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310 6TH AVE N (2)vi -IA L)c �j Fire Protection Contractd,rs'Tslnc*6 1930 VIKIN AUTOMATIC SPRINKLtR COMPANY 3434 First A". So., Seattle, WA 9$134, 2006.622.4656 WA.: VI-KI-NA-S 602 California Way, Longview, WA 98632,360,425.7620 ,373NT LEVEL N Fire Sprinkler Inspection Report Page:lof2 REPORT TO: r-Dn2L.fijA-, e-&,E JOB NO. &J-51 -7 4 7 q? DATE: ev-.29-/& STREET: 'Z'7'A/ 'gut- AkRZLI BLDG. / LOCATION: CITY/STATE: E'awiuo'-) IA�,4 INSPECTOR: 3)" I.GENERAL a. Is the building occupied ? . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . ... . b. Is occupancy the same as previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Are all fire protection systems the same as last Inspection ? . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . a. Is the building completely sprinklered ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Are all new additions and building changes properly protected ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . g. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . h. Was property free of fires since last Inspection ? (Explain any fire on Page 2) . . . . . . . . . . . . . . . . . . . . . . . . 1. In areas protected by wet syste me, Is building properly heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected against the cold ? 2. CONTROL VALVES (See Section 17) a. Are all sprinkler system main control valves open ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Are all other control valves In proper position ? - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - - c. Are all control valves In good condition and sealed or supervised ? . . . . . . . . . . . . . . . . . . . . . . . . . .. . 3. WATER SUPPLIES (See Section 18) a. Was a water flow test preformed and were the results satisfactory ? . . . . ... . . . . . . . . . . . . . .. . . . . . . . 4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? . . . . . . . . . . . b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight ?. ".Zaz . . . . 5. WET SYSTEMS (See Section 13) a. Are cold weather valves open or closed as necessary ? . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? . . . . . . . . . . . . . . . . . . . c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? . . . . . . . . . . . . . . . . . . . . . 6. DRY SYSTEMS (See Section 14) a. Are dry valve(s) In service and In good condition ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Are pressure and priming water levels normal ? - - - - - - - - - - - - - - - - - - --- ... . . . . . . . . . . . . c. Is air compressor In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . d. Were low points drained during fall and winter Inspections ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. Are Quick- opening devices In service ? . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . f. Has piping been chocked for stoppage within the past ton (10) years ? . . . . . . . . . . . . . . . . . ... . . . . . . . g. Has piping been chocked for proper pitch within the past five (5) years ? . . . . . . . . . . . . . ... . . . . . . . . . . h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - -- - - - - - - - r . . . . . . . 1. Are dry valves adequately protected from freezing ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . J. Are valve house and heater conditions satisfactory ? . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 7. SPECIAL SYSTEMS (See Section 16) a. Were valves tested as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Were all heat -responsive systems tested and were the results satisfactory ? .. . . . . . . . . . . . . . . . . . . . . . . . c. Were supervisory features tested and were the results satisfactory ? - - - - - - - - - - - - - - - - --- - - - -- - - - - - 8. ALARMS a.:: the water motor and gong test* satisfactory?. S_Lec IF,,j(- -Z-ey 1-ka� .5y &�e_ j'j\ 7jklp- Dt- b. the electric alarm -test satisfactory? b&-�N -:57-0k . . . . . . . . . . . . . . . . . . c. Is the supervisory alarm service test satisfactory ? Monitoring Co. Ph.: 47.5 34� —S"qv);Code`: 4' �d 9. SPRINKLERS - PIPING A j<'WCg0 6? & 3 0 a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loading ? - - - - - --- - - - - - - - - - - - b. Are all sprinkler heads less than fifty (50) years old ? Head Manufacturer Date of head WHITE- WING COPY YELLOW INVOICE COPY PINK: FIRE DEPARTMENT COPY GOUD- BUILDING COPY VIrJN .4 Iq Ue_ F41rq Protection Contrapto.rs since 1930 3 AUTOMATIC S I PRINKLER COMPANY 34XFhWAw_Sm,SeaftWA.48134,206. 622.4656 WA: V1LKJ-M-S373NT LEVEL /it 602 Caffw* Wily, Longviow, WA, 3W. 425. 71620 Fire Sprinkler Inspection Report Page:202 9. SPRINKLER / PIPING (Continued) YES N.A. NO c. Are extra sprinkler heads readily available ? ;� - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - Ives, hangers, pressure gauges, open sprinklers, and strainers sattlactory ? 0154.16. d. Is condition of piping, drain valves, check va a. Are all sprinklers of proper temperature rating? . . . . - - - - - - - - - - - - - - - - - - - - - - - I. Are portable fire extinguishers In good condition ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - g. Is hand hose on sprinkler systems satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Date Dry System Piping last chocked for stoppage .. ... . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . ry)' 11. Date Dry System Piping last checked for proper pitch. - . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . A10 12. Date Dry Pipe Valve last trip tested .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13. Wet systems: Number. Make Model I Year. 14. Dry Systems: Number: Make Model You: 15. Accelerator: Make / Model / Year: 16. SpecialSystems: Number: -Type: Make / Model / Year: Condition i�. CONTROL VALVES a. City Connection Control Valves b. Tank Cont�o_lValves - - - - - - - - - c. Pump Control Valves - - - - - - - - - d. Sectional Control Valves . . . . . . . . . a. System Control Valves - _� . . . . . . . Number Type Open yes No Secured Yes No Closed' yes No Sign Yes No* Condition J J -te I Barmw4!/ IJ I I J I el -1 I& WATER FLOW TEST a. Water Pressure Source: Ity, 0 Tank, 0 Fire Pump, Water Flow Test taken ? If not, reason: Test Pipe Location Size Test Pipe Pressure Before Flow Pressure Pressure After AT Rt,<ep 15 .19. Explanation of any "No" answers: 20. Recent changes In building occupancy or fire protection equipment: 21. Adjustments or corrections made: 22. Desirable Improvements: 23. � Has building owner / representative been notified of any deficiency to the fire protection system? 