400 WALNUT ST (2)(400'. Q A L /J Lrj FIRE PREVENTION
*X 8
" I INSPECTION REPORT
Servit.igBrier, Edmonas, Ultu 12425 Meridian Ave S
SNOHONnSH CO - 4.:
Aw ��
0 EDMONDS
Moinitlake Terrace Everett, WA 98208 0 BRIER
FI 0 MOUNTLAKE TERRACE
Phone (425) 551-1200 0 UNINCORPORATED
D1 TR "T w w'w. FireDistrict]. org Fax (425) �51-1272
400 Walnut Street 98020 FAEnQnUUEayy STAfyte SHIFT
LOCATION:
BUSINESS NAME: Emerald Place Condos PHONE: SCHEDULED Mar 2017
DATE DUE II'
423
MAILING 400 Walnut Street, Edmonds, WA 98020 LIFIR 0
ADDRESS:
Hanson, Eric
BUSINESS OWNER: HOME PHONE:
Carroll, P. 2063630235
EMERGENCY-1: HOME PHONE: CU�RRENT
KEY ACCESS-2: HOME PHONE: I YES NO
USI
FB NESS
EMAIL: LICENSE 11 11
PERSON CONTACTED: ke- INITIAL INSPECTION DATE
3
NAME OF -INSPECTOR:
Date Last Service 1�k\060 116 1
HAZARDS FOUND AND LOCATIONS / COMMUNICATIOf4S
1�_,yp,�v evv-v�j-1 );)LJ &,�4de (OLi
.2. F�D, ],.e—,t
2-
3 (ir-e Z-. OIL -�ei�� a,&, 3
4 4
.5 5
6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
6
VA
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:
INSPECTOR: INSPECTOR: 2
INSPECTOR:
DATE: DATE DATE. 3
VIOLATIONS VIOLATIONS CITATION ISSUED
PRE -CITATION 4
1 5 1 5 LETTER SENT NUMBER.
CODE 5
2 6 2 6 DATE SECTION
RETURN RECEIPT
3 7 3 7 RECEIVED 6
DISPOSITION.
7
4 4 '8 DATE:
LETTERNEEDED C] YES EINO LETTER NEEDED YES NO
8 y
EdmondS Fire Department
AAA Fir & Safety, Inc.
30133 rd Ave N Seattle, WA 98109
Ph: 206-284-1721 Fx: 206-284-1769
Ern: info@aaaflre.com Date:;/2015 12:00pryl
Five Year Internal Pipe Exam, FDC Internal Exam and MIC Testing
Occupancy Name:
Occupancy Address:
EMERALD PLACE CONDO ASSOC
400 WALNUT ST #301
Citv: EDMONDS State:WA Zip: 98020
Responsible Person:
Phone Number:
BOB WRIGHT
(C) (206) 920-4749 425-776-34
Testers Name:
NICET & SFD#:
Richard McLean
Location of System:
Certification Given:
Garage
RED YELLOW WHITE
The following tests were performed: YES NO N/A
1. Five year internal pipe inspection on DRY pipe fire sprinkler system(s) F 0 D
2. Five year internal pipe inspection on WET pipe fire sprinkler system(s) El F E
3. Water samples taken from sprinkler system(s) tested for
microbiologically influenced corrosion (MIC) 0 11 Fl-
4. Fire department connection 5 year internal obstruction investigation and
caps are in place and connections rotate properly F1 11 El
S. 5-year replacement of gauges F F1 F
Problems found: None
Corrective Actions:
This certifies that the fire sprinkler system(s) have bee rly inspected internally and chemically to cover the items listed in
this report and are consistent with NFPA standards.
Phone:
Signature of Tester: JA '7 '�
Testing Agency: AAA Fire & Safety, Inc. Phone: 206-284-1721
Building Representative (signature):
tit AAA FIRE & SAFETY, INC
RA a 3013 3RD AVE NORTH
(800) 223-3473 SEAME, WA 98109
9*06AAAERESOM
SNOHOMISH CO.
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
FIRE ALARM SYSTEM
Status Given
(One System per Report)
RED
YELLOWF]
I WHITE
JXJ
CONFIDENCE TEST
0
[ REPAIR
Sprinkler Monitoring Panel?E]
Occupancy Address: 400 WALNUT ST.
Occupancy Name. EMERALD PLACE CONDOS
Responsible Person BOB WRIGHT
First & Last Name:
425-776-3455
Phone Number:
Responsible Person
Address, City, State, Zip:
Responsible Party RWRIGHT1985@AOL.COM
E—Mail Address
Date of Inspection:
AUG 24, 2015
Inspection Annual
Frequency/Type: Quarterly
Testers Name Richard Rees
(Please Print):
Nicet
Number: —
Identification
Number:
System Location ALARM ROOM in GARAGE
Central station monitoring? Yes El No [I
Monitoring
Monitoring Required? Yes El No r-1
Company Name: ACI
System Make: SILENT KNIGHT
System Model: 5208
FIRE CODE VIOLATIONs FOUND: (If additional room is needed, please add a separate sheet)
NOTE: Limited access, listed to horns through units doors
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet) Nicet 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 Wth Fire Department
Fire Code standards, and that
discrepancies are noted and h been reported ".. k -
rl er Manager for corrective action.
Signature of Tester: a je 5c,"z5hone
# (206) 551-6303
Building Representative (signature)
Fire Alarm Systems Page 1 of 2
aw
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements.
Alarm Svstem Functionali
1. Trouble signal with AC power off?
Yes X
No
2. System operates properly on battery backup?
Yes
NoH
3. Battery voltage (no load) 27.3 volts
4. Battery voltage (full load) 26.0 volts (signals operating)
5. Charge circuit voltage 27.3 volts
6. System operates properly on standby power?
M\7
Yes Lnj
No
7. All signals operate on AC power?
YesFX�
No
8. Number of initiating circuits 10
9. Number of signal circuits 3
10. Does alarm system meet audibility standards as accepted?
Yes
No
11. All circuits checked for electrical supervision?
Yes
No
12. All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
Yes
No
13. Ventilation controls operate?
N/A
Yes
No
14. Key to panel available?
N/A
Yes
No[:]
15. Materials and equipment needed to restore pull stations are available at the
N/A
Yes Z
No0
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?
