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22716 HWY 99'ZZ71(p' FIRE PREVENTION Serving. 'r tct,- uuid0l7ds, atid 12425 Meridiati Ave S INSPECTION REPORT SNOHOMIsli CO. F1. E Mountlake Terrace Everett, WA 9820 8 IMEDMONDS 0 BRIER T Phone (425) 551-1200 0 MOUNTLAKE TERRACE [I UNINCORPORATED www.FireDistrictl'.org Fax ('425) 551-1272 LOCATION: 22716 Highway 99 98026 Gilson Restaurant BUSINESS NAME: MAILING 22716 Highway 99, Edmonds, WA 98026 ADDRESS: BUSINESS OWNER: EMERGENCY-1: KEY ACCESS-2: A LAM 1 RV-4 EMAIL: PERSON CONTAC.TED; A t-A A4 NAME OF INSPE(�TOR: L, Zl,) 6 Date Last Serviced: Vwr�- 4256735334 PHONE: HOME PHONE: #-A-,- - ltzov Ija;72f) HOME PHONE: Z,-Xe W713 4p 3 to 7 HOME PHONE: , 'TEnQUUE Sly& n ajCY SHIFT SCHEDULED Mar 2017 DATE DUE Ibl UFIR CURRENT CITY YE .& (D BUSINESS LICENSE 42--r :0 INITIAL INSPECTION DATE 'S/11/17 , FIRE PREV.�NTION Serving Brier Edmonds, and 12425 Meridian Ave S INSPECTION REPORT SNOHOMISH . c(la)& Mountlake Terrace IR Everett, WA 981-108 OEDMONDS OBRIER, I S RkT Phone (425) 551-1200 0 MOUNTLAKE TERRACE qQN1 . INCORPORATED www.FireDistrictl.org Fax (425) 551-1272 FREQUENCY STATION & SHIFT LOCATION: 22716 High-,Aay 90 08026 Itlual 20-C BUSINESS NAME: Gkinn Rm-LauranL PHONE: 426035M SCHEDULED hilar 2014 DATE DUE MAILING UFIAbl �DDRESS: 2271E I ligh�Aray 30. bdamrids, WA 08026 BUSINESS OWNER: HOME PHONE: EMERGENCY-1: Lirm I lar�k, HOME PHONE: 425E73272f) CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS V] El EMAIL: LICENSE PERSON CONTACTED: LA INITIAL INSPECTION DATE NAME OF INSPECTOR: FE\tl ILHI)(2),3113 HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 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 lst RE -INSPECTION DATE DUE: 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTEDTO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: E: 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 '8 4 '8 DATE: DISPOSITION: 7 LETTER NEEDED [] YES NO LETTER NEEDED [:] YES El NO 8 FIRE DEPARTMENT COPY Range Hood Systems Report A FIRE CONTROL NO" 877-866-3473 Phone / 877-841-9293 Fax PO Box 11369 Olympia, WA 98508 CUSTOMER .Name 0 Addressj;�Z city Ayl 0114-S State 1,�,,La,.ZIP _%nac �Telephone tore No. bwner or Manager �OOKING APPLIANCE LOCATIONS: LEFT TO RIGHT DATE OF SERVICE TIME I I *a I A.M P.M. - ;� / /-I / / I . 0 <) X, ANNUAL sr-&ANNuAL __ RECIIARGE IISTALLATION RENO1111TION I 'X LOCATION OF SYS IEM CYLNOERS UL 300 IDYES []NO N%NUFACTURER MOULLNUMBER VA"T DRYCKEWCAL CYUNMVZO(�STER V CYLtNnFR SZE SLAVE CYLINDER SIZE SLAVE q q C, ( I N____ * I FUSE LO�k 3160- F. FUSE LINKS 45UO F. FUSE LINKS W0- F. OTHER FUaSHUTOFF ELECTRIC GAS SIZE X I - )( 3ERLALNU&IDER LAST HYDRO TEST DATE LAST RE -CHARGE DATE I MANUFACTUREKS MANUAL PREFERENCE [PAGENUMBEH'. _ _ DRAV0ING NUMBER: nATE e K All appliances property covered w/correct nozzles 1, 20. Replaced fuse links 2. Duct and plenum covered w/correct nozzles Y. 21. Check travel of cable nuts/G-hooks 3. Check positioning of all nozzies X 22. Piping & conduit securely bracketed 4. System installed In accordance w/MFG UL listing le 23. Proper separation between fryers & flame 6. Hood/duct penetrations sealed w/weld or UL device X 24. Proper clearance - flame to filters 6. Check if seals intact, evidence of tampering Y. 25. Exhaust tan in operating order .7. If system has been discharged, report same -4 26. Ali filters in place 8. Pressure gauge in proper range (if gouged) 27. Fuel shut-off in on position 9. Check cartirdge weight (if applicable) 28. Manual & remote sellseals in place 10. Hydrostatic test date &e- 29. Replace systems covers ll. 6 year maintenace date 30. System operational & seals in place 12. Inspect cylinder and mount 31. Slave system operational 13. operate system from terminal link 32. Clean cylinder & mount 14. Test for proper operation from remote 33. Fan warning sign on hood 5. Check operation of micro switch 34. Personnel instructed In manual operation of system 16. Check operation of gas valve 35. Proper hand portable extinguishers 17. Clean nozzles 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place 37. Service & Certification tag on system ,tl 9. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW X COMMENTS: On this date, this range hood fire suppression system was inspected and operationally test?o in accordance wi�h the fire suppression system requirements of N FPA1 7 or 17A, 96 and the manufacturer's manual, yvitti. tl�@ results indica ted above. -7c X Aa7� '0 Q _"SERVICE CH ICIAN PERMIT NO. DATE: TIME: AM PM CUST-q-J�R'S AUTHdRl�Ec ',AGENT The above service technician certifies that the system was personally inspected and found cond(tions to be as indicated on this report WHITE - CUSTOMER COPY I CANARY - DISTRIBUTOR / PINK -AUTHORITY HAVING JURISDICTION Range Hood Systems Report r I A .FIRE CONTROL "W40' 877i.866-3473 Phone / 877-841-9293 Fax PO Box 11369 Olympia, WA 98508 CUSTOMER Name -at vqej yj H?a Address �Q7) 6 cj qq city n1jk)-s State _L-2!2:, ZIP atQ2 Te I ep h o n e Q a _r, - A Store No. a I Owner or Manager APPLIANCE LOCATIONS. LEFT TO RIGHT DATE: OF SERV.