0 Yes -0 No, Person notified: If answer Is "No",explain: 24. Inspector's Signature: owner/ lessee) and date: WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY I ? FIRE PREVENTION INSPECTION REPORT Bfiei; i6nds, and— 124-25 ei-iji e Se4-vin..g � I I tEdfi an Av S 0 EDMONDS Mountlake Ter'race Everett,'WA 98208 El BRIER Phone (425) 551-1200 El MOUNTLAKE TERRACE [I UNINCORPORATED www.FireDistrictl.org Fax (425) 551-12 72 FREQUENCY STATION & SHIF7T LOCATION: 310 6 th Avenue N 98020 Annual 17-A Boy's & Girl's Club Of Edmonds 4257740630 SCHEDULEcApr 2015 BUSINESS NAME: PHONE: Ej E DUE 141 203 MAILING 31 , 0 6th Avenue N, Edmonds, WA 98020 UFIR ADDRESS: BUSINESS OWNER: &"j HOME PHONE: -Kaptz,MGhaeI— 5098995140 EMERGENCY-1: HOME PHONE: "'CURRENT t ES NO KEY ACCESS-2: HOME PHONE: CITY BUSINESS EMAIL: LICENSE INITIAL INSPECTION DATE PERSON CONTACTED: \j "'o 4 NAME OF INSPECTOR: HAZARDS FOUND LOC[TI NS/COMMONS 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 2nd RE -INSPECTION FINAL RE -INSPECTION EXTENSION VIOLATIONS DATE DUE: DATE DUE: GRANTEDTO: DATE DUE: CITED: PERSON PERSON PERSON CONTACTED: CONTACTED: CONTACTED: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: E: DATE: 3 VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 1 5 1 5 LETTER SENT NUMBER: 4 CODE 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 3 7 7 RECEIVED 6 DISPOSITION: 7 4 8 4 8 DATE: LETTER NEEDED F] YES NO LETTER NEEDED [] YES NO FIRE DEPARTMENT COPY itaNcir Fire Protection Contractors since 1930 VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656 WA.: VI-KI-NA-S373NT LEVEL N . . -.0 li ,92 Ca fornia Way, Longview, WA 98632,360,425.7620 Fire Sprinkler Inspection Reportl 9- REPORTTO: 6'd1'( lr<�-Jcd f' JOB NO. STREET: BLDG./LOCATION: --pow CITY/STATE: INSPECTOR: '00, Page:W2 1.GENERAL a. Is the building occupied ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Is occupancy the same as previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C. Are all systems In service ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - d. Are all fire protection systems the same as last Inspection ? - - - - - - - - - - - - - - - - - - - - - - - - - - - e..Is the building -completely sprinklered ? - - ----- - - ----- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - f. Are all new additions and building changes properly protected ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - g. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h. Was property free of fires since lost Inspection ? (Explain any fire on Page 2) - - - - - - - - - - - - - - - - - - - - - -- - - 1. In areas protected by wet systems, Is building properly heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected againstthe cold ? 2. CONTROL VALVES (See Section 17) a. Are all sprinkler system main control valves open ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Are all other control valves In proper position ? - - - - - --- - --- - - - - - - - - - - - - - - - - - - - --- - - - c. Are all control valves In good condition and seated or supervised ? - - - - - - - - - - - - - - - - - - - - - - - -- - --- 3. WATER SUPPLIES (See Section 18) a. Was a water flow test preformed and were the results satisfactory ? - - - - - - - - - - - - - - - - - - - --- - --- - - - 4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS a. Are fire pumps, gravity tanks, resevoirs and pro sours tanks In good condition and properly maintained ? b. Are Fire Department Connections in satisfactory condition, couplings free, caps In place and check valves tight 5. WET SYSTEM (See Section 13) a. Are cold weather valves open or closed as necessary ? . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . b. Have antifreeze systems been tested and left in satisfactory condition ? Temp. ? . . . . . . . . . . . . . . . . . . . c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? . . . . . . . . . . . . . . . . . . . . . 6. DRY SYSTEMS (See Section 14) a. Are dry valve(s) In service and In good,condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Are pressure and priming water levels normal ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - c. Is air compressor In good condition ? --- - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - d. Were low points drained during fall and winter Inspections ? . . . . . . . . . . . . . . . . . a. Are Quick- opening devices In service ? - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - f. Has piping been checked for stoppage within the past ton (10) years ? - - - - - - - - - - - - I - - - - - - - - - - - - - - g. Has piping been checked for proper pitch within the past five (5) years ? - - - - - - - - - - - - - - - --- - - - - - - - - h. Have dry valves been trip tested satisfactorily as required ? - - - - -- - - - - - - - - - - - - - - - - - --- - --- - - - 1. Are dry valves adequately protected from freezing ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Are valve house a nd heater conditions satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7. SPECIAL SYSTEMS (See Section 16) a. Were valves tested as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Were all heat -responsive systems tested and were the results satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . c. Were supervisory features tested and were the results satisfactory ? - - - - - - - - - - - - - - 8. ALARMS - Is the - - - - - - - - - - - �/ a. ?_ _ water motor and gong test satisfactory - - - - - - - - - - - - - - - - - - - - - - - - b. Is the electric alarm test satisfactory ? - - - - - - - - . . . . . . . . . . . . . . . c. Is the supervisory alarm service test satisfactory ? Monitoring Co. _Ph.: . . . . . . . . dod a: 9. SPRINKLERS - PIPING a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loading ? - - - - - - - - - - - - - - - - b. Are all sprinkler heads less than fifty (50) years old ? Head Manufacturer Z4F 01/01;/ Date of head WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY Fir r e Contractors:: since 1930 'of 'etion" VIKING AUTOMATIC SPRINKLER COMPANY _34W Rrst Aw- So., Seatift WA 98134, 206.'622. 4656 WA: V1LK1-NA-S373ArT LiVEL IN 602 CAWMMb W Longview, WA 98IM, 360.425. 7620 Report. Fire Sprinkler his piiectioh' Pagq� 2of'2 9.. SPRINKLER/ PIPING' iCOMInued) YES -N.A. iNO c. Are extra sprinkler heads readily available'? d.111i covidldo� of 0101rij,"drain vahicis, che�k 4611yes hangem" prf"urq 'o ,�,�a�geqj sOrfnit" and stralneri $!Iffactoryj e; Are all -i0iinklers of proper temperature rating? . . . . . . . . . . ... ... . . . . . . .. . . . . . . . .. . .'f. Are Portable fire extinguishers In good condition ?_ - -- - - - - - - 9. Is hand hose on sprinkler systems satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10. Date Dry System Piping last checked for stoppage -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11. Date Dry System Piping last checked for proper pitch .. . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . 12. Date Dry Pipe Valve last trip tested --_-------------------- 13. Wet systems: Number- Make / Model I Year 14. Dry Systems: Number: Make /Model/ Year. 7. T__ -A5.