300 ADMIRAL WAY STE 10000 ADM7ZR
FIRE PREVENTION
.Serving. Brier, Edmonds, and 12425 MePid . ianAve S INSPECTION REPORT
Mountl4ke Terrace Everett, WA 913208 ) Q'61VIONDS
[3 BRIER
0 MOUNTLAKE TERRACE
Phone (425) 551-1200
[3 UNINCORPORATED
www.FireDistri.ctl.org Fax (425) 551-1272
LOCATION:
300 Admiral Way Suite 100 98020
BUSINESS NAME: Coast Property Management
PHONE: "'4253393638
MAILING
ADDRESS:
300 Admiral Way, Suite 100, Edmonds, WA 98020
BUSINESS OWNER: Hoban, Tom'/ HOME PHONE:
EMERGENCY-1: HOME PHONE: LCbD_1,S5 _3(�3 Y
KEY ACCESS-2: L_ 0 LI— I S CoQ S.,— juq�, (ID In HOME PHONE:
EMAIL:/
PERSON CONTACTED:
NAME OF INSPECTOR: (C— <Ej�_
FIRE SYSTEMS.: AS 2/13 FA 2/13 FIE 4/12 FD Lk Box
natp I q_-d.1;PryirPfi-
Ir 4&� �)i
FREOUENCY STATION & SHIFF`�
Annual 17-D
SCHEDULED
DATE DUE Jan 2016
UFIR 1" 509
CURRENT
CITY YES Or -
BUSINESS KA-
LICENSE -ni 1:1
INITIAL INSPECTION DATE
AAZARDS FOUND AND LOCATIONS /COMMUNICATIONS
--- V1,
2
AkA
2::'
3
3 N"
Wi�
Ir.
71
wt,
. . . . ... ... ..... .. .... .
-5 -------
6
6
7
7
I AGREE TO cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS'
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
PERSON
CITED:
PERSON
PERSON
.SONTACT��
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS:-
I
PRE-C TATION
CITATION ISSUED
1 5
5
LETTER SENT
NUMBER:
4
CODE
6
2
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
7
4
8
4
18
DATE:
LETTER NEEDED [3 YES NO
LETTER NEEDED [:] YES NO
8
COMPLETE
FIRE PROTECTION
R High Pressure Hood Clearing
&THood and Duct Services, Inc. Fire Suppression Installation & Service
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-7607 Filter Sales & Service
Occupancy Name: hi
Occupancy Address:
Responsible Person:
Building Owner: —
Certification Given: RED[:] YELLOWE] WHITE gr
CONFIDENCE TESTING RANGEHOOD
SYSTEM TE,ST REPORT
I CONFIDENCE TESTE5 REPAIRS
DATE: 10) 1 � / I
City, State, Zip:
Phone Number 17
Phone Number:
Building Owner Address: —
City, State, Zip:
Testers Name (Please Print): �. Zqmpo
SIFD Certification Number: scp-(34A(T�
System Alarm? Yes 12/ No F-1 Central station monitoring? Yes V No Ej
Monitoring company name: PPISD mo� dr.
Control Panel manufacturer:
Model Number:
Location of Alarm Panel:
Extinguishing System Manufacturer
SystemSiz3kVA3 U.L. 300 System? Yes [ZNo [] I.I.L. 300 Compliant? Yes [!�No Chemical Type: Wet EKDry
Location/ Height of Range hood
3A-
Is'p" S617rq�$@V69jridic atdr i.moperable range?.
res�
A)J^s
12 year hydro date of cylinder.
.
Is there chemical inside of the cylinder?
as No
Were hand is I NAO
extingqi_�qrp_propery serviced?
YesEP"'No El
W1�90'002'br* nitrogen 6artridge.,
NAO
_portable
Were all cooking surfaces protected? If not, give owner full
Yes�VNo�]
No visible signs of a system fire or system tampering (if signs check no). Yes No Fj
Check - allp . iping and I conduit. Ar e.all piping a . nd conduit immobilized with Yes Non
information.
Was operating procedure verbally given to restaurant personnel?
Ye�YNoE]
p-rcr angers:*an brackets
Was UL 300 compliance explained to owner or manager?
, - - - - .
Yesy"wo
-No [I
Are all protective covers present on nozzles?
Yes 0
Yes -No
Gas shuts down upon sy st am activation? NA E]
--- ---
Yes
NOD
Are"all nozzle,s c,hecked'in the.prop�r- position?
