249 4TH AVE S (2)77-, _71
-7
FIRE PREVENTION
8
INSPECTION REPORT
ServingBrier, hamonas, and 12425 Meridian Av*e S
sriOk S14 Co. 0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DISTRT www.FireDistrictl.org Fax (425) 551-1272 [1 UNINCORPORATED
249 4 th Avenue S 98020
LOCATION:
BUSINESS NAME: Saratoga Condos PHONE: 3605402876
MAILING 249 4th Avenue S, Edmonds, WA 98020
ADDRESS:
rEnQUUaEVCY STjT
I _t& SHIFT
Mar 2017
SCHEDULED
DATE DUE �
42320
UFIR
Kleweno, Donivan #30S
BUSINESS OWN ': HOME PHONE:'qz.';-3& 15,1k
Hart, Jim
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
EMAIL: C7 BUSINESS
LICENSE 1:1 1:1
INITIAL INSPECTION DATE
PERSON CONTACTED: "il jt:f- fc, Z_
NAME OF INSPECTOR: A
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
21,
3
4
5_
6
7
2
3
4
5
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION 2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
IFE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED:
PERSON PERSON P RSON
E
CONTACTED: CONTACTED: CONTACTED: i 1,
2
INSPECTOR: INSPECTOR:
INSPECTOR:
DATE. DATE DATE, 3
VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED
1 5 1 5 LETTER SENT NUMBER. 4
CODE 5
2 6 2 6 DATE, SECTION
RETURN RECEIPT
3 7 3 7 RECEIVED 6
DISPOSITION
7
8 .8 DATE
LETTERNEEDED [:] YES NO LETTERNEEDED [] YES NO
8
Cwnfidence Testinq Cc&obny-:
�A 98072
Wolfe Fire Protection
Firj&-Department
Confidence Test Report
Confidence Testing: 206.793.0936
17321 Tye Street SE #B Monroe, WA 98272 WET
Certification Give.n
RED
YELLOW
WHITE
(NOTE: ONE SYSTEM PER REPORT)
CONFIDENCE TEST: R E P A I R S: I Fj
Occupancy Address: a yq Q SILL Vf '--?Occupancy Name: Sa (-,rx +Oac� C'n /),/ 0
Building Owner: Phone Number: ,271
Responsible Person: Do n —KRLA)r�fyl Phone Number: 1P
Building Owner
Address:
rA
Date of Inspection: Inspection Frequency Type: ,nnua
Tester's Name (print): Certification Number: SCP- S -ca-q
Central Station monitoring? YesW-, No U Monitoring Co. Name: IIA4��,,ro)(,;<
Primary Component: 01 1 1 U00 V � 7- System Make.
System Model: Z2
4- i,(1
System Location: 91'5cr (Cory) Von.o:�_ Identification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected: Corrected by:
(if additional room is required, please add a separate sheet.) Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properlyj inspected for reliability to cov6r the items
listed in this report and is consistent with the Authority Having Jurisdiction's Fire Department Fire Code standards.
All discrepancies are noted and have been re"pcwted to the building Owner/Manager for corrective action.-.,
Signature of Tester- Phone #:i 360-794-7926
Testing Agency:
Mailing Address: Wolfe Fire Protection, Inc.
17321 Tye Street SE #B Monroe, WA 98272
Building Representaiive(siginature)-
Spr inklers e WET I
.!Page: 1 of 2
A
f-he' below items on the check list shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the Fire and Life.Safety system. Refer to the Authority Having- Jurisdiction's
Fire Department Fire Code for inspecting and testing requirements.
General-
............ ....... --No 0
Yesw5l
Flow test conducted?
? ................................ ............... 11.1 ....... ......... ....... I .................. .......
2. Static Pressure: i Flow Pressure:
psi psi
3. Total number of sprinkler heads on this system?
—A
4. Was 2" Main Drain check6d? ....................................................................................................... OtherO Y e 9:�W N 0 LI
5. Flow Switches, Supervis'O I SwitpPes and Alarm Bells tested? ...... ........................ . N/AE)_� Y e sZ No C)
6. Pressure regulatiqo, valves tested? ............................................................................... Y No 0
je s
�YesQ No Q-
7. Alarm Bell operate? ........................................................................................................ N/A'D
8. System inspected �rid'161br'16:atedl ? ................................................................................. Yes ZI No 0
9. Valves sealed or supervised? .................... .............. ..................... Yes �2— No Q
.............................................
