? . . . . .... . . . . . . . . . . . . . . . . . . . . . . . ... .
c. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Are all fire protection systems the same as last Inspection?.
a. Is the building completely sprinklered ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Are all new additions and building changes properly protected ? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Is"all stock or storage properly below sprinkler piping ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Was prop6ity'free-of fires since last Inspection ? (Explain any fire oi�'Page 2') ---- -- - - - - - - - - - - - - - - - - - - --- -
1. In areas protected by wet syste me, Is building properly heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected against the cold ?
2. CONTROL VALVES (See Section 17)
a. Are all sprinkler system main control valves open ? . . . . . . . . . .. . . . . . . . . . . . . . . . . . . ... . .. .
b. Are all other control valves In proper position ? . . . . . . . . ... . . . . . . . . .. . ... . . . . .
c. Are all co ntrol v Ives'l n 'ood c onditio
a n and sealed or supervised ? . ... . . . . .
V 9 . . ... . . .
3. WATER SUPPLIES, (See Section 1. 8).
a. Was a water flow'tist p reformed and were the results satisfactory ? - - - - - - - - - - - - - - - - - - . .. . . . . . . .
4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS
a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? - - - - -- - - - - - - - - - -
b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight ?.
5. WET SYSTEM (See Section 13)
,,k-,Are cold Wqohenoves open or closed as necessary ? . . . . . . ... . . . . . . . . . . . .
b. H011m0freeze systems been tested and left In satisfactory condition ? Temp. ? .......
c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? . . . . . . . . . . . . . . . . . . . . .
6. DRY SYSTEMS (See Section 14)
a. Are dry valve(s) In serAce,and In good condition ?
6.'Ais�pressUre i�di;liriln'g �rate� levels n6'rmal ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Is air compressor In good condition ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -
d. Were low points drained during fall and winter Inspections ? . . . . . . .. . . . . . . .. . . ... . . .
a. Ar�_qqlck- opening devices in service ? . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....
.�i�;-kas piping'64n Q6ked for stoppage within the past ton (10) years ? - - --- - - - - — - - ruxi ow-Q - - - - - - -
9. Has piping been checked for proper pitch within the past five (5) years ? . . . . . . ..... . . . . . . . .
h. Have dry valves been triptested satisfactorily as required ? - - - - - - - - - - - - - I . . .... . . . . . . . . . . . . .
1. Are dry valves adequately protected from freezing ? - . .....................
1. Are valve house and heater conditions satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - -
7. SPECIAL SYSTEMS jSee Section 16)
a. Were valves tested as required ? - - - - - - - - - - - - - - - - -
b. Were all heat -responsive systems tested and were -the results satisfactory ?:
c. Were supervisory features iested and were the results satisfactory ? . . . .. . . . . . . . . . . . . . . . .
&ALARMS
a. Is the water motor and gong test satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Is the electric alarm test satisfactory ? . . . . . . . . . . ... . . . - - - - - - - - - - - - - - - -
c. Is the supervisory alarm service test satisfactory ? MonItorIngCo. <IL�SJAL ;;;�; ,
Ph.:
9. SPRINKLERS - PIPING
a. Are all sprinkler heads In good condition, not obstructed and f roe from corrosion or loading ---------------
b. Are all sprinkler heads less than fifty (50) years old? Head Manufacturer: Date of head: 17
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
YES
N.A.
NO
ZYh.
/L
.
7
-.7': 7.—
Fiie Protection Contractors since 1930
VIKING AUTOMATIC SPRINKLER COMPANY
34M ~Aw— So., Swft WA 98134,206. 622.4656
WA.: VILKI-NA-S373AT LEVEL M
602 6aftwirds WW, Longvh*K WA 3W. 4W. MW
Fire Sprinkler Inspection Rep ort Page:W2
9. SPRINKLER /.PIPING (Con I Inu ad)
YES
N.A.
NO
c. Are extra sprinkler heads readily available ? . . . . . . . . . . . . .
. . . . ... .
d. Is, condition of piping, drain valves, check valves, hangers, pressure gauges, open
.7
sprinklers, ana strainers ?_
selffectory
e.'Are all sprinklers of proper temperaiurCrating?
I. Are portable fire extinguishers In good condition ? . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
g. Is hand hose on sprinkler systems satisfactory ? - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - -
10. Date Dry System Piping last chocked for stoppage -- - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - -
11. Date Dry System Piping last chocked for proper pitch - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - iA )Xg yk�,%o
A 12 Date Dry Pipe Valve last trip tested -- - - - - - - - - - - - - - -
- - - - - - - - - - - - - - - - - - - - - - 4_9R
- K�
13' Wet systems: Number Make Model Year �1
14. Dry Systems: Number - Make Model Ve-a ;�'-QJ2 �W
7
It. Accelerator: Make/Model/ . Year:
16. Special Systems: Number: —Type:
Make / Model / Year:
Condition:
17. CONTROL VALVES
a. City Connection Control Valves - - - - - -
b.Tank Control Valves . . . . . . . . .
c. Pump Control Valves -
d. Sectional Control Valves . . .. . ... . . .
ntrol Valves -
9. System Co
A
I& WATER FLOW TEST
a. Water Pressure Source 0 Tank, 0 Fire Pump, Water Flow fest,taken ? If not, reason:
Test Pipe Location
Size Test Pipe
Pressure Before
Flow Pressure
Pressure After
y
00
19. Explanation of any "No" answers:
77
— 7�! _7_� , I
�t changes In building occupancy or fire protection equipment:
. 21. Adjustments or corrections made:
esirable mprovements:
.,�22. D I
23. Has building owner / representative been notified of any deficiency to the fire protection system? 0 Yes 0 No, Person notified:
If answer Is "No",explain:
24. Inspector's Signature: _z��
le
r%- te Witness (property owner / lessee) and date:
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
-iei:. Edt nonds, and 12425 Meridian Ave S
SNO U184 Co
Terrace Everett, WA 98208
FiR Phone (425) 551-1200
DISTR FireDistrict]. org Fax (425) 551-1272
FIRE PREVENTION
INSPECT-1-0h REPORT
tl EDMONDS
0 BRIER
El MOUNTLAKE TERRACE
[I UNINCORPORATED
:� . 11
" FREQUENCY
STATION & SHIFT
LOCATION:
22127 Highway 99 98026
Annual
20-B
BUS.INESS NAME:
PHONE: 4257760200
SCHEDULEDMar 2015
Ebehmckf
DATE DUE
MAILING
LIFIR 1,443
ADDRESS:
22127 Highway 99, Edmonds, WA 98026
BUSINESS OWNER:
Kim, Jeff
HOME PHONE:
EMERGENCY-1:
Skc Lodging Inc
HOME PHONE: 4257760200
"'CURRENT
KEY ACCESS-2:
HOME P146NE:
YES. NO
CITY
BUSINESS
EMAIL:
LICENSE
I/,-
PERSON CONTACTED:
INITIAL'INSPECTION DATE
NAME OF INSPECTOR/ (z, y
FIRESYSTEMS:
AS5/1,2FA*_6/!%4LFL &/114,
1_;711CK
HA7DS FOUND �ND LOCATIONS COMMUT��7TPIONS
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2
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3\/ 72
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4
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5 V//
5
6
.,A) C_ I
FA I L_
6
ZL)lt
7
JL_L
A),r. �T
7
F L
I AGREE TO CORRECT THE ABOV ATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR: r � V
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
4
1
5
1 5
LETTER SENT
NUMBER:
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
6
3
7
7
RECEIVED
-3
DISPOSITION:
4
18
�L
18
DATE:
LETTER NEEDED F] YES Nol
ETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
li�
3.4 1
, ; ; x
JeRAVVIVES
nkff CWP.
MA WA UUJ
alp"MFOV V I r
FM ALARM SYSTEMS
(One System per Report)
jWW4MM 10 1 REPAIRS
ECEIVE
MAY 2 1 2014
BY10
Confidence Test Report
Certification Given
RED D I YELLOW 0 1 WHITIE X
kq-�l -ft
a 0-1- 22127 Highway 99 Ednwds
rr-;- Aadress: WA UM Occupancy Name: Travelers Inn
4ft-011111011117. America's best value Inn Phone Number: 425-776-0200
-7bpix�: Jeff jar" Phone Number: 425-776-0200
Cr
Owner Address: 22127 Highway 99 Edmonds WA 98026-8041
o PA, 1-
ld-10- -- 5=2014 InspecdonType: Annualx QuartedyD Acceptanceo
.Aa Yawitz SFD Certification Number: SCP-YO7283
[;!!jjjjRjkWIoq monitoring? Yes X NoO Monitoring company name: Washington Alarm
i amufacturer Silent Knight Model Number SK5207
(Naddilimal nxxn is needed. pleaw add a separate sheet)
DWNFPA72
1111"r, Date Corrected: Corrected By:
rms 6 needoW. gilease add a seDarate sheet) SFO Certification Number:
911it Oft fire and life safety system has been properly inspected for reliability to cover the
leport and is consistent with Seattle Fue Department Fire Code standards, discrepancies
been reported to the building OwnedUanager for corrective action.
'A Phone # 206-364-1998
Signal Semices
PO Box 9537. SeaMe. WA 98109
1 1
F! gaOTAJOS TGUM 609L BBC 90Z Iva C0:60 tloz/TZ/90
Alarm System Functionality
s,*W with AC power off?
Yes x
No 0
aperates properly on battery badcupI
Yes x
No C)
ViOne (no bad) 13-67 x2 volts
(full load) 12.59 x2 volts (signals operating)
4 11 Voltage 13-62 x2 volts
qmsbs properly on standby powerl
Yes x
No n
operate on AC power?
