300 ADMIRAL WAY STE 2113a
FIRE PRtVE* N*TION
.k
INSPECTION REPORT
Ser� ... —.r, Edinonds, and 12425 Meridian Ave S
SNOHO Co.
0EbmONDS
Mow7dake Terrace Everett, WA 98208 0 BRIER
FIRE
Phone (425),551-1200 0 MOUNTLAKE.TERRACE
[I UNINCORPORATED
DIa.-jr.LPR k--'�;T WWW.'Fire'District].org Fax (425) 551-1272
LOCATION: 300 Admiral Way Suite 211 98020
BUSINESS NAME: Arnie's At The Landing
PHONE: 4257715688
MAILING
ADDRESS: 300 Admiral Way, Suite 211, Edmonds, WA 98020
BUSINESS OWNER: Lumm, Fran
EMERGENCY-1: 4— LUC-
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED: '1� I et
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 10/15 HD UL300 10/16
FREQUENCY 'I STATION& SHIFT
Annual 17-A
SCHEDULED Jan 2017
DATE DUE I`
UFIR � 161
C
HOME PHONE:
HOME PHONE: 20233-tt52IJ--
HOME PHONE: 17
CURRENT.
city S NO
BUSINESS
LICENSE A E
INITIAL INSPECTION DATE
I - ;z & - /�,
FIRE PREVENTION
SNOHOMISH CO. Servipg Brier, Edmonds, and 12425 Meridian Ave S 11�$PECTION REPORT
4flEDMONDS
'Wountlake Terrace Everett, WA 98208 13BRIER
FIRE Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DISTR 11111 www.FireDistrictl.org Fa� (425) 551-1272 [3 UNINCORPORATED
FREQUENCY STgIONA SHIFT
LOCATION: 300 Admira . I Way Suite 211 98020
BUSINESS NAME: Arnie's AQ;he Landing PHONE: "4257715688
MAILING
ADDRESS: 300 Admiral Way, Suite 211, Edmonds, WA 98020
BUSINESS OWNER . Lumm, FranL/ HOME PHONE:
Annual i—I 7-D
SCHEDULED
DATE DUE � Jan 2016
U FIR � 161
EMERGENCY-1: Rennington, Bill
HOME PHONE: 2063311531
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO'
EMAIL: 4) IJ�J in r
n f Cc�\",-
BUSINESS T-1
LICENSE K-J
PERSON CONTACTED:,
2t KeN I
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
(V
NRE SYSTEMS: FE 9/13
nqtp I qczt Sprvirpri-
HD UL300 10/15
.LQAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
5
6
-4
6
7
7
I AGREE To cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
DATE DUE:
2nd RE-INSPECTIOR
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:A
PERSON
CONTACTED:
PERSON I
CONTACTED:
I
INSPECTOR: 0 W)- I/V
INSPECTOR:
INSPECTOR:
2
DATE:
DATE
DATE:
VIOLATIONS
5
6
VIOLATIONS--
3
5
6
17 ___ --I
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
5
DATE:
CODE
SECTION:
7
RETURN RECEIPT
RECEIVED
__F8
4
RA
DISPOSffi1ON.
7
8
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES 0 NO
Certification Given: RED El YELLOW� WHITE E7:1
V COMPLETE
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
&THood and Duct Services, Inc. Fire Suppression Installation & Service CONFIDENCE TEST 51"AiPAIRS—EM
6100 12th Ave. S. Phone (206) 726-0940 Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Seattle,WX 98108 Fax (206) 767-2607 Filter Sales & Service DATE: Loll -9 /1/-
Occupancy Name: ArA il e I 's J -F-r-
Occupancy Address: �1316n 1QM;r11y tk)OA-e- fft/1 CltyState,Zip: &V1MChj-5 el 2-jo
Responsible Person: Cj Phone Number: 'Y15-77Z-,569,T
Building Owner:
Building Owner Address:
Testers Name (Please Print): 1&4 Eh4uK I
System Alarm? YesPj---No El
Control Panel manufacturer:
Extinguishing System Manufacturer
Location / Height of Range hood:
Central station monitoring? Yes F] No F]
Model Number:—
L.
Phone Number:
City, State, Zip: 14 4
SFD Certification Number: SCP- R-a6SY7
Monitoring company name:
Location of Alarm Panel:
�o - I.I.L. 300 Compliant? Yes F� No E��Chemical Type: Wet 2<0
Is pressure gauge indicator in operable range?
--r--- -
Yes;,V,�fi-. L]
-
12 year hydro date of cylinder.
Is there chemical inside of the cylinder*?
Ye No
1 (7 k9 k OZ-
Were hand portable extinguishers properly serviced? NA El
Were If full
Yes [��- No
Yes 01' No [j
Weigh CO2 or nitrogen cartridge.
NA [:] -;&
all cooking surfaces protected? not, give owner
No visible signs of a system fire or system tampering (if signs check no). s r-;��No—F
Check all piping and conduit. Are all piping and conduit immobilized with Yes Eq--No E]
information.
Was operating procedure verbally given to restaurant personnel?
Yes E�-/No E]
proper hangers and brackets?
Was UL 300 compliance explained to owner or manager?
Yes U�No F
Are all protective covers present on nozzles?
Yes E�" No E]
Gas shuts down upon system activation? NAE]
Ye N o 10
Are all nozzles checked in the proper position?
Yes No C]
Electric power shuts down upon system activation? NAW
/,I*es [:] NoF
Does system have adequate volume and/or nozzle coverage? Yes ET' No Ej
Range hood tied to building alarm panel? NAQ�
�jsF No L]
Are all appliances inside of the hood protection area?
Yes 0--' No E]
Range hood activation signal received at building alarm panel? N A VU
j-Yes F-1 No El
Have fuse links been replaced?
YesE�' No Ej
Class K extinguisher present?
Yes R No
Was system operational from terminal link?
Ye&F!r No E]
Grease buildup i group:
H�a�ecommend
Was system operational from manual remote?
Was system and micro switch operational?
Yes No
NA <,ff NoF
Light Medium— cle 9—
Date of last cleaning C*,c
Is system visible and free from obstruction?
Yes 21' No E]
Are cleaning intervals within NFPA standards?
AJ-,
Y�
Ejo 1:1
L
Is the inspection and service tag on the cylinder?
Yes Rr' Noo
Previous Confidence Test Company & Technician-f,?-T-
. I r-t I I.;
—
IN
INS
in;
mom
N
on
MEE
N
Found: (if additional room isjeeded, pie s!5rte sheet)
I -
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: r SFD Certification Number:
I I in I
Wed —11cl 6), 1,01,30 ArA
This certifies that this fire and life safety -t— h.. h— -hpear
I �iectecl for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies are n ne Responsible Person for corrective action.
Signature of Tester: - - Phone # (206) 726-0940
Testing Agency: R&T Hood andZucL-QeP,;4-r. 11; Mailing Address: - 6100 12th Ave. S., Seattle, WA 98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the mont y inspections is to kept reflecting the date in?pecte inititals of
r, d
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing th inspection and orrections requi ea.
