24111 HWY 99_1 (2)7.7'
IAt PREVENTION
!PSPECTION REPORT
and, 12425 Meri
Serving Bi Ldtn'onds� than Ave S
NOHONI I SH CO.' IaEDMONDS
Mount1dke Terrace Everett, WA 98208 0 BRIER
0 MOUNTLAKE TERRACE
FIRE' Phone (425) 551-1200
[I UNINCORPORATED
T www.fireDistrict1.o Fax (425) 551-1272
DIST rg
F
Rn�VpajCY ST16to SHIFT
24111 Highway 99
LOCATION:
Burlington Pdia't Facto�y #19 4257762221 SCHEDULED Jun 2017
BUSINESS NAME: PHONE: DATE DUE
2
MAILING241 11 Highway 99, Edmonds, WA 98026 UFIR
ADDRESS: \1
Seiw, Robert
BUSINESS OWNER:
6&
EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: Vl\lf& VA7LLM.
NAME OF INSPECTOR: W I
Date Last Serviced:
HOME PHONE:
-2068959984-
HOME PHONE: 20
HOME PHONE:
CURRENT
CITY YES NO
BUSINESS El
LICENSE
INITIAL INSPECTION DATE
lo- 7 &-1-7
SNOHOMISH CO.
j
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountla,ke Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 55 1-1272
FREQUENCY STATION & SHI
LOCATION:
24111 Highway99 Bldg98026
BUSINESS.NAME: PHONE: SCHEDULED
Siew Building 4256435635 PATE DUE 0 1 in
MAILING LIFIR 0
ADDRESS:. 509
15100 SE 38th St #702, Bellevue, WA 98006
BUSINESS OWNER: HOME PHONE:
Siew, Robert 1%
EMERGENCY-1: HOMEP ' HONE: CURRENT
KEY ACCESS-2: YES NO
HOME PHONE: CITY
EMAIL: BUSINESS
LICENSE
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR: r
nr
--FE,,,l 2/14 F
FIRE SYSTEMS: AS 3/16 FA 111-14 D Lk Bow/A- 1�116
R)M#U§gt)Sgt#Nj78tDCATIONS,i-(��OMMUNICATIONS,
2 -2
A]!;.
T
5
5
r7 6
6
.7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st. RE -INSPECTION 2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION VIOLATIONS
2ATE DUE:, DATE DUE: GRANTEDTO: I - I .
DATE DUE CITED:
PERSON"
PERSON PE
CONTACTED: CONTACTED: SK
TACTED.
INSPECTOR: INSPECTOR: 'NSP"TO 12
R-
DATE. 3
DA�TEW-.
v6afidNs VIOLATIONS,� il�CITATI�N
PF
5 15 U
..... .. .. §ENT tNUMBER:
2 DATE: CODE 5
SECTION:
RETURN RECEIPT
17 REC 6
3 EIVED
DISPOSITION-
4 8 It
p,�TF, 7
4
%.�LETTER NEEDED YES El NO LETTER NEEDED YES NO
8
FIRE PREVENTION
INSPECTION REPORT
OEDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
SNOHOMISH CO.
,.FIRE
DIST:
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
LOCATION:
.24111 Highway 99 LD 98026
BUSINESS NAME: PHONE:
Vacant
MAILING
ADDRESS:
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: HOME PHONE:
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED: Z6e
NAME OF INSPECTOR:
Uc7< (0
FIRE SYSTEMS:. FE
FIRE PREVENTION
INSPECT16N REPORT
OEDMONDS
[3 BRIER
OMOUN ' TLAKE TERRACE
(3 UNINCORPORATED
UENCY I.STATION&SHIFT-\
ILED
IE
201
CURRENT
CITY YES NO
BUSINESS M .17—
DallaRD59tcasm, doCATIONS /COMMUNICATIONS
�fw ci)
7
A
2
A/0
2
3
4
4
5
5
6
6
7
7
I AGREE To coRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst.RE-INSPECTION
2nd RE -INSPECTION
EXTENSION ..FINAL
RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
VIOLATIONS
VIOLATIONS-,
1.
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
RETURN RECEIPT
6
3
7
3
7
RECEIVED
- -------- ----- --
DISPOSITION:
A
8
4
8
DAT
7
LETTER NEEDED I-] YES NO
LETTER NEEDED [] YES NO
m ra
e,'' Id T7ire
fire Spfinkler Specialists
11021 Cramer Rd. KPN - Gig Harbor, WA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
2-t] (One System per Report) D))
0
Occ pancANJOUs: Y\ F�"th�) - V 2� tAr ;yi CDR 1�
pan��y4i.l
Occ
Responsible Person
Pho e Nu ber
_�Occ &A
n
Building Owner: Phone Number:
ID
Date of Inspection: Type of Inspection: Quarterly F1 Annual Other E]
Testers Name (Please Print):
WA State FSCC#
DRY SYSTEM/PRE-ACTI jN SYSTEM-
1 Trip test (dry trip or full flow) conducted: ............................................. �� No
System tripped in _seconds.
2. All flow switches, supervisory switches and alarm bells tested: .. ................. Yes Ej No El N/A E]
3. Alarm bell operates: ................................................. .............. I ............ Yes [] N6 [j N/A
4. Flow tests conducted: .................................... ................ ..... .............. Yes Ej No F]
Flow pressure: — -psi 2-inch dr i . ............ . ..... .. .............. Yes R NoR
5. Systems inspected and lubricated: .... ......................... ..... .. .. ............... Yes 0 No El N/A R
6. Air compressor refills system i minutes: ............................................... Yes Ej NoR
7. System drained and re red to normal operation: ..................................... Yes [] NoR
8. Were the heat aic ation devices tested on pre -action an . d del ge system? ..... Yes R NoR N/A Ej
WET SYSTEM " Tested at 5 - 4,
I - Trip test conducted: ................................... ... ......................... 3
... Yesff NoR
Static pressure: —Ly--psi Flow pressure: psi 2 inch drain? ....... yes;�T No [] N/A f-l'
2. Flow switches, supervisory switches and alarm bells tested: ..................... yes Z No El N/A R
3. Alarm bell operates: ............................................................................. Yes
,Z No [I N/A R
4. Systems inspected and lubricated: .......................................................... Ye�o NoR
5. Pressure regulating valves tested: ............................................................ Yes [] No El N/A�,
.1010MATIC SPRINKLER SYSTtMS (continued)
General:
1 Central Station Monitoring? .......................................................................... Yes,� No Ej
Monitoring company name
2. Location of Sprinklers
100% .......... ��Parking ......... Basement ......... Hallways ......... El Other ........
3. Pumper connections and clapper valves unobstructed ................................. I ..... Y040'No El
4. Sprinkler heads less than 50 years old ............................................................. Yes'o, NoR
5. Sprinkler coverage is acceptable .................................................... ................ Yes
'Z No F-1
6. Spare sprinkler heads are available ................................................................. Yes No Ej
7. Systems left in service .................................................................................. Yes No F-1
8. Valves are sealed or supervised ...................................................................... YesA No
9. Signs are provided on valves ......................................................................... Ye No
10. City static water pressure ___psi.
Problems Found:
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
SNOHOMISH
IWT112 W
Serving Briet: Edmonds, and
m"'ountlake 'Terrace
DISTRICT�w'wwY"i reDistrict]. org
4
LOCATION: 24111 i4jh�hmy 00 Bk-J.q 080-16
.q
BUSINESS NAME: Siow Building
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 42554
-FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
OUNINCORPORATED
MAILING
UFIR 1, '109
ADDRESS:
15100 BE 33b SL 4702, kmdrimn&-, WA 32,00L
BUSINESS OWNER:
Sit-w, R0,A-rt
HOME PHONE:
? EMERGENGY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
eV_AC)4 t-L
-4/6
I A I
F E s';l 13 1 FD
fEt
�31 �4F
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12./ 1 A..
It 0-vt f,�V;5,mtld
HAZARDS FOUND AND LOcATi6NS/ COMMUNICATIdNS ' I
C n t,_6 Pw-TLD , )Orl nyr,,t-.1f7 (I
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99_ 9�� I t�j r-
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2
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3 Is.1 w1e�3 V=zy
D
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st REIINSPECTION
I
DATEIDUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PE ON
.CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:-
E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATI ! ONISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
18
DATE:
DISPOSITION:
LETTER NEEDED F] YES No
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
FIRE COPY
CITY OF EDMONDS
121 5TH AVENUE NORTH - EDMONDS, WA 98020
PHONE: (425) 771-0220 - FAX: (425) 771-0221
Expiration Date: 10/01/2014
Parcel No: 00491100000107
PROPERTN'OV?1ER APPLICArIT CONTAACTW,
BURLINGTON COAT FACTORY BUILDING BURLINGTON COAT FACTORY BUILDING GILLEN CONSTRUCTION INC
C/O ROBERT SIEN C/O ROBERT SIEN 17455 68Th Ave Ne Ste 303
C/O SPARTUS INTL CORP C/O SPARTUS INTL CORP Kenmore, WA 98028
15 100 SE 38TH ST 10 1-702 15 100 S E 3 8TH ST 10 1-702
BELLEVUE, WA 98006 BELLEVUE, WA 98006
(425) 785-1972: (425) 785-1972 (425) 821-7700
LICENSE 9: GILLEC1895CH EXP:03/24/2016
REMOVE 1,000 (EST) DIESEL TANK, FILL SITE. REMOVE AND FILL 2ND TANK - SIZE UNKNOWN.
VALUATION: $0.00
PERMIT TYPE: Commercial
PERMIT GROUP: 70 - Tanks[Fuel
GRADING: N CYDS: 0
TYPE OF CONSTRUCTION:
RETAINING WALL ROCKERY:
OCCUPANT GROUP:
OCCUPANT LOAD -
FENCE: 0 X 0 FT.)
CODE:
OTHER: OTHER DESC:
ZONE:
NUMBER OF STORIES: 0
VESTED DATE:
I NUMBER OF DWELLING UNIT& 0
1 LOT #:
AREA
EXISTINC AREA
BASEMENT� 0 1 ST FLOOR: 0 2ND FLOOR: 0 —7BA—SEMENT:
PROPOSED
0 1 ST FLOOR: 0 2ND FLOOR: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
13RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0
I BEDROOMS: 0 BATHROOMS: 0
1 BEDROOMS: 0 BATHROOMS: 0
FRONT SETBACK SIDE SETBACK REAR SETBACL-1
REQUIRED: PROPOSED: IREQUIRED: PROPOSED: IREQUIRED: PROPOSED:
HEIGHT ALLOWED:O PROPOSED:O I REQUIRED: PROPOSED:
SETBACK NOTES:
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED �: REBY, NO
PER (ON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WOF MEN'S
X COMPENSATION INSURANCE AND RCW 18:27.
P 'I
THIS P 7 TION ISPNOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER PEPUTY AND ALL FEES ARE PAID.
Sig
I —t--w
Name Date
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF
OCCUPANCY HAS BEEN GRANTED. UBC 109/ IBCI 101 IRCI 10.
ONLINE APPLICANT ASSESSOR OTHER
STATUS: ISSUED BLD20140291
CONDITIONS I
• Fire Marshal must be present for tank work (fill, removal, or cap.)
• Final approval on a project or final occupancy approval must be granted by the Building Official prior to use or occupancy of
the building or structure. Check the job card for all required City inspections including final project approval and final
occupancy inspections.
• Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from
adopted codes, ordinances or policies must.be specifically requested in writing and be called out and identified. Processing
fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable.
Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been
specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision
of city code or state law does not approve any items not to code specification.
Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits
of ECC Chapter 5.30 only during the hours of 7:00arn to 6:00pm on weekdays and 10:00am and 6:00pm * on Saturdays,
excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must
comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120.
Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold
harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of
whatever nature, arising directly or indirectly from the issuance for this pen -nit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirements of any City ordinance nor limit in any way the City's ability to enforce any
ordinance provision.
I INSPECTIONS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE
PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION.
PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6)
I BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720 —1
I PUBLIC WORKS (425).771-0235 1 PRE-TREATMENT (425) 672-5755 1 RECYCLING (425)275-4�8�01
When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection
beine reauested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon.
. F-Tank Inspection
240TH STREET S.W.
A. 04
, r . -13, is Tf
2
-Tm
477.,
-4,
H115.
19
7
TOTAL PARKING, 380 SPACES
Is
20.
r
IvILI GRAVEL SURFA E - IN THIS AREA
242NO STREET S.W.
0, 20* go,
(::)SITE PLAN SUNNI
ILI
10, 40, NORTH
Project Data
Burlington cifice. lumhfwm.
and —civinj spat,e.
Meaani.e retail space.
ZZA 40 sl..
Inol includInj mmmm areal
Middle wsrvhoum IpAce:
13.720 lf
Inot Including commm "e-I
111 11— 11.1 —hu.:
19.8 DO 91
.2.d 11— w —,h.—
19111LISAIMAkw
19.960 'L
. 143-filt I -
PACIFIC DISCOUNT CENTER
FQEIIIEIT (�r Ito
I
AQCIIITECT(B. INC- P&
EDMONDS, WASHINGTON
I— — ... a))" t-.. — .2, —.. —
Wote, Mai
240th ST.S.W.
7—,i
�Asph a',
N1 Vd 0 P P
N 88' 29'56" W 157.47'w
',�RECTIONAL—
SIGN
� E-TC.
rJ
40
Needed lo Fill Pool.
Apptomimaiely 112 Cubit: Yards
Sp
ho
)ip
In
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-in
Ne� `0
W AA
g—od
F T..ks
nch
9A
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7,
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71
�777777.
777
............
Opt II IMF
M/Y
T
U.S. MARINE CHEMISTS & ENGINEERING - MARINE C LJEMIS T CER TIFICA TE
Philip Dovinh, P.O. Box 63, Mukilteo, WA 98275 Serial 667-01543
Office: (206) 200-6912 Fax: (206) 763-8084 Page 1 of 1
Cell: (206) 200-6912 Email: pdovinh@comcast.net
Dan/Whitman Environmental Whitman Environmental/Marine Apr 3, 2014
Tom Myler/Marine Vacuum Serv. Vacuum Services, Inc.
Survey Requested by Vessel Owner Agent Date
LIST Underground Storage Tank 24111 Highway 99, Edmonds,
WA
Vessel Type of Vessel Specific Location of Vessel
Diesel Fuel Oil (3x) 02, LEL, Visual, CO, H2S 7:00
Last Three 3 Loadings Tests Performed Time Survey Completed
Inspected Spaces:
Group 1. —ONE (1) 10,000 GALLON LIST
) A
L-V -2 D T�
Test Results 0/60, % LEL CO
Inspected spaces group 1 <5% 0% 0 ppm
Safety Desianations:
NOT SAFE FOR WORKERS
NOT SAFE FOR HOT WORK
INERTED
Inert Medium: —Carbon Dioxide (CO2)
Method for maintaining safe conditions: —Keep openings
closed and secured for duration of excavation and transport.
Measures for safe disposal of inert gas: —Keep Inerted
Spaces Closed, Secured As A Means Of Inert Gas Disposal.
Other instructions: —Tank is inerted as of 07:00 AM on April 3,
2014.
—Tank is authorized for Excavation & Transport to Marine Vacuum
Services 1516 S. Graham St, Seattle, WA 98108.
—Remove tank from property by 07:00 AM on April 4, 2014 or
recall Chemist to re-inertltest tank again prior to transport.
H2S
0 ppm
Limits of Detection
0.5%02, 1%LEL,0.1 ppmH2S, I pprnC0,0.1 ppm Benzene, 0.1 pprnTHCsN0Csw/P1[),0.1 ppbTHCsN0Csw/PPBP1D
Entire Vessel Instructions
6-50# CO2 Cylinders used for inertion.
In the event of physical or atmospheric changes affecting the STANDARD SAFETY DESIGNATIONS assigned to any of the above
spaces, this certificate is voided; spaces not listed on the Certificate are not to be entered unless authorized on another
Certificate and/or maintained in accordance with OSHA 29 CFR 1915; or if in any doubt, immediately stop all work and contact the
undersigned Marine Chemist. Unless otherwise stated on the Certificate, all spaces and affected adjacent spaces are to be
reinspected daily or more often as necessary by the competent person or the authority having jurisdiction as applicable in
support of work prior to entry or recommencement of work.
QUALIFICATIONS: Transfer of ballast. cargo, fuel or manipulation of valves or closure equipment tending to alter conditions in pipelines, tanks, or compartments subject to gas accumulation, unless specifically
approved on this Certificate, requires inspection and a new Certificate for spaces so affected. All lines, vents, heating coifs, valves, and similar enclosed appurtenances shall be considered 'not safe* unless
otherwise specifically designated, Movement of the vessel from Its specific location voids the Certificate unless shifting of the vessel within the facility has been specifically authorized on this certificate.
STANDARD SAFETY DESIGNATIONS: (partial list, paraphrased from NFP 306, Subsections 4.3.1 through 4.3.6)
ATMOSPHERE SAFE FOR WORKERS: In the compartment or space so designated (a) the oxygen content of the atmosphere shall be at least 19.5 percent and not greaterthan 22 percent by volume; (b) the
concentration of flammable materials is below 10 percent of the lower explosive limit; (c) any toxic materials in the atmosphere associated with cargo, fuel, tank coatings, inerting mediums, or fumigants are
within permissible concentrations at the time of the Inspection.
NOT SAFE FOR WORKERS: In the compartment or space so designated, entry shall not be permitted.
ENTER WITH RESTRICTIONS: In the compartment or space so designated, entry for work is permitted only if conditions of proper protective equipment, or clothing, or time, or all of the aforementioned, as
appropriate, are as specified.