Yes x
No ri
of bomb- V circuits 8
s"md circuits 4
i - - systern meet audibirdy standards?
Yes x
No ij
ciieaed for electrical supervision?
Yes x
No Ci
Z equipment operates (Elevators, fans, dampers)?
NIA D
Yes x
No 0
trols operate?
N/A x
Yes 0
No 0
available?
Yes x
No 0
ons at panel?
Yes x
No 0
function properly?
Yes x
No L
Ammciator Panels function properly?
N/A x
Yes 0
No 0
Cal Down fuinctions properly?
N/A 0
Yes x
No 0
na&o posted at panel?
Yes x
No 0
alarm automatic time delay (rrdnutes)
N/A x
GqOm (Specify)
Yes ri
No o
D 19 LSOEMO
Yes 0
No
1. pans."a'-,
SY Devices
Total Number
Total Number
Test Results
of Units in
Units Tested
Acceptable
Building
Honw, Chimes
64
64
NIA 0
Yes 0
No x
(voice Clarity)
-
-
N/A x
Yes Li
No u
22
21
N/A 0
Yes x
No 0
-
-
N/A x
Yes 0
No 0
-
-
N/A x
Yes C I
No 0
Flow switches
2
2
N/A 0
Yes x
No U
&ipenAsory Switches
3
3
N/A 0
Yes x
No 0
Devices
11
1
N/A 0
Yes x
No ri
6
6
N/A 0
Yes x
No 0
110 O= Lkdocks
-
-
N/A x
Yes 0
No 0
-.000loor Release
3
3
N/A rl
Yes x
No 0
111� �
1-i.14M.
-7. --A-9 =-
Non Equipment
Total Number
Total Number
Test Results
of Units in
Units Tested
Acceptable
Building
sets
N/A x Yes 0 No 0
Jacks
N/A x Yes n No 0
SJOSW
. - I
-
, N/A x Yes 0 No 0
903TAJOS IBU9TS 609L 99C 90Z YVA CO:60 PTOZ/TZ/90
AA,
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terraceand
Everett, WA 98208
DEDIVIONDS
0 BRIER
the Town of Woodway
T
Phone (425) 551-1200
0 WOODWAY
[I MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
[1 UNINCORPORATED
FREQUENCY
�ATGN & SHiFr-*,
LOCATION: 22127 Highway 99
365
20 D
BUSINESS NAME: Traveler's Inn & Suites
PHONE: 4257760200
SCHEDULED
DATE DUE 0 03101/13
MAILING 22127 Highway 99
UFIR o 443 3107
ADDRESS: Edmonds
98026
BUSINESS OWNER: Skc Lodging Inc
HOMEPHONE: 4257760200
AC-nVE
EMERGENCY-1: Kim, Jeff
HOMEPHONE: 4257760200
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
N 1:1
LICENSE
0-
PERSON CONTACTED:
KIM
INITIAL INSPECTION DATE
1(9-t S
NAME OF INSPECTOR: 56arus -Ench:-on
Q Ckee
FIRE AS & FA 5112
FE — I —
SYSTEMS:
ANNUAL
HAZARDS F ICATION
1 TN D A I ND LOCATIONS COMM,,UN,., (�e, Q CL e4r(; rK
4
2
nao
44()ars
2 Q�r
-0 04 A
pro
4 IV( KIW F-AIr AIX
4
/t/06; 7D L-eg- IaA Y-e�94*-C_
AX lhe5
All
16
6
IAG EE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
kpou'r continuing effort to promote fire safety and prevention with' e`cAllm,,unity, your fire department conducts
regularly scheduled "Fire Safety Survey Inspections" of all busi;:ses 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 or the Town of Woodway, call (425)
775-7720; for Mountlake Terrace or Brier, call (425) 754-0434.
BUSINESS COPY
7
PERMITS: FIRE $EPARAROVS:
1 Obt from the Fire Department: I.F.C. 105.1 5 . U Orscrfitf . nue block�- or *edg if ; jg�fp;ji I fire LF 7;)32,,,
in a p ( is
a ci L
iesacc rding toyd4p �M� 7 i.-t fire dYor( h
2. Maintain h7frd,.,3,nteriaIs/prowss ep7tment pe
.F.C. I "Of-51, Cf. fly a r 4'�rorjLr)equence I.F,C.
Fire !465-3
re'u D F?� x open fire door is nec,�ssnry for ventilation or convenience, a -iold open device
3. R.n
-,,a location. I.F G. 105 3 roved by the Fire Marshal m,.ist be used* I F C, 703 2 211 B.C. 715.3.7.2
C.r,� post F Z�
4. ime%porrnii(iln ap
bt
5, s license
.,�e 41A upanry �,Pip,,irafioni, area -parationv,, op partilions.
/V 'M ' , N
ills, and Waft st
6. Obtain permit from 1`301din. I s . b _ j
sh. & maintained assperifiedirt the International Building Code, l,r,C. 701.1/703.1
5,1 Rr-pair lhr� da[Nig�,,d pli,ic- %-,ith n fir(,-i�,,J�Jivo 11j,Aleriil (�(juivalvnt to th�� :,iirmunding
surfaces: I.F,C, 703.1
FIRE PROTECTIOW
7. Remove all foreign material frorn the sprinkler head�- of ruplace the sprinkler heads:
I.F,C.901.61
8. Nothing shall be plaued an or hung from sprinkler piping: I.F.C. 901.6.1
9 Install approved cover(s) on the Fire Department sprinkler conno.dion, 1,17 C. 901 6.1
10. Remove all storage from around sprinkler system control valves: I.F.C. 901.61
11� Repair sprinkler system deficiencips� LF.C. 901 �6,1
.12. Remove all items that might block access to sprinkler control valves Fire
Department hose connections, I.F.C. 901.6 1
13, Lower the storage to a minimum of 18" below the sprink;ar head deflectors: I.F.C.
315,2.1
114� Annual confidence test must be performed on spnnkler tystem(s) by a qualified
person, and doctirfionkilion mu5I be pT0Vi11Pd to Filf2 klaf"01ril: I.F.r- 901.6 1