-_1Acceleiiet_6r: Make/ Model /Yeaiw­ 16. SpecialSystems: Number: -Type: Make / Model / Year: Condition: 17. CONTROL VALVES Number Type 0 n Sign Y.. No YeSsecuraNdo YeTosello Yes No I Condition a. City Connection Control Valves ej, e. o b. Tank Control Valves - .7 c. P6m' Control Valves - - - - - - - - - P d. Sectional Control Valves - . a System Control.Valves. EH !�'18. WATER FLOW TE a. Water Pressure Source,: Achy,-. 0 Tank 0 FirePump, Water Flow Test taken' ?4A,< Itnot,reason: Test Pipe Location Size Test Pipe Pressure Before Flow Pressure PressureAfter 77 A/- ,4 1-7 419.`Explanation of an'y`4No""a'Kiw6*rs: 20. Recent changes In building occupancy,q!i fire protection -.'equipment: 21. Adjustments or corrections 'made: ':,22. Deilrable,improvements: r 23. Has building owner representative been notified of any deficiency to the fire protection system? 0 Yes 0 No, Person notified: If answer Is "No",explain: 24. Inspector's Signal ure: It Witness (property owner / lessee) and date: oe YELLOW: INVOICECOPY -PINK FIRE DEPARTMENT COPY GOLD: BUILDING COPY 'Fire Protection Contractors since 1930 VIKING AUTOMATIC SPRINKLER COMPANY.��. 3434 First Ave. So., Seattle, WA 98134, 206.622.4656 WA.: VI-KI-NA-S373NT LEVEL N A 98632, 360.425.7620 602 California Way, Longview, W Fire Sprinkler Inspection Report Pa9e:1of2 REPORTTO: /y JOB NO. DATE: STREET: Adz= BLOG./L . OCATION: 0/WeZ- A4'_,e),o4_1 CFTY/STATE: ZA INSPECTOR: 1.GENERAL YES N-A. NO a. Is the building occupied ? . . . . . . . . . . . . . . . . . . . . . . �7/Z./ .. . . . . ... . . . . . . . . ... 10 b. Is occupancy the same as previous Inspection ? . . . . . . . 4 ... . . . . . . . . . . . . c. Are all systems In service ? . . . . . . . . . . . . . . . . . ..... Z . . . . . I . ... ... . . . . . . . . . .. d. Are all fire protection systems the some as last Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IX a. Is the building completely sprinklered ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f. Are all now additions and building changes properly protected ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . . . . . - - - - - - - - - - - - - X h. Was property free of fires since last Inspection ? (Explain any fire on Page 2) . . . . . . . . . . . . . . . . . . . . . . . . . 1. In areas protected by wet syste me, Is building property heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected against the cold ? '*j< 2. CONTROL VALVES (See Section 17) a. Are all sprinkler system main control valves open ? . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . 2t< b. Are all other control valves In proper position ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Are all control valves In good condition and sealed or supervised ? . . . . . . . . . . . . . . . . ? . . . . . . 3. WATER SUPPLIES (See Section 18) am a. Was a water flow test preformed and were the results satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? - - - - -- 'K b. Are Fire Department Connections In satisfactory condition, couplings free, c p n plac; 7k I I , a a[ 0 and check valves tight . . . . . .. 5. WET SYSTEMS (See Section 13) —4— 1 a. Are cold weather valves open or closed as necessary ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x b. Have antifreeze systems been tested and Is Itin satisfactory condition ? Temp. ? . . . . . . . . . . . . 7 - - - - - - c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? . . . . . . . . . . . . . . . . . . . . . . 6. DRY SYSTEM (See Section 14) a. Are dry valve(s) In service and In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Are pressure and priming water levels normal ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Is air compressor In good condition ? . . . ... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Were low points drained during fall and winter inspections ? . . . . . . . . . . . . . . . . . . ... . . . . 9. Are Quick- opening devices In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f. Has piping been checked for stoppage within the post ten (10) years ? . . . . . . . . . . . . . . . . . . . . . . . . . . g. Has piping been checked for proper pitch Within the past five (5) years ? . . . . . . . . . . . . . .... . . h. Have dry valves been trip tested satisfactorily as required ? . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 1. Are dry valves adequately protected from freezing ? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Are valve house and heater conditions satisfactory ? . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . ... . 7. SPECIAL SYSTEM S (See Section 16) a. Were valves tested as required ? . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . .. . . b. Were all heat-responsiv a systems tested and were the results satisfactory ? . . . . . . . . . . . . . . . . . .. . . . . . c. Were supervisory features tested and were the results satisfactory ? . . . . . . . . . . . . . . . . . . .. . . . . . . . . S. ALARMS Ong test satisfactory . . . . . . . . a. Is the water motor and g gh.' 1"o A/ . . . . . . . . . . . . . . . . . . .0 b. Is the electric alarm test satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Is the supervisory alarm'service test satisfactory ? Monitoring Co 102we6o"'. Ph, 41"A M IWC.de: 9. SPRINKLERS - PIPING a. Are all sprinkler heads In good condition, not obstructed and free from corrosion I ding ? - - - -- - - - - - - - b. Are all sprinkler heads less than fifty (50) years old ? Head Manufacturer - Date of head WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY. GOLD: BUILDING COPY Fire Protection Contractors since 1930 VIKING AUTOMATIC SPRINKLER COMPANY','. 3434 RWAw- Six, Saaffie, WA 98134,206. 622.46M WA.:VWJ-NA-S373Afr LEVEL N 6a2 Calffimde Way, Longview, WA 360.425.7620 Fire Sprinkler Inspection Report Page:2of� 9. SPRINKLER PIPING (Continued) YES N.A. NOW c. Are extra sprinkler heads readily available ? - - - - - - . . . . . . . . . . . . . . . . . . . . . . . . d. Is condition of piping, drain valves, check valves, hangers, pIp4sure gaugeal open sprinklers, and strainers sattfactory ? - 41�-VY'01Z. - - - . a. Are all sprinklers of proper temperature rating? . . . . . . . . . . . . . . . . ... . . . . . . . . . .. X f. Are portable fire extinguishers In good condition ? . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . 9. Is hand hose on sprinkler systems satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Date Dry System Piping last chocked for stoppage -- - - - - - - - - - - - - - - - - -- - - --- - - - - - - - - - - - 11. Date Dry System Piping last checked for proper pitch - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 00�-. 12. Date Dry Pipe Valve last trip tested .. . . . . . . 