23025 100TH AVE W (4)1 1'. 4,
SNOHOATIS14 CO.
FIRE
DI mm'
SAJ
5
Z3o?_)— 100�h POE -
Serving Brier, -Lamonds, and 12425 Meridian Ave S
Afountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrict].org Fax (425) 551-1272
LOCATION: 23025 100 th Avenue W 98026
BUSINESS NAME: Chopsticks In Edmonds
MAILING
ADDRESS: 23025 100th Avenue W, Edmonds, WA 98026
BUSINESS OWNER: Woo, Terry
EMERGENCY-1: Woo, Boyt- I ...... . ... .
KEY ACCESS-2:
EMAIL:
......... . ....... ...........
6
7
PHONE: 4257761196
HOME PHONE:
HOME PHONE.
HOMERV6NE: 20
FIRE PREVENTION
11�4MTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCYT-STATION & SHIFT*'
Annual 20-B
SCHEDULED
DATE DUE II' Jan 2017
UFIR � 161 204
CURRENT
CITY YES,, NO
I
BUSINESS
LICENSE
WITIAl 1KlQDE:rTlrAKl MATC
5
6
7.
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
....... ...
CONTACTED:
INSPECTOR:
INSPECTOR:
..INSPECTOR:
2
DATE:
DATE:
DATE:
3
vimki6iNs
PRE -CITATION
CITATIO14 ISSUED
L MkR SENT
NUMBE
4
C DE
0
%V.�_
2 6
2 �6
DATE:
SE ION:
RETURN
RECEIPT
3 �7
3 7
RECEIVED
6
DISPOSITION:
7
4 �8
4 .
wl�l
. .........
. ........
, _
LETTER NEEDED YES NO
.. ........... . ...... . .. ... I'll,
LETTER NEEDED C] YES 0 NO
0
.Serving Brier, Edmonds, and 12425 Meridian Ave S
,,Mountlake Terrace. Everett, WA 9820&
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 23025 100 th Avenue W 98026
BUSINESS NAME: Chopsticks In Edmonds PHONE: 4257761196
MAILING
ADDRESS: 23025 1 00th Avenue W, Edmonds, WA 98026
BUSINESS OWNER Woo, Terry HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
[3 MOUNTLAKE TERRACE
[3 UNINCORPORATED
00 FREQUENCY I STATION& SHIFT
Annual 20-A
SCHEDULED
DATE DUE � Jan 2016
IFIR 11, 161 204
U __j
civir-mur-ro., T-i: Woo, Boyd HOME PHONE: 2067237051 CURRENT.
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
EMAIL: LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: Y-ok CCN
FIRE SYST , EMS: FE 10/14)UL300 10/15
Date Last Serviceds [Ul /6 lv(fiff
HAZARDS FOUND AND LOCATIONSPCOMMUNICATIONS
2
2
iA/v
3
3
4
4
5
5
6
6
7 'A
7
I AGREE TO cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTAC ED-
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS;�
PRE -CITATION
C I TAT �10_N TS—S U E D
1
LETTER SENT
NUMBER:
4
CODE
6
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
7
--RECEIVED
6
.3
DISPOSITION:
4
DATE-__1'_
7
LETTERNEEDED [:] YES NO
LETTERNEEDED [:] YES NO
8
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name:
Occupancy Address: -,zneLl�;
Responsible Person: Ttrn�_
Building Owner:
COMPLETE Certification Given: RED [] YELLOW El WHITE Z
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service CONFIDENCE TEST 0 REPAIRS
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE: 1 Z2 12 A;
;, , 'V,,f CityState,Zip: .,GdM0-C
Phone Number:
Phone Number:
Building Owner Address: — City, State, Zip: — _7657IGc,
Testers Name (Please Print): V,,�rr fnalk K-f- Lk-) S SFD Certification Number: SCP-
System Alarm? Yes E] No [Z Central station monitoring? Yes E] No 0 Monitoring company name:
Control Panel manufacturer: Model Number:-- Location of Alarm Panel:
Extinguishing System Manufacturer ROLI, I Si I \ U L 300 Systw� Yes Noo U.L. 300 Compliant? Yes 7No E] Chemical Type: Weto Dry
4 e y
Location / Height of Range hood: ki icQ, Y
Is pressure gauge indicator in operable range? Yes E21 No 12 year hydro date of cylinder.
Is there chemical inside of the cylinder? Yes F/I No [j Were hand portable extinguishers properly serviced? NAE] Yes [Z No
Weigh CO2 or nitrogen cartridge. NAV
j Were all cooking surfaces protected? If not, give owner full Yes No E]
No visible signs of a system fire or system tampering (if signs check no). Yes [Z No F_� information.
Check all piping and conduit. Are all piping and conduit immobilized with Yes 7 No F-1 Was operating procedure verbally given to restaurant personnel? Yes No
proper hangers and brackets? Was LIL 300 compliance explained to owner or manager? Yes [Z] No Ej
Are all protective covers present on nozzles? Yes [Z No E] Gas shuts down upon system activation? NA [j Yes Z] No E]
Are all nozzles checked in the proper position? Yes V No [j Electric power shuts down upon system activation? NA El Yes No El
Does system have adequate volume and/or nozzle coverage? Yes [Z No Ej Range hood tied to building alarm panel? NA� Yes No
Are all appliances inside of the hood protection area? Yes [7
.j No F-1 Range hood activation signal received at building alarm panel? NA Yes F No Ej
Have fuse links been replaced? Yes [Z NoF Class K extinguisher present? Yes Vj No E]
Was system operational from terminal link? Yes FA_ No Ej Grease buildup in group:
Light M di _Z_ Heavy, recommend cleaning
Was system operational from manual remote? Yes [;a No E]
Was system and micro switch operational? NAE] Yes 7 No Date of last cleaning
Is system visible and free from obstruction? Yes Ft] No E] Are cleaning intervals within N PA standards? FA 1:1
I No Lj
Is the inspection and service tag on the cylinder? YesT No Ej Previous Confidence Test Company & Technician
MMMMMMMMM
INN
M ME
0 ME
ON
M
NEON
MMME
0
ON
0 0
NO
M
MOM
MEN
EN
so
ON
M
NIMEM
MENEM
0
No
MM
M
M
0
NOON
No
MEMO
OEM
0
MEMO
ME
MM
N
ONEEME
ONE
ME
No
MOM
momms
sommosom
m�om
No
MENOMMON
MEMO
�mmommsimom
in
MINIMMOM
Mims
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INN
No
M
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sm�
ON
Problems Found: (If additional room is needed, please add a separate sheet)
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: 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. Discrepa Oct a n rje
p ed to thebuilding Ow
,,�r/Responsible Person for corrective action.
Signature of Tester: A PAA -Y-1� Phone # (206) 726-0940
Testing Agency::::::: o an Duct S rvices, Inc. MailingAddress: 610012thAve.S..Seaftle,WA98108
Theow ri t p4worm 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 extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in pl4ce and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriat , e corrective action,qbAllbe �taken immediately.
intended use. 9. A record of the monthly inspections, is to be kept reflecting the ected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspectionand ahy cK!&ons -required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
� 0—
R AAA"
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
COMPLETE
FIRE PROTECTION
High Pressure Hood Cleaning
Fire Suppression Installation & Service
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service .
Occupancy Name:
_% IcLwr -4 k
E_
Occupancy Address :
A j,&7—
Responsible Person: !J�� Ile L4
Building Owner:
Building Owner Address:
Testers Name (Please Print): XA
System Alarm? Yes F� No� central station
monitoring? Yes[] NoZ
Control Panel manufacturer:
Model Number: —
Extinguishing System Manufacturer R
System Size I.I.L. 300
Location / Height of Range hoc
I
n Z�001111
is pressure: gauge indicato6noperable, range?-
Y s No
Is there chemical inside of the cylinder?
Yes ET No F-1
CO2 or nitrogen 6aft6a
No visible signs of a system fire or system tampering (if signs check no). Yes No
C�h6,c��all'�p*ip,ing,,and,cqpouil:,-,�re;,all.piping and conduit
immobilized with Yes No
proper*ainiers,and brackets?
Are all protective covers present on nozzles?
No F]
Are aII'nozAIes'checkqdJn,the , proper position?',
-Yes-[D"
Yes 131 No
Does system -have- adequate volume and/or nozzle coverage? Yes E?r' No F]
Are�'qllappliances,insic!6 ofthe hood protection area?
Yes E�J' No
Have fuse links been replaced?
Yes EZ' No F-1
Was sysie ri-o'perational from t - erminallink?
Y;sf:5 Not]
Was system operational from marival remote?
Yes [� No E]
Was system and Micro switch operational?
NA?r Yes F� No
Is system visible and free from obstruction?
Yes Z Noo
Is the inspection-'ain'-d service tag on 66 cylinder?
Yes Er No [7
Problems Found: (If additional room is needed, please add a separate sheet)
Certification Given: RED E] YELLOW E] WHITE
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
City, State, Zip:
Phone Number:
Phone Number:
City, State, Zip:
SFD Certification Number:
CONFIDENCE TEST REPAIRSE]
SCP- S-a.&749
Monitoring company name:
Location of Alarm Panel:
3tem?YesZNo[] I.I.L. 300 Compliant? Yes j'No E] Chemical Type: Wet EeDry E]
12 year hydro date of cylinder.
a -portable extinguishers propArly serviced?