15, Fusible
,)ink or spnokler head must, be replaced on hood and vent exiincitlishing,
systery� 1. F. C. 904.11.6.3
16 Hood and vent extinguishing systern must be servicpd serni-arintially by a
qualified person: I.F.C. 904.11.6.2
17. Remove all accumulations of grease from the range hood, filters and connecting
grease flue and institute periodic cleaning to prevent such accumulation in the
future: I.F.C. 609-3:3.1
18. Spray booth filters shall be maintained and changed in accordance with. LF.C. 1504,3
19. Remove all items or condifions, which might interfere with pfoppr tiso of fire
hvdrant: I.F.C.507.5,4
20. Repair fire alami system. I.F.C. 907 9
21 Fire alirm system shall he tested and maintained annually, I F C. 907.()
Documentation �hall bQ litrividod to Firy MarOial: I F C.. 907 9.5
22 Install portable fire exting,jisher-s- I F.0 906 1
23. The fire extinguisher(s) Must be inspucted/taggod annually: I.F.C. 901.6.1
24 The fire sxhnguisher(-�) mijst be servirpd1recharged by a qL1aIlf1Pd person: I F.C.
901.6.1
25 Fire/life safety sy,;ti-.ms must be tested and maintained, documentation must be
provided to the Fire Marshal. I. F.C. 901.6.1
26. The dry standpipe shall be hydrostatically tested every five years: I.F.C. 901.6
27� All devices in approved locations: I.F.C. 907A
EXITIM310
28. Maintain exit pathwayfignting- I F C 100C I 1100C.3
29. Maintain exitsign illuntirralion: I.F,C,IQll,?J10I 1A
30. Provide approved signs indicating the direction of travel to fire exits- I F,C 1011 1
31. Provide approved signs indi�ating the fire eAit(s): I.F.C. 1011.1
32 Exits shall not be blocked or obstructed in tiny way, and thp required width of
aisles leading to exits shall be maintained ' I.F.C. 1030
33, Properly repair the panic hardware on the exit door(s), I F C. 1008. 1. 10 1
34. Exit doors shall be openable from the inside without the use of a key or any
special knowledge or effort. Exit doom shall not be locked. chainod, barred,
latched, or otherwise rendered unusable, All locking devices shall be of an
approved type: 1. F,C.1008. 1.9
35. In group A-3, 8, F, M & S occupancies, in all churches main exit door(s) may have
key -locking haidware if an il)ljffjvod si(
,4n is postud, zAafing, `Thi�l Door To Romaill
Unlocked Donna Business Hnurs"� I F.0 1008 I.Q 3
36 Provide a rninifrium of -36' of cleat disle width, I F C. 1008 1 1
37. Provide a minimum of 44" of clear aisle widft I F C 10182
38. Every building of threa or niore stories bfiall have approved stairway identification
signs posted: I.F.C. 1022.8
39 All assembly occupancies shall have occupant load posted in conspicuous plake;
LF.C� 1004.3
40. Overcrowding of a room or building shall not be permitted: I.F.C. 107.6
ELECTRICAL:
41. Install approved covers on the open'electrioal �ervice pan'ol(s) or ju h*ction bo.�(6s):
11 C 605 b . - 1. 1 . I
42 A junction box with an approved cover is required at every spicc. Therefore
provide such boxes LF.C. 605.6
43 Maintain a minimum nt.Tclearance in front of electrical paneis- I F.0 605.3
44. Provide doculnentation that electrical wiring, partels, etc., have been inspe,cte., d
and approved by Washington State electrical inspector I.F.C, 605 1
45. Electrical wiring and equipment in -any vapor area shall be explosion-pr9of type
approved for use in �iuch hazardous location: I.F.C. 11K3.2-1/j403-1/2-301 �5
46 Extension cords shall riot be used as a substitute for -rmanent wirine: I F C 605 6-
47. The current capacity of an extension cord shall not be less than the rated capacity
of the appliance or fixture served by that Cord: I.F.C. 605.5�2
48 Extension cords shall be maintained in good condition without sphc6;
deterioration, or damage- I F�G 605�5.3
49 Extension Cords shall be of Ilia grOLInd0d type when serving (ji-oundod appliances or
fixtures' I F C 605 5A
FLAMM IOUI]QS ASE�% A�lll) HAY-ARIDDLIS MATEPIALS:
AQUIUL , -&L- - - - -
5,5 Reduce the quantity of flammable I�quirls I F.0 -1-104 3 4 2
56. Flammable liquids nf;t excvc ding 120 gallons may be stared in an �pprovad storage
Cabinet. Such cabinet shall be r!onspcuously Ial�ieled in rea letters 'Parnmab:e-Koep
Fire Away": I.F.C. 3404.3.2.1.2/34G4.3.2.2
57 Remove the accumulation of combustible residues from th,4 walls. floor and reiling of
the spray room area. I.F.C. 1503.4
58 Disppi-ising device- 1;hal� bn of anapproved typ,? Class I -A flammable liquids shall not
be dispensed from tanks, drums. barrels, or similar containers by gm vil:v. Approved
PUMP'; taking sijtli.)n finni fl*,-�. top of thi, toniai%r Oilll ho us,,-d I F f-, 3405 2*
!�9� Huse nozzle ValVeS Li.0d It Z�elf-service stations for 6spensing ot Class I flammable
I liciiid-sh"Ill I F`C. 22G6 7 6.1 -
60, When damage to LP gas systems from vehicular traffic is a possibility, precautions
against such damage hall bu taken, therefore provide posts or a protective barrier to
prevent such damage: I.F.C. 3807,4
61. All compressed gas cylindrs in service or storage shall be secured to prevent falling or
being knocked over: I.F.0 1003.5 3
62 Oil burning equipment�.shall beof an approved type*, I.F.0 603 1 2 1
63. Installireparr vvoodworl�inq refuse remdva] systom: I.F.r- 1903,2
A4 Po�,Isigtis stating lowtion of �rirergency pump shutofc. I F.C. 2203.2
65 Post "NO SMOKING' �;ign(�-,),)n LPG tank, 1,F,C. 3807.2
66. Remove and safely dibpose or damaged or leaking containers of flammable hazardous
materi.-il I F C. ^,70.� 2 (4 2
67, U�;e, dispensing, storage zino hancling of hazardou� materials shall be in accordancsi
with I F C r3tvipter 27and �otrr Fire Drparlrn�,ni permit- I F C 105 G 21 and 2701 A
68, Provide Material Safety Data Sheets (MSDS): I.F.C. 2703A
69 ProvidL HLLardous Material Inventory Statement (HMIS), I F.C. 2701.52
70. Provide Hazardous Materials Management Plan (HMVM.P): IF C 2701.5.1
STORAPE:
71, Remove all flammable or v�mbijst,ble sloraqt�, from the. unfinished attic area. I.F.C.
315.2.4
72 Remove all cnmbuqtiblP mqlerifil from beneath thesirtiriure- I F 0, 315.2.4
73. Lower the storage toa minirnum uf 24" below the ceiling- I F C 315 2 1
74. Low.ir the f1oragv Ion n6niawn of 18" holow the �,prinl,lorhead � i-;fl, ctorT
1,F.C.315.2.1
75 Reroovo all combustible -jr ha-ardous material: I.F.C. 315
76. Unlawful to park or store any fueled equipment in any dwelling unit, office, exit way or
location that would create a f;r,-, or life haiard: I.F.C. 313
77. Boller rooms, mechanical rooms, and electrical panel rooms shall not be used lor
storage: LRC. 315.2.3
78, Any exterior door that has been rendered nonwi unctonal in an approved manner by the
Chief shall be posted in an approved manner with the tvord�, 'Thi,, Door Blockf-.d
I. F�C. 504.2
79, Dumpsters and containers w0h an individual capacity of 1 5 cubic yards or greater shall
riot he plarsd within 5 foet of rombijsfiblp walls, opp. nings, or rombi istible root eave
lines: I.F.C. 304�3 3
�X) Rey-novorind proporly N tn-� romhustb1c. mll gra�%s, brij,,h And other dpbriq,.
LF.C. 304.1:2
AL
81, Sirictiv enforce "NO SMOKING' restrictions: I.F.C. 310
82, 'Post "NO SMOKING' �igns: Washington Clean Air A6t of 1985 and I.F.C. 310.3
83, DiSC0.rIbnu6 the of�hclic ofillpg�l outdoor burning: I.F.C. 307.1
84. Secure this vacant building to reduce tie fire ha7ard: I.F.C. 311.1
8 S A I I dpro rative mate. rials, a re rpqt ii re d to be of I la me reta rda n t matpr' a I or tro�Meci I o
provide flarTib, resistant chara,clelfisti=, I.F.C; 806i807
86 Any owner, operator, orcup,-vit nroiher resp?niblo person who shall fail Io take
lmrne acti
dlatd� onto'6batealr� azard When ordered or notified to do so by the Fire
��N�M,slhall br- guilty IF.C.109 .
8 -1: Post and maintaM the ��or rect street address numbiar'In an approved man!1or. I.F,CZ05
A8. Post and nijinl�iin thc oorroct suiteor unit designator. I. F.C. 505.1
8.9 .,-Striping and,'Fire Lane - No Parking" s4grisimarkings shall cleaity indicate where the
approved fire lane is low r6d 1. F.C! 503.3
90. Pfovide a key box for emergency �;Ccess to the buildmg, I.F.C. 506, 1.
�ji. Provide appropriate access lothe bu;loincl: 1,F.C. Section 503
FIRE PREVENTION
Servi��ig ier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE
......... .�! I , :.: W
Mountlake Terraceand
Everett, WA 98208
OEDMONDS
0 BRIER
DISTI klffT
the Town of Woodway
Phone (425) 551-1200
OWOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fay (425) 551-1272
0 UNINCORPORATED
e' FREQUENCY STATION & SHIFT'**'
LOCATION:
22127 Highway 99
365 20 C
I
BUSINESS NAME:
Travelees Inn &!Suites
PHONE: 4257760200
SCHEDULED 03101/12
DATE DUE
MAILING
22127 Highway 99
LIFIR � 443 3107
ADDRESS:
Edmonds 98026
BUSINESS OWNER:
Skc Lodging Inc
HOME PHONE: 4257760200
ACTIVE
EMERGENCY-1:
Kim, Jeff
HOME PHONE: 4257760200
"CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
Z 1:1
LICENSE
PERSON CONTACTED:
A
INITIAL INSPECTION DATE
NAME OF INS��:�N I? S
/z- 'q f/z—
FIRE
FA 7/05)1
4/1)[
_1
FEl _-2_, 1
SYSTEM '�A!S
1
ANNUAL
HAZARpOUN94d9b LOCATIONS COMMUNICATIONS
M&I &<- �4
p
4:7 1]
000C
3,-7-306
2
2
3
3
4
4
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
I .
.
I I
2nd RE -INSPECTION
DATE DUE:
I
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
J6 � 4- —
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR: Ujj7
INSPECTOR:
-
INSPECTOR:
2
DATE: 6
DATE:
DATE:
3
VIPLATIONS
1 15
VIOLATIONS
1 15
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:*
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
4
'8
4
8
DATE:
DISPOSITION:
\1 LETTER NEEDED El YES I-] NO
LETTER NEEDED [] YES NO
I
FIRE DEPARTMENT COPY
ILIANCE
F91RE PROTECTION
81011 104(h Aventic SE - P () ffi)k -128 - Pwq,ai IVA IM050-0421i
Seattle Fire Department
Confidence Test Report
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
SPRINKLER — DRY SYSTEM
Certification Given
(One System per Report)
RED
YELLOW
WHITE
CONFIDENCE TEST C3 REPAIRS 13
Occupancy Address: —
Occupancy Name -
Responsible Person
First & Last Name:
Phone Number:
Responsible Person
Address, City, State, Zip:
Responsible Party
E-Mail Ad&ess
Date of Inspection: h -z—
Inspection �inij
Frequency/Type:
Testers Name
(Please Print):
SFD Certification
Number: SCP_ Is
Identification Number
(Required):
System Location: fc"�' O� �;.L'j
Central station monitoring? Yes No 13
Monitoring
Monitoring Required? Yes. 0"' No 0
Company Name: __11;5
System Make:
System Model:
SEATTLE FIRE CODE VIOLATIONs FoUND: (if additional room is needed, please add a separate sheet)
VC,we- L�tkl-Cr
NJ T P'(-:�-
CORRE CTIONS MADE: Date Corrected:
Corrected By:
(If additional room is 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 b n reported to the building
Owner/Manager for corrective action.
Signature of Tester:
Phone # Q
Building Representative (signature)
Sprinklers - Dry Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
4
inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department Fire Code for inspe�tiit -
and testing requirements.
General
1.
Trip test conducted?
Yes
N o
2.
System tripped in /,-/-I seconds. - \_N1 -W\ 9
3.
Main Drain and Inspector's Drain flow test conducted?
Yes
No
4.
Static pressure: .4ft psi
5.
Number of Sprinkler Heads?
6.
2-inch drain?
Other Yes
No
7.
Flow switches, supervisory switches and alarm bells tested?
N/A 0 Yes
No
8.
Alarm bell operates?
N/A 0 Yes
No
9.
Air compressor refills system in 30 minutes or less?
Yes
No
10.
Heak4auation devices tested on pre -action and deluge systems?
N/A 01/"' Yes
No
11.