10. Provided on all valves? .............................................................................................................. YesM No Q
11. Pumper Connections and Clapper valves unobstructed and turn freely .................... Yes4 No 0
12. Sprinkler coverage acceptable? ............................................................................................. Yes,:�U No C3
13. Have the sprinkler!heads been replaced -or s-u-cces-Oully sample tested i-n-tho last 50 years? Y e s�j� -No C)
o e S,(2� 0
1-4. Proper.nu- mber spaire sprinkler heads, -available with appropriate wr'enchs f r acfil-.'..... e N'
15. System left in service? .......................................................... ................................................. YesQ, No 0
16. System gauges been replaced or calibrated within the past 5 years? ............................. YesM No C]
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Yes,@ No Q
18.'Was debris found in the Fire Department Connection (FDC)? ................................................ Yes No C3
4
19. Was the Fire Department Connection (FDC) back flushed within the last 5 years? ................. YesM No L)
20. Was an internal pipe and valve inspection performed within the last 5 years? .................. Yes D No-�D
Date Performed: 2016
21. Was a signal received at the Central Station monitoring company? .................... N/A Q. Yes�Q No D
Sprinklers - WET Page: 2 of 2
FIRE PREVENTION,
�erving Briei; Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
MISH CO.
OEDMONDS
'FIRE
Mountlake Terrace
Everett, WA 98208
El BRIER
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
DISTR
T wwwFireDistrictl.org
Fax (425) 551-1272
[1 UNINCORPORATED
FREQUENCY
STATION 1, SHIFT-*,
LOCATION:
210 4 th A,�,anue 9'98020
Annual
17-D
I
BUSINESS NAME:
Sarabga Candas
PHONE- 3ED5402871
SCHEDULED Mar 2014
DATE DUE
MAILING
UFIR423 20'-'
ADDRESS:
240 4Lh Avinnuc S, LdrTmri&-.. VVA 03020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE: 420730787
"CURRENT
KEY ACCESS-2:
&PA
HOME PHONE:
CITY YES NO
BUSINESS
EMAIL:.
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRL SYS ILMS:
A� SiK F A t�MT F E -V-6 F D L k- b a w
'Tll� 10/1-6 71)_�
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
L42 Art�:M V=:Z� uY"
uf.
2
2
3 6
3
/
4 fl- 1C, 2-1--Nrc 26
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
I st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
I
EXTENSION
GRANTED TO:
FINACRE-INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:-------
INSPECTOR:
2
DATE:
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
6
4
8
4
8
DATE:
DISPOSITION:
7
1
LETTER NEEDED E] YES El No
LETTER NEEDED F] YES El NO
I
8
FIRE DEPARTMENT COPY
qth-,ing Briet; Edinonds
SNO)IOMISU CO. ke T c
untia erra *e,and
A&,4
FIRE
'it Town of Woodway
DISTR www.Fir,eD,istrictl.org
LOCATION: 249 �th Ave S
FIRE PREVENTION
12425 Meridian Ave S
INSPECTION REPORT
Everett, WA 4�268-'
Ji
0 EDMONDS
0 BRIER
Phone(425)A ' -1
0WOODWAY
[I MOUNTLAKE TERRACE
Fax (425) 551-1272
0 UNINCORPORATED
FREQUENCY STATION & SHIFT�
365 1 17 C
BUSINESS NAME: Saratoga Condos PHONE: SCHEDULED 03/01/13
DATE DUE
MAILING 249 4th Ave S UFIR � 423 3202.
ADDRESS: Edmonds 98020
,(,)
--V(
BUSINESS OWNER: V MA V,-L
HOME PHONE:
EMERGENCY-1: HOME PHONE: �'CURRENT YES NO
KEY ACCESS-2: F A26--_Q��6 HOME PHONE: CITY
BUSINESS
77 7J`7 LICENSE
K INITIAL INSPECTION DATE
PERSON CONTACTED:.
NAME OF INSPECTOR: Bl�n`L-
FIRE AS 6112 7,41, 7111 FD LkBx FE
SYSTEMS: ANNUAL'
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
Z_ I
2
2
r
3
4 A&
4
5
5
6
6
V
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
X
lst RE -INSPECTION
2nd -INSPECTION
RE
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE,
DATE DUE,
GRANTED TO:
DATE DUE:
CITED -
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
I N PECTOR:
INSPECTOR:
2
3
DATE:
DATE:
DATE:
VIOLA IONS,
VIOLATIONS
PRE -CITATION
CITATION ISSUED
15
1
LETTER SENT
NUMBER:
2
I 6
2
X
DATE:
CODE
SECTION:
5
'7
R&URN RECEIPT
6
3
3
RECEIVED
.7
DISPOSITION:
4
I
4
8
DATE:
7
LETTER NEEDED YES El 'No
N, %,
ETTER NEEDED 0
F H:�d
-
8
0
FIRE DEPARTMENT COPY
1�1111&me MCI 11 0=1 emsm- I 1 11
FIRE DEPARTMENT NOTIFICATION
CANcEL oRLossf oF CawmuNwArzon
360-456-11"1
360-438-4245 FAx
Date: 12/4/2013
Alarm Center Contact Person
Alarm Install/Service Company
phone# 425-774-9099
Customer
Name
Customer Address
City
State
Postcode
Phone#
Contact Person
Manager
Protection & Communications. Inc.
