23028 100TH AVE W (2)3 FIREYREVENTION,
Servingurier,'Edinonds, and 12425 Meridian Ave S INSPECTION REPORT
CO EDMONDS
A
Mountlake Terrace. Everett, WA 98208 0 BRIER
0 MOUNTLAKE TERRACE
Phone (425) 551-1200 [1 UNINCORPORATED
k_.7 JL www.FireDistrictl.org Fax (425) 551-12-72
r-FREQUENCY STATION IL SHIFT
LOCATION: 23028 100 th Avenue W 98026 Annual 20-D
Bartell Drug CO. #58 4257744916 SCHEDULED Feb 2017
BUSINESS NAME: PHONE: DATE DUE
MAILING UFIR 11, 543203
ADDRESS:
BUSINESS OWNER: Bartells HOME PHONE:
Wsm
EMERGENCY-1: 4a
HOME PHONE: CURRENT YE NO*
KEYACCESS-2: HOME PHONE: CITY
BUSINES
EMAIL: LICENSE
PERSON CONTACTED: Cf�g'aoc(_ INITIAL INSPECTION DATE
NAME OF INSPECTOR: V) _rbd
FIRE SYSTEMS- AS 3/16 FA 3/15 FE 3/1.5
Date Last Se I rviced: 31n 31n
HAZARDS FOUND AND LOCATIONS /COMMUNICATIONS
c_k-ectr, 4T- (ATr- -�o see
--j-'0 -T�e I f-i5 2�
3
4
5
6
7
4
5
6
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION 2nd RE -INSPECTION
EXTENSION FINAL RE -INSPECTION VIOLATIONS
DATE DUE: DATE DUE:. GRANTEDTO:
DATE DUE: CITED:
PERSON PERSON PERSON
CONTACT D. CONTACTED*
CONTACTED:
2
INSPECTOR INSPECTOR.
INSPECTOR:
DATE: DATE. 3
DATE
VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSbEb
1 5 1 5 LETTER SENT NUMBER 4
CODE 5
2 6 2 6 DATE SECTION
RETURN RECEIPT
3 -7 3 -7 RECEIVED- . . .... .
DISPOSITION*
7
4 8 4 8 DATE
LETTER NEEDED E] YES [__1 NO LETTERNEEDED E) YES [I NO
8
FIRE PREVENTION
SNOHOM'ISH Co., Serving Brier, Edmonds, and 12425 Meridian Ave S INSPECTION REPORT
DEDMONDS
,Mo U` hilake Terrace Everett, WA,.98208 [3 BRIER
FIRE Phone (425) 551-1200 [3 MOUNTLAKE TERRACE
[I UNINCORPORATED
DISTRiLur. www.FireDistrictl.org Fax (425) 551-1272
FREQUENCY STATION & SHIFT
LOCATION: 23028 100 th Avenue W 98026 Annual 20-C
BUSINESS NAME PHONE: SCHEDULED
Bartell Drug CO., #58 4257744916 DATE DUE o Feb 2016
MAILING LIFIR 0 543 203
ADDRESS:
BUSINESS OWNER: HOME PHONE:
Bartells
EMERGENCY-1, Wang, Tah HOME PHONE: 2064338907. "CURRENT -S
KEY ACCESS-2: HOME PHONE: CITY YE NO
BUSINESS
EMAIL: 60 El
NNeItAotl-e LICENSE
INITIA I L IN ECTION DIE
NAME OF INSPECTOR: S)
PERSONCONTACTED:
FIRESYSTEMS: AS3/15FA3/15FE;3/15
nqtp 1 nst .0,pryarpri-
HAZARDS FOUND AND LOCA1$OPTM 9MMOMCATIONS
2'
.1 A
3
3
4
4
5
6.
5
6
7
7
AGREE TO cbRRE.CT,'T,HE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
w
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS,'
CITED:
PERSON
CONTACTED:
INSPECTOR:
PERSON
CONTACTED:
PERSON
INSPECTOR:
_�ONTA�LE
INSPECTOR:
2
DATE:
DATE:
DATE:
3.
VIOLATIONS
2 6
VIOLATIONS;�'
2 16
PRE -CITATION
L rER SENT
CITATION ISSUED
NUMBER:
4
DATE
CODE
SECTION:
5
7
3
7
RETURN RECEIPT
RECEIVED
DATE:
6
7
18
4
8
-4
LETTER NE EMD YES 0 NO
LETTER NEEDED YES [_1 Np
8
Confidence Test Report From:
SeaTac Fire Protection LLC
PO BOX 88565
Yle".
Tukwila, WA. 98138
253.341-7132 P 866.558.7475 F
SPRINKLER - WET SYSTEM
Certification Given
(One System per Report)
RED C3
YELLOW 0
1 WHITE 0
CONFIDENCE TEST M � REPAIRS C3
Z'3otS On, A ve, W
Occupancy Address. —
Cd Mo nd S, WA, SS 0 Z 0
13 LA r r P. i 1 1) (- 0!Cj
Occupancy Name:
Responsible Person
First & Last Name': M (Xnc\ e,,r
Phone Number: L415- -7 -1 k4 - L4 Ci i
Responsible Person
Responsible Party
Address, City, State, Zip: S ayn Q
E-Mail Address
Date of Inspection:
Inspection MAnnual MQuarterly
Frequency/Type: Owinterization
Testers Name
State Certification
(Please Print): P_ y-
Number: (9 6%ci IT - 0 73 1 S 16
Identification
Number: C,�Ck - T_ T- 0 1 10
System Location: w1nole
Central station monitoring? Yes M No C3
Monitoring
Monitoring Required? Yes 91 No 0
Company,Name:
System Make: SlhcrS3 U V)
System Model: LA" ShoTbur)
STATE FIRE CODE VIOLATIONs FOUND: (if additional room
is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected:-
Corrected By:
(If additional room is needed, please add a separate sheet) State 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 Washington State Fire Code standards/NFPA 25, and that
discrepancies are noted and have been reported t e building Owner/Manager for corrective action.
Signature of Tester: 1��_�Phone
# 7-S 3 - 3 L4 1- -7 13 Z
Building Representative 1�signature)
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the NFPA 25 for inspecting and testing requirements.
General
1.
Main Drain and Inspector's Drain flow test conducted?
Yes
No
2.
Staticpressure: p.s.i. Flowpressure: T5 p.s.i.
3.
Number of Sprinkler Heads:
4.
2-inch drain? Other
Yes
No
5.
Flow switches, supervisory switches and alarm bells tested? N/A,
Yes
No 0
6.
Pressure regulating valves tested? N/A M
Yes
0
No 0
7.
Alarm bell operates? —1,; p—� -�,, .... '12- N/A
Yes
No
8.
System inspected and lubricated?
Yes
No
9.
Valves are sealed or(s—up—e—rv--is6
Yes
No
10.Signs
are provided on valves?
Yes
No
11.
Pumper connections and clapper valves unobstructed and turn freely?
Yes
No
12.Sprinkler
coverage is acceptable?
Yes
No
13.
Have the sprinkler heads been replaced or successfully sample test in the
Yes
No 0
last 50 years? Date of last test: Aje.jAx 10 0 Z
14.
Proper number of spare sprinkler heads available with appropriate wrenches
Yes
M
No 0
for each?
15.
System left in service?
Yes
No
16.
System gauges replaced or calibrated within the last 5 years?
Yes
No
Year changed: 0 �A 10 CA
17.
Sprinkler heads free of corrosion, paint, obstructions and/or physical
Yes
No
damage?
18. Was debris found in the Fire Department Connection (FDC)? Yes 0 No 3
19. Was the Fire Department Connection (FDC) back flushed within the last 5
Yes No
years? Date of last back flush o 4 / 0 (1
20. Was an internal pipe and valve inspection performed within the last 5 years? Yes C3 No
Date Performed —0 L� .10 9
21. Is the hydraulic nameplate installed and visible on riser, if No then Yellow Tag. Yes No
(Ref: NFPA 25 5.2.7) C�ey)SITY
22. Was a signal receive . d at the Central Station . monitoring N/A Yes No
company?
Sprinklers - Wet Page 2 of 2
11-1114L FKLVLN I 1UN
SerOna Briet: Edmonds, and
I SNCIHOTN�ISHjCOI.