4. Observe system, checking that no obvious physical damage or condition exists 1011A,71 (-p
that might prevent operation. AUTHORIZE
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATUREZ-- t-ffs
FIRE DEPARTMENT COPY
871400d and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Nern '01!1' le
Occupancy Add.L.: Adh7j,pa
Responsible Person: 1#—,�
Building Owner:
Building Owner Address, I I I I I I
Testers Name (Please Print): /74"e"k 'e�,j -ML, ii
COMPLETE r��ication ' Given:REDEJ YELLOWD WHITE
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service CONFIDENCE TEST 0 REPAIRS
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE:jf0/
Q)AZI City, State, Zip: 1Vj0,26:?"1A,
d:y- Phone Number: W.25 - 7171 , `S-A�M
System Alarm? Yes �;�cE] Central station monitoring? Yee,45--No El
Control Panel manufacturer: Model Number: —
Phone Number:
City, State, Zip: 11!
SFD Certification Number: SCP- L7, - 4:2Z2
Monitoring company name: -
Location of Alarm
Extinguishing System Manufacturer A NJR 1,2- System Sizaf'--3� LI.L. 300 System? Yes ��- I.I.L. 300 Compliant? Yes [4ffof] Chemical Type: Wet �ry [I
Location / Height of Range hood:
Is pressure gauge indicator in open
Is there chemical inside of the cylin
Weigh CO2 or nitrogen cartridge.
No visible signs of a system fire or!
Check all piping and conduit. Are al
proper hangers and brackets?
Are all protective covers presen o
t �
Are all nozzles checked in the pro
NAE1
tampering (it signs check no).
and conduit immobilized with
- position?
Does system have adequate volu e and/or nozzle coverage?
pr,
0
it,
Are all appliances inside of the hrod ction area?
Have fuse links been re I d-1/
. �face ti
Was system operationa rom minal link?
Was system op nual remote?
Was system an 1.1erational?
Is system visible and free from obstruction?
Is the inspection and service tag on the cylinder?
Problems Found: (if additional room is needed, please add a separate sheet)
12 year hydro date of cylinder.
Were hand portable extinguishers
Were all cooking surfaces protect
information.
Was operating procedure verbally
Was UL 300 compliance explainei
Gas shuts down upon system acti
Electric power shuts down upon s�
Range hood tied to building alarm
Range hood activation signal rece
Class K extinguisher present?
Grease buildup in group:
Light — Mediu
Date of last cleaning —
Are cleaning intervals within NFP)
I
Previous Confidence Test CompEl
liven to restaurant personnel?
to owner or manager?
ation? NAF-1
tem activation? NAE]
anel? NAn
ed at building alarm panel? NAD
— //1
YesF-1 No[]
Yes [:] No E]
Customer �as declined repairs X
' L
Corrections Made- Date orrecied: 10.1 L?J 1,6 Cor,ected y: SFE) �ertification Number: q
0
V:�
U
This certifies that this fir`e-and life safety system.4as bee../poperly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies are noted and have wner/Responsible Person for corrective action.
Signature of Tester: Phone # (206) 726-0940
Testing Agenc
Mailing Address: 6100 12th Ave. S., Seattle, WA 98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verity 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 a nd 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 Apt reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the spection and ections required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
R
&THood and Duct Services, Inc. NO
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: —
Occupancy Address:
Responsible Person:
Building Owner:
COMPLETE Certification Given: RED E�'YEILILOW E] WHITEE]
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service F-CONFIDENCE TEST REPAIRS EI]
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE:
City, State, Zip:
Phone Number:
Phone Number:
;7/ — !T6
Building Owner Address: City, State, Zip:
Testers Name (Please Print): flok, 6-, e., SFD Certification Number: SCP- :5
System Alarm? Yes 2� No E] Central station monitoring? Yes E] No F-1 Monitoring company name:
C6ntrol Panel manufacturer: Model Number: Location of Alarm Panel:-
%!e-ely 1! r,
Extinguishing System Manufacture System Sizilte li,3 U. L. 300 System? Yes —1 No Ell,
[I'No[:] I.I.L. 300 Compliant? Yes Chemical Type: Wet 2t<E]
Location / Height of Range hood: a,11 A
Is preissuria,gauge indicator in operable range? VE-
inside
Yes LJ No LJ
Yes ff� No
Is there chemical of the cylinder?
Weig,h,'CO'2 or rutrqgqr� paqridge. NAE:[
No visib le signs of a system fire system tampering (if signs check no).
YesE�"NOEI
-or
Check'all. piping and -conduit. Are all piping and conduit immobilized with
Yesl�_ NoLf
proper hangers and brackets? -
YesD-`� 'o F�
Are all protective covers present on nozzles?
Arb�,all`nozzljes �heckecl,in_the proper position?
Yes g--'N . M
Does sys tem have adequate volume and/or nozzle coverage?
Yes L,_-'__No_Fj
Ar,e,a - 11,Appli-ance,s,inside'eof�ttre,hood protection area?
Yes[?" No[—]
Have fuse links been replaced?
Yes NoF_1
We w s s ste m,opefational, from terminal link?
-Yes No E.--
'y
Was system operational from manual remote?
Yes [�?No
Was systern,a-nd r,hicro svvritch'operational? NA
Yes&—Nou
Is system visible and free from obstruction?
Yes [-]I- No
Is the�in`spection� and I se I rvice tag on the cylinder?
Yest;4-NoEl
12 year hydro date of cylinder.
Were an d- portable extinguishers pr op AD
_90y serviced?
Yes � No
Were all cooking surfaces protected? If not, give owner full
Yes E?r'— No El
information.
Was op era ting procedure verbally give n t o res taurant person net?
Yes F�J No
Was UL 300 compliance explained to owner or manager?
Yes [�J" No E]
Gas -shuts down upon system activatidni-1. NAE]
2— No El
Elect ric power shuts down upon system- activation? NAg�
,;,Yes
Yes L;;'- No E]
-
Range hood tied to building alarm,panel? NA
Yes [�j' No
Range hood activation signal received at building alarm panel? NAF�
Yeaqj- No
�Class K extinguisher, present? 4,11100"
, Ye f-�r' No.[]
S_
Grease buildup in group.
Light diurl). H vy, recommend cleaning
Date of last cleaning, V /-/,M; ve_j'q!�
IF
Are cleaning intervals within NFPA standards?
Yes [�J' No E]
Previous Confidence Test Company,kTechnicia,n
MINIM
SEEN
IN
ME
MEN
M
N
0
mom
Elm
Problems Found: (If additio I
a rooLn is needed, please add a separate h t) 10,
'ILO3,C> T;P,
',
ha, Ilk
Corrections Made: Date Corrected: Corrected By:
f4 5&
al�t C0 d, CIA
rr
4!4,,1n0_ fo!-Cgd, /0 "Al )9 r-, cp--�Wrriew- 134'6t-
6,ta� 4�m - 4
Customer has declined repairs X
SFD Certification NAer.0
This certifies that this fire and fe saf ty t has been prcnerly inspft
Ry peHm reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. IDiscrepanc ar � :nds ;;�eenmported t the bui ng Owner/Responsible Person for corrective action.
Signature of Tester: ipdm I f, 7-" = -.1 Phone # (206) 726-0940
Testing Agency: _A&f_H6odin`dbuctServ16e/s'Tnc. -- - MailingAddress: 610012thAve.S.,Seaftle,WA98108
The owner is to perform and keep a written *record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seats are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspection and any corrections required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT 9�0_
COMPLETE
FIRE PROTECTION
R High Pressure Hood Cleaning
&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) 767-2607 Filter Sales & Service
A - I I
Occupancy Name: ex 11 V1 I C.