0
-
No H
Electric power shuts down upon system activation? NAE]
Range hood tied to building
Yes
Yes No 11
Does system have adequate volume and/or nozzle coverage?
-
Yes
7
r4,, -No
alarm panel? NAEJ
Fil, r-1
Are all appliances insidebf the h6od protection ar ea?
Have f links been
Yes m-
Yes Non
Rang-e hood activations ig'nal-received'at-buildi-ng alarm panel? NAE1
Class_K
Yes No
Yes Y No E)
I use replaced?,
Was��syptemb terminal link?
Yes -NOD
extinguisher present?
Grease buildup in group:
perg�iicnal'from
V/1,
Was system operational from manual remote?
Yes No E]
Light Medjurg— Heavy, recommend
Date of last cleaning!7 1 2V-'W)-
clean
em and micro switch operational?
NA Ya. No
r�K/
V EJ
Is system visible and free from obstruction?
Yes No[]
R/-N -f7
Are cleaning intervals within NFPA standards?
Yes No
I ftip inspection and service tag on the'c'ylinder?
s
Yes I
Previous Confidence Test Compan & ni ia
_,y. Tech c n—?C'Til:
i i -
1
I - -9
C.
Ic
�J_2
V
- r,
—
LAY
I i 12
''A
C
L!
711
CLrt441—
i
I I
I
I
L
G-7-771tLLIL
---t
I—
7-
Problems Found: (If additional room is needed, please add a separate sheet)
Customer has declined repairN,
Corrections Made: Date Corrected: Corrected By:
SFD Certification Number:
This certifies tha is fire d life ejj,s7btepm--baE0een properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discr ancie are n,,)tZf dnd havfbiK reported to the building Owner/Responsible Person for corrective action.
Signature of Tester. Phone # (206) 726-0940
Testing Agency: ' & ood and Duct Services, Inc. Mailing Address: 6100 12th Ave. S., Seattle, WA 98108
t
The owner is to perform and keep a written record of the following
I . The extinguishing system is in its proper location. The extinguishing cylinder is in
place and has not been removed or tampered with.
2. The manual pull stations are unobstructed and in clear view and are labeled for
intended use.
3. Insure that all tamper seals are intact and that system is in a ready condition.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation.
5. The pressure gauge reading on the cylinder shall be in the green operable range.
"quick check" fire system inspection to verity the following:
6. The nozzle disc caps and their seals are intact, undamaged and tight.
7. The inspection tag or certificate is in place and current.
8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
person performing the inspection an ic, required.
AUTHORIZED
SIGNATURE
FIRE DEPARTMENT COPY
COMPLETE Certification Given: REDO YELLOWD WHITE
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
High Pressure Hood Cleaning I --
&THood and Duct Services, Inc. Fire Suppression Installation & Service CONFIDENCE TEST Z REPAIRSO]
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy Name: A Y,-#1 1es
Occupancy Address: 3&2 Ad^b'Al U)0�-%5 City,State,Zip: Edr.,crldc , wA . J&zo
Responsible Person: Fj�04- r% Phone Number: 2 7:1 gxgv
Building Owner:
Building Owner Address:
Testers Name (Please Print):
Phone Number:
City, State, Zip:
SFD Certification Number:
scp- 5— cy 63 kv
System Alarm? Yes [?r No E] Central station monitoring? Yes E] No El
Monitoring company name:
Control Panel manufacturer:
Model Number:
Location of Alarm Panel: 5 ea- F—sra A
Extinguishing System Manufacturer A mst-
System Size34-74-1 U. L. 300 System? Yes E!rNo E] I.I.L. 300 Compliant? Yes E� No E] Chemical Type: Wet [�`Dry
Location/ Height of Range hood:
I& pf6ssureg�uge,,indicatoir,,,in,,o�erable'range?
A' Yese3��7�
12 year hydro date of cylinder.
Is there chemical inside of the cylinder'?
,
Yes Efl' No F
I
N
air I AD
ql�_ _extinguishers prope�qy se
rjdlpcip� Iq rviced?
_Yes[3;- 0--
El
No F�
Weig� 'CO2-or nitrogem cartridge.
NAE] _q �Ai-
Were all cooking surfaces protected? If , not, give owner full
Yes
No visible signs of a system fire or system tampering (if signs check no). Yes Rr No E]
-Yes -0
information
Wasoperatingpiro to r estaurant
Yes Noo
KJ
Chtck,al!ipiping and, conduit. Are all. piping and conduit
immobilized with- C?r- N 0
cedure verbally gitan personnel?
...
0-(80e'FRa- Lghd brackets?