13. Wet systems: Number. Make Model Year 4 14. Dry Systems: Number: Make Model Year: 15. Accelerator: Make / Model / Year: 16. SpecialSystems: Number: -Type: Make / Model / Year Condition: 17. CONTROL VALVES a. City Connection Control Valves . . . . . . b. Tank Control Valves - - - - - - - - - c. Pump Control Valves - - - - - - - - - d. Sectional Control Valves - - - - - - - - - e. System Control Valves. ; - - - - - - - WFO, ORM I& WATER FLOW TEST a. Water Pressure Source ? WK -< If not, reason: I firCity, D Tank, 0 Fire Pump, Water Flow Test taken' Test Pipe Location Size Test Pipe Pressure Before Flow Pressure Pressure After A 7- /W 19. Explanation of any "No" answers: 20. Recent changes In building occupancy or fire protection equipment: 21. Adjustments or corrections made: 22. Desirable Improvements: 23. Has building owner / representative been notified of any deficiency to the fire protection system? OYes 0 No,Person notified: If answer Is "No",explain: 24. Inspector's Signature: VIKING p2l� Witness (property owner / lessee) and date: 01 YELLOW INVOICE COPY PINK. FIRE DEPARTMENT COPY, GOLD: BQILOING COPY EVERGREEN FIRE PROTECTION BUREAU — FIRE AND LIFE SAFETY INSPECTIONS PO Box 42600 Olympia, WA 98504-2600 (360)596-3900 FAX- (360)596-3934 FIRE ALARM SYSTEM INSPECTION REPORT RETAIN COPY ON PREMISES FACILITY NAME --] I . 0/06/114 Boys & Girls Club - Edmonds DATE BUILDINU NAME OR NUMBER OC ANCY CLASSIFICATFORN Commercial ADDRESS 310 6th Avenue North, Edmonds LOCAL FIRE AUTHORM Snohomish ounty Fire Dist#1 TEST DESCRIPTION MONTHLY QUARTERLY UZANNUALLY ------- — 10 CONSTRUC ION ACCEPTANCE EQUIPMENT TEST EQUIPMENT TYPE NUMBER OF UNITS7ESTED TEST DATE SATI� LACTORY CHECK ES No. NIA) TYPE AND MANUFACTURER CONTROL PANELS MANUAL STATIONS HEAT DETECTORS SMOKE DETECTORS AUDIBLE ALARMS :�2 SMOKE DETECTOR SENSITIVITY VISUAL ALARMS AUTO DOOR RELEASES TROUBLE INDICATORS MASTER ALARM BOX BATTERIES DATE INSTALLED_ CHARGER GENERATOR VENTILATION CONTROLS FIRE DEPARMTENT INTERCONNECTION EXTERIOR SPRINKLER ELECTRIC ALARM BELL SPRINKLER WATERFLOW SWITCH SPRINKLER GATE VALVE TAMPER ITCH ANNUNCIATORS 0 Ov7p ELEVATOR RECALL DUCT DETECTORS SMOKEIFIRE DAMPERS SPECIAL EGRESS CONTROL DEVICES PHONEJACKS TIME TEST TRANSMISSION RECEIVED BY CENTRAL STATION /---(f[WE—) &�AM PM FIRE ALARM SYSTEM LEFT IN SERVICE AT THE COMPLETION OF INSPECTION YES NO TIME FIRE ALARM RESET 15-0 (TIMEJ &AM PM TEST OF ALARM SYSTEM ON EMERGENCY POWER IS SATISFACTORY &::m .. r I NO COMMENTS EXPLAiN:TklN OF UNSATISFACTORY RESULTS AND CORRECTIVE ACTIONS TAKEkY 0 -h el SIGNATURE _ _ THIS IS TO CERTIFY THAT THIS AUTOMATIC FIRE ALARM SYSTEM HAS BEEN INSPECTED IN ACCORDANCE WITH THE INTERNATIONAL FIRE CODE, AS ADOPTED BY THE WASHINGTON STATE FIR - MARSHAL. —r-FH—ONE FIRST NAIME Tony Pearce, Evergreen Security Systems, Inc. 425-348-3850 ADDRESS 8115 Broadway Suite 10 1, Everett WA 98203 ELECTRICAL CONTRACTORS LICENSE NO. EVERG-SI 112W SPECIALTY ELECTRICIANS LICENSE NO. PEARCT*088RE OFwc7rSiGNATU)0 FIRM PROPERTY 7 EFIfREPRESENTATIVE SIGNATURE SNOHO Fl Serving. Brier, �4t�iqi!.ds, and Moun'tlake Terrace ,STRICTii,ii,ii,.',PireDistrict]. org', LOCATION: 310 6 th Avamm N 28MI) BUSINESS NAME: Grrsaub CY Edt-mInds MAILING ADDRESS: 310 ELh A,,cnLm N, Edrymrmfs, \JVA 98M0 BUSINESS OWNER: EMERGENCY-1: rl:2-lbf, IMUlad KEY ACCESS-2: EMAIL: PERSON CONTACTED: NAME OF INSPECTOR: �_b �-�S`VS EIV& Fl�_J.lg FD L14�x 10-C� 1242iXeridian Ave S kiie-r-Lit',' WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 I PHONE: 42.IjR4DM HOME PHONE: HOME PHONE: f;M3D-'Zl4() HOME PHONE: FIRE PREVENTION INSPECTION REPORT .9EDMONDS BRIER 0 MOUNTLAKE TERRACE El UNINCORPORATED I` FREQUENCY I STATION& SHIF-*" Animal 17-0 SCHEDULEDApr 2M4 DATE DUE 0 LIFIR CURRENT CITY YES NO BUSINESS LICENSE m F] INITIAL INSPECTION DATE HAZARDS FOUND AND LOCATIONS C;07MUNICATIONS 1 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::�=51_� lst RE -INSPECTION DATE DUE. 2nd RE -INSPECTION DATE DUE. EXTENSION GRANTEDTO* FiNrL-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 LETTER SENT CITATION ISSUED NUMBER: 4 2 6 2 6 DATE: CODE SECTION: 5 3 7 3 7 RETURN RECEIPT RECEIVED 6 4 18 4 18 DATE: DISPOSITION: 7 LETTER NEEDED [] YES F-1 NO LETTER NEEDED [] YES F-1 NO 8 FIRE DEPARTMENT COPY d. ON FIRE PREVENTION A : Serving Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT f�lolt SNOHOMISH CO. Mountlake Terraceand FIRE, Everett, WA 98208 DEDMONDS 0 BRIER the Town of Woodway DISTR_ T Phone (425) 551-1200 El WOODWAY [1 MOUNTLAKE TERRACE www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED e FREQUENCY STATION & SHIFT LOCATION: 310 6th Avenue N 366 17 C BUSINESS NAME: Boys & Girrs Club Of Edmonds PHONE: 4257740630 SCHEDULED DATE DUE 1' 04/01/13 MAILING 310 61h Ave N LIFIR � 141 4203 ADDRESS: Edmonds 98020 BUSINESS OWNER: Kantz, Michael HOMEPHONE: 5098995140 ACTIVE 70 EMERGENCY-1: Seeley, Paul HOME PHONE: 4252106749 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS El LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE V?' NAME OF INSPESPR—.,,) FIRE AS 7/1;tAf�l �OF eq�� FE _j_LN.2- SYSTEMS: ANNUAL HAZARDS FOUND AND LOCATIONS COMMUNICATIONS 2 2 3 3 4 4 5 5 6 6 7 V 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: INSPECTOR: INSPECTOR: INSPECTOR: 2 'I� DATE: DATE: DATE: 3 VIOLATIONS 1 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 2 6 2 6 DATE: CODE SECTION, 5 3 7 3 7 RETURN RECEIPT RECEIVED 6 4 18 4 18 DATE, DISPOSITION: LETTER NEEDED E] YES F1 No I LETTER NEEDED E] YES (I NO 8 FIRE DEPARTMENT COPY Vt UK& Fire Protection Contractors since 1930 VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656 WA VI-KI-NA-S373NT LEVEL M 602 California Way, Longview, WA 98632,360,425.7620 Fire Sprinkler Inspection Report Page:W2 REPORT TO JOBNO. DATE: #/ STREET: Wx BLDG. / LOCATION: CITY/STATE: INSPECTOR: 1.GENERAL a. Is the building occupied ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Is occupancy the same as previous Inspection ? - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - C. Are all systems In service ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - d. Are all fire protection systems the same as last Inspection ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - a. Is the building completely sprinklered 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - f. Are all new additions and building changes properly protected ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - g. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h. Was property free of fires since last Inspection ? (Explain any fire an Page 2) . . . . . . . ... .... . . . . . . . ..... . I . . . . 