SAFE FOR HOT WORK: In the compartment or space so designated (a) the oxygen content of the atmosphere is not greater than 22 percent by volume; (b) the concentration offlammable materials in the
atmosphere is less than 10 percent of the lower explosive limit; (c) the residues, scale, or preservative coatings are cleaned sufficiently to prevent the spread of fire and are not be capable of producing a
higher concentration than permitted by (a) or (b); (a) all adjacent spaces, containing or having contained flammable or combustible materials shall be sufficiently cleaned of residues, scale, or preservative
coatings to prevent the spread of fire; or they are Inerted. Ship's fuel tanks, tube tanks, or engine room or fire room bilges, or other machinery spaces, are treated in accordance with the Marine Chemist's
requirements.
SAFE FOR LIMITED HOT WORK: In the compartment or space so designated (a) portions of the space meet the requirements Safe for Hot Work and Partial Cleaning, as applicable. or (b) the space is
inerted, adjacent spaces meet the requirements for Safe for Hot Work, and hot work is restricted to specific locations; (c) portions of the space shall meet the requirements for Safe for Hot Work, as applicable,
and the nature or type of hot work shall be limited or restricted.
NOT SAFE FOR HOT WORK: In the compartment or space so designated, hot is not permitted.
CHEMISTS ENDORSEMENT. This is to certifyo that I have personalty determined that all spaces in the foregoing list are in accordance with NFPA 306 Control ofGas Hazards on Vessels and have found the
condition of each to be in accordance with its assigned designation.
�Tha undersigned acknowledges receipt of this Cortificat. under NFPA 306 and understands condibons and imitations This Cortfi�te is based on conditions existing at the finno the Inspection herein set forth was completed and is issued
under which it "a asuea. and the requirements for mintaining its valido." subject to cornpRonce with oil qualifluitions and instructions.
- I I ,' "
/A
Apr 3, 2014 Whitman 667
Authorized Representative Date Company Signed Marine Chemist CMC No.
EMERALDFmE., LLC
Fire Sprinkler Specialists
11021 Cramer Road KPN, Gig Harbor, Washington 98329
Ph (253) 857-2056 - Fax (253) 857-2312
SYSTEM CORRECTION REPORT
Date (0-0 -q4 FPB File #
System Type:
Alarm v""Sprinkler Rangehood Standpipe Fire Escape _ Other
Name of Facility: (�,4 *oily - Contact Person:
U jff-k� �-
Address: �Zq j I Hyv�j qq 5dktAPvvtS (IVO,. %-020 Phone: q,2S-- -7-X- --�4Z-2o.
I
Have yDur service provider complete section below and return to this off -ice within 7 days of
completion:
Date Corrections Made: 6-10-/14
Company Making Corrections: Emerald Fire
I —
Company Contact Person: Bob Pacfay — Phone: 253-857-2056
Corrections Made:
'3 Wled-
4, a,,d
W
'.3 Signa0ire of Technician
Emerald. Tire
Fire Spfinkler Specialists
11021 Cramer Rd. KPN -Gig Harbor, WA98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
;zq (i I H wy
occupancy Add
0
Responsible Person:
Building Owner:
Date of Inspection: Type of Inspection:
Testers Name (Please Print):
4/_ V- 4 ,- G �-A * c iq
Occupancy Name:
_1
PhozeZumber:
Phone umber:
uarterly E] Annual 10/ Other E]
WAStateFSCC# 0633-IT-051809
DRY SYSTEM/PRE-ACTION SYSTEM:
1 Trip test (dry trip or full flow) conducted: ........................ ......................... Yes Ej No 0
System tripped in second s. i /testei
2. All flow switches, supervisory switches and.alarm bel tested: ..................... YesF� Noo N/A[j
3. Alarm bell operates: ................ Yes Ej No F1 N/A E]
-V YesE] No
4. Flow tests conducted: ............. . * .... *"**'** — , **"*** ... --------**-
Flow pressure: si 2-inch dr in? . .. .................................. Yes E] No F�
'n 'c
hr
in
5. Systems inspected and lubricated: ........ .......... ....................................... Yes E-] No El N/A El
6. Air compressor refills system in 30 mi tes: .............................................. Yes E] No E]
1 0 ti
7. System drained and restored to no al operation: ..................................... Yes [:] No E]
8. Were the heat actuation devices.tested on pre -action and deluge system? ..... Yes El NoE] N/AE1
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at
1. Trip test conducted: .............................................................................. Yes d No E]
9,,
Static pressure: 15Q psi Flow pressure: ��L- psi 2 inch drain? ....... Yes &K No Ej N/A E]
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes 9/ No E] N/A Ej
3. Alarm bell operates: ................. I ........................................................... Yes Q/ 'No E] N/A E]
4. Systems inspected and lubricated: ....... I ........... ..................................... .. Yes [VNo []
5. Pressure regulating valves tested: ........................................................... Yes E] No E] N/A 2//
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
I
Central Station Monitoring? ..........................................................................
Yes No
G2111"
F1
Monitoring company name A DT
2.
Location of Sprinklers
100% ......... Y Parking ......... E] Basement ......... El Hallways ......... Other .........
3.
Pumper connections and clapper valves unobstructed .......................................
yesU(
Non
4.
Sprinkler heads less than 50 years old .............................................................
Yes Qf
Non
5.
Sprinkler coverage is acceptable ....................................................................
Yes
No F]
6.
Spare sprinkler heads are available .................................................................
Yes
No
7.
Systems left in service ................... ...............................................................
Yes
Non
8.
Valves are sealed or supervised .......................................................................
Yes J;6
No E]
9.
Signs are provided on valves .............. ...........................................................
Yesw
Noo
10.
City static water pressure psi.
Problems Found:
q ov,
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig_Harbor,WA 98329
0,Emerald Tire
Fire Sprinkler Specialists
11021 Cramer Rd. KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
'Z(H1(
OccupancyAd
Responsible Persom.
Occupancy Nam
Phone Number:
Building Owner: . Phone Number:
Date of Inspection: -,-Z—IR--4q Type of Inspection: Quarterly Annual Bi/Other El
Testers Name (Please Print): :EA� 'Pn WAStateFSCC#-. 0633-IT-0512(
DRY SYSTEM/PRE-ACTION SYSTEM:
I Trip test (dry trip or full flow) co ducted: ....................... ........................ Yes E] No F
I no y a
System tripped in _ s c nds.
ry or swit
2. All flow switches, supe is r swit hes an alarm b Is /tested: ..................... Yes 0 No E] N/A 0
3, Alarm bell operates: ....... .\-." .......... ... .................................... Yes F] No 0 N/A E]
/ .......... .....
4. Flow tests conducted: ............................ ...... .................................. Yes No F]
Flow pressure: psi 2-in drain . ... ................................... Yes Non
n
d
r
a
in? .
5. Systems inspected and lubricated: .. ............. ......................................... Yes 0 No El N/A n
1
6. Air compressor refills system in minutes: .............................................. Yes [] No
7. System drained and restore o normal operation: ..................................... Yes F1 No F]
0
8. Were the heat actuation vices tested on pre -action and deluge system? ..... Yes E] No E] N/A n
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at
1 . Trip test conducted: ................................... ...... Yes 5/ No [-I
........................ .. ..........
Static pressure: 4�%� psi Flow pressure: :24 psi 2 inch drain? ....... Yes G�� No [-] N/A
Of I <
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes [V No E] N/A E]
3. Alarm bell operates: ............................................................................. Yes EVNo n N/A 0
4. Systems inspected and lubricated: .......................................................... Yes Q40 El
5. Pressure regulating valves tested: ........................................................... Yes E] No[-] N/Am/
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
I Central Station Monitoring? .......................................................................... Yes E�( Non
Monitoring company name
2. Location of Sprinklers
100% ......... [jK Parking ......... Basement ......... 0 Hallways ......... E] Other ........ El
3. Pumper connections and clapper valves unobstructed ....................................... Yes Y No E]
4. Sprinkler heads less than 50 years old ............................................................. Yes 13/ No
5 Sprinkler coverage is acceptable .................................................................... Yes El No
6 Spare sprinkler heads are available ................................................................. Yes No
7. Systems left in service .................................................................................. Yes No
8. Valves are sealed or supervised ...................................................................... Yes E/ Non
9. Signs are provided on valves ......................................................................... Yes �/ No F1
10. City static water pressure 63 psi.
Problems Found:
;q- ft,�, ae'e',"-s s",es
2
e., te /9-0 , 1 1) '3 -/ (�*z
N
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
Emerald Pire
Fire Spf inkJer Specialists
11021 Cramer Rd. KPN - Gig Harbor, WA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
h HW'1 -
Occupancy Address: EE6eKAosj� In D n Occupancy Name:
Responsible Person: Phone Number:
Building Owner: Phone Number:
Date of Inspection: 3 (4 Type of Inspection: Quarterly F� Annual N/Other Ej
Testers Name (Please Print): f?c�o
qqQS4 WAStateFSCC#_ 0E33_jT__n.;;1r-,0
1j 1 9
DRY SYSTEM/PRE-ACTION SYSTEM:
I Trip test (dry trip or full flow) conducted: .................................................. Yes No Fl
System tripped in seconds.
2. All flow switches, supervisory switches 100 alarm �ells tes /d .................. Yes No Ej N/A El
3. Alarm bell operates: .. .... ........ ..... ............................... Yes F� No E] N/A E]
4. Flow tests conducted: ................. .......... . .. .......... ........................ Yes 7 No
.................... /
Flow pressure: psi -�-inch drai . .......... ............................ Yes E] No E]
5. Systems inspected and lubricat*ed: .......... .............. .... ......................... Yes E] No E3 N/A E]
s
.n c
h
r
a
'i*'*.
i/ted ...
6. Air compressor refills system in 30 mi tes: ............ ................................. Yes E] No F]
7. System drained and restored to n mal operation: ..................................... Yes El No El
s D
8. Were the heat actuatic - - - tested on pre -action and deluge system? ..... Yes [-] NoE] N/A[-]
oliq
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at S s4s - *3
1 Trip test conducted: ....................................... I ........................................ Yes Eg"No n
Staticpressure: 6`4 psi Flow pressure: ' z51— psi 2 inch drain? ....... Yes VNo E] N/A E]
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes ff-"*No E] N/A Ej
3. Alarm bell operates: .......................................................... I .................. Yes ej,/No E] N/A 0
4. Systems inspected and lubricated: .......................................................... Yes E�?/No 0
5. Pressure regulating valves tested: ........................................................... Yes E] Non N/A 0/
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1 Central Station Monitoring? .......................................................................... Yes D� No F�
Monitoring company name
2. Location of Sprinklers
100% ......... E( Parking ......... Basement ......... 0 Hallways ......... E) Other ......... E]
3. Pumper connections and clapper valves unobstructed ....................................... Yes No E]
4. Sprinkler heads less than 50 years old ............................................................. Yes No E]
5. Sprinkler coverage is acceptable .................................................................... Yes 19/ No Ej
6. Spare sprinkler heads are available ................................................................. Yes E2t/No [-]
7. Systems left in service .................................................................................. Yes D/ No R
8. Valves are sealed or supervised ...................................................................... Yes Fi( No E]
9. Signs are provided on valves .......................................................................... Yes[9/NoE)
10. City static water pressure Psi.
Problems Found:
Q0Q,4--eL LJ15, Mikk
V V
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire I PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor. WA 98329
Emerald Tire
Fire Spfinkler Specialists
11021 Cramer Rd. KPN -Gig Harbor, WA98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
;Lm
occupancy Address: lyo. Rg=o Occupancy Namez"'fl, �±'4ny' cz'�
Responsible Person: Phone Number:
Building Owner: Phone Number:
Date of Inspection: Z9 Type of Inspection: Quarterly E] Annual Vother F_�
Testers Name (Please Print): a&4 WA State FSCC#
�j I
DRY SYSTEM/PRE-ACTION SYSTEM:
1. Trip test (dry trip or full flow) conducted: .................................................. Yes[] No El
System tripped in second s
2. All flow switches, supervisory switchejand alarm b9,165-t-ested ..................... Yes [] No [-] N/A Ej
3. Alarm bell operates: ............... . Yes Ej No N/A E]
4. Flow tests conducnd: ............ .. . .... ....... Yes E] No E]
ain
Flow pressure: psi 2 inch r . ....................................... Yes E] Noo
5. Systems inspected and lubricated: ..... ... . .......................................... Yes [] No E] N/A E]
6. Air compressor refills system in 30 inutes: .............................................. Yes [] No E]
n
7. System drained and restored7normal operation: ..................................... YesE] Noo
8. Were the. heat actuation devices tested on pre -action and deluge system? ..... Yes [] No E] N/A R
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at :TV9,
I Trip test conducted: ............................................................................... Yes [j;f No
Static pressure: ZgJ�- psi Flow pressure: 6k,) psi 2 inch drain? ....... Yes No E] N/A
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes No F1 N/A Ej
3. Alarm bell operates: ............................................................................. . Yes Eg"No D N/A E]
4. Systems inspected and lubricated: .......................................................... Yes FV'N0 El
5. Pressure regulating valves tested: ........................................................... Yes E] No 0 N/AV
..,A,k0T0MAT1C SPRINKLER SYSTEMS (continued)
General:
1. Central Station Monitoring? .......................................................................... Yes Y No E]
Monitoring company name A DT
2. Location of Sprinklers
100% ......... V Parking ......... 0 Basement ......... El Hallways ......... F� Other ........ E]
3. Pumper connections and clapper valves unobstructed ....................................... Yes Non
4. Sprinkler heads less than 50 years old ............................................................. Yes No F1
5. Sprinkler coverage is acceptable .................................................................... Yesg( No G2/
6. Spare sprinkler heads are available ................................................................. Yes 2� No E]
7. Systems left in service .................................................................................. Yes No
8. Valves are sealed or supervised ...................................................................... Yes 0
9. Signs are provided on valves ......................................................................... Yes '/No
10. City static water pressure (&,�: Psi.
Problems Found:
40 s4ocl-,2 &Qd�t= 13V
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
-SNOHOMISH CO. -
FIRE
DIST]
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0WOODWAY
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY I STATION & SHIFT)
20 C
BUSINESS NAME: PHONE: SCHEDULED
Siew Bldg 42564356 DATE DUE � 07/01/13
A
&rving Brier, Edmonds 42425,Meridian Ave'S,
�aount ake lerrace, and erett, WA 98208";."".
.......
i�e Town of Woodway Phone (425) 35*' _1200-
www. FireDisdic'tl. org Fax (425) 551-1272
LOCATION: 24111 Highway 99
MAILING
151 DOSE 38th St #702
-
UFIR � 509
7006
ADDRESS:
Bellevue
98006
BUSINESS OWNER:
Siew, Robert
HOME PHONE: 4256433838
PREFIRE
EMERGENCY-1:
FAX #425-747-5482
HOME PHONE,
"'CURRENT
CITY
YES N�
KEY ACCESS-2:
HOa-PHONI':
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE AS 3/12
A*dl,�,
FE I
ANNUAL
I h
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
1 C4 c C4- o i
(?
2 in u
2
3
A
3
4
4
5 A
5
ik
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
ist RE-INSPEcTibN
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
V16LATIONS
CITED:
PERSON
CONTACTED: q
PERSON
C ONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE: C_�
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
4
8
4
8
DATE:
DISPOSITION:
\ LETTER NEEDED [] YES�,') NO
I LETTER NEEDED [] YES NO
FIRE DEPARTMENT COPY
Emerald Pire
Fire Sprinkler Specialists
:7
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
Euvj
Occupanc Address I
Ed 08N, 17ro 52A Occupanc Name: R�-4 40 1
y
Responsible Person:. Phone Number:
Building Owner: Phone Number:
Date of I nspqctjon:.g-,7c'a -12 Type of Inspection: Quarterly Annual,
9ther E]
Testers Name (Please Print):
WA State FSCC#0633-1T-
DRY SYSTEM/PRE.-ACTION SYSTtft.
1.
Trip test (dry-tripor full flow) condutted:..., ................ ..................... ...........
Yes 0
No R
System tripped in. ---seconds.
2.
All flow switches, supervisory switches a d. alarm bells test ....... ............
Yes
No.E] N/A E]
:3.
Alarm bell operates.:.... ........
Yes Fj
No N/A E]
4;--
Flow tests conducted: ............ . ............ ..................... ...........
Yes,[]
No,M
Flow pressure.:.. psi 24nch dr ? ................................. ......
Yes E]
No 0
5.
. .... ..........
Systems inspected.and lubricated: ...... .............. . ....................
Yes E3
No E] N/A E]
6.
Air *compressor refills system in 30 inutes: ......... ............... ..................
Yes n
No M
7. System drained and rest ed normal operation: ................................. ; ..... Yes Ef No E]
8... Were the heat actuatio evices tested on pre -action. and deluge system? ..... Yes E] No F-1 N/A
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at 1� -
1.
Trip test conducted: ..... ; ................................................................. .....
Yes 2' No F-1
Staticpressure: 6,9- Psi Flow pressure: psi 2inchdrain?
YesEf Non
N/A D
2.
Flow switches, supervisory switches and a . larm bells tested: .....................
YesE� NoE]
N/A n
3.
Alarm bell operates: ......................................... ............. ...... ...................
Yes IM/ No F1
N'/A F-�
4.
Systems inspected and lubricated: ...........................................................
Yes Y/ No M
5.
Pressure regulating valves tested: .............................................................
Yeso NoE]
N/Aw
0 %
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1 Central Station Monitoring? .............................................................................. Yes No
Monitoring company name 0 03 '7 9-- 0 a -u a
2. Location of Sprinklers
1000/o ........ .&d Parkin.9 ......... [:1 Basement.:..., .... 0 Hallways ......... 0 Other ........