Was UL 300 compliance explained to owner or manager?
Yes No
Are all protective covers present on nozzles?
Yes Z- No F-1
Gas shuts down upon systen�pctivation? NAO
YesEZ' No E]
Are.all'nozzles checked in the proper position?
Ye�o' Non
Electric power shuts down upon system activation? NA
Yes No El
Does system have adequate volume and/or nozzle coverage? Yes E! r' No E]
Range hood tied to building alarm panel? NAM
Yes No F�
Are,all appliances inside of,the hood protection area?
Yes No
Range hood activation signal received at building alarm panel? NA
-Clas-s-
Yes Noo
Have fuse links been replaced?
Yes No
K extinguislher present?
Yes Non
Was system operational,from terminal link?
Yes No
Grease buildup in group:
Was system operational from manual remote?
Yes No
Light Medium— Heavy, recommend
i �Qp-ljos4N-- 5nfe, Ve-.+
PateRfjastcle n.ng
cleaning
Wa&sy'stem a'nd,micro.switch operational?
NAF� Yes a No
-a
Are intervals NFPA
Yes No E]
Is system visible and free from obstruction?
-and
Yes El' No E]
cleaning within standards?
Confidence Test Company_& Technician
Is the, inspection on the cylinder?
Yes (!r Non
Previous
Mom
I
I
NIP==
0101MININIMENE
mm�mmommmom
MMEMMMEM
Problems Found: (If additional room is needed, please add a separate sheet) 4ZG.&O
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: SFD Certification Number:
This certifies that this fire and life safety system ixected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
m
v
standards. Discrepancie �ecl a�ncl hav n ort ot e ding Owner/Responsible Person for corrective action.
Signature of Tester- Phone # (206) 726-0940
Testing Agency: :R% �00 and D9ff&9.W1ceS IKCI MailingAddress: 610012thAve.S..Seaftle.WA98108 Z
The r is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
r
1 . The extingu 9 system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
s s
place and hisg:n�.gt tyeen removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective aCtio shall be taken immediately.
intended use. 9. A record of the monthly inspecti ns is to be ke the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person perfo the inspecti and any corr e i red.
4. Observe system, checking that no obvious physical damage or condition exists rming
that might prevent operation. AUTHORIZED V,-
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE _ -
FIRE DEPARTMENT Cnl—"
ler
HOMISii"CO. Serving Bi Edmonds, and
Mountlake Terrace
FIRE
sr.K4 www.FireDistrictl.org
LOCATION:
BUSINESS NAME:
FIRE -PREVENTION
11-N�Ptctlb-N 'REPORT
12425 Meridian Ave S EDMONDS
Everett, WA 9848 BRIER
Phone (425) 551-1200 ,0 MOUNTLAKE TERRACE
[I UNINCORPORATED
Fax (425) 551-1272
FREQUENCY I STATION 1, SHIFT
300 Admiral Way Suite 11M D8020 Annua 17-B
QO `� SCHEDULED
L-amiTVg-didg�"i,Cr;- PHONE: I Jan 2014
CkR70\
16
D E DUE
—
MAILING
ADDRESS:
398-Adfnir�, �-_ ��mridLWA-98&28-
10�lz S 1z 59.0-1103 �,
LIFIR 0
t7to 0II'j
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
CURRENT
HOME PHONE:
,,KEY ACCESS-2:
FQM5 PHONE-
CITY YES NO
BUSINESS
F__j
0
EMAIL:
LICENSE
I
1
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
L
FIRESYSTEMS;
AS3/09FA31019FE L11/9, FDUE.�uw
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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:
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:
DATE:
DATE:
3
VIOLATIONS
1 15
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED E] YES El NO
8
FIRE DEPARTMENT COPY
FCertification Given: RED[:] YELLOW[] WHITE01
COMPLETE
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
&V mod and Duct Services, Inc. Fire Suppression Installation & Service [CONFIDENCE TESTO REPAIRS El
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy
Occupancy Address: -900
Responsible Person:
Building Owner:
Building Owner Address:
Testers Name (Please Print):
Sy I stem Alarnn'<�Y�esoNoE] O�Centr�alsttion�monitori
Control Panel m Model
Extinguishing System ManufacturerAid.Salt System Si;
Location / Height of Range hood: & (�, ,�J& //
City, State, Zip: 1-- 4 P" Q PJ 65 Ly"It 11 Ifu LU
Phone Number: !V zs-- 2 21 -!!�% 930
Phone Number:
City, State, Zip:
YesLZ NoF1
Number: SCP- L'LO
name:
of Alarm P;
I.I.L. 300 System? Yes/NoF� 1.11.30OComplizint?Yes/N.E] Chemical Type: WeteDyE]
F2, Z -
Is p assure gauge indicator in operable range? IA- - -
*0-
NoM
12 year hydro date of cylinder. zoov
Q .1
Is there chemical inside of the cylinder?