16. Operating instructions at panel?
Yes Cj
NoN
17. Trouble indicators function properly?
Yes
No[:]
18. Remote Annunciator Panels function properly?
N/A
Yes
No[:]
19. Elevator Call Down functions properly?
N/AEJ
Yes g
No
20. Test record posted at panel?
Yes FX�
NoH
21. General alarm automatic time delay - (minutes)
N/A
22. Was a signal received at the Central Station monitoring company?
N/AF�
Yes
NoE]
23. Other Devices (Specify)
Yes
No EL -
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
36
15
N/A
Yes
No
25. Voice Speakers (Voice Clarity)
N/A
Yes
No
26. Visual Alarm Devices
10
10
N/A FXJ
Yes
No E:1
27. Smoke Detectors
13
13
N/A
Yes
No
28. Heat Detectors
N/A
Yes
No
29. Duct Detectors
N/A
Yes
No
30. Sprinkler Flow Switches
2
2
N/A
Yes
No
31. Sprinkler Supervisory Switches
N/A
Yes
No
32. Manual Pull Stations
8
8
N/A
Yes MX
No
33. Annunciator(s)
1
1
N/A
Yes
No
34. Beam Detectors
N/A
Yes
No
35. Automatic Door Unlocks
N/A
Yes
No
36. Automatic Door Release
5
5
N/A
Yes
No
37. Fire Dampers
N/A
Yes
No
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A Yes No
39. Phone lacks
N/A Yes No
40. Call -in Signal
N/A Yes No
Fire Alarm Systems Page 2 of 2
.;"tit AAA FIRE & SAFETY, INC.
0 a a
Me & 3013 3RD AVE NORTH
(SOD) 223-3473 SEAME, INA 98109
INFO FRECOM
Snohomish Co.
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
SPRINK LER - WET SYSTEM
Status Given
(One System per Report)
RED
F7]
I YELLOW
FX
WHIT
CONFIDENCE TEST I JXJ I REPAIRS
Occupancy Address: 400 WALNUT ST
Occupancy Name: EMERALD PLACE CONDOS
Responsible Person BOB WRIGHT
First & Last Name:
425-776-3455
Phone Number:
Responsible Person
Responsible Party
Address, City, State, Zip:
E—Mail Address
Date of Inspection: AUG 24, 2015
Inspection Annual
Frequency/Type: Quarterly F-1
Testers Name RICHARD REES
(Please Print):
Nicet Certification 2458-1007-E
Number:
Identification
Number:
System Location:
Central station monitoring? Yes El No 11
Monitoring
Monitoring Required? Yes No
Company Name: ACI
System Make:
System Model:
FIRE CODE VIOLATIONs FOUND: (If additional room is needed, please add a separate sheet)
NOTE: 5YR. FDC INSPECTION DUE
CORRECTIONS MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification
Number: -
This certifies that this fire and life safety system has bgWI&Wperly
inspected for reliability to cover the
Items listed in this report and is consiste ire Code stan and that
d3W '
discrepancies are noted and e re ed t building
0-w-Nnni Manager for corrective action.
Signature of Tester:
one #
Building Representative (signature)
Sprinklers - Wet Page 1 of 2
AP
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
I General
1.
Main Drain and Inspector's Drain flow test conducted?
Yes
No El
2.
Static pressure: 98 s.i. Flow pressure: 89 P. S. i.
3.
Number of Sprinkler Heads: 300-1000
4.
2-inch drain? Other 0
Yes
El
No El
5.
Flow switches, supervisory switches and alarm bells tested? N/A El
Yes
NoE]
6.
Pressure regulating valves tested? N/A Fx-1
Yes
NoEl
7.
Alarm bell operates? N/A El
Yes
NoEl
8.
System inspected and lubricated?
Yes
No El
9.
Valves are sealed or supervised?
Yes
0
NoEl
10.
Signs are provided on valves?
Yes
N
No [:1
11.
Pumper connections and clapper valves unobstructed and turn freely?
Yes
FX-1
No El
12.
Sprinkler coverage is acceptable?
Yes
No
13.
Have the sprinkler heads been replaced or successfully sample test in the
Yes
El
last 50 years? Date of last test: 1998
No
14.
Proper number of spare sprinkler heads available with appropriate wrenches
Yes
RX
El
for each?
No
15.
System left in service?
Yes
RX
No [:1
16.
System gauges replaced or calibrated within the last 5 years?
Yes
0
No El
Yearchanged: 2014
17.
Sprinkler heads free of corrosion, paint, obstructions and/or physical
Yes
X
El
damage?
No
18. Was debris found in the Fire Department Connection (FDC)? Yes El No 0
19. Was the Fire Department Connection (FDC) back flushed within the last 5
years? Date of last back flush UNKNOWN Yes El No M
20. Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed N/A PLASTIC PIPE Yes El No 0
21. Is the hydraulic nameplate installed and visible on riser. Yes 0 No E]
(Ref: NFPA 25 5.2.7)
22. Was a signal received at the Central Station monitoring N/A 0 Yes 0 NoEl
company?
Sprinklers - Wet Page 2 of 2
AAA FIRE & SAFETY, INC.
3013 3RD A VE NORTH
(=)2
A 2�
14FQ AFX7C30M SEAME' WA 98109
KIRKLAND
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
SPRINKLER - DRY SYSTEM
Status Given
(One System per Report)
RED
_]I
YELLO
WHITE
CONFIDENCE TEST IN I REPAIRS j
Occupancy Address: 400 WALNUT ST.