Mounflake Terrace
DISTR '''T vi`,-wwFireDistrict1.org
LOCATION: 23028 100 th Avenue W 98026
BUSINESS NAME: Bartell Drug CO. #58
MAILING
ADDRESS:
Bartells
BUSINESS OWNER:
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
—1-,--iwj %v-_/ -
6-(Avo.�l 04
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: -"4257744916,
INSF_,ECTION REPORT
-O'EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY I STATION & SHIFT_*�
Annual 20-B
SCHEDULEcFeb 2015
DATE DUE 1'
LIFIR P43.203
I�CA —I-
HIDML-PHONE:
0-fi-kc'r-' —? qn634-AqRqn7
HOME PHONE: CURRENT,
.11 HOME PHONE: CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
o c) I�r'
HAZAR* FOUND AND LOCATIONS / COMMUNIFAYONS
4V&
A) A I
AM
2
3
-7
2
3
4
4
5
5
6
6
7
7
A
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAY�
V
1st RE -INSPECTION
DATE DUE:
2nd, RE -INSPECTION
DAT� DUE:
V EXTEN % SION
GRANTEDTO:
N RE -INSPECTION
DIE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECt.—
PE N
C ko E D:
0 CT
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
15
PRE -CITATION
LE rER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
[4
7
18
RETURN RECEIPT
RECEIVED
6
4
18
DATE:
DISPOSITION:
7
11 LETTER NEEDED F] YES NO
LEjER NEEDED [I YES NO
8
FIRE DEPARTMENT COPY
Jurisdiction Edmonds
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
FIRE ALARM SYSTEM
Certification Given
(One System per Report)
RED
D
YELLOW
I D
I WHITE
CONFIDENCE TEST REPAIRS I [I
Occupancy
Occupancy
Address: 23028100thAve West
Name: Bartell Drug #58 (Edmonds)
Building Owner Bartell Drug Compan
Phone Number: (206) 767-1343
Responsible Person: CChher
Phone Number: (425) 774-4916
Building Owner Address: 4025 Delridge W y SW,'#400
Seattle, WA 9810 , 6
Date of Inspection:
Inspection Annual'5i Other[]
Frequency/Type: Quarterly Floors Tested
Testers Name
(Please Print):. V'4 -e C
SFD Certification --r-2
Number: SCp- 0--�(-) -3/
Central Station
Monitoring? Yes No
Monitoring
Company Name:, C —e' -
Primary Component: Fire Alarm Panel
System Make: 4; -e i., System Mod,el:
System Location: 134 Zt!- V6,c, Identification No.
PROBLEms FoUND: (if additional room is needed, please add a separate sheet)
CORREMONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet)
SFD Certification Number:
This certifies that this fire and life safety system has been propedy inspected for reliability to cover the
items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are notCd—dnd+ava_been reported to the building Owner/Manager for corrective action.
Signature of Tester:
Phone # (206) 762-1450
Testing Agency: The Safety Team Inc.
Mailing Address: 670 S. Lucile St.
Seattle, WA 98108 PO Box 81246
Building Representative (signature)
CTF- 0 1 Nee I of 2
items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
I
;testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
Al�a;The
rm System F nctionality
Trouble signal with AC power off?
Not Tested El
Yes -k-
No E
System operates properly on battery backup?
Not Tested 0
Yes)�
No 0
Charge circuit voltage volts
Battery voltage (no load) ,-S5 volts
Battery voltage (full load) _Z4 S , volts (signals operating)
Sy stem,op , q
prooerl on gpn ' erator standby power?
Not Tested-N-
Yes o
No 11
All signals operate on AC power?
Yes--N-
No F-i
Numberof initiating cirp0t-s t'2
Number of signal circuits LA
boiet'ai4
Yes-Nz
'Noo
All circuits checked for electrical supervision?
Yes4s
No 11
All auxiliary equipment operates (Elevators, fans, dampers)? N/A h-
Yes,.,,El
No n
Ventilation controls operate?
N/A-N;-
Yes 11
No ri
Key to panel avaj,10,011P.7,
Yes
No,[]
Operating instructions at panel?
Yes-N
No F-i
Trouble indicatbri's"function .-properly?
No 0
Remote Annunciator Panels function properly?
NWN-
Yes n
No ri
Elevator Call Down functions properly?
N/A.N-
Yes [I
No LI
Test record posted at panel?
Yes-'f�
No ri
General alarm aut6matic"firriedelay �minutes)
N/A-I�r
Was a signal received at the Central Station monitoring company? N/A [I
Ye09--
No
Total Number of
Total Number
System Devices
Units Tested
Units Inoperable
Test Results Acceptable
1. Bells, Chimes
N/ft,
Yes 11
No 0
2. Voice Speakers (Voice Clarity)
N/A-S;-
Yes 11
No [i
3. Horns (Only)
IN /A -S-
Yes 11
Nol]
4. Visual Alarm Devices (Strobes)
N/A Fi
Yes-)S-
No 0
5. Horn/Strobe Combos
N/A 11
Y es.&,
No 0
6. Heat Detectors
N/A *�9k-
Yes 11
No LI
7, DUCt,D6,tecto r rs
N/A El
Ye-§A�-
No El
8. Sprinkler Flow Switches
N/A [I
Yes-N
No F-I
9. Sprinkler Supervisory Switches
N/A [I
'�esA-
No El
10. Smoke Detectors
N/A El
Yes-;4,-
No 1-1
11. Manual P ' ull Stations
N/A El
Yes*
No o
12. Annunciator (s)
N/A"n-
Yes El
No 11
X
'a
14. Automatic Door Unlocks
N/A'79
Yes 1:1
No 11
iwf
Total Number of
Total Number
Communication Equipment
Units Tested
Units Inoperable
Test Results Acceptable
T7, 37 7--,
77 , - , , �77, ,
77-i 7777,1�,
N
, 1;11 �
ft
-
17. Fire Phone Jacks
N/AT
Yes 11
No,Ej
Notes/Observations:
Jurisdiction Edmonds
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
SPRINKLERS - WET
Certification Given
RED
El
I YELLOW
WHIT
(One System per Report)
CONFIDENCE TEST REPAIRS1 El
Occupancy Address: 23028 100th Ave West OccupancyName:- Bartell Drug #58 (Edmonds)
Building Owner: Bartell Drug CornpLny --Phone- Number: _(206) 767-1343
Responsible Person: Cheryl Phone Number: (425) 774-4916
Building Owner Address: 4025 Delridge Way SW, #400 Seattle, WA 98106
Annual
Date of Inspection: Inspection Frequency/Type:'
Other
Testers Name C4 L� C
(Please Print): C/4 P-42 C4`�r- L-,:/ SFD Cert #: -Y2-&-72'�, ITT #:
Central Station Monitoring Company
Monitoring? , Yes No 11 Name: c'-p-r4-0?
Primary Component: Riser System Make:
System Model: 13 Valve Size: Valve Year: i0c,
System Location: Ide n1tification No.
PROBLEms FOUND: (if additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) SFD Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent With Seattle Fire Department Fire Code standards, and that
discrepAncies,@re noted and have been reported to the building Oyiner/Manager for corrective action.
Signature of Tester: Phone # (206) 762-1450
Testing Agency: The Safety T�eam Inc.
Mailing Address: 670 S. Lucile St. Seattle, WA 98108 PO Box 81246
Building Representative (signature)
Page I of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
General
Flow test conducted?
Static pressure: I(."- psi Flow pressure: psi
Total Number of System Sprinkler Heads-
2-inch drain? Other El
Flow switiph6 s" " supery�sqry. switches and, alarmr'bells tested? -N' El
/A
Pressure regulating valves tested? N/A"�]
Alarm bellop
prate,�? MAO
System inspected and lubricated?
Control Valves are sealed or supervised?
Signs are installed on valves?
Yes"Sz-
No [I
Yes.,N
No L!
Yes-61 ,
No El
Yes 11
No 1-1
Yes-N
No El
Yes-K
Yes��
Yes.-SJ
Pumper connections and clapper valves unobstructed and turn freely? N/AE1 Yes:R
Wet type sprinkler heads have been replaced or successfully sample tested in the
last 50 years? ,,��A Yes El
Sprinkler coverage, is acceptable? *NFPA25-2002-Sec 5.2.1.1 (Floor Level Only) yes'N
Proper number of spare sprinkler heads available? Yes
System left in service? Yes-N
System gauges replaced or checked for accuracy within the last 5 years? Yes
Install/Calibration Year -7 Shut off valves
Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? Yes-*F�t No 1J
Fire Department Connection (FDC) caps are present and undamaged? N/All Yes-N No El
wot be, 4 0
Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed Yes El No-k-
Proper signals -,re" be' Jve'd,,,a't-'the, CenttalStatiori monitoring com 00hy? Y4s -,N 40 Q
Sprinkler wrench available for each type of sprinkler? Ye"-- No F.1
Notes/Observations:
No Ll
No El
No 1]11
No L1
No F!
No 0,
No 11
No"El
No D
!ktying Briei; Edinonds
the To Woodway
MISH CO. www.FireDistrictl.org
mi
_At untlake Terraceand
FIRE
wn of
DISTR
LOCATION: 23028 100th Avenue
BUSINESS NAME: Bartell Drug Co. #58
MAILING
ADDRESS:
BUSINESS OWNER: Bartell Drug Co.
EMERGENCY-1: Wang, Tah
KEY ACCESS-2: Cole, Douglas
12425 Meridian Ave S
Everett, WA 98208. -
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257744916
FIRE PREVENTION
INSPECTION REPORT
REDMONDS
`[IbRIER
0 WOODWAY
[I MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY STATION & SHIFT"'
365 20 A
SCHEDULED IllA
DATE DUE 0
LIFIR 0 543 2053
HOME PHONE: 2067632626 410 N
HOME PHONE: 2064338907 CURRENT
HOME PHONE: 4252268105 CITY YES NO
BUSINESS F]
LICENSE
PERSON CONTACTED: t-/1 � -rc_tAu_L INITIAL INSPECTION DATE
NAME OF INSPECIOR-._--____ V-J HKI -7 / It) I
FIRE S & F'A 3/J12TLkl3x FE a1_1Z
SYSTEMS: � --5/ n - ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
-------- ----------
3
3
4 Ir
4
5
5
6
6
7
7
1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATt DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
P
��RSON
PERSON
CONTACTED:
""CONTACTED:
CONTACTED:
INSPECTOR:
-INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
�CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
7
3
7
RECEIVED
6
DISPOSITION:
�4
8
4
8
DATE:
LETTER NEED D C] YES El No
LETTER NEEDED [] YES NO
8
I , FIRE DEPARTMENT COPY
tv
670 South Lucile St. - Seattle, WA. 98108
Phone (206) 762-1450 Fax (206) 762-1799
Jurisdiction EDMONDS
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
FIRE ALARM SYSTEM
Certification Given
(One System per Report)
RED
I El
I YELLOW
1 0
1 WHITE
CONFIDENCE TEST
'I
REPAIRS
'K ---TE]
Occupancy
Occupancy
Address:
23028 100TH AVE WEST
Name: BARTELL DRUG # 58
Building Owner
BARTELL DRUG COMPANY
Phone Number: 206-767-1343
Responsible Person:
STEVEN
Phone Number: 425-774-4916
Building Owner Address: 4025 DELRIDGE WAY SW # 400 SEATTLE WA 98106
Date of Inspection:
I
Inspection Annual N Other El
Frequency/Type: Quarterly El Floors Tested_
Testers Name
SFD Certification
(Please Print):
tcy\
Number: SCP- V-D6S7'?L-
Central Station
Monitoring?
YeslZ No El
Monitoring
Company Name: A�ayy'N &L'k�ck�L�
Primary Component:
Fire Alarm Panel
System Make:
C� tev� Y-V, i
System Model:
System Location:
ti-vi,
Identification No.
PROBLEms FoUND: (if additional room is needed, please add a separate sheet)
CORRECTIONS MADE:
Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet)
SFD Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrep are)Wed a9d have been reported to the building Owner/Manager for corrective acUon.
Signature of Tester:
,pD@es
lww�
Phone # (206) 762-1450
Testing Agency:
T6e Safe!y Team Inc.
Mailing Address:
670 S. Lucile St. Seattle, WA 98108 PO Box 81246
Building Representative
(signature)
CTF- 01 Page I of 2
0 1
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
1.
testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
Alarm System Functionality
Trouble signal with AC power off?
Not Tested El
Yes X
No D
System operates properly on battery backup?
Not -Tested D
Yes X
No D
Battery voltage (no load) 25-03 volts
Battery voltage (full load) �q - N, volts (signals operating)
Charge circuit voltage )-7- '33 volts
System operatesproperly on generator standby power?
Not Testedk
Yes 11
No El
All signals operate on AC power?
Yes,9
No [-I
Number of jnitiating circuit%,
Number of signal circuits
Does alarm system meet audibility standards?
Yew
No Ei
All circuits checked for electrical supervision?
Yes U
No 0
All auxiliary equipment operates (Elevators, fans, dampers)? N/A R
Yes El
No D
Ventilation controls operate?
N/A R
Yes 11
No LI
Key to panel availa ' ble?
Yes X
No 0
Operating instructions at panel?
Yes 9�
No D
Trouble indicators function properly?
Yes,Df
No 0
Remote Annunciator Panels function properly?
N/A g
Yes 11
No 11
Elevator Call Down functions properly?
N/A 9
Yes [I
No El
Test record posted at panel?
Yes >6
No I--]
I M (minutes)
General alarm automatic ti i e'delay
N/A 5
Was a signal received at the Central Station monitoring company? N/A ii
Yes t4
No ii
Total Number of
Total Number
System Devices
Units Tested
Units Inoperable
Test
Results Acceptable
1 . Bells, Horns, Chimes
(0
QK
N/A D
Yes 9
No 0
2. Voice Speakers (Voice Clarity)
N/AW-
Yes D
No 11
3. Smoke DetectQrs,�
7<Z
01"
N/A El
Yes W
No 11
4. Heat Detectors
N/A X
Yes El
No EI
5. Duct Detectors
N/A El
Yes A
No 11
6. Sprinkler Flow Switches
0111
N/A 11
Yes-0
No 11
7. Sprinkler Supervisory Switches
N/A El
YesZ
No L-I
8. Visual Alarm Devices
� D
r
�Ifl
N/A ii
YesX
No LI
9. Manual Pull Stations
3
N/A D
YesX
No El
10. Annunciator (s)
N/A 'N
Yes El
No Ij
11. Beamr'-, pt
-'Wp-
"i
12. Automatic Door Unlocks
N/A H
Yes El
No El
13. Autbmatic."Dob�p
"y
Total Number of
Total Number
Communication Eguipment
Units Tested
Units Inoperable.
Test Results Acceptable
14.- Phone�Aow
_-Y, sst]
��`,No El
15. Fire Phone Jacks
N/A
Yes 11
No o
iA,2P
Yes 11
'Noo
Notes/Observations:
CTF- 01 Page 2 of 2
Jurisdiction EDMONDS
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
SPRINKLERS - WET
Certification Given
(One System per Report)
RED
0
1 YELLOW
I D
I WHITE
CONFIDENCE TEST REPAIRS I El
Occupancy Address: 23028 100THAVE WEST Occupancy Name: BARTELL DRUG #58
Building Owner: BARTELL DRUG COMPANY Phone Number: 206-767-1343
Responsible Person: STEVEN Phone Number: 425-774-4916
Building Owner Address: 4025 DELRIDGE WAY SW # 400 SEATTLE WA 98106
Date of Inspection: Inspection Frequency/Type: Annual A
3/Iq 113 Other [I
Testers Name I
(Please Print): SFD Cert #: ITT #b't3 5TF ol i
Central Station YesX No Monitoring Company
Monitoring? Name:
Primary Component: Riser System Make: r-o
System Model: yy� , " � f" I A Valve Size: Valve Year: 0�00 �;L-
System Location: V) C-0-ytL"tK- (4- '5�odc Voo-'."-� Identification No. 0
PROBLEms FOUND: (if additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) SFD Certification Number:
This certifies that tWire and life safety system has been properly inspected for reliability to cover the
Items listed in_jhig-repprt and is consistent with Seattle Fire Department Fire Code standards, and that
discrepaoci6is are ngkod and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: N11- - Phone # (206) 762-1450
Testing Agency: TWSafety Team Inc.
Mailing Address: 00 S. Lucile St. Seattle, WA 98108 PO Box 81246
Building Representative (signature) ---
Page I of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
General
Flow test conducted?
Yes 10
No
Static pressure: I o Q psi Flow pressure: 60 psi
Total Number of System Sprinkler Heads:
2-inch drain? Other [I
Yes X
No D-
Flow switchds," supervisory switches and alambells tested? N/AE1
Yes
No El
Pressure regulating valves tested? N/All
Yes
No El
Alarm bell operates? NJAII
Yes N�
No 11
System inspected and lubricated?
Yes'R
No
Valves are sealed, or supervised?
Yes M
No F1
Signs are provided on valves?
YesK
No El
Pumper connections and clapper valves unobstructed and turn freely? N/AE1
YesY
No El
Wet type sprinkler heads have been replaced or successfully sample tested in the
YesZ
No El
last 50 years?
Sprinkler coverage is acceptable? *NFPA25-2002-Sec 5.2.1.1 (Floor Level Only)
Yes P�
No F1
Proper number of spare sprinkler heads available?
Yes
No L]
System left in service?
Yes Y
No El
System gauges replaced or calibrated within the last 5 years?
Yes >4
No F1
Install/Calibration Year ;gLocl� Shut off valves Ve--:5,
Sprinkler heads free of corrosion, paint, obstructions and/or physical 'damage?
Yes M
No El
Was debris found in the Fire Department onnection (FD )? N/All Yes M No 11
h bt
idt, dk4l hed
Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed /-I ii /A Yes 11 No 11
Was a-. signal..roce-i -th6t6htfal�Staition monitoring company? j4jA[] Ye- s- g No[I
Sprinkler wrench available for each type of sprinkler? YesX No 11
Notes/Observations:
C'so 'Y�� I I
C'n
M
Al 001- tit, I, --
Page 2 of 2
Jurisdiction Edmonds
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
SPRINKLERS - WET
Certification Given
(One System per Report)
RED
YELLOW
WHITE
CONFIDENCE TEST I R REPAIR7S El
cc* 23028 100t' Ave W Occupancy Name:
Occupancy Addre . Bartell Drug #58
Building Owner: Bartell Drug Co Phone Number: 425-774-4916
Responsible Person: Michael Phone Number: 206-767-1343
Building Owner Address: 4727 Denver Ave S, Seattle, WA 98134
Annual E�
Date of Inspection: Inspection Frequency/Type:
Other El
Testers Name ,q
(Please Print): Aesz —014U�11,�11� scvt-SFDCert#: �4e'-],Z�-7-1 ITT
Central Station Y e s FS No 11 Monitoring Company
Monitoring? Name: r-eJI6,-
Primary Component: Riser System Make:'
System Model: Valve Size: tj 11 Valve Year:
System Location: 'OeCL 61yje- 1� IK-1-11,1� Identification No.
PROBLEms FOUND: (if additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) SFD Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancieApre noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: Phone # (206) 762-1450
Testing Agency: The Safety Team Inc.
Mailing Address: 670 S. Lucile St. Seattle, WA 98108 PO Box 81246
Building Representative (signature)
Pagel of2
64
The items on the checklists below shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
General
Flow test conducted?
Yes
No 0
Static pressure: too psi Flow pressure: W i
psi
Total Number of System'Sprinkler Heads:
2-inch drain?
Other 11
Yes �C
No 1-1
Flow switches, supervisory switches and alarm bells tested?
N/AD
Yes
N o 11
Pressure regulating valves tested?
N /A L--4-
Yes [I
No D
Alarm bell operates?
N/AE1
Yes 5�
No [I
System inspected and lubricated?
Yes 9
No LI
Valves are sealed or supervised?
Yes 1,;;9
No D
Signs are provided on valves?
Yes K
No El
Pumper connections and clapper valves unobstructed and turn freely? N/AEI
Yes �d
No [I
Wet type sprinkler heads have been replaced or successfully sample tested in the
Yes il,
No 11
last 50 years?
Sprinkler coverage is acceptable? *NFPA25-2002-Sec 5.2.1.1 (Floor Level Only)
Yes
No El
Proper number of spare sprinkler heads available?
Yes IK
No F-I
System left in service?
Yes W
No 11
System gauges replaced or calibrated within the last 5 years?
(�alibration Year ZckD9 Shut
Yes �Q
No D
- off valves. kle.-s
Sprinkler heads free of corrosion, paint, obstructions a'nd/or physical damage?
Yes
No El
Was debris found in the Fire Department Connection (FDC)? N/ALI
Yes El
No k
pti -�,FQC us , , 1 7 q
Was -the Fire artment Coil e on )'b R -1 6
p
Was an internal pipe and valve inspection performed within the last 5 years?
Yes D
No ED
Date Performed
Was a signal received �at the C entral Station monitonn company? -IN/A-0
Yei� 0
0''
Sprinkler wrench available for each type of sprinkler?
Yes
No 11
Notes/Observations:
Y� j VIL C) k C U IIL[4e_jA4 L,)J'k t
Page 2 of 2
Jurisdiction Edmonds
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
FIRE ALARM SYSTEM
Certification Given
(One System per Report)
RED
I El
I YELLOW
I �FTWH17TE
El
CONFIDENCE TEST
REPAIRS
D
Occupancy
Address:
23028 100th Ave W
Occupancy
Name: Bartell Drug #58
Building Owner
Bartell Drug Co
Phone Number: 425-774-4916
Responsible Person:
Michael
Phone Number: 206-767-1343
Building Owner Address:
4727 Denver Ave S,
Seattle, WA 98134
Date of Inspection:
Inspection Annual V Other
Frequency/Type: Quarterly El Floors Tested
Testers Name
(Please Print):
Central Station
Monitoring?
Yes[] No El
SFD Certification
Number: SCP-060-7-1
Monitoring
Company Name: h3l"
Primary Component:
Fire Alarm Panel
System Make:
System Model: i1L 5�2�0
System Location:
Identification No.
PROBLEms FoUND: (if additional room is needed, please add a separate sheet)
0, 4, 1- A-4
6,Jslaw
es
CORRECTIONS MADE:
DateCorrected: 3113h7-
Corrected By: 1, T�Av�,,cN
(If additional room is needed, please add a separate sheet)
SFD Certification Number: '�0 D- Q 651,j
'�A Rev
�ce J
t t n 11e SaTer
t t
This certifies tha d lif f system has been properly inspected for reliability to cover the
Items li:ste r� e �rtnd is consi:ent with Seattle Fire Department Fire Code standards, and that
is r PC
ci s 0 an
discrep cies are note( and have been reported to the building Owner/Manager for correLftive action.
Signature of Tester:
Q--1—
Phone # (206) 762-1450
Testing Agency:
Mailing Address:
jtlij��aktyTe—affiinc.
K-gin C-- '-"rile St. Seattle, WA 98108 PO Box 81246
Building Representative
(signature)
CTF- 01 Page I of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
Alarm System Functionality
Trouble signal with AC power off?
Not Tested [I
Yes k-
No 11
System operates properly on battery backup?
Not Tested El
Yes N.
No 0
Battery voltage (no load) �L613 volts
Battery voltage (full load) 7- 1� -0 k volts (signals operating)'
Charge circuit voltage 7-1 -33 volts
System operates properly on generator standby power?
ot Tested -80,
Yes 0
No 11
All signals operate on AC power?
Yes;kP
No El
NumberoofAnitlating clircoits
Number of signal circuits
Does alarm system meet audibility standards?
YesNb
No [I
All circuits checked for electrical supervision?
Yes N3
No 0
All auxiliary equipment operates (Elevators, fans, dampers)? NIA'�W
Yes D
No 0
Ventilation controls operate?
N/A �4,
Yes o
No ri
Key to panel available?
Yes 0*
No o
Operating instructions at panel?
Yes N.
No 1-1
Trouble indicators function properly?
YeSIF
No 11
Remote Annunciator Panels function properly?
N/A'nO
Yes F]
No [I
Elevator Call Down functions properly?
N/A'w
Yes 0
No LI
Test record posted at panel?
Yes �sa
No F-I
General alarm automatic time delay _ (minutes)
N/A�P
Was a signal received at the Central Station monitoring company? N/A 0
Yes$40
No Fj
OthelrDeA66SIS 6ci
0 NO`
VA �6
I Y,
Total Number of
Total Number
System Devices
Units Tested
Units Inoperable
Test Results Acceptable
1 . Bells, Horns, Chimes
10
-0
N/A 11
Yes-f%
No 0
2. Voice Speakers (Voice Clarity)
-
N/A 11
Yes 11
No 11
3. Smoke Detectors
I
5;4�
N/A 11
Yes A
No [I
4. Heat Detectors
-
N/A El
Yes El
No El
5. Duct Detectors
1
0
N/A El
Yes -so
No 0
6. Sprinkler Flow Switches
I
N/A Ei
Yes 11
No �-]
7. Sprinkler Supervisory Switches
4
1
N/A D
Yes 0
NoP�-
8. Visual Alarm Devices
P
N/A El
Yes'�6
No El
9. Manual Pull Stations
N/A o
Yes >m
No El
10. Annunciator (s)
N/A 11
Yes 11
No 11
11. Beam -Detectors
N/A El
Yes El,
No 0
12. Automatic Door Unlocks
N/A LI
Yes 11
No 11
13. Auto rh6tid W&A' s4�
N A C1
Y , -
"-ia� i' b
A 0�11
Total Number of
Total Number
Communication Equipment
Units Tested
Units Inoperable
Test Results Acceptable
14. Phone. Sets
N/A 11
Yes 0
No 0
15. Fire Phone Jacks
N/A LI
Yes El
No 1.1
16. Call -in �$Jgpol
��`I-NIAO
Yes El
NOD
Notes/Observations:
CTF- 01 Page 2 of 2
,C]TY OF EDMONDS'''''
121 5� AVENUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE DEPARTMENT
W
LOCATION: 23028 1 00th Avenue
FIRE PREVENTION
SAFETY SURVEY
4257744916
BUSINESS NAME: 13artell Drug Co. #58 PHONE:
MAILING
ADDRESS:
BUSINESS OWNER:
Bartell Drug Co.
HOME PHONE: 2067632626
EMERGENCY-1:
KEY ACCESS-2:
Wang, Tah
Cole, Douglas
HOME PHONE: 2064338907
HOME PHONE: 4252268105
FREQUENCY
STATION& SHIFT
365
20 B
SCHEDULED
DATE DUE 11
LIFIR 0 543
2053
410
PERSON CONTACTED: 6y,-) AJ 0 /4/\ INITIAL INSPECTION DATE
NAME OF INSPECTOR: 0 2- 0
FIRE AS 3 FE/
q1 /09 FA 3/09' FD'LkBx .2�0
SYSTEM& 0 Cl ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ENTER CODE ONLY ONCE 1�
VIOLATION CODE
�."(_ypkd , r
0 U Aj
A 11 C, o 0, r) '5
4
-1 r. -
2 ) �A)
C- A AA r-fl. A
C-7 I oo ( J
Ofl- AL) 6
2
f:-,K T
FA-) c- 0
0 W
3
3
A 6�L F-
0 07 1-1
4 AA).
4
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR-
DATE: 2.A�ZI'7
INSPECTOR-
INSPECTOR,
2
DATE.
DATE:
3
c) VIOLATIONS
5
VIOLATIONS
1 5
PRE-CITAnON
LETTER SENT
CFIATION 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:
8
LETTER NEEDED [] YES No
LETTER NEEDED 0 YES NO
FIRE DEPARTMENT COPY
Jurisdiction Edmonds ..
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
SP RINKLERS - WET
Certification Given -
(One System per Report)
RED
El
I YELLOW',
El
I WHIT
CONFIDENCETEST REPAIRS] El,.
Occupancy Address: 23028 100th Ave West
Occupancy Name: Bartell Drug #58
Building Owner: Bartell Drug Company
Phone Number: 206-763-2626
Responsible Person: CheL)Ll
Phone Number: 425-774-4916
Building Owner Address: 4727 Denver Ave S, Seattle, WA, 98134
Date of Inspection:
3/4410
Inspection Annual 99
Frequency/Type: Other El
Testers Name 46444V�1� fV11A.-K
(Please Print): V—tA& 1&t�+An
SFD Certification P005116
Number: SCp- K00,51Z,
Central Station Yes N o
Monitoring?
Monitoring Company
Name: 6&A4ri,
Primary Component: Riser
System Model: 0 JA
System Make: It
Valve Size Valve Year
System Location:N.waaLmr 0-F 5�&Ae- L,,.
Identification No.
PROBLEM fe66: (if additional room is needed, please add,a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
(If additional room is needed, ple . ase add a separate sheet)
SFD Certification Number:
This cF A s that this !i e has been properly inspected for reliability to cover the
, ') m
r if,eJ nnsisten1syZ!,teh se4ttle Fire Department Fire Code standards and that
d r nnd
Items e in this repc t
discrian (Aare noted n ave'bee eforQAL the building Owner/Manager for corrective action.
�,e
Signature of Tester: Y,, I �,, r Q+4VJ
- Phone # (206) -762-1450
Testing Agency: The Safety Team Inc.
Mailing Address: 670 S. Lucile St. Seattle, WA 98108 PO Box 81246.
Building Representative (signature)
Page I of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
General
Flow test conducted?
Static pressure: _k frpsi Flow pressure: -7r) psi
Total Number of System Sprinkler Heads:
2-inch drain?
Flow switches, supervisory switches and alarm bells tested?
Pressure regulating valves tested?
Alarm bell operates?
System inspected and lubricated?
Valves are sealed or supervised?
Signs are provided on valves?
OtherEl
N/A
N/A
N/A0
Pumper connections and dapper valves unobstructed and turn freely? N/Arl
Wet type sprinkler heads have been replaced or successfully sample tested in the
last 50 years?
Sprinkler coverage is acceptable? *NFPA25-2002-Soc 5.2.1.1 (Floor Level Only)
Proper number of spare sprinkler heads available?
System left in service?
System gauges replaced or calibrated within the last 5 years?
Install/Calibration Year Shut off valves V .
Y vq
es IS) No 0
Yes 9
Yes,M
Yes P
Yes 10
Yes 91
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
N o El
No 0
No 0
No 0
No El
No 0
No El
No El
No El
No 0
No El
No 0
N o 0
Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? Yes 0 No 0
Was debris found in the Fire Department Connection (FDC)? N/AZ Yes El No El
r
M?
theff .4' hn owlm 4heJas
Was an internal pipe anq valve inspection performed within the last 5 years?
Date Performed Yes 1:1 N o E]
WAi§ a, s n received at the Central Station monitoring company? NJA0 Yell
0
Sprinkler wrench available for each type of sprinkler? Yes N o El
Notes
tA-CAkt�S UMk,1A,6ahA
Jurisdiction Edmonds
Confidence Test Report
(Seattle Fire Dept. Only)
206-386-1448 Confidence Testing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
FIRE ALARM -SYSTEM
Certification Given
(One System per Report)
RED
YELLOW
I ' I
A I
WHITEI
CONFIDENCE TEST REPAIRS I El
Occupancy . 100th
Address: 23028 Ave West
Occupancy
Name: Bartell Drua #58
Building Owner: Bartell Drug Company
Phone Number: 206-763-2626
Responsible Person: ChervI
Phone Number: 425-774-4916
Building Owner Address: 4727 Denver Ave S, Seattle, WA, 98134
Date of Inspection:
3/4/10
Testers Name IIRCVI-F�ft
(Please Print): I �; 44A
Inspection Annual k Other El
Frequency/Type: Quarterly 1:1 Floors Tested
SFD Certification ?W5V
Number: SCP-_ 1<0(0,5--7 2-
Central Station Yes No El
Monitoring?
Monitoring
Company Name: &'6'h'n
Primary Component: Fire Alarm Panel
System Make: Is ed k4w 6 Lv�
System Model: -Sk-5-ZOO
System Location: tj-pj- C4rW(0-r1,-kcjj rooen-
Identification No.
PROBLEms FOUND: (If additional room is needed, please add a separate shee
4-0�m-,e-s ea",d o6V c-&".
OVA- twl� +�^%A—
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet)
SFD Certification Number:
This cerpqs that this fire and life safety system has been properly inspected for reliability to cover the
Items y9tef in this repolafiq OltZnVent with Seattle Fire Department Fire Code standards, and that
discrPanfienare notetarld'haye Ven WorjAd to the building Owner/Manager for corrective action.
Signature of Tester: LAX�= tfk"L-�
Phone # (206) 762-1450
Testing Agency: The Safejy team fnc.
Mailing Address: 670 S. Lucile St. Seattle, WA 98108 PO Box 81246
Building Representative (signature)
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting
and testing requirements.
Alarm System Functionality
Trouble signal with AC power off?
Not Tested
Yes
No El
System operates properly on battery backup?
Not
TeSted'0
Yei 0
No 0
Battery voltage (no load) a 6, O�— volts
Battery voltage (full load) g r— volts (signals operating)
Charge circuit voltage -1,;
A (d Volts
-a
System operates properly on generator standby power?
t4jA Not
Tested 0
Yes 0
No 0
All signals operate on AC power?