System inspected and lubricated?
Yes
No
12.
Valves,�.are sealed or supervised?
Yes
No
13.
Signs are provided on valves?
Yes
No
j-44.
Pu hnections and clapper valves unobstructed and turn freely?
Yes
No
15.
Sprinkler heads replaced or successfully sample tested in last 10 years?
Yes
No
Date of last test:
16 .
Sprinkidir Coverage is ac ceptable?
Yes
No
17.
Proper number of spare sprinkler heads available with appropriate wrench for
Yes 0/1"
No C]
each?
Sys"i in'service?
Yes
No
19.
System gauges replaced or calibrated within the last 5 years?
Yes
No
Year changed: -Zo\-Z—
corrosion, paiht,.ob'structions and/or physical damage?
Yes
21.
System drained and restored to normal operation?
Yes
No
vt
D'
as db rf�� ",,,the re 6p
f i fi; a ftwe�n 76 ction -(F
b , 'C np�q "Pq
Yes
N
23.
Was the Fire Department Connection (FDC) back flushed in the last 5 years?
Yes
No
Date of last back flush
2.4.,.
?
Was,& signol received at-66, Ceijti�61 Station" monitoring. company N/A.* 0�-
Yve�
"NO"
25.
Is the hydraulic nameplate installed and visible on riser, if No then Yellow Tag.
Yes
No
(Ref: NFPA 25 5.2.7)
26. Was an internal pipe and valve inspection performed within the last 5 years? Date
Performed Yes No C3
Sprinklers - Dry Page 2 of 2
1A NCE
FIRE PROTECTION
8168 304th At enue SE - P 0 Box 428 - Preston 1,VA 98050-0428
Seattle Fire Department
Confidence Test Report
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED
YELLOW
WHITE
___7x _7_0
CONFIDENCE TESTT-E3 I REPAIRS
Occupancy Address:
Responsible Person (J 0 LW
Occupancy Name:
First & Last Name:
Phone Number:
Responsible Person
Address, City, State, Zip:
Responsible Party
E-Mail Address
Date of Inspection:
Inspection n
Frequency/Type:
Testers Name
(Please Print):
SFD Certification
Number: SCP--'S-o7'Ql5--
Identification
Number:
System Location: f'6 Q'C aArV
Central station monitoring? Yes No 13
Monitoring
Monitoring Required? Yes No 0
Company Name: 6\6Fv--
System Make: (,1,X+ Q-01CU Et
System Model:
SEATTLE 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) 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 havreen reported to the building Owner/Manager for corrective action.
Signature of Tester: 2�4
-- -S Z
Phone # c9OL
Building Representative (signatur�e
Sprinklers - Wet Page 1 of 2
We
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 Seattle Fire Department Fire Code for inspecting
and testing requirements.
General
Main Drain and Inspector's Drain flow test conducted?
Yes
No 13
2. Static. pressure: J� U p.s.i. Flow pressure: ��7— p. s. i.
Number of Sprinkler Heads:
4.
2-inch drain? Other
0" Yes
No
Flow sw'itdhe�'super'visory-sw'i'tch'e's','a'nd alarm bells tested? .'N/A
Yes
No
6.
Pressure regulating valves tested? N/A
Yes
No
.7.
Alarm- bell: operates?, N /A
Y es
No
8.
System inspected and lubricated?
Yes
No
9..",.
Valves are sealed or supervised?
Yes
No
10.
Signs are provided on valves?
Yes
No
umper connections clapper: valv
11,' P es unobstructed and turn freely?
Yes
0/'
No.0
12.
Sprinkler coverage is acceptable?
Yes
No 0
A3.'Have,the,s
p e ample t6k in the- -
*'rinkler heads be 6 repla .66d�,or. successfully:s
Yes
0.
las ears?. -Date of. last,"test: `,�'o
N 6.
14.
Proper number of spare sprinkler heads available with appropriate wrenches
Yes
for each?
No
p`115.
Sys'fe"616ft-iri'se ic 9
ry
Yes
-No:0
16.
System gauges replaced or calibrated within the last 5 years?
Year changed: (30-1 -L—
Yes
No
17.
S r) ri n kle r h ea ds free of co rros io n, p 6 in t, obstrd ction si a nd/6r:0 h ygica I,,
Yes
1�
a 1;,
'damage.,
No
18. Was debris found in the Fire Department Connection (FDC)?
Yes No
'Mi'th Departffient,Cdhned b ck
�1,9-.`, F ti6h:',*(F-,DC):, a -Wlt6i e�.h
iii ;` "'4" 16 § k �'fj c
e ars.." e*:jo
N o,,'. 7;r;
.a
20. Was an internal pipe and valve inspection performed within the last 5 years?
Yes No
Date Performed
hydtaulic�-.n8Meplate�'i'hsti�li�d,an'd.-'visible'-o'n,'r'i"s.dr'�;.,if,.,'�N�b'�'t""-"' )e�
he6 Yellow"Tag;
NO:
-,(Ref:*:,4.k 2.
-7)
22. Was a signal received at the Central Station monitoring
N/A
Yes No
company?
Sprinklers - Wet . Page 2 of 2
0 5/23/2012 15:40 FAX 206 368 7809
GIVA L SER VICES
of tynsen Electronics Cop.
ill;i 'A MORA AVE N., SEA rTLF, WA 98133
FIRE ALARM SYSTEMS
(One System per Report)
F—CONFIDENCE TEST 10 1 REPAIRS
Signal Services
Confidence Test
CertificMw
RED [I I YELLOW [I
--ftcupancy Address:
a..—, -- --.1 ------ TravAllaww1h& I
;;Wi80"*2'6 Occupancy Name: Travelpp4lft i
'I ding Owner:
America's best value Inn Phone Number: 4257;111�"
posponsible Person:
Jeff Kim Phone Number:
*Ulding Owner Address:
22127 Highway 99 Edmonds WA 98026-8041
)0 6'of Inspection:
5/22/2012 Inspection Type: Annual x Quarterly
iT.-sters Name
IlPlease
Yawitz SFD Certitication Number:
Print):
7
Central station monitoring? Yes X No E) Monitoring company name:
Washingkm
'Control panel manufacturer: Silent Knight Model Number:
SKS207
-KriDblems ound. (if additional room is needed, please add a separate sheet)
:(AVE.
T.
41r. -
470
Wilk;
Corrections Made: Date Corrected: Corrected br.
fif additional room is needed, please add a separate sheet) SFD Certificafflon Niliilkiiiij�
11. 1.0 �;
T'. 7
certifies that this fire and life safety system has been properly inspected for reliabRiW
�ihs listed in this report and is consistent with Seattle Fire Department Fire Code *fta
W-9ted and have been reporte building Owner/Manager for corrective action. - -
. NA )f
Phone# 206-N4-19"
ighature of Tester: J7 j;:
�stjng Agency: Sital sAvkqs--
11ailing Address: P7 ox 9537, Seattle, WA 98109
@Mir, n@111116ruteMPREMM - el
2011-Jun-05 Washington Alarm, Inc. 206-328-6755
ImWashington Alarm Inc. Phone: 206-328-3288
1253 S. Jackson Street Fax; 206-328-6755
Seattle, WA 98144 www.washingtonalarm.com
NOTIFICATION OF SUSPENDED FIRE ALARM MONITORING
DATE 6/5/11
FIRE DEPARTMENT: EDMONDS
TIME- 2206
PREMISE NAME: TRAVELER'S INN & SUITES
PREMISE ADDRESS: 22127 HWY 99
EDMONDS WA USA 98020
PREMISE PHONE: (425) 776-0200
AS OF: NOW
FAX NUMBER: 1425-775-7721
The Fire- Alarm at the above referenced premise IS NOT monitored.
The Fire Alarm at the above referenced premise WILL NOT BE monitored.
REASON:
MONITORING CANCELLED FOR NONPAYMENT
SERVICE TO BE REINSTATED? 7 YESF—] NO
EXPECTED REINSTATEMENT DATE: UNKNOWN
COMMENTS'
OPERATOR #: 15
&—(0
T(q-t�-
\T(2'33f�- J,.,�,jq
(A
&r(—
OA,' 17.
'04-
147 J-0 C
UL AND FM APPROVED CENTRAL STATION
LICENSED AND BONDED ELECTRICAL CONTRACTOR
04/28/2011 15:59 4255511272
R1A NCE
..1,FIRE PROTECTION
WA Contractors License: ReLtAFP102LJ
DRY - AUTOMATIC SPRINKLERS
CONFIDENCE TEST I [A I REPAIRS 10
Occupancy Address: j2d %
Building Owner: Rzfx�
SCFD1 FP PAGE 01/01
Cortificaflon Givegn
RED 0 1 YELLOW Id I WHIIE F-1
Occupancy Name:
.4inwi r (h �> Best 1k x Lay�
Responsible Person: i-ai�c V-�, rn
Phone Number: (L195) J.-7(g -!Q.--Ioo Phone Number:
Build;ng Owner Address: ?a t a-) I" qQ
Date of Inspection: _q/14bi Inspection Type: Annual Ei( Quarterly 0 Acceptance 0
Testers Name (Please Print); SFP Certification Number: scp-_�� -C\7-RL,&
Problems Foun :
-orrections Made: Date Corrected: 1/4 /1 f
Corrected By: �m
gnature of Tester:
!sting Agency.
ailing Address:
Phone # — (206) 682-6636
— 8 68 3041h Ave SE, P 0 BOX 428. Preston, WA 98050
^ — d. . .
Ritelk Ir
11111111=9111111M
04/28/2011 16:00 4255511272 SCFD1 FP PAGE 01/01
DRY SY��
1. Trip test (dry trip) conducted ..................................................... ' ....... Yes No
System tripped in _:��seconds.