Yes 2r
117-
No E]
iA- Fere —ha nd- po RAD
_qable extinguishers p!9p serviced?
Yes 2 No"M
Weigh CO2 Or nitrogen cartridge. NA E)
WP all cooking surfaces protected? If not, give owner full
Yes2t No
No visible signs of a system fire or system tampering (if signs check no).
ndconduit.Are-all
Check all piping a piping and conduit immobilized welth-
Yes
yest��
No F-1
information.
_pj(jqedure verba I iven to restaurant personnel?
k9
Yes
-;? No[]
proper hangers and brackets.?
Was UL 300 compliance explained to owner or manager?
YesV NoE]
Are all protective covers present on nozzles?
Yes.Z
No [:1 L Gas shuts down upon system activation? K I A yp
Are a-11-n—ozzles-c-hecke'd in the proper position?
Yes
Noo j
Electric power shuts down upon system acti tion? NA
em actv tion
No
Yes No
rN
Does system have adequate volume and/or nozzle coverage?
Yes
No E]
01 -an ge h o od t i ed It o- b W I cl-i n g - -a Is rm p a n e I ?- h NAM
n 1?
Eing�a�panel?
0
Yeso No C
1 Are all appliances inside of the hood protection area?
Yes?
No
Range hood activation signal received at bui rm NAEJ
rm p
YesK NoD
Have fuse links been replaced?
Yes
No
Class-K - exting6�iisher present?
_U
er&ul�o 0
s system operational from terminal link?
YesT-�
No I
El
Grease buildup in group:
Was system operational from manua! remote.)o-
Was; 0 3rational? (A
Yes .
Opt
No F-1
. no
Light Medium Heavy, recommend cleani
of last deanihg.—.2-; -C - I" AJT
_syqt6rhandm1crosVvitch pg_____
�f]'7*�s
_ye
0
--Date
Are cleaning intervals NFPA
Yes Ej No[
Is system visible and free from obstruction?
Yes
0
0,
within standards?
Is theinsoection and service taa n At c inder? YY6S 0
e_yj
Previous Confidence TestC�o _anyAle '-in 91 19675�
hnici n-!L-
Tp _q-----------------
ProbleTs Found: (if additional room is needed, please add a separate sheet)
oil �1 tJol- AUI- AZA, fb QA *A — rZ /4,& V1 k&" A(Zess 6t AkAt Srlk,�A—
Corrections Made: Date Corrected:
Corrected By:
Customer has
SFD Cerffica)ion Number:
This certifies that this fire and life piety 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. Discrepanc . s a e n d and een reported to the building Owner/Responsible Person for corrective action.
Signature of Tester: C -t2egft Phone # (206) 726-0940
Testing Agency: -R&T Hood and Duct Services, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing th i spect' nd any corrections required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE V 495���
FIRE DEPARTMENT COPY
09!
p
FIRE PREVENTION
Sei�-ving Bilei: Edmonds
SNOHOKISH CO.
(
12425, Meildia'n Ave S,
INSPECTION'REPORT
kEDMONDS
-FIREI Mountlake Terraceand
Evereft, WA 98208 y".