Occupancy Name: EMERALD PLACE CONDOS
Responsible Person BOB WRIGHT
First & Last Name:
425-776-3455
Phone Number:
Responsible Person
Responsible Party
Address, City, State, Zip:
E—Mail Address
Date of Inspection: AUG 24, 2015
Inspection Annual
Frequency/Type Quarterly 0
Testers Name Richard Rees
(Please Print):
Nicet Certification 2458-1007-E
Number:
Identification Number
(Required):
Sprinkler Room
System Location:
Central station monitoring? Yes E] No
Monitoring
Monitoring Required? Yes El NoD
Company Name: ACI
System Make:
System Model:
FIRE CODE VIOLATIONS FOUND: (if additional room is needed, please add a separate sheet)
NOTE: 5YR I.P.I. DUE and 5YR FDC INSPECTION DUE
CORRECTIONS MADE: ' Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life s fety
VRaerly inspected for reliability to cover the
Items listed in this report and is si nt with Fire e and and that
discrepancies are noted and h be repo t e /Manager for corrective action.
W, —I
Signature of Tester: A
r —
one #
Building Representative (signature)
Sprinklers - Dry Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
General
1.
Trip test conducted?
Yes 0
No El
2.
System tripped in 14 seconds. Trip point 14 Time to inspectors test NIA
3.
Main Drain and Inspector's Drain flow test conducted?
Yes
No
4.
Static pressure: 100 psi Flow pressure: ___90 _psi
5.
Number of Sprinkler Heads? �"100
6.
2-inch drain? Other 1:1
Yes ZX
No El
7.
Flow switches, supervisory switches and alarm bells tested? N/A
Yes 0
No El
8.
Alarm bell operates? N/A
Yes M
No El
9.
Air compressor refills system in 30 minutes or less?
Yes NX
No El
10.
Heat actuation devices tested on pre -action and deluge systems? N/A
Yes
No
11.
System inspected and lubricated?
Yes
No
12.
Valves are sealed or supervised?
Yes
No
13.
Signs are provided on valves?
Yes
NoEl
14.
Pumper connections and clapper valves unobstructed and turn freely?
Yes
No
15.
Sprinkler heads replaced or successfully sample tested in last 10 years?
Yes
No
Date of last test: _N/A STANDARD
16.
Sprinkler coverage is acceptable?
Yes
No El
17.
Proper number of spare sprinkler heads available with appropriate wrench for
Yes
No [j
each?
18. System left in service? Yes 0 No El
19. System gauges replaced or calibrated within the last 5 years?
Yearchanged: 2014 — Yes No
20. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? Yes Z No El
21. System drained and restored to normal operation? Yes Z No El
22. Was debris found in the Fire Department Connection (FDC)? Yes El No 0
23. Was the Fire Department Connection (FDC) back flushed in the last 5 years?
Date of last back flush UNKNOWN YesEl No Z
24. Was a signal received at the Central Station monitoring company? N/A [:] Yes 0 No El
25. Is the hydraulic nameplate installed and visible on riser.
(Ref: NFPA 25 5.2.7) Yes No
26. Was an internal pipe and valve inspection performed within the last 5 years? Date
Performed UNKNOWN YesEl No 0
Sprinklers - Dry Page 2 of 2
lit AAA FIRE & SAFETY, INC
a a a
I.. & - I.C'.. 30133RDAVENORTH
(800) 223-3473
INF CAAAFRE.COM SEATTLE, WA 98109
SNOHOMISH CO.
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
FIRE ALARM SYSTEM
Status Given
(One System per Report)
RED
T-7
YELLOW
WHITE
[MA
CONFIDENCE TEST
M
I REPAIRS I
Lj
Sprinkler Monitoring Panel?E]
Occupancy Address: 400 WALNUT ST.
Occupancy Name: EMERALD PLACE CONDOS
Responsible Person BOB WRIGHT
First & Last Name:
Phone Number: 425-776-3455
Responsible Person
Address, City, State, Zip:
Responsible Party RWRIGHT1985@AOL.COM
E—Mail Address
Date of Inspection:
AUG 24, 2015
Inspection Annual
Frequency/Type: Quarterly 7
Testers Name Richard Rees
(Please Print):
Nicet
Number: —
Identification
Number:
System Location ALARM ROOM in GARAGE
Central station monitoring? Yes El No [I
Monitoring
Monitoring Required? Yes El No [I
Company Name: ACI
System Make: SILENT KNIGHT
System Model: 5208
FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
NOTE: Limited access, listed to horns through units doors
CORRECTIONS MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate sheet) Nicet 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 vAth Fire
Department Fire Code standards, and that
discrepancies are noted and h been reported
eer'Manager for corrective action.
Signature of Tester: ;&:� )ca
hone # (206) 551-6303
Building Representative (signature)
Fire Alarm Systems Page I of 2
C,
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements.
Alarm Svstem Functionali
1.
Trouble signal with AC power off?
Yes
Noo
2.
System operates properly on battery backup?
Yes
No
3
27.3
Battery voltage (no load) volts
4
Battery voltage (full load) 26.0 volts (signals operating)
5.
Charge circuit voltage 27.3 volts
6.
System operates properly on standby power?
YesFXI
No
7.
All signals operate on AC power?
Yes
No
8.
Number of initiating circuits 10
9.
Number of signal circuits 3
10.
Does alarm system meet audibility standards as accepted?
Yes Z
No
11.
All circuits checked for electrical supervision?
Yes
No
12.
All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
Yes
No
13.
Ventilation controls operate?
N/A
Yes
No
14.
Key to panel available?
N/A
Yes
No[-]
15.
Materials and equipment needed to restore pull stations are available at the
N/A
Yes
No[:]
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?
16.
Operating instructions at panel?
Yes
NoZ
17.
Trouble indicators function properly?
Yes
No [:]
18.
Remote Annunciator Panels function properly?
N/A
Yes Z
No[:]
19.
Elevator Call Down functions properly?
N/A
YesFXI
No
20.
Test record posted at panel?
Yes Z
NoB
21.
General alarm automatic time delay _ (minutes)
N/A
22.
Was a signal received at the Central Station monitoring company?