fax #
Sarato2a Edmonds - 8 Unit
249 4th Ave S U)
Edmonds
WA
98020
Donovan Kleweno
Comments Missed Daily Communic
If this notification should be sent to a different jurisdiction, p I ease advice us of the
and the correct email address or fax number. Thank youl
jurisdiction
4
Confidence Testing Company:
Fire Department
_�-_.,I�DVANCED
'%,FIRE PROTECTION, 1NC.
.� P.O. Box T543 - Woodinville, WA 98072
Ph.: 425.483.5657
Confidence Test Report
Confidence Testing: 206.793.0936 '
SPRINKLERS - WET
Certification Given.--.".1,
(NOTE. ONE SYSTEM PER REPORT)
RED
"
YELLOW-,.Q,'.
I k I T E-
CONFIDENCE TEST: ],,0-1 R E P A I R S:
Occupancy Address:,___V�� 5. ...1.6ccupancyName:
Building Owner: Phone Number:
Responsible Person: Phone Number: '344 _:5�a —
Building Owner
Address:
.Date of Inspection: Inspection Frequency / Type: _ ��n a I
Tester's Name (print): Certification Number: SCP'.S' aq es"Y"
Central Station monitoring? Yes -a No U Monitoring Co. Name:
Primary Componen System Make:
System Model:
System Location: Identification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected: Corrected by:
(If additional room is required, please add a separate sheet.) Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the items,
listed in this report and is cons, tent with the Authority Having Jurisdiction?s Fire Department Fire Code -standards.
All discrepancies are notarba 4-ve been r portedAo the building Owner/Manager for corrective actlon.
�2
Signature of Tester: Phone #: 425.483.5657
Testing Agency: A'd' v a'n c e d Fire Protection, Inc.
Mailing Address: P.O. Box 1543 - Woodinville, WA 98072
Building Rep rese ntati ve (signature):
Sprinklers a WET Page: 1 of 2
The bplow items on the check list shall be *inspected and tested. This list does not constitute all of the required
inspecting and testing of the Fire and Life -Safety system. Refer to the Authority Having -Jurisdiction's
Fire Department Fire Code for inspecting and testing requirements.
General
T. Flow Testconducted? ......... >�! ....................... I ...................................................................... .......
Ye��_ No (3
2. Static Pressure: i Plow Pressure: psi
ps
3. To tal-nUmber of sprinkler heads on this system?
4. Was 2"� Main Drain checked?_�.� ....... ........ ............... I ....... I ............... ..................... .................. . Other Q
iYes No Z)
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ..................................... N/A (3
Y e_q_� No C3
....................................................
6. Pressure regulating,vciives tested? ...... e E I No [I
7. Alarm Bell operate? .................... t'--V ..................................................................... 0
No E)
8. System inspected and lubricated ? ........ .........................................................................
Yes-4--No L1
9. Valvei seAledor' supervised? ........................................................ ...................................... ............
Y e ��,--N o LI
10. Provided on all valves? .......................................................................... ...................................
Yes_,Ej�—No 0
14P-Rwnper Connections and Clapper valves unobstructed and turn_fre�l . ....................
YeA,.�No C)
12. Sprinkler coverage acceptable? ................................................ ............................. I ................
Y e sa,-N o L)