3. Pumper connections and clapper valves unobstructed ........................................ Yes Gd No 17�
4. Sprinkler heads less than 50 years old .................. ......... ............................... No E]
Yes [0,
5. Sprinkler coverage is acce able .................................. ................ ........... Yes EP/ No[]
Pt
6. Sp8resprinklOr heads at6lavailable ................................. " .................................. Yes Q/ No:C3
7. Systems left in service .................... e ................................. o ................ a ...... o ... Yes V No E]
8. Valves are sealed ............ o e.. a.. e.. a; a ........ .......... : Yes E� -No 0
9. �Jgns are provided on Valves .......................................................................... �es WE]
10. City static wate . r pressure . (o;z- DSL
Problems Found:
4s
Q -P -7
.Z. 1!2�0_cg_ ffen&
Corrections Made Date Corrected: Corrected BY:
SIGNATURE OF TESTER: Emerald Fire LLC
11021 Cramer Road KPN
Gig Harbor, WA 98329
merald Tire
Fire Spnnkler Specialists
AUTWATIC SPRINKLER SYSTEMS
(Ono System per Report)
9' , P-1v 1 *111, -4
Occupancy Address:.=d.A,, 14,�L,, 2=4 Occupancy Name:
Responsible Person: Phone Number:
Building Owner: Phone Number:
Date of Ins pe ct1on:&,;?4 —13 Type of Inspection: Quarterly 0 Annual pJ(Cc"5q?jf:"d9
Fire Sprinkler Certificate
Testers Nam e (Please Print)::Z-4, PeLprX.4 of Competency FSCC-#
DRY SYSTEM:
1. Trip test (dry trip) conducted ................................................................... Yes 0 No 0
System tripped in seconds.
2. All flow switches, supervisory swftche�and alarm bells I teste4,,/ .................. Yes 0 No 0 N/A 0
3. Alarm bell operates: ............ / ....................... :. / .......................... Yes 0 No 1; 0 N/A 0
4. Flow tests conducted: Yes 0 No 0
:, * * : .............
Flow pressure: ��sl 2-Inch drain .......Yes 0 No 0
5. Systems inspected and lubricated: ............ ............... ................................ Yes No 0
6. Air compressor refills'systern in 30 Xmies: ............ . .............................. Yes 13 No 0
7. System drained and restored to rmal operation: .. .................................... Yes 0 No 0
8. Were the heat actuation d-W(ces tested on pre -action and deluge system? ....... Yes 0 No 0
WET SYSTEM:
Yes G� No C1
I . Flow test conducted:..S.��,,, . . ....... ......
Static pressure: tg--, sl 2-inch drain? ..............
si -Flowpressure: Yes No 0 Other 0
2. Flow' switches, supervisory switches and alarm bells tested: ........................... Yes No 0 N/A 0
3. Alarm bell operates: .................................................................. I .......... . Yes Q/No 0 N/A C
4. Systems inspected and lubricated: ............................. I ............................. Yes Ip/No 0
5. Pressure regulating valves tested: .......................................................... Yes 0 No 0
H 021 Cramer Rd. KPN -- Gig Harbor, WA 98329 1 Office (253) 857-2056" , Fax (253) 857-2312 , Local 699 Contractor
AUTOMATIr _qPpimLe,&R_SYSTEMS_(cont1nued)
j �eneral:
Central station monitoring? ..................................
........ .................. ....Yes Q�lNo n
Monitoring company name
2. Location of Sprinklers
100% ...... 0 Parking ......... 0 Basement ........ 0 Hallways.,....... a Other ......... o
3. Pumper connections: and clapper valves unobstructed ................................. ye* s VNo o
.4.. Sprinkler heads lesithan 510 years old ..................................................... Yes @"No 0
5. Sprinkler coverage is'ac'6eptable.'............., ................................................. Yes G( No 0
6. Spare sprinkler heads''are available ...........................
.............................
-yes d No 0
7. Systems left in ser . vice .......................................................................... yes Ao o.
8. Valves are sealed or supervised ..............
............................................... Yes 0
9. Signs are provided on valves ................................................
.......... yes @/No 0
10. bty static water pressure 4f3 psi.
Problems Found
Date Corrected: Corirected By.
SIGNATURE OF TESTER ---
AGENCY L Lit PHONE
MAILING ADDRESS:
Emerald Fire LLC
11,021 Cramer Road KPN
Gig Harbor, WA 98329
CTFA
Emerald Tire
Fire Spnnkler Specialists
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
awill //WV 97 ,
Occupancy Address: EAAb,,jL- LVx,. !3=a6 Occupancy Name:
Responsible Person: Phone Number:
Building Owner:
Phone Number:
Date of Inspection: Type of Inspection. Quarterly 0 Annual ?A"cceptance 00ther 0
Testers Name (Please Print): Fire Sprinkler Certificate 0633-IT-05180:'
of Competency FSCC #1 -
DRY SYSTEM:
1. Trip test (dry trip) conducted .............. ................ ...... ...... Yes 0 No 0
System tripped in seconds.
ested.
2. All flow switchest supervisoryAwftc es and alarm be ...................... Yes.0 No 0 N/A 0
3. Alarm bell operates: .......... /...V ................... ............. I ................. Yes 0 No 0 N/A 0
4. Flow tests conducted: ...... / ...................... ..................................... ....... Yes 11 No 0
Flow pressure: ---Psi 2-inch d n? .. ......................................... Yes 0 No 0
/1n h n�.
c
n
- ! d-
5. Systems inspected and lubricated:_ .................. ........... Yes 0 No 0
6. Air compressor refills system in minutes: ..............................................
orma I op tjo
7. System drained andresto to n era n.,.
ormal operation: ....................................... Yes 0 No 0
- 8. Were the heat actuation. devices tested on pre -action and deluge system? ....... Yes 0 No 0
e—
WET SYSTEM: .� - :1�2
1. Flow test conducte :.0' Yes No 11
Static pressu ........... Yes No 0 Other 0
re: 6c si wpressure: '_psi 2'
2. Flow' switches, supervisory switches and alarm bells tested: ......................... Yes V No D N/A 0
3. Alarm bell operates: ......................... .................................................. . Yes VNo 0 N/A I-
4. Systems inspected and lubricated ............................................................ Yes 13/No 0
5. Pressure regulating valves tested: .......................................................... Yes 0 No E) �VIIIA
11021 Crarner Rd. KPN -v Gig Harbor, WA 98329 -. Office (253) 857-2056 Fax ('2153) 8,57-2312 , Local 699 Con tractor
i
-ER SYSTEMS(continued)
9.eneral:
Central station monitoring? ........................................... .............. :...,....Yes, rv/No 01
Monitoring company name Ap-1 Hod�R7,2g,2,-W
2.' Location of Spdnklers
100% ...... 0 Parking ......... 0 Basement ........ 0 Hallwa'ys.........Q Other ......... 0
F
I Pumper connections and clapper valves unobstructed ................................ Ye*SiNo 0
4. Spdnkler heads I
ess than 50 years old .................................................... Yes Wf No o
5. Sprinkler coverage is acceptable ......... ............ .......................... Yes G( No 0
6. Spare sprinkler headiar6 available ............................... ................ .........,..Yes [Mo 0
7. Systems left in service .......................................................................... Yes PNo. 0.
8. Valves are sealed or supervised ............................................ ................ Yes 14,
o 0
9. Signs are provided on valves ......................
........................................... Yes (9/N o 0
10. bity static water pressure psi.
Problems Found
SIGNATURE OF TESTE
AGENCY
MAILING ADDRESS:
Date Corrected: Corrected By:
PHONE
Emerald Fire LLC
11021 Cramer Road KPN
Gig Harbor, WA 98329
CTF-4
ald Tire
Emer
Fire Spfinkler Specialists
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
Occupancy Address: g,�&AAawL- Wb�. q2a�� Occupancy Name: ffw.J�14
Responsible Person: Phone Number:
Building Owner: Phone Number:
Date of Inspection: Z-61(_qJ3 Type of Inspection: Quarterly 0 Annual pkccaptance DOther o
Testers Name (Please Print): RAI iham�a Fire Sprinkler Certificate0633-1-1705'180".,*
. . \j I of Competency FSCC # - 0��
DRY SYSTEM:
1. Trip test (dry trip) conducted ................................................................... Yes 0 No n
System tripped in second
2. All flow switches, super)(isory sw* hes and, alarm 401s tested: ...................... Yes.0 No 0 N/A 0
3. Alarm bell ope ................ ........... ............. ............ Yes 0 No 0 N/A 0
rates./ .................... ....... Yes 0 No 0
4. Flow tests conducte ......................... ......... I .............
Flow pressure: ____psi 2-inc rain? ............................................ Yes 0 No 0
-s
in
j
c
r
.9 * n�
5. System s:i nspected and /lubftated'., .......... . ............................................. Yes 0 No 11
n
0 m
V e 3 inutes.
6. Air compressor refills system 30 minutes: ........ ....................................... �0��
tion:
rM I op t
7.. System drained and res red to normal opera ion ....................................... Yes 0 No 0
S.. Were the heat acludfion devices tersted on pre -action and deluge system? ....... Yes o No 0
WET SYSTEM:
1 - Flow test conducted: ............................................................................ Yes V No 0
Static pressure: -cL-Z—psi Flow pressure: _:;:�psi 2-inch drain? .............. Yes V No 0 Other D
2. Flow' switches, supervisory switches and alarm bells tested: ......................... Yes G/No 0 N/A . 0
I Alarm bell operates: .................. 11 ......... I ........................................ .......YesG(NoON/A C
4. Systems inspected and lubricated: ........................................... ....... I ...... Yes 6(No 0
5. Pressure regulating valves tested: .......................................................... Yes 0 No 0 11V
11021 Cramer Rd. KPN -- Gig Harbor, WA 98329 �� Offic� (253) 8571-2056 , Fax (2153) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS-(continu . ed)
P_eneral:
1 - Central station monitoring? ........ I ........ .......................... ................. O/No
Monitoring company name 4 [)T
2. Location of Sprinklers
100% ...... 0 Parking ......... 0 Basement ........ 0 Hallways ........ o Other .......... 0
3. Pumper connections and clapper valves unobstructed ................................ Yes Cl/ No o
4. Sprinkler heads less than 60 years old ................. .................................. Yes VNo '0
5. Sprinkler coverage is acceptable ............................... ............................ Yes -6( No V�
6. Spare sprinkler heads are available .......................................................... Yes VNo o
7. Systems left in service ............................................................. Yes E(No o.
S. Valves are sealed or supervised ............................................. 0
................ Yes
9. Signs are
provided on valves ................... ............................................. Yes IVNo
10. (jity static water pressure -u'7 psi.
Problems Found
I
92f-Mc-l-lon-s Made: Date Corrected: Co"ected By:
SIGNATURE OF TESTE
V
AGENCY PHON . E
MAILING ADDRESS:
Emerald Fire LLC
11021 Cramer Road KPN
Gig Harbor, WA 98329
CTF-4
FIRE PREVENTION
Ser-WngBifier, Edmonds
12425 Jl�eridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
FIRE
Mountlake Terraceand
Everett, WA 98208
EDMONDS
0 BRIER
DISTRIti-
e Town of WoodwaA.
Tw'hww.FireDistrictl.org
Phone (425) 551-1200
E]WOODWAY
[I MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
LOCATION:
24111 Highway 99
BLDG
e- FREQUENCY TATION & SHIFF*)
366 2. B
BUSINESS NAME:
Siew Bldg
PHONE: 4256435635
'SCHEDULED
DATE DUE 0710 , 1/12
-,I-,
MAILING
15100 SE 303th St #702
UFIRI,. 509 :7, 7 006
ADDRESS:
Bellevue
98006
BUSINESS OWNER:
Siew, Robert
HOME PHONE: 4256433838
PREFIRE
EMERGENCY-1:
FAX #425-747-5482
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
1:1 1:1
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
I
FIRE AS 3/12
FE
SYSTEIMS:
ANNUAL
HAZARDSFOUND ND LOCATIONS /COMMUNICATIONS
2
2
3
3
�7
r_d_,�
4
4
5
5
6
6
7
7
1 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
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
6ATE:
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:
LETTER NEEDED [:] YES Ej NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
Em erald Tire
Fire sprinkder Specialists -
11021 Cramer Rd. KPN - Gig Harbor, WA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
119
Occupancy Address: E CA/a. IRk'O Xk Occupancy Name: fo
Responsible Person: Phone Number:
Building Owner: Phone Number:
Date of Inspection: Type of Inspection: Quarterly Annual 521""Other EI
rl.0 06334-1-001809
Testers Name (Please Print): 1�r� WA State FSC.-.ff
DRY SYSTEM/PRE-ACTION SYSTEM:
1. Trip test (dry trip or full flow) conducted: ............................................. s F] No F�
System tripped in seconds.
2. All flow switches, supervisoryAwit . che7and alarm bells tes
_,I.- ............ Yes E] No E] N/A C-]
3. Alarm bell operates: ......... / ..... \ ... / ................ .................................. Yes. [-] No [-] N/A E]
4. Flow tests conducted: ..... / ....................... ............................................. Yes 0 Noo
Flow. pressure: psi 2-in rain? ....................................... Yes E] No E]
d***
s
i n d ra i*
5. Systems inspected and lubricate ..................... .... .................................. Yes E], No E] N/A.0
6. Air compressor refills syste In30minutes: .... ........ ................................ Yes E] No
I op t
7. System drained and tored to normal operation: ..................................... Yes E] No E]
8. Were the heajAaftuation devices tested on pre -action and deluge system? ..... Yes Ej No E] N/A E]
WET SYSTEM/ANTI-FREEZE SYSTIEft-Tested at
1. Trip test conducted: ............................................................................... Yes[;( No F�
Static pressure: 6,2- psi Flow pressure: _57H p si 2 inch drain? Yes No E] N/A
2. Flow switches, supervisory switches and alarm bells tested: ...................... Yes No [-] N/A E]
3. Alarm bell operates: ............................................................................. Yes 5?" No F� N/A E]
4. Systems inspected and lubricated: .......................................................... Yes &KNo
5. Pressure regulating valves tested: ............................................................ Yes[] No[:] N/Av
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
I
Central Station Monitoring? ..........................................................................
Yesd
No R
Monitoring company name EEL-
2.
Location of Sprinklers
100% ......... Parking ......... E Basement ......... E] Hallways ......... R Other ........
3.
Pumper connections and clapper valves unobstructed .......................................
Yes [Q/
No E]
A
Sprinkler headsjess tha.n 50 years old .............................. ...................................
Yes-5/.
No El
5.
Sprinkler coverage is acceptable ....................................................................
YeQ/
No E]
6.
Spare sprinkler heads are available .................................................................
YesP/
No E]
7.
Systems left in service ...................................................................................
Yes V
No R
8.
Valves are sealed or supervised ......................................................................
Yes E;Y
No R
9.
Signs are provided on valves ..........................................................................
Yes KK
No F-1
10. City static water pressure &2 '2-. -psi.
Problems Found:
-Z eo_ -R,V',s &t --7
I
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
Emerald Pire
Fire Sprinkler Specialists
. 11021 Cramer Rd. KPN - Gig Harbor, WA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
'p-If I I 1 77 -0
es': t4lk.' ' cieloacQ _Occ*�ncy Na-me-SviAl -c-i :0i
Occlupancy�Addr s
Responsible Person:
Building Owner:
Phone Number:
Phone Number: I
Date of Inspection: 2 -;L;- I -;L Type of Inspection: Quarterly E]
Testers Name (Please Print): WA State FSCC#
i
Annual V Other El
0633-IT-05isl
DRY SYSTEM/PRE-ACTION SYSTEM:
1. Trip test (dry trip or full flow) conducted: ................................................... Yes F] No E]
System tripped in second
2. All flow switches, supervisory switch sand alarm bells tested: YesF] No[] N/AE]
3. Alarm bell operates: ..... 71 ..... \ ... / .......................... ......................... Yes F� No F] N/A F]
4. Flow tests conducted ........................... ........................................ Yes E] No Ej
Flow pressure: —psi 2-inch n? ..... ................................ Yes E] No Ej
si
i n
c
5. Systems inspected and.lubricated: ... ....................
i.."Yes El. EL-BIA E]_
6. Air compressor refills system i minutes: ......... .................................... Yes El No F
0
7. System drained and rest d to normal operation: ..................................... Yes E] No E]
8. Were the heat actuatfon devices tested on pre -action and deluge system? ..... Yes [] No 0 � N/A E]
jCj
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at Z�n.
1 Trip test conducted: .............................................................................. Yes V No R
Static pressure: tp,,� psi Flow pressure: psi 2 inch drain? ....... Yes La" NoR N/A
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes'V No E] N/A E]
3. Alarm bell operates: ...... I ........................................................................ Yes E�' No E] N/A E]
4. Systems inspected and lubricated: .......................................................... Yes 0' No E]
5. Pressure regulating valves tested: ........................................................... Yes E] No [] N/A EV
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1 Central Station Monitoring? .......................................................... ................. Yes Z/"No r-1
M onitoring company name OT
2. Location of Sprinklers
100% ......... K( Parking ......... Ej Basement ......... E] Hallways ......... E] Other ........ E]
3. Pumper connections and clapper valves unobstructed ....................................... . Yes V No E]
.4. Sprinkler headsJess than 50 years,old .................. i .......... I ................... I ....... I ....... Yes.V.,.N,.Q
5. Sprinkler coverag e is acceptable .................................................................... Yes No
6. Spare sprinkler heads are available ................................................................. Yes No E]
7. Systems left in service .................................................................................. Yes No R
8. Valves are sealed or supervised ...................................................................... Yes No F-1
9. Signs are provided on valves .......................................................................... Yes R/ No E]
10. City static water pressure -psi.
Problems Found:
I. qL�mm a&c yrs. 01ce ob4r,
�4 W Le rA 6..! 's
R.
J
k M-P,
WAV/
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
eg;._ 5iWA
Emerald Pir
Fire SprinkJer Specialists.
11021 Cramer Rd. KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
9 R.0 61ccupancy'N
Occupancy Address: Edt,� h -rK6-_1
Responsible Person: Phone Number:
Building Owner- Phone Number:
Date of Inspection: 3-2--12,- Type of Inspection: Quarterly E]
Testers Name (Please Print): 'Rnh, WA State FSCC#
j
Annual G21"' Other E]
0633-1-1-0518
DRY SYSTEM/PRE-ACTION SYSTEM:
1. Trip test (dry trip or full flow) conducted: .................................................. Yes 0 No F1
System tripped in seconds.