0 BRIER ,
e Town of Woodway
T trww.Fh-eDisu-ict1.oi-g
DISTRIfl,
Phone (425) 551-1200
El WOODWAY
[1 MOUNTLAKE TERRACE
Fax (425) 551-12i'_�
0 UNINCORPORATED
r FREQUENCY
STATION 1, SHIF1
LOCATION: 300 Admiral Way
100,
365
17 D
I
BUSINESS NAME: Landing Bldg, The
PHONE: 4257759127
SCHEDULED
DATEDUE 0 01101112
MAILING 2829 Rucker #100
UFIR � 509 1201
ADDRESS: Everett
98201
BUSINESS OWNER: Gait Enterprises
HOME PHONE: 4255510817
PREFIRE
EMERGENCY-1: blindsey@coastmgt.com
HOME PHONE:
�'CURRENT
KEY ACCESS-2: Lindsey, Barbara
HOME PHONE: 4253393638
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE AS 3/09 FA3/09 FD LkBx
FE - I -
SYSTEMS:
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
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTEFTSENT
CITATION ISSUED
NUMBER:
4
2
6
2
61
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
,-,e
7
LETTER NEEDED [] YES NO
LETTER NEEDED YES NO
8
FIRE DEPARTMENT COPY
W- �--Pmw, 016 11 = W=- 0- a
04/12/2010 07:49 2062911498 SIMPLEX GRINNELL PAGE 13
tqco—
F ALARM SY$YEM
SimlocGrinnell, LF
9520 1 01h Ave So,
Fire &
-REPORT OF SPEC-M-ON
secuffty
Seattle, WA 99108
Voice: 206-291-1400
Fia: 206-291-1500
www.simpZ=grinneH.com
Date:.2/15/201
Occupied as: The Landing
Address: 30kAdmiral Way City: PA=ncl5
County, Snehomi Zip: 98020 Telephone: 4;L.L5 1.08 11
Building Designation (if more than one building):
Inspection by: K.Fi&LD.Brown Date of Inspection: 2/15/10
I - Type of Test: Monthly [I Quarterly 0 Serni-Annual D Annual 0
2. Type of System: Non -Coded M Common Coded El Selective Coded D
Dual Coded E] * as pertaining to Chapter 212-14 WAC
3. Local Fire Department: Edmonds Fire DM
4. Fire Department official contacted: EyeraM Scw'q
5. Test Received at Fire Department: Yes No
6. Master Box Reset: -AM _PM
7. Comments / Explanation Of unsatisfactory results and action taken. etc.: N_Q Umblems
fbund dM&& this jUV2gfio
Corrections Made:
Date Corrected: By:
(page I of 2)
M I A 1111111111U., ITA-RAP-141) - 10=1 smaw-
04/12/2010 07:49 2062911498 SIMPLEX GRINNELL PAGE 14
(page 2 of 2)
NEEMILUM
Control Panel
Dialer
1
2115/10
DWXR5SL
Manual Station
Heat Detector
Smoke Detectors
0
F-
Audible Alarm
Devices
2/15/10
Viking
Visual Alarm
Davices
El
Automatic Door
Releases
V15110
El
Univerlml Batt.
Charger
2/15/10
DMP
Generator
0
Conbul Station
Interconnection
2/15/10
Evergreen, Sec.
Sprinkler Water
Flow Switch
2/15/10
El
Viking
Sprinkler Gate
Valve
supervision
2/15/10
Kennedy
Switch
Annunciators
2/15/10
cl
Dialer (DM?)
Other
El U
+
8. Automatic Time Delay of General Alarm minutes. None Installed
9. Test of alarm system on emergency power, Satisfactory; Yes g No
10. This is to certify that this fire alam system has been properly inspected fbr reliability covering die
items fisted in this report and is consistent with NFPA Fire Alarm Maintenance Standards.
A. Sigm"re of Owner or Repmentative:
B. Signature of Fire Alarm Fim Representative. I 'A Tl��
C. Name of Firm: SimplexGrinnel,!LP Elect Ueen No.: sl��&Z;ry --N
"20 10th Ave So N188,
Seatde,WA 98108
Phone: 20&291-1400 Fax- 206-291-ISW
Wet a-Mm- 1A - 1111164151 6=1 am
04/12/2010 07:49 2062911498 SIMPLEX GRINNELL PAGE 15
Sintpleff0grineeZIBE SAFE.
Talk# 22287W Quarterly E] Annual 0 3 Your [j 5 Year E]
SFW 1=me REPORT OF SPRINKLER INSPECTION DaU
CUSTOMER The Lending R
BUILiXNG /LOCATION
r8WPLE7XXCRlNNGtL O"ICE 0450
M
STREET 300 Admiral Way - 9520 10th A—ue S. Suite 1001 seams, W
CITY I STIPROV I ZJPIPC Edmonds WA 9=0
kTTH: Barb Undeav,
I - GENERAL (To be. anewred by customer.)
a- Have there b8W any Charges In the OccuPancy deavilicallon. machinery or operations since the lam Inepection?
b. He" them beian any changes or mpaim to the fine protection gy6lisme since the lost I, is"? ,
e. If a ft has Occurred since ft last insp9dion, have all dem!ed sprinkler systern components bom replaced?
fitanw-red-pe-to aborc.11stcha no In8sCdOn13- I
d. Has the piping in all dry systems, been Checked for pro -per pkh within the past five Mrs?
Dan last chocked: (check moominended at least eviery 5 years)
a. Has the piping In all ayalams been chocked for CWructive mallrigis?