N/A
Yes RX
No[:]
23. Other Devices (Specify)
Yes 0
No 1:1
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
36
15
N/A
Yes rX-I
No [:1
25. Voice Speakers (Voice Clarity)
N/A
Yes
No
26. Visual Alarm Devices
10
10
N/A
Yes
No
27. Smoke Detectors
13
13
N/A
Yes
No
28. Heat Detectors
N/A N
Yes
No
29. Duct Detectors
N/A
Yes
No
30. Sprinkler Flow Switches
2
2
N/A
Yes
No
31. Sprinkler Supervisory Switches
N/A
Yes
No
32. Manual Pull Stations
8
8
N/A
Yes
No
33. Annunciator(s)
1
1
N/A
Yes
No
34. Beam Detectors
N/A
Yes
No
35. Automatic Door Unlocks
N/A
Yes
No
36. Automatic Door Release
5
5
N/A
Yes
No
37. Fire Dampers
I N/A Z
YesE]
NoEl I
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A Yes No
39. Phone lacks
N/A Yes No
40. Call -in Signal
N/A Yes NoEj
Fire Alarm Systems Page 2 of 2
itt AAA FIRE & SAFETY, INC
3013 3RD AVE NORTH
(800) 223-3473 SEATTLE, WA 98109
INFOCAAAFRE.COM
SNOHOMISH CO.
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
FIRE ALARM SYSTEM
Status Given
(One System per Report)
RED
F71
YELLOWFI
I WHITE
Z\j
CONFIDENCE TEST
I LX
I REPAIRS
Sprinkler Monitoring Panel? El
Occupancy Address: . 400WALNUTST.
Occupancy Name: EMERALD PLACE CONDOS
Responsible Person BOB WRIGHT
First & Last Name-
425-776-3455
Phone Number:
Responsible Person
Address, City, State, Zip:
Responsible Party RWRIGHT1985@AOL.COM
E—Mail Address
Date of Inspection:
AUG 24, 2015
Inspection Annual
Frequency/Type: Quarterly F I
Testers Name Richard Rees
(Please Print):
Nicet
Number: —
Identification
Number:
System Location ALARM ROOM in GARAGE
Central station monitoring? Yes El No [I
Monitoring
Monitoring Required? Yes El No [I
Company Name: ACI
System Make: SILENT KNIGHT
System Model: 5208
FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
NOTE: Limited access, listed to horns through units doors
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet) Nicet 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 Fire
Department Fire Code standards, and that
discrepancies are noted and h e been reported
ner/Manager for corrective action.
Signature of Tester: ;&:
hone# (206) 551-6303
Building Representative (signatu re)
Fire Alarm Systems Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements.
Alarm Svstem Functionali
1. Trouble signal with AC power off'?
Yes
No
2. System operat6s propeTly o - n battery backup?
Yes
NoH
3. Battery voltage (no load) 27.3 volts
4. Battery voltage (full load) 26.0 volts (signals operating)
5. Charge circuit voltage 27.3 volts
6. System operatts properly on standby power?
Yes ED
NoE]
7. All signals operate on AC power?
Yes RX
No
8. Number of initiating circuits 10
9. Number of signal circuits 3
10. Does alarm system meet audibility standards as accepted?
Yes
No
11. All circuits checked for electrical supervision?
Yes
No
12. All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
Yes
NoR
13. Ventilation contro - Is - operate?
N/A
Yes
14. Key to panel a7,6ilable?
N/A
Yes
No
15. Materials and equipment needed to restore pull stations are available at the
N/A
Yes FXJ
NoE]
I main panel, e.g. -glass -rods, and_plates;_ keys and allen wrenches, etc?
16. Op Actions at panel? Yes NoN
- erating instl
17.- Trouble indicators, function, properly? -------- Yes NoE]
18. Remote Annuffciator Panels function. properly? N/A Yes nX No
19. Elevator Call. Down functions properly? N/A Yes No
20. Test record, pQt�ed at pand? Yes NoH
21. General alarm automatic time delay (minutes) N/A
22. Was a sicinal received at the Central Station monitoring company? N/A Yes
23. Other Devices (Specify) Yes
No E]
No 1:1
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
36
15
N/A
Yes
No
25. Voice Speakers (Voice Clarity)
N/A
Yes
No
26. Visual Alarm Devices
10
10
N/A
Yes
No
27. Smoke Detectors
13
13
N/A E:]
Yes Eg
No
28. Heat Detectors.
N/-A
Yes
No
29. Duct Detectors
N/A
Yes
No
30. Sprinkler Flow.$witches
2
2
N/A
Yes
No
31. Sprinkler Supervisory Switches
N/A
Yes
No
32. Manual.Pull Stations
8
8
N/A
Yes
No
33. Annunciator(s)
N/A
Yes
No
34. Beam Detector's
N/A
Yes
No
35. Automatic Door Unlocks
N/A
Yes
No
36. Automatic Door Release
5
5
N/A FX�
Yes
No
37. Fire Dampers
N/A
Yes
No
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A Yes No
39. Phone lacks
N/A Yes No
40. Call -in Signal
N/A Yes No
Fire Alarm Systems Page 2 of 2
'kkk AAA FIRE& SAFETY, INC
a a a
3013 3RD AVE NORTH
(SH) 223-3473 SEATTLE, INA 98109
INFOCAAAM.COM
Snohomish Co.
FIRE
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
DEP
7 MENT
SPRINKLER - WET SYSTEM
Status Given
RE6
F]
I YELLOW
FXJ
I WHITE
(One System per Report)
CONFIDENCE TEST IN I REPAIRS
Is- 400 WALNUT ST
Occupancy Addres .