*CE -I IWE A.M. P.M. - � /21 / I !i, I C) 0 I I ANNUAL SEN.1-ANNUAL RECHARGE INSTALLATION RENOVATION X LOCATION OF SYSTEM CYUNDERS UL 300 YES [] NO MANUFACTURER MODZ-:LNUMDrR wEr DRY C4 iEMICAL 'AMC., I I T� ..10- ;L, X I CYLINDER 31ZF MASTER CYLINDER SIZE SLAVE CYUNOER SIZE SLAVE FUSEUNKSMO-F. USEU F NKS45PF. 1USELINrS,1114F, OT"Ell FUELSHUrUFF ELECTRIC GAS SIZE A SEFUALNUMOCR LAS] HYDRO TESTONTE LAST RECHARGE DATE MANUFACTURER'S MANUAL PREFERENCE PAGE NUMiiem: DRAWING NUMBER; DATE jj. All appliances property covered w1correct nozzles 20. Replaced fuse links Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/G-hooks Check positioning of all nozzles 22. Piping & conduit securely bracketed 14. System installed In accordance w1MFG UL listing 23. Proper separation between fryers & flame ..5. Hood/duct penetrations sealed w/weld or UL device 24. Proper clearance - flame to filters x 6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order X 7. If system has been discharged, report same 26. All filters inplace 8. Pressure gauge in proper range (if gauged) 27. Fuel shut-off in on position X 9. Check cadrdge weight (if applicable) 28. manual & remote set/seals in place "A 10. Hydrostatic test date 29. Replace systems covers 11. 6 year maintenace date 30. System operational & seals in place 12. Inspect cylinder and mount 31. Slave system operational 13. Operate system from terminal link 32. Clean cylinder & mount , 14. Test for proper operation from remote 33. Fan warning sign on hood ."15. Check operation of micro switch 34. Personnel instructed in manual operation of system Check operation of gas valve 35. Proper hand poriable extinguishers �17� Clean nozzles 7+ 36. Portable extinguishers properly serviced .18. Proper nozzle covers in place 37. Service & Certification tag on system 19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this range hood fire suppression system was inspected and operationally tes;pd in accordance with the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual,jofth the results ipj'cated above. 'A x 62SI-7 0 0 1 '--S�RVICE TECHNICIAN PERMIT NO. TIME; AM PM- CUS�OMtR"S AUTHt*IfED AGENT The above service techNclan certifies that the system was personally inspect( bund cnnclih Jlcated on this report.' WHITE - CUSTOMER COPY I CANARY - DISTRIBUTOR I PINK -AUTHORITY HAVING JURISD DATE OF SERVICE *.-,I Z, Y _3 rF I - () 0 1 'ZNUAL SIM14WNUAI RFCHARG1 INSTALLATION RENOVATION I X I ArION OF SYSTEM CYLINDERS UL 300 aIES [3NO MANUFACIURER MODELNUMBER W4T DRYCHEMICAL AVK-t,,l I ?- I 0-;k, >C I CYLIMER SIZE MASTER CYLINDER SIZE SLAVE - CYLINDER SIZE SLAVE FUSE LINKS 3W F. FUS 460-F. E LINKS FUSE LENK95WF, OTHER FUELSIIVTOFF ELECTRIC GAS S17F X A X I SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE I :)'n 0 MAJ4UFACTURFFrS MANUAL PREFERENCE FAGFWV.0EFL DRAWINGNUMBtH: DATE Range Hood Systems Report A A FIREgCONTROLO 877-866-3473 Phone / 877-841-9293 Fax PO Box 11369 Olympia, WA 98508 CUSTOMER Name -o, 1-5nrl 3 .Addrej qq bity 60a0 -Ar'K?6nAS- State L)�� ZIP 'T'01 C/ Telephone /-n5 Store No. I Owner or Manager COOKING LOCATIONS: LEFT TO RIGHT I . All appliances property covered w/correct nozzles 'A 20. Replaced fuse links 2. Duct and plenum covered w/correct nozzles N4 21, Check travel of cable nuts/G-hooks ,3. Check positioning of all nozzles 14 22. Piping & conduit securely bracketed ,4. System installed in accordance w/MFG UL listing P. Proper separation between fryers & flame Hocd/duct penetrations sealed w/weld or UL device 24. Proper clearance - flame to filters '6. Check if seals intact evidence of tampering 25. Exhaust fan in operating order If system has been discharged, report same 26. All filters in place 14 8. Pressure gauge in proper range (if gauged) 27. Fuel shut-off in on position 1. 9. Check cartirdge weight (if applicable) 28. Manual & remote settseals in place .10, Hydrostatic test date Y. 6 date 29. Replace systems covers ,11. year maintonace 30. System operational & seals in place i12. Inspect cylinder and mount 31. Slave system operational -AI/A 13. Operate system from terminal link 32. Clean cylinder & mount 14. Test for proper operation from remote 15. Check operation of micro switch A- �3. Fan warning sign on hood 34. Personnel instructed in manual operation of system 16. Check operariop'of gas valve 35. Proper hand portable extinguishers 17. Clean nozzles 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place -?C 37. Service & Certification tag on system 19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this range hood fire suppression system was inspected and operationally te t d in accordanpip with the fire 'suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manua!�(_,-(thrlhe results �dicatedabove. VOC) SERVICE TECHNI PERMIT NO. DATE: TIME: A. 1. jT-H rjIZED;�GENT The above service technician certifies that the system was personally inspected and found conditions In hp as ind it 'd cri this report. WHITE - CUSTOMER COPY I CANARY - DISTRIBUTOR / PINK - AUTHORITY HAVING JURISDIC�LN j Range Hood Systems Report 'A FIRECONTROLO i 877-866-3473 Phone 1 877-841-9293 Fax PO Box 11369 Olympia, WA 98508 CUSTOMER .Name 64 5 9 �Nddre 7 b, 1-1 i�ty ACIIE2,0y7jS State _&Jo, ZIP *Ie' e 11Z -�_7_3-6 3' 1 Store No. Ire phon 16�vner or Manager 60KING APPLIANCE LOCATIONS: LEFTTORIGHT DAIF OF SE RI/-5/ -a TIME -.0 AAC I P.M. C) kl ANNUAL SE-M $-AN IIECIIARGE 1113TAILATKIN RE-OVAno,4 XN— I LOCATION OF SYSTEM CYLINDER$ UL 300 Vii �-r h ev) I@Yrs []NO MANUFAC1UfMR 1"ILNIIIIIIER WET DITYCII&IOM CYU E MAST R CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE FUSE 36DO F. K FUS �: S 45DO F. FUSE UNKS 11D" R OTHER rutLSIIUMFF ELECTRIC- GAS SIZE X SERIAL NUMIIER 1 AS r HYD ROTES7 DATE LAST RCCItARGLUAW IN 96 WkNUFACTURrR'S MANUAL PREFERENCE PAGE NUMBER: DRAWNG NU.MaER: DAI E I.