Date IM chocked, 91152009 (chec* required at least WMjy 5 ywre)
L Have all fire pumps been Iseled to full Capacity using how streenr s or Raw meters within the past 12 monft?
g. Are gravity, wfte of pm"ure tanks protected from hearing?
h. Standard sprInklen; 60 yam old or older? El OR (20yr) E)OrY (10 Yr) ED-325FIlM (Syr) OCCROVA smi't. (5yr.)
k I ogling Or POPISOOment required for these typea of sprInklerej
I. Are any oft high temperature soldier sprinklers regularly W9068d to temperaWme now 30OF114OC?
I. Hays galges been leated, calibratat! or replaced In the bet 5 yeam? Date SMS/2009
k. Alarm valvac and associated trim begn InteMelly inspected Past 5 years? Date
I. Mack V11hrus Intemally Inspeabad In the last 5 yam? Date
m. Has the private fire main been flow tested in last 5 years? Data
n. Standolloo 6 year requirements.
Is
1. Dry ftendpipe hydrostatic test
2. Flow but
3. Hose hydrostatic Wet
4. Pressure control valve test
Date
Date
Date
Dole
6, Pressure reducing vow test Date
0. Have pressure reducing valves been tested at full Cow within the past 5 years? Data
q. Have magWr pressure (educing VaNn been tested a(M 4ow within the past 1 year?
r. Have the sprinkfor systems been wtivinded to all area of the building?
a. Are On bulkilng areas protected by a wet system heated. Including its blind offics and parlin
I. Are all exleirlow openings ptotected against the entrarm or cold sk? slier view?
2. CONTROL VALVES
0
01
o-
Ell
a. Am all sprinkler system main Control valves and all other valves in the appropriate open or Closed position?
6. Am all control valves sealed or supervised In the won position? IMMI
]I
Location of Control Valves.,
NE Corner of Mg PIV
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04/12/2010 07:49 2062911498
SIMPLEX GRINNELL
I
PAGE 16
Simplex6rinneffSE SAFE.
REPORT OF SPRINKLER INSPECTION
WATER SUPPLIES
Ffas 2 014
G- WWO(SUPPOYSOUFC867 City. PPONSM Fire Pump & Tir*—=�—
Gravity Tanir El
Pleasure Ffre Pump & City
Main Drain Test Rwub Made During This Inspection
11
Pressure Fire Pump & pond
Tom
—1
0
Size 1uppli F—R—eplaual ftethWUMM TOM Sterile Supply
Pipe Test PAN$= Pro"" to Sbdc Pipe S:=
I
Raturn bm to
Located Poe Teat Pressure Pressure
Beim Pfessq Locam
UFO Pipe
—room
Slow
winsce Before
2 Inch
Pleasure
4. TANKS, PUNWS, FIRE olEpT. CONNECTIONS
a- Do &a Pumps, gravity, suff8cs Or PFUSIUMS tanks appear to be In good aftmal conditions?
TES1 NA I NO]
b. Are 0". sUffacs end PfMUre tanks at the prOper pleasure lintUor VAter levols?
c. Hu the eforage tank been irdemally Inspected in ft lost 3 yra. (unlined) or 5 yra. (lined)? Dath;
d. Are the dept. connections in 810110ectory condition, COUP111198 JIM, awe or plugs In plam and check vahfw light?
o. Are fire dept. conneclJons vISIbb and accessible?
5. WET ByartmS
a. No. of systame: I Make & MOW V'Mng Mod F-1
b. Are coldi wmilm vi �sfn Ift �Wpmpflgts Open Or d0sW posillon?
If closed, has piping been drabwd?
lil U
G. HOO the CuWbxw been Advised that cold "ather valvaq am no fficommend ?
ad
d, Have ON IM anifilresm 0"terne ban tested? Dais:
The Drft*ftm tub Indicated pmtection to: (Note tamp & type for each. Examole: Aarm 2ne- A—i
a- Did alarm vMvc%. water ffQW Marm devices and rotarde i—ml so'b-slactorily?
0. DRY SYSTEMS
a. No. of systerns: Make 6 Model.,
Data Mgt trip mate 0 Partial Lj Full
b. Are ft 0irpressure and pftirW %volorlevals normal?
c. Old the air compressor operob &Misftdoflr
d. Air cOmpmeacroo d*Cked? El Bait? F
a. Wale Awdilary I Low Point dralm dralfted during this Inspection? No. of Drains;
--2)
4)
F. Did all quick Opening devices operate S&IjefactoriW Make: Model:
g. Did all the dry valves operate saveaclofily au" this inspection?
h. Is the dry valve house heated?