EMERALD PLACE CONDOS
Occupancy Name:
Responsible Person BOB WRIGHT
First & Last Name:
425-776-3455
Phone Number:
Responsible Person
Responsible Party
Address, City, State, Zip:
E—Mail Address
Date of Inspection- AUG 24, 2015
Inspection Annual
Frequency/Type: Quarterly F-1
Testers Name RICHARD REES
(Please Print):
Nicet Certification 2458-1007-E
Number:
Identification
Number:
System Location:
Central station monitoring? Yes El No 11
Monitoring
Monitoring Required? Yes El No 11
Company Name: ACI
System Make:
System Model:
FIRE CODE VIOLATIONs FoUND: (if additional room is needed, please add a separate sheet)
NOTE: 5YR. FDC INSPECTION DUE
CORRECTIONS MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification
Number: -
This certifies that this fire and life safety system h hiz 1=gWerly
inspected for reliability to cover the
Items listed in this report and is consiste ire Code s anucti and that
discrepancies are noted and e re ed t building
Own Manager for corrective action.
Signature of Tester:
one #
Building Representative (signature)
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required -
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
General
1 -
Main Drain and Inspector's Drain flow test conducted?
2.
Static pressure: 98 p.s.i. Flow pressure: 89 p. S. I.
3.
Number of Sprinkler Heads: 300-1000
4.
2-inch drain?
Other
5.
Flow switches,.!�supervisory switches and alarm bells tested?
N/A
El
6.
Pressure regulating valves tested?
N/A
Z
7.
Alarm bell operates?
N/A
Ej
8.
System inspected and lubricated?
9.
Valves are sealed or supervised?
10.
Signs are provided on valves?
11. Pumper connections and clapper valves unobstructed and turn freely?
12. Sprinkler coverage is acceptable?
13. Have the sprinkler heads been replaced'i or successfully sample test in the
1968
last 50 years? Date of last test:
14. Proper number of spare sprinkler heads available with appropriate wrenches
for each?
15. System left in service?
16. System gauges replaced or calibrated within the last 5 years?
Yearchanged: 2014
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical
damage?
18. Was debris found in the Fire Department Connection (FDC)?
19. Was the Fire Dqp*artment Connection (FDC) back flushed within the last 5
years? Date of last back flush UNKNOWN!
20. Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed N/A PLASTIC PIPE
21. Is the hydraulic nl�'meplate installed and visible on riser.
(Ref: NFPA0,25 5.2.7)
22. Was a signal received at the Central Station monitoring
company?
Sprinklers - Wet
Yes 0
Yes El
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No El
No El
NoE]
No El
No El
No r-1
No El
No El
No El
No El
Yes
No El
Yes
No El
Yes
No El
Yes 0
No El
Yes M
No El
Yes El
No 0
Yes El No M
Yes EJ No M
Yes 0 No [:]
N/A Yes FX1 No El
Page 2 of 2
ittAAA FIRE& SAFETY, INC
RAJO.. 3013 3RD AVE NORTH
,me I.
(NO) 223-3473 SEATTLE, INA 98109
INF00AAAFRE.COM
KIRKLAND
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
SPRINKLER - DRY SYSTEM
Status Given
(One System per Report)
RED
I I YELLOW
JXJ
I WHITET
CONFIDENCE TEST I LX I REPAIRS I F�
Occupancy Address: 400 WALNUT ST.
Occupancy Name: EMERALD PLACE CONDOS
Responsible Person BOB WRIGHT
First & Last Name:
425-776-3455
Phone Number:
Responsible Person
Responsible Party
Address, City, State, Zip:
E—Mail Address
Date of Inspection: AUG 24, 2015
Inspection Annual
Frequency/Type Quarterly F-1
Testers Name Richard Rees
(Please Print):
Nicet Certification 2458-1007-E
Number:
Identification Number
(Required):
Sprinkler Room
System Location:
Central station monitoring? YesE] No
Monitoring
Monitoring Required? YesEl No C]
Company Name: ACI
System Make:
System Model:
FIRE CODE VIOLATIONs FOUND: (if additi nal room is needed, please add a separate sheet)
NOTE: 5YR I.P.I. DUE and 5YR FDC INSPECTION DUE
CORRECTIONS MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life s fet,
g erl, inspected for reliability to cover the
11 is
Items listed in this report ar d i nt with Fire e stand-1 and that
e
discrepancies are noted and hj&gfbe repo ed t e
r/Manager for corrective action.
Signature of Tester: VIA
one #
Building Representative (signature)
Sprinklers - Dry Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
General
1.
Trip test conducted?
Yes 0
No El
2.
System tripped in 14 seconds. Trip point 14 Time to inspectors test N/A
3.
Main Drain and Inspector's Drain flow test conducted?
Yes M
NoEl
4.
Static pressure: 100 psi Flow pressure: 90 psi
5.
Number of Sprinkler Heads? �l 00
6.
2-inch drain? Other
Yes 0
No El
7.
Flow switches, supervisory switches and alarm bells tested? N/A
Yes 0
No El
8.
Alarm bell operates? N/A
Yes
No El
9.
Air compressor refills system in 30 minutes or less?
Yes Z
N o El
10.
Heat actuation devices tested on pre -action and deluge systems? N/A
Yes E]
N o El
11.
System inspected and lubricated?
Yes M
No El
12.
Valves are sealed or supervised?
Yes IX
No El
13.
Signs are provided on valves?
Yes Z
No El
14.
Pumper connections and clapper valves unobstructed and turn freely?
Yes 0
No El
15.
Sprinkler heads replaced or successfully sample tested in last 10 years?
YesEl
No 0
Date of last test: N/A STANDARD
16.
Sprinkler coverage is acceptable?
Yes N
No El
17.
Proper number of spare sprinkler heads available with appropriate wrench for
Yes
No El
each?
18.
System left in service?
Yes 59
No El
19.
System gauges replaced or calibrated within the last 5 years?
Yes
No El
Yearchanged: 2014
20.
Sprinkler heads free of corrosion, paint, obstructions and/or physical damage?
Yes
No El
21.
System drained and restored to normal operation?
Yes
N o El
22.
Was debris found in the Fire Department Connection (FDC)?
Yes 1:1
N o RX
23.
Was the Fire Department Connection (FDC) back flushed in the last 5 years?
Yes El
No 0
Date of last back flush UNKNOWN
24.