-, All appliances property covered w/correct nozzles 20. Replaced fuse links X 2 1 Duct and plenum covered w/correct nozzles 7�, 21. Check travel of cable nuts/G-hooks Check positioning of all nozzles 22. Piping & conduit securely bracketed 4 System installed in accordance w/MFG UL listing 23. Proper separation between fryers & flane 5. Hood1duct penetrations sealed w/weld or UL device 24. Proper clearance - flame to filters -Check if seals intact, evidence of tampering 25. Exhaust fan in operating order :7.': If system has been discharged, report same 26. All filters in place Pressure gauge in proper range (if gauged) 27. Fuel shut-off in on position 9.*',-'. Check cartirdge weight (if applicable) 28. Manual & remote set/seals in place io.! Hydrostatic test date 29. Replace systems covers 6 year maintenace date 30. System operational & seals in place Inspect cylinder and mount 31. Slave system operational .13. Operate system from terminal link 32. Clean cylinder & mount Y. Test for proper operation from remote 33. Fan warning sign on hood X 4K Check operation of micro switch 34. Personnel instructed in manual operation of system _7 1, 6., Check operation of gas valve 35. Proper hand portable extinguishers jT-7:. Clean nozzles 36. Portable extinguishers properly serviced ii 8. Proper nozzle covers in place 37. Service & Certification tag on system 19 Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: �5,4eial A — C�w� 0_ bil VqA On this date, this range hood fire suppression system was inspected and operationally tested in accordance with the fire sq uppression systqT requirements of NFPA1 7 or 17A, 96 and the manufacturer's manual, with the results indicated above. lyd I i� TIME AM PM CUSTOMER'S AUTHORIZED A�;Ehl SERVICE TECHNIC�AN PERWIW DATE: �E, _�_. Tfie* above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. I Fr�"i I" WHITE - CUSTOMER COPY I CANARY - DISTRIBUTOR / PINK - AUTHORITY HAVING JURISDICTION Range Hood Systems Report FIRE CONTROL 877-866-3413 Phone / 877-841-9293 Fax PO Box 11369 Olympia, WA 98508 . �! CUSTOMER .Name—d)i --snrl 1g.gn "'A A:J�&a Addres p"ity w"Al -S State Z I P &OP 0 i"ephone a3t IStore No. �bwner or Manager APPLIANCE LOCATIONS: LEFT TO RIGHT X n I All appliances property covered w/correct nozzles 'A 2.. Duct and plenum covered w/correct nozzles 3. Check positioning of all nozzles Y System i6stalled in accordance w/MFG UL listing '5. Hood/duct penetraflons seated wtweld or LIL device Check if seals intact, evidence of tampering If system has been discharged, report same R.' Pressure gauge in'proper range (if gauged) Check cartirdge weight (if applicable) 110" Hydrostatic test date I 1. 6 year m aintenace date Inspect cylinder and mount 11 � 3. Operate system from terminal link Test for proper operation from remote Check operation of micro switch A ,1 6� Check operation of gas valve W. Clean nozzles 'A A-8, Proper nozzle covers in place ---%u P. Check fuse links and clean 1 COMMENTS: Z�qf- 0:!j 4L-:;Q4. 4 f '�7) $'.I -A DATE OFSERVICE. TIME A.M. P.M. ANNUAL RECHARGE 04STALLATIO.N RENOVATIOM rEMI-ANNUAL I LOCATION! OF SYSTEM CYLINDERS UL 30C 15LYES ONO W�A�,ACTVREJ`e YVET DRY CH=-MtM Lk �ELNUMBEK lx� CYLINDER SIZE MASTER CYLIM>ER SIZE SIAVE CYLINDER 82E SLAVE 3 1 1 FUSEUNKS38NF. FUSE LINKS 45W F. Avahlw FUSE LINKS 500 F. 01HER J7UFLs5Zw#: ELECTRIC GAS SIZE IX X -k I SERIAL NUMBER LAST HYDROTE67 DATE LAST RFCIAARGE DATE LIANUFACTUREWS MANUAL PnEPERENCE IA-INUNIIIER: DRAWING NUMBER: 20. Replaced fuse links 21. Check travel of cable nuts/G-hooks 22. Piping & conduit securely bracketed )c 23. Proper separation between fryers & flane X 24. Proper clearance - flame to filters %- 25. Exhaust fan in operating order A 26. All filters in place y 27. Fuel shut-off in on position 28. Manual & remote set/seals in place 29. Replace systems covers 30. System operational & seals in place AIIA 31. Slave system operabonal 32, Clean cylinder & mount X 33. Fan warning sign on hood X Y. 34. Personnel instructed in manual operation of system 35. Proper hand portable extinguishers 36. Portable extinguishers properly serviced 37. Service & Certifidation tag on system NOTE DISCREPANICES OR DEFICIENCIES BELOW N .04.n this date, this range hood fire suppression system was inspected and operationally tested in accordance with the fire §'uppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual, with the results indicated above. 3 SERVICE TECHNICIAN PERMIT NO. DXI'E: TIME: AM PM CUSTOMER'S AUTHORIZED AGENT t'k. .T,4e above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. WHITE - CUSTOMER COPY / CANARY - DISTRIBUTOR / PINK - AUTHORITY HAVING JURISDICTION Range Hood Systems Report DATE I rimi: 1. A,M. I RM. �q7ff f /.