Occupancy Address: Vi
Responsible Person: Fir ov
Building Owner:
Certification Given: REDO YELLOWE] WHITE
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
FC_0NFlDENCE:rESTZr: REPAIRS:[:]]
D ATE: -3 A? /h �'
City, State, Zip:
Phone Number:
Phone Number:
Building Owner Address: City, State, Zip:
P, � n SFD Certification Number: SCP_
Testers Name (Please Print): iell'&
System Alarm? Yes,�No E] Central station monitoring? Yes Ej No E] Monitoring company name:
Control Panel manufacturer: Model Number: Location of Alarm Panel:
Extinguishing System Manufacturer AA Sy§tem Size,3450 LI.L. 300 System? Yes [?rNo E] LI.L. 300 Compliant? Yes 2<o E] Chemical Type: Wet (!I < EJ
Location / Height of Range hood: A DKt-- wall
d -rl PL
Is pressure�gauge'indicator in operable -range? j4- CIL- --
- - -- - [3 --
Yes No
12 year hydro date of cylinder.
0
Is there chemical inside of the cylinder?
_-i
Yes No
_ -a- _NA0
V hand portable.extinguishers properly serviced?
V
s O_
Y6 O'N [I
n ro NA0_
Weigh d6jor it gen.cartridge.-
I ' 7 1
Were all cooking surfaces protected? If not, give owner full
-
Yes ff No E]
No visible signs of a system fire or system tampering (if signs check no).
, -
`I
Yes No E]
information.
Was verbally tolestaurantpersonnel?.
Yes No
�_ - -1 9, 'A'
con�u�iitfgrea I,pipi 'g:ard�c9qduitjmnnobiIized with
Ch eck-all�pipingsdn'5 d - 'A P
&n
.j
. Yes R No C]
o perating procedure given . .
Yes Ej No E]
foperAm�$eAft'Md t�racRets?
Are all protective covers present on nozzles?
Yes KNor-1
Was LIL 300 compliance explained to owner or manager?
Gas shuts down upon system activation? NA
Ye . s Fo No n
Are,all rioi-zles,,checkdd�in..the�proper position?
Yes No
Electric power shuts down upon system activation? N A[]
Yes F� No rj
Does system have adequate volume and/or nozzle coverage?
Yes rl"O No E]
_Rangeh__oo_d,_ti,e_d to bui-Iding alarm panel? _NA
Yes Noo
Are all,appliances inside.,of,the hoodprotection area?.
Yes 1�' Noo 1
Yes No E] 1
Rang e hood activation signal r eceived at build - in - g alarm panel.? NAE3
Class'K
Ye97 No El
No-0
Have fuse links been replaced?
link?
Yes No
extinguisher present? _-,..'Yes[!
Grease bui in
.Was system operational,frorfi�terminal
Was system operational from manual remote?
Yes Noo
'Yes
group:
Light- �IM a d i H a reconrmend cleaning
Wa�,sysi,�mand,��icro'switchop.e-rati.o.nal? NA[j
NgFj__�
te.of,las't clean
Pa ... iing
intervals NFPA
Yes 1;;��No El
Is system visible and free from obstruction?
I
Yes E� No E]
Are cleaning within standards?
Technician
Is the inspectionran d service tag on the cylinder?
Yes No
Previous Confidence Test Company &
ME
0
moms
Nis
01
MEMO
MEE
m
IN
Problems Found: (if additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire and life f ty y t h is beerthropperins acted for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies are t d h I i(od tc r e lilding Owner/Responsible Person for corrective action.
-0940
Signature of Tester: A-11- jr I— Phone # (206)726
Testing Agency: R&T Ho6crand-Duct Si9rces, lfic7 MailingAddress: 610012thAve.S.,Seaftle.WA98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the m onthly inspections is to b ke t fl ' ting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing theyspection an ar �' �rpctrieoriescrequired.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
SNOHOMISH CO. ervii.ig Briei: Edmond,�rand 12425 Meridian Ave'S
Younilake Teirace Everett, WA 98208
FIRE
PIS . Phone (425) 551-1200
T, I V 11,11'. FireD is tric t 1. o rg .,Fa.y (425) 551-1272
LOCATION: 300 Admiral Way Suite 211 Q8W0
BUSINESS NAME: Arnic*ti AL Ihc Landing PHONE;,, 4257715M
FIRE PREVENTION
'INSPECTION REPORT
'NEDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
MAILING
LIFIR
ADDRESS:
31013 Ad mi raJ Way, Sui Ic 211.
Edrm nds-, 03110.20
BUSINESS OWNER:
Ltjmn� Fran
HOME PHONE: 06— 5'�2_jj34 L 2_6�- -715
EMERGENCY-1:
Arnit's Rrsuiurant
A'
H M�P H 1�0 E: 4,)5r, i &jbtj
_-Z
'CURRENT
CITY NO
I KEY ACCESS-2:
i;;�tk f-e_i%.(t4s4&^
'.P� �,_
HO NE:�2
EMAIL:
BUSINESS
LICENSE El
PERSON CONTACTED:
IN
INITIAL./PEC/�ION DATE
NAME OF INSPECTOR:
e,
FIRE SYSTEMS; FE 6)1 0JHD UL300W-13
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1411z E79
2
2
3
3
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
D E DUE:
EXTENSION
GRANTEDTO-
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED.
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
-
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
2 6
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
\1 LETTER NEEDED [] YES NO
LETTER NEEDED F] YES F-1 NO
I
. FiRE-bt0AkfMENT'CO0Y
R
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
�-!f
Occupancy Name: -
Occupancy Address:
Responsible Person:
Building Owner: —
Certification Given: RED[] YELLOWD WHITE
COMPLETE Z"
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service F-CONFIDENCE TEST 2' RE
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE:
A R A
City, State, Zip: r
�-�O,Apts .11*1 9 0 ;Id
Phone Number: 6 Ff Er
Phone Number:
Building Owner Address: A
�5!!R
City, State, Zip:
_e
A'
Testers Name (Please Print):
?M I
SFD Certification Number: SCP_
SystemAlarm? Ye&' NoEJ Central station monitoring? Ye No F1
Monitoring company name:
Control Panel manufacturer: Model Number:
___Sys____Size3qy__W___ ----- -
Location of Alarm Panel:
�D
Extinguishing System Manufacture-AW9VI
am 1.300 Y,tem?YesE�'N.Cj I.I.L. 300 Compliant? Yes Er_N'. Chemical Type: Wet EJ
Location / Height of Range hood: ......
a,11
s pressure gauge indicator in operable range?
as[
/cC Ye
12 year hydro date of cylinder.
09
_C3
Is there chemical inside of the cylinder?
YesEr oFj Lrj�q� 9 hand pvqable extinguishers pop rvke_d_?__NJA
__ix _pryse
16es a-kio
Weigh C-02 o-r--n-itr-o--e-n-c-a-rtrid-g-e-.-
9
NkEf 1-7-7
�Yo_
Were all cooking surfaces protected? If not, give owner full
Yes E?' No E)
No visible signs of a system fire or system tampering (if signs check no). es No [3
Check all piping and conduit. Are all piping and conduit immobilized with Yes E!1� No 0
information.
Was oqerating ure verball given to restauran perscin�el?
_pjqqe�d
-Was
Yes NoM
proper hangers and brackets?
I
LIL 300 compliance explained to owner or manager?
Yes E?No El
Are all protective covers present on nozzles?
Yes NoE]
Gas shuts down upon system activation?
Ye� 0.0_�
Are all nozzles checked in the proper pqsiiion? .