Was a signal r' eived at the Central Station monitoring',company? NVA
Yes
No El
25.
Is the hydraulic nameplate installed and visible on riser.
Yes ED
No 0
(Ref: NFPA 25 5.2.7)
26.
Was an internal pipe and valve inspection performed within the last 5 years? Date
Yes El
No 0
Performed UNKNOWN
Sprinklers - Dry Page 2 of 2
AAA Fire and Safety, Inc. SNO CO. FIRE DEPARTMENT fNVOICE# 29136
3013 P Ave. No. Confidence Testing ACCOUNT# 30127
Seattle, WA. 98109 AUTOMATIC SPRINKLER SYSTEM DATE 8/27/2014
800.223.3473
Address 400 Walnut St. City Edmonds Zip Code 98020
Occupied As Emerald Pl. Condos
Building Owner , Phone No. [OCT
Address ' city Zip Code
Date of Inspection 08/26/2014 Type of Inspection Annual
Tester's Name Richard Rees, SFD Certification # SCPR 00200
DRY SYSTEM Location Garage/Attic
1. Wet test trip conducted. YES
2. System tripped in 14 seconds.
3. All flow switches, supervisory switches and alarm bells tested. YES
4. Alarm bell operates. YES
5. Flow test conducted. YES
Static pressure 105 psi.
Flow pressure 95 psi.
6. Two inch drain. YES
7. Air compressor refills system in thirty minutes or less. YES
8. System drained and restored to normal operation. YES
9. Heat actuation devices tested on pre -action and deluge systems. N/A
WET SYSTEM Location MAIN BUILDING
1. Flow test conducted. YES
Static pressure 105 psi.
Flow pressure 97 psi.
2. Two inch drain. YES
3. Flow and supervisory switches and bells tested. YES
4. System inspected and lubricated. YES
GENERAL
I . Central station monitoring. Name ACI . YES
2. Sprinkler heads less than fifty years old. YES
3. Spare heads and wrench available. YES REVIEW
4. System left in service. YES
5. Valves sealed and/or supervised. YES � 1—t4
6. Gauges recalibrated or replaced (every five years). YES
7. Signs provided on valves. YES
8. Static water pressure 105 psi.
PROBLEMS FOUND: None.
CORRECTIONS MADE: None.
Date corrected _ By
This is to certify that the 7spri systZemh s been �ppropper tested and inspected for reliability to cover
port Lq�
the items listed in this report
_ . e,4
Signature of tester SFD License # SCPR 00200
z;1 I
AAA Fire and Safety, Inc. SNO CO. FIRE DEPARTMENT INVOICE# 29136
3013 P Ave. No. Confidence Testing
ACCOUNT# 30127
Seattle, WA. 98109 FM ALARM
DATE 8/27/2014
800.223.3473
Address 400 Walnut St. City EDMONDS, Zip 98020
Occupied as Emerald Place Condos
Building Owner H.O.A. Phone # 425-776-3455
Address city Zip
Date of Inspection 8/26/2014 Type of inspection Annual Tester's Name Rick Rees
Control Panel Silent Knight Model # 5208 SFD Certificate # SCPR00200
No. of Initiating Circuits 10 No. of Signal Circuits 3
Battery Voltage 27.1 Battery Voltage Under Load 25.5 (signals operating)
Charge Voltage 27.2
1 . Trouble signal with A/C power off
YES
2. System operates satisfactorily on standby power
YES
3. All auxiliary equipment operates (elevators, fans, dampers, etc.)
YES
4. All signals operate on A/C power
YES
5. All notification appliances checked for proper operation
YES
6. All circuits checked for electrical supervision
YES
7. Control panel checks per manufacturer's instructions
YES
8. Central station or remote connection
YES
9. Name of monitoring company Aci .
10. Kev to Danel available
YES
TYPE I #OF UNITS TESTED I SATISFACTORY I #OF TOTAL UNITS
Bells, Horns, Chimes
36
YES
36
Voice Alarm Speaker
0
N/A
0
Visual Alarm Devices
6
YES
6
Trouble Indicators
2
YES
2
Flow Switches
2
YES
2
Supervisory Switches
3
YES
3
Smoke Detectors
13
YES
13
Heat Detectors
0
N/A
0
Manual Pull Stations
8
YES
8
Ventilation Control Ops.
0
N/A
0
Central Station
1
YES
1
Annunciators
I
YES
I
Elevator Call Down
0
N/A
0
Fire and Smoke Damper
0
N/A
0
Phone Jacks
0
N/A
0
Door Unlocks (fail safe)
0
N/A
0
Door Release
5
YES
5
emical Release 0 N/A 0
Other' 0 N/A 0
Problems found: None
Corrections Made: None By
Date Corrected
ical License GRAUELL143BB
SNO
F
D
Serving Briei- . Edmonds, and 1242 -5 Meridian' Ave S
-e T -race
Motintla.4 ei EV&ett, WA 98208
Phone (425) 551-1200
wwwFireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
)EQ EDMONDS
t3l�RIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY
STATION 1, SHIFT
LOCATION:
400 Walnut Steet 98020
Anti
17-D
I
BUSINESS NAME:
�-mcrald PlaGc C�art&4i
PHONE:
SCHEDULED
r 21014
DATE DUE
MAILING
N__
400'Walnul SV�c� Ednmti&-, 'IVA 1) S'l) D
UF14-'S
ADDRESS:
w2 i
BUSINESS OWNER:
Hamnit, Erill
HOME PHONE:
EMERGENCY-1:
Carrall, P.
HOME PHONE:
2063E30235 �'CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
1:1
0
EMAIL:
LICENSE
1
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
4
HHE SYS I EMS: AS--71-1,34W7,"FE _H 11; FD Lk Box ?? 04,
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
3
3
4
4
.............