__Wereh nd
NA Yes
Were all cooking surfaces protected? If not, give owner full
YesE?r NoF�
information.
Was operating procedure v erb a Ily 'given t6 restaurant personnel? Yes No'[] -
Was UL 300 compliance explained to owner or manager?
Yes F/I No Ej
-das shuts down upon system ac I tiva - tio . n?
NA-ri- -Yes?r_- NoD
S
Electric power shuts down upon system activation?
NA ?5' Ye -E]
-hange hood tied to building _. a __
_al rm panel?
NA Yes No�
L
Range hood activation signal received at building alarm panel? NA Yes No F]
Class K extinguis I h - er present?
Yes No
Grease b Id in group:
Light Medium— Heavy, recommend
AC� _' k - L.1
Date of last cleaning 0 11 C4 a
cleaning
. ---
E]
Are cleaning intervals within NFPA standards.
s R!r' No
Previous Confidence Test Company & Techriician _iR141r.
LAO
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: SFD Certification Number:
A /1�
This certifies that this f e d I 'fe safe� ste 6be(prop rly 4invcted for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
ort I
3te j t
.01, �
3 e�
standards. Discrepa Caanre note. e e rted ng Owner/Responsible Person for corrective action.
Signature of Tester: Phone # (206) 726-0940
Testing Agency: MailingAddress: 610012thAve.S.,Seaftle,WA98108
_A"ood and D- Q-nd
40E
The Aner 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 extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate . �1013ce and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, a Xopriqe corrective action-4wVtaken immediately.
intended use. 9. A record of the monthl ns is to b4 kept reflEpklthe date inspected, inititals of
y Lor (=.W.
d
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the I an Fy orreci s required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED,
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTIVIENr copy
COMPLETE Certification Given: REDD YELLOWE] WHITES2 I
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R AAA" High Pressure Hood Cleaning — SYSTEM TEST REPORT
&THood and Duct Services, Inc. Fire Suppression Installation & Service FCONFIDENCE TEST REPAIRS9 1
6100 12th Ave. S. Phone (206) 726-0940 Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy Name: (f /to '51-1 C- & :r
Occupancy Address: '02 0/.*0 QVI-e,11-5r 4J t4—
_I o 01, 5— t4cle- k city, state, Zip: ' -,A�- 7- ety < 7)
Responsible Person: 727ir-C!j Phone Number: .2 4
Building Owner: Phone Number:
Building Owner Address: City, State, Zip:
Testers Name (Please Print): 5 SFD Certification Number: SCP-
System:Alamn? 'Yes E] No 5�r-- Central station monitoring? Yes E] NoL2r- Monitoring company name:
Contr&l Panel manufacturer: Model Number: Location of Alarm Panel:
/t -L 4—/
Extinguishing System Manufacturer System Size d�f<../ U.L. 300 System? YesE] No7 I.I.L. 300 Compliant? Yes E] No [j Chemical Type: Wet E] Dry El
Location / Height of Range hood:
Is pressute! gaugt indicator in, operable range? Yes-c]--Noo 12 year hydro date of cylinder.
Is there chemical inside of the cylinder? Yes E] No El �_,Were handpprtable extinguishers properly serviced?
Weigh CO2dr nitrogen�cartridge, Were all cooking surfaces protected? If not, give owner full
No visible si ns of a s stem fire or s—tem tampering [if signs c c nol Yes r--1 No F-1 information.
2- <> / 6--
NA [] '-N�es N 0 01"
Yes NOE]
Was operating procedureverbally giv - n to restaurant pers,6nel? Yeso
Check, al ' . Irpipin g and c onduit,-Are�,all piping and conduit im ilized with Yes n No
pr9perhan rs
ame' and brac'kets? Was UL 300 compliance explained to owner or man r? Yes
t 0 s., - Yes
Are all protective covers present on nozzles? Yes Ej No F� Gas shuts down upon s stem activation? NAn
Y.
ti
Are all, noziles�checked in the proper position? Yes (:] Non Electric power shuts down upon system ac' tion? NAEJ Yes El
Does system have adequate volume andlor zzle coverage? Yes El No Range hood tied to building alarm pa NA Yes
O'ume an
00 Pro t.
0 Range hood activation signal r!e�qq4ed at building alarm panel? NAE1 Yes F-1
t
— , ' n area? Noo
Are, all,appliances inside the hood pr Yes
Yes
Have fuse links been reriloa'ced? Yes No E] Class K extinguisher prese I
No E]
No El
No 11
No El
No El
NOD
No El
Was'/,sisteiml,operatignil from ter i al link? Yes Noo Grease buildup in gro
Light— Pool,' Medium Heavy, recommend cleaning
Was system operational from nual remote? Yes E] No El
Was�,,iystem,and-microswit operational? sLI No E] 'bate of last' anirig
NAO ye
ng inte
Is system visible and free f m obstruction? Yes r--j No E] Are cEOrvals within NFPA standards? Yes E) Nof
Is ttietins dbtion - nd' ervi, tag on the cylinder? Yes NoM , Previous Confidence Test Company & Technician
,p a s ice
ME
IMIIIMI MEN
MENE Emil E wimm ME IEEE
Elm 1 0 0
IN
NEE
11
MOMEMN NM
Elm MEN 0 1
EEE
SEEN MEN 11EI
MEMMMIMEMON 11111101110111111111 E 0EEUMNMNM
Problems Found: (if additional room is needed, please add a separate sheet)
Customer has declined repairs X
Corrections Made: Date Corrected. Corrected By: SFD Certification Numberodz' 73 L,/ �F
12.kr &illlrald
This certifies that this fire and life sar system bUnj2roperly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies are note *ntFn rd1p'qPqgjpAft building Owner/Responsible Person for corrective action.
Signature of Tester: — Phone # (206) 726-0940
Testing Agency: R&T Hood and Duct Services, Inc. Mailing Address: 6100 12t h Ave. S., Seattle, WA 98108
The owner is to perform and keep a written record of the following "quick check" fire s m inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and th ir s als are intact, yf� aged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certifi te is n ee
Place and curr�r
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found appro riate corrective a4ion shall be taken immediately
intended use. 9. A record of the monthly insp ctions i to �efle ing the date inspected, inititals of
,%k,eptj,ele r
p f
yc� cto
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspe tion and y c rection required.
4. Observe system, checking that no obvious physical damage or condition exists
FIRE DEPARTMENT COPY
W
R
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607 INS
Occupancy Name: —
COMPLETE Certification Given: RED[:] YELLOW0 WHITEEI
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
i h Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service CONFIDENCE TEST Z REPAIRSE]
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE: 4
Occupancy Address: Zj,!�2 C./06k'_7 _)Lj,-IL, I
Responsible Person:
Building Owner:
Building Owner Address:
Testers Name (Please Print): /*Zi�nx/z
SystemAlarm? YesF_1 NoZ)
Control Panel manufacturer: —
Extinguishing System Manufacturer
Location / Height of Range hood:
71.11U -
City, State, Zip:,
Phone Number:
Phone Number:
City, State, Zip:
SIFD Certification Number: SCP_
Central station monitoring? Yes[:] No El Monitoring company name:
Model Number: I A I Oro Location of Alarm Panel:
System Si /0S�:X?Yes,2Noo LI.L. 300 Compliant? YeizNoEl Chemical Type: Wet 2try El
_�110
7" 1 1 692� - zl/�
is Rressure-ga-ugs inclicato . r I in op arable .. range?
Y"F!!j
- No[D-
12 year hydro date of cylinder.
Is there chemical in . side of the cylinder?
Yes -En
No F]
Were hand portable-ex-ti-inguishe�9-pro . perly serviced? RQ
-'Yes 0--
No
Wei - gh CO2 or nitrogen cartridge. NArff
Were all cooking surfaces protected? If not, give owner full
Yes E]
NOE]
No visible signs of a system fire or system tampering (if signs check no).
Check all piping and conduit. Are all piping and conduit imirridbilized with
Yesa
Ye;e
No [I
140 CD
-information.
n a n I
Was operat! g procedure verbally given to r staura t personne ?
NOO
proper hangers and brackets?
Was UL 300 compliance explain ed I o owner or manager?
Yes E]
No Ej
--No[]
Are all protective covers present on nozzles?
YesEtj
No E]
-,--Gas shuts down upon syste . rn . a I ctivati.on?- NAO
--Yeso
Are all nozzles checked in the proper position?
Ye&rl
Noo
Electric power shuts down upon system activation? NA El
Yes F�
No [I
Does system have ade I qua . te volume and/or nozzle coverage?
Yesffj
NOD
Range hood tied to buildin - g alarm panel? NAE]
Yes
No
Are all appliances inside of th I a I hood protectio - n area?
YesoF;_'t
No E]
Range hood activation signal received at building alarm panel? NAD
Yes
NoF
Have fuse links been replaced?
Yesftl
NoD
Class K extinguisher present?
Yes El.
-No 11
Was system operatio . n a] - from - terminal link?
Yes e
NOE)
Grease buildup in group:
Was system operational from manual remote?
Yes e
No E]
Light Medium— Heavy, recommend
cleanin
Was system and micro swit-choperational? NA El
-and
Yes [?'