Yes 11
No 0
Number of Initiating circuits
Number of signal circuits
—sta�ndards?
Does alarm system meet audibilltj
Yes IN
No 0
All circuits checked for electrical supervision?
Yes 19
No 0
All au)dliary equipment operates (Elevators, fans, dampers)?
N/A K
Yes 0
No 0
Ventilation controls operate?
N/A 0
Yes
No 0
Key to panel'wallabl!6?
Yes 19
No 0
Operating instructions at panel?
Yes X
No 0
Trouble Indicators function properly?
Yes ad
No 0
Remote Annunciator Panels function properly?
N/A 0
Yes rZ
No 0
Elevator Call Down functions properly?
N/A
Yes 0
No 0
Test record posted at panel?
Yes
No 0
General alarm automatic time delay _ (minutes)
N/A DO
Was a signal received at the Central Station monitoring company?
N/A El
Yes
No El
V-
If 00W
Total Number of
System Devices Units Tested
Total Number
Units Inoperable
Test Results Acceptable
1. Bells,Homis, Chimes
N/A 0
Yes 0
No 0
2. Voice Speakers (Voice Clarity)
N/A W
Yes 0
No 0
3. Smoke Detectors
N/A 0
Yes %&
No 0
4. Heat Detectors
NIA,9-
Yes 0
No 0
5. Duct Detectors
N/A 0
Yes
No 0
6. Sprinkler Flow Switches
N/A 1:1
Yes
No 0
7. Sprinkler Supervisory Switches
N/A El
Y�s"QP
No, 0
8. Visual Alarm Devices �;�Vz5
Ile
N/A 0
Yes )�P
No 0
9. Manual Pull Stations
N/A �O
Yes Z
No 0
10. Annunciator (s)
N/A 19
Yes El
No 0
11. Beam Detectors
N/A 4
Yes 0
No 0
12. Automatic Door Unlocks
N/A �9
Yes El
No 0
13. Automatic Door Release
N/A
Yes [J.
No 0
Communication Equipment
Total Number of
Units Tested
Total Number
Units Inoperable
Test Results Acceptable
14. Phone Sets
N/A FX'
Yes .0
No 0
15. Fire Phone Jacks
-7
N/A 9
Yes 0
No 0
16. Call -in Signal
';—�7
NIA 16
Yes 0
No 0
Notes
CTF- 0 1 pnap ? nf')
Westfall, John
From:
Westfall, John
Sent:
Friday, April 04, 2003 2:47 PM
To:
Fire Dept Group
Subject:
Bartell's 23028 1 00th Ave W.
I've approved/finaled Fire Sprinkler and Fire Alarm systems at Bartells this date.
Sprinkler system include tampers for DDCVs, PIV, Sprinkler valve and waterflow for the wet system.
The fire alarm includes 3 manual.pulls, 2 duct detectors and one FACP smoke.
Both systems will now remain in service. The fire alarm is monitored off -site.
Project final is anticipated in 2 weeks. Problems call Ron @ Abbot Construction (425) 640-5921.
FM
4/4f2003 1:40 PM
System Event Report Page I of 2
Sorted by CS#
Installer# First to Last
CS# 75361261 to 75361261 Site Type All Dates 4/412003 to 4/4/2003
Employee# All
Corporate Acct. All
System Type All Reporting Group AJI
Date Op
Zone Event
Location/Comment Disposition Scheduled User
CS# 75361261
Site Name BARTELL'S
#58 Alt#
Site Addre" 23028 - 100TH AVE Edmonds, WA 98020
41412003 12:39:55
CALU OH2D01 Caller ID
'Test (425) 697 - 5599
41412003 12:39:55
3 2321 JROUBLE:SEW
*Test OUTDOOR PIV
In
414/2003 12:39:57
3 2000 RESTORE
rest OUTDOOR PFV
N
4/412OD3 12:40:36
CALLI OH2001 Caller ID
-Test (425) 697 - 5599
41412003 12*40:36
3 23211 :TROUBLE :SEW
*Test OUTDOOR PIV
cu
N
4/4/2003 12:40:38
3 2000 RESTO RE
'Test OUTDOOR PIV
ED
414r2003 12:41.08 JS
0
CU
4/4/2003 V:4`1:111
CALH OH2001 Caller ID
*Te5t (425) 697 - 5599
414/200312-41:11
3 2321 -.TROUBLE:SEW
*Test OUTDOOR PIV
4/4/2003 12.41:13
3 2000 RESTORE
*Test OUTDOOR PIV
4/412003 12:43:55
CALLI OH2001 Caller ID
'Test (425) 697 - 5599
4/4/2003 12:43:55
10 2275 *TAMPER:SEW
*Test SPRINKLER TAMPERS
C
4j412003 12,43*59
10 2000 RESTORE
*Test SPRINKLER TAMPERS
.r4
414/2003 12:46:32
CALLI OH200i Caller ID
'Test (425) 697 - 5599
L
0
4/412003 12:46:32
9 2371 A:FIRE:FE
'Test WATERFLOW
- 0
4/4/2003 12:47:11
CALL) OH2001 Caller ID
*Test (425) 697 - 5599
C
0
4/4/2003 12:47:11
9 2000 RESTORE
*Test WATERFLOW
Ic
4/4/200312:51-19
CALLI OH2001 Caller ID
*Test (425) 697 - 5599
E
4/4/2003 12:51:19
4 2371 A:FIRE:FE
*Test FACP SMOKE
L
414/2003 12:57:00
CALU OH2001 Caller ID
*Te5t (425) 697 - 5599
414/2003 12:57*00
7 2371 A:FIRE:FE
*Test BACK PULL
Q4/2003 12:59:07
.
CALU OH2001 Caller ID
*Test (425) 697 - 5599
:3
Z:
4/412003 12;59:07
6 2371 A:FIRE:FE
*Test SIDE PULL
41412003 13:01:02
CALLI OH2DO1 Caller ID
*Test (425) 697 - 5599
414/2003 13:01:02
5 2371 A:FIRE:FE
*Test FRONT PULL
SL
414/2003 13:02--20
CALLI OH2001 Caller ID
*Test (425) 697 - 5599
4/412003 13:02:20
8 7370 PROTECTION LOOP:V
'Test DUCT DETECTORS
414/2003 13:02:55
CALLI OH2001 Caller ID
*Test (425) 697 - 5599
0
414/200313:02:55
a 2000 RESTORE
*Test DUCT DETECTORS
M
4/4/200313,02:59
8 2465:SUPERVISORY:SEW *Test DUCT DETECTORS
0
41412003 '13.03-50
CALLI OH2001 Caller ID
*Test (425) 697 - 5599
q,
4/412003 13:03:50
8 2000 RESTORE
*Test DUCT DETECTORS
0
4/4/2003 13-.04:27
CALLI OH2001 Caller ID
*Test (425) 697 - 5599
L
IL
41412003 13.04*27
4 2000 RESTORE
*Test FACP SMOKE
Cr
41412003 13:04:29
5 2000 RESTORE
'Test FRONT PULL
page I of 2
414/2003 1:40 prn
System Event Report
Sorted by CS#
Installer# First to Last
CSN 75361261 to 75361261 Site Type All
Employee# All
Corporate Acct. All
System Type AJI
Date Op
Zone Event
Location/Comment Disposition
CS# 75361261
Site Name BARTELL'S #58 Ajt#
Site Address 23028
- 1 OOTH AVE Edmonds, WA 98020
4/4/2003 13:04:31
6 2000 RESTORE
*Test SIDE PULL
4/4/2003 13:04:35
7 2DOO RESTORE
*Test BACK PULL
4/4/2003 13:05:03
CALLI OH2001 Caller ID
*Test (425) 697 - 5599
414/2003 13:05:03
8 2465:SUPERVISORY:SEW
*Test DUCT DETECTORS
4/412003 13:05:08
8 2000 RESTORE
*Test DUCT DETECTORS
41412003 13:06:47
CALLI OH2001 Caller ID
*Test (425) 697 - 5599
41412003 13:06:47
8 2465:SUPERVISORY:SEW
*Test DUCT DETECTORS
41412003 13,06,49
8 2000 RESTORE
*Test DUCT DETECTORS
4/4/2003 13:10:33
CALLI OH2001 Caller It)
-Test (425) 697 - 5599
41412003 13:10:33
E302 2263:LOW BATTERY;W
*Test
4/4/2003 113:111:35
CALU OH2001 Caller ID
*Test (425) 697 - 5599
4/41200313:11:35
R302 2264;BATTERY RESTORE:
*Test
4/4/2003 13:21:59
CALLI OH2DOI Caller ID
'Test (425) 697 - 5599
4/4/200313-21:59.
4 7373 FIRE TROUBLE
*Test FACP SMOKE
4/4/2003 113:28:58
CALU OH2001 Caller ID
*Test (425) 697 - 5599
4/4/2003 13:28:59
4 2000 RESTORE
*Test FACP SMOKE
Page 2 of 2
Dates 4/4/2003 to 4/4/2003
Reporting Group All
Scheduled User
CSO 75361261
loc. 18) 11
CITY OF EDMONDS GARY HAAKENSON
MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 - (425) 771-0215 - FAX (425) 775-7721
FIRE DEPARTMENT www.edmondsfire.org
February 24, 2003
Mr. Ron Nelson
Bartell's
Fax 425 640-5692
Dear Mr Nelson:
Enclosed with this cover letter you'll find a Lockbox authorization letter. The Edmonds Fire
Department utilizes a security lockbox system which provides Fire Department access during fire
and medical emergencies while maintaining security at all times for the "access item(s)".
The Lockbox would be secured outside the entry to your building.
Fire department accessible spaces may include; main entry, alarm room/panels, automatic
sprinkler/ standpipe riser rooms and electrical or mechanical r , ooms, depending upon your
business and the building. The secured access items may include keys, written combinations for
locks and electronic keypads or manual buttons and switches for electrically -activated access.
You have requested an authorization letter from the Edmonds Fire Department. You may contact:
Tri-City Locksmiths, Inc.
22908 Highway 99
Edmonds, WA 98026
(206) 771-2445
Tri-City Locksmiths provide lock boxes at essentially their cost.
Once installed, a completed copy of the authorization letter must then be returned to:
Edmonds Fire Department
121 5th Ave N.
Edmonds, WA 98020
(206) 775-7720
Upon return receipt of the letter, the Fire Department Crews will be able to access those spaces
concerned to quickly mitigate the emergency at hand. Should you have any questions, please
contact me in the Fire Prevention Office at the above phone. Thanks for staying fire-_pfe!,, /)
enclosure
Jgfin J. Wes
Pire Marshal
Incorporated August 11, 1890
Sister City - Hekinan, Japan
This is to authorize
for the:
Bartell's
EDMONDS FIRE DEPARTMENT
LOCK BOX AUTHORIZATION LETTER
Mr. Ron Nelson
(Agent)
at 23028 Highway 99
Building Name Building Address
To purchase a Lock Box for Fire Department use for emergency access..
1
2
Assigned Key #
Location of Lock Box
Box Style: Supra Knox
The Fire Department requires the box be located just to the right of the main door, or at an approved
location.
3. Key(s) identification/access to
Identify each key with a brief description of what the key will unlock. Keep a minimal number
of keys in the box. The Fire Department should have easy access to: %
Main Entrance
Electrical Room
Mechanical Room
Sprinkler Room
Alarm Panel
Fire Defr)artment AuthorizeW'Sia nature
NOTE: Lock boxes must be purchased from TRI CITY LOCK 22908 HWY P9 EDMONDS
(425) 771-2445
A copy of this authorization noting the assigned key number must be returned to the Edmonds Fire
Department.
G/Word/Fire/Inspection/Lockbox 02/24/03be
Message Page 1 of I
Westfall, John
From: Westfall, John
Sent: Monday, December 09, 2002 1:39 PM
To: Taylor, Kevin
Cc: Beard, Melissa
Subject: Contractor/Fire Company Training
Kevin:
Mr. Ron Nelson (425) 640-592 1, general contractor's rep for Westgate Bartell's project at 23028 1 00th Ave W.
wishes to work together with Fire Crew (s) in a joint training medical/worksite event. This is a good opportunity for
a single crew to see the construction site, get to know the project and builders who they are protecting. There are
detention vaults on site. Their safety committee has never worked jointly with FDs before, so this will be first for
both of us. Would you like to assign to a BC or should Melissa run it through as a Pub Relations request. No Pub
Ed will be required, only joint evaluation/assistance for all parties. Thank you,
John
12/9/2002
Message
, Page 1 of 1
Westfall, John
From: Westfall, John
Sent: Tuesday, November 12, 2002 4:19 PM
To: Harrison, Marie
Cc: Smith, Mike
Subject: RE: 02-511 Bartell Drugs Fire Suppression
Thanks Marie. Just to clarify a point ... BJY is charged to review and make comments
to the plans. Mike or I are the ones who will make the final approval. We'll be down
to review and make sign -offs.
John
----- Original Message -----
From: Harrison, Marie
Sent: Tuesday, November 12, 2002 11:53 AM
To: Smith, Mike; Westfall, John
Subject: 02-511 Bartell Drugs Fire Suppression
Back approved from BJY.
E. Marie Harrison
Development Services
City of Edmonds
425.771.0220 x 1389
harrison@ci.edmonds.wa.us
11/12/2002
Date:
To:
From:
Subject:
MEMORANDUM
August 9, 2002
Building Department
Mike Smith, Fire Inspector
Plan Check 02-205 Bartell
The Fire Department has the following comments:
Thanks you for responding to my previous issues. In reviewing the plans it appears
these items have been satisfied.
I have been in contact with Ann Bullis regarding the area accessed by a ladder housing
the mechanical mezzanine. These comments are addressed in her memo under item
# 2. 1 concur with her concerns regarding the size and the fact it needs a complying
stairway.
Please decide how you want to proceed with this and make the necessary changes to
the plans.
If you have any questions please contact me at 425-775-7720.
City of Edmonds Fire Department
0,F E D Af
0
DATE: August 7, 2002
City of Edmonds
PLAN REVIEW COMMENTS
BUILDING DIVISION
(425) 771-0220
TO: Heather Mertes
FAX: (206) 368-9558
FROM: Ann Bullis, Assistant Building OfficiaA��
RE: Plan Check # 02-205
Project: Bartells
Project Address: 23028 100'h Ave W
During re -review of the above noted project, it was found that the following information, corrections, or
clarifications are needed.
1) Door 12 at loading dock cannot be a required exit since unloaded items, vehicles, etc. could potentially
block the exit, as well as items in the stockroom. Please remove the exit signs from this location on the
plans. UBC 1004.2.2
2) As described in my previous comments and in our phone conversation, the code permits a ladder to be used
to access mechanical equipment and a roof hatch. However, the floor plan for this area shows
approximately 560 square. feet of space. Past experience for both the Building and Fire Departments has
shown that areas such as these are often used for storage, just as the plans for the original submittal labeled
this area. The intent of the code will be met if the mezzanine area is reduced to only include the mechanical
equipment and access to the roof hatch. If the owner wishes to use the area as storage, a complying
stairway is required.
3) Ordinance 340 1, recently adopted by the City Council, requires that all restaurants install greas6
interceptors. Since your proposal for future Building C is to house a restaurant and site utility work is
being done under this project, please note on the site plan and utility Civil plan that a "Grease Interceptor
will be required for future restaurant".
4) We are still waiting for copies of the recorded common parking/utilities easements.
Please provide 2. sets of revised plans and written responses to each correction to a Permit Coordinator.
Date:
To:
From:
Subject:
MEMORANDUM
June 27 Ih 2002
Building Department
Mike Smith, Acting Fire Marshal
Plan Check/Bartells #2002-0205 Wf*$Iroll�97.,6]gir,,.
The Fire Department has the following comments:
1 ) Show portable fire extinguisher locations throughout building. Minimum size is
2A10:B:C. Maximum travel distance must be less than 75 feet to a F/E from
anywhere in the building.
2) Exit signage and location of emergency egress lighting is vague or non-existant.
Please show locations and clearly mark on plans.
3) Add a fire hydrant at the drive entrance off 1 00th Ave W at the 90-degree bend in the
water line (NE entrance to lot). Hydrant can be placed in the planter area.
4) A Fire Department Lockbox will be required for emergency access. Please contact
my office at 425-775-7720 for information prior to building final.
5) A Fire Connection Permit is required at the time the building permit is issued.
Contact the Development Services for a handout listing requirements.
City of Edmonds Fire Department
I
PRE -APPLICATION MEETING
NOTIFICATION & PLANS
Date:
To:
Building El Engineering El Fire Planning E]
From:
JanaEl Linda C@
Meeting Date:
Wednesday, January �0, 2002
Meeting Time:
1:30
Applicant
Bartell Drugs
tY Attached are the plans for the meeting scheduled above.
e SS 0 Al A . I/
7- /4
'Llo
&eC
-3)
(V
D:MyDocuments/SpeUmaTi/Forins/Po-App Notify to Staff
f- Cxt j 7- 9 t,-,p C-
City of Edmonds
DEVELOPMENT SERVICES DEPARTMENT
i
, 890 - 19 -9
CITY OF EDMONDS
250 - 5TH AVE. N. - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEP ARTMENT
Public Works 4i Planning e Parks and Recreation * Engineering
March 24, 1994
-1
t:
William C. Nelson
Westway Shopping Center
P.O. Box 461
Redmond, WA 98073-0461
Re: ADDRESS CHANGE - Westway Shopping Center
��b I -I q6-3 k
LAURA M. HALL
MAYOR
/4,1) P A,6-56
L-, (5- 7-
Per your request for an address change at the Westway Shopping Center,
the Building Offical and the Fire Marshall have co-ncurred that such a
change would be in conformance with the addressing policies of the
City, and, in fact, correct an existing discrepancy where one building
has separate addresses for each unit while the other building has one
address and unit numbers assigned within that building. The City
policy is one address to one building; the landlord then assigns unit
numbers in a logical, consistent manner.
Therefore, approval has been given to change "Bldg A" to 10008 Edmonds
Way, and "Bldg B" to 10016 Edmonds Way., Unit numbers shall be assigned
at the discretion of the landlord. The examples you provided of "A"
through 'IF" are satisfactory.
The City will notify all applicable City departments of the change. It
will be your responsibility to notify all others, including the Post
Office and building tenants. You have 30 days to post new address
numbers. -
Thank 4you,
t�,.VC5 A -
Sharon Nolan
Permit Coordinator
cc: Fire
Police
Public Works
Utility Billing
.Address Files
Street Files
Building Official
Incorporated August 11, 1890
qicfor (7itior IntornAtinn;NI - HolcinAn AAnAn
AW\
11,61
I r7,2 -5, N I Y, -a
lk
%OA
1W
oi
q-q-3A
A --3
FIRE PREVENTION
W OF EDMONDS SAFETY SURVEY
Lw 121 5TH AVENUE N. * EDMONDS, WASHINGTON 98020 - (425) 775-2525
O_F_ FIRE DEPARTMENT
199 " FREQUENCY STATION & SHIFT"
LOCATION: 10008 Edmonds Way 31 20 C
BUSINESS NAME: Chopsticks Restaura;!� PHONE: 4257761196 SCHEDULED
DATE DUE o- 02/01/03
MAILING 10008 Edmonds Wy #D rUFI R �l 6 1 253
ADDRESS: WA 98020
BUSINESS OWNER: uWoo, Tenyu HOME PHONE: 2067210184 ACTIVE 150
EMERGENCY-1: "Woo, Boyd Ling" HOME PHONE: 2067237051 YES NO
KEY ACCESS-2: HOME PHONE: LETTER
NEEDED F1 F]
INITIAL INSPECTION DATE
PERSON CONTACTED: z_( , -, 0,-3
NAME OF INSPECTOR:
FIRE HD 6101 FE I
SYSTEMS: A�NU�L
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
ENTER CODE ONLY ONCE 0
VIOLATION CODE
2
2
3
3
4
4
5
5
6
6
7
7
8
8
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
1 15
VIOLATIONS
1 5
PRE-CITA71ON
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
14
8
4
8
DATE:
DISPOSITION:
7
8
LETTER NEEDED [] YES NO
LETTER NEEDED r] YES E] NO
FIRE DEPARTMENT COPY
A P P L I C A T 1 0 N
To: CITY OF EDMONDS FIRE DEPARTMENT
For Permit
Jack F. Cooper, Fire Chief
Edmonds Fire Department pA11D
250 - 5th Avenue North
Edmonds, WA 98020 JAN I'l
Dear Sir:
RECEIVED
(DATE) Decemb.er 291, 1975
CITY TREASURER
0
.0m Not. WAISM
JAN 14 AN
JEDMONDS RRE ffin.,
In conformity with the terms of the Fire Code, application is hereby
made to store, use or maintain the following specific materials or processes:
Public Assembly
Occ. Load 150
The materials or processes are at the following specific locations at
the below address:
Chopsticks Restaurant
10002 Edmonds Way
Name of Fire or Company Edmonds Fire Department
Address (Street and Number) 250 5th
Signature
Title
owl
0
EDMONDS FIRE DEPARTMENT
INSPECTION REPORT
DATE_Aq
._��tj�.INSPECTOR
BUSINESS DE_j
ADDRESS__Z 0 0 Z l7ewl? 1- 1-1.4 V PHONE C? C,
4
LOCAL ACCESS-(M) PHONE
BUSINESS OWNER IT
ADDRESS__ po q t __C±scA l7e P14ONE
MANAGER Ulf
jTe� e /-, '-,
PHONE
PROPERTY OWNER
ADDRESS PHONE
CONSTRUCTION ROOF STORIES
SPECIAL PROTECTION: SPRINKLEaS STANDPIPES ,EXTIXG� SYSTE.M
EXTINGUISHERS�. WATER CO2 �j - DR)t 0,EM3:CAL ABC
APPROVED EXITS STAIRWAys— ._jMAT FUEL
PERMIT NUMBER(S)
SPECIAL PROCESS OR WJJW f7.o ,--,og FA 7-- X-, k-,,4 1,
f
LOCATION OF FIRE DEPARTMENT CONNECTION
LOCATION OF SPRINKLER SHUT OFF
REMARKS:
7-70 efd
Addresses of Westway Center
Rancho Chico Restaurant Westway Center, Bldg: A, Space A, 10008 Edmonds
Way, Edmonds, WA 98020
Ab.arim Business Computers Westway Center, Bldg. A. Space C, 10008
,EAM�bnds Wa Edmonds, WA 98020
y
Chopsticks Restaurant - Westway Center, Bldg. A, Space D, 10008 Edmonds
Way, Edmonds, WA 98020
Westway Cleaners, Westway Center, Bldg. B, Space A, 10016 Edmonds Way,
Edmonds, WA 98020
JJ Shoe Repair,Westway Center, Bldg. B, Space B, 10016 Edmonds Way,
Edmonds, WA 98020
Westgate Printing, Westway Center, Bldg. B. Space C, 10016 Edmonds Way,
Edmonds, WA 98020
Sub Shop, Westway Center, Bldg, B. Space D, 10016 Edmonds Way, Edmonds,
WA 98020
Little Caesar's Pizza, Westway Center, Bldg., B. Space E, 10016 Edmonds Way,
Edmonds, WA 98020
W
& QWfiJWJ N
�Q
jMdD
R�A.PEDERSEN
MANAGER
K. E. GASTFIELD
CH 49F ENGINEER
L.A.LEONARO
CHIEF ENGINEER
PUBLIC FIRE PROTECTION
R. W. CLARK
CHIEF SURVEYOR
M. F. JACOBS
ADMINISTRATIVE ASSISTANT
FIRE INSURANCE AND APPURTENANT COVERAGES
ALASKA BUILDING
P.O. BOX lion
SEATTLE, WASHINGTON 98111
March 1.3. 1973
Restaurant Fire Protectors Co., Inc.
4025 - Stone Way North
Seattle, Washington 98103
LOS AMIGOS
Reference: Edmonds, Wa.
(Restaurant Name & Location)
Gentlemen:
BRANCH OFFICES
SPOKANE - SHERWOODBLDG.
L. E, FICCA
BRANCH MANAGER
TACOMA RUST BLDG.
F. W. DA V JES
BRANCH MANAGER
,;C-/4 104011-
W10-.111
The extinguishing system for the protection of hoods, filters and ducts
used for ventilation of restaurant cooking equipment, (including protect-
ion extended to the cooking equipment), recently installed at the cap-
tioned location has been inspected and
IT] is approved for fire insurance rating purposes.
F-1 is not approved for fire insurance rating purposes.
F� limited approval, only.
Note: If system is not approved, or limited (see reasons below)
All comments, approvals and acceptances relate exclusively to relative
effect of various conditions upon fire insurance rates. They are not to
be construed as bearing in any way upon the question of whether "due
care" has been exercised with respect to possible liability for personal
injury or damage to property. It is recognized that hazards which may
result in loss still exist.
By Z '0
Form 165A Surveyor
/ I