I. DOdFYVONBBaPP@attObopmtoofodtmfnfnm;ding7
7. SPECIAL SYSTEMS
a. No. of systems: Make & Model;
TVP%b,Wa volvestestedasFaquired?
C. Old all heat responsive system opersta sub9ftclority?
d. Did the SUPOrvisOlY hWuf*s Operaft duFlng testing?
a. Has a supplerwrtal lost form for this s)%twn been completed and provided to the custonw?
(Plasm attech)
Awdlilary equipment No. Type:
Location
Test reoulls
S. ALARMS
A. Did the water motors and song operate during testing?
b. Did the electric alarms OPM1119 dUffing ISA111197
c. Did the supervisory allemis opemb during testing?
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0 4/12/2010 07:49 2062911498
SIMPLEX GRINNELL
PAGE 17
9. SPRINKLERS -
SJfMP10X6F1Dn011 HE SAFE.
REPORT OF SPRINKLER INSPECTION
a- Do sprinkWe genwGily SPpeer to be In good exlernal condition?
b- Do spw*Iers generally appear to be free of coffoalop. paK or boding and visible obsuuctlons?
c. Are exbu sprinklers and sprtnkfor wnanch avelf" an the pmnim?
(A size. fmlsh, tamp, brand. of swrg hftdv)
d. Does the expoW eXterb? Conclition of piping, dralin valves, chock valve@, hgngsm. 1310"M gulges. open
and MIGiners appear to be saW�otory?
e. Does the hand hose on the sprinvor system appear lo be in saftfactory condIllion?
I. Do" thate appear to be propw dexrj"cq b91ween ft Wp of all StoMge and the apflnkl@r de%ctor?
10- EXPLANAT" OF "NO' ANSWERS AND DEFICIENCIES. (Sedloneldthruft
11-THENGPECi SUGGESTS THE FOLLOVANG NECESSARY IMPROVEMENTS. THESE SUGMTIONS ARE NOT THE
RESULT OF AN ENGINEERINO SURVEY AND Do NOT REFLECT CONDITIONS ABOVE CIEPJNOS OR IN CONCEALED SPACES:
In tenant spaos, 210. there *(a 1%* heads go cbse (4'apart) and one needs 10 be rafocgtgd go he
caned so they Ste Further sped, Min. mQuImnant Is 6'.
12. ADJUSMENTS OR CORRECTIONS MADE:
Pop 8 OF4
13. LIST CHANCES IN OCCUPANCY, HAZARD OR FIRE PROTECTION SYSTEM, AS ADVISED BY CUSTOMER IN SECTION i
14. INSPECTION DEFICIENCIES AND OUGG63TED IMPROVEMENTS WERE DISCUSSED WTTH T"E CUSTOMER ICUSTOMER LYESI NO I
REPRESENTATIVE.
N NO, 030MIL
I111PORTAffr MOTU TOCUBTOMER CAdwierackmA 'a
Peftmied wam of a Ifimponvy mWm, In wMich cae Cudmw w*wAladgm that W of mlorner's sYstem may fim been IyWwwocl or Is *sfflim WPvWo W mpg w1less =vim
MDEW#ty ANO OTHER CONDITIONS AT THE RMRSE IUDEfEmD OF
cornoetad. CUSTOMERS ATTENTION 18 DIREMO TO THE LINNAYNM OF LABILITY. WARRA1111Y, urd wvlw can be
THIS REPORT. DIs Apurneol has bw dfown up and executed In Eqbh at the mqml of and Oth the full wncumm of CwAnw. Ce contisd a 60 r6do an anqW 6 Is deminoe
et MO Isuentimert du client.
CUSTOMER fig
PRINT NAME V"S&LEXGRINNELL INSPECTOR SIGNATURE
DUPLICATE TO:
STREET:
CITY, STATE AND ZIP:
ATTIN�
9071007 (Rev.61M)5iMP16X6rftJ1&11 BE SAWA. LP. AR f4t"newrved
MINITISTAL
04/12/2010 07:49 2062911498 SIMPLEX GRINNELL PAGE 18
I% AV
SAf#np1eK4fffffnn4qfjF ASE SAFE.