!,- -----
__:Kes __ __
Electric power shuts down upon system activation? NAF_j
Yes E5 No E]
-_ - - ___ -_ ____ _ - . -, ---
Does system have adequate volume and/or nozzle coverage? Yes No Ej 1
�angeh-oo'*d-tie-d-t-o--b-u-i-ld-i-n--g-a-la-r-m'-pan-el-?-_--- NA -Li
Yes No I
Fallappliances inside of t.he-ho.od p!otection area?
IG
Yes
Range hood activation signal received at building alarm panel? NAE]
Yes, No Ej
Have fuse links been replaced?
Yes E�� No F] I
_Pia s t)Lingui her present?
Yes wo
�W�s s Ltemrnin�FlWkY ----------------
:y from
-Y-es - �00 1
--Y-es- Y-w
Grease buildup in group:
Light bledium H repornmend
cleaning
Was system operational from manual remote?
o
_ �aavy,
—da-te—oi--I�-st-c*iez�ni�-�7-91/,T-,1-5 F &h4 i4lr
LWas_�y�tem and T:ic�qswitch o erational?
�L_ _ �_
NA ::�Y�
Is system visible and free from obstruction?
Yes E?- No E]
Are cleaning intervals within NFPA standards? �,s E�t-<o
1 1� 4" ;--ii— —fl-4.17
revioUs Confidence, Test Company & Technician k
Problems Found: (if additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
Customer has declined repairs X
SFD Certification Number:
A f I
This certifies that this fire gand , safety system has be � cted for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
ns
'in
01 or
prc
standards. Discrepancie oted an een ire C. d t , e b�, III d
,raveT ing Owner/Responsible Person for corrective action.
Ze
Signature of Tester: Phone # (206) 726-0940
T 00
�R T Hoo an, 51A v-
Testing Agency: id DuctS#Fvices, Ind. MailingAddress: 610012thAve.S.,Seaftle,WA98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
I . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the ingpection ajaOwy corrections required.
4. Observe system, checking that no obvious physical damage oi� condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATIL
FIRE DEPARTMENT COPY
AWR�___
FIRE PREVENTION-
'&rving BrierEdinonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO. L_
[]�DMONDS
,�V7 Mountlake Terrace,and
Everett, WA 98208
0 BRIER
/F1REjTj*4fte** th Town of Woodway
�-DIST T
Phone (425) 551-1200
OWOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
I
e- FREQUENCY STATION & SHIF"�
LOCATION: 300 Admg,?al Way
211
365 17 D
BUSINESS NAME: Arnie!s,"' Landing
PHONE: 4257715688
SCHEDULED
DATE DUE 1' 01/01/12
MAILING 300 Admiral Wy #105
LIFIR 10 161 1201
ADDRESS: Edmonds
98020
BUSINESS OWNER: Amie's Restaurant
HOME PHONE: 4257715688
OCC LOAD 202
EMERGENCY-1: Lumm, Fran
HOME PHONE: 2067158311
CURRENT
KEY ACCESS-2-
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE HD 10/11
FE
SYSTEMS: �e -
�NNYAL
I
I
11)
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
27S A, "� f_- 44:z:!)
2
2
-77
3
3
4
4
5
5
6
6
7
7
r— 11
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-INSPECT16N
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTA6,TED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTO R:
INSPECTOR:
2*
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
2
6
2
6
DATE:
CODE
SECTION:
5
7
3
7
RETURN RECEIPT
RECEIVED
6
-3
�4
18
4
8
DATE:
DISPOSITION:
LETTER NEEDE D [] YES NO
LETTERNEEDED [-] YES NO
8
FIRE DEPARTMENT C01py
COMPLETE
FIRE PROTECTION
High Pressure Hood Cleaning
Hood 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) 767-2607 Filter Sales & Service
Certification Given: RED E] YELLOW,,K WHITED]
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
CONFIDENCE TEST2!r REPAIRSE]
D ATE: /0 —,? -12-,
Occupancy Name: AeA8E_---r
Occupancy Address: 300 mw& A* City, State, Zip: ff,0,70
Responsible Person: Phone Number:
Building Owner:
Building Owner Address:
Testers Name (Please Print): _d. 629"1_6<9
System Alarm? Yes ff No r_1 central station monitoring? Yes Z No
Control Panel mandfa�turer: Model Number":
Phone Number:
City, State, Zip:
SFD Certification Number: SCIP- -07=3
Monitoring company name:
Location of Alarm Panel:
Extinguishing System Manufacturer 260T �Z_ System Size-37'3"-3 U.L. 300 System? Ye 59 NoF� I.I.L. 300 Compliant? Ye5&�NoX Chemical Type: Weo Dry E]
Location / Height of Range hood: 6,orle
Is pressure gauge indicator in operable range?
Is there chemical inside of the cylinder?
Weigh,CO2_or nitrogen cartridge. - - 117. - YY - N
No visible signs of a system fire or system tampering (if signs check
Check all pipipg4and conduit. Are all pip , ing and concluitimmobilized
proper hangers,and brackets?
Are all protective covers presentonnozzles?
Are all nozzle�s_oeckecl in the -proper
_posi!ion?,
Does system have adequate volume and/or nozzle coverage?
Are all appliances inside of the hood p-rotection-airew?
Have fuse links been replaced?
Was system operational from terminal link?
Was system operational from manual remote?
Wass stem and micro switch operational? INA
I Y.
Is - system visible and free from obstruction? -
Is the inspection and service tag on the cylinder?
Yes��NoLj
s o F-1
12 year hydro - date of cylin - der.
-Were handportable extingui shers properly_serviced? N 0
Yesz Noo
LYe
.
Were all cooking surfaces protected? If not, give owner full
Yes
No E]
io). Yeso
No El
info - rm - ation.
vith *Y . esZ
NoF
Was operating procedure verbally given to restaurant personnel?
YesZ
Noo
Was LIL 300 compliance explained to owner or manager?
Yes Z
No E]
Yes
-No E]
pas qhqts down upon system _activation? ImA�F]
Ye SO
No ri
YesZ
NoD_;
Electric power shuts down upon system activation? NAE]
Yes WO— No Ej
Yes FZ
NoE]
__Tlaqgq�hpod tied to build-Ing alarm panel?-- NA[]
YesT4
N60
Yeso
No [D
Range hood activation signal received at building alarm panel? NA El
YesV-
NoF_1
YesZ
No ED
Class K extinguisher present?
Yesz
Non-,
YesW___N0_0__j
Grease buildup in group:
Yes
No
Light Medium g Heavy, recommend
cleaning
Yes No
0-
Date of last - cleaning
_4
Yeso
NoE]
Are cleaning intervals within IN, %landa'rds?
s
Ye ;2f'
Noo
YesPf'
-Noo
-Previous Confidence Test Company & Technician
-0-
0,
I
f
I LLLI-It"k,
7
Problems Found: (If additional room is needed, please add a separate sheet) �46 V07_ Zj
lf-A)VC
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: SFD Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies are noteSPO, ha!sJjw-en reocided to the building Owner/Responsible Person for corrective action.