5
5
34-
6
6
T
7
7'
,,L,AT X��IN THE NEXT 30 DAYS X
"MMEE To,'60 R R E ff--T�H &A B Q%4EVjQ ,1,,0
lst RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
;1 -0,
EXTENSION
-INSPECTION
LA'TI S
DATE D
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSO�
N
PER96'
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LE TER SENT
NUMBER:
4
CODE
5
2
6
2 6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
14
8
4
8
DATE:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED E] YES [I NO
8
FIRE DEPARTMENT COPY
Serving Brier, Edmonds
SNOHOMISH CO.
FIREMountlake
IfT
Terraceand
DISTR,
the Town of Woodway
www.FireDistrict].org
LOCATION:
405 Walnut Street
BUSINESS NAME:
Hopper Bldg Apts
MAILING
402 9th Ave S
ADDRESS:
Edmonds
BUSINESS OWNER:
Curtis, Chester 6
EMERGENCY-1:
KEY ACCESS-2:
�1
PERSON CONTACTED: VQ () � --,A.4r--T
NAME OF INSPECTOR: 9 ') S
FIRE Mail Notice to Owner
S YST E M S:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257787111
98020
HOMEPHONE: 4257787111
HOME PHONE:
HOME PHONE:
lqco,j e, cIi
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0WOODWAY
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY rSTATION & SHIFT_'*�
366 17 6
SCHEDULED
DATE DUE � 04/01/13
LIFIR 1,, 422 4202
ACTIVE
e--CURRENT
CITY YES NO
BUSINESS
LICENSE 1:1 R]
INITIAL INSPECTION DATE
b, 1 1-3
FE
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 )o
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
,4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES El No
LETTERNEEDED C] YES NO
8
FIRE DEPARTMENT COPY
HX 3013 3rd AVE NORTH FIRE DEPARTMINOO 69 13INVOICE # _3010'? 7
ESEATTLE WA 98109
�206) 284-'l 721 Confidence Testing ACCOUNT #
(800) 223-FIRE
(206) 284-1769 FAX AUTOMATIC SPRINKLER SYSTEM DATE -7
lo'15- /3
"Fm w- ' AAA.FIRE.COM
Address 1100 City: &OdMMdS Zip Code 4?4F()0'70
Occupied as: &Udyty nit-i&l
Building 60woeru- PIW, &b Ph.# �Q�- -1-* -,3q5,S-
Address: _,36RP24 City: Zip Code:
Date of Inspection: 7A. Type of nspectior Annual Other
T Ai9ijoi SFD Certification#
Tester's Name (PLEASE PRINT)
DRY SYSTEM
1. Trip test (dry trip) conducted:
System tripped in 90 seconds
2. All flow switches, supervisory switches & alarm bells tested
3. Alarm Bell operates:
4. Flow tests conducted:
Static Pressure /00 psi
How pressure psi
2 inch drain?
5. Systems inspected and lubricated
6. Air compressor refills system in 30 minutes
7. Systems drained and restores to normal operations
8. Were the heat actuation devices tested on pre -action and deluge systems?
WET SYSTEM
1. Flow test conducted:
Static Pressure psi
How Pressure psi
2 inch drain?
2. Flow switches, supervisory switches & alarm bells, tested
3. Alarm bell operates:
4. Systems inspected and lubricated:
5. Pressure regulating valves tested:
GENERAL
I . Central Station Monitoring?
Name of Company
2. Location of Sprinkler:
Basement Hallways As Designed V111" Others
3. Pumper connections and clapper valves unobstructed
4. Sprinkler heads less than 50 years old
5. Spare sprinkler heads are available
6. Systems left in service
7. Valves are sealed or supervised
8. Signs are provided on valves
9. City Static Water Pressure — 110 psi
Date corrected
By
Yes V No
Yes No
Yes No
Yes No
Yes V/'- No
Yes No
Yes No
Yes ��No
Yes No
Yes / No
N/A
N/A
N/A
Yes No Other
Yes __7No
Yes No
NIA
N/A
Yes No
Yes No
N/A
N/A
Yes /No
Yes V" NA
V7' , —
Yes No
Yes No
Yes; V7 N o
Yes No
Yes No
A
COM ate /k,
Lod ., 11r.-I
cl�' ;,t1.__
or, z
W
THIS IS TO CERTIFY THAT THE SPRINKLER SYSTEM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY TO COVER
THE ITEMS LISTED IN THIS REP�
SIGNATURE OF TESTER SFD LICENSE # Fom #: 8304
AAA Fire and Safety &"WS FIRE DEPARTMENT rNVOICE 4 _ala�a
3013 3 d Ave. No. Confidence Testing ACCOUNT# - 1, 146 1 t
DATE -�jj Q�S 13
Seattle, WA. 98109 ME ALARM V
(800).223-3473)
Address YOD
Occupied as coluaLq 1-1la-y7f, I
- 4 -7-710-j
B Ll i I d i n g evoftef 4—L- 440� Phone
Address "I city Zip
Date of 1—nspectio7�n Type of inspection Annual Tester's Name: Michelle Huber
Pa I JJM� �
_ lUa 5W
j- Model# SFD Certificate # SCP-H-04401
Control Panel S, -.1 F —
No. of Initiating Circuits a/0. No. of Signal Circuits Battery Voltage Q-7.
Battery Voltage under Load c95, Y _ (signals operating) Charge Voltage J-7 -3
1 . Trouble signal with A/C power off
0
U
N/A
2. System operates satisfactorily on standby power
NO
N/A
3. All auxiliary equipment operates (elevators, fans, dampers, etc.)
IS
VJNN
NO
N/A
4. All signals operate on A/C power
NO
N/A
5. All notification appliances checked for proper operation
NO
N/A
6. All circuits checked for electrical supervision
E&)
NO
N/A
7. Control panel checks per manufacturer's instructions
NO
N/A
8. Central station or remote connection
/W50
NO
N/A
9. Name of monitoring company Parm
0::Iq�
N 0
N/A
Type OF Equip
# evices Tested
Satisfacto
ES-- NO N/A
Total # Devices
Bells, H-orris, Chimes
Voice Alarm Speaker
------
Visual Alarm Devices
;7o--�
Trouble Indicators
Flow Switches
Supervisory Switches
Smoke Detectors
Heat Detectors
Manual Pull Stations
Ventilation Control Ops.