13. Have the sprinkler heads been replaced or successfully sample tested ih the last 50 years?
Ye§_Q ---- No Q
14. Proper number spare sprinkler heads available with appropriate wrenchs for each? ..............
Yeaz� No 0
15. System left in service? ............................................................................................................ Yes (3 No 0
14,,S.y,stem gauges been replaced or calibrated within the past 5 years? ...... .. ... 4�7 ....... Y e s..8— N o C1
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Yes-@, No Q
18. Was debris found in the.Fire Department Connection (FDC)? .................................................. Yes C1 No�El
19..Was theFire DepartmenVIC.9nneiction (FDC) back flushed within the last 5 years? ... ............. Yes C1 No 0
20. Was an internal pipe and valve inspection- performed within the last 5 years? ................. Y e No 0
Date Performed:
21. Was a signal received at the Central Station monitoring company? .................... N/A E) Y N o Q
Sprinklers e WET Page: 2 of 2
Confidence Testing Company:
_....A'DVANCED
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
Se-MR-ftri. F i re D e p a rt m e n t
Confidence Test Report
206.386.1448 Confidence Testing Officer
206.615.1068 (fax)
206.233.7219Red Tag Hotline
SPRINKLERS WET
Certification Given
RED
YELLOW
WHITE
(ONE SYSTEM PER REPORT)
CONFIDENCETEST: REPAIRS-1
Occupancy Address., Occupancy Name:'_�;A��470g"4 Co/yvz��
Building Owner: Phone Number:
Responsible Person. PhoneNumber:
Building Owner
Address:
Date of Inspection: Inspection Frequency Type: Annual
Tester's Name (print): �X74/1�/SFD Certification Number: SCP-
Central Station monitoring? Yes No D Monitoring Co. Name: IN
7 ��/_57/
Primary Component: System Make:
System Model:
4,
SystennLocation: Identification Number:
Problems Found: (if additional , room is . required, please add a separate sheet.
Corrections Made: Date Corrected: Corrected by:
(if additional room is required, please add a separate sheet.) SFD Certification Number: SCP-
If J, '7�
.. .......
This certifies that this Fire and Life Safety system has been properly inspected for reliability to coverthe items
listed in this report and is consistent with the Seattle Fire Department Fire Code standards, and all discrepancies
are noted and have 0 er/Manager for corrective action.
7�lp
7
'7�
b;
Signature of Tester: Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 -Woodinville, WA 98072
Building Representative(signature):
Sprinklers - WET
Page: 1 of 2
The below items on the check list shall be inspected and tested. This list does not constitute all of the
i,,,requked inspecting and testing of the Fire and Life Safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
General
..........................................
...... ..................... .......... I YeSwUr— No
2. Static Pressure: Psi Flow Pressure: Psi
3. TOW(" -0 'of s, rinklee head
�pn 8 on'thissystern?
4. Was 2" Main Drain checked? ........................................................ . ............................................ OtherEl Yes No Q
5. Flo�',"Oltcheis, -Supervisory SvVitches and Alarm Bellstested? ......................... 0 Ej
............. I N/A 0 Ye&_E�t
6. Pressure regulating valves tested? .............................................................................. No Q
a
7. Alsl�in
...... . ................ ............................................. No Ej
...... ......... t41A E) Yes
8. System inspected and lubricated ? .................................................................................. Yesrj3- No [I
9. Valy 'Osat6d or supervised?
. .................................................................................. N o n
.......... YOW
10. Provided on all valves? ............................................................................................................. Yes-Q- No L]
? .....
onnections, and, Clap vi No U
per Ives unobstructed'and turn free
........................................ Y
y e*13
12. Sprinkler coverage acceptable? ............................................................................................. Y es _Q, No L]
13. Haye,`*b sprinkler heads'been,'replaced or successfully sample tested in ih I e I last 60 years? No L)
Yes
14. Proper number spare sprinkler heads available with appropriate wrenchs for each? .............. Yes-0--- No C3
15. System left in service? I .......... I — ............... I ................................ II ................................ ........... Yes-Q No L)
16. System gauges been replaced or calibrated within the past 5 years? ........................ �
i ....................... Y e st3--- No LI
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Yes-E)-- No L)
18. Was debris found in the Fire Department Connection (FDC)? ................................................ Yes Q No L3
19. Was the Fire Department Connection (FDC) back flushed within the last 5 years? ..... Yes U No Q
20. Was an internal pilpe and valve inspection performed within the last 5 years? ................. Yes-C]--- No L]
Date Performed:
21. Was a signal received at the Central Station monitoring company? .. .................. N / A L) - Y N o
Sprinklers - WET Page: 2 of 2
FIRE PREVENTION
Set-ving Bilet: Edinonds
12425 Met-idian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Tei-i-ace,and
FIR
Evei-ett, WA 98208
0 EDMONDS
0 BRIER
the Town of Woodway
DIS T
Phone (425) 551-1200
E]WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
[1 UNINCORPORATED
" FREQUENCY
STATION & SHIF"�
LOCATION: 249 4th Ave S
365
17 B
I
BUSINESS NAME: Saratoga Condos
PHONE:
SCHEDULED
DATE DUE, 1' 03/01/12
MAILING 249 4th Ave S
LIFIR 1, 423 3202
ADDRESS: Edmonds
98020
BUSINESS OWNER: Michel Properties
HOME PHONE: 4257762211
EMERGENCY-1: Bruce, Reg
HOME PHONE: 4257720646
r CURRENT
KEY ACCESS-2: Fax 425-778-9086
HOME PHONE:
CITY YES NO
BUSINESS M
11
LICENSE Lai
PERSON CONTACTED:. tic)
INITIAL INSPECTION DATE
OF INSPECTOR: ::�,
ANAME
FIRE AS 5/11 FA 7111 FD 1_1113x
FIE
SYSTEMS: 4_5 I 17
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
A t
1
2
2
3
3
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
1
I
2nd RE -INSPECTION
D TE DUE.