1. In areas protected by wet syste me, Is building property heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected against the cold ? CONTROL VALVES (See Section 17) a. Are all sprinkler system main control valves.open ? - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - b. Are all other control valves In proper position ? - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - c. Are all control valves In good condition and sealed or supervised ? - - - - - - - - - - - - - - - - - - - - - - - - - - - 3. WATER SUPPLIES (See Section 18) a. Was a water flow test preformed and were the results satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - 4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? - - - - - - - - - - - - - - - b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight Z - - - - - - - - - - - 5. WET SYSTEM (See Section 13) a. Are cold weather valves open or closed as necessary ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? - - - - - - - - - - - - ---- - - - - - c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? - - - - - - - - - - - - - - - - - - - - - 6. DRY SYSTEMS (See Section 14) a. Are dry valve(s) In service and In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Are pressure and priming water levels normal ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - c. Is air compressor In good condition ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - d. Were low points drained during fall and winter Inspections ? - - - - - - - - --- - - - - - - - - - - - - - - - - - - - a. Are Quick- opening devices In service ? - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - f. Has piping been checked for stoppage within the past ton (10) years ? - - - - - - - - - - - - - - - - - - - - - - - --- - g. Has piping been checked for proper pitch within the past five (5) years ? - - - - - - - - - - - - - - - - - - - - - - - - h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - 1. Are dry valves adequately protected from freezing ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Are valve house and heater conditions satisfactory ? - - - - - * - - - - - - - - - - - - - - - - - - - - - - - - - - - 7. SPECIAL SYSTEMS (See Section 16) a.Were valves tested as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - b. Were all heat -responsive systems tested and were the results satisfactory ? - - - - - - - - - - - - - - - - - - --- - - - - c. Were supervisory features tested and were the results satisfactory ? - - - - - - - - - - - - - - - --- - - - - - - - - - - 8. ALARMS a. Is the water motor and gong test satisfactory ? - - - - - - - - - - - - - - - - - - - - I - - - - - - - - - - - - - - b. Is the electric alarm test satisfactory ? - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - c. Is the supervisory alarm service test satisfactory ? Monitoring Co. 4F P h.: 4'ff- lig- I A?' C. d. Ae) 2 2. 9. SPRINKLERS - PIPING a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or Ya Ing ? 7 - - - - - - - - - - - - - - - b. Are all sprinkler heads less than fifty (50) years old ? Head Manufacturer Zee -11 il Date of head WHITE- VIKING COPY YELLOW INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY 7- o- W-0 Fire Protection Contractors since 1930 VIKING AUTOMATIC SPRINKLER COMPANY 34M RistAve. So., Seatilile, WA, 98134, 200.1622.4656 W -W73NT' LEVEL W, 6a2 Cmlfilwnlia fty1mgWow, WA 9=2, 3M. 425. 7M. Fire Sprinkler Inspection Report Paqe:W2 9. SPRINKLER PIPING (continued) YE S N.A. NO c. Are extra sprinkler heads readily available ? - - - . . . . . . . - - - - --- - - - - - d. Is condition of piping, drain valves, check valves, hangers, pri open sprinklers, and strainers satffactoryL? C6re, gau g�) rNA, a. Are all sprinklers of proper temperature rating? rtable fire extingui Are po shem In good condition z -- - - - -- g*, -19'fiand h6, on sprinkler ma ? y 10. Date Dry System Piping last checked for stoppage. . . . . . . . . . . . . . ... . . . ... . . . . . . 11. Date Dry System Piping last checked for proper pitch .. . . . . ... . . . . . . . . . . . . . . . .. ... . . . . . . . . 12. Date Dry Pipe Valve last trip tested .. . . . . . . . . . . . . . . . 7 - - - A1,F7— Wet Number: Make Model I Yea 13. systems: 14. Dry Systems: Number: — Make Model Year: 15. Accelerator: Make / Model / Year: 16. SpecialSystems: Number: —Type: Make Model Year: Condition 17;- CONTROL VALVES a. City Connection Control Valves - - - - - - b. Tank Control Valves - - - - - - - - - c. Pump Control Valves - - - - - - - - - d. Sectional Control Valves; -- - - - - - - - a. Systemtontrol Valves - -: - - - - - - - Number Type Yegope"No Secured Y,, No C Yes'No Sign Yes No Condition,,, 2. x X 4:,ff-f/� 1,X I& WATER FLOW TEST a. Water! Pressure Source : Jd- city, 13 Tank, 0 Fire Pump, Water Flow Test taken if not, reaw''n: Test Pipe Location. Stre.TeatTipe Pressure.Eleiori Flow Pressure Pressure After A T do J XV A16. 19. Explanation of any "No" answers: 0. Rec'ent changes In building occupancy or fire protectl�6n equipment: 21. Adjustments or corrections made: 24. Inspector's Signature: Witness (property owner / lessee) and date: WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY n Contractors since 1930 VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656 A Fire Protectio WA.: VI-KI-NA-S373NT "LEVEL M 602 California Way, Longview, WA 98632,360,425.7620 Fire Sprinkler Inspection Report Page:lof2 -17 -Ing REPORT'ib: JOB NO.i"1Q'-S'T— DATE: 7J J 0)', STREET: BLDG./LOCATION: 7) CITY / STATE TLV,C, INSPECTOR: 1.GENERAL a. Is the building occupied ? - - - - - - - - - - - - - - - - - ---- -- - - - - - - - - - . . . . . . . . b. Is occupancy the same as previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . - - - - - -- - - C. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Are all fire protection systems the same as last Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Is the building completely sprinklered ?- - - - - - - - - - - - 0 . . . . . . . . . . . . . . . . . . . I. Are all new additions and building changes properly protected ? - - - - - - - - - - - -- - - - - - - - - - - - - - - - - g. Is all stock or storage properly below sprinkler piping ? - - - - - - - - - - - - - - - - - - - - - - - - - - h. Was property free of fires since last Inspection.? (Explain any fire on Page 2) .. . . . . . . . . . . . . . . . . . . . . 1. In areas protected by wet systems, I I a building property heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected against the cold ? 2. CONTROL VALVES (See Section 17) a. Are all sprinkler system main control valves open ?_ - /j.559 - - - - - - - - - - - - - - - - - - - b. Are all other control valves In proper position ? . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . c. Are all control valves In good condition and sealed or supervised ? . . . . . . ... . . . . . . . . . . . . . . . . . . . 3. WATER SUPPLIES (See Section 18) a. Was a water flow test preformed and were the results satisfactory ? - - - - - - - - - - - - - - 0 .. . . . . . . . . . . . 