2. All flow switches, supervisory switches anp alarm bells tested: . . . . ............ Yes [-] No [-] N/A F]
3. Alarm bell operates: .......... r. N ......... .................... Ile` . ........................ Yes E] No [-] N/A E]
4. Flow tests conducted: .... * Yes 0 No Ej
.................................
p V
n? .....
FI ow pressure: si nch dr _, .................................. Yes E] No
5. Systems h1spected andjubricated: ..... ........ .... ... ..... ....................... Yes No N/AE]
S.
6. Air compressor refills system in 3 Zminute� . . ....... ................................. Yes No E]
7. System drained and restor 0 normal operation: ..................................... Yes El No El.
8. Were the heat actuatyidd�evices tested on pre -action and deluge system? ..... YesE] NoE] N/A[-]
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at
1 Trip test conducted: .............................................................................. Yes V No F�
Static pressure: &So- psi Flow pressure: -53:e psi 2 inch drain? ....... YesE3"NoE] N/AE]
2. Flow switches, supervisory switches and alarm bells tested: * ..................... Yes Fm( No E] N/A 0
3. Alarm bell operates: .............................................................................. Yes E?O' No R N/A E]
4. Systems inspected and lubricated: .......................................................... Yes Z"'No R
i1q
5. Pressure regulating valves tested: ........................................................... Yes E] No F� N/Aj��
a
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
I
Central Station Monitoring? ..........................................................................
Yes M' No R
Monitoring company name DT
2.
Location of Sprinklers
100% ......... [�r' Parking ......... E] Basement ......... E] Hallways ......... E] Other ........ 0
3.
Pumper connections and clapper valves unobstructed .......................................
Yes Y No E]
4.
Sprinkler heads,less than 50 years old ......................................... ........... ............
Yes. &a"" No El
5.
Sprinkler coverage is acceptable ....................................................................
Yes R( No Ej
6.
Spare sprinkler heads are available .................................................................
Yes V No E]
7.
Systems left in service ..................................................................................
YesZ No R
8.
Valves are sealed or supervised ......................................................................
YesZ No R
9.
Signs are provided on valves ..........................................................................
Yese No E]
10.
City static water pressure 1\ psi.
Problems Found:
A 2 &,G%W1Pz va, nick gq, we-�,r
V
;Z. MNReg
I
I Pa,�wkj� J&,j &Z fj, lc>,vs
I WV
/73:7
f
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
Emerald Pire
Fire Sprinkler Specialists
11021 Cramer Rd. KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
qq
'Occu ancy Na'me-)�
Occupancy'Aciclress:'Edy,-�T
Responsible Person: . Phone Number:
Building Owner: Phone Number:
Date of Inspection: 3-2-la_ Type of Inspection: Quarterly E] Annual Other E]
i � - 5 11 S
Testers Name (Please Print): WA State FSCC#
DRY SYSTEM/PRE-ACTION SYSTEM:
1 Trip test (dry trip or full flow) conducted: .... ............................. I ................ Yes E] No F]
System tripped in seconds.
2. All flow switches, supervisory switches d alarm bells tested: .... ................. Yes F No N/A F]
sec
nd
sory switches d a rm bel is tested .... ..............
3. Alarm bell operates: ........... ..... ..... .......................... ........................ Yes E] No N/A F
4. Flow tests conducted: ...... .............................. I .. ................................... Yes 0 NoF
i
........................
Ds r z -] No
Flow pressure: psi 2-inch drai ....................................... Yes [_
5. Systems inspected and lubricated- ................ '1�9_[] N/A El
�ecl ......... ...........
6. Air compressor refills system7in X30nutes:......, ... .... ................................. Yes No E]
7. System drained and restore normal operation: .......................................... Yes E]_ NoE]____
8. Were the heat actuatie6 devices tested on pre -action and deluge system? ..... YesE] NoE] N/AE]
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at
1. Trip.test conducted: .............................................................................. Yes F?' No F�
Static pressure: �7c_:) psi Flow pressure: Z
z. - psi 2 inch drain? ....... YesE� NoE] N/AE]
.2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes g No E] N/A E]
3. Alarm bell operates: ............................................................................. Yes Ej( No V N/A E]
4. Systems inspected and lubricated: .......................................................... Yes M" No 0
0,1
5. Pressure regulating valves tested: ...................... I ..................................... Yes E] No E] N/A Q/
01
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1 Central Station Monitoring? .......................................................................... Yes M' No F1
Monitoring company name
2. Location of Sprinklers
100% ......... V Parking ......... [] Basement ......... [] Hallways ......... E] Other ........ E]
3. Pumper connections and clapper valves unobstructed ....................................... Yes V No[]
4. Sprinkler heads less than 50 years old .............................................................
Yesy
Noo
5. Sprinkler coverage is acceptable .....................................................................
YesZ'
No E]
6. Spare sprinkler heads are available ..................................................................
YesZZ
No E]
7. Systems left in service ..................................................................................
Yes V
No F1
8. Valves are sealed or supervised ......................................................................
Yeslo
No F1
9. Signs are provided on valves .........................................................................
Yes 2(
No E]
10. City static water pressure '-7 0 psi.
Problems Found:
Tole:;
I ��& 4'",
4f- wmc, 04 !a!0j6& jAJ-h4 i�!A
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire f PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
IN /'
FIRE PREVENTION
..............
Serving Briet: Edmonds 12425 M�ridicin AveAs,, I INSPECTION REPORT
15fEDMONDS
Mountlake Terraceand Everett, WA 98208 0 BRIER
f/ [3WOODWAY
Phone (425) 551-1200
the Town of Wbodwqj� [I MOUNTLAKE TERRACE
T www.FireDistrictl.org Fay (425) 551-1272 0 UNINCORPORATED
" FREQUENCY STATION&SHIFF)
LOCATION:
24111 Highway 99
BLDG
366. 20 A
I
BUSINESS NAME: Siew Bldg
PHONE: 4256435635
SCHEDULED
DATE DUE 1 07101/11
MAILING 15100 SE 38th St #702
LIFIR 0 509 7006
ADDRESS: Bellevue
98096
BUSINESS OWNER: Siew, Robeft
HOME PHONE: 4256433838
PREFIRE
EMERGENCY-1: FAX #425-747-5482
HOME PHONE:
"'CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
0 E]
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
A3 / ZZ I I
NAME OF INSPECTOR:
FIRE AS 3/11
FEq�\ & 1)
SYSTEMS: '�/Wll
ANNUAL
HAZARDS FOUND AND LOCATIONS /COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE.
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTED TO,
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
4
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUEP
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6�
.4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED E] YES NO
LETTER NEEDED [] YES El NO
8
FIRE DEPARTMENT COPY
Incident History for: #EF11002328 Xref: #EP11013942
Case Nfumbers: $DF11008751 $EF11002681 $S211011546 $TF11001629
Entered 06/24/11 06:57:02 BY SCPC07 SC754
Dispatched 06/24/11 06:58:08 BY SCPC08 SC716
1�qrdute 06/24/11 07:01:17
,,.;-'Onscene 06/24/11 07:05:50
Closed 06/24/11 08:23:23
Initial Type: HZ Initial Alarm Level: 1 Final Alarm Level:
Final Type: HZ (HAZMAT RESPONSE ALARMS 1 - 4) Pri: 1 Dispo:
Pol'i-ce BLK: E008 Fire BLK: EF006 Map Page: 474J-3 Group: EF1
c: T
Loc: 24111 HWY 99 EDM -- BURLINGTON COAT EDM high xst: RAMP (V)
Loc Info:
Name: SNOPAC
/0657 (SC754 ) ENTRY
/0658
(SC716
DISP
B16
/0658
$ASNCAS
B16
/0658
ASST
E20
/0658
ASST
E19
/0658
$ASNCAS
E19
/0658
ASST
DFX1
/0658
$ASNCAS
DFX1
/0658
ASST
TAC22
/0658
$ASNCAS
TAC22
/0659
(SC741
CHANGE
/0700
(SC716
AIQ
DFX1
/0700
AIQ
TAC22
/0700
(SC741
CHANGE
/0701
(SC716
ENROUT
B16
/0701
ENROUT
E20
/0702
ENROUT
E19
/0705
ONSCNE
E20
/0706
NEWLOC
E20
/0706
ONSCNE
B16
/0707
MISC
B16
/0708
MISC
E20
/0708
NEWLOC
E19
/0708
MISC
B16
/0709
MISC
E20
/0709
MISC
E20
/0711
CHANGE
/0715
MISC
B16
/0715
CHANGE
/0719
CHANGE
/0725
MISC
B16
/0728
MISC
B16
/0734
MISC
B16
Addr:
Phone:
1
Beat: MD17 Sr
,SCSO OS - GARBAGE TRUCK INTO LIGHT POLE - NEAR
BURLINGTON COAT FACTORY - SCSO OS SAYS HAZMAT -
NON INJ - LIGHT POLE IS SMOKING - TRUCK IS LEAKI
NG GAS
#FD8902 DAHL,D-B [E,MI
$EF11002681
#FD9609 MCALLISTER,B-C [E,M,Rl
#FD0816 CASTELLON, M-F [E]
#FD8405 HILLS,R-F (E,M,Rl
,#FD9803 HUGHES,J-C [P]
#FD9408 TOREY,S-F (C)
#FD0508 FULLER,J-F [P]
$TF11001629
$DF11008751
$S211011546
LOC: 244 ST SW/HWY 99 EDM --> 24111 HWY 99 ED
M
,IS IN PARKING LOT BURLINGTON COAT FACTORY PER P
D WHO IS OS
I ROADWY INTO PARKINGLOT - 99 COMMAND
[99 COMMAND I
,PUD TO LOCATION - STILL HAVE POWER TO POLE
,E19 STANDBY ON HIGH
[ON HIGH I
,BRING YOUR HZ KIT
,BOTH ECOL /CITY EDMONDS
,DESL.FUEL STORM DRAIN
,PUD ITS NOT THERE POLE - WILL COME DOWN TO SHUT
IT OFF
,425 754 9710
,DEPT OF ECOLOGY NOTIFIED
,MIKE /EDMONDS STREET/STORM DIV NOTIFIED
,ESCA -
,ESCA CALL ME
,SAND TRUCK TO LOCATION FOR DIESEL
Iq VV y
L--Ps 6-
/0740
AOR
E19
/0744
CHANGE
/0745
MISC
B16
/07,53-
MISC
B16
.i/0753
AOR
B16
/0759
CHANGE
/0823 (SC798
AOR
E20
/0823
CLOSE
E20
,PAGED LYN GROSS/ESCA AND DANIEL GOOD - NO ANSWE
R TO PAGEOR CELL PHONE
,WE WILL FOLLOW UP ESCA LATER
,LEAVE A MSG FOR ESCA - HZ MAT BILL NUMBERING
,PER REQ B16 - KEEP TRYING TO GET A HOLD OF ESCA
- THEY NEED TO GET AHAZMAT NUMBER STARTED - FOR
BILL PURPOSE
,HWY 99 COMMAND TERMINATED
Incident Report
2011-0008751 -000
Snohomish County Fire District I
Basic
Alarm Date and Time
06:57:02 Friday, June 24, 2011
Arrival Time
07:05:50
Controlled Date and Time
Last Unit Cleared Date and Time
08:23:23 Friday, June 24, 2011
Response Time
0:08:48
Priority Response
Yes
Completed
Yes
Fire Department Station
20
Shift
C
Incident Type
411 - Gasoline or other flammable liquid spill
Initial Dispatch Code
HZ
Aid Given or Received
N - None
_Alarms
I
Action Taken 1
43 - Hazardous materials spill control and confinement
Casualties
No
--Apparatus - Suppression
3
Suppression Personnel
7
Hazardous Material Released
5 - Diesel fitel/fuel oil - vehicle ftiel tank/portable
Property Use
965 - Vehicle parking area
Location Type
Address
Address
24111 99 HWY
City, State Zip
Edmonds, WA 98026
District
I
Map Page
EF006
Person Involved - Billings, Steve
Involvement Code
DRV
Last Name
Billings
First Name
Steve
Business Name
Allied Waste Services
Street Address
Person Involved - Jones, Jeremiah
Code
MGR
Last Name
Jones
First Name
Jeremiah
Business Name
Allied Waste Services
Street Address
21325 66 AVE W
City, State Zip
Edmonds, WA 98036
Phone
4256462556
Person Involved - Kurnz, Liz
Involvement Code
EMP
Last Name
Kurnz
First Name
Liz
Business Name
Department of Ecology
Street Address
Page: I Printed: 06/27/2011 11:45:17
Snohomish County Fire District I
Incident Report
2011-0008751 -000
Person Involved - Moles, Tod
Last Name
Moles
First Name
Tod
Business Name
City of Edmonds
Street Address
Apparatus - E20
-Apparatus ID
E20
Response Time
0:08:48
Apparatus Dispatch Date and Time
06:57:02 Friday, June 24, 2011
En route to scene date and time
06:57:02 Friday, June 24, 2011
'Apparatus Arrival Date and Time
07:05:50 Friday, June 24, 2011
Apparatus priority response
Yes
Number of People
3
Apparatus Use
I
Apparatus Action Taken 1
43 - Hazardous materials spill control and confinement
Apparatus Type
I I - Engine
Personnel 1
8405 - Hills, Randy
Position: FF/RR
Personnel 2
0816 - Castellon, Moises
Position: FF/EMT
Personnel
9609 - McAlister, Brian
Position: CAPT/RR
Apparatus - E19
Apparatus ID
E19
Response Time
0:08:48
"'Xpparatus Dispatch Date and Time
06:57:02 Friday, June 24, 2011
En route to scene date and time
06:57:02 Friday, June 24, 2011
Apparatus Arrival Date and Time
07:05:50 Friday, June 24, 2011
Apparatus priority response
Yes
Number of People
3
Apparatus Use
I
Apparatus Action Taken 1
43 - Hazardous materials spill control and confinement
Apparatus Type
I I - Engine
Personnel 1
9408 - Torey, Sean R
Position: FF/EMT
Personnel 2
0508 - Fuller, Jhareme L
Position: FF/PM/l
Personnel 3
9803 - Hughes, Joseph D
Position: CAPT/PM
Apparatus - BC16
Apparatus ID
BC16
Response Time
0:08:48
Apparatus Dispatch Date and Time
06:57:02 Friday, June 24, 2011
En route to scene date and time
06:57:02 Friday, June 24, 2011
Apparatus Arrival Date and Time
07:05:50 Friday, June 24, 2011
Apparatus priority response
Yes
Page: 2 Printed: 06/27/2011 11:45:18
Incident Report
Snohomish County Fire District I
2011-0008751 -000
--Number of People
Apparatus Use
Apparatus Action Taken I
Apparatus Type
Personnel I
Apparatus - BC16
43 - Hazardous materials spill control and confinement
9 10 - Battalion Chief unit
9409 - White, Donald
Position: BC
Authority
Reported By 9609 - McAlister, Brian
09:32:19 Friday, June 24, 2011
Officer In Charge 9609 - McAlister, Brian
09:35:20 Friday, June 24, 2011
Reviewer 9609 - McAlister, Brian
09:32:22 Friday, June 24, 2011
Narratives
.-..,,.,.Narrative Name
:'7" Narrative Type
Narrative Date
,Author
,.kuthor Rank
Author Assignment
-Narrative Text
Narrative Name
Narrative Type
Narrative Date
E20
Incident
08:57:00 Friday, June 24, 2011
9609 - McAlister, Brian
CAPT/RR
I
E20, E 19 and BC 16 were dispatched to this location for a garbage truck into a light pole
with a HazMat spill. SnoCom. informed us on response this was non -injury but that diesel
fuel was leaking from the truck's tank. On arrival we found Edmonds PD already on scene
with a garbage truck in the parking lot of Burlington Coat Factory that had made contact
with a parking lot light pole. The light had been knocked to the ground but was still
powered with the lights on. There was a sheen of fuel on the ground which was
approximately 40 feet by 60 feet and there was diesel fuel actively flowing into a storm
drain located in the parking lot. Both E20 and E 19 controlled the flow into the drain then
used absorbant on the sheen of fuel. The saddle tank had been partially knocked off the
truck and had been punctured towards the top of the tank. The tank had stopped leaking by
the time we arrived. There was some fuel dripping from the fuel filter. Aborbant pads were
used for this area. The driver stated there was approximately 40 gallons in this 50 gallon
tank but was not sure how much spilled. We approximated that five to ten gallons had
spilled out and up to five gallons had entered the storm drain. Liz Kurnz with the
Department of Ecology was notified of the incident as well as ESCA. PUD was also
notified to assist with securing the electical light. Burlington Coat Factory also notified a
private electrician to assist. The City of Edmonds was notified and Tod Moles responded.
Allied Waste personel arrived on scene (Operations Supervisor and a mechanic). Allied
Waste dispatched their own spill response as well as a third party HazMat containment
company. They also formulated a plan to measure the fuel remaining in the tank to
determine how much had spilled. They were also managing the removal of the truck. Once
the power was secured access to the truck was granted to the Allied waste crews. 99
Command was terminated at 0823 hours.
E19
Incident
09:09:41 Monday, June 27, 2011
Page: 3 Printed: 06/27/2011 11:45:18
Incident Report Snohomish County Fire District I
2011-0008751 -000
Narratives
Author 9803 - Hughes, Joseph D
Author Rank CAPT/PM
Author Assignment I
Narrative Text E19 was dispatched as part of a "Hazmat Ist Alarm" response with E20 & B16. On arrival
E19 stood by and waited for instructions. After about 5 minutes E19 brought forward our
"Engine Co Haz-Ops Kit" along with manpower. E 19 assisted with applying absorbent
and booms. E19 had no other assignments during this incident.
End of Report
Page: 4 Printed: 06/27/2011 11:45:18
VVestfall, John
From: Moles, Tod
Sent: Tuesday, July 12, 2011 10:02 AM
To: Westfall, John
Subject: FW: Investigation Summary - 627563
Edmonds Allied Edmonds Allied Investigation
Waste Diesel Sp... I Waste Diesel Sp... ;ummary - 627563.. Hey John . . . you left a couple voice mails for me
while I was out on vacation. This is the report from Ecology on the Diesel spill.
I think they did a good job on the clean-up, I was satisfied with the efforts
from Allied. As you can see from the statement from Ecology, "as much as 32
gallons may have been lost". The other message was concerning the water ball
competition on the fourth and the placement of traffic controls. It is obviously
after the fact, but can you tell me if there were any issues so I can make sure
we have them covered in the future.
Thanks
----- Original Message -----
From: Jackson, Celia (ECY) [mailto:CJAC461@ECY.WA.GOVI
Sent: Friday, June 24, 2011 3:59 PM
To: Moles, Tod
Subject: Investigation Summary - 627563
<<Investigation Summary - 627563.pdf>> Hi Tod,
I appreciate the report. Here is mine, along with a few pictures.
Best,
Celia
b
1
SPILLS PROGRAM - ERTs INVESTIGATION SUMMARY
Incident Name: Edmonds Allied Waste Diesel Spill
Date/Time Reported to EIVID: 6/24/20110814
Date/Time Reported to Ecology: 6/24/20110721
INCIDENT SUMMARY -
How was notification made?
Edmonds fire department made the initial notification to Ecology for Allied Waste. The call
came to Liz Kunz, after-hours primary responder at 0721. Allied Waste submitted an NRC
report at 0814.
Who responded?
ECY NWRO Spill Responder Celia Jackson
ECY NWRO Spill Responder Chris Wilkerson
Edmonds Public Works Tod Moles
Snohomish Co. Fire District 1 John Westfall
Snohomish Sheriffs Office William Nelson Badge # 1587
What did you find on scene?
I arrived on scene at 0845. Allied Waste personnel were on scene. The Allied Waste truck
was parked just within the west entrance of the Burlington Coat Factory parking lot.
The angle of the truck suggested that the driver was heading south on HWY 99 and turned
left into the parking lot. The truck then struck a light pole on its left front side. The light
pole jammed between the front left wheel and the frame, smashing the wheel into the fuel
tank directly behind it.
According to Allied Waste, the capacity of the tank was 50 gallons. Every morning the
trucks begin their route with a full tank. Allied Waste trucks burn fuel at a rate of
approximately four gallons per hour. The truck had been on route for around three hours
at the time of the accident.
Accordingly, there should have been between 41 and 35 gallons left in the tank. Some fuel
was still in the tank when it was removed from the truck. From the boom and oiled sorbent
material, it's possible that as much as 32 gallons were lost.
The diesel traveled south in the storm -drain system under the parking lot. It then migrated
east along 242nd Ave to the end of the road. It was contained in the catch basin just before
the outlet to Lake Ballinger. There was no evidence of diesel in Lake Ballinger.
When and how was the spill contained?
The spill was contained by Allied Waste, Snohomish Co. Fire and Edmonds Public Works.
Granular sorbent was applied to the parking lot pavement, sorbent pads and boom sealed
the catch basin in the parking lot, and Edmonds Public Works placed sorbent boom in the
catch basins on 242nd AVE.
What was the operation/process underway at the time of the spill?
The Allied Truck was in transit on a commercial route.
How was the spill cleaned up?
Allied Waste hired West Vac Services to vactor the catch basins and sweep the pavement.
ENVIRONMENTAL CONDITIONS: (INCLUDE UNITS OF MEASURE)
0 Weather: Partially cloudy with showers
a Visibility: 8.4 miles
0 Temperature: 58oF
0 Wind (direction and speed): N 5 mph
Tidal stage & height (feet + MILW): Flooding at 6 feet
Tidal Current (set and speed): 0.9 knots 180o
Wave height: NA
Swell: NA
What was the immediate cause? (See StatesIBC Oil Spill Task Force Spill & Incident
Reporting Data Collection Dictionary.)
Human Error: the driver pulled into a parking lot and struck a light pole.
What were the contributing factors? (See StatesIBC Oil Spill Task Force Spill & Incident
Reporting Data Collection Dictionary.)
Human Error: Inattention - not paying attention, or failure to detect, critical situational
information.
Did the RP's actions or behaviors comply with applicable law, regulation, standard or
company guidance? Explain. Describe evidence gathered to support this finding (see
Investigation Activity below).
The liable party may have made an illegal left hand turn and did not wear his seat belt.
Evidence of the angle of the truck and its position near the entrance makes a right hand
Spills Program — Investigation Summary Form 2
turn very unlikely. The driver hit his head on the windshield, which would have been
prevented by a seat belt.
Allied Waste complied with their oil spill response policy. They had an oil spill response kit
on the truck, which they used as soon as conditions were safe. They also made notifications
to Ecology and EMD and hired a contractor.
Was the response effective? Why or why not?
The response was effective in cleaning up the diesel from the storm -drain system. The
contractor used a vac truck to clean out the drains and catch basins starting with the cul-
de-sac on 242nd Ave and ending at the Burling
Was the responsible party cooperative in the response, cleanup and/or
investigation? Explain.
The responsible party answered all questions, offered a narrative of events and
independently hired a contractor.
Were there environmental impacts or threats? Explain.
The only impacts were to the storm drain system.
What actions were taken, or will be taken, by the responsible party to prevent future
incidents?
Unknown.
ADDITIONAL OBSERVATIONS: (COMPLICATING OR MITIGATING FACTORS.)
NA
INVESTIGATION ACTIVITY. (DESCRIBE INVESTIGATION ACTIVITIES
UNDERTAKEN, SUMMARIZING SIGNIFICANT ISSUES.)
Investigation activity included note taking and photographs.
Name(s) of Ecology or other agency personnel contributing to the investigation:
Spills Program — Investigation Summary Form
Emerald Pire
Fire Sprinkler Specialists
11021 Cramer Rd. KPN -Gig Harbor, WA98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
Aif I I t4wy. 7 q W
occupancy Address: 16Zo,- 9ZO,2 4e Occupancy Name.&t -mLoV_C_oJ 01
U,
Responsible Person: akve- Phone Number:/A5--*77e,,-�?-2-;L/
Building Owner:
Phone Number:
Date of Inspection: ( Type of Inspection: Quarterly E]
Testers Name (Please Print)k--,b P4;�" WA State FSCC#
I -U I
Annual F
,,,K Other E]
0633-IT-0518
DRY SYSTEM/PRE-ACTION SYSTEM:
1. Trip test (dry trip or full flow) conducted: ................................................... Yes F-1 No E]
System tripped in seconds.
2. All flow switches, supervisory switches ar)d alarm bells tested:..",-. �- ..... Yes E] No[-] N/A E]
3. Alarm bell operates: .............. .. . ............................... ........................... Yes E] No E] N/A E]
4. Flow tests conducted: ......... ....... .................... ..................................... Yes [] No El
Flow pressure: psi nch�clra* . ....................................... Yes E] No F�
...... ........... .
5. Systems inspected and lubricated: ..... ............ .. Yes E] No E] N/A E]
6. Air compressor refills system
7. System drained and
8. Were the heat
minutes: ..... ......................................... Yes E] No E-]
to normal operation: ..................................... Yes 0 No 0
tion devices tested on pre -action and deluge system? ..... Yes E] No E] N/A E]
WET SYSTEM/ANTI-FREEZE SYSTEIVIjested at
1 Trip test conducted: ............................................................................... Yes [�K No Ej
Static pressure: psi Flow pressure: psi 2 inch drain? ........ Yes M' No E] N/A E]
2. Flow switches, supervisory switch.es. and alarm,bells.teste.d: ....................... Yes g' No E] N/A E]
-3. Alarm bel ( operates:'... * ............................................................................ Yes C�� No N/A 0
4. Systems inspected and lubricated: .......................................................... Yes Er -No EJ
5. Pressure regulating valves tested: ........................................................... Yes E] No E] N/A E�/
f
a
AUTOMATIC SPRINKLER SYSTEMS (continuedl
General:
1 Central Station Monitoring? ........................................................................... Yes F( No E]
Monitoring company name paly��[ I'v-
2. Location of Sprinklers
100% ......... E( Parking ......... El Basement ......... E] Hallways ......... E] Other ........ E]
3.
Pumper connections and clapper valves unobstructed .......................................
Yes [�r
No El
4.
Sprinkler heads less than 50 years old ..............................................................
Yes E�(
Noo
5.
Sprinkler coverage is acceptable ....................................................... ........
Yes Sj'
No E]
6.
Spare sprinkler heads are available ..................................................................
Yes F,,K
No El
7.
Systems left in service ..................................................................................
Yes a
No El
8.
Valves are sealed or supervised ......................................................................
Yes [�r
No El
9.
Signs are provided on valves .........................................................................
Yes Ell'
No
10.
Qty static water pressure -psi.
Problems Found:
�aL/42$2-3 TIA5C
,2-
3
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER: —
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
Emerald Pire
Fire Sprinkler Specialists
11021 Cramer Rd. KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
,:7-4 1 i / HVVY, 9 9 - It
Occupancy Address: ?E��LAA AA- k ci`Fro 2,(, OccupancyName:& ItgloyGo-d -1b
Responsible Person: Phone Number:
Building Owner:
Phone Number:
Date of Inspection: E_ t (_ I ( Type of Inspection: Quarterly 0
Testers Name (Please Print): 3R
WA State FSCC#
Annual R"'Other El
0633-IT-05180
DRY SYSTEM/PRE-ACTION SYSTEM:
1 Trip test (dry trip or full flow) conducted: ....................... Yes E] No E]
System tripped in seconds.
2. * All flow switches, supervisory switches�ncl alarm bel!'54ested: ............ I ......... Yes E] No E] N/A [:]
3. Alarm bell operates: ..................... / .............. X .................................... Yes 0 No 0 N/A 0
4. Flow tests conducted: .............. .............. ............................................. Yes E] No E]
Flow pressure: /S i 2-inc in? ....................................... Yes E] No E]
5. Systems inspected and lubricated: . ....................................................... Yes E] No E] N/A E]
6. Air compressor refills syste n minutes: .............................................. Yes EJ No EJ
sto t
7. ' System drained and re re7o normal operation: ..................................... Yes E] No 0
8. Were the heat actuation devices tested on pre -action and deluge system? ..... Yes[-] NoE] N/AE]
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at S!js
I Trip test conducted: .............................. ....... ........................................... Yes Ee"'No F-1
Static pressure: 66,��_ psi Flow pressure: psi 2 inch drain? ....... Yes [J' No[] N/A E]
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes [j�� No 0 N/A E]
3. Alarm bell operates: ............................................................................. Yes [ja/ No 0 N/A Fj
4. Systems inspected and lubricated: .......................................................... Yes2/NoE]
0i
5. Pressure regulating valves tested: ........................................................... YesE] NoE] N/AD--,*'
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1 Central Station Monitoring? .......................................................................... Yes 19/"No E]
Monitoring company name
2. Location of Sprinklers
100% ......... 0' Parking ......... Basement ......... Hallways ......... Ej Other ........
3. Pumper connections and clapper valves unobstructed ....................................... Yes [jj' No E]
4. Sprinkler heads less than 50 years old .............................................................. Yes V No[:]
5. Sprinkler coverage is acceptable .................................................................... Yes. 5;�' No Ej
6. Spare sprinkler heads are available ..... ............................................................ Yes E( No E]
7. Systems left in service .................................................................................. Yes VNo E]
8. Valves are sealed or supervised ...................................................................... Yes &r No El
9. Signs are provided on valves ......................................................................... Yes D/ No El
10. City static water pressure 6 �r_ -psi.
Problems Found:
/I Q UO-1(.1tox 0 ,�
PC,, W1,j &Mk
Oemz Joslk -rV10-1 (a-0 Apc,,,,r+ F3:7 -Co,,f4<!5� 6�,, ME
�2, Ad,�, a ke4A quwaLs 1k, 73 o ff,
Corrections Made: Date Corrected: Corrected By:.
SIGNATURE OF TESTER:
AGENCY:
PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cr'amer Road KPN, Gig Harbor, WA 98329
Emerald Tire
Fire Sprinkler Specialists
1021 Cramer Rd. KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
Occupancy Address: Hwy qq *'0
Ed",A,,h "o, - 2,F02-6 OccupancyName:E tn"��C"*c
Responsible Person: S le'y le- Phone Number:,q-2f--7M-.� I
Building Owner:
Phone Number:
Date of Inspection: R—( ( - (t Type of Inspection: Quarterly E] Annual L?"' Other []
Testers Name (Please Print): �301:2 WA State FSCC# 06'_33-IT-05i809
V
DRY SYSTEM/PRE-ACTION SYSTEM:
1 Trip test (dry trip or full flow) conducted: .................................. .............. Yes 0 No E]
System tripped in seconds.
2. All flow switches, supervisory switches andAlarm bells t e Zd: ................. I ...... Yes F No[_-] N/A F
3. Alarm bell operates: ............ ... ........... ........... .................................... Yes E] No [:] N/A E]
4. Flow tests conducted: ....... ......... .... ....... ........................................... Yes El No El
Flow pressure: psi -inc rain? ....................................... Yes EJ No El
5. Systems inspected and lubricated: .. .................. .. ................................ Yes E] No [-] N/A 0
6. Air compressor refills system in minutes* ....... ....................................... Yes [j No Ej
7. System drained and restor to normal operation: ..................................... Yes E] No Ej
8. Were the heat actu * n devices tested on pre -action and deluge system? ..... Yes E] Noo N/AE]
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at 3y:s-
1�. Trip test conducted: ................................................................................. Yes [�' No E]
Static pressure: 70 psi Flow pressure: /,o psi 2 inch drain? ....... Yes E-,K No N/A 0
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes E?""No 0 N/A E]
3. Alarm bell operates: ............................................................................... Yes [Er' No F] N/A E]
4. Systems inspected and lubricated: .......................................................... Yeso' No FI
5. Pressure regulating valves tested: ........................................................... Yes E] No Ej N/A ZI/
4-
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
I Central Station Monitoring? .......................................................................... Yes D/ No E]
Monitoring company name
2. Location of Sprinklers
100% ......... E?/ Parking ......... E] Basement .......... El Ha Ilways ......... El Other ........
3. Pumper connections and clapper valves unobstructed ....................................... Yes [� No E]
4. Sprinkler heads less than 50 years old ............................................................. Yes GY-No E]
5. Sprinkler coverage is acceptable .................................................................... Yes El No E�f
6. Spare sprinkler heads are available ................................................................. Yes [;�- No E]
7. Systems left in service .................................................................................. Yesj�?/ No
8. Valves are sealed or supervised ...................................................................... Yes Ef No 0
9. Signs are provided on valves ......................................................................... Yes G2/ No E]
10. C-ity static water pressure 2c:� -psi.
Problems Found:
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
. Emerald Tire
Fire Sprinkder Specialists
11021 Cramer Rd. KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 80-2312 'Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
;2-qtt( VWjy 9 q
Occupancy Address: S lAi-A. qR-0,Z& Occ u pa n cy N a m e:_&zd i
Responsible Person;- -s4 eVQ_ —Phone Number:_'(,;�-77_/o-a2.9L I
Building Owner:
Phone Number:
Date of Inspection: Type of Inspection: Quarterly Annual ER/ Other F]
i 809
Testers Name (Please Print): Fo[o WAStateFSCC# 06-'33-ff-05
DRY SYSTIEWPIRE-ACTION SYSTEM:
1. Trip test (dry trip or full flow) conducted: ..................................................... Yes E] No F-�
System tripped in seconds.
2. All flow switches, supervisory swipi(hes and alarm bellste-siteed . .................... Yes [] No F� N/A E]
3. Alarm bell operates: .. .... V ..................... ..................................... Yes E] No E] N/A E]
4. Flow tests conclucte : ........................... .............................................. Yes E] No E]
Flow pressure: .0 —psi 2-i drai ? ....................................... Yes E] No E]
5. Systems inspected and lubricate ............ . .. ........................................ Yes El. No El N/A El
6. Air compressor refills syste in 30 minutes . ............................................. Yes 0 No E]
7. System drained and r ored to normal operation: ..................................... Yes E] No
uation devices tested on pre-actio
8. Were the heatidn and deluge . system? ..... Yes 0 No E] N/A E]
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at Sys�
I
1 . Trip test conducted: ..................................... ................................................ Yes ED` No El
Static pressure: 7o psi Flow pressure: 6o psi 2 inch drain? ....... Yes 1:2- No E] N/A E]
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes [R' No E] N/A
3. Alarm bell operates: ............................................................................. Yes [�K No F� N/A F1
4. Systems inspected and lubricated: .......................................................... Yes E;-"*No R
5. Pressure regulating valves tested: ........................................................... Yes 0 No F-1 N/A E�/
1(�
AUTOMATIC SPRINKLER SYSTEMS (continued
General:
I Central Station Monitoring? ........................................................................... Yes [�r No F1
Monitoring company name
Location of Sprinklers'
100%. ........ g' Parking ......... El Basement ......... E] Hallways ......... E] Other ........ El
3. Pumper connections and clapper valves unobstructed ....................................... Yes Z' No E]
4. Sprinkler heads less than 50 years old ............................................................. Yes M"' No El
5. Sprinkler coverage is acceptable .................................................................... Yes Rr No []
6. Spare sprinkler heads are available ................................................................. YesO� No EJ
7. Systems left in service .................................................................................. Yes 2' No
8. Valves are sealed or supervised ...................................................................... Yes �21 No
9. Signs are provided on valves .......................................................................... Yes �y No Ej
10. City static water pressure 7-o -psi.
Problems Found:
Corrections Macle� Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
56923
tqCCj1 Fire &
So C�jr $hnplexGrinnei
9520 IMAV�fiue S. Suib
iin6W98108*1�hon'e*,"(206)201-*1400 *FrL.
Date 6/9/2010
BurlingLon Coat FactoEy #
011
Bill To:
24111 HigbMy 99
Job Location:
EdmoncN, Wa. 98026
P.O.
Terms
Bill To: Burlington Coat Factoa
1. B
Salesperson Bob D 0
1830 Route 130 N
44
Contact Minaq��,'Qn Dut��'
Budinatom NJ. 08016
22 1' FAX:
2A'A 2
National Account P11,
Commcnts
Terms of This
Agreemen
t Arc: F1 Time and Material Fixed Price of /'�rice Not to Exceed
#
Descripti -on
Quantity
-Net Price
Price Ext.
cost
SR# 16208582
Annual Wet Sprinkler Inspection vt,
4
A
34t
OUR LINGTON
PAC,
41yp'l1r,
X0
A P8020
Straight Time: Monday -Friday 7 arn-3:30 pm
Overtime Monday -Friday 3:30 pm-7arn
Saturday -All day
Double-time: Sunday -All day
Holiday -All day
Date: 6/9=10
ACCEPTED BY
YES NO DID SUPERVISORY SWITCHFS OPERATE PROPERLY
PRINT NAME
YES NO DID SUPERVISORY SWITCHES RESET
P;
0 . ShnPlex6rinnell BE sA FE.
TWk 4 24529241 Quarterly 0 Annual Q 3 Year [j 5 Year E] Pap 1 d4
SRO 23666178 REPORT OF SPRINKLER INSPECTION Dater' 61912010
CUSTOMER Burlington Coat Factory # 0119 INSPECTOR NAME Brandon Hlgl�y
BUILDING I LOCATION SIMPLEXORINNELL OFFICE $458
STREET 24111 Highway 99 9520 10th Avenue 8, Suite 100. Seattle. WA
CITY I STIPROV I 23PIPC Edmonds. We. 98026
[ATM manager un uuty PHONE# 201
IPHONEN (425) 776-2221 LICENSEO F;
1. GENERAL (To be answered by Customer.)
a. Have there been any changes in the occupancy classification, machinery or operations since the last Inspection?
b. Have there been any changes or repairs to the fire protection systems since the last Inspection?
c. If a fire has occurred since the last inspection, have all damaged sprinkler system components been replaced?
If answered *yeW'to a. b or c, list changes In Section 13. 1
d. Has the piping In all dry systems been checked for proper pitch within the past five years?
Date last checked: N/A (check recommended at least every 5 years)
a. Has the piping In all systems been checked for obstructive materials?
Date last checked: Unknown (check required at least every 5 years)
f. Have all fire pumps been tested to full capacity using hose streams or flow meters within the past 12 months?
9. Are gravity, surface or pressure tanks protected from freezing?
h. Standard sprinklers 50 years old or older? 2] OR (2oyr) E]Dry(10yr) a325F/163C(5yr) [:]Corrosive envl. (5yr.)
(Testing or replacement required for these types of sprinklers.)
i. Are any extra high temperature solder sprinklers regularly exposed to temperatures near 30OF/149C?
J. Have gauges been tested, calibrated or replaced In the last 5 years? Date 2003
k. Alarm valves and associated bim been Internally inspected past 5 years? Date Unknown
1. Check valves Internally Inspected in the last 5 years? Date Unknown
m. Has the private fire main been flow tested In last 5 ars? Date N/A
n. Standpipe 5 year requirements.
1. Dry standpipe hydrostatic test Date NIA
2. Flow test Date NIA
3. Hose hydrostatic test Date N/A
4. Pressure control valve test Date N/A
5. Pressure reducing valve test Date N/A
o. Have pressure reducing valves been tested at full flow within the past 5 years? Date NIA
q. Have master pressure reducing valves been tested at full flow within the past I year?
r. Have the sprinkler systems been extended to all areas of the building?
s. Are the building areas protected by a ' wet system heated, Including Its blind attics and perimeter areas?
I. Are all exterlor openings protected against the entrance of cold air?
Z CONTROL VALVES
a. Are all sprinkler system main control valves and all other valves in the appropriate open or closed position?
b. Are all control valves seated or supervised In the open position?
77
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17
7
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El
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El
El
I
FA
I
0101
El
10
1
0
Uli
off �-
Supervision
Operational
Location of Control
on wet system # I
on wet system # i
on wet system # 3
SG71607 (Rov.01108)
�A
SiMPIOXGFinn011 BE SAFE.
REPORT OF SPRINKLER INSPECTION Pep2of4
3. WATER SUPPLIES Pressure Fire Pump & Tank LJ
a. Water supply sources? City- 21 Gravity Tank: Pressure Fire Pump & City
Main Drain Test Results Made During This Inspection Pressure Fire Pump & Pond
Test
Pipe
Located
Size
Test
Pipe
Static Supply
Pressure
Before
Residual
Pressure
Return Urn
to Static
Pressure
Test
Pipe
Located
Size
Test
pipe
StaticSupply
Pressure
Before
Residual
Pressure
Returntimeto
Static
Pressure
At riser # 1
2-
60
so
2 sec
riser# 4
2'
65
60
2sec
At riser # 2
2-
60
55
2 sec;
I At riser # 3
1 2"
1 65
1 55
1 2 see
4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS YESI NA N I
a. Do fire pumps, gravity, surface or pressure tanks appear to be In good external conditions? I ki Ll I
b. Are gravity, surface and pressure tanks at the proper pressure and/or water levels?
c. Has the storage tank been internally Inspected In the last 3 yrs. (unlined) or 5 yrs. (fined)? Date: N/A
d. Are fire dept. connections in satisfactory condition, couplings free, caps or plugs in place and check valves tight? U-1 I U
e. Are fire dept. connections visible and accessible? L U-1 I Li
S. WET SYSTEMS
a. No. of systems: 4 Make & Model 8" Star Model C Alarm Valves
b. Are cold weather valves In the appropriate open or closed position?
If closed, has piping been drained?
c. Has the Customer been advised that cold weather valves are not recommended?
d. Have all the antifreeze systems been tested? Date: WA'
The antifreeze tests Indicated protection to: (Note temp & type for each. Example: -15F/126C atvcol or -15F/-26C
a. Did alarm valves, water flow
6. DRY SYSTEMS
test
a. No. of systems: 0 Make& Model: N/A
Date last trip tasted: N/A Partial
b. Are the air pressure and priming water levels normal?
c. Did the air compressor operate satisfactorily?
d. Air compressor oil checked? 11 Belt?
0. Were AuAllary I Low Point drains drained during this Inspection?
Locations I ) 2)
3) 4)
f. Did all quick opening devices operate satisfactorily?
g. Did all the dry valves operate satisfactorily during this Inspection?
h. Is the dry valve house heated?
1. Do dry valves appear to be protected from freezing?
No. of Drains: 0
7. SPECIAL SYSTEMS
a. No. of systems: 0 Make & Model: NIA
Type: NIA
b. Were valves tested as required?
c. Did all heat responsive systems operate satisfactodr.
d. Did the supervisory features operate during testing?
a. Has a supplemental test form for this system been completed and provided to the customer?
Au)dliary equipment: No. 0 Type: N/A
Location N/A
Model: N/A
(Please attach)
Test results N/A
8. ALARMS YES NA NO
a. Did the water motors and gong operate during testing? Ur T7"U
b. Did the electric alarms operate during testing? UrT=
c. Did the supervisory alarms operate during testing?
56923
SG71607 (Rev.01=) 0 1116 17-10 1'�Jr2 E N rWta reseried.
Simplex6rinnell aEsAFE.
Pap3of4
REPORT OF SPRINKLER INSPECTION
9. SPRINKLERS - PIPING
a. Do sprinklers generally appear to be In good external condition?
b. Do sprinklers generally appear to be free of corrosion, paint, or loading and visible obstructions?
c. Are extra sprinklers and sprinkler wrench available on the premises?
(0, size, finish, lemp, brand. of spare heads)
d. Does the exposed exterlor condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers
and strainers appear to be satisfactory?
a. Does the hand hose on the sprinkler system appear to be In satisfactory condition?
f. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector?
YES
NA
NO
UrTTTT
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Ur
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IT
T7
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El
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121
13
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jaecuonsioinruvi:
SEE ADDITIONAL COMMENTS PAGE —
SEE ADDITIONAL COMMENTS PAGE —
SEE ADDITIONAL COMMENTS PAGE —
11. THE INSPECTOR SUGGESTS THE FOLLOWING NECESSARY IMPROVEMENTS. THESE SUGGESTIONS ARE NOT THE
RESULT OF AN ENGINEERING SURVEY AND 00 NOT REFLECT CONDITIONS ABOVE CEILINGS OR IN CONCEALED SPACES:
None
12. ADJUSTMENTS OR CORRECTIONS MADE:
None
I& LIST CHANGES IN OCCUPANCY, HAZARD OR FIRE PROTECTION SYSTEM, AS ADVISED BY CUSTOMER IN SECTION I a-c:
None
14. INSPECTION DEFICIENCIES AND SUGGESTED IMPROVEMENTS WERE DISCUSSED WITH THE CUSTOMER /CUSTOMER FY—ESrN70
REPRESENTATIVE.
If No, explain.
IMPORTANT NOTICE TO CUSTOMER Customer admowledges and agrees that in the absence of a Service Agreement between the parties. seMoes hereunder am performed pursuard
to the terms and conditions of this Report agrees that the services have been completed to Customers saUsftctbn and that the system Is In good working order and repair, urdess semices
performed were of a temporary nature. In which case Customer acknowledges that pad of customees system may have been bypassed or Is otherwise InoperaW " sentice can be
completed. CUSTOMER'S ATrFJMON IS DIRECTED TO THE LIMITATION OF LIABILITY, WARRANTY, INDEMNITY AND OTHER CONDITIONS AT THE REVERSE SIDEIEND OF
THIS REPORT. This Agreement has been drawn up and executed In English at the request of and wth the full concurrence of Custom. Ce contract a 06 r6dkj6 en anglals h la demands
at avoc Vassenlintent du client.
CUSTOMER Date: 619/2
PRINT NAME
SIMPLEXGRINNELL I�SPWOR SIGNATURE
toloi I
DUPLICATE TO:
STREET:
CITY, STATE AND ZIP:
ATTN: 56923
SG71607 (Rov.01108) FTF2- ? I �j 0 ad.
SimplexGrinneffm sA FE.
Task # 24529241 Inspector: Brandon Higley
SR# 23686178
Additional Comments Date awnio
1) On arrival conducted a main drain test on system risers. Found that the water pressure dropped to
zero. Found that the PIV control valve behind the building was shut. Another company was doing
repairs to a sprinkler system in another tenant space and had closed to PIV unaware it shut water down
to all system in building. The PIV control valve was re -opened and main drain tests were redone. PIV
control valve is open and locked on departure.
2) No Indication that the systems ( 4 wet ) have had a 5 year Internal pipe exam done. System # 4 piping
-- appears to be all exposed approx. 20ft high. Need a small lift to access piping. Systems # 1, 2, & 3
piping is exposed and concealed above hard lid and wood beams. Highest point of piping appears to
be approx. 20ft. The mains are exposed and are painted and/or textured. Piping is threaded.
3) No indication that the fire department connection has had a 5 year internal obstruction Investigation
done. FDC check valve Is in a man hole behind the building by FDC and PIV. The fire department
connection also feeds sprinkler systems In other tenant spaces not just Burlington Coat Factory
systems.
4) System pressure gauges on all 4 systems are dated 2003 and are due for replacement/recalibration
( Total of 8 water gauges )
5) There is a branch line in the back store room area by roll up door that has been hit and the piping is
bent.
6) There is a broken hanger Is the bak store room In the rack storage area
7) There are several sprinkler heads that are painted and/or textured: Locations listed below
a) I in boys clothing section above book display ( Upright)
- b) 1 in boys clothing that has tape on it. Tape need to be removed ( Upright
c) 1 in mens shoe area ( Pendent )
d) 1 between mens shoes and jacket area ( Pendent)
e) 2 in the leather jacket area ( Uprights )
0 1 in womens accessories area that has tape on it. Tape needs to be removed
g) 1 in womens dress area ( Pendent
h) 2 by front register area ( Uprights
--The sprinklers that are installed are all Star sprinkler heads. The spare head box has Central sprinkler
heads.
UPRIGHT: Central Model A (?) 1/2" Brass 165F Links
PIEDENTS: Central Model A (?) 1/2" Brass 165F Links.
56923
Fire Incident Report
Edmonds Fire Department
Incident Number: EF06001721 Exposure: 0 Incident Date: 5/27/2006,
Jurisdictional Station: 20 Location Type: Street address
Address: MOTIF1101001,9WHOWK,
City: Edmonds State: WA Zip: 98020
Incident Type: Service Call, other
Shift: A Alarms: 1 Grid: EF006
Aid Type: None
Alarm Time: 11:09:11 5/27/2006
Arrival Time: 11:15:30 5/27/2006
Last Unit Cleared Time: 11:50:49 5/27/2006
Actions Taken: Information, investigation & enforcement, other
HazMat Released: None
Property Value: 0 Contents Value: 0
Property Loss: 0 Contents Loss: 0
Fire Service Deaths: . .0 Civilian Deaths: 0
Fire Service Injuries: 0 Civilian Injuries: 0
Detector:
Officer In Charge: ROBERT NICHOLS Assignment: Other
Mixed Property Use: Not mixed use
Property Use: Department or discount store
v TIRS
+
Fire Incident Report
I Edmonds Fire Department
Incident Number: EF06001721 Exposure: 0 Incident Date: 5/27/2006
Apparatus and Personnel
Apparatus ID Personnel ID('s)
A17 EF1111 EF1602 EF2205
L20 EF1303 EF1343 EF2208
' 'Cf.-FIRS
1A 1 7
Fire Incident Report
Edmonds Fire Department
Incident Number: EF06001721 Exposure: 0 Incident Date: 5/27/2006
Narrative
L20 responded to Bur smell at 24111 Hwy 99 Burlington Coat Factory. L20 investigated
building to find slight =r 2nd floor top of stairs coming from HVAC system. L20 and A17
searchid all floors and roof to confirm suspicion of odor coming from HVAC, unable to confirm,
L20 checked parameter found nothing. UO inservice returning.
FF ROBERT NICHOLS
-i,w1;F1RS
Fire Incident Report
Edmonds Fire Department
Incident Number: EF06001721 Exposure: 0 Incident Date: 5/27/2006
Narrative
At 1109 hours L20 was dispatched to 24111 Hwy 99 for the presence of a burniLn mell. B16
contacted us as we were clearing from Stevens Hospital and asked us to assist 2%s On our
arrival L20 asked A17 crew to assist in finding the origin of the smell which was evasive. The
source of this odor was not located and L20 sent A17 backto, quarters.
FF BRIAN MCALLISTER
°
05/27/06 13078001 PRINT
REQu[ETEb Bf
TERMINAL
EFPC42
incident History
for:
#EF06081721
Case Numbers:
aEF06001973
ISRO6089329
Received
05/27/ou
11:0031 BY
EEPC04 SC754
Entered
05/21,80
11:09:85 E/
?1PE@4 s[-54
Dispatched
05/271%
11:89:11 Py
SCmCW4 5C754
Enruute
05/27/02
11:11:13
Onscene
05/27/W6
11:15:30
Closed
05/27/06
11:50:49
Initial Type;
TTNg.5
Initial Alarm
Level: 1
Final
Plarm ievel: 1
Final Type:
SINULE (SINGLE
R[SPDUS0
Doi: 2
DiTpc:
Police BLK:
E009 Fire
BLK: EFOW6
Map PaUe:
4;4J_;
Q`ovp: FF] ReO" FF"
c: 9
Loc: 24111
HWY 99 #201
,EUM -- ANTIQUE
PAVILION
high
"st: RAMP (V)
Lac Info: AURORA
ANTIQUE PAY|L7OW INC,
Name:
nddr;
24111 HWY
99 #201
`FDM Phone; 4P57758997
/1109
(SC754 ENTRY
/1109
DI5P
L20
/1109
$A5NCAS
L20
/1109
A5ST
TAC21
/11@9
$PAi^rAS
TAF21
/1109
CHANGE
/1109
AID
TA[21
/1111
ENPOUT
L28
/1113
ASSTEH
All
/1113
AVL
A17
/1115
ONCCNE
L2O
/1120
MISC
L 2 0
/1120
MlSC
A17
/3120
ONSCNE
A17
/1123
MISC
L20
/1139
MiSC
L20
/1150
AOR
L20
/115121
POP
A17
/1150
CLOSE
A17
,5MELLING BURNING SMELL - No SMOVE OR FLAMES SEE
N-
#EF1343 NICHOLS, RCB - RESCUE TECH
#EF1303 KUHN,BRETT - RESCUE TECH
#EF2209 DOWLIA61 J &E9CUE TECH)
$EF060Gl973
65206009329
TXT: SMELLS LIKE HAIR BURNING OR GUN POWDER - CO
MIND FROM THE YENT5 - ALSO 5MFLi9 DOyN5TATRS AT
BURLINGTON COAT
[24111 HWY 99 4201 ,EDM]
#EF1602 MCALLI5TER, B -RESCUE TECH
#EF1111 ERICKSON,DAVID
#EF2205 SMITH, CLAYTON
, LARGE COMM 9TR0CTURE NVI
,LOCATE THE HEATING ROOM
,BRING MANPOWER lNSIDE - AND WALK THRU BLDG
,NOTHING FOUND - 5TTLL IN','
,WALKED ALL BDG - NOTHING FOUND - COULD BE AC UN
IT TURING UH CAUSING SMELL - CHECKING ADJACENT B
LDWE,
MEMORANDUM
Date:
October 18, 2000
To:
Robert Siew re: Siew Building/24111 Hwy 99
From:
Mike Smith, Fire Inspector
Subject:
Fire Prevention Safety Survey
The following deficiencies were found in a recent inspection of your
building:
1) The Fire Sprinkler Systems in the building need an annual service
performed.
2) The Dry Sprinkler System, which covers both North and South loading
docks, is currently out of service. This needs immediate attention and
must be put back in'to service as soon as possible.
3) The fire hydrants on the North and South ends of the building are
overgrown with bushes, and need to be brushed out. On the East side of
the building the Fire Dept. Connection and PIV are overgrown with
bushes also and need clearing. The brush growing over the cyclone fence
in this area should also be cut back.
Thank you for your immediate attention to this matter. A re -inspection
will be conducted in 30 days to confirm that the listed items have been
corrected.
cc: file
fax (425)747-5482
City of Edmonds Fire Department
TRANSMISSION VERIFICATION REPORT
1; 1
DATEJIME 10/18 16:35
FAX NO./NAME 84257475482
DURATION 00:00:37
PAGE(S) 01
RESULT OK
MODE STANDARD
TIME 10/18/2000 16:36
NAME
FAX
TEL
CITY OF EDMONDS BARBARA FAHEY
rF.:
MAYOR
220 FAX (425) 771-0221
121 5TH AVENUE NORTH - EDMONDS, WA 98020 - (425) 771-0
COMMUNITY SERVICES DEPARTMENT
Public Works - Planning/ Building * Parks and Recreation * Engineering Wastewater.Treatment Plant
C.
July 28, 1997
RECEIVED
Mr. Robert Sieu JUL 29 1997
Spartus International Corporation
15100 Southeast 38th Street, Suite 702 EDMONDS FIRE DEPT6
Bellevue, Washington 98006
RE: Burlington Coat Factory & Antique Pavilion @ 24111 Highway 99, Edmonds
This is the third letter I have sent you regarding the required repair permit for the beam
work in the warehouse sections of the subject building. - As you know, sections of the
warehouse were posted "DO NOT OCCUPY" on May 15, 1997.
The purpose of this letter is to reiterate the. position of the City:
1) The warehouse section(s) that are posted shall remain void of activity --no person(s)
shall enter or use this space until repair work is approved.
2) As owner, it is your responsibility to obtain the required permit, follow the approved
plans and contact the City for the required inspection before use can be re-established for
these areas.
You have made verbal promises to me to obtain the required permit and make the
required repairs but as of this date the City has not even received an application from you.
If an application is not filed by August 4, 1997 you shall force me to initiate the City's
civil penalties procedures to gain code compliance whereby fi.nes of $100 per day may be
assessed.
Thank you,
Jeannine L. Graf
Building Official
cc: City Fire Marshal
Michell Engineering
a
0 Incorporated Aug'ust 11, 1890 0
Sister Cities International — Hekinan, Japan
4�' St. 189%-)
CITY OF EDMONDS. BARBARA FAHEY
MAYOR
250 5TH AVENUE NORTH - EDMONDS, WA 98020 - (206) 771-0220 - FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Public Works * Planning * Parks and Recreation * Engineering
May 15,1997
Mr. Robert Sieu
Spartus International Corporation
15 100 Southeast 3 8th Street, Suite 702
Bellevue, Washington 98006
RE: Burlington Coat Factory & Antique Pavilion @ 24111 Highway 99, Edmonds
As a follow-up to my letter dated 3/26/97, as of today, the City has not received the
required repair permit for the beam work in the warehouse section of the subject building.
The purpose of this letter is to reiterate the position of the City:
1) The warehouse section(s) shall remain void of activity --no person(s) shall enter or use
this space until repair work is approved.
2) As owner, it is your responsibility to obtain the required permit, follow the approved
plans and contact the City for the required inspection before use can be re-established for
these area.
3) As stated in your engineer's report dated 1/8/97 there are two other beams in the
Underhill storage area that also need repair, for which a permit shall also be required and
this area shall also remain void of activity and use until a permit is issued and inspection
approved.
In order to be assured that these areas are not being used by employees the area(s) shall be
posted by the City Building Inspector on May 20, 1997.
Thank you,
MAY 16 1997
]EDMONDS FIRE DEPT.
Jeannine L. Graf
Building Official
m"
cc: City Fire Marshall rj
Michell Engineering
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
/Z_
CITY OF EDMONDS, BARBARA FAHEY
MAYOR
250 5TH AVENUE NORT� - EDMONDS, WA 98020 - (206) 711-0220 FAX (206) 771-0221
COMMUNITY SERVICES DEPARTMENT
Pub lic Works * Planning * Parks and Recreation Engineering
March 26, 1997 R E C F. I V F_ ID
MAR 271 1997
Mr. Robert Sieu EDMONDS Fll-(L DEPT.
Spartus International Corporation
15 100 Southeast 3 8th Street, Suite 702
Bellevue, Washington 98006
RE: Burlington Coat Factory & Antique Pavilion @ 24111 Highway 99, Edmonds
The City is in receipt of your professional engineers design for the beam repair in the
warehouse section of the subject building. However, as I told you in our telephone
conversation on 12/31/96 a repair permit from the City would be required for this work,
and as of today, the City has not received the required permit application. During this
same conversation, as recommended by your engineer, I agreed that immediate shoring of
the beam(s) be done but I reiterated that the warehouse area was "off limits" to employees
until the repair permit was issued and required inspections approved.
The purpose of.this letter is to clearly state the position of the City:
1) The warehouse section(s) shall remain void of activity --no person(s) shall enter or use
this space until repair work is approved.
2) As owner, it is your responsibility to obtain the required permit, follow the approved
plans and contact the City for the required inspection before use can be re-established for
these area.
3) As stated in your engineer's report dated 1/8/97 there are two other beams in the
Underhill storage area that also need repair, for which a permit shall also be required and
this area shall also remain void of activity and use until a permit is issued and inspection
approved.
Thank you,
�1^ xj4r�)
Jeannine L. Graf
Building Official
cc: City Fire Marshall 4';-
. Michell Engineering
e Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
REPORTED BY OF
SUBJECT
ADDRESS:
CONCERNS/
HAZARDS: pie I vz� - Ll V1 or fu I L-,0 I &r-6
-K6-.t3rT- 5-ljolc Arcr-rr
I\fo r--7
SIGNED
FOLLOW-UP:
CA L L
0,V
FbX-
SIGNED
City of Edmonds * Office of Fire Prevention
Date:
To:
From:
MEMORANDUM
August 23, 1995
Jeannine Graf, Building Official
John Westfall, Senior Fire Inspector
Subject- Fire sprinkler coveracie: 24111 Hinhway 99
Refs: UBC 904.1.2
UBC Standard 9-1: 9-1.1
UFC 1001.5.1
Fire inspection at Underhill's found areas unprotected by existing firemextinguishing
system. Observed areas in Ste #C, Underhill's Warehouse, include; an administrative
office area (approx. 20'x 15), and single -tiered solid rack shelving encircling the entire
west end of the warehouse (approx. 360), The shelving varies in width to 12' in areas
and abuts the warehouse walls. I am unsure how long the office space or shelving
have been, constructed. Attached are original floor plans for main and mezzanine levels
of �building. Please advise me on this situation.
Current building owner information: Eastern Investments, 15100 SE 38th St #702,
Bellevue, WA, 98006. Mr. Robert Siew, 643-3838.
cc- Fire Marshal McComas
Office of Fire Prevention
DOCES INC
24111 HWY 99
SC ALE I ---Go /
N
110
LOADING
DOCK
rAl N F I-DOR
LDADING
DOCK
. DOCES INC.
24111 HWY c)g
SCALE 1 60
N
10
MEZZANINF-
IF
MEMORANDUM
DATE '7 A 7 LD.
REPORTED BY OF
SUBJECT
ADDRESS:
CONCERNS/ A)C
HAZARDS:
FOLLOW-UP: SIGNED
stya�v!,-J6-
AA5/V-lj 7?�F U-)q&t,57 WC -TT- .57 i"OF C5.1=
5Pitc- 4�-D 1717A4 f
u4c
oc c
DL/
k4 06
t.71
<—I/ 0 ) 1. 9- - I C6,'J'L,
5& C 103 L t -0 F- (A5
C-C - SIGNED
Z4c4c 5
c- 510�—lb
�'-""Office of Fire Prevention
occ/06C)5?
Zo -7
in
/\,J(,j C
. ...... ......
�4*
ol
["A-
;TG-I-&A ,JAI*IC 0 (,o, 7& -�7 —
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6-j
. t/0-
9 0
CITY OF EDMONDS LAURA M. HALL
CIVIC CENTER - EDMONDS, WA 98020 - (206) 771-0215 - FAX (206) 771-0208 MAYOR
FIRE DEPARTMENT
November 1, 1994
Mr. Robert Siew
M11 S n, tuft r, oo ria � ge n
r
B W
1, Mug- 8- Q, 177;�
Dear Mr. Siew:
Regarding our phone conversation this morning, I wish. to reiterate the points we had
discussed:
I've enclosed Fire Department lockbox information for dissemination to your tenants.
A minimum of three boxes; for the North, South and West entrances to the building at
24111 Highway 99, in Edmonds, would provide a convenient means for the Fire
Department to access and allow prompt mitigation of unanticipated emergencies. This is
strictly a voluntary program.
Thank you for contacting your sprinkler maintenance company. They will send the
test report to the Fire Department.
In order to update Fire Department records, please send a list of tenants and
vacancies (by suite number) to the following address:
Edmonds Fire Department
Fire Prevention Office
250 5th Ave N.
Edmonds, WA 98020
Also, if you would have a cuffent diagram of your building's layout, this would prove
invaluable for emergency planning in order to reduce anticipated losses from fire or other
disaster.
Thank you for your assistance and feel free to call me at (206) 771-0215 ext. 301 if you
have further questions or concerns.
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
r,
0
, A.
CITY OF EDMONDS
CIVIC CENTER - EDMONDS, WA 98020 - (206) 771-0215 - FAX (206) 771-0208
FIRE DEPARTMENT
8 9 0
Mr. Robert Siew
Eastern Investment Corp
1000 124th Ave N.E.
Bellevue, WA 98006
Dear Mr. Siew:
August 18, 1994
,F/fl - ClIvs fue—1 )< eo Y677
LAURA M. HALL
MAYOR
lilt - W-S �*4- f�;A6 A'1�(5)(r
04,Acc F��
9 K- 0,#-C-6-
J46
The Fire Department has recently inspected the building and occupancies at
24111 Highway 99 in Edmonds. The following items require your attention:
1 An annual confidence test for your automatic sprinkler system is required. The
last "Report of Inspection" found on file is from December, 1991, by Triangle Fire
Protection Inc. of Woodinville (phone: 483-5211).
It was also noted on -site that the required caps on the Fire Department inlet
connection are not in place. Please contact your current *qua I ified service
representative for system maintenance.
Your service company is required to send a copy of their-aWe'Port of inspection" to
the local authority having jurisdiction. Have them send this to:
Edmonds Fire Department
Fire Prevention Office
250 5th Ave N.
Edmonds, WA 98020
2. In order to update Fire.Department records, please send a list of tenants and
vacancies (by suite number) to the above address.
Also, if. you would have a currieni diagram of your building's layout, this would prove
invalu.ablef6r emergency planning, in order for us to minimize property loss, should
a fire or other emergency occur.
I will contact you in 30 days to confirm that the preceding items have been taken care of.
Thank you for. your assistance and feel free to call me at 771-0215 (ext. 301) if you have
questions or concerns.
15-tOO S_(�, 3br?-i <-r 5x-e. ?02
0 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
744 (1 ( t4 (w,1-y ?I
August 18,1994
Mr. Robert Siew
Eastern Investment Corp
1000 124th Ave N.E.
Bellevue, WA 98006
Dear Mr. Siew:
The Fire Department has recently inspected the building and occupancies at
24111 Highway 99 in Edmonds. The following items require your attention:
1 An annual confidence test for your automatic sprinkler system is required. The
last "Report of Inspection" found on file is from December, 1991, by Triangle Fire
Protection Inc. of Woodinville (phone: 483-5211).
It was also noted on -site that the required caps on the Fire Department inlet
connection are not in place. Please contact your current qualified service
representative for system maintenance.
Your service company is required to send a copy of their "Report of Inspection" to
the local authority having jurisdiction. Have them send this to:
Edmonds Fire Department
Fire Prevention Office
250 5th Ave N.
Edmonds, WA 98020
2. In order to update Fire Department records, please send a list of tenants and
vacancies (by suite number) to the above address.
Also, if you would have a current diagram of your building's layout, this would prove
invaluable for emergency planning in order for us to minimize property loss, should
a fire or other emergency occur.
I will contact you in 30 days to confirm that the preceding items have been taken care of.
Thank you for your assistance and feel free to call me at 771-0215 (ext. 301) if you have
questions or concerns.
Sincerely,
John J Westfall
Fire Prevention Officer
5-1 va,- BOX-
51A
38
- LAvduvW.ls
5(kri
ITY OF EDMONDS LAURA M. HALL
C CENTER - EDMONDS, WA 9802 0 - (206) 771-0215 - FAX (206))771-0208 MAYOR
FIRE DEPARTMENT
9 0 C�
Sept. 11, 1992
ago
Mr. Robert Siew .z-0V - CERTIFIED MAIL
Eastern Investment Corp. P 468 633 556
1000 124th Av. N.E.
Bellvue, Wa. 98006
Dear Mr. Siew,
SUBJECT: TENANT IMPROVEMENZ --WA-X--99 EDMONDS WA.
During a recent fire inspectio�n ��ew--tn�-or�med me that
there was an existing remodel that does not comply with building
regulations. I believe this condition has existed for a few years,
but irregardless, it is still in violation.
The area of concern is located on the south side of the Doces
complex where the stairway leads to the Deliciously Northwest and
Pure Potential Studio businesses.
This modification has altered the fire protection system in this
area by blocking the sprinkler heads that were designed.to cover
this area.
A solution to this problem is to install additional sprinkler
heads or head to protect this stairwell.
I will reinspect this condition in approximately sixty days'to
determine compliance. If you have any questions please give me a
call at (206) 771-0215 Ext. 301.
In the.future, be sure that all tenant improvements to this
building be approved by the Edmonds Building Department.
—NLO 14
rl
fSV
BJS: wdb
cc:.Fire Marshal
Sincerely,
Robert J. Schmitt
Senior Inspector,
A 0 CIrm 19ho-0 Ce 17,1.-.6, )V6
e44 C,
IvO
9 Incorporated August 11, 1890 0
Sister Cities International - Hekinan, Japan
24111 HWY 99
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CITY OF EDMONDS
CIVIC CENTER - EDMONDS, WA 98020 - (206) 771-0215 - FAX (206) 771-0208
FIRE DEPARTMENT
41 8 C)
9 0 - 19
Sept. 11, 1992
Mr. Robert Siew
'Eastern Investment Corp.
1239 129th Ave N.E. #D
Bellvue, Wa. 98005
Dear Mr. Siew,
CERTIFIED MAIL
P 468 633 558
LAURA M. HALL
MAYOR
SUBJECT: TENANT IMPROVEMENT AT 24111 HIGHWAY 99, EDMONDS WA. ,
During a recent fire inspection the crew informed me that
there was an existing remodel that does not comply with building
regulations. I believe this condition has existed for a few years,
but irregardless, it is still in violation.
The area of concern is located on the south side.of the Doces
complex where the stairway leads to the Deliciously Northwest and
Pure Potential Studio businesses.
This modification has altered the fire protection system in this
area by blocking the sprinkler heads that were designed to cover
this area.
A solution to this problem is to install additional sprinkler
heads or head to protect this stairwell.
I will reinspect this condition in approximately sixty days to
determine compliance. If you have any questions please give me a
call at (206) 771-0215 Ext. 301.
In the future, be sure that all tenant improvements to this
building be approved by the Edmonds Building Department.
BJS: wdb
cc: Fire Marshal
Sincerely,
e-
), --sa4ze
Robert J. Schmitt
Senior Inspector
o Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
0,0�
CITY OF EDMONDS
CIVIC CENTER - EDMONDS, WA 98020 - (206) 771-0215 - FAX (206) 771-0208
FIRE DEPARTMENT
(Ij 1
9 0 C� ooul_�;p
Mr. Robert Siew
Eastern Investment Corp.
1000-124th Avenue N. E.
Bellevue, WA 98006
Dear Mr. Siew,
SUBJECT: ELECTRICAL HAZARD
rt� i e�,,
June 3, 1992
CERTIFIED MAIL
P 468 633 544
24111 HIGHWAY 99
LAURA M. HALL
MAYOR
S, WA
It was brought to my attenj
- t.i_o_n_t11a-t-aP5`tential electri-
cal hazard may exist at the Buri—ingfun coat Factory complex.
Upon investigation, I discovered a possible overloaded circuit
at the main electrical panel located on the second floor,
occupied by Aurora Antique Pavilion.
Many of the breakers were too hot to touch and identified
as "electrical lighting relays" for the "south half -main
floor" and "front -south half". After tracing the conduit to a
point at least thirty feet from the breaker, I noticed the
conduit was warm to the touch. At this point (in the storage
area -east of the antique mall) the conduit travels down the
wall to the first floor.
Section 85.104, "Abatement of Electrical Hazard" thetl988
Uniform Fire Code (copy attached) requires abatement of any
electrical hazard. Please contact a qualified electrician to
evaluate and correct this situation -as soon as possible.
Please contact the Fire Department when the work is com-
plete so we can note it in your business file. A copy of this
letter has been forwarded to the State Electrical Inspector.
If you have any questions, please feel free to call me at
771-0215, #301, Monday through Friday.
Sincerely,
116W1161--111 . , U
Robert J. Schmitt
Senior Inspector
BJS: be
cc: Fire Marshal
Washington State Electrical Inspector
0 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Japan
V
Dept. of Labor & Industries
Electrical Section HC-660
Olympia. Wa. 98504
AGENCY REQUESTED INSPECTION
date
Edmonds Fire DeDartment
I
Agency address
city
state zip
250-5th Avenue North,
Edmonds
RA __98020
Nature of Frob—lem
Possible overloaqed circq�it
b�reqker,5--,----
Location o investigation (address)
--------
city
----- Z.
ip
county
24111 Hi hw
ghKu 99
Edmonds
Owner's name
telephone number (day)
Eastern Investment Corp.
Owner's address
city
zip
county
1000-124th Avenue N. E.
-Bellevu
Title/Signed by
.............