E)(TENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED.
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 15
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
\. LETTER NEEDED E] YES [I NO
LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY
828 Poplar Place S. Seattle Fire Department
Seattle, WA 98144 Confidence Test Report
206-957-0907 Phone 206-386-1448 Confidence Testing Officer
P, -Acj.fal I C, 206-726-8160 Fax 206-615-1068 (fax)
— WA State ID: PACIFFS973PU 206-233-7219 Red Tag Hotline
FIRE ALARM SYSTEM
Certification Given
(One System per Report)
RED
YELLOW
WHITE
CONFIDENCE TEST
X
REPAIRS
Occupancy Address.' Z9'i -LA-\A Ajb S-
Occupancy Name: SAit-PL—inG-R
Responsible Person yy\c.,-� t) �, 1
First & Last Name: MA U
Phone Number: 9 1
Responsible Person
Responsible Party
Address, City, State, Zip:
E—Mail Address
Date of Inspection:
7- 1&- t\
Inspection Quarterly FlHigh-tise Only)
Frequency/Type:
14
Annual
Testers Name —
(Please Print): I � 1) A �A Lt,
SFD Certification
Number: SCP--O 01 323
Central station monitoring? Yes V No E]
Monitoring
Monitoring Required? Yes F& No C]
Company Name:
System Make: V-"%(,��
System Model: 5%017,
System Location
Identification Number: IEL 11-79
PROBLEMs FOUND: (if additional room is needed. please add a separate sheet)
X7 Ef�j i�,z, D
CORRECTIONS MADE: Date Corrected: 1- IZ— N
Corrected By: L
j
(it additional room is needed. please add a separate sheet) SFD Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have beenrWrte to the building Owner/Manager for corrective action.
Signature of Tester: , 4--,
Phone#
Testing Agency: 2 A c-4
0`1 C- 1,�-
Mailing Address: qu <-k '0
P— -P 1,
Building Representative (signaturE
I- �/ — _::
Pacific Fire and Security, Inc. Page I of 2
A A
The items on the checklists below shall be inspected and tested. This list does not constitute all of
the required inspecting and testing of the fire and life safety system. Refer
to the Seattle
Fire
Department Fire Code for inspecting and testing requirements.
Alarm System Functionality
1. Trouble signal with AC power off?
Yes
No El
stem operates properly on battery backup?
N! �es
N6 El�
3. Battery voltage (no load) _IcRD.v_9Its_.
Pa Ltery voltage&�! load), volts (signals.opqrpting)
5. Charge circuit voltage -z'I'Lo-volts
6. System operates properly on standby power?
Yes,&J-
[771777,
-Nq__��
7. ___1 All __ si I gn . at - s . o I pe - ra - te - on - AC power?
es
NoE]
8. Number of initiatinq circuits
Number of signal circuits
10. Does alarm system meet audibility standards as accepted?
Yes
1�0
11. All circuits checked for ele I ic;;1 su ervision?
sio
Yes
No
Ator fans, dampers)?
12. All auxiliary equipment,opetatb ElevatO
N/A
Yes
_--y-oEl'�
13. Ventilation controls operate?
N/A
Yes
No
14. Key to panel available?
Yes
�es
`N-0 �7
15. Operating instructions at panel?
s
Yes
No
16. Trouble indicators function properly?
-ye
Yes
No
I �. Remote Annu-n-6-ia-t-or P-an-e-l-s-fu--n-ct-io--n-p-r--o-per-ly-?-
N/A
Yes
No
18- Elevator Call Down functions properly?
NIA EL
_.-Yi
N
11§_.te�_t record- -posted- at-paire-P-
Yes
N 1:1
20. General alarm automatic time delay
NIA
2 - -Wasa si-gnal -received at the Central Station m ring company?