�), X 00 �1\ ANNUAL SEMI-ANNUAL I RECHARGE INS-TALLAVON RENOVATION I X LOCATION OF SYSTEM CYLINDERS UL 300 10,66\/ MYES ONO FACTURER MODELNUMSFR WET ORYCHEWAL X MINDEN $1Z% MASTEN CYLINDER 814.: SLAVE CYLINDER SUE SLAVE FUSEUNKS3WF. FUSE LINKS 450- F. FUSE LINKS 600. OTHER -3 FUM SHUTOFF ELEMW GAS WE SERIAL NUMBER LAST i IYORO IEST UAI C LAS r RECMRGE DATE c. MANUFACTURER'S MWAL I'WERENCE PAGE NUMBER.- DRAVING NUMSEM, DATE A 6-1 A$ M FIRE CONTROL 877-86�-.3473- Phone / $77-841-9293 Fax PO Box 11369 Olympia, WA 98508 CUSTOMER Name - ( Address C i ty 64 Vk7 oljrj State jn2�Zl P T�lephone store No. Owner or Manager I OOKINGAPPLL4NCE LOCATIONS: LEFTTORIGHT X -�� d__ All appliances property covered w/correct nozzles 2. Duct and plenum covered w/correct nozzles Check positioning of all nozzles System installed in accordance w/MFG LIL listing 5. H.00d/duct penetrations sealed w/weld or LIL device Check if seals intact, evidence of tempering 7' If system has been discharged, report same B., Pressure gauge in proper range (if gauged) 9. Check cartirdge weight (if applicable) 10. Hydrostatic test date 11, 6 year maintenace date !12. inspect cylinder and mount Operate system from terminal link .13. Test for proper operat on ornremote ,15. Check operation of micro switch 1 '16 -,Check operation of gas valve _t_, '17., Clean nozzles Proper nozzle covers in place Check fuse links and clean COMMENTS: Olk 20. Replaced fuse links 21. Check travel of cable nuts/G-hooks 22. Piping & conduit securely bracketed X 23. Proper separation between fryers & flane Y, 24. Proper clearance - flame to filters 25. Exhaust fan in operating order 26. All filters in place 27. Fuel shut-off in on position A—_ 28. Manual & remote set/seals in place 29. Replace systems covers 30. System operational & seals in place 31. Slave system operational Aa 32. Clean cylinder & mount 33. Fan warning sign on hood 34. Personnel instructed in manual operation of system 35. Proper hand portable extinguishers 36. Portable extinguishers properly serviced 37. Service & Certification tag on system NOTE DISCREPANICES OR DEFICIENCIES BELOW ---%— ,in this date, this range hood fire suppression system was inspected and operationally tested in accordance with the fire sqppression system rp.,quirements of NFPA17 or 17A, 96 and the manufacturer's manual, with the results indicated above. The above service technician certities that the system was personally inspectea ano touna conaitions to no as inaicalea on this report. FWHITE - CUSTOMER COPY i CANARY - DISTRIBUTOR / PINK - AUTHORITY HAVING JURISDICTION 22. Piping & conduit securely bracketed X 23. Proper separation between fryers & flane Y, 24. Proper clearance - flame to filters 25. Exhaust fan in operating order 26. All filters in place 27. Fuel shut-off in on position A—_ 28. Manual & remote set/seals in place 29. Replace systems covers 30. System operational & seals in place 31. Slave system operational Aa 32. Clean cylinder & mount 33. Fan warning sign on hood 34. Personnel instructed in manual operation of system 35. Proper hand portable extinguishers 36. Portable extinguishers properly serviced 37. Service & Certification tag on system NOTE DISCREPANICES OR DEFICIENCIES BELOW ---%— ,in this date, this range hood fire suppression system was inspected and operationally tested in accordance with the fire sqppression system rp.,quirements of NFPA17 or 17A, 96 and the manufacturer's manual, with the results indicated above. The above service technician certities that the system was personally inspectea ano touna conaitions to no as inaicalea on this report. FWHITE - CUSTOMER COPY i CANARY - DISTRIBUTOR / PINK - AUTHORITY HAVING JURISDICTION ,in this date, this range hood fire suppression system was inspected and operationally tested in accordance with the fire sqppression system rp.,quirements of NFPA17 or 17A, 96 and the manufacturer's manual, with the results indicated above. The above service technician certities that the system was personally inspectea ano touna conaitions to no as inaicalea on this report. FWHITE - CUSTOMER COPY i CANARY - DISTRIBUTOR / PINK - AUTHORITY HAVING JURISDICTION APPLICATION FOR PERMIT FOR MATERIALS OR PROCESSES January 3, 2012 Please verify and correct the following information: P Name of Company (DBA): Gilson Restaurant Edmonds Location : 22716 Highway 99 In confor mity with the terms of the International Fif6—Gode, appli6a—tio—n is hereby made to store, use Places of Assembly - Occupant Load: 53 or maintain the following activity, storage or pro- cesses: Mailing Address: 22716 Hwy 99 Edmonds, WA 98026 EFD UFIR #: 1610530106 (for office use) Your Signature Your Name (print) ry-) V�O_U_r Title 0 IAI Y7 ' 1� ' Please make corrections, attach $40 payable to the City of Edmonds and mail to: Fire Marshal Department of Fire Prevention 121-5 th Avenue North Edmonds, WA 98020 FOR OFFICE USE ONLY Rec d s 4.6 Check# 3 DFP 1-11 , 6�' F'A'&W""dul tvA q86W Range Hood SysteTs Report SERVICE COMPANY - F I R E 40, M A S T E R S A Division of IZM Services, Inc. 877-866-3473 Phone 1 877-841-6293 Fax PO Box 1] 369 Olympia, WA 98508 CUSTOMER Name !