2. All flow switches, supervisory switches and alarm bells tested .......................... Yes Z No N/A
............ Yes I/ No N/A
3. Alarm bell operates .............. I ............................... 11 .............................
4, Flow tests conducted — ................................................................................... Yes No
Flow pressure: psi 2-inch drain? ...................................... .......... Yes No
5. System inspected and lubricated ..................................................................... Yes No
............. Yes N o
6. Air compressor refills system in 30 minutes ........................................
7. System drained and restored to normal operation ............................................ Yes No
8. Were the heat actuation devices tested on pre -action and deluge systems? ...... Yes — No —_-NIA
9. Sprinkler heads recalled? .......... ..................................................................... Yes No
8168304"AveSE,POSOX428 * Preston,WA98050 * (206)682-6636 * Fox:(206)682-6744 * www.rallancenre.com
CITY* OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
4�' Co
LOCATION: 22127 Highway 99
FIRE PREVENTION
SAFETY SURVEY
BUSINESS NAME:
Travelers Inn 9 Suites
PHONE:
4257760200
MAILING
22127 Highway 99
ADDRESS:
Edmonds
98026
1�
BUSINESS OWNER:
Ske Lodging Inc
HOME PHONE:
42157760 1 �00
EMERGENCY- 1:
Kim, Jeff
HOME PHONE:
4257760200
KEY ACCESS72:
HOME PHONE:
FREQUENCY
STATION 1, SHIFT
2
20 A
I
SCHEDULED
01
/0
03 1/10
DATE DUE
UFIR P. 443
- 3107
ACMVE
PERSON CONTACTED: -5 e- �- �- \L % ,,- INITIAL INSPECTION DATE
NAME OF INSPECTOR: V-6-al D ITL 00b I I o
FIRE AS 2/07 FA V05 FEC)&_%
SYSTEMS: 1211 01 1 � Ito) ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE I�
-LL 3
VIOLATION CODE
6—f Y
< LA 119
2
2
Fe
IJ
3
4,
3
77A,16161� 4(""A
4
5
5
6
6
7
7
6d iL
8
7 /_L' i�
8
Ist RE-INSPECTIQN
DATE DLIE*
2nd RE -INSPECTION
DATE DUE-
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE,
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR: zw
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2 >(4-1
6
DATE:
CODE
SECTION: y
5
34
7
3 A&
7
RETURN RECEIPT
RECEIVED
4
6
7
4/V17
8
4 k4LJ
�8
DATE:
DISPOSITION6 r1jo
8
LETTER NEEDED 0 YES C] NO
LETTER NEEDED 0 YES C-] NO
FIRE DEPARTMENT COPY
12/09/2009 21:11 FAX 206 368 7809 Signal Services 001
SIGIVA �L SER VICES
Divisiun o-f Lypisen Electronics Corp.
11?29AUROJZA AVE. N., SLOYLE, WA PSJ33
20.6-364-1998
FIRE ALARM SYSTEMS
(One System per Report)
CONFIDENCE TEST I X I REPAIRS 1 0
22127 Highway 99
Occupancy Address: WA 98026
Building Owner: Travelers Inn
Confidence Test Report
Certification Given
RED El F YELLOW El I WHITE
Occupancy Name: Travelers Inn
Phone Number: 426-77M200
Responsible Person: Jeff Kim Phone Number: r
Building Owner Address: 22127 Highway 99 Edmonds WA 98026-8041
Date of Inspection: 12/9/09 Inspection Type: Annual x Cluarterly L
Testers Name yawitz SFD Certification Number:
(Please Print):
x
Acceptance 0
SCP- Y07283
Central station monitoring?
Yes X No D
Monitoring company name:
Washington Alarm
Control panel manufacturer:
Silent Knight
Model Number:
SK5207
Problems Found: (it additional room is needed, please add a separate sheet)
Room 2050 hon not functioni- service to be sechduled
Corrections Made: Date Corrected: Corrected By:
(if additional room is needed, please add a separate sheet) SFD 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 with Seattle Fire Department Fire Code standards, c1sc lawk�
'i fre noted and have been reported to the building Owner/Manager for corrective action.
7
gignature of Tester: Phone # 206-364-1998
Testing Agency: Signal Services
Mailing Address: PO Box 9537, Seattle, WA 98109
W C&IT. U =1�11
rej rem To I 1=4
12/09/2009 21:11 FAX 206 308 7809 Signal Services
02
,
Alarm System Functionality
1
Trouble signal with AC power off?
YeI
System operates properly on battery backup?
Yes X 910
FIFrj!
'311
Battery voltage (no load) 26.1 volts
4 L"
Battery voltage (full load) 25.2 volts (signals operating)
Charge circuit voltage 26.3 volts
System operates properly on standby power?
Yes X N"fPVT
All signals operate on AC power?
Yes z
.8,
No. of initiating circuits 8
.9.,
No. of signal circuits 4
lo.
Does alarm system meet audibility standards?
11.
All circuits checked for electrical supervision?
W-1
12.
All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
o
Yes x No- - ,�F -
13.
Ventilation controls operate?
N/A
x
Yes 0
14,
Key to panel available?
ybW
15.
Operating instructions at panel?
Yes X
6.
Trouble indicators function properly?
J7.
Remote Annunciator Panels function properly?
N/A
x
Yes 0
8.
Elevator Call Down functions properly?
Test
NIA
0
Y6s_ 7.1
record posted at panel?
0
.
General alarm automatic time delay (minutes)
N/A
x
I
Other Devices (specify)
yet 0
t; R, " "
Other Devices (Specify)
Ye4b
-
System Devices
Total Number
Total Number
Test
of Units in
Units Tested
- 002
6W, 0 �WEF
Building
123.
Sells, Horns, Chimes
64
64
NIA
13
TOY-
24.
Voice Speakers (Voice Clarity)
-
-
N/A
x
Yes 0
Smoke Detectors
22
22
N/A
Li
Yeos x
.,?5.
�6.
Heat Detectors
-
-
NIA
x
Yest -1.
7
27.
Duct Detectors
-
N/A
x
Y06tVi . . ...
Sprinkler Flow Switches
2
2
N/A
0
Yesk
Sprinkler Supervisory Switches
3
3
N/A
o
Yes—' 0. f
A X
10.
Visual Alarm Devices
11
11
NIA
0
Yes 1,
"N'
?,.,l.
Manual Pull Stations
6
6
N/A
0
Y41s
,V2.
Automatic Door Unlocks
-
-
NIA
x
Yes io
Automatic Door Release
3
3
N/A
.0
Yefx
Communication Equipment
Total Number
Total Number
Test Redubd
of Units in
Units Tested
Building
NIA
x
34. Phone Sets
:35.
Phone Jacks
N/A
x
YeW
.:a6.
Call -in Signal
WA
x
VeW
2.
12/09/2009 21:08 FAX 206 368 7809 Signal Services 03
SIGiVAL SER VrCES
Division of Lynsen Electronics Corp.
iMN AURORA AVE. N, SEAME, WA 98133
2Q6-364-1998
FIRE ALARM SYSTEMS
(One Sy5teM per Report)
CONFIDENCE TEST I X I REPAIRS 1 0
Occupancy Address:
Building Owner:
22127 Highway 99 Edmonds
WA 98026
Travelers Inn
Confidence Test Report
Certification
RED D I YELLOW D I WHITE x
Occupancy Name:
Phone Number:
Travelers Inn
425-776-0200
.Responsible Person: Jeff Kim Phone Number:
-�Bu'ilding Owner Address: 22127 Highway 99 Edmonds WA 98026-8041
-Date of Inspection: 12/9/09 Inspection Type: Annual x Ouarterly 0 Acceptance 0'.
-T
, esters Name
I'Please, Print): yawitz SFD Certification Number: SCP- Y07283
Central station monitoring?
Yes X No 0
Monitoring company name:
Washington Alarm
Control panel manufacturer:
Silent Knight
Model Number:
SKS207
Problems Found: (11 additional room is needed, please add a separate sheet)
Room 20SO hon not functionl- service to be SeChduled
F
Corrections Made: Date Corrected: Corrected By:
(if additional room is needed, please add a separate sheet) SFO Certification Number:
1his certifies that this fire and life safety system has been properly inspected for reliability to cover the m--'7
'ftms listed In this report and Is consistent with Seattle Fire Department Fire Code standaTCIS, C&MV.1 arl_diil�'
.are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester:
Testing Agency:
Mailing Address:
Phone # 206-364-1998
Signal Services
PO Box 9537, Seattle, WA 98109
40
A 1� f--O--7 00 Z 5- (' C;-'
'we C7 F 0 R S.
Fire Incident Report
Edmonds Fire Department
incident *: EF07002275 Case $: $EF07002566 Incident Date: 7/272007
Exposure: 0 3urisdictional Station: 20 Location Type: Street address
Address: 22127 99 HWY
city: Edmonds State: WA Zip: 98026
incident Type: -GGe44RtePAreeff—,00�ef
Shift: C Alarms: 1 Grid: EF107E
Aid Type: None
Alarm Time: (21:47:46) 7/2/2007
Arrival Time: (21:54:07) 7/2/2007
Last Unit Cleared Time: (22:03:09) 7/2/2007
Actions Taken: Enforce code
Investigate
Refer to proper authority
HazMat Released: None
Property Value: 0* Contents Value:
0
Property Loss: 0 Contents Loss:
0
Fire Service Deaths: 0 Civilian Deaths:
0
Fire Service Injuries: 0 Civilian Injuries:
0
Detector:
officer In Charge: DEAN WARREN Assignment:
Command
Mixed Property Use: Not mixed use
Property use: Hotel/motel, commercial
I
-webFIRS.
Fire Incident Report
Edmonds Fire Department
Person('s) Involved
Business name: Travelers Inn Role: Other
Name: Thomas Contreras Phone Number:
Address:
Role: Other
Name: Angela Addison Phone Number:
Address: f
Apparatus and Personnel
Apparatus ID Personnel ID('s)
L20 EF0320 EF1035 EF1112
�-wc[+IRS
Fire Incident Report
Edmonds Fire Department
Incident Number: EF07002275 Exposure: 0 Incident Date: 7/2/2007
Narrative
L20 responded to the listed address for a citizen calling regarding the AFA sounding on call
EF2274. Dispatch short report stated that the person in unit #216 states she has a detector
issue and would like someone to investigate wiring in her unit. Upon arrival I made contact
with the Front Desk worker, Mr. Contreras. I advised Mr. Contreras that the person in #216
had some type of issue. FF Boyle and I roceeded to unit #216 and made contact with Ms.
Addison. She stated that the fire alarm Q gone off a few minutes prior and that they did not
hear it in her room. She pointed out the missing smoke detector and a table lamp that had the
plug removed and the wires placed directly into the outlet. Further investigation by L20 found
that the enunciator panel in the room was filed with some type of putty or caulk making it
unable to alert occupants. Ms. Addison asked if it was safe for her to be in the room. I advised
her that I would not stay in a room with these issues. Talking with Mr. Contreras it was
arranged for the occupants to be moved to another room until repairs could be made. I also
advised Mr. Contreras of the issues found and advised him of the need to repair. L20 returned
in service. Notification of these issues emailed to Fire Marshal, Fire Inspector, and BC. DGW
FF DEA14 WARR
O7/02/0/ 22:!7:4q
PklN| KLUUESIEU 8Y TERMINAL EFPC42
incident History
for:
#EF07002275
Case Numbers:
tEF070@L566 $S20701e0b7
Entered
07/02/07
21A/:L8 V SUPC12 KU/9
Uispatched
0//0d.'01
21:47:3n bY SCPC07 SC767
Enroute
0/02/07
01:09:00
Onscene
07/02/07
21:54:07
Closed
07/02/07
22:03:09
Initial Type:
FAC
Initial Alarm Level: 1 Final Alarm
Level: 1
|'zna1 !ype:
tA[
VIHE ALARM - CUMABHLlAL? Pri: 2
Dispn:
Police 8LK:
E009 Kzre
SiK: EF1OK May Oa]e: 455A-7
Group: EF1 Beet: EF20 S
rc: |
Lacs eE1d/ HWY
JS od1b
�tUM -- [kHvaKEkb INN otwn 220
IT 6W & 2K A 54 Q/
Loc Into: [R:O[URE INN
Name: ADDlSON, ANGELA Addr: CEL
Phone: 4257500907
/2147
(SC779 )
ENTRY
,FIRE ALARM JUST WENT OFF
/2147
(SC767 )
D)bP
E20
#EF11l2 WAKNEN`D-F (L) [M,E`HJ
KF@SY@ HlLLO,R-F [E,M,w
#EF1035 BOYLE,W-F LE,M]
/wl4i
wmSNCPS
E2@
$EF07002566
/d1U
ASSl
TAU21
/214/
$ASNCA6
1AC21
%00.`01205/
/21q/
HI0
E2N
/2147
ASa/
Le0
#01112 WAR%N`0-V IL) LM:E,!U
#EF0320 HILLS,R-F [E`M`R]
#EF1035 BOYLE,W-F [ExM]
/2147
AlQ
TAC21
/2148
/SC//9 )
CHANGE
LOU: 4212/ HuY 90 `EuM --} e212/ H0 00 felh
DM,
NAM: --> ADDlSON, AN6ELA,
ADR: --> LEL;
PHO: --> 4257500907`
TXT: HP IS HEQ LONTACT IN RM 216 AF:nR UBK
/2148
CHANGE
TXT: RP IS REQ CONTACT RE ALARM, AND EXPOSED WIR
ES IN HER RM.
/2149
(SC/67 )
PISEEN
/e149?
ENROUT
L20
M154
(su/ud
UNS[NE
LOW
, 4 u!HY M[}/Ki i,}MPLEX NVI
/a2N3
AOR
L20
/2203
CLOSE
L20
Westfall, John ?
From:
Smith, Mike
Sent:
Tuesday, July 03, 2007 6:03 AM
To:
Warren, Dean; Westfall, John
Cc:
Allison, Steve
Subject:
RE: EF2275
I will follow up this AM.
----- Original Message -----
From: Warren, Dean
Sent: Monday, July 02, 2007 10:38 PM
To: Westfall, John
Cc: Smith, Mik e; Allison, Steve
Subject: EF2275
FM John,
L20 responded to the Travelers Inn for a citizen (resident) calling regarding an AFA (EF2274). She stated she did not
hear the alarm in her room. Not only did I discover that there was no smoke detector in the room (had been removed
at some point) but the enunciator was filled with putty or caulk making it useless. She also showed me an electrical
cord to the night lamp that had the plug end cut off and the wires were placed directly into the outlet. Unit #216. 1
advised the front desk person, Mr. Contreras and he stated it would be fixed. The occupants were moved to another
room.
FYI
Dean
i /C TIRS,
,v t)
Fire Incident Report
Edmonds Fire Department
incident Number: EF06004375 Exposure: 0 Incident Date: 12/18/2006
3urisdictional Station: 16 Location Type: Street address
Address: 22127 99 HWY
city: Edmonds State: WA zip: 98026
Incident Type: Smoke or odor removal
Shift: B Alarms: 1 Grid: EF107E
Aid Type: None
Alarm Time: 17:35:33 12/18/2006
Arrival Time: 17:43:01 12/18/2006
Last Unit Cleared Time: 18:25:06 12/18/2006
Actions Taken: Investigate
Ventilate
HazMat Released: None
Property Value: 0
Property Loss: 0
Fire Service Deaths: 0
Fire Service Injuries: 0
Contents value: 0
Contents Loss: 0
Civilian Deaths: 0
Civilian injuries: 0
Detector:
officer in Charge: DENNIS OFTEDAHL Assignment: Command
Mixed Property Use: Not mixed use
Property Use: Hotel/motel, commercial
ivct)FIRS
Fire Incident Report
Edmonds Fire Department
Person('s) Involved
Business name: Travelers Inn Role: Other
Name: Tomas Phone Number:
Address: 22127 99 HWY Edmonds, WA 98026
Apparatus and Personnel
Apparatus ID Personnel ID('s)
E16 EF0117
1;k
�wcb-FIRS,.
Fire Incident Report
Edmonds Fire Department
Incident Number: EF06004375 Exposure: 0 Incident Date: 12/18/2006
Narrative
on E16's arrival people were outside of the motel. The alarm was sounding. There was no
smoke or flames visible. E16 crew checked the third and second floor. An alarm was sounding
in room *225. The door was locked. The manager had a key and let E16 crew into the room.
There was a haze of smoke and Smell of burning food. A two burner hot plate was found with i
fry pan on it with burned food in it. The hot plate was turned on., The hot plate and fry_pan
were removed to the outside. A power fan was set up and second floor and room # 225 was
ventilated. The alarm was silenced and the reset button activated. The alarm company could
not varify a reset. I advised the night clerk (Tomas) that the system was not reset. And that a
technician will have to come out and service the system. And until that happens someone will
have to be here to provide a fire watch. E16 then retuend.
av - %�
12 . /18/06 18:50:29 PRINT REQUESTED BY TERMINAL EFPC23
Incident History for: #EF06004375
Case Numbers: $EF06004972 $S206023499 01 SC718
Entered 12/18/06 17:35:10 BY SCPC
Dispatched 12/18/06 17:35:33 BY SCPC05 SC712
Enroute 12/18/06 17:38:14
Onscene 12/18/06 17:43:01
Closed 12/18/06 18:25:06
Initial Type: FAC Initial Alarm Level: 1 Final Alarm Level: 1
Final Type: FAC (FIRE ALARM - COMMERCIAL) Pri: 2 Dispo:
Police BLK: E009 Fire BLK: EF107E Map Page: 455A-7 Group: EF1 Beat: EF20 S
Loc: 22127 HWY 99 EDM -- TRAVELERS INN btwn 220 ST SW & 224 ST SW (V)
Loc Info: TRAVELERS & INN Addr: 107 5 AV N #103 EDM Phone: 4257715757
Name: WASH ALARM/#20
/1735 (SC718 ) ENTRY DETAILS TO FOLLOW
/1735 SUPP TXT: 3RD FLOOR - NO RESET
/1735 (SC712 ) DISP E16 #EF0117 OFTEDAHL,DENNIS
/1735 $ASNCAS E16 $EF06004972
/1735 ASST TAC21
/1735 $ASNCAS TAC21 $S206023499
/1737 AIQ TAC21
/1738 ENROUT E16
/1743 (SC718 ONSCNE E16 [99 CMD]
/1748 CALLBK E16 CHECK FOR RESET. ET ON 3RD FLOOR TRIP NOW ALSO
/1807 SUPP TXT: STILL NO RES
2ND FLOOR
/1812? SUPP LOC: 107 5 AV N #103 EDM,
LOCI: OLIVES GOURMET FOODS,,
ADR: 107 5 AV N #103 EDM,
PHO: 4257715757
/1825 (SC770 AOR E16
/1825 CLOSE E16
Fire Incident Report
Edmonds Fire Department
Incident Number: EF06004379 Exposure: 0 Incident Date: 12/19/2006
Jurisdictional Station: 16 Location Type: Street address
Address: 22127 99 HWY
city: Edmonds state: WA Zip: 98026
incident Type: Alarm system sounded, no fire - unintentional
Shift: B Alarms: 1 Grid: EF107E
Aid Type: None
Alarm Time: 04:39:53 12/19/2006
Arrival Time: 04:47:48 12/19/2006
Last Unit Cleared Time: 04:59:51 12/19/2006
Actions Taken: Investigate
HazMat Released., None
Property Value: 0
Property Loss: 0
Fire Service Deaths: 0
Fire Service Injuries: 0
Contents Value: 0
Contents Loss: 0
Civilian Deaths: 0
Civilian Injuries: 0
Detector:
officer In Charge: DENNIS OFTEDAHL Assignment: Operations
Mixed Property Use: Not mixed use
Property Use: Hotel/motel, commercial
wc6FIRS.
Fire Incident Report
Edmonds Fire Department
Incident Numb er: EF06004379 Exposure: 0 Incident Date: 12/19/2006
Apparatus and Personnel
Apparatus ID Personnel ID('s)
E16 EF0117 EF0510 EF1126 EF2376
i/vicbFIRS
Fire Incident Report
Edmonds Fire Department
Incident Number: EF06004379 Exposure: 0 Incident Date: 12/19/2006
Narrative
E16 arrived on scene of the Traveler's Inn, no alarm was sounding. The system had not reset
from an earlier trip the day before EF*4375. There was no fire or event that caused an
activation. The system was reset and confirmed by the alarm company through Sncom. E16
then returned.
Lt DENNIS OFTEDAHL
12/19/06 05:09:39 PRINT REQUESTED BY TERMINAL EFPC23
Incident History for: #EF06004379
Case Numbers: $EF06004978 $S206023520
Entered 12/19/06 04:39:49 BY SCPC04 SC721
Dispatched 12/19/06 04:39:53 BY SCPC04 SC721
Enroute 12/19/06 04:43:01
Onscene 12/19/06 04:47:48
Closed 12/19/06 04:59:51
Initial Type: FAC Initial Alarm Level: 1 Final Alarm Level: I
Final Type: FAC (FIRE ALARM - COMMERCIAL) Pri: 2 Dispo:
Police BLK: E009 Fire BLK: EF107E Map Page: 455A-7 Group: EF1 Beat: EF20 S
Loc: 22127 HWY 99 EDM -- TRAVELERS INN btwn 220 ST SW & 224 ST SW (V)
Loc Info: TRAVELERS INN
Name: WASH ALARM/#14
/0439 (SC721 ENTRY
/0439 DISP E16
/0439
$ASNCAS E16
/0439
ASST TAC21
/0439
$ASNCAS TAC21
/0439
PISEEN
/0440
AIQ TAC21
/0442
SUPP
Addr: R/0438 N/0439 US/0439 Phone: 2063281800
, COMM FIRE ALARM - COVERAGE/2ND AND 3RD FLOOR -
ALARM HAS NOT RESET
#EF0117 OFTEDAHL,DENNIS
#EF1126 SOUCY,JOSEPH HAZMAT TECH
#EF0510 MARTIN, JAMES
#EF2376 BEARDSLEY, DOUG-PARAMEDIC
$EF06004978
$S206023520
TXT: ALARM CO SPOKE TO DESK CLERK - HE SAYS EVER
YTHING SEEMS OKAY ONSITE - UNA BLE TO RESET ALAR
M - STILL NEEDS FD TO RESPOND
/0443 (SC744 ENROUT E16
/0447 ONSCNE E16 MAKING CONTACT
/0456 MISC E16 ALM CO GOT A RESET
/0459 AOR E16
/0459 CLOSE E16
MEMORANDUM
DATE 113010 &
REPORTED BY OF
SUBJECT 2,12 -7 kk:!y-1 I_P'W�6z Is -
ADDRESS:
CONCERNSI
HAZARDS: &e— U.; j j4ee-1 I A-00 jFZ7,41
VY-0 F-r-7— h4v 03CCF-
I A.C7 SIGNED
FOLLOW-UP:
cso-�� -I cX__ 6�
A.d%lAA.r 'Tt!> , . tnrc4g-e A L_
K16j;^ A/& 417 #36wv
,-Y�W &'tl- y'"Wee AC-7-'5_
RZ--A-1 CV%--V
Hours Expended:
[ .0
C-14 LAI Cvet�c�
Ae:. I ev ff0VrF_ -
/ ff -To X-c�
T"7-- f 74 ? Ll�_
SIGNED 4
7 V
City of Edmonds �b Fire Prevention Division
�
' ^ 1
*m�/03/N5
06:41: REQUESTED BY
0� PRINT RE
TERMINAL EFPC4 0
-rncident
History for: #EFW5000/46
Case Numbers: $EF05000884
Entered
03/03/05 05:06:10 BY
SCPC07
SC768
Dispatched 03/03/05 05:06:18 BY
SCPC04
S0762
Enroute
03/03/05 0509:27
Onscene
03/03/05 05:13:01
Closed
03/03/05 06:08:40
Initial
Type: AFA Initial Alarm
Level:
1 Final Alarm Level: 1
Final
Type: SWFA (SPRINKLER WATERFLOW
ALARM) Pri: 2 Dispo:
Police BLK:
E009 Fire BLK: EF107E
Map
Page: Group: EFJ Beat: EF20 Src:
T
Loc:{22127
HWY 99-�EDM -- TRAVELERS
INN (no
xsts) (V)
Lac Info: 425 776 0200
Name: WASHINGTON ALARM
/0506
(SC768 )
ENTRY
/0506
(SC762 )
DISP
E20
/0506
$ASNCAS
EEO
/0506
(SC768 )
SUPP
/0506
CHANGE
/0506
(SC762 )
ASST
E16
/0506
(SC768 )
CHANGE
/0507
CHANGE
/0509
(SC762 )
ENROUT
E20
/0510
ENROUT
E16
/0511
(SC768 )
SUPP
/0511
SUPP
/0511
SUPP
/0512
SUPP
/0512
(SC762 )
MISC.
E20
/0513
NEWLOC
E20
/0514
ONSCNE
EiG
/0515
MISC
E20
/0516
MISC
E20
/0518
MISC
E20
=20
(SC768 )
SUPP
/0520
/N521
/0522
/0524
/0527
/0527
/0529
10530
(SC762 )
(SC719 )
(SC762 )
MISC
�
CHANGE
ASST
MISC
ENROUT
MISC
MISC
MISC
E16
B16
E16
B16
E20
E16
E20
Addr: R/0504 N/0504 S/0506 Phone: 2063281800
,NO FURTHER INFORMATION
#EF1126 SOUCYvJOSEPH HAZMAT TECH
#EF1111 ERICKSON,DAVID
#EF0320 HILLS,RANDAL — RESCUE TECH
$EF05000884
TXT: COVERS — FIRE WET WATER FLOW
TYP: AFA --> SWFA,
RSP: 010 --> 020
#EF0868 STORM,JOHN HAZMAT TECH
#EF2313 SCHLEICHER, 8RIAN
#EF1785 HUNTER, DAVID
ADR: --> R/0504 N/0504 S/0506,
TXT: NO RESET
LOCI: --> 425 776 0200,
PHO: --> 2063281800
TXT: RP FROM TRAVELEH'S INN, ALARM SOUNDING, ROO
M ON 3RU FLOOR ACCROSS FROM 32 1 IS FILLING WITH
WATER
NAM: CHRISTINA
NAMr CHRISTINA,
TXT: RP DOESN'T SEE SMOKE, ISJN HER ROOM
NAM: CHRISTINA,
TXT: FEMALE IS IN THE ROOM WHERE SPRINKLERS, STA
NDING IN THE DOORWAY
,HOTEL BLDG NVI, RESD EVACUATING
[HWY 99 COMMAND ]
, STRNDIN8 BY
,COMM TO E16 — STDBY SPRINKLER HEAD ON 3RD FLOOR
— GETTING READY TO SHUT SYSTEM DOWN
,SPRINKLER 323 SET OFFY16 SHUT SYSTEM DOWN
,HAVE SOMEONE CHECK RM 223
TXT: ALM CO SENDING RESPONDER, RESPONDER INFO TO
FOLLOW
,SHUT DOWN ON E/S OF BLDG
,ALARM CO ADVISING JEFF KIM, RED GEO ETA 20
#EF0326 PETRELLA,MARC
,RAINING IN RM 223
,INCIDENT SWITCHED TO TAC 22
NOWER SHUT OFF IN 223
,WATER AND POWER SHUT OFF IN RM 223
/0530'
/0554
/0608
/06N8
/0608
/0608
(SC733 )
ONSCNE 816
AOR E16
MISC E20
AOR E20
AOR B16
CLOSE B16
,COMMAND TERM
Fire Incident Report
Incident Number: EF05000746 Incident Date: 3/3/2005
Jurisdictional Station: 20 Location Type: Street address
Address: 22127 99 HWY
City: Edmonds State: WA Zip: 98026
Incident Type: Water problem, other
Shift: C Alarms: 1 Grid: efl07e
Aid Type: None
Alarm Date: 3/3/2005 05:06:18 Arrival Date: 3/3/2005 05:14:42
Last Unit Cleared Date: 3/3/2005 06:08:40
Actions Taken: Shut down system, Remove water
HazMat Released: None
Property Loss: 0 Contents Loss: 0
Property Value: 0 Contents Value: 0
Fire Service Deaths: 0 Civilian Deaths: 0
Fire Service Injuries: 0 Civilian Injuries: 0
Detector:
Officer In-Charge:--SOUCY,—JOSEPH--- officer - In Charqe assignment: Command
Mixed Property Use: Not mixed use Property Use: Hotel/motel, commercial
Person('s) Involved
Business name: Travelers Inn Role: Owner Phone Number: 4257760200
Name: Jeff Kim
Address:
P 0 Box:
Role: Suspect Phone Number: 4257061183
Name: Lisa Dougherty
Address: 1521 NW 51st ST 11
P 0 Box: seattle, WA 98107
0
Narrative(s)
Engine 20 responded with E16 to a report of a SWFA at 22127 Hwy 99, Traveler's
Inn. On scene of a 3 story hotel building, crew found alarms sounding with some
occupants evacuated. Crew met with on -site manager who stated there was no fire
and that a sprinkler head was broken. Crew found a broken head in #323. occupant
stated she was going to hang a plant from the sprinkler head and it broke open.