Signature of Tester: Phone # (206) 726-0940
Testing Agency: — R&T Hool—nd Strct TervicFs7inc. Mailing Address: 6100 12th Ave. S., Seattle, WA 98108
The owner is ti� 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 monjhly inspections is to be Wt reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing.Te inspection and a ctions required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZN
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY �
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607 rill
Occupancy Name: -
Occupancy Address:
Responsible Person:
Building Owner:
COMPLETE Certification Given: REDO YELLOWD WHITE
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire, Suppression Installation & Service FCONFIDENCE TEST REPAIRS
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE: / -0 AD
1�6_�- - City, State, Zip:
Building Owner Address: & F I I I / f
Testers Name (Please Print): /-KAcYh/',d 17f,-jah,J
System Alarm? YeTff—NoF-1 Central station monitoring? Yes M No
Control Panel manufacturer: Model Number:
Phone Number:
Phone Number:
City, State, Zip:
SFD Certification Number: scpjy�
Monitoring company name:
Location of Alarm Panel:
Extinguishing System Manufacturer 147 S� L Chemical Type: Wet2_15W 1:1
lejo�&stemSize14?�L7? LI.L. 300 System? Yes4���(J.L. 300 Compliant? Yes RN.-cy
V - 1,- 0---777, - "
Location / Height of Range hood: j J
42 "
X
Ks p!mu're gauge indicator in operable range?
-Yes
12 year hydro date of cylinder.
Is there chemical inside of the cylinder?
Yes F]
NoF
portable extinguishers rty serviced?
n'
Were NAD __�es
F_
No
'[Weigh CO2-or nitrogen cartridge. �A
. _
.
Were all cooking surfaces protected? If ot, give owner full
,e V If 0 t'
Yes
No F]
No visible signs of a syste m fire or system t ampering (if signs che ri�o).
-and
Yes n
N o
in - format . io . n. ---------------
verbally o restauranl:
Was 0
o
Fdhec�allphping co-n-d-u-ItAre- ali piping and conduit immobilize with
Yes
Non
,ivpn personnel?
operating p�ocedure given
Yes
Lproper hangers and brackets?
.d
Was UL 300 compliance explained to o ner, or manager?
to 0 ne
Yes E]
No F]
Are all protective covers present on nozzles?
Yes n
No E]
v 10
at
Gas shuts down upon system activatio
- - ..
? NA
...
e
N., nj
!.Are all nozzles checked in the proper position? . ......
Yes E]
No [j_
ys e
Electric power shuts down upon syste
c
activation? NAE]
a 1"
Yes E]
No F]
Does system have adequate volume and/or nozzle coverage?
Yes E]
No E]
pan I?
Range - hood tied to'6uilding�alir`m pan P- NA F1_
Yes
N-0 M_
Are all appliances inside of the hood protection area?
Yes
No E3
,v . u
t
1 Range hood activation signal receive at building alarm panel? NAD
Yes n
No [I
Have fuse links been replaced?
Yes El
No El
Class K extinguisher present?
Yes F]
No 011
tional from terminal link?
Yes El
No [3__j
Grease buildup in group:
Was system operational from manual remote?
Yes E]
Non
Light Mediu - m H . ea vy, recom me . nd cleaning __
I_Was system and micro switch operational? NAF
Yes n
No [:3
Date of last clearij _ng
Is system visible and free from obstruction?
Yes n
Non
Are cleaning intervals within NFPA standards?
Yes Ej
No E]
I Is the in pectign and serviic@ tagon the c linder?
y
yoso
N oQ_
Previou s Co nfidence Test C ompany & Technician
------------
Problems Found: (if additional room is needed, please add a s eparate sheet)
Correct de: Date Corrected: 1600/12— Corrected By- 4 ; _j �% r_r4 4- SFD Certification Number: H-0= /,,v
., rj�, -,: V (;, ) JAI FILI&A.- rc1.j.,.r9%iAJ IV. W-)
This certifies that this fire and life safety system has
W, n properly inspected for reliability.to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies are __ _R9 ARVA ner/Responsible -Person for corrective action.
Signature of Tester: 7019��� Phone # (206) 726-0940
Mailing Address: 6100 12th Ave. S., Seattle, WA 98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are foundi appropriate corrective action shall be taken immediately.
intended use. 9. A record of the mo hly inspections is to bA 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 e inspection ai d an I orrections required.
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZk
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE LIU J14
FIRE DEPARTMENT COPY
R
&THood and Duct Services, Inc.
6 100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: —
Occupancy Address:
Responsible Person: F=- &4^j
Building Owner:
Building Owner Address: -
Testers Name (Please Print):
COMPLETE
FIRE PROTECTION
High Pressure Hood Cleaning
Fire Suppression Installation & Service
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service
�,- W 4 V -a
System Alarrn? Yes No F-1 Central station monitoring? Yes No
X
Control Panel manu(gctlirer: Model Number: —
Certification Given: REDO YELLOWE] WHITE71
CONFIDENCE TESTING RANGEHOOD
SYSTEM TEST REPORT
CONFIDENCE TEST E] REPAIRAI.
City, State, Zip:
Phone Number:
Phone Number:
DATE:
City, State, Zip:
SIFD Certification Number: SCp- A 0-7001-
Monitoring company name:
Location of Alarm Panel:
Extinguishing System Manufacturer 14pj S LA (_ System Size-2-L
t- 3 +31J.L. 300 System? Y.s&;416E] LI.L. 300 Compliant? Yes E] NoE] Chemical Type: WetZDryo
Location / Height of Range hood:
Is pressure gauge -indicator in operable range?
Yes
Noo-
12 year hydro date of cylinder.
Is there chemical inside of the cylinder?
Yes Ej
No E]
-Were hand portable extinguishers proper I ly sery . ic I ad? NAD
Yes E]
No
Weigh CO2 or nitrogen cartridge. NAO
Were all cooking surfaces protected? If not, give owner full
Yes E)
No
No visible signs of a system fire or system tampering (if signs check no).
Yes F1
No F-1
information.
operating verbally to restaurant
Yes E]
No Cj
Check,all piping and conduit. Are all, piping and conduit immobilized with
'brackbts?
Yes
Non
Was proce - dure - given personnel?
roper rsand,
p ' 'hange
Was LIL 30-0 compliance explained to owner or manager?
Yes
Non
Are all protective covers present on nozzles?
.-Gas shuts down upon system activation? NA[j
Yes
No
971550REU-in-the properposition? Yes
Does system have adequate volume and/or nozzle coverage? Yes
Are all appliances inside of the hood protection area? Yeg
Was system operationa-Iftorn"terminal link?
Yes
Was system operational fro
YesF-1
Was system and,micro swit h rational?
NA Yes
Is system visible and free f bstruction?
e n
Is the inspectionand , ry
17
Yes
Yes.2
No
Electric power shuts down upon system activation? NAE]
Yes
No Ej
No El
Range hood tied to building alarm panel? NAE]
Yes
NoF
No �F-j
Range hood activation signal received at building alarm panel? NAD
Yes Ej
No r-�
Class K extingui sher I presen - t?
Yes
Noo
:
Grease buildup in group:
No F�
Light— Medium— Heavy, recommend cleaning
No Fj-
_Datie�qtlasl cleaning -
No E] -
Are cleaning intervals within NFPA standards?
I I . . . - - - -
Yes Ej
No
No
P r e viou s Co n fid an ce Test Com paKy & Technician
Elm
MEN
ism
Problems Found: (if additional room is needed, please add a separate sheet)
Customer has declined repairs X
Corrections Made: Date Corrected: Corrected By: -A!57. 4XtL&-,ne: - SFD Certification Number: 6 7 00 L
This certifies that this fire qag4oseatety syste Das been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies noteclandh �blfen rogp.0 to the building Owner/Responsible Person for corrective action.