N/A
Yes
No
22. Other Devices (Specify)
Yes
No,[],�'d
Total Number of
Total Number
System Devices
Units in Building
Units Tested
Test Results cceptable
23. Bells, Horns, Chimes
3a
WA
Yes
No,E]
24. Voice Speakers (Voice Clarity)
N/A
Yes
No
25. Smoke Detectors
A_1�
N/A
Yes
No
26. Heat Detectors
N/A
Yes
No
27. Duct Detectors
Yesm
28. Spri . nk , ler Flow - Sw . i . tches
_N/A
Yes
_-Ndt',
No
29. Sprinkler Supervisory Switches
N/A
Yes'
No� F]
_ 30. - Vis I ual - A , la - rm Device's
-j Q_
N/A-
No
31. Manual Pull Stations
/A
N El
Yes
No
__32. Annunciator(s)
N/A
Yes
No
33. Beam Detectors
N/A
Yes
No
34. Automatic Door Unlocks
N/A,8
Yes
NoE]
35. Automatic Door Release
N-JA E]
Yes,27-7
Np�
36. Fire Dampers, every 4 yrs.
NIA R1
Yes
No
Total Number of
Total Number
Communication Equipment
Units in Building
Units Tested
Test
Results Acceptable
37. Phone Sets
N/A
Jacks
Yes
NoR
39. Call -in Signal
-N/A_;g
N/A
Yes El
No [11
Pacific Fire and Security, Inc. Page 2 of 2
City zMew-00- Fire Department
_=�ZDVANICED
N==MM2��� CONFIDENCE TEST REPORT
beattie rire wepar'Emeni toniriuenrue iebTing utiit;er; r-i2&X.,LV0.0 lu. I VU0
WET - AUTOMATIC SPRINKLERS Certification Given
(NOTE: ONE SYSTEM PER REPORT) RED 0 IYELLOWL31 WHI E
Date of Inspection: 5-:;/
.&-,// I CONFIDENCE TEST.- Annual-B- QuarterlyEl Acceptance 01REPAIRS:0
Tester's Name (piint): 4-1y49'j9e::P SFD Certification Number.- SCP - __'z- 0,20-5T
Occupancy Name:SP4kr/6
Occupancy Address:4219? — _41-zo-
/66A 92a:20
Responsible Person:
Phone Number:
�ulldin wrier's Name:
Btfl ngg 00wner's Address:
Contact Person:
Phone Number:
Central Station monitoring? Yes-2-- No Ll Control Panel Manufacturer: /IV-
m , AZA?Flfl� Cl"73-p -4
Monitoring Co. Na e. Model Number: �V /
ProblemsFound: (if additional room is required, please add a separate slieet.)
Corrections Made: (if additional room is required, Please acm a separaw dwa) DateCorrected: Corrected by:
The below items on the check:list shall be inspected and taw. This list does not constitute all the required 1n'spe'ct'i' _'A"
9g.an testing -
of the Fire and Life Safety system. Please refer to the Seattle Fire Department Fire Code for inspecting and -testin g requirements.
80. Was a Flow Test conducted?
81. Static Pessure: //0 . psi Flow Pessure: psi
82. Was 2" Main Drain checked?
83. Were all Flow Switches, Supervisory Switches and Alarm Bells tested?
84. Does the Alarm Bell operate ?
85. Were all valves inspected and lubricated ?
86. Were Pressure Regulating valves tested?
87. Were all valves "sealed" or supervised?
88. Are signs provided on all valves?
89. Are the Pumper.Connections and Clapper valves unobstructed ?
90. Are the sprinkler heads -less than 50 years old?
91. Is the sprinkler head coverage acceptable?
92. Are spare sprinkler heads available?
93. Was the system left in service?
OtherE]
N/A Q
N/A E]
Yes4a-
No C3
Yes-@-
No L3
Yes.,Q_
No E]
Yes.@-
No E]
Yes-ja-
No Q
Yes,el---
No L]
Yes L]
No-a-
Yes,Ej-'
No L]
Yes -Er
No E]
Yes.Ej'
No E]
-Yes,ZY-_--
No C3
Yes,V�'
No L]
Yes,ffl"
No 0
Yes,d'
No Q
This certifies that this Fire *and ' Life Safety system- has been properly inspected fo^r
reliability to cover the items listed in this report and is consistent with the Seattle
Fire Department Fire Code standards and discrepancies are noted and have been
reported to the building Owner/Manager for corrective action.
r
Signature of Testa.,
Testing Agency: Advanced Fire Protection, Inc. Phone: 425.483.5657
Mailing Address: P.O. Box 1543 , Woodinville, WA 98072
CITY OF EDMONDS.