�2n a cyll All , C. Address22�2i6 w1AIL 15 C i ty A rw in A, s State 1)�, zlp%rab Telephone 'J�2S'- 137 -533�\ Store No. Owner or Manager COOKJNG APPLIANCE LOCATIONS: LEFTTORIGHT DATEOF$Eh'4CE A.M1 P.M. 3M11121 ITIMF 11:� 1 06 I y ANNUAL 15EMI-ANNUAI I1EC4AR11E IN3TALLAT;QN RENOVATION I LOCATION OF SYSTEM CYLINOUtS UL M 1�,L V ", []YEs ONO 0 eJ MANUIdCTURER MODELNUMBER WFT URYCAIEWCAL �11,rhe 1-1 <4!5 >< CYLiNq,0 SIZE MASTER SLAVE CYLINDZR SIZE SLAVE kii 4 91t% I FUSE Lbh& M0- F. FUSE LINKS 450- r. ruW, LWKIa 5111, E, 011,Ek FUEL SHUTOFF ELEC IMIG GAS SIZE L SFRIAF- NUMHER ST WDROTEST DATE LAZIT R C C I M GE DATE I jql(6 MANUFACTURER'S MANUAL PREFERENCE PAUENUMBEW ORNWING NUMBER;* OATE 1. All appliances property covered w/correct nozzles 20. Replaced fuse links 4- 2. Duct and plenum covered w1correct nozzles X 21. Check travel of cable nuts/G-hooks 3. Check positioning of all nozzles X 22. Piping & conduit securely bracketed _X 4. System installed in accordance w1MFG LIL listing 23. Proper separation between fryers & flane 5. Hood/duct penetrations sealed w/weld or UL device 4- 24. Proper clearance - flame to filters K 6. Check if seals intact, evidence of tampering - 25. Exhaust fan in operating order 7. If system has been discharged, report same X 26, All filters In place 8. Pressure gauge in proper range (if gauged) 27. Fuel shut-off in on position 9. Check cartirdge weight (if applicable) 28. Manual & remote set/seals in place 10. Hydrostatic test date X 29. Replace systems covers 11. 6 year maintenace date X X 30, System operational & seals in place 12. Inspect cylinder and mount 31. Slave system operational X 13. Operate system from terminal link 32. Clean cylinder & mount 14. Test for proper operation from remote 33, Fan warning sign on hood 15. Check operation of micro switch X 34. Personnel instructed in manual operation of system 16. Check operation of gas valve 35. Proper hand portable extinguishers 17. Clean nozzles X_ 36. Portable extinguishers properly serviced 18- Proper no771a covers in place 37. Service & Certification tag on system 19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: arn e-,) L . . ...... ... On this date, this range hood fire suppression system was inspected and operationally test�d in' ccordance with the fire suppression syster�,requlirements of NFPA17 or 17A, 96 and the manufacturer's manual, with th results indicated above. X 4 V-1 7 SERVICE TECHNJeTAN PERMIT NO. DATE TIME: AM PM CUSVK4qR`,14U'n4ORIZED AGENT The above service technician cerfifies that the system was personally inspected and found conditions WNW as indicated an this report. IC WHIT E -CUSTOMER COPY CANARY -DISTRIBUTOR I PINK -AUTHORITY HAVING JURISD 'Range Hood Systems Report SERVICE COMPANY F I R E i, M A S T E R S A Division of RM Services, Inc. 877-866-3473 Phone / 877-841-6293 Fax PO Box 11369 Olympia, WA 98508 CUSTOMER Name 6-il 4_;ny? I!, ryk r_ 0 -, C rle Address City,,.,- 610oj Stateu-p- ZIP 1'11�") Te I e p h o n e 33'! Store No. Owner or Manager COOKING APPLIANCE LOCATIONS.- LEFT TO RIGHT Y- IfflyTIME &M. AWDAL S`7"UA` I Rra LARGE INSTALLATION RFJ#QVAT- LOCATION OF SYSTCM CYLINDERS UL WO 10YFS []NO UREY DELWMSER VVLI' DRYCIIEWCAJ� CYLINDER SIZE MASTE CYLINDER SIM SLAVE CytJ*JDER SUE SLAVE 1115F0101113101F FUSE LINKB AIMP F. FU'.WLINV_9SWF. OTHER ruEL ShU`rOrF ELECTRIC GAS SIZ17 '*X. SERLALNU."ER ....... ... LAW I IY1DR0 TEW DATE LASTRECHAFMI! DATE MANUFACTURER'S MANUAL PREFERENCE PAGE NUMBER: DRAWHONUMBM. DATE I . All appliances property covered w/correct nozzles 20. Replaced fuse links 2. Duct and plenum covered w1correct nozzles 21. Check travel of cable nuts/G-hooks 3. Check positioning of all noz-4es X 22. Piping & conduit securely bracketed 4. System Installed in accordance w/MFG UL listing X 23. Proper separation between fryers & flane X 5. Hood/duct penetrations sealed wtweld or UL device X 24. Proper clearance - flame to filters X 6. Check if seals Intact, evidence of tampering X 25. Exhaust fan in operating order 7. If system has been discharged, report same 3< 26. All filters In place 8. Pressure gauge in proper range (if gauged) 27, Fuel shut-off in on position 9. Check cartirdge weight (if applicable) 28. Manual & remote settseals in place 10. Hydrostatic test date 29. Replace systems covers 11. 6 year maintenace date 30. System operational & seals in place 12. Inspect cylinder and mount 31. Slave system operational 13. Operate system from terminal link 32� Clean cylinder & mount 14. Test for proper operation from remote 33. Fan warning sign on hood 15. Check operation of micro switch 34. Personnel Instructed in manual operation of system 16. Check operation of gas valve 35. Proper hand portable extinguishers 17. Clean nozzles 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place 37. Service & Certification tag on system 19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this range hood fire suppression system was inspected and operationally testedlp accordance with the fire suppression system requirements of NFPAI 7 or 17A, 96 and the manufacturer's manual, with Joe results indicated above. X SERVICE TECH (CIAN PERMIT NO. 'DA-(E: TIME: AM PM C�U�M AGAUTHORIZED AGENT The above service rechnician certifies that the system was personally inspected and found condit[ s b as indicated on this report. WHITE - CUSTOMER COPY I CANARY - DISTRIBUTOR I PINK - AUTHORITY HAVINP JURISDICTI7ON Range Hood Systems Report SERVICE COMPANY , F I R E 40, M A S T E R S A Division of RM Services, Inc. 877-866-3473 Phone / 877-841-6293 Fax PO Box 11369 Olympia, WA 98508 CUSTOMER Name &,i son aA icl',Ien Address �a-711, I "I I city rS",tVjj State Wc, ZIP "?Z), Telephone �1';6-63_�)�:VoreNo. Owner or Manager COOKING APPLIANCE LOCATIONS., LEFT TO RIGHT "'IT F I --), TIVIF M%ocj I AM. I R.M. X ANNUAL SEM "rAL I RECHARGTJ INSTALLA71014 HENOVAVION LQr.A,AQ' N OF SYSTEM CYLINDERS UL 3W 4no Yyl [gyiis []NO MANUFACTURF MOOFLNUMBER WFF DAYCHEMICAL I Vv� LA or,)- X vYuwm,wrmAsTrR cyLiNneR aim vmr CYLINDER SIME SIA%M rUSE LINKS 350- F. FUSE LINKS 45M F. F USF LINKS 5W- F. OTUER FUEL5HUTOFF ELECTRIC OAS SIZE �>� >C I >< I SERIAL NUMBER LAST hYDR0 TEST DATE - LAST RECRARGE DATE e"�Oo L( I MAKMACTUREWS MANUAL PRU14RENCE PAGE NUMBEM DRAWING NUMBER: DATE 1� All appliances property covered w/correct nozzles Ix 20. Replaced fuse links X, 2. Duct and plenum covered w/correct nozzles X 21. Check travel of cable nuts/G-hooks, X 3, Check positioning of all nozzles X 22. Piping & conduit securely bracketed X 4. System installed in accordance wJMFG UL listing X 23. Proper separation between fryers & flane X 5. Hood/duct penetrations sealed wtweld or UL device X 24. Proper clearance - flame to filters 6. Check If seals intact, evidence of tampering X 25. Exhaust fan in operating order 7. If system has been discharged, report same _X_ 26. All filters in place 8. Pressure gauge in proper range (if gauged) --X- 27, Fuel shut-off in on position 9. Check cartiridge weight (if applicable) X 28. Manual & remote set/seals in place 10. Hydrostatic test date 29. Replace systems covers 11. 6 year maintenace date T 30. System operational & seals In place X 12. Inspect cylinder and mount 31. Slave system operational 13. Operate system from terminal link 4- 32, Clean cylinder & mount 14. Test for proper operation from remote A 33. Fan warning sign on hood V X 15. Check operation of micro switch 34. Personnel instructed In manual operation of system 16. Check operation of gas Valve 35. Proper hand portable extinguishers 17. Clean nozzles 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place 37. Service & Certification tag on system K 19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this range hood fire suppression system was inspected and operationally teste4 in accordance vvith the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual, wit the results indicated above. X. SERVICE TECHN�CIAN PERMIT NO. DATE: TIME: AM PM The above service technician certifies that the system was personally inspected and found coi FVS AUTHORIZED AGENT as indicated on this report. WHITE -CUSTOMER COPY / CANARY- DISTRIBUTOR / PINK -AUTHORITY HAVING JURISDICT107N APPLICATION FOR PERMIT FOR MATERIALS OR PROCESSES March 7, 2011 Please verify and correct the following information: m4y PkiD EDMONDS Z�Z�E DEPT. Name of Company; DBA Gilson Restaurant Edmonds Location 22716 Highway 99 In conformity with the terms of Places of Assembly - Occupant Load: 53 the International Fire Code, application is hereby made to store, use or maintain the following activity, storage or processes: Mailing Address: 22716 Hwy 99 Edmonds WA 98026 EFID LIFIR #: 161053000106 (for office use) Your Signature Your Name (print) Your Title 6WNEk- Please make corrections, attach$40 payable to the City of Edmonds, and mail to: Fire Marshal Department of Fire Prevention 121-5 th Avenue North Edmonds, WA 98020 well CITY OF EDMONDS DEPARTMENT OF FIRE PREVENTION PERMIT January 1, 2011 161-053-000-106 December 31, 2011 Date of Issue LIFIR Number Date of Expiration This PERMIT is issued to: I Gilson Restaurant located at: 122716 Highway 99 Edmonds, WA To engage in the business, occupation or process of: And shall constitute permission to maintain, store, use or handle materials or to conduct process which produce conditions hazardous to life or property or to install equipment used in connection with such activities as follows: Places of Assembly - Occupant Load: 53 I Allowed Occupant Load: 1 53 Pursuant to the provisions of the International Fire Code, any violation of the Code may be grounds for the revocation of this PERMIT. This permit does not take the place of any license required by law and is not transferable. Any change in the use or occupancy of premises shall require a new permit. This Permit Must Be Posted At All Times in The Premises Identified Above City of Edmonds Community Development Code 19.25.020 was PM Froo-KINKO'—S.L.L.Y.N_NW.O.O.D...,- 425 774 6403 T-497 P.002/003 F-278 Thunder Group Inc. Since 1956 r, Xy rr AftJ1 ANSI/ NSF-4 CSA, M P-%Hje 21W4 BBQ GR ILL _4allk 414*" *;q*71 41" ;MA21-11 1911*jt� 1-471.-- *71 "V] 0114 md OW-S 4- _M -4 �A_ -4 V A 4 -A mem�l q1 71 t It * I )-Q IN14. MAI 2W*1951) W.J2 471 --1 *4 *11 AJ,�f q *I,-- q ot 280CA1.1-9 4 iirVi "M 74 X-714 WI q _F* *t� 16M rel *91 471t, "_V-1 A*qlq. VW3 1921 M49 NIM" I&I V-71 TV *V_ *444 VA31 4 -_�* 1.71 V-6 Vj A &K-* 41 Vt.S.RM Aj+0j IM 90 *V MAMI "1*_1 Act 01-491M M*"Dv*�c %ql _701714_z� lei A)*"q-S "14 41A 4A 4711' 2% aftdr' ZR4 V*4^2�112 .11" 4404N41 ams M"qiml tRoj A414_" 44E�� "'M 0;; jW171q_1_P1 QJVH 2q;P TQCq;P4!k±L 7) -_-� *ILI-54 .71 V%. -3�* "].% 540q M &A '§&SV71.71 "IN 4, _Scpa"A sqol "*I ft6 W"% AMWO W_^-RW -?OIL* kWl V15' lim 91 it ?r'4- --7LD1 -VE4,- sel ';�- ".. 41 V .1 'g -Ti W= lFral t: Al P_ V "R 1-0 1 d 1� c� L+ qFi 7139 4*01. MI-01 NON-STICK GREDDLES SOLDSEPARATELY I— r I. 4W Elm" CIP us CSA'Gote AbNAM" *R71 A)*t *Rlard 2 _rA1 TIE 'dq*1)VAq-) wuxx Laccar unay ame PH".61 x ".* WNR F C V 'D '._.jNjF 14 1/4 iWies (362mm) T4 _YT 7-7 Nov 19 2.003 I.. LES GTR j)LVEL01'MEN1 S':�hvl C MY of Fv.)Mows 1. Only Korean Gas BBQ Grill in USA with both CSA and ETLapproval to meet ANSI/NSF4 Standards. 2. Smokeless. 3. Cooks perfect beef, pork, fish, and vegetables every time. 4. Fail -sae thermocouple safety control. 5. Fan operation on -off switch. 6. Electronic spark ignition. 7. Full factory support. T'n R &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 ESTABLISHMENT NAME COMPLETE FIRE PROTECTION High Pressure Hood Cleaning Fire Suppression Installation & Service Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Sales & Service ADDRESS qq CITY, STATE, ZIP C�6Am&jns IjA 196.2(o PHONE !4a,c— ba3, — SYSTEM LOCATION/HEIGHT Are, LA4414-_ CONFIDENCE TESTING RANGEHOOD SYSTEM TEST REPORT DATE 10C,7 d-3 SEMI ANNUAL ANNUAL FUEL GASVGASn ELEC.. ELEC.0 SHUT-OFF YESAJNO LJ YES NO SYSTEM ALARM YES — NO [�,DRY POWDER SYSTEM XWET CHEMICAL SYSTEM Is pressure gauge indicator in operable range? YESK NOD Was system operational from terminal link? Weigh CO2 or nitrogen cartridge. Was system operational with manual remote? Are all lead and wire seals intact? Are there are any visible signs of a system fire or system tampering? If yes, check and report. Check all piping and conduit. Are all piping and conduct immobilized with proper hangers and brackets? Are self -closing caps operational? Are all protective covers replaced on nozzles? Is system UL 300 compliant? Are all nozzles checked in the proper position? Does system need additional volume and/or nozzles? Are there any appliances out of hood protection area? YESg NOE] YESO Nov YESW NOD YESO NODO)k YESLX NOD YESE] NO YESE] N YESEI N6V YEEIT� NOE] 11-3 Have fuse links been replaced? YEN ,�J=N= MM7 M WIN NOMMENEMMMM ERNUMMENNENRE mmmmmmmm M1111110"MIXEMMMM W"MMMMMMMMMM1111 —0.92MMMMMMMM MMMMMMMMMMNIl"___%11K=21j -,z-.Npem�"NIMMMMMMMMMFAFAMIFAMMMMMMMMMM ,,t Or jo _. MMMMMMMMMM1jV.K11 M1 MACIANI MMMMMMMMMr8AWjMR1jMMMMMMM mmmmmmmmmummmmumawwki7-sonammmmmmmmmoti7vism mmmmmmmmm mmmmmmmmmmmompromompsmpommmmmmmmmmmilmmmmmmmmmmmm immmmmmmmmmimriiiiiamomfimu;gi:i LAMINIMMINK&A SAMMON001101 Was system and micro switch operational? Is system visible and free from obstruction? Is the inspection and service tag on the cylinder? 12 year hydro date of cylinder. Were hand portable extinguishers properly serviced? Were all cooking surfaces protected? If not, give owner full information YES NOD YES� NOE] YESE] N000(k YESW NOD YEEg NOD YES, NOD X YESE] NOK Was verbal operations procedure given to YESK NOD restaurant personnel? Was UL300 compliance explained to owneko:r7;YESyJ NOE] manager? Grease buildup in group: Heavy, recommend cleaning — Medium — Light COMMENTS: Z-5 Axl &L &.aa,6,2e 40F�7_� ffA.f �A, M_A'FrA0r--1'-5W1-F 1i 11 r MOWN F4,1 NAME OF SERVICE PERSON Ki)(-Ptff The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1. The extinguishing system is in its proper location. The 6. The nozzle disc caps and their seals are intact, undamaged and tight. extinguishing cylinder is in place and has not been removed 7 The inspection tag or certificate is in place and current. or tampered with. 8. If any deficiencies are found, appropriate corrective action shall be 2. The manual pull stations are unobstructed and in clear view taken immediately. and are labeled for intended use. 9. A record of the monthly inspections is to be kept reflecting the date 3. Insure that all tamper seals are intact and that system is in a inspected, inititals of person performing the inspection and any ready condition. corrections required. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. 5. The pressure gauge reading on the cylinder shall be in the AUTHORIZED green operable range. SIGNATURE FIRE DEPARTMENT COPY -v m -n m c: z m rrl m 0 UL 300 COMPLIAHT SYST E M MFG. AIISUL R. 102 3 GAILI-0t] lkNUAL PULLS C) :5 0 G) 33 0 C) < n M m vl� cn 0 > mm cl CROWH RESTAURAHT 22716 HVVY 99 EDMONDS WA. 98020 %-ArAt3L-r- FLURY 1-1 A L I UAL FLV ;? INSTALLED BY R & T HOOD SERVICES INC- 6100 12-rH S. SEATTLE WA. 9010B PHONE (206) 726-0940 FAX (206) 767-2607 "n Name m mo- 04 (�p 4:Z 360* FUSE LINKS 2.5'HOODS "� 811 x 14" GAS BROILER NOTE: m All pipe is black schedual 40 m No fire alarm 0 System operating and maintenance instruction posted by manual pull E 2-A 1 BC K Back up portable fire extinguisher (54" Max above floor level) located along path of egress within 30'travel distance m Plenum nozzle must be located within 6" of end of plenum and deviding the length into sections equal to or less than 10' X N Cylinder has mechanical corTtrol head M M M a M- C= M B" x 8" DUCT S 3 GALLON ANSUL R1 02 FIRE SYSTEM MANUAL PULL BY EXIT 48" ABOVE FLOOR 0 El" x 14" GAS ELECTRIC BROILE AUTOMATIC �) GAS SHUTOFF SYSTEM I M ELECTRIC GAS VALVE RESET RELAY CROW11-11 RESTAURAHT UL 300 COrAPLIA"T 22716 HWY 99 SYSTerl MFG. AtISUL R 102 3 GALLOIJ EDMONDS WA. 98020 CAPA 8L � FLOW 11 ACTUAL FLOW 6 INSTALLED BY R & T HOOD Sr=RVICr=S INC. 6100 12TH S. SEATTLE WA. 98108 PHONE (206) 726-0940 FAX (206) 767-2607 16 L-Sr.-M-0. ram _0 X m -n fq m n M cm F eV, x 14`� ......... . T x -14" ------- -------- 8x 14' GAS SROL ER BPf' ALER BROILER NOTE, a AN ptie, is Wwk scheW:al 40 a No *P- "Awn wid dion po'ded by mwwj pufl 2-A I 8C il, ea0 up portabie *e extriu-sher (54" M�x aWim lloor �evef) kocaed dmg p;wh of egre" "4vtKo W ifavei 4.0ance 0 PLNnum non-te. mud Lxr, �orcgp-4 S"Awl V of end of P�enws and devid-ka the lefvth into ons ooqw� to or �e,�,t then I q 0 Cyrindw hu mftmhalrk,�Nl control Nod -S' TEM 2 3 GALLON AWSUL Rl L12 FIRE TMEPA ELECTRIC fGAISN I/A LVE RESET MAI NUAL. PLCL. RELAN BY 6KIT 49' ABOVE FLOOR ELECTRK AUTOMATIC GA S S H U T F F CPA- Ml RESTAURAUT OL �"O COWLIAlff Y.171 6 WIN, 99 SnTEM MF'G, AUSUL R 10Z 3. rALL16-11 ED"ONDS W.A.- 98020 CAPAME FLOW ft ACTUAL FLOW 9 DISTALLEg By R & T HOOD SERVICES INC� 6100 Or" S, SEATTLE WA, W08 PMME 9,206) 726-0940 PAX (206) 70-2607 SECTION IV — SYSTEM DESIGN UL EX. 3470 ULC CEx747 Page 4-28 REV. 3 10-1-02 Nozzle Application Chart The following chart has been developed to assist in calculating the quantity and type of nozzle required to protect each duct, plenum, or appliance. NOTICE This chart is for general reference only. See complete details for each type of hazard. Minimum Maximum Hazard Nozzle Nozzle Hazard Dimensions Quanti Heiaht Duct'for..-Transition Length — Unlimited 1 (Single Nozzle) Perimeter — 50 in. (127 cm) Diameter — 16 In. (40.6 cm) Duct or Transition Length — Unlimited 1 (Single Nozzle) Perimeter — 100 In. (254 cm) Diameter — 31 7/8 in. (81 cm) Duct or Transition Length — Unlimited 2 (Dual Nozzle) Perimeter — 150 in. (381 cm) Diameter — 48 In. (122 cm) Electrostatic Precipitator Individual Cell (At Base of Duct) Plenum Length — 10 ft. (3.1 m) 1 (Horizontal Protection) Plenum Length — 6 ft. (1.8 m) 1 (Horizontal Protection) Width — 4 ft. (1.2 m) 1 Plenum Length — 4 ft. (1.2 m) I (Vertical Protection) Width — 4 ft. (1.2 m) Fryer/Split Vat Fryer** Maximum Size (without drip board) 15 in. (38 cm) x 14 In. (36 cm) High Proximity 1 27 — 47 in. Medium Proximity 1 20 — 27 in. Maximum Size (without drip board) 19 1/2 in. (49.5 cm) x 19 in. (48.2 cm) High Proximity 1 21 — 34 in. Low Proximity 1 13 — 16 in. Maximum Size (without drip board) 18 in. (45.7 cm) x 18 in. (45.7 cm) High Proximity 1 25 — 35 in. For multiple nozzle protection of single fryers, see detailed Information on Pages 4-12 through 4-14. (64-89 cm) F! 25 Nozzle Tip Nozzle Part No. Stamping — Flow No. 430912 1100 419337 2W 419337 2W 419334 1/2N 41 9335 1N 430192 1100 419336 1W 419336 1W 419339 230 419340 .245 419338 3N 419342 290 419338 3N RECF.IVED FEB - -9 2004 PERMIT COUNTER SECTION IV — SYSTEM DESIGN a EX. 3410 ULC CEx747 Page 4-30 REV. 3 10-1-02 Nozzle Application Chart (Continued) Minimum Maximum Hazard Nozzle Nozzle Hazard Dimensions Quantity Helahts Griddle Longest Side (High Proximity) 1 30 — 50 in. 48 In. (122 cm) (76 — 127 cm) Area — 1440 sq. in. (perimeter (9290 sq. cm) located) Lon gest Side (High Proximity) 1 30 — 50 in. 30 in. (76 cm) (76 — 127 cm) Area — 720 sq. in. (center located) (4645 sq. cm) Longest Side (High Proximity) 1 35 — 40 in. 36 in. (91 cm) 0 (89 — 102 cm) Area — 1080 sq. in. (perimeter. located) (6968 sq. cm) Longest Side 1 20 — 30 in. �Medium Proximity) (51 — 76 cm) 48 in. (122 cm) (perimeter Area — 1440 sq. in. located) (9290 sq. cm) Longest Side (Low Proximity) 1 10 — 20 in. 48 in. (122 cm) (25 — 51 cm) Area — 1440 sq. in. (perimeter (9290 sq. cm) located) Chain Broiler* Longest Side — 34 In. (86 cm) 2 10 — 26 in. (Overhead Protection) Area — 1088 sq. in. (25 — 66 cm) (7019 sq. cm) Chain Broiler Length — 43 in. (109 cm) 2 1 — 3 in. (Horizontal Protection) Width — 31 in. (79 cm) (3 — 8 cm) Gas -Radiant Char -Broiler Longest Side — 36 in. (91 cm) 1 15 — 40 in. Area — 864 sq. in. (38 — 102 cm) (6574 sq. cm) Electric Char -Broiler Longest Side — 34 in. (86 cm) 1 20 — 50 in. Area — 680 sq. in. (51 7 127 6m) (4388 sq. cm) Lava -Rock Broiler Longest Side — 24 in. (61 cm) 1 18 — 35 in. Area — 312 sq. in. (46 — 89 cm) (2013 sq. cm) Natural Pharcoal Broiler Longest Side — 24 in. (61 cm) 1 18 — 40 in. Area — 288 sq. In. (46 — 102 cm) (1858 sq. cm) Lava -Rock or Natural Longest Side — 30 in. (76 cm) 1 14 — 40 in. Charcoal Char -Broiler Area — 720 sq. in. (36 — 102 cm) (4645 sq. cm) Minimum chain broiler exhaust opening — 12 in. x 12 In. (31 cm x 31 cm), and not less than 60% of internal broiler size. . . ` " , A` . � I—, Nozzle Tip Nozzle Stamping — Pa[I No. Flow No. 419341 260 419342 290 419335/417332 1 N/1 NSS 419342 290 419343 2120 - 419336/417333 1W/1WSS 419335/417332 1N/1NSS 419335/417332 1 N/1 NSS 419335/417332 1N/1NSS 419335/417332 1N/1NSS 419335/417332 1 N/1 NSS -419338 3N RF-ceiVED FEB -.4,2004 PERMIT COUNTER