-0940
Signature of Tester: "e Phone # (206)726
Testing Agency: R&TT[6od;ihdV-ucnerv!ces, 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 610 hl s 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 perform 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
-r-
FIRE DEPARTMENT COPY ;
Certification Given: RED[:] YELLOWrVt WHITEE]l
COMPLETE L-NL
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R AAA" High Pressure Hood Cleaning — SYSTEM TEST REPORT
aTHood and Duct Services, Inc. Fire Suppression Installation & Service FCONFIDENCE TEST NQ REPAIRS El
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 P nge Hood and Fan Service & Repair
'a
Seattle, W'A 98108 Fax (206) 767-2607 Filter Sales & Service DATE:
Occupancy Name:
S
Occupancy Address: -Sc) Q iM CA V�.A � Vics-111 W (AhA —7—'4
Responsible Person: Ckj-.A
Building Owner:
Building Owner Address:
Testers Name (Please Print): Cjo\,ic3\-je.Y'
System Alarm? Yes X No[-] Central station monitoring? Yes X No
Control Panel manufacturer: Model Number—
P17e-4r-
Extinguishing System Manufacturer P\\AS\31 S,stem' —S-' U. L. kc
Location / Height of Range hood:
City, State, Zip:
Phone Number:
Phone Number:
S
City, State, Zip:
SFD Certification Number: scp- C, - 01 S (19
Monitoring company name: (N��Lpa ON-e43, N 1;140-,
Location of Alarm Panel:AZ 6n VA-n---n I !rN6w5Z
System? Ye-XwoEl U.L. 300 Compliant? Yes E] No X Chemical Type: Wet K Dry[]
s pressure gauge indica�to�-,indoe.rable.range?
No L3
12 year hydro date of cylinder. -
Is there chemical inside of the cylinder?
Yes?,Non
W hand,portableigxtinguishers properly serviced? NAO
Tkire
full
Yes
Yes E]
NoU
No E?S.
Wei h 0" nk'
9 C 2-or rogen1cartridge._,
were all cooking surfaces protected? If not, give owner
No visible signs of a system fire or system tampering (if signs check no).
g, nd conduit. Are a I piping and conduit immobilized with
Check all pipin A
Yes[Z
Yes
No F-1
No
information.
Was o erating procedure verbally given to restaurant personnel?
__p
Yes_U
No [D
proper hangers and brackets?, -- -----
Was UL 300 compliance explained to owner or manager?
Yes L&
No E]
Are all protective covers present on nozzles?
Yes [Z
No
uts upon system activation?'---
---das-s-6 clown NA
No
�op�r position?
Are all nozzles -checked in,thpjp-
YesM_
NoN
Electric power shuts down upon system activation? NA
Yes
NoF
Does system have adequate volume and/or nozzle coverage?
Yes [W
No E]
L., Range hood tied t building alarm panel?, NA F-1
ye s2,
No
Are all appliances.intide of'the'hood protection area?
YesE2___Nq[]__'
Range hood activation signal received at building alarm panel? NA
Yes 2
No Ej
-No[:)-
Have fuse links been r eplaced?
Yes EZ
No F�
extin guisher p resent?
Was system operitional4rom,termihal link? -,-.Yes,[Z_
Grease builtp in group:
Was system operational from manual remote?
Yes 2
No E]
Medium— Heavy, recommend cleaning
Was system and micro jWitch o rational? NA
pe - -----
Is system visible and free from obstruction?
Yes M
Yes
No r!
No
Dateof last cleaning A Z- -
Are cleaning intervals within NFPA standards'? Yes 25
No EJ
Is the inspection and servic e-tag on the cylinder9
Yes
NOM
Previous Confidence Test C o mpan y iCT"c niicianp"�
T
t
r
I t I
F-
L
vl—
J
-- - -
H11-
4
7",
Corrections Made: Dat C cted: Corrected By: N — SFD Certification Number:
I . 'V E!,
-Wp, . , G-L
awa, V\.AG kA v ]ll <5 u
This certifies that thispb-,and life safety system been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepan es are "t Ind haye b en g rt d t Responsible Person for corrective action.
Signature c - - - � 16., A., �ng Owner/ Phone # — (206) 726-0940
Testing Agency: —R&Y Hood and Duct Sei�lces, Inc. Mailing Address: 6100 12th Ave. S., Seattle, WA 98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately.
intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspection and any corrections required.
4. Observe system, checking that no obvious physical damage or condition exists
thnt minht nrpvpnt nnprntinn AUTHORIZED
Certification Given: REDO YELLOWM
COMPLETE I
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R AAA" High Pressure Hood Cleaning SYSTEM TEST REPORT
&THood and Duct Seirvices, Inc. Fire Suppression Installation & Service FCONFIDENCE TESTM RE
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: 101 10111—
Occupancy Name: Y-1 ry-�t -e,
Occupancy Address: 1A00
Responsible Person: Gm�
Building Owner:
Building Owner Address:
Testers Name (Please Print):
SystemAlarm? Yesf& NoE] Central station monitoring? Yes& NoE]
Control Panel manufacturer: Model Number —
Extinguishing System Manufacturer
Location / Height of Range hood:
City, State, Zip:
Phone Number:
Phone Number:
�=M�
City, State, Zip:
SIFID Certification Number: scp- ItA-M&15
Monitoring company name:
Location of Alarm Panel:
*15Vo El I.I.L. 300 Compliant? Yes E] NoN Chemical Type: wetNDry El
U.L. 300 System? Yes
ls�pressurk�gqqge�incli6atorin operable range?
YeZJA No,
12 year hydro date of cylinder.
04 x
—
Is there chemical inside of the cylinder?
�N
Yes
NAO.
No F-1
�Viere.hand pqirta�bleextingqi�hers properly serviced?
Were If not, owner full
---Y,
Ye- (NL�,j
Yes&
-
NoO
d
9 (.j2';o'r'nitrogpn cartri ge.
all cooking surfaces protected? give
No visible signs of a system fire or system tampering (if signs check no). YesjS
Che6k.'ail,pipinig' aindcon,cluit Are all piping and conduit immobilized with Yes`E�
No
1144
information.
P
Was operating procedure verbally given to restaurantpersonne .
YbsN
NOE]
'pro I pjar-hangers-and brackets?
Was UL 300 compliance explained to owner or manager?
YesSQ
N o F-1
Are all protective covers present on nozzles?
Yes&
Noo
wo
Gas shuts down uDon systern activation? A0_
Electric down NAF-1
*��
Ye�gr
Noo.j
No El
Arel�all-,nozzles�checkecl.in theproper position?
Yes&
power shuts upon system activation?
Does system have adequate volume and/or nozzle coverage?
Yes 0
No a NAF
0�rig -hoo6-tied-to--,-bUi'ldin-g-plaCr'm*p-an--e-l?-
(espK
No
A , relail�appliances�inside�ofthe, hood protection.area?
Ye§SL
No
Range hood activation signal received at building alarm panel? NA
YesM
No E]
Have fuse links been replaced?
Ye SN&
NoF
Class K extinguisher present?
Yes*F,] _
No0_1
Was systemoperational from terminal link?_
Yek
-NoE]
Grease b4jidup in group:
Medium Heavy,
Was system operational from manual remote?
Yes
No
recommend
cleaning
W4-.'system'6T-0,-T-
icro switch operational?
NAn Ye4Mr
No
last cleaning
tar�ds!
Is system visible and free from obstruction?