121 5T11 AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215
FIR DEPARTMENT
LOCATION:
249 4th Ave S
BUSINESS NAME:
Saratoga Condos
MAILING
249 4th Ave S
ADDRESS:
Edmonds
BUSINESS OWNER:
Michel Properties
EMERGENCY-1:
Bruce, Reg
KEY ACCESS-2:
Fax 425-778-9086
FIRE PREVENTION
SAFETY SURVEY
PHONE:
98020
HOMEPHONE: 4257762211
HOMEPHONE: 4257720646
HOME PHONE:
FREQUENCY
STATION& SHIFT
365
17 D
SCHEDULED
1,
03/011/10
DATE DUE
LIFIR 111, 423
3202
11 INITIAL INSPECTION DATE
PERSON CONTACTED: To,., �9_ h
NAME OF INSPECTOR: 9914g, sowda." 0go-7
FIRE AZ�� J/UZJ I -A J/Ub t-LI LKbX fl= i
SYST EMS: ANNUAL
HAZARDS FOUND AND LOCATIO / MMUNICATIONS
1 eewEarp' o'Mov- prVV7oL( proor'
o,,AnjJ <y
ENTER CODE ONLY ONCE I�
I-
VIOLATION CODE
i ALo(
2 cx� ov
A,-a%/1'cQc Rrpv� o-� T-1 V,-P-
2 A,'�� 0 1
3 fZ ct.� Q.444 gj�r
fr'c)�41*"
4 1* fd "i't
3 EXOS
4 le �r q�� 0,—J /0 V"
jA 0 V
O'F 0�— e V- 4-1, -'V I ry C.,_.-
4 Fe 0
V
5
5
6
6
7
7
8
8
1st RE -INSPECTION
DATE DUE.
2nd RE -INSPECTION
DATE DUE.
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE& 0
DATE:
DATE:
3
(sr VIOLATIONS
5
VIOLTTIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
C,
2
6
DATE:
CODE
SECTION:
5
7
7
RETURN RECEIPT
RECEIVED
6
7
4
18
4
8
DATE:
DISPOSITION:
\ LIE R NEEDED [] YES C] NTJ
LETTERNEEDED 1:] YES NO
FIRE DEPARTMENT COPY
02/15/2011 05:58 2067268160 PACIFIC FIRE & SEC PAGE 07
828 Poplar Place S,
Seattle, WA 98144
206-957-0907 Phone
206-726-8160 Fax
WA State ID: PACIFFS973PU
Seattle Fire Department
Confidence Test Report
206-386-1448 Confidence Tesfing Officer
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
FiRF- ALARM SYSTEM
Certification Given
(One System per Report)
Rim
YELLOW
[7
w"rrr=
CONFIDENCE TEST
I
REPAIRS
Occupancy Address: P-!L.9
Occupancy Name: -5-4AMA0-,4W Zlw,001
Responsible Person "IWAIV-T
First & Last Name: legewly
Phone Number: d?7 - -5-10-7
Responsible Person
Responsible Party
Address, City, State, Zip:
E-Mail Addrass
Inspection Quarterly 0 (Hig"se Only)
Date of Inspection:
Frequencyfrype- Annual 20"
Testers Name
(Please Print):
SFD Certification
Number; SCp-
central Mtion monitoring? Yes [9" No Ej
Monitoring
Monitoring Required? Yes 9?1� No F-1
Company Name: "-Vz4'&V2 4C-V;0e
e 2., eA,, -7 A ', vl o �A-v
System Make: $�
System Model:
System Location &dV—
Identification Number
PROBLEms FoUND: (if addifional room is needed, please add a separate sheet)
Al,o ,,�ew.AeXA7-1- jlc'.v
CORREc'noNs MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate shW) SFD Certification Number- SCP 7
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent Wth Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Managerfor corrective action.
Signature of Tester:
Phone
Testing Agency:
Mailing Address- 0:
Building Representative (signature)
Pacific Fire and Security, Inc. Page 1 of 2
02/15/2011 05:58 2067268160 PACIFIC FIRE & SEC PAGE 08
The items on the checklists below shall be inspected and tested. This list does not constitute all of
the required inspecting and testing of the fire and life safety system. Refer
to the Seattle Fire
Department Fire Code for inspecting and testing requirements.
Alarm System functionalij�( !g�xwA,�m-;d 4Axwx
I. Trouble signal with AC power off?
Yes [�f,
No Lj
gill
BOOM
3. Batt
�tteryvoltage �no load) 27
At
IN
5. Charge circuit voltage '9Z.-mv-01ts
1URFAM IV.