4. TANKS, PUMPS, & FIR E DEPARTMENT CONNECTIONS a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly *maintained ? - - - - - - - - - - - - - - - b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight Z 5. WET SYSTEM (See Section 13) a. Are cold weather valves open or closed as necessary ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? — - - - - - - - - - - - - - - - - - - c. Are alarm valves, water flow Indicators and retard chambersIn satisfactory condition ? - - - - - - - - - - - - - - - - - - - --- 6. DRY SYSTEM (See Section 14) a. Are dry valve(s) In service and In good condition ? - - - - - - - - - - - - - - - b. Are pressure and priming water levels normal ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - c. Is air compressor In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 - - - - - - - - - d. Were low points drained during fall and winter Inspections ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - a. Are Quick- opening devices In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . f. Has piping been chocked for stoppage within the past ten (10) years ? - - - - - - - - - - - - - - - 0 - - - - - - - - - -- g. Has piping been checked for proper pitch within the past five (5) years ? . . . . . . . . . . . . . . . . . . . . . . . ... h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Are dry Valves adequately protected from freezing ? - - - - - - - - - - - - - - - - - - - - - - Are valve house and heater conditions satisfactory ? - - - - -- - - - - - - -- 7 - - - - - - - - - - - - 0 - - - - - - 7. SPECIAL SYSTEMS (See Section 16) a. Were valves t sated as required ? - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - b. Were all heat -responsive systems tested and were the results satisfactory ? . . ... . . . . . - - - - -- - - - - - - c. Were supervisory features tested and were the results satisfactory ? - - - - - - 8. ALARMS a. Is the water motor and gong test satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - b. Is the electric alarm test satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - c. Is the supervisory alarm service test satisfactory ? Monitoring Co'-F—Imt, "z ea-, 1304:2 if :3 4) 0' Code: Z 90 2-" 9. SPRINKLERS - PIPING COP10=_ <5 a. Are all sprinkler heads In good condition, not obstructed . and free from, corrosion or loading ? - - - - - - - - - - - - - - - - - - b. Are all sprinkler heads less then fifty (50) years old ? Head Manufacturer. .40,A)ZW1 1­ Date of head 9 WHITE: VIKING COPY YELLOW: INVOICE COPY - PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY Fire Protection Contractors since 1930 IKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seaffle, WA 98134, 206. 622. 4656 WA.: VI-KI-NA-S373NT LEVEL N 602 Calfibmia Way, Longview, WA 98632, 360. 425. 7620 Fire Sprinkler Inspection Report Page:W2 9. SPRINKLER / PIPING (Continued) YES N.A. I NO c. Are extra sprinkler heads readily available ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, and strainers satifactory ? - - - a. Are all sprinklers of proper temperature rating? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - f. Are portable fire extinguishers in good condition ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - g. Is hand hose on sprinkler systems satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10. Date Dry System Piping last checked for stoppage -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11. Date Dry System Piping last checked for proper pitch -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12. Date Dry Pipe Valve last trip tested -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - - 13. Wet systems: Number: I / Year: 021n I ? Make Mode aZ4 4_1 �S!A2; 74 14. Dry Systems: Number: Make Model / Year: 15. Accelerator: Make/ Model /Year: 16. SpecialSystems: Number: —Type: Make / Model / Year: Condition 17. CONTROL VALVES a. City Connection Control Valves - - - - - - P. Tank Control Valves - - - - - - - - - c. Pump Control Valves - - - - - - - - - d. Sectional Control Valves - - - - - - - - - a. System Control Valves - - - - - - - - - 18. WATER FLOW TEST a. Water Pressure Source 4city, OTank, 0 Fire Pump, Water Flow Test taken ? W-J-7 If not, reason: Test Pipe Location Size Test Pipe Pressure Before Flow Pressure Pressure After V2 5t )77;ilp Le- 19. Explanation of any "No" answers: dtQ 14W 20. Recent changes in building occupancy or fire protection equipment: 21. Adjustments or corrections made: Z, 7F-ST OF -TAj�P?ef_,e_ 0:'*Y F_:�_R1;7QNP_5 EV,__c_-nEuAA1 22. Desirable improvements: 23 Has building owner / representative been notified of any deficiency to the fire protection system?VYes 0 No, Person notified: If answer is "No",explain: en�� --Witness (property owner / lessee) and date: 24. Inspector's Signature: FIRE DEPARTMENT COPY Fire Protection Contractors since 1930 'VIKING AUTOMATIC SPRINKLER COMPAN'Y' 3434 First Ave. So., Seattle, WA 98134, 206.622.4656 WA.: VF-K1-NA-W73NT LEVEL N. A, 602 California Way, Longview, WA 98632,360,425.7620 Fire Sprinkler Inspection Report Page:lof2 .4 4) 5irl'111<9 - 6<_ �;_// REPORT TO: JOB NO. DATE: STREET: —, ? BLDG. / LOCATION: CITY/ STATE: 6� INSPECTOR: I.GENERAL a. Is the building occupied ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Is occupancy the same as previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Are all fire protection systems the same as last Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. Is the building completely sprinklered ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Are all now additions aAd building changes properly protected ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . g. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . h. Was property free of fires since last Inspection ? (Explain any fire on Page 2) . . . . . . . . . . . . . . . . . . . . . . . . 1. In areas protected by wet syste me, Is building properly heated, Le.: blind attics, perimeter areas, and are all exterior openings protected against the cold ? 2. CONTROL VALVES (See Section 17) a. Are all system main control valves open ? . . . . . . . . . . . . . . . . . . . . . . . i� .. . . . . . . . . . b. Are all other control valves In proper position ? . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . c. Are all control valves In good condition and sealed or supervised ? . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. WATER S UPPLIES (See Section 18) a. Was a water flow test preformed and were the results satisfactory ? . . . . . .. . . . . . . . . . . . . . . . . . . . . . 4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? . . . . . . . . . . . . . . . b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight ? - - - - - -- - - - - - - S. WET SYSTEMS (See Section 13) a. Are cold weather valves open or closed as necessary ? . . . . . . . . . . . . . . . . . . . . . . . . b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? . . . . . . . . . . . . . . . . . . . c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? . . . . . . . . . . . . . . . . . . 