Yesj;Q
No
cleaning intervals within NFPAit!an
- -
YesN
No Ej
I - - - -1. - -
Is the inspection and service tag on the cylinder9
I
Previous Confidence Test CompAny ic an
_je9hnican.------.---
MEN
mom
I
Problems Found: (If additional room is needed, please add a separate sheet) rz\ jkusup Ww\p\-\
I . . - t I A - - --a �
Corrections Made: Date Corrected:
Corrected By:
Customer has declined rep4fqP0
SFD Certification Number:
This certifies that this f e an Ii e 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. Discrepan . e ar ted an ported to the building Owner/Responsible Person for corrective action.
Signature of Tester: -UB 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 ninspection and any corE2Aions 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
John J. Westfall
From: John J. Westfall
Sent: Friday, February 03, 2012 8:22 AM
To: controller@arniesrestaurant.com'
Subject: Arnie's Edmonds Occupant Load Breakout
Attachments: 20120203081329.pdf
Dana:
I've identified the break out for the Edmonds' Arnie's occupant load in the electronic attachment. With this you may
finalize your cable company contract.
Please follow directions in mailed annual bill from City of Edmonds and I'll send a hard copy to Fran for posting.
Let me know if I can be of further assistance.
John I Westfall
Fire Marshal
Fire Prevention Services
425-771-0213 Desk
425-775-7721 Fax
425-231-3644 Mobile
FIRE,,
DISTRWT
1
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCES
ECE
March 7, 2011 MAR 2 PA/
Please verify and correct the following information: EDm
ONDS
EPT.
Name of Company; DBA
Arnie's At The Landing
Edmonds Location
300 Admiral Way
In conformity with the terms of
Places of Assembly - Occupant Load: 202
the International Fire Code,
application is hereby made to
store, use or maintain the
-following activity, storage or
processes:
Mailing Address:
Arnie's Restaurant N. W., Inc.
714 Second St
Mukilteo WA 98257
EFID UFIR
1612020113201
(for office use)
Your Signature
Your Name (print)
Your Titie
Please make corrections, attach $40 payable to the City of Edmonds, and mail to:
Fire Marshal
Department of Fire Prevention
th
121-5 Avenue North
Edmonds, WA 98020
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
PERMIT
January 1, 2011 161-202-01 B-201 December 31, 2011
Date of Issue UFIR Number Date of Expiration
I This PERMIT is issued to: I Arnie's At The Landing
[ located at: 1300 Admiral Way - I Edmonds, WA I
I To engage in the business, occupation or pr cess of: I I
And shall constitute permission to maintain, store, use or handle materials or to -conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Places of Assembly - Occupant Load: 202
I Allowed Occupant Load: 1 20
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds for the revocation of this PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
Firi
De
This Permit Must Be Posted At All Times in The Premises Identified Above
City of Edmonds Community Development Code 19.25.020
R AAA"
aTHood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: —
Occupancy Address:
Responsible Person:
Building Owner: —
Building Owner Address:
Testers Name (Please Print): VNJ�a� V\CTW ns
System Alarm? Y-s's, No M Central station monitoring? Yes`&, No E] Monitoring company name:
Control Panel manufacturer: Model Number: Location of Alarm
U.L. 300 System? Ye3'�No El U.L. 300 Compliant? Yes El N.'CSI Chemical Type: W.r&,Dy El
COMPLETE
FIRE PROTECTION
High Pressure Hood Cleaning
Fire Suppression Installation & Service
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service
Certification Given: REDE] YELLO WHITEEJ]
CONFIDENCE TESTING RhAGEHOOD
SYSTEM TEST REPORT
City,State,Zip:
Phone Number: U2L
I CONFIDENCE TEST N REPAIRS I I I
Extinguishing System Manufacturer
Phone Number:
City, State, Zip:
SFD Certification Number:
Location / Height of Range hood: QNACX-- V-VWN. C) I og
Islare es�sure qa-u:ge:tn—qicjt& �io-eratiiea� 12 year hydro date of cylinder.
Is there chemical inside of the cylinder? Yesl�Q NoF-1 WerehandpprAt xtinguishers pop d rviced? N AD _Yes' 7,
,W-66�:Cqq --- . _ P!t-e_ —_L-e_ys_e__ _5,--No.0
ME] were all cooking surfaces protected? If not, give owner full Yes'&, NoM
No visible signs of a system fire or system tampering (if signs check no). Yes No F-1 information.
W ti procedure verbally given to restaurant personne . Ye s& Noo.;
Check all �piping, andcon"duit."Arig all piping and conduit immobilized with, YesS No 0 as opera. ing
proper hangeirsAqd_Prqpkats�? Was UL 300 compliance explained to owner or manager? Yes`f�j, No
Are all protective covers present on nozzles? as No Gas shuts down upon system activation? NA Ej No 0
Are all nozzles checkedin the prope�position? No F� Electric power shuts down upon system activation? NAn YW No
Does system have adequate volume and/or nozzle coverage? Ye sN No E:) Range hood tied to building alarm panel? 1,140 _yd&TV No,13
Are all appliances inside of the hood protection area? s sz 0 Range hood activation signal received at building alarm panel? NAD YJ
_T!Z No E]
Have fuse links been replaced? YesS, No Class K extinguisher present? s No
wa�s- Grease buildup in group:
systern cippratio'nal from terminal link? YeST!�— 0
Was system operational from manual remote? YesT& No F] Light Medium Heavy recommend cleaning
sy�t�T- and -micro -switch- opo-, ratio-nal?- Dat_ of fast cleari6g:3
ygoW, N F — !:�a-q -- � .-- - -
L Is system visible' and free from obstruction? Yes n, _ NoF -No
Are cleaning intervals within NFPA standards'? �es� Q
nspectiq�� an P - C infidence Test Company 171.
's rvice,ta onthec irlder7 Ye N eVOu &T h - , I .- .
Is the i _j Launician =I
_q_se�_.g __yjL
MEMO
NO
M
M
I
MMMIN
=III
M
M
WIN
T
L
R wal;
195 �40 I FNTRIIWIMR , NWTSINTRIMO %WWRINS
Corrections Made: Date Corrected:
Corrected By:
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire and life safety s t h been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepantadh rted hav een reported to the building Owner/Responsible Person for corrective action.
Signature of Tester: 16 A/ ; Phone # (206) 726-0940
Testing Agency: Ft&rHobd and Duct Services, Inc. MailingAddress: 610012thAve.S.,Seaftle,WA98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and 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 grformi the inspection a ny correctigns required.
4. Observe system, checking that no obvious physical damage or condition exists I
that might prevent operation. AUTHORIZ 6 �
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATUR
FIRE DEPARTMENT COPY
R AAA"
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: -
Occupancy Address:
Responsible Person:
Building Owner:
COMPLETE Certification Given: REDD YELLOW E?I' WHITE[—]
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TE5T REPORT
Fire Suppression Installation & Service CONFIDENCE TEST Z" RE�PAIRSEJ
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE: 0
Building Owner Address:
Testers Name (Please Print): re,10'r-
System Alarm? Yes 2r No El Central station monitoring? WV Non
Control Panel manufacturer: Model N mber:
I Extinguishing Sys I tem Me n - uf acturer System 5' Tom, t;
Location / Height of Range hood: F. W CL I ow " A -w
Phone Number:
City, State, Zip:
SFD Certification Number: SC12-:�R1.2-
Monitoring company name:
Location of Alarm Panel: 10`75-e-li, /-0oA4
System? Yes ��N._E3 I.I.L. 300- Compliant? Yes E'] No 2r, Chernical-Type: Wet
;'is pre IVA s
essurp-g aug �in Y U_ qr��
,e
Is there chemical inside of the cylinder? s
es
s
Y Ej
12 year hydro date of cylinder.
oil
—Yes No-D
d p edlij:_ NA
_pqable extingui
Weigh CO2 or nft�ogen cartridge. NA 0-.-,
�7L
Were all cooking surfaces protected? If not, give owner full
Yes Ej No C��
_ _ _ _ __ __ __ ___ _ __ _
No visible signs of a system fire or system tampering (if signs check no)
�cqriduit.
Yes1?r1No`_[j
information.
W as operating procedure verbally givento restaurant personnel?
Yes []�r N om
h k all Are all,piping and conduit immobi ized with
C e-c
11 , -,,piping, and
brackets?
Yes No Ej
Was UL 300 compliance explained to owner or manager?
_
s F
Ye !1' No
pro erhangers�and
Are
Yes [!I�Nlo
--t- __NA
Gas down ion?
Yes E�r n
all protective covers present on nozzles?
Are all nozzles checked in the proper position?
shuts uponsystem active
Electric power shuts down upon system activation? NAF
-1
No
Yes ET' No F1
Yes No r3o,
Does system have adequate volume and/or nozzle coverage-?
No ]eo_ -Rangehood bed-to-bul-lifing a- larmpariel_?
Yes NAD�
Yes Ee No[:]
Are all appliances -inside of the hood protection area?
Yes No
Range hood activation signal received at building alarm panel? NAO
Yv%kr No E]
Have fuse links been replaced?
Yes No F-1
Class K a - x - tingui - sher present?
Yes C�!'No El
Was system operational from terminal link?
_jo
Grease b 'Id
!!2"g'oup:
Was system operational from manual remote?
Yes E�i" Nor-i
Light M c1iva__.,_j eavy, recommend cleaning
- - ---------
D t, of lastcleaning- 0 e let4i
stem icro switch operational? NA No __a ------
____Yqs [ � �EL__
Is system visible and free from obstruction? Yes E�� No[] Are cleaning intervals within NFPA standards? e+
--Y.—s
f
-Yes __NoQ
Is t-he-ins-p-e-ic6io rjaqd s�ryicqjag on the cylinder?
[;?o'N_o
Previous Confidence Test CompanyA _jqq!jq19ian
MEMO
01M
M
M=MMMMKM
Problems Found: (if additional room is needed, pleas
ddaseparate h t)
A�irce_prt
lkew�fe,
soml� cDve
0-Vey Aro
a, L 30 0 t- e_� q ke,,5 _,tl
;�o 7)
iffoxtle-,
coomenteg 7to
JoWilpf-gs.5ate,
_P.V1 2Af) &-.
. - - - +_
A 1. - - - L . -1
.1.. , - .. I fl
- � _F_- el ; . -0,
Corrections Made: Date Corrected:
Corrected By:
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire n ife safqti� system h been perly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepande &aed ah e beerepok e building Owner/Responsible Person for corrective action.
Signature of Tester: )15'1� I Phone # (206) 726-0940
Testing Agency: R&T Hood and McA%emrvicies, Inc. MailingAddress: 610012thAve.S..Seaftle,WA98108
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verity 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 irlspectip� to be k6pt'reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing t re
4. Observe system, checking that no obvious physical damage or condition exists
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY
COMPLETE Certification Given: RED[] YELLOW M�" WHITE[:]
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
R High Pressure Hood Cleaning — SYSTEM TEST REPORT
&THood and Duct Services, Inc. Fire Suppi-ession Installation & Service FCONFIDENCE TEST [:?- REPAIRS
Fire Extinguisher Sales & Service
6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair
Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE: 0
Occupancy N me: Ar 14 Tf!�,5 A
Occupancy A:dress: DO AJ M."r CL I WV City, State, Zip: W R62 0
Responsible Person: Phone Number: Lif -7 1 — 5b F 8'
Building Owner: Phone Number:
Building Owner Address: o City, State, Zip:
Testers Name (Please Print): I fd;;�7— V, lkn SIFD Certification Nurnber:* SCP-
System Alarm? Yes El Central station monitoring? Yes F� NoE] Monitoring company name:
Control Panel manufacturer: o a umber: Location of Alarm Panel: Gfj1;r/-,9-eV' kfil�
Extinguishing System ManufacturerA'145K Pystem Si3frek"I 116P 306 System? Yes No E] U.L. 300 Compliant? Yes No 0' Chemical Type: WetEKEJ
Location / Height of Range hood: h
I/ X A,
pressure �gauga indicator in erab
ble range?
1%
t10
12 year hydro date of cylinder.
0
Is there chemical inside of the cylinder?
es No
ere hand p n I I serviced?
__We� -_ortable-exti gu_ishers_p opery
Weigh CO2 or nitrogen cartridge
NAO
Were all cooking surfaces protected? If not, give owner full
Yes No
No visible signs of a system fire or system tampering (if
0,
signs check no). Yes No [j
informati . on.
------------- --------
Check all pipihg�and conduit. Are all piping and conduit immobilized with Yes Nof
___kas o erating procedure verbally given to restaurant personnel?
p
Yes No
,proper hangers and brackets?
Was UL 300 compliance explained to owner or manager?
Yes No E]
Are all protective covers present on nozzles?
Yes [:�--No F-1
Gas shuts down upon s stem activation? NAD
Yesr-j� o
N
Are all nozzles checked in the proper "o ition?_
YeSD -No[;�-�
Electric power shuts down upon system activation? NAD
Y^9 Vj No F-1
Does system have adequate volume and/or nozzle coverage? Yes No
IF�Ne hood tied tcobuilding alarm,panel?_ NA El
YeAF
ff NoE]
re a[
A I appliances inside of the hood protection area?
Yes No
Range hood activation signal received at building alarm panel? NA El
Ye No
AEr El
Have fuse links been replaced?
Yes2NoF-j
—Plass K extinguisher pireserit?
[�'
I- Was system operati on al f rom terming I link?
Gre ase buildup in group:
-Yes _No-[:].,.-.
Was system operational from manual remote?
Yes E?- No El
Light Medium— Heavy, recommend cleaning
systgaland micro switch operational?
NA - Yi99 No
D ale of last cleaning
Is system visible and free from obstruction?
' th-
Is a inspection and service tag_qn the cylinder?
Yes No
s
Are cleaning intervals within NFPA standards? Yes F-1 No
Previous ConfidenceTes Company &
MEN
0
MEN
SON
MEN
SON
M=
5.
MEN
IN
smom
N
MEN
MIN
0
MEN
IN
ON
MIEN!
N
INEENNINEE
No
0
Emommmmmmmmm
LOSS
SOON
Nis
0
N
MEMMMOMEMM�m
MINES
Problems Found: (if additional room.is needed, plege Add a separates r.t5vv
k W
MLVffV&rd 11,691,
W101 N IVVWMT�W I r-M mi ---
Corrections Made: Date Corrected:
Corrected By:
Customer has declined
SFD Certification Number:
A
This certifies that this fire and life afe syyem has been p ped d for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies aA nopaind hr be re orteUt. the Efuilding Owi3er/Responsible Person for corrective action.
0
Signature of Tester: I \) L--/ I . ArIA& Phone # (206) 726-0940
Testing Agency: RVII�Wcrand DFuct Sertigs, 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 mont�ly inspe�tions is t 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 We Inspection Vdjtnv corrections required.
4. Observe system, checking that no obvious physical damage or condition exists I
that might prevent operation. AIUTHOR[ZkD ILA
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURVIt-, --L�y A
FIRE DEPARTMENT COPY