No F�
-,Date. of last cleanin
Is system visible free from obstruction?
Yes4��]
No F�
Are cleaning intervals within NFPA standards?
. .
UO 1-1
Is the inspection and service tag on the cylinder?
Yes-rT
NOE)
Confidence Test Company & Te chnicipri J&Z
V
Pr?blems.Found: (if additional room is neqded, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
1 0, T
Customer has declined repairs X
SFD Certification Number:
t
This certifies that this f!rp d life safety system h4 been p o erly inspec Qe for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrep ..e ioled a ave N the building Owner/Responsible Person for corrective action.
Signature of TesteF 9:� Ess Phone # (206) 726-0940
Testing Agency: VII&T H6jod and 0uct Services: lhc. MailingAddress: 610012thAve.S..Seaftle,WA98108
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 extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspection and any c�orrrections r .
4. Observe system, checking that no obvious physical damage or condition exists , jquired
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
. C . 0.
F1 E�iz
E7,
-I'Se .1,in Brier' -5 Meridian Ave S
,gidnionds, aJ' 124 2..'
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
4MJL%-.# www.FireDistriet].org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY
STATION & SHIFF)
LOCATION:
23025 100 th A,venue W 98026
Annual
20-D
I
BUSINESS NAME:
Chopsticks In Edmonds 4257761196
PHONE:
SCHEDULEDJan 2015
DATE DUE 0
161 204
MAILING
23025 1 00th Avenue W, Edmonds, WA 98026
LIFIR 0
W ADDRESS:
Woo, Terry
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Woo, Boyd 2067237051
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YE NO
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
o o b)
I ARE %
r 5Yb 1 EIV16:
FE UL300 10/14
� k
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
OL A7
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONT4CTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
CNSPECTOR:
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 E] YES NO
8
FIRE DEPARTMENT COPY
COMPLETE
FIRE PROTECTION
R AAM" High Pressure Hood Cleaning
&THood and Duct Services, I Fire Suppression Installation & Service
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service
Occupancy Name: N--'y I L)H,-) — 11 V_%TULjy-CJ4— -
Occupancy Address: 2 A.'O 245 100 91 j
Responsible Person: 777g Kr-,
Building Owner:
Building Owner Address:
Testers Name (Please Print):
Fc—ertif icationGiven: RED El YELLOW F1 WHITE�
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
CONFIDENCE TEST [Z REPAIRS[]l
DATE: I o — zz— /4,
City,State,Zip: I'L V 1-1 1 V
Phone Number: 4�2,__77,6 11g6
Phone Number:
City, State, Zip:
SIFD Certification Number: SCP_ -0
System Alarm? Yes E] NoV central station monitoring? Yes El NoX Monitoring company name:
Control Panel manufacturer: Model Number: Location of Alarm Panel:
Extinguishing System Manufacture S stem Size U.L. 300 System? Yes 21No Ej LI.L. 300 Compliant? Yes Ej No 21 Chemical Type: Wet EeDry El
" de 9JM3 � q ,4
Location / Height of Range hood:' _ktPh
Is pressure gauge indicator in o erable rar;ge? Yes No 12 year hydro date of cylinder.
� p- -1 '-Yes 2 No [I
Is there chemical inside of the cylinder? Yes No E] Wer6ihand portable extinguishers properly serviced? -
Weigh C62 or nitrogen cartriclgq�. NAZ Were all cooking surfaces protected? If not, give owner full YesZ No E]
No visibi I e signs . of a system fire or system tampering (i I f I signs check no). Yes No information.
Are,,alVpiping and c onduit1mmobilized with Yes No as ope ra ting p roced ure verbally given to restaurant personnel? Yes
Check all piping and conduit
proper hangers and brackets? - Was UL 300 compliance explained to owner or manager? Yes No E]
Are all protective - covers present I on nozzles? Yes Z Noo Gas shuts down upon system activation? NA Ye_sM"__,_,No0
Are'all nozzles checked . . in the proper position? Yes E/j No F� Electric power shuts down upon system activalion? NA Yes No
Does system -have' adequate volume and/or nozzle coverage? Yes [2' No Range hood tied -to bu I ildingafa�rnj.panel? NAL] Yes No 0
Are,all, appliances inside, ofthe hood I . protection area? Yes Lfn Noo , Range hood -activation signal received at building alarm panel? NAD Yes El No ED
Have fuse links been replaced? Yes Z Noo 'Clas's K extinguisher pr as - a , nt? Yes� No
Was ysterA o6erational,from terminal IinV Yes [21 No[3_ Grease buildup in group:
Was system operational from manual remote? Yes [?I No E] Light Medium— Heavy, ;gpommend cleaning
ning
Wassystem and micro switchopeiational? NAEJ Yesl2r N9,13, Date of last-clea A(_ /Ky
Is system visible and free from obstruction? Yes No Are cleaning interval within NFPA stan rds? Ye s �N.
Is the inspection and service ta Yes No I'M Previous Conf idence Test Company & chnician," 7
gonthecylinder7
T
- WO�
F6'
-= -7
Corrections Made: Date Corrected:
Corrected By:
X
SFD Certification Number:
This certifies that this I re an
,d-IVe saLfety system has been prope I pected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
n s
standards. Discrepancies r t and aveAe
'I r :t aeulding 0 ner/kesponsible Person for corrective action.
.eel) !
Signature of Tester:MMA 1 11 A d 1 V Phone # (206) 726-0940
A'111 11/ -LLk
F% 66and b-&ct Services, 1
Testing Agency: THO nc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108
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 extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspection and any corrections required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT G-bPY
COMPLETE Certification Given: REDO (YELLOW,21:�)WHITEg'JI
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
&THood and Duct Seirvices, Inc. Fire Suppression Installation & Service CONFIDENCE TEST,&. EPAIRSE]
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE: -Z 3
Occupancy Name: 0— k4 cp� 5 7— 14-- le —5
Occupancy Address:
Responsible Person:
Building Owner:
Building Owner Address:
Testers Name (Please Print): Q ryl, I r
System Alarm? Yes F] No 10
Control Panel manufacturer
Extinguishing System Manufacturer
Location / Height of Range hood:
Phone Number:
City, State, Zip:
SFD Certification Number:
SCP- (f) 60 -3 t-/5
Central station monitoring? Yes Lj No kj Monitoring company name:
Model Number: Location of Alarm Panel:
A-P-- LA-/
System Size CVq- I I.I.L. 300 System? Yes [2No[] LI.L. 300 Compliant? Yes E2No E] Chemical Type: WetEn Dry 0
I - - - -- ---- - - - - ---- - --- - -- - — -
ls�pressure,gaude indicator in, operable range?_
Yes
---
-No
12 year hydro date of cylinder.
( C
Is there chemical inside of the cylinder?
Yes
No
guishers properly service ?
Were hand-p9-q-abIe--,e-xiih- d NA_
Yes [4
No- [D
�,';Weigh �CO2-or nitrogen cartridge. NA4
Were all cooking surfaces protected? If not, give owner full
Yes [Z
No E]
No visible signs of a system fire or system tampering (if signs check no).
Check:all ' piping andcoriddit. Are all piping andcond6it immobilized..with
Yes El
Yes V1
No F-1
NoF
information._
Wasqpqrating procedure verbaliv cliven to restaurant personnel?
Yes
_No[]
proper, hangers and brackets?
Was UL 300 compliance explained to owner or manager?
Yes;�
No Fj
Are all protective -covers'present on nozzles?
Yes Z
No E]
bas shuts doWn�,upon-s- stem activation?- N�C
-y . -- ------- --
Yes 1;��
-No M
-
Are all no checkedkin the proper position?
Yes
No
Electric power shuts down upon system activation? NAEJ
Yes 2
NoF -1
Does system have adequate volume and/or nozzle coverage?
Yes [Z]
Noo
Range hood tied to building alarm,'qanel? NAZ
Yes 0
No Cj
Are alisappliancOs inside,of the hood,protection area?
Yes [Z
No
Range hood activation signal received at building alarm panel? NAVI
Yes Ej
No Ej
Have fuse links been replaced?
Yes Z
No Ej
_qqss K extinguisher present?
Ye6;2
No Lj
Was*system�operatjonal-from terminal link?
Yes Ca
N
Grease b=uildin group:
Was system operational from manual remote?
Yes E]
Yes
No F]
-1
Light Medi m Heavy, recommend
Date of last'deaning 77 L-4 - .5 t<,*Cj Xc
cleaning
Wassy9tem and,micro s itch operational? NA01
Is system visible and free from obstruction?
Yes
'No-F
No F-1
Are cleaning intervals within NFPA standards?
Yes
No
Is the in s I - ection and service tag on -the cylinder7
Y6so
N 0
T, h
Previous Confidence Test Company & ec nipan
mom
MIME
MIME
NMI
Corrections Made: Date Corrected: Corrected By: SFD Certification Number:
This certifies that this fire anolife Vfety 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. Discrepancies a,(ep ha
n�een reported to the building Owner/Responsible Person for corrective action.
Signature of Tester: ( t" " .— Phone # (206) 726-0940
Testing Agency: R&TI-lood and Duct Services, Inc. Mailing Address: -6100 12th Ave. S., Seattle, WA 98108
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 extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing d ions required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE :9�7
FIRE DEPARTMENT COPY
SNOHOMISH CO.