6. DRY SYSTEMS (See Section 14) a. Are dry valve(s) In service and In good condition ? . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . b. Are pressure and priming water levels normal ? - - - - - - - - - - - - - - . . . . . . . . . . . . . . . . . ... . c. Is air compressor In good condition ? . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . d. Were low points drained during fall and winter Inspections ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a. Are Quick- opening devices In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I. Has piping been checked for stoppage within the past ton (10) years ? . . . . . . . . . . . . . . . . . . . . . . . . . . g. Has piping been checked for proper pitch within the past five (5) years ? . . . . . . . . . . . . . . . . . . . . . . . . . h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Are dry valves adequately protected from freezing ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Are valve house and heater conditions satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7. SPECIAL SYSTEMS (See Section 16) a. Were valves tested as required ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Were all heat -responsive systems tested and were the results satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . c. Were supervisory,!eatures tested and were the results satisfactory ? . . . . . . . . . . . . . . ... . . . . . . . . ... . 8. ALARMS a. Is the water motor and gong test satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Is the electric alarm test satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . c. Is the supervisory alarm service test satisfactory ? Monitoring Co. 4 1^ Ph.: q25- 71/8— 29 ft4)Code: 9. SPRINKLERS - PIPING a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loadl I ? . . . . . . . . . . . . ... . . . . b. Are all sprinkler heads less than fifty (SO) years old? Head Manufacturer:--... —Dt.ofhead: WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY Fire Protection Contractors since 1930 I 01"r VIKING AUTOMA71C SPRINKLER COMPANY 3434 FhW Am- Sm, Seeft WA 98134, 206. 622. 4656 602 Caftmils Wr/, Longview, WA 360.425.7620 WA.: VI-KI-M-W.731VT LEVEL Hk Fire Sprinkler Inspection Report Page:W2 9. SPRINKLER PIPING (Continued) YES NA. NO c. Are extra sprinkler heads readily available ? . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, and strainere sadfactory ? - - - - - - - - - - X sprinklers of proper temperature rating? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f. Are portable fire extinguishers In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X, g. is hand hose on sprinkler systems satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I >< I I 10. Date Dry System Piping last chocked for stoppage .. . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . .. 1AJ E 7 11. Date Dry System Piping last chocked for proper pitch .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. Date Dry Pipe Valve last trip tested .. . . . . . . f? 13. Wet systems: Number. Make Model Year 4/1 14. Dry Systems: Num bar: Make Model Year 15. Accelerator: Make / Model Year: 16. SpecialSystems: Number: -Type: Make / Model / Year: Condition: 17. CONTROL VALVES a. City Connection Control Valves . . . . . . b. Tank Control Valves - - - - - - - - - c. Pump Control Valves . . . . . . . . . d. Sectional Control Valves - - - - - - - - - a. System Control Valves - : - - - - - - - 10, WATER FLOW TEST a.Water Pressure Source:13 City, 07ank. 13 Fire Pump, Water Flow Test taken ? _iLKI-K-If not, reason: Test Pipe Location Size Test Pipe Pressure Before Flow Pressure Pressure After 7- ation of -any "No" answers: /i foo I re <4 b* 01 20. Recent changes In building occupancy or fire protection equipment: 21. Adjustments or corrections made: 22. Desirable improvements: Se r -xvit e k, /,,.,7 1,c),r1A d., 711& 1! 4 23. Has building owner / representative been notified of any deficiency to the fire protection system? 0 Yes 0 No, Person notified: If answer Is "No",explain- w 24. Inspector's Signature: Witness (property owner / lessee) and date: WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY ,4, Fire Protection Contractors since 1930 MC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656 IUIVC,r VIKING AUTOMA WA: VI.KJ-NA-W73NT LEVEL Hi 602 California Way, Longview, WA 98632,360,425.7620 Fire Sprinkler Inspection Report Page: I of 2 REPORTTO: 65�151AWA414 A60ae 1 4,14 JOBNO. OArE,. to STREET: BLDG. I LOCATION: -7— C[TY/STATE: Wv 5; INSPECTOR: 1.GENERAL a. Is the building occupied ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Is occupancy the same as previous Inspection ? - - - - - - - - - - - - n - - - - - - - - - - - - -- - - - - - - - - c. Are all systems In service ? - - - - - - - - - - - - - - - - - L - - - - - - - - - - - - - - - - - - - - - - d. Are all fire protection systems the same as last Inspection ? . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 9. Is the building completely sprinklered ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f. Are all new additions and building changes properly protected ? - - - - - - - - - - .. . . . . . . . . . . . . g. Is all stock or storage properly below sprinkler piping ? - - - - - - - - - - - - - - - - - - - - - - - - - h. Was property free of flres since last Inspection ? (Explain any fire an Page 2) . . . . . . . . . . . . . . . . . . . . . . . . 1. In areas protected by wet systems, Is building properly heated, I.e.: blind attics, perimeter areas, and are an exterlar openings protected igahW the cold ? 2. CONTROL VALVES (See Section 17) a. Are all sprinkler system main control valves open ? . . . . ... . . . ... . . . . . . . . . . . .. . . . . . . . . . . b. Are all other control valves In proper position ? - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - c. Are all control valves In good condition and sealed or supervised ? - � . . . . . . . . . . . . . . . . . . . . . . . . . 3. WATER SUPPUES (Sao Section 18) a. Was a water flow teat preformed and were the results satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - 4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS a. Are fire pumps; gravity tanks, resevoIrs and pressure tanks In good condition and properly maintained ? - - - - - - - - - - - - - - - b. Are Fire Department Connections In satisfactory condition, couplings free. cape In place and check valves tight ? . . . . . . . .. . . . . S. WET SYSTEMS , (gee Section 13) a. Are cold weather valves open or closed as necessary ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Have antifreeze systems been tested and left In satisfactory condition ? Temp..? — - - - - - - - - - - - - - - - - - - c. Are alarm valves, water flow Indicators and retard chambers In satlifacitory condition ? - - - - - - - - - - - - - - - - - - - - - DRY SYSTEMS (See Section 14) a. Are dry valve(s) In service and In good condition ? . . . . . . . ... . . . . . . . . . . . . - - - - - - - - b. Are pressure and priming water levels normal ? - -- - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - c. Is air compressor In good condition ? . . . . . . . - - - - - -- - - I - - - - - - - - - - - - - - - - d. Ware low points drained during fail and winter Inspec tions ? - - - - - -- - - - - - - - - - - - - - - - - - - - - - - a. Are Quick- opening devices In. -service 7 . . . . . . . . . . .. . - - - - - - - - — - - --- - - - - - - - - L Has plping"been checked for stoppage within the past ton (10) years ?. . . . . . . . . . . . . w - - - - - - - - - g. Has piping been checked for proper pitch Within the past five (5) years ? - - — - - - - - — - - - - - - - - - - h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. Are dry valves adequately protected from freezing ? . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Are valve house and heater conditions satisfactory ? - - - - - - - - w - - - - --- - - - - - - - - - - - - - 7. SPECIAL SYSTEMS (See Section 16) a. Were valves tested as required ? - - -- - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - b. Were all heat -responsive systems tested and were the results satisfactory ? - - - - - - - - --- - - - - - - - - --- - - - - c. Were supervisory features tested and were the results satisfactory ? - -- - - - - - - - - - - - - - - - - - - - - - - - - - 8. ALARMS a. Is the water motor and glani; test satisfactory ? . . . . . .. . .. . . . . . . . . . . . . .. . . . . . ... . . . . . . b. Is the electric alarm test satisfactory ? . - - - - - - - - - - - - - - c. is the supervisory alarm service test satisfactory 7 Mon . lloringCo. Ph.: 7' 7 V<,2 Code: Z 9 ?1/ 9. SPRINKLERS - PIPING* a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loading ? - - - - - - - - - - - - - - - - - - b. Are all sprinkler heads less than fifty (50) years old ? Head Manufacturer Dateolhead:_ 15�4!r r� oa~c rTuw mm. R= nmxaTu;*a rrpy r4v rt Fti m ro4r rripy Fire Protection Contractors since 1930 . V,1VJNG'AUTOMATIC SPRINKLER COMPANY 3&WRrstAw_SaL,SwfftWA98134*,206_ 622-4656 WA_ VNGWAS=JVT- LEVEL N: 60 CaNkff lib MV, Lofy9yia%W1_A NOW- 360.425.7UM Fire Sprinkler inspection Report Page: 2of 2 9. SPRINKLER I PIPING (Continued) YES N.A- NO 7 -d. W c6ndltlon -va1ves,:hbv 7, 9� a6dstratnemssfilectory?* ILL L-f,-! 7 of p!ping.,lraip Fal4M;hbck go' .�llis g. Is hand hose an sprinkler syslems,satisfacto ? - - - - - - - - - - Ty . . . . . . . . . Ia. Date Dry System Piping last chocked for stoppage .. . . . . . . . . ... . . . . - - - - --- - - - - - - - - - 11. Date Dry System Piping last checked for proper pitch - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12. Date Dry Pipe Valve I set trip tostod� - - - - - - - - - - - - - - - - - - - - - - - - - - 13. Wet systems: Number / Make I Model ' /Year 14. Dry Systems: Number:— Makal Model I Your 15. Accelerator Make/ ModellYear. Ia. SpeclalSystamw Number:_Type: Make/ Model /Year: 17. CONTROC VALVES a. City Connection Control Valves - - - - - - b.Tank Control Valves - - - - - - - - - C* Pump Control Val ves - - - - - -- - - - d. Sectional Control Velves . . . . . . . . . 6:,Sistem control Valves . . . . . . . . . 4 t -0 ST. !W-TIE. :1G4..WATih:FL X, nk;' me 13 PT test Pipe'Lo;at6i %,664 Pipe �146,s��r'a'iiii­ ore F1 "'0' ow res-LIM'.. Afi- ,Pqk3sure-. er,-L td T A 7- fi3O.1 Ia. Explanation of any "No" answeri:67—it-L/ L 4i, I, /z, 20. Recent changes In bulldln . 9 occupancy or--ilre prote ictio-n �qulpmen'V" X& 7 Adjuistments or corrections made tTqptS: 22­ oii Al, 4, 7 &D 23. Has building owner/ representative been nollifled of any deflcl ency to. the fire protection system? O.Yes, 13 No. Person notified: It answer Is "No",explain: 24. Inspector's Signature: 21� X74� — Witness (property owner / lessee) and date: 'e wHrrF: VIK W-61r— Ya I Oft INVOCE COPY PiNK FRE DEPARTWW COPY GOLD: BULDING COPY VIKING AUTOMATIC SPRINKLER COMPANY 0�— Fire Protection 3434 First Avenue Sodth 802 California Way Suite #1 Since 1930 Longview, WA 98632 Seattle, WA .98134 (ZQ6) 622-4*656 4; (160) 425-7620 F0REMAN'SREP0RTWEtKLNDiN'G: VIKiNG J013 isunday's Data) EmployeeName: (Ont nam -one Person Per dam slip) Mon Tue Wed Thur Fil Sat Sun Parking $ Ferry $ Travel Expense ( Miles # Subsistence (Days) # Miscellaneous Expense $ Customer PO* JobAddress:, 7,//) /,/- A,--:- Hours on Job: Building Area: A; Travel Time: Foreman's Sianature: Provide a brief description of work or services performed: /c77 A� - y7_:,1_1 I Comment on status of the job (future work to be completed, parts needed, -desirable improvemerds)- x 4! b J1, Is:job domplete? Yes No Was sprinkler system shut-off by others? Yes No Was sprinkler system.restored by Viking? Valve Seal # Yes No Are all Shut-off valves open? Yes (,x) No Is system to be restored by others? If yes, by whom Yes No Is system connected to central signal service? Yes No If yes. Monitor Co: Monitor Phon.e #and Code: V? 7 1,,, Viking Employee Report of Safety (must be completed) Work area insp6ctedfof Safety prior to starting work Yes�­[ -] No I # of Viking Employee's on Job; Number of Viking Employee's in attendance: Issues Found: Suggestions Offered: AUTHORIZATION TO PERFORM WORK AND ACKNOWLEDGEMENT OF SERVICE Signature of Owner or Representative: Date: Print Narne'and Title: rev 12-08 White - Vildng Copy Ffnk -Safety (ratumto office) , Yeflow - Customer Copy Page 1 Page 2 Page 3 CITY OF EDMONDS 121 5TH AVENUE N. - EDMONDS, WASHINGTON 98020 - (425) 771-0215 FIRE DEPARTMENT LOCATION: 310 6th Avenue N BUSINESS NAME: Boys & Girfs Club Of Edmonds MAILING 310 6th Ave N FIRE PREVENTION SAFETY SURVEY PHONE: 4257740630 FREQUENCY STATION& SHIFT 366 17 D SCHEDULED DATE DUE 11 ID4/01/10 UFIR 1� 141 4203 Auuhr_00: Edmonds 98020 C N� BUSINESS OWNER: &filz 7- HOME PHONE: 42-54 AC_nVE 9 -is G 79ef . —';110 - ' EMERGENCY-1: HOME PHONE: KEY ACCESS-2:,. HOME PHONE: fffl PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: C4 -711 C�, FIRE AS 1/03 FA 8107'PD LkBx V FEI� I t 0 SYST EM '_): (" / q 51161 ANNUAL HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS ENTER CODE ONLY ONCE 10 VIOLATION CODE 2 2 3 3 4 4 5 5 6 6 7 7 8 8 'Ist RE -INSPECTION 2nd RE -INSPECTION EXTENSION FINAL RE -INSPECTION VIOLATIONS DATE DUE: DATE DUE: GRANTED TO: bATE DUE: CITED: PERSON PERSON PERSON CONTACTED: CONTACTED: CONTACTED: 2 INSPECTOR: INSPECTOR: DATE: 2ATE: DATE 3 4 VIOLATIONS 1 VIOLATIONS 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 5 2 6 2 6 DATE: CODE SECTION: 3 7 3 7 RETURN RECEIPT RECEIVED 6 7 DISPOSITION: 4 18 4 8 DATE: LETTER NEEDED 0 YES NO -LETTER NEEDED [] YES E) NO 8 FIRE DEPARTMENT COPY