Water was 2-3 nches deep in the room and flowing under the door and into the
hallway. Sprinkler system was shut off and alarms silenced. Room 223 was checked
and had water flowing through ceiling fixtures with water flowing into hallway
as well. Power was secured in this room. on the exterior, water was seeping from
the 3rd floor exterior wall and the ceiling of the open garage area. Tiles in
the garage had fallen due to the.weight of the water.
For water removal, crew removed the toilet in #323 and successfully drained a
good portion of water. Management had a commercial water vac on site and used it
to-quickly-remove-remaining.-mater. The will contact their insurance company for
further cleanup.
Management was advised to contact the alarm and sprinkler companies ASAP, to
restore all alarm systems. Engine 20 in-service.
Acting Lt., Joe Soucy
FF JOSEPH SOUCY
Washington Alarm, Incorporated
1253 South Jackson St reet
Seattle, Washington 98144-2018
October 13, 2000
RE: Ramada Tan-
1-12-ff7'HwY--2-9 - - 2,
- EAftio—iid's, WA 98020
This location continues to be monitored. We have resolved the nonpayrnent issue. If you
have any further questions, please contact Michelle at (206) 328-3288 ext. 701, Thank
you.
S incerely,
%--h'cluff /-). �-
Michelle Liu
Accounting
UL LISTED AND FM APPROVED CENTRAL STATION LICENSED AND BONDED ELECTRICAL CONTRACTOR
WASHINGTON ALARM, INC. - 1253 South Jackson Street - Seattle, Washington 98144-2018
(206) 328-3288 Sales - (206) 328-1800 Central Station -(206) 322-7214 FAX
Z*d VH�L ZZE 9OZ 0N1'V1dV7V N0J.0N1HSVM HOdJ Hdvz:Lt OOZ-ZL-01
Washington Alann Inc. Phone: 206-328-3.288
1253 S. Jackson Street Fax: 206-322-7214
Seattle, WA 98144 www.washingtonalarm.com
FAX COVER SHEET
TO; =A'C' Jp� DATE: (0)
ATTN: TIME:
FROM: FAX #:
Cc:
RE:
NUMBER OF PAGES INCLUDNG COVER SHEET: 7>
MESSAGE -
This fax is CONFIDENTIAL and intended for the recipients listed above ONLY. If you have received this fax
in error, please call the number below for fiather instructions. If your fax machine does not ase plain paper,
please copy this fax onto plain paper for preservation purposes.
If you have any problems with this fax and/or you have received this fax in error, please call 206-328--1288.
UL LISTED AND FM APPROVED CENTRAL STATION
LICENSED -AND BONDED ELECTRICAL CONTRACTOR
L'd 'PLZL ZZE 90Z 0N1'HdV-1V N0i!DN1HSVM H0dJ Ndvz:Ll OOZ-ZL-01
Sent By: Washington Alarm Inc.; 208 328 6755;
*,ashingtofi Alarm Inc.
'111253 S. Jackson Street
Neattle, WA 98144
Oct-5-00 10:44AM; Page 1/1
Phone: 206-328-3288
Fax: 206-32"755
www.walarm,com
DATE: AW tf)4�� TIME:
FIRE DEPARTMENT: AX NUMBER:
! i
H
PREMISE NAME.,
,0
P SE ADD=
H
K�
'the Fire Alarm at the �bove referenced premise is no longer being monitored.
REASON:
SERVICE TO BE
EXPECTED RENST
COMMENTS:
SIGNATURE:
TED? C1 YFS
TWENT DATE;
4Z:� 126- 7-76OZOO
OPERATOR 0- m
UL AND FM APPROVED CENTRAL STATION
H LIANSIPT) AND RONDED ELKCMCAL CONTRACTOR
6;6:�- 0,%j IT #C16 tf7--
SIGNAL\SERVICES
P�
FAX
11728 Ammro Ave. A . Seattle. WA 9a 13)
#*h*'W; MN J6.1 1999
Dote July 9, f 999
Number of pages including cover sheet 3
TO. Inspector Smith FROM.- Lisa Nordin
Edmonds Fire Dept
Phone Phone 206-364-1998
Fax Phone 425-775-7721 Fax Phone 206-368.7809
REMARKS: Urgent Foryourreview El ReplyASAP C1 Please Commont
Ramada LimiW Hotel
Annual Firg Alairm, Test
22127 HN. 99
FORM3 W0R0,FAXC0%WII DOO
'Z'O*d 6S:7,T 66'60 Irf . ON -131
SEATTLE FIRE DEPARTMENT
CONFIDENCE TESTING
FIRE ALARM
Address:
Occupied as: __AA1nAnA j1m,,rw-,6
BuildingOwner: Phone:
7 �_ -_
NAME OF TESTER CERTIFICATION NO.: -Z— 2
Date of Inspection: Type Of InspWion: Quarterly [3 Annual 0 Acceptance [3 Other
Control panel manufacturer: -5/4 Qt�7'_�t, �jra#T -Model No.: �007
No. of initialing circuits; No. of Signal Circuits;
Battery voltage: —_ ;� ?, :2 42 volts Charge circuit voltage: Q 2.
�92
volts
Battery voltage under full load: - Q71 2L volts (signals operating)
1
Trouble signal with AC power off: ............. I ......... I ....... Yes [RNo C]
N/A
2.
System operates satisfactory on standby power: .........................
yes 0 No []
N/A
3.
All signals operate of AC power: ............. ........................
Yes ONO F1
4.
Have all alarm notification appliances been chocked for proper operation? . . . - .
Yes KNo Fj
5.
All circuits chocked for electrical supervision: ............................
yes 1KNo [j
NIA [3
a.
Control panel checks made per manufacturer's instructions: ................
yes JZNo []
NIA []
7.
All auxiliary equipment operates: (Elevators, fans, dampers) ................
Yes �MNo 0
NIA [D
8.
Central station or remote connection: ..................................
yes ZINO El
NIA El
Name of Monitoring Company: __ U)AS',41A,1(522v
9.
Key to panel available: ..............................................
Yes ZNo
N/A
10.
Operating instructions at panel?: ........ ............................
yes RNo
N/A
111.
Service Label or Tag (SFC. Appendix I ll-B) .............................
Yes �@No F-1
(Over)
RE: FIRE ALARM TEST (Continued): EQUIPMENTTESTED
�0*d 6S:Zl 66'60 Irr . ON 131
SATISFACTORY
TYPE OF EOUIPMENT
NUMBER OF
UNITS TESTED
YES
NO
N/A
NO. OF UNITS
IN BUILDING_
Sells, Horns, Chimes
Voice Alarm SpeA
VIsual Alarm Devices
IV
Trouble Indicators
Super. Switches Coutosor.)
Q
Auto Spr. Flow Switches
Smoke Detector(
Heat Delector(&)
Manual Pull Stations
Ventilation Controls Op#Rte
Q
'et
Centeral Station
Annunciators
y
Elevator Call Dow n
Fire OamperstSmoke Dampers
y
Phone Jacks
Auto, Door Unlocks
(Failsafe)
—
Auto. Door Release
X
I
Other
Problems
found: A)OA)E-
IF MORE SPACE IS NEEDED, ATTACH SEPARATE SHEET.
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 THIS REPORT.
SIGNATURE OF OWNER OR REPRESENTATIVE:
SIGNATURE OF TESTER, C&S� -
cy
Electrical License No. � LfdL%�j=g F?
AGENCY: Y16NQ4 '�rrelaLz PHONE: QOe- 30'- d�ZA?
MAILING ADDRESS: 160"( 47&:7-7- - rEA-r;r4 r !FP/,T7
w0ft: COW W DOC
TO'd 8S:Zl 66,60 Irr . ON 131
��-s t . 18 () '
April 18,1996
CITY OF EDMONDS
250 5TH AVENUE NORTH - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning e Parks and Recreation * Engineering
Sang M. Kim
SMK Development
8308 Fredrick Place
Edmonds, WA 98026
RE: Permit #9605851- 22121 Highway 99
5 5 Unit Motel
Dear Mi. Kim:
k ECE I VE I'
APR 21199)
� iwONDS FIRE Dr "I
BARBARA FAHEY
MAYOR
This letter is to inform you that no mechanical permit has'been obtained for the above noted
project. No further inspections will be given until a mechanical permit is obtained. Your
application for a mechanical permit must include two sets of detailed mechanical plans, a schedule
of all mechanical fixtures, an energy code analysis and a completed permit application.
Sincerely,
5".
Ann Bullis
Plans Exan-dner
cc: Geston Construction, 2100 196th Street SW, #115, Lynnwood, WA 98036
Building Inspector
Fire Marshal
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
MEMORANDUM
Date: October 6,1995
To: Jeannine Graf, Buildings Official
From: Gary L. McComas, Fire Marshal
Subject: Plan Review, Kim 55 Unit Motel, 22127 Hwy 99
After review the fire department has the following comments:
1. a copy of the automatic fire sprinkler plans must be submitted for -review.
2. a copy of the fire alarm system must be submitted for review.
EDMONDS FIRE DEPARTMENT
OFFICE OF THE FIRE MARSHAL