121*001 "IftfIV [3 Annual [Z 3 Year 0 6 Y., rl
ISN"02- REMT OF SPRINKLER INSPECTION
U*TOWR -- Winwood 2 Datel I III
NO I LOCATION CTOR WAI! Jacob A. Ofter
ET 14M Und Avq W IMPLAIMMINWELL Opp#" 0, #458
L9520101hAvenue U11811100. S991]08
18WROVIMPIPC Ettimo wA �100. seem:! wk-wq
qf"Aft 98026 --
ry"; Hammond
a MIAIL�&4 -- Om 0 208.201 1AAA
C QMRAL (To be answww by Customer.) I-191maw z F
a' Have thars' be" any changes In On 000upency classifiegliOn, Mw*4wy or qmrapmg sin" the as, I
on?
b. New ftm bee4 any dienges or repairs, to the fire pmUction SpIgme since the as, M on?
$pect
C. if a ore ties OCOU Lfb4 sInce the ISO In"quo", have all da wa softlw
U@tCh System OOMPOnOnth n F000000
I Has the poing in all di�ft—vfsme been docked fbr prqmr pitch within the OW fen years?
04% lost Cho Uf*AWM (check r000rn ad at least " 6 yge1q)
0. Has ft p6ping In W=
IVS on C1100ad ftr obstructive materials?
Daft MW docked: r1known (check ftq at least every 5 years)
C Have 40 WO PUMP$ OW liffilted I capacity using hoes, oreems or flow mew Wn the put 12 month*?
C. Am gravity, surf&* or pressure ton pruhpftdkcmfteozlng7
Ic
h. ftndard sprinklers 60 yagro Old or r?OQR(20r) oory(joyri 325FI,03C(&A []Cormlvoa t.(5yF.)
(TIesting or replaosmant nWbW for *@ Was Of BVM*WnL) rw
1. Are wW wdm 111911 temperature solder apd m regulgey S)VO&W 10
ad to raltures now 30OF114SC7
j. Have gouges been Wled. c0brated or rgog In the jut 6 Vast&?
It. Alan velves And associated tdm been Irdame DOW
Inspected past 6 to? Dim
L ChOCk valves internally inspected in " last 5 yea ? Data
M. Hasths PfWftft Main been flowlestedin "isys ? Dam
n. Slendpilm 6 year Mquhumnis,
I - Dry slancip" hydrostsilc met Date
2. Flow led Date
3. Moo byd=WlC test Dam
4. Pressure oof*W vahra mal Daft
S. Pawsure reducing valve Not Date
OIH&v*PrulumWUC409v&NgfWsPtslt@d [fUllflOwwflhlnl paslSywre? Daw
q, Have maqW pffinurg reducing V&Mm been to at full now WMIR get I year?
r. Have the spinkler system been wdanded tD MM of the bUllftg7
a. Are the building arm protected by a wel heated. IncludIng to blInd W and ponmetw are"?
t. Are all axwer Openings pro! against entrance of cold gig?
2. COUML VALVRS
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Wesffall, John
From: Westfall, John
Sent: Monday, June 19, 2006 9:21 AM
To: Smith, Mike
Subject: Landing Sprinkler Permlit �30@ AId"NffilQ,9yMPo-
Folks have been doing work -creating dry storage nook and -capping 1/2" drop as called out on the sprinkler annual test
report.
Ken Briner Simplex-Orinnel will be obtaining permit for that sprinkler in dry storage.
John
Message Page I of 1.
Wesffall, John
From: Westfall, John
Sent: Monday, June 12, 2006 9:09 AM
To: 'shabrown@tycoint.com'
Cc: Smith, Mike
Subject: FW: The Land inJgL3@,@1Ad mt, 'riallkany Edmonds WA 98020
Thank you, Shawnee. Yes, please convey to the owners that sprinklers are required throughout the building.
If anyone has questions they may email or contact me.
John Westfall
Edmonds Fire Marshal
425 771-0213
----- Original Message -----
From: Brown, Shawnee [mailto:shabrown@tycoint.com]
Sent: Wednesday, June 07, 2006 11:16 AM
To: Westfall, John
Subject: The Landing 300 Admiral Way Edmonds WA 98020
Dear Sir,
During the annual fire sprinkler inspection for this c ' ustomer, our inspector noted that the kitchen storage room and the furnace room
do not have sprinkler coverage. The customer is asking if this is something that you as AHJ are going to require them to install.
Copies of the inspection report have been mailed to your division but I can certainly fax you and additional copy at your request.
Please email or call me with your input or questions.
Thank you,
Shawnee Brown
SimplexGrinnell, Seattle
Service Sales Representative, Deficiencies
Ph 206-291-1437
Fax 206-291-1408
6/12/2006