FIRE
T F-
k5 �11
!:ying Bilei: Edmonds, and
Mountlak-,e -Terrace
T14,14,wFireDistrictl.,,ory
LOCATION: 23025 lf)&h Awnue W OM26
BUSINESS NAME: ChapEIJck-Q In Edrmridb
MAILING
12425 Meridian Ave S
'W*,*4'98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
[I BRIER
0 MOUNTLAKE TERRACE
El UNINCORPORATED
FREQUENCY STATION& SHIFT
Atitiva I 20�C
PHONE: 4207611SE SCHEDULED Jan 2014
DATE DUE
UFIR
ADDRESS:
23025 10OLh Avonuc W,
Edmanc!8, V11A 0802fi
BUSINESS OWNER:
lkr)ri, 'rt-riy
HOME PHONE:
EMERGENCY-1:
%yd
HOME PHONE- 'JM7'7�11
CURRENT
KEY ACCESS-2:
tA
I
2 1 If
OME PHONE,,-,,
CITY YES NO
wo
T5
dh^-t ,
Co
BUSINESS
A
El
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
r4,C -_
NAME OF INSPECTOR:
jtWj;
. , (
Kc
FIRE SYSTEMS; FE —1 HD 4113
_L'
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 u c�e c,J A(_)IAq
-5an, - f4
_q .
A
"C-5
I-) C. ne
('0\We
2
3
3
4
0
4
5
... . .... ......... v\V
\A
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
lst RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
�
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED T,)�
I I
DATE DUE:
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
v... . ..... . .
-
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
DATE:
INSPECTOR:
2
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
4
1 5
1 5
LETTER SENT
NUMBER:
2
6
2
DATE:
CODE
-SECTIM
5
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
7
4
18
4
8
DATE:
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
Kevin Zweber
Frorh. Terry Woo [terrywoo88@yahoo.com]
Sent. Tuesday, June 17, 2014 2:00 PIVI
To: Kevin Zweber
Subject: Re: fire inspection follow up
Everything is fixed
Sent from my iPhone
On Jun 17, 2014, at 1:32 PM, Kevin Zweber <kZweber@fi red istrictl.o rg> wrote:
Mr. Woo,
A fire inspection was conducted at 23025 100th Ave W on 4/4/14 and the following issues were noted:
South Exit lights need replaced/repaired, upstairs and downstairs
Access panel in South stairwell storage needs to be covered.
Could you please tell me the status of these issue.
Thanks,
Kevin Zweber, CH
Captain/Deputy Fire Marshal
Fire Prevention Services
Snohomish County Fire District #1/
City of Edmonds
Office 425-775-7720
R
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: C
Occupancy Address: 25
Responsible Person:
Building Owner: cr—
COMPLETE F4j�� Given: RED E] YELLOW E] WHITE
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service CONFIDENCE TEST [Z R
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE: b013
-Ir-a-2
City, State, Zip:
Building Owner Address:
Testers Name (Please Print): Q�a
System Alarm? Yes E] No Pfl Central station monitoring? Yes El NoZ
Control Panel manufacturer: Model Number:—
Exting uishing Sys te m Manufact ur S,
Location / Height of Range hood: -J�
Phone Number: 1-4 -L 4Z- -
Phone Number: I
City, State, Zip:
SFD Certification Number: SCP-
Monitoring company name: —
Location of Alarm Pai
VAW U. L. 300 System? Yes;Z No El
1% 1
U.L. 300 Compliant? Yeaq] No
Chemical Type: Wet Z Dry[j
Is pressu re gauga-jindicator in o per able ran ge? Yes No 12 year hydro date of cylinder.
Is there chemical inside of the cylinder? Yes No E] �-�-a���prta-b-['e-e-xtinguish-ersprgp I sq -NoF]
_�ny �cecl?-- No E]
Weigh CO2 or nitrogen cartridge. Were all cooking surfaces protectecl'�.? If not,,bive owner full Yes
No visible signs of a system fire or system tampering (if signs check no). Yes No Ej information.
Check all piping and conduit. Are all piping and conduit immobilized with Yes NoM Was operating_procedurev y giverfo restaurant personneri Yes NO
proper� hangers and brackets? Was UL 300 compliance explained to owner or manager? Yes No E]
Are all protective covers present on nozzles? Yes No EJ Gas shuts down upon sy NA Yes
L stem act!!!! on? No- -i
Are all nozzles checked in the proper pasitio0_ Yes [,7 No E3 Electric power shuts down upon syi mactivation? NAr-j yes No
NAO' Ye
Does system have adequate volume and/or nozzle coverage? Yes N o EF-11 Range hood tied to building alarrJ1 ane
Are all appliances inside of the hood protection area? Yes --,No,E_I_ Range hood activation signal re'deived at building alarm panel? NAVI Yes E] No E]
Have fuse links been replaced? Yes NoEl i Class K extinguisher present,#� Yes No F�
Was "--WoE] G a a buildup in group:
__§y§Wm opeLa "ioal from terminal link? Yes re s
Was system operational from manual remote? Yes Z No E] Light edi m—_ Heavy, recommend cleaning
m ..... ... ...
Was §y onal? -N A - -::)iest6- Date of last cleaning_ �2 Low
stern and mic switch -op rafi 0
Yes NoM Are cleaning intervals within N PA standa sEj No E]
Is system visible and free from obstruction? NY -,tanclards?
ic7
ous Confidence Test Company &
— ----- Previ fe.hn an-
ction,and service,tao on the cvlinder?
Is the insoe y6s M,
Problems Found: (if additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire and life safe sysernhasbeen roperly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. DiscrepanciesWn avoeen rep ed to the building Owner/Responsible Person for corrective action.
Signature of Phone # (206) 726-0940
Testing Agency: R&T HooCaA QbcM—ervices,-1ri6 MailingAddress: 610012thAve.S.,Seaftle,WA98108
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 extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspection and any corrections required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED NY
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE C
FIRE DEPARTMENT COPY
aTHood and Duct Services, Inc.
6100 12th Ave. S. phone (106) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: —
Occupancy Address:
Responsible Person:
Building Owner:
COMPLETE Certification Given: RED[:] YELLOWE] WHITE VLJ
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service CONFIDENCE TEST E REPAIRSE]
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair 1 -7
-'Filter Sales & Service DATE:
i 06+1— 4 Vej
City, State, Zip:
Phone Number:
Phone Number:
Building Owner Address:
City, State, Zip:
C,- 6-7 5; (4
Testers Name (Please Print):
SFD Certification Number: SCP_
System Alarm?, Yes E] NoR Central station monitoring? Yes$4� NoEl
Monitoring company name:
Control Panel manufacturer: Model Number:
Location of Alarm Panel:
tAew
Extinguishing System Manufactu %6�6wystem Siz I.I.L. 300 System? YesXNoE:] U.L. 300 Compliant? Yes$ NoEj Chemical Type: Wet4WryEl
%I
Location / Height of Range hood: —
noperable range?
Is pressure gayqq indicaW_ii yes�
12 year hydro date of cylinder.
Is there chemical inside of the cylinder? Yes
No L
were hand port ble extinguishers properly serviced? NA Yes
a
_LJ i
Weigh CO2 or nitro en cartridge. NA [TE)
Were all cooking surfaces protected? If not, give owner full yes
No E]
No visible signs of a system fire or system tampering (if signs check no). Yes
Check -all -piping and concluit- Are all piping and conduit immobilized -w—ith --Yes
'No
--__.Vq§.9pjrating
information.
pLrgcelyre.yerbally given to restaurant personnel? Yes
L 1
proper hangers and brackets?
Was UL 300 compliance explained to owner or manager? yes
No[
Are all protective covers present on nozzles? Yes [Z
No[-]
as uts down upon sy�t
�rnactivation? __NAEI,.---yesZ--
No
Are all nozzles checked in the proper p si ion?
Electric power shuts down upon system activation? NAE] yes [Z
No E]
Does system have adequate volume and/or nozzle coverage? Yes
No
--king h 0 Yes F!
ge oodtied.t. -building alarm panel? NA?j ___
Nc�F
Are all appliances inside of the hood protection area? Yes
f,io[:]
ge hood activations
Ran ignal received at building alarm panel? NAZ Yes Ej
Non
Have fuse links been replaced? Yes Z
No E]
---Yes ____
glass K� ing�jjtwl3�resw
No
was system operational from terminal link? yes
Grease buildup in group:
Was system operational from manual remote? Yes
Was�s s mandMicqswitch�op atiomki? NAF�
I We _ _ _ __eir
No
Light Medium— Heavy, recommend cleaning
Date of last cleanin
No El
Z
Is system visible and free from obstruction? Yes
Noo
rcls�
Are cleaning intervals within NFPA stand ;4 yes
Problems Found: (If additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
�Pqmpany A
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire d lif �ektlety syste been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
V m
p v
standards. Discrepancie, r d have brn it onsible Person for corrective action.