7. All signals operate on AC power?
)lllles
No
Number of sign al circuits
11. All circuits checked for electrical supervision?
es
K
No
9j
n'tt"JI. . I mum
an M. . . M,
13. Ventilation controls operate?
E
N/A
Yes
No
111% 1 !'1 !1
15. 6pe"rating instructions at panel?
Yes
No F�
17. Remote Annunciator Panels function properly?
IN .. o
MRIM81111R. M "'t, M."
19. Test record posted at panel?
No
MOMOR MIN "'.. - RIM
21. Was a signal received at the Central Station monitoring company?
PQ 1111 ill! 11121, ill! l�,
N/A F''I . Yes
No
Total Number of Total Number
SXstem Devices
Units in Building
Units Tested
Test Results A ceptable
24. Voice Speakers -(Voice Clarity)
Yes
NoEl
26. Heat Detectors
Yes
No 0
0
0:
M-2
28. Sprinkler Flow Switches
1
Yes
No
30. Vis al arm Devices
5MVIN, MIN 0111"M
TMOMM
4
/4
i
L1
Yes R—
N
I W"...
32. Annunciator(s)
911FEMIN
oom
N/A
L1
11111awl
Yes F!ffr
No
33. Beam Detectors
N/A
2"
Yes
No
34. Automatic DoorUnlocks
N/A
2'
Yes
No
Total Number of Total Number
Communication Equipment Units in Building Units Tested Test Results Acceptable
1111:111! :%:! TI!
. I M
38. Phone Jacll N/A'[O' Yes F] No
Pacific Fire and Security, Inc. Page 2 of 2
-..�I�DVANCED City of 5133W Fire Department
Nzu��� CONFIDENCE TEST REPORT
,)eaxxie rire uepa rime rit 1.,umiuviit;e I UbL11111V %J I I I UVI- LWO-20U. I fftffto I 1-djL-4WV.Q 1;J. I WOO
WET - AUTOMATIC SPRINKLERS I Certification Given
(NOTE: ONE SYSTEM PER REPORT I RED 0 IYELLOWEII WHITE --S
Date of Inspection: CONFIDENCE TEST. Annua+IH—QuarterlyO Acceptance 0 1 REPAIRS: 0
0e.
Tester's Name (print): - � �e,:: �o 6 4,519"6W I SFDCortification Number. SCP--5-Q,?C5-9
Occupancy Name: CAlg,4 7-A4'a <-12z1zw �S
Occupa <
Responsible Person:
Phone Number: --
Building Owner's Name:
Building Owner's Address:
Contact Person:
Phone Number:
Central Station monitoring? YesM2— No Q Control Panel Manufacturer: 411-16L
Monitoring Co. Name:-A�#Rl'�14 Model Number: x/ :�e—
ProblemsFound: (if additional room is required, please add a separate sheet)
Corrections Made: (If additional room is required, please add a separate stieet.) DateCorrected:
Corrected by:
4
The below items on the check list shall be inspected and tested. This list does not constitute all the required inspecting and testing
of the Fire and Life Safety system. Please refer to the Seattle Fire Department Fire Code for inspecting and testing requirements.
A
80. - Was a Flow Test cond7�ted? 7
81. Static Pessure: — psi Flow Pessure: psi
82. Was 2" Main Drain checked?
83. Were all Flow Switches, Supervisory Switches and Alarm Bells tested?
84. Does the Alarm Bell operate ?
85. Were all valves inspected and lubricated ?
86. Were Pressure Regulating valves tested?
87. Were all valves "sealed" or supervised?
88. Are signs provided on all valves?
89. Are the Pumper Connections and Clapper valves unobstructed ?
90. Are the sprinkler heads less than 50 years old?
91. Is the sprinkler head coverage acceptable?
92. Are spare sprinkler heads available?
93. Was the system left in service?
Yes-5� No Q
Y e s-Ej— N ci E]
OtherQ Y e s,,Ej-
No Q
N/A Ej Yes -9—
No Q
N/A L] Yes-5—
No L]
Y e s-2—
No L)
Yes C]
No-5—
Y e s-E�—
No L]
Yes4a—
No C]
Y e s-@—
No L]
Yes-5—
No C]
Yes 421—
No Q
Yes.�� '
No E]
Yes-@—
No Q
This certifies that this Fire and Life Safety system, has been properly inspected for
reliability to cover the items listed in this report and is consistent with the Seattle
Fire Department Fire Code standards and discrepancies are noted and have been
reported to the building Owner/Manager for corrective action.
Signature of
Testing Agency: Advanced Fire Protection, Inc. Phone: 425.483.5657
Mailing Address: P.O. Box 1543 , Woodinville, WA 98072