REPORT OF INSPECTION
[For DEPARTMENT of LABOR and INDUSTRIES use only]
Information only Date
Corrections needed
The electrical safety corrections listed below are hereby ordered and must be completed Permit ReL -Jf
within 15 days. Refer to National Electrical Code and State Rules for Standards.
Inspector's stamp
Do NOT conceal electrical work prior to written approval.
I
------ - ---- ----
Furnish electrical work pennit for inspection of corrections.
- -----------------
NOTIFY INSPECTION OFFICE WHEN READY FOR REINSPECTION
white - permit canary - mon rept pink - job site goldenrod - dept rtn
F500-025-000 agency request for inspection 4-88
CITY OF EDMONDS
CIVIC CENTER - EDMONDS, WA 98020 - (206) 771-0215 - FAX 1206) 771-0208
FIRE DEPARTMENT
8 9 0 - 1 9 C) -
Mr. Robert Siew
Eastern Investment Corp.
1239-120th Avenue N. E., #D
Bellevue, WA 98006
Dear Mr. Siew,
June 8, 1992
CERTIFIED MAIL
P 468 633 545
LAURA M. HALL
MAYOR
SUBJECT: ELECTRICAL HAZARD AT 24111 HIGHWAY 99, EDMONDS, WA
It was brought to my attention that a potential electri-
cal hazard may exist at the Burlington Coat Factory Complex.
Upon investigation, I discovered a possible overloaded circuit
at the main electrical panel located on the second floor,
occupied by Aurora Antique Pavilion.
Many of the breakers were too hot to touch and identified
as "electrical lighting relays" for the "south half -main
floor" and "front -south half". After tracing the conduit to a
point at least thirty feet from the breaker, I noticed the
conduit was warm to the touch. At this point (in the storage
area -east of the antique mall) the conduit travels down the
wall to the first floor.
Section 85.104, "Abatement of Electrical Hazard" the 1988
Uniform Fire Code (copy attached) requires abatement of any
electrical hazard. Please contact a qualified electrician to
evaluate and correct this situation as soon as possible.
Please contact the Fire Department when the work is com-
plete so we can note it in your business file. A copy of this
letter has been forwarded to the State Electrical Inspector.
If you have any questions, please feel free to call me at
771-0215, #301, Monday through Friday.
Sincerely,
Robert J. Schmitt
Senior Inspector
BJS: be
cc: Fire Marshal
Washington State Electrical Inspector
* Incorporated August 11, 1890 e
Sister Cities International — Hekinan, Japan
a of -mvadgid&n- (i
24111 fiig
,,,, �va
s nam
'-Eastarn. Invel
1000-124th Ai
I
Ip
telephone number (day)
85.103-85.109 UNIFORM FIRE CODE
days for Christmas decorative lighting, carnivals and similar purposes, and for
experimental or developmental work.
(c) Attachment to Structures. When temporary wiring is attached to a
structu ' re, it shall be attached in an approved manner.
Abatement of Electrical Hazards
Sec. 85.104. When any electrical hazards are identified, measures to abate
such conditions shall be taken. All identified hazardous electrical conditions in
permanent wiring shall be brought to the attention of the authority enforcing the
Electrical Code.
Electrical Motors
Sec. 85.105. All electrical motors shall be maintained in a manner free from
accumulations of oil, dirt, waste and other debris which will interfere with
required motor ventilation or create a fire hazard.
Extension Cords
Sec. 85.106. (a) Prohibited Use. Extension cords shall not be used as a
substitute for permanent wiring.
(b) Use with Portable Appliances. Extension cords are permitted only with
portable appliances or fixtures, while in immediate use, in accordance with the
following:
I . Each extension cord shall be plugged directly into an approved receptacle
and shall, except for approved multiplug extension cords, serve only one
appliance or fixture.
2. The current capacity of the cord shall be not less than the rated capacity of
the appliance or fixture.
3. The extension cord is maintained in good condition without splices,
deterioration or damage.
4. The extension cord is of the grounded type when servicing grounded
appliances or fixtures.
(c) Installation. Extension cords and flexible cords shall not be affixed to
structures, extend through walls, ceilings, floors, under doors or floor coverings,
nor be subject to environmental damage or physical impact.
Multiplug Adapters
Sec. 85.107. The use of multiplug adapters such as multiplug extension cords,
cube adapters, strip plugs or any other device that does not comply with this code
or the Electrical Code is prohibited.
Access
Sec. 85.108. A minimum of 30 inches of clearance shall be provided in front of
electrical control panels for access.
Nonapproved Appliances
Sec. 85.109. Electrical appliances or fixtures shall not be sold, offered for sale
or rent, disposed of by gift or premium, nor made available for use or used unless
they are of an approved type.
388
TTRIANGLE FIRE PROTECTION INC.
P.O. Box 264 0 19201 Woodinville Snohomish Hwy.
F 3
Woctdinville,Washington 980-72
(206).483-5211 0.52775211
Wa. State Contractor Lic. No. TR-IA-NF-P274 OP
Inspection Report
No.
REPORT OF INSPECTION
Conferred With
SHEET I OF 2
Inspection Contract
No.
Bureau File
No.
REPORT TO BUILDING OR LOCATION 6110rX 61'
*rkj E et-S �&4_S-e%
STREET 12- INSPECTOR "&00eA-C
CITY & STATE DATE 2-
1. GENERAL Yes
N.A.1
No*
Is the building occupied according to information furnished by owner or owner's repre-
sentative?
*00*0
49 0 0 0 0
b. Is occupancy same as previous inspection according to information furnished by dwner or X
owner's representative
0 0 0 * 0
c. Are all systems in service" X
d. Ar eall fire protection systenissame as last inspection acrording to information furnished by
owner or.owner's repeesentative?
di
e. Is building completely sprinklered?
f. Are all new additions an(] building changes properly protected according to infortuation fur-
nished by owner or owner's represent.LtiVe' ' '
g. Is all stock or storage properly below sprinkler piping?
h. Was property free of fire's since last inspection aceording to information furnished by owner
or owner 1 .4 representative'-(E'xplain any fire un separate sh(,.et)*
i. In areas protected by'wet systern, does the building appear to be properly heated in - all
areas, including blind attics, perimeter areas and are all exterior openings protefted against
entrance of, cold air" -
-2. CONTROL VALVFS (See Section IG)
a. Are all sprinkler system main control valves open?
40 Is 0
b. Are all other valve's in proper position?
0 0 0
c. Are alfcontrol -valves in good condition and sealed or supervised?
3. WATER SUPPLIES (See Section 17)
a. Was a. water How test, made and results satisfactory?' 000
4. TANKS. PUMPS. FIRE DEPT. CONNECT16NS
a. Are fire pumps. gravity tanks, reservoirs and pressure tanks in good condition and prop-
erly in * ai - ntained?
b. Are fire dept. connections in satisractory condition, couplings free, caps in place and check
valves tight?
.5. WET SYSTEMS (See Section 13)
a. Are cold -weather valves open or closed as necessary?
b. Have anti -freeze systems been tested and left in satisfactory condition?
c. Are alarm* valves. water -flow indicators and retards in satisfactory condition?
6.
7
S.
DRY SYSTEMS (See Section 14)
a. Is dry valve in service and in good condition?
b. Is air pressure and priming water level normal?
c. Is air compressor in good condition?
d. Were low points drained during fall and winter inspections?
e. Are quick -opening devices in service?,
f. Have dry valves been trip tested satisfactorily as required?.
g. Are dry valves adequately, protected from freezing?
h. Are valve house and heater condition satisfactory?
SPECIAL SYSTEMS (See Section 18)
a. Were valves tested as required?
b. Were� all beat responsive systems tested and results satisfactory?
c. Were supervisory features tested and results satisfactoory?—
ALARMS
a. Are water motor and gong test satisfactory?
b. Is electric alarm test 43atisfactory?
c. Is supervisory alarm service test satisfactory?
*Explain "No 1. answers in. Item # 19
:Not Applicable
y
V
110:�
TFP 005
J.
SHEET 2 OF 2
.4;
- SFF Yea
K L E S --fl-PING."
N.A. t No*
all sprinklers in good condition."not obstruc.ted. and free of corrosion or loading?—
r
b. Are,alLbp�inklers less than 50 years oldf
.c. Are ��xiia sprinklers readily. available?
V
d. Is condition of piping. drain valves. check valves, hangers, pressure gages-, open sprin-
klers. strainers satisfactory?
0-0 0 0
C Have sprinklif#��-Keen checked., for propeeitemperature rating?
1 f . Are portable fiie, extinguishers in good coiidition? Se'
g. Is hand hose on'sprinklee systems satisfactory?
10.
Date Dry-syAem Piping last checked for stoppage.- 2
11.
Date Dry-sylitem- Piping last checktd fb.r properpitch. — JR 4
12.
Date Dry-pi,pe Valve last trip tested.
13. Wet Systems: No? Make and Model?
14 *.
Dry Systems: No? Make and Model?'— A a— i-K t,
15.
Special System: No? Type
Make and Model? Condition?
Open Secured Closed Signs
16'. tONTR6L VkLVkq No?"'-!"' Type.
Y es
0
i3on ition
City Connection Control Valve
rank Control Valves
Pump Control Valves
3ectional Control, Valves
3yetem' Control Valves
17. WATER -FLOW TEST
Water Piessure�� CITY. PS 1. 7 -TANK—PSI—FIRE PUMP Psi
Water -flow Test? (If none made. why
-Si Pressure F Size Pre*aure Flow Pressure-
ieL. low Pressure
Test Pipe Located T-el't-Pipe Bifo-�e P r e a6`ur e After Test Pipe Located Test Pipe Before Pressure After
A Qd=A;gv
-70 dppyc be k) k, tL
18. Heat Responsive Devices: Type?
Type of test?
Valve No A_B_CL4P
D_E_F_
Valve No—
A B—C
D_E_F_
Valve No. —A—B—C—D—E—F—
Valve No—A—B—C—D
i
E_F_
Valve No. —A#
B—C
_'D
_F
Valve No
A B_-C_D_E
Valve No.
B—C—D
—F—Valve
No.
A—B—C—D
E_F_
Auxiliary equipment: No?.Type?
—Location?
—Test
Results?
19. Explanation. of any "No', &nswers.L 1v
20. Recent changes in building occupancy or fire protection equipment.
21. Adjustments ou',correctiono made.
22. Desirable improveLments.
DUPLICATE TO:
STREET CITY STATE
*Explain "No" mowers in Its= 019
TFP 005
DRY PIPE VALVE TRIP TEST.REPORT
TRIANGLE FIRE PROTECTION
P.O. BOX 264
WOODINVILLE, WASH. 98072
For Q->+-'570 �J—%A L, Inspection No.
siueet /2 o t�� A-%j state (A-1; Contract No.
Date ol Ti i p Test —Z-14 =EJ I — inspector 0 Day Work No.
NOTEt BEFORE ANY DRY PIPE VALVE 19 TRIP TESTED. THE WATER SUPPLY LINE TO IT SHOULD BE THOROUGHLY rLUJIMED. THE TWO INCH
DRAIN BELOW THE VALVE GHOULD BE OPENED WIDE. AND WATER AT FULL PRESSURE SHOULD BE DISCHARGED LONG ENOUGHTO
CLEAR THE PIPE or ANY ACCUMULATION or SCALE OR FOREIGN MATERIAL. IF THERE 12 A HYDRANT ON THE SUPPLY LINE.TAIS
HYDRANT SHOULD BE FLUSHED BEFORE THE TWO INCH DRAIN IS OPENED. THE DRIP VALVE ON THE DAY PIPE VALVE SHOULDBE
CHECKED BEFORE TRIPPING T E DRY PIPE VALVE. TO SEE THAT IT IS IN OPERATING CONDITION.
DRY PIPE VALVES
SYSTEM NO. I
SYSTEM NO.
SYSTEM NO.
SYSTEM NO.
VALVE 894111AL NUMBER
MANUFACTUPIKA (NAMPI
S 4,4 Q
VALVE MODEL
VALVE 81919
INCH
INCH
INCH
INCH
CONTROLLING
SPRINKLERS
ILOC AT(ONJ
/-.c A -DI A4 f0o
(NUMBER)
IAPPROXI
IAPPROX)
(APPROXI
DATE LAST TRIP TIL*tgD*
DATE LAST OPERATED*
01a,01119 r a ST
: Isuma
^loll
Los
LOS
Los
LOS
WATER
LOS
LBS
LOS
LOS
SIX19 AND LOCATION OF TEST VALVE
WAS GATE VALVE BELOW DRY VALVE OPEN
WICIL AT TEST- (IP NOT. NO* MANY TURN$?)
WATER TRIPPED AT
AIR PRESSURE
LOG,
LOS
Los
LOS
WATER PRESSURE
LOS
LOS
608
Los
TIME
*AIN SEC
MIN SEC
MIP4 sac
Ulm
sac
IF SY8Trm "LOODED. LIST Tim Z WATER
OPgNfN0
MIN
MIN
SEC
MIN
sac
MIN
sac
PERFORMANCE
VALVE CONDITION
INT 91111001 Or BODY
MOVING PARTS
RUBBER FACING
SEATS
04959T?
010 ALA011MI OPCNATR AT TAID TUBT?
A LL LOW POINT CRAIP44 BLOWN OUTV
"ATER CONTROL VALVE LEFT
0 0 r,-4 AND 19AL.f.n'__
ALARM CONTAOL VAL.VL LErT
OPCN ANE)
OUICK OPENING DEVICES
SYST" NO.
SYSTEM NO.
SYSTEM NO.
SYSTEM NO.
DEVICE SERIAL NUMBER
MANUFACTURER (NAMt)
TYPE AND MODEL
AIN PRESSURE IN UPPER CHAMBER
x L92
LOS
LOS
LOS
QUICK OPENING 09VICIE TRIPPED AT
a C LOS
sac
LOS
sac
LOS
sac
LOS
PERFORMANCE
';'.JICK
C� V' E04ING O:VICN L'CFT-IN S9PtVIC&
AND CONTAOLOP N A _D EALEVI_
LIST ANY UNSATISFACTORY CONDITIONSt
REMARKS%
i��
CITY OF EDMONDS
CIVIC CENTER EDMONDS, WA 98020 - (206) 775-2525
FIRE DEPARTMENT
9 0 C) 1� ()
DATE: October 4, 1991
TO: Attn-Robert Siew
Doce's Building
1239-120th Avenue N. E.
Bellevue, WA 98005
SUBJECT: DOCEIS BUILDING
PERSON CONTACTED:
LARRY S. NAUGHTEN
MAYOR
A reinspection was conducted to check on your progress in regards to
correcting the violation(s) found during our regularly scheduled
"Fire Safety Survey Inspections".
Item(s) that have been corrected:
Item(s) still requiring correction: #1
The remaining uncompleted item(s) require your immediate attention.
A reinspection will be scheduled in 30 days. Please contact our
office if additional time will be needed to correct the above listed
item(s).
Any overlooked hazard or violation of the fire regulations does not
imply approval of such condition or violation. If you require addi-
tional information or assistance, please contact this office by
calling 775-2525, Ext. 231, between the hours of 8 a.m. and 5 p.m.,
Monday through Friday.
,,Y2aialrs for a safer community through fire prevention,
Tom VonSchuessler
Senior Inspector
Enclosure
9 Incorporated August 11, 1890 0
Sister Cities International — Hekinan, Japan
CITY OF EDMONDS
FIRE DEPARTMENT HAZARD FORM
---- ---------- ------ ----
BUSINESS* NAME.,...BURLTNGTON COAT FACTORY 019
BUSINESS ADDRESS..24111 HIGHWAY 99
---------------------- i ---------------------------
H A Z A R D S
DATE INSPECTED
8/15/91
1* AN ANNUAL CONFIDENCE TEST OF YOUR AUTOMATIC SPRINKLER SYSTEM
SHALL BE PERFORMED BY A "QUALIFIED SERVICE PERSON". A COPY
OF THE ANNUAL TEST RESULTS SHALL BE MAILED TO THE EDMONDS
FIRE DEPARTMENT AND A COPY SHALL BE KEPT IN THE SPRINKLER
CONTROL VALVE AREA.
--- A 10, W
war—
C"Jjv
�,)- u , z -,? " (, - ") .
00 000!7 f
CITY OF EDMONDS
CIVIC CENTER EDMONDS, WA 98020 - (206) 775-2525
FIRE DEPARTMENT
890 9 q
March 19, 1991
Mr. Robert Siew
Eastern Investments
1239-120th Avenue N. E., #D
Bellevue, WA 98005
Dear Mr. Siew,
LARRY S. NAUGHTEN
MAYOR
I would like to thank you for your assistance in correct-
ing the fire code violations for your building at 24111 High-
way 99, Edmonds, WA. Your cooperation and personal interest
is appreciated and I hope it will continue, as needed, in the
future.
TV: be
Thank you again.
Sincerely,
Tom VonSchuessler
Senior Inspector
0 Incorporated August 11, 1890 *
Sister Cities International — Hekinan, Janan
January 30, 1990
MEMO TO: Jerry Saterlie
Acting Building Official
FROM: Stan Olsen
Senior Inspector
SUBJECT: DOCE'S BUILDING. 24111 HIGHWAY 99
It was noted on my last visit to the building that there is a new ten-
ant occupying the mezzanine portion of the building. I understand that
there is one principle party and they are engaged in running an antique
mall with spaces for 30 or so dealers.
It was noted that seven foot walls have be installed with electrical
outlets, etc. I asked if there had been.any building permits issued
and they said no. They were informed that an application for a permit
and a business license was required by the City of Edmonds.
SO:be
cc: Business License Clerk
DOCES INC
24111 HWY 99
SC ALE 1 60
1�1
-l/ N
0
LOADING
DOCK
j 1
-T 30
7
LOADING
DOCK
".1. "
41
14
10
DOCES INC
24111 HWY 99
SC ALE 1 60
9
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0
m
LOADING,
DOCK
15
rm
WT�
F 1�
30
LOADING
DOCK
(0,
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