Signature of Tester: Phone # (206) 726-0940
Testing Agency: R&"ood and Duct SeiVices, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108
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 extinguishing cylinder is in 6. The nozzle disc are intact, undamaged and tight.
p
�'Ja,
caps and their sp ce and current.
place and has not been removed or tampered with. 7. The inspection tag or cert,ficat, - -�
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are fc�un prot..sate corrective action shall be tak9n immediately.
pected, inititals of
rithly, ion I ept re eo' !
intended use. 9. A record of the mo recip o be k fl I t h a �d a teX
e(
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing ection c �;dn7 Eree�
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
COMPLETE Certification Given: REDO YELLOWE-] WHI
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
&THood and Duct Services, Inc. Fire Suppression Installation & Service F-CONFIDENCE TES10' REPAIRSE]
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy Name: —
Occupancy Address:
Responsible Person:
Building Owner:
City, State, Zip:
Phone Number:
Phone Number:
Building Owner Address:
City, State, Zip:
Testers Name (Please Print):
SFD Certification Number: SCP_
System Alarm? Yes 0 Nft Central station monitoring? Yes E] No*
monitoring company name:
Control Panel manufacturer:
Model Number: Nov Location of Alarm Panel:
Extinguishing System Manufacturer
System Size
U. L. 300 System? Yes/N. [D U.L. 300 Compliant? Yes/No Chemical Type: Wet Dry El
Location / Height of Range hood:
v/, e,
Is preissure-,gauge indicator inoperable range?
YesX
Noo_
12 year hydro date of cylinder.
Is there chemical inside of the cylinder'?
Ye� VI
NoD
__W9m_hgnc1 portable extinguishers properly serviced?
Ye-z�
No
Weig'h,CO �or-,,nitrogen cartridge.
NA2r
Were all cooking surfaces protected? If not, give owner full
Ye;?
No F�
No visible signs of a system fire or system tampering (if signs check no). YesZ
Check'all,piping and, conduit. Are all piping and conduit immobilized with
No F-1
No
information. Ye,%e5
Was operating procedure -verbally given to restaurant personnel
NoE]
pr6pbr hhi� g*ers and brackets?
Was LIL 300 compliance explained to owner or manager?
Yes�K
No El
Are all protective covers present on nozzles?
Yes
No E]
biii shuts clown upons -stem activation?--
NA'0 Ye4e
No F-1
Are all nozzles checked in the proper Rosition?
s
No
Electric power shuts down upon system activation?
NA YesZ
No [j
-Ye
Does system have adequate volume and/or nozzle coverage? YesZ
No
Ra-Q-g'e hood tied to building alarm panel?
NA Yes
No
Are all appliances I inside of the ho , od , pro , tection are a?
YesZ
No L]
Range hood activation signal received at building alarm panel?
NAX Yes n
Non
Have fuse links been replaced?
Yeso
No E]
. 914m K . extinguisher present?
Y.sO
No,E)_ j
Wa&system operational from terminal link?
Yesj�j
No
Grease buildup in group:
Was system operational from manual remote?
-------
Yes,21
- --sZ
No
Light Medium Heavy, recommend clearing
b__ iin
ate_oflastcleaning__
Was system an"d-micro switc -operational?
Is system visible and free from obstruction?
.1 -
NAF Ye
Yes
No
Non
Are c . le - aning intervals within NIFIRAItanclards?
_.f
No E]
Is the inspia9tion,and s ervide ta on the cylinder?
s
Noo
Previous Confidence Test Company & Technician
mom
ME
El
MO
MENIN
NOM
101111111111111
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1
N Elm=
MI
1OM
ME
01
11111101111
NMI=
ME
11101101111111
E
M
Problems Found: (if additional room is needed, please add a separate sheet)
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By:
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. Discrepancies ar��e an een d to the building Owner/Responsible Person for corrective action.
Signature of Tester: - I" Phone # (206) 726-0940
Testing Agency: R&T HooWd Ducneryff-es, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108
i
The owner is to p600rm and keep a written record of the following "quick check" fire tern inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps a th ir seals are intact, undamaged and Wot.
place and has not been removed or tampered with. 7. The inspection tag or rtific ite is in place and current.
be
2. The manual pull stations are unobstructed and in clear view and are labeled for
intended use.
3. Insure that all tamper seals are intact and that system is in a ready condition.
s I u cl ive taken imm ediately.
8. If any deficiencies ar Ifond app iate t, action I
pr
r c`,rk) re e;
c 'v
m ly 'nsp ke Dt refle !W the date inspected, inititals of
s s 'is
9. A record of the ly iusp ctio to, I r fl `U rtPhe da
Orr 'o s
person parlor I theinspe tion, Undny correc ions re.'
"in. I , p ciuired.
m
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 green operable range.
AUTHORIZED
SIGNATURE
FIRE DEPARTMENT COPY
... ...... FIRE PREVENTION
SNOHOMISH CO. �q?-ying Briei:.E.dinonds 12425., Meridian Ave S INSPECTION REPORT
0,EDMONDS
6uhtlake Terr�keand Everett, "WA 98208 0 BRIER
)FIRE E]WOODWAY
e Town of Woodway Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DISTR T wthww.FireDistrictJ.org,. Fax (425) 551-1272 0 UNINCORPORATED
r FREQUENCY STATION& SHIF"'
LOCATION: 23025 1 00th Avenue
W
365 20 A
I
BUSINESS NAME: Chopsticks in Edmonds
PHONE:
4257761196
SCHEDULED
DATEDUE 0 01101112
MAILING
23025 1 00th Ave W
LIFIR 10 161 1054
ADDRESS:
Edmonds
98020
BUSINESS OWNER: VVOO, Terry
HOME PHONE:
2067233345
OCC LOAD 13.8
EMERGENCY-1: Woo, Boyd
HOME PHONE:
2067237051
CURRENT
KEY ACISS-2:
HOME PHONE:
2067233345
CITY YES NO
BUSINESS
ak L
LICENSE
PERSON CONtACTED: LIQ(" W(Y)
INITIAL INSPECTION DATE
-
10 -12
NAME OF INSPECTOR:
FIRE HD 10/11
FE kl/ It
SYSTEMS: 4/12—
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1 wo
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TOZORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
, A
lstRE-INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I r?
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
10
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
7
RETURN RECEIPT
RECEIVED
6
4
'8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED F] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
COMPLETE Certification Given: REDEJ YELLOWLY WHITE[:]]
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R High Pressure Hood Cleaning SYSTEM TEST REPORT
&THood and Duct Services, Inc. Fire Suppression Installation & Service FC-ONFIDENCE TEST [Z REPAIRS
C
6100 12th Ave. S. Phone (206� 726-09 Z Fire Fxtinguisher Sales & Service
Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy Name:
Occupancy AddreE
Responsible Persc
Building Owner: —
rnone Numuer;
Building Owner Address:
City, State, Zip:
Testers Name (Please Print):
SFD Certification Number: SCP-=-
System Alarm? Yes E] IN Central station monitoring? Yes[-] No E]
Monitoring company name:
Control Panel manufacturer��e
Model Number:
Location of Alarm Panel:
Extinguishing System Manufacturer "R
SysternSize-4— U.Lr-300 System? Y��NoE] U.L. 300 Compliant? Yes E] Noz, Chemical Type: Wet/ Dry
Location / Height of Range hood:
.
02-
I s- pressure gauge indicator in operable range?
Ye s/.--`No-
12 year hydro date of cylinder.
Is there chemical inside of the cylinder'?
Y�e
NA�e
Noo
--NA0-
Were hand portable extinguishers properly serviced?
Were all cooking surfaces If not, owner full
YesX
Ye
Noo
No
Weigh CO2 or nitrogen cartridge.
protected? give
information.
No visible signs of a system fire or system tampering (if signs check 6o). Yes
Check all piping and conduit. Are all pip ing and conduit immobilized wi th Ye
No
No Ej
Was operating procedure verbally given to restaurant personnel?
Yes
Noo
Proper hangers and brackets?
- -11
Was LIL 300 compliance explained to owner or manager?
No
Are all protective covers present on nozzles?
Yesjo
Noo
Gas shuts down upon system activation? NA E]
Yes ;K
NoEl
Are all nozzles checked in the proper position?
Yef.
No
Electric power shuts down upon system activation? NAE]
Yes'2t
NoD
D I oes syst , em have adequate volume and/or nozzle coverage? Ye��o
No Fj
Range hood tied . to - b - uild . ing . afarm . pan I el? . NAZ
Yes� D
Noo
Are all appliances inside of the hood protection area?
Ye
No
Range hood activation signal received at building alarm panel? N4K
Yes [:]
No [j
Have fuse links been replaced?
Yes
NoEl
Class K extinguisher present?
Yes 2r
No f:j
Was system operational from terminal link?
Ye
�-
.-No[-]_
Grease buildup in group:
Was system operational from manual remote?
Was sy stem and micro switch opera , t ional? -
Ye s
NAO _y6sZ
No
Noo
Light Med Heavy, recommend clea ning
--Date of last cleaning Ve
Is free from
YesX
N,F-j
,
Are cleaning intervals within FP�rAstanVda/s'l
Yes
No/
system visible and obstruction?
A1
Is the inspection and service ta on the cylinder?
Ye
IN 0
Previous Confidence Test Company & Tachnicia , �411!?;r'
--N
0
111
oil
11
Oro
0
NOON
Jim
ONE
0
OWN
MMEM
Problems Found: (If additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
/4P/I
Number:
This certifies that this fire and lite 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. Discrepancies are not�ed
�a�n =av a orted
�!�uilding Owner/Responsible Person for corrective action.
Signature of Tester: Phone # (206) 726-0940
TestingAgency:— &T-HOdyb-ndOud Services, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108
The owner is to perform and keep a written record of the following "quick check" fire
1. The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and
place and has not been removed or tampered with. 7. The inspection ta or ce
T 0
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are u
I
intended use. 9. A record of the mont y in
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing e ins
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
i inspection to verify the following:
ils are intact, undamaged and tight.
in place and current.
correqn2lact!on shall be taken immediately.
be kAt (at ecfiinpe date inspected, inititals of
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
Name of Company (DBA):
Chopsticks Restaurant
Edmonds Location :
23025 100th Avenue W
In conformity with the
terms of the International
Fire Code, -applic�ation is
hereby made to store, use
Places of Assembly - Occupant Load: 138
or maintain the following
activity, storage or pro-
cesses:
Mailing Address:
23025 100th Ave W
Edmonds, WA 98020
EFD UFIR #:
1611380 g653/
(for office use)
Your Signature
Your Name (print)
Your Title
Please make corrections, attach $40 payable to the City of Edmonds and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
FOR OFFICE USE ONLY
Rec'd
Check#
-7
"C
COMPLETE Certificati . onGiven:REDE:] YELLOW[:] WHITE[Z
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R High Pressure Hood Cleaning — SYSTEM TEST REPORT
&THood and Duct Services, Inc. Fire Suppression Installation & Service FCONFIDENCE TEST REPAIRSMJ]
Fire Extinguisher Sales & Service
6100 12th Ave. S. - Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy Name: L-r�'414
Occupancy Address:
Responsible Person:
Building Owner:
Building Owner Address:
Testers Name (Please Print): IWee
System Alarm? Yes[] Nox Central station monitoring? Yes[] No
Control Panel manufacturer: Model Number:—
City,State,Zip: W/7-1f7'
Phone Number: -71��
Phone Number:
City, State, Zip:
SFD Certification Number: scp-
Monitoring company name:
Location of Alarm Panel:
Extinguishing System Manufacturer System Sizew/6;lw—
LI.L. 300 System? Ye5e NoE] U.L. 300 Compliant? Yes
Chemical Type: Wete Dry E]
Location / Height of Range hood: R/
Z
—
-�A-E]
Is pressure gauge-inclicator in operab le ran - ge ?
12 year hydro date of cylinder.
Is there chemical inside of the cylinder?
Yes 1Z
No E]
Were-handportable extinguishers properly serviced.?
NAE]
Yes
Noo
Weigh CO2 or nitrogen cartridge. NAZ
—
Were all cooking surfaces protected? If not, give owner full
Yes
No E]
No visible I signs of a system fire or system - tampe I ring (if s - ign s ch eck no) .
Check all pip�ng andconcluit. Are all piping and conduit immobilized -with
Yes Z
Yes f?n
No F-1
NoEl
information.
Was operating procedure verbally given to restaurant persoi inel?
Yes
No[3
proper hkngers and brackets?
Was UL 300 compliance explained to owner or manager?
Yes
No Cj
Are all protective covers present on nozzles?
Yesv,
NoF
Gas shuts own upon system activation?
- do
NAO
Yes 2n
No[]
Are all nozzles checked in the proper position?
Yes
No
Electric power shuts down upon system activation?
NA E]
Yes Ej
Noo
Does system have adequate volume and/or coverage?
Yes 21
No Ej
Range hood tied- to-buii-lding alarm panel?
NAZ,--
Yes
No
-nozzle
Are all appliances,inside of the hood protection area?
Yes;21
No
Range hood ac tivation signal received at building alarm panel?
NAZ I
Yes
No
Have fuse links been replaced?
Yes
No E]
- -
Class K extinguisher present?
Yes
No E]
Was system operational from terminal link?
Yes
NoE]
Grease buildup in group:
Was system operational from man ual remote?
Yes 1
No7
- -
Light Me, Heavy,
Date - o I f last cleaning- 44y
recommend cleaning
Was system and micro switch operational ? NAO
Yes;
NoR
NFPA
Yesle
No E]
Is system visible and free from obstruction?
.
Yes
No E]
Are cleaning intervals within standards?
Previous Confidence Test Company & Tech�ici.n At
I s the inspection and service tag on the cylinder?
0
MINE
Problems Found: (If additional room is needed, please add a separate sheet) _0
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: 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. Discrepancies are noted anA.0evoJo0en d to the buildina Owner/Responsible Person for corrective action.
Signature of Tester: Phone# (206) 726-0940
Testing Agency: ___B&T Hoy;gFnd DUct Sgrvices. Inc. Mailing Address: 6100 12th Ave. S., Seaftle, WA 98108
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 extinguishing cylinder is in 6. The nozzle disc caps and ir seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or ce if' ate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are und, ropriate corrective action,,§hall be taken immediately.
t �
intended use. 9. A record of the mont inspe ibns is to bi�e
r t �refle i he date inspected, inititals of
t
�PU t,
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing t ins a i and any c rre ti equned.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED J7
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
March 7, 2011
Please verify and correct the following information:
1.
9 n
Lj
MA
R 2, _8 PAID
EDMONDS FIRE DEPT.
Name of Company; DBA
Chopsticks Restaurant
Edmonds Location
23025 100th Avenue
In conformity with the terms of
Places of Assembly - Occupant Load: 138
the International Fire Code,
application is hereby made to
store, use- ormaintain-the
following activity, storage or
processes:
Mailing Address:
23025 100th Ave W
Edmonds WA 98020
EFID LIFIR
16113802BO53
(for office use)
Your Signature
(14�
N"
Your Name (print)
Your Title
Please make corrections, attach $40 payable to the City of Edmonds, and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
I
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
PERMIT
January 1, 2011 161-138-0213-053 December 31, 2011
Date of Issue LIFIR Number Date of Expiration
I This PERMIT is issued to: I Chopsticks Restaurant I
located at: 123025 1 00th Avenue W Edmonds, WA
I I To engage in the business, occupation or pr cess of: I I
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly - Occupant Load: 138
I Allowed Occupant Load: 1 113877]
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.
of Fire Pr6ention
This Permit Must Be Posted At All Times in The Premises Identified Above
City of Edmonds Community Development Code 19.25.020
R
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: t,
Occupancy Address:
COMPLETE Certification Given: RED[] YELLOWE] WHIT��l
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service CONFIDENCE TESTIZ EPAIRSE]
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE:
�4 A4 4J, City,State,Zip: 4VM-nVCjs-
Responsible Person: iie
Building Owner:
Building Owner.Address:
Testers Name (Please Print): O�*",/�e, 61-6141IJ
System Alarm? Yes F] No/ Central station monitoring? Yes E] NoZ
Control Panel manufacturer: Model Number:
Phone Number:
Phone Number:
City, State, Zip:
SFD Certification Number: SCP-- 22- L 0
Monitoring company name:
Location of Alarm
Extinguishing System Manufacturer
SystemSize (,C4C- U.L.300System?YesXNoE] I.I.L. 300 Compliant? YesoNoF]
Chemical Type: Wet2rDryF]
Location / Height of Range hood:
7- 15 F /,!�V
ciii
P
Is pressure gauge indicator in operab le range?
YeZ
No n
12 year hydro date of cylinder.
Is there chemical inside of the cylinder?
Yest�
No 0
Were hand portable extinguishers properly serviced?
j No
NA [j Yesr
Weigh CO2 or nitrogen cartridge.
NA-!j
Were all cooking surfaces protected? If not, give owner full
YesZ- No F]
No visible signs of a system fire or system tamnerina (if
sions check no). Yesr_r
Non
information.
Check all piping and conduit. Are all piping and conduit immobilized with Ye;��- Non
proper hangers and brackets?
Are all protective covers present on nozzles?
Ye5,L�--
No E]
Are all nozzles checked in the proper position?
Yes E5
No
Does system have adequate volume and/or nozzle coverage?
Yes;?'
No
Are all appliances inside of the hood protection area?
Yes7
j
No
Have fuse links been replaced?
Yes 2e
No
Was system operational from terminal link?
Yes;?r
No [j
Was system operational from manual remote?
Yes7
No E]
Was system and micro switch operational? NAD
Yes Z'
Noo
Is system visible and free from obstruction?
Yes2r
No E]
Is the inspection and service tag on the cylinder?
Yes/ I
j
No E:]
Was operating procedure verbally given to restaurant personnel? Yes 2- No [:)
Was UL 300 compliance explained to owner or manager? Yes2-
No E]
Gas shuts down upon system activation?
NAM YesE-r
No F]
Electric power shuts down upon system activation?
NAM Yes,2!�
No F]
Range hood tied to building alarm panel?
NA,?? Yes E]
No F]
Range hood activation signal received at building alarm panel? NAQ--` Yes E]
No [:]
Class K extinguishe sent,.?
Yese
No E3
Grease buildup ir;0-P-UrP9:
Light Me d;'uS
Date of last clea ing -pn— JX
Heavy, recommend cleaning
, A
�5ky
er F
Are cleaning intervals within NFPA standards. es No 0
Previous Confidence Test Company & Technician
L
-
NEE1
INN=
IN
om
=�N=�sm
Problems Found: (if additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
Customer has declined repairs X
SFD Certification Number:
This c rtifies that this fire and life safetlAystem has been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Diiscrepa 0 d ha )een reported to the building Owner/Responsible Person for corrective action.
Signature of Tester: ��Clx Phone # (206) 726-0940
Testing Agency: R&T Hood and Duct Services, Inc. MailingAddress: 610012thAve.S.,Seaftle,WA98108
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 extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and currNtiion shall be taken immediately.
corr
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate r ctive -
intended use. 9. A record of the mont IyW* spections is to be kek reflecling the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person pertormin t e in,� quired.
4. Observe system, checking that no obvious physical damage or condition exists NV
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
t—IhL Ut=.I'Ah I IVILN I LoUt'll
FIRE PREVENTION
CITY OF''EDMONDS SAFETY SURVEY
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIRE DEPARTMENT
41S
LOCATION:
23025 1 00th Avenue
w
BUSINESS NAME:
Chopsticks in Edmonds
PHONE:
4257761196
MAILING_.
23025 1 00th Ave W
ADDRESS:
Edmonds
98020'�:�
2067233345
BUSINEss OWNER:
Woo, Terry
HOMEPHONE:
EMERGENCY-1:
Woo, Boyd
HOMEPHONE:
2067237051
2067233345
KEY ACCESS-2:
HOMEPHONE:
FREQUENCY
STATION & SHIFT
�,M5-
20 D
SCHEDULED
01
01/0"ll 1
DATE DUE
LIFIR 0- 161
1054
OCC LOAD 138
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE HD*1 0 FE 16 �20
SYSTEMS: 10,(10
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 0
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
8
8
lst RE -INSPECTION
2nd RE-INsPEcTibN
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATEDUE�-,__
DATE DUE:
G RANTE D TO:
CITED:
PERSON
PERSON
IPERSON
CONTACTED:
CONTACTED:
______.LC?NTACTED:
1
2
INSPECTOR:
INSPECTOR:
[-INSPECTOR.
DATE:
DATE:
DATE:
3
4
VIOLATIONS
1
VIOLATIONS
5
PRE -CITATION
LETTER SENT
NUMBER:
5
2 6
2
6
DATE:
CODE
SECTION:
RETURN RECEIPT
RECEIVED
-CISPOSITION:
6
3 7
3 7
FDATE.
7
4 8
8
�,LETTERNEEDED .D YES L7 NO
LETTERNEEDED E]YES 7 NO
8
FIRE DEPARTMENT COPY
R AAA"
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: --�
Occupancy Address:
Responsible Person:
Building Owner:
COMPLETE Certification Given: RED E] YELLOWE] WHIT
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning — SYSTEM TEST REPORT
Fire Suppression Installation & Service FCONFIDENCE TEST 2- REPAIRSE]
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE: A0 /0
City, State, Zip:
Phone Number:
Phone Number:
— 2 ZF- —
7W
Building Owner Address: City, State, Zip:
Testers Name (Please Print): SFD Certification Number: SCP-
System Alarm? Yes F-1 No Central station monitoring? Yes [3 Npel monitoring company name:
Control Panel manufacturer: Model Number: Location of Alarm Panel:
Extinguishing System Manufacturer A 6 System Size I.I.L. 300 System? Yes hoF] I.I.L. 300 Compliant? YesoNoE] Chemical Type: Wet,2 Dry E:1
-- A- --ff 111% 01 .1�2r
Location / Height of Range hood:
Js pressure gikqge indicator in operable range?
Yes
No[.
12 year hydro date of cylinder.
Is there chemical inside of the cylinder?
Ye;2T'
No[] �—Were-handpor
, table -"-
extinguishers properly serviced?
NA e-s
eigh C - 02 or - n I Itrogen ca - rt . ridge. 7
Were all cooking surfaces protected? If not, give owner full
Yes�t- NoF-1
No visible signs of a system fire or system tampering (if signs checFrno). Yes;;?
Check all piping and conduit. Are all piping and conduit immobilized with Yes [;-or
No F-1
-N rj
o
___information._ -neP 0-
Was operatipg_procedure verball cliven to restaurant pers� et1N
Y------ - — - _ 9nne . ___ -
proper hangers and brackets?
J—
Was UL 300 compliance explained to owner or manager?
Yes E�J--No [j
Are all protective covers present on nozzles?
Yes
No F-1
Gas shutsdown-upon system- activation?-
NA EJ
Are all nozzles checked in the proper Rasition?
Yes
No
Electric power shuts down upon system activation?
NA F] Yes2-"NoE:l
Does system have adequate volume and/or nozzle coverage?
Yesj;��
No
Ran a hood tied to building alarm pastel?
7n ljo 0
NA �es
Are all appliances Inside, of the -hood prq1tection-a-re-0-
Y6621'_�No
Range hood activation signal received at building alarm panel? NAE?Yes F-I No E]
Have fuse links been replaced?
YesZ
No Ej
-C 6ss- K ext -ingu ishe r- —pre se nt?
e
-Y - j�� 0
Was system operational from terminal link?
No
Grease buildup in group:
Was system operational from manual remote?
Was sy stem and m - icro switch operational?
Yes
NA Ye
No
Light !ed
M_ �-,.m Heavy,
Date of last cl
.--qAaning—
recommend cleanin
Af4l C,6---
Is system visible and free from obstruction?
Yes,,,_
—Ye
No E]
--WO-M
Are cleaning intervals wit - hin - NFPA - sAndards?
--W -
Y.es-L;�—No
Is the inspection and service ta on the cylinder?
g
ev-pus . nfidence Test C mpany & Technici
do 0
Corrections Made: Date Corrected:
Corrected By:
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire and life safe
svt e m h been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
e
0:
d
0or
reported to the building Owner/Responsible Person for corrective action.
ii�
4 a b
standards. Discrepa iie ootoyaan
Signature ofTester:?�M Ot 4 Phone # (206) 726-0940
Testing Agency: R&T Ho6crancTbubt SeRvices-RA—F.- MailingAddress: 6100 12th Ave. S., Seattle, WA98108
The owner is to perform and keep a written record of the following "quick check" fire s em inspection to verity the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and I sea s are intact, undamaged and tight.
ag or ce
place and has not been removed or tampered with. 7. The inspection t :e ica e is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are und, ; pp ppriate corrective action shall be taken immediately
intended use. 9. A record of the mon y inspe( tion � is to k kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performin e inspect on tn/dy deftctions required.
n
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED t-- -
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
COMPLETE Certification Given: REDD YELLOW[�T' WHITE[JI
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R High Pressure Hood Cleaning — SYSTEM TEST REPORT
&THood and Duct Services, Inc. Fire Suppression Installation & Service FCONFIDENCE TEST Z' REPAIRS[:]
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE: 0 5rhff-1,10
Occupancy Name: -
Occupancy Address:
Responsible Person:
Building Owner:
Building Owner Address: ir , 4
Testers Name (Please Print):
System Alarm? Yes[] No Central station monitoring? Yes E] No E]
Control Panel manufacturer: Model Number: —
Extinguishing System Manufacturer 'R
Location / Height of Range hood:
LI.L. 300
City, State, Zip:
Phone Number: - Y-2-5 — 7 7,,� — /I ?,�
Phone Number:
0 2�_CED
City, State, Zip: 4 1
SFD Certification Number: SCP- H-,C)4syl-
Monitoring company name:
Location of Alarm Panel:
Ej
;tem?Yes� �oE]U.L. 300 Compliant? Yes No Chemical Type: Wet Erv� Ei
AV'2 0'
Is pressuregauge_Iriclic tor in operable range?
as - 0
12 year hydro date of cylinder.
Is there chemical inside of the cylinder?
st' NoEl 'L -.1 b I a a At i n gy §-�h - NA0-Yes-C2f-No
pj?!l 9!s_ properly serviced?
rW CO2,or nitrogen cartridge.
Were all cooking surfaces protected? If not, give owner full
Yes No E]
--eigh�
No visible signs of a system fire or system tampering (if signs check no). Yes No
Check all piping and conduit. Are all piping and conduit immobilized with Ye Non
information.
Was operating procedure verbally given to restaya nt personnel?
_ _L_ _ _ _
Yes Noo
-
proper hangers-and-brack-6ts?
Was UL 300 compliance explained to owner or manager?
. .
da d
Yes No
Are all protective covers present on nozzles?
Yes [�r- No El
s- shuts own upon system activa tion? NAE]
Yes a No
Are all nozzles checked in the proper position?
Yes f�,7NO o
Electric power shuts down upon system activation? NA F�
Yes No E]
Does system have adequate volume and/or nozzle coverage?
Yes Noo
--7:;,
'Range
Rang e-h-o-o-d- tied to- buil-din-gi a-lar m
-- panel? NAE�-
Yes 0 No F]
Are all appl�riances insi - d - a of the hood - protection area?
Yes D Non
hood activation signal received at building alarm panel? NA El'
Yes F] No[:]
Have fuse links been replaced?
Yes [?r- No E]
Class K extinguisher present?__
Yes IT- N-o
'-Was- systern-cp m termi inal link?-
-Yes[�T—Non
Grease buildup group:
Was system operational from manual remote?
Was syste - m - an d - micro s . witch .- operational?
Yes [�J— No E]
NA Yes 1400
1�! Iium— Heavy, recommend
D - te-of last cleanhi—CM K4, iv
a
clea0ig
�t ilz,/
Is system visible and free from obstruction?
Yes [?r' No E] —
No
of
Are cleaning intervals within NFPA standards?
?,7
Previous Confidence Test Company & T-6
Technician
Yes B—No EI
4
js the inspection _qnq service tag on the cylinder?
. ... .. Nis� 1—]
ME
7,
P blems Found: (I fad ton oomisneeded,plqaeada eparatesheet) 4�,,7K'
9-11 e 4 C ej Vii (A-S 47 C.L4
X vicc-g I"? -Sc� Y�e- 6'.0'Al'ot
iji'a-dV-Q�1zq aoe-,"t, s
Dc-r- Al rlA Mw I 7,5� 4 IVA,-A V C- P
)Q--V
YL Y!so /,.,7 Li'l X, 1-70 Lt- 5 "on in .5 C;, ide- C-,, 4, JM�A
Pl- 11Z;- ej 1�- :5,er y: ce) . -&%&CjZn Ls ne-t /j
L -Z C:) Q r— A —.a 14 Al-0 iA,- A-,, e. 4 � t. S-rl-
I " -
lryj
- Jr
C2 0
LA L:110- -,1 1 17,4
Al
Corrections Made: Date Correcta��. orrected By:
SFD Certification Number:
for reliability
This certifies that this fire and LE etysys$m�baai�-.
to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
.e�(��d
rid ha u ng Owner/Responsible Person for corrective action.
standards. Discrepancies are nj1ed)n2 ,
rn
Signature of Tester: >
Phone # (206)726 -0940
Testing Agency: R&T HoNad DO)
!== -5M
MailingAddress: 610012thAve.S.,Seaftle,WA98108
The o-w-n—er 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 extinguishing cylinder is in
6. The nozzle disc caps an heir seals are intact, undamaged and tight.
place and has not been removed or tampered with.
, cion
7. The insl i tag or rti icate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for
8. If any d( cies four d, appropriate corrective -Iction shall be taken immediately.
'icien,
intended use.
9. Arecordofthem thlyinipectionsis 't ct,ng the date inspected, inititals of
to_ Xep
3. Insure that all tamper seals are intact and that system is in a ready condition.
person performi the insi e orr ioCs required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation.
AUTHORIZED
r!
5. The pressure gauge reading on the cylinder shall be in the green operable range.
SIGNATURE I
FIRE DEPARTMENT COPY
CIW,OF EDMONDS
121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
41 t 89
LOCA�ION: 23025 1 00th Avenue w
BUSINESS NAME: Chopsticks in Edmonds
MAILING 23025 1 00th Ave W
FIRE PREVENTION —
SAFETY SURVEY
PHONE: 4257761196
ADDRESS:
Edmonds 98020
BUSINESS OWNER: Woo, Terry HOME PHONE: 2067233U,5
I
1 2067237051
EMERGENCY-1: Woo, Boyd HOME PHONE:
KEY ACCESS-2: HOME PHONE: 2067233345
FREQUENCY
STATION 1, SHIFT,"'
3
I
20 C
SCHEDULED
DATE DUE
LIFIR ll� 161
1054
OCCLOAD 138
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
I 2� A Inn I if ^^n 1 -2
r1mr— I ILJ -ripu UL.'JUL)
SYSTEMS: %0101
" �_Yjj
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE lo
VIOLATION CODE
2
2
3
3
4
4
5
6
6,
7
7
8
8
lst RE-IN8PECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
VIOLATIONS
5
PRE -CITATION
LETTER SENT
CrIATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
18
DATE
DISPOSITION:
T8
LETTER NEEDED 0 YES NO
LETTER NEEDED [] YES NO
.FIRE DEPARTMENT COPY
MEOMM AUTOVAX GAS 9W
uo�
&0 GALLON
ROM GIM PRE
mwx RILL By off MPE
NOTE: ALL PIPE IS BLACK SCHEDULE 40 48- AM FLOOR LM
ALL ELECTRICAL HOOK UPS- DONE BY OTHERS
NO ARE ALARM
SYSTEM OPERATING AND MAINTENANCE
INSTRUCTIONS POSTED BY MANUAL RELEASE
2-A, 1-B:C:K BACK UP PORTABLE ARE
EXTINGUISHER (54" MAX ABOVE FLOOR
LEVEL) LOCATE ALONG PATH ` OF EGRESS
WITHIN 30' TRAVEL DISTANCE
PLENUM NOOZLE MOST BE LOCATED
WAIN 61 OF END OF THE PLENUM
AND DIVIDING THE LENGTH INTO
SECTIONS EQUAL. TO OR LESS THAN 10'
CYUNDER HAS MECHANICAL CONTROL HEAD
12* X W
P PPE Ilf
PE 'If
12* X W' DWE
3/4*
go
N REE LN(S
45�1
4
WE 10/24/02
CHOPSTICKS
Jo 0
RESTAURW
RESTAURANT
NAME
DR.SY
ADDRESS 23025
1 OOTH AVE
W-
G.WILKINS
c Ty 17DIVIONDS
mp 98020
nRE SYSTEM 11WALLED BY
S'ZE A
R-'& T HOOD and
DUCT SERVICES INC.
ssf OF
6100 12TH SO.
PHONE (2W) n6-0940
x x
SEATME WA. 98108
F" (2W) 767-2607
DM WAG SrANDARDS
SYSTEM MFG.
CAPABLE 18
RD-
��nL%ow 16
PIPE
PD? AAW Y— 14.5M
CYL FLOW
SaE
CITY OF EDMOND—S
BUILDING DEPARTMENT
WORKJ--
ADDRESS
OVYNER--.�
APPROVED DATE:
P-11-0G. OFFICIAL -
PIP-7-nn MITT NUMBER
EDAf
NOTICE
TO PERMITTEE AND/OR OWNER
-31 (( 0 1 S_ 3,,f:>
10, DO NOT REMOVE.,
PARTIAL APPROVAL CORRECTON REQUIRED El ENFORCEMENT VIOLATION
Owne Permit Number 6? CD3—OWO
Job Address iAAK (A) Site Contact
El 'WORK DESCRIBED BELOW HAS BEEN INSPECTED AND IS APPROVED
El APPROVED PLANS AND JOB -CARD MUST BE AVAILABLE TO INSPECTOR ON SITE
L3 CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE NEXT PHASE
OF WORK IS STARTED
Ll RECALL FOR INSPECTION $45 REINSPECTION FEE MUST BE PAID PRIOR TO INSPECTION REQUEST
El STOP WORK -UNTIL AUTHORIZED TO CONTINUE BY CITY INSPECTOR
LJ NO PERMIT -STOP WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK COMPLY'WrrH
ALL APPLICABLE CITY CODES
THE ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED TO BE CORRE(
3 0 CALENDAR DAYS OR PENALTIES MAY BE APPLIED. FOR INSPECTION CALL
Building Ll Planning Ll Engineering
0.
owl
Q
.771-0
(IDTX
0 Fire 0 Public w 0�
)r 1-U, o3 'Date �j
White: Permit File
Pink Enforcement
Buff: Applicant
&041
xt4
9 0 9 C)
Permit Number
Job Address ")
NOTI.CE
TO PERMITTEE AND/OR OWNER
F-1 PARTIAL APPROVAL
F-1 VIOLATION
Zf CORRECTIONS REQL9RED
Owner
02-S- 100
� ISAME
a
F --- i No PERMIT -STOP WORK -REMOVE CONSTRUCTION OR OBTAIN PERMIT AND MAKE WORK'COMTLY
WITH ALL APPLICABLE CITY CODES
F-1 CONSTRUCTION Is NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT - STOP WORK.
MAKE WORK COMPLY WITH APPROVED PLANS AND PERMIT OR REMOVE.
F-1 STOP WORK - UNTIL AUTHORIZED To CONTINUE By CIT Y INSPECTOR.
F-1 CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/OR THE
NEXT PHASE IS STARTED; To AVOID POSTING OF A STOP WORK ORDER, ORDER To
CORRECT, OR ABATEMENT PROCESS.
F-1 JOB CARD MUST BE POSTED ON SITE AND BE VISIBLE FROM STREET.
71 APPROVED PLANS MUST BE AVAILABLE To INSPECTOR ON SITE.
F-1 WORK DESCRIBED BELOW HAS BEEN INSPECTED AND is APPROVED.
F-1 CONTACT INSPECTOR AND ARRANGE FOR APPOINTMENT.
tidRECALL FOR INSPECTION.
) - C-�Ac'�Vk
THE ACTIONS OR C-0-MVECTIONS INDICATED ABOVE ARE REQUIRE W
DAYS OR PENALTIES MAY BE APPLIED. FOR INSPECTIONS CA�LLI
75--772-0
F-1 r
Ll Building Division Planning Department Engineering Department I�Zire epartment
CITY OF EDMONDS
LA L .. k-t- 444!5- 3 -1 -Inspector Date
�P& - 0-130