Central Station
Annunciators
Elevator Call Dowti
Fire and Sirioke Dainper
Phone Jacks
Door Unlocks (fall s
Door Relea se
Chemical Release
Other
Problems found
Corr-ections Made:
Date Corrected
Sign
Electrical License HUBERMJ93 I KB
AAA Flie & Safety, Inc
30133 d Ave N
Seattle, Wa 98109
Ph: 206-284-1721 Fx: 206-284-1769
Email: info@aaafire.com
&6VW65 Fire Department
Confidence Test Report Acct # 301,V
Inv # _z0j/
�0
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED 0
1 YELLOW C3
I -WHITE
CONFIDENCE TEST 9 1 REPAIRS 13
Occupancy Address: Occupancy Name:
6dmoza5l AM 9FdR0
r
Responsible Person
&;uA2/x Phone Number: ry1:q6)_ 774V3k-ro
First & Last Name:
V
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Date of Inspection: Inspection Annual
Frequency/Type: 1 -33
3
Testers Name SFD Certification
J T-&M/
(Please Print): Number: SCP-
Identification
Number: System Location: g iLu' A
Central station monitoring? Yes -No 0 Monitoring
Monitoring Required? Yes No 0 Company Name: IQUM
System Make: System Model:
SEATTLE FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
I I 654t- V V
FIX
CORRECTIONS MADE: Date Corrected: Corrected By:
1 1 9
(If additional room is needed, please add a separate sheet) SFD Certification Number: SCP -
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: Phone.#
Building Representative (signature)
"ro
119
Sprinklers - Wet Page 1 of 2
� ko I I
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department Fire Code for inspecting
and testing requirements.
General
nspector's Drain flow test conducted?
1. Main Drain and',
2. Static pressure: 0 p. s. i. Flow pressure: q5 P.S.i.
3. Number of Sprinkler Heads: A-90Z
4. 2-inch drain? Other
5. Flow switches, -supervisory switches and alarm bells tested? N/A
6. Pressure regulating valves tested? N/A
7. Alarm befloper6tes? N/A
8. System inspected and lubricated?
9. Valves are sealed or supervised?
10. Signs are provided on valves?
11. Pumper connecti ons and clapper valves unobstructed and turn freely?
701
12. Sprinkler coverage is acceptable?
13. Have thesprinkilbr heads been replaced or OccestfUlly, sample test, in the -
last 50 years? Date of last test:
14. Proper number of spare sprinkler heads available with appropriate wrenches
for each?
15. System left in service?
16. System gauges replaced or calibrated within the last 5 years?
Yearchanged: O<:> i
17. Sprinkler heacls�jree of corrosion, paint, obstructions and/or physical
damage?
18. Was debris found in the Fire Department Connection (FDC)?
19. Wag the Fire. epartment Connection (FDC) back flushed within the last 5
years? v Date of last back flush
20. Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed .0/"
21. Is the hydraulic nameplate installed and visibleon ris,er, if'No then Yellow Tag.
(Ref: NFR�Q5'5.2.7)
22. Was a signal received at the Central Station monitoring N/A
company?
v "
MR
Yes YN
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No 0
No
No 0
No C3
-No 71
No
No
No
No
No
NO'71
Yes No
Yes No
Yes No
Yes (�f No 13
Yes No99
Yes Noi
Yes No M
voc
No
Yes No
Sprinklers - Wet Page 2 of 2
FIRE & SAFETY. 1Nr
0013 3RD A
MVE N
SEATTLE, WA 98109
PH: 206-284-1721
FX: 206-284-1769
SPRINKLERS - DRY
(One System per Report)
CONFIDENCE TEST
Occupancy Address:
City, State, Zip
Building Owner:
Responsible Person:
Building Owner Address:
Date of Inspection:
Testers Name
(Please Print):
Central Station
Monitoring?
Primary Component:
System Model:
REPAIRS I FI
951
71,
M/0,09M
Confidence Test Report ACCT# :�0/0?
206-"86-1448 Confidence Testing Officer !NV#J-09-7C20
206-615-1068 (fax)
206-233-7219 Red Tag Hotline
Certification Given
RED YELLOW_... [] I WHITE
r)cCupancy Name: Aaa
P one Number:
PhoneNiumber: !Vj-5--W?-3RMk
Inspection
Frequency/ Type:
SFD Certification
Number:*
Monifrwin
Annual
A4 - 53,31 - T /09—"0
-SCP- 16 - 4 #�v /11/) /*-?94
Yes )ff No. El �1
Company Name: A&vw 6-ti&
System Make: I
;VJ
Identification
AAIJVJ�A Z�,YIAAio5 ".: -,:, '-- — �:- , I -.. , /1 —1
I 'U. I IU%-,l /16
PROBLEms FoUND: (If additional ro�omis ne �ded, =1ease a �da separate sheet)
"I "fie 111111111
CORRECTIONS MADE Date Corrected:
(If additional room is needed, please add a separate sheet) SFID Certification
This certifies thA thit fire �nd life safety s7stem his' been properly inspected for reliability to cover —
the
Items listed� in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted ano_�&e been reported to the building Owner/Manager for corrective action.
. 1
Signature of Tester: Phone #
.2.06-284-172
Testing Agency: AAA E SAFETY, INC
Mailing Address: 3013 3 RD AVE N SEATTLE,-.WA 98109
Building Rcepresentat-ilve (signat-ure)
. a. .. ., �
The items on the checklists below shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the fire and life safety system. Refe'r, to the Seattle Fire Department
Fire Cocle for inspecting and testing requirements.
�General
.6:.-:-
2-.inch drain?
Other
D yesK
N MI. .
0.
7.
Flow switches, supervisory switches and alarm bells tested? N/A
0 Yes
No 171
.�8.
Alarm bell operates? N/A
El Yes
i 9.
Air compressor refills system in 30 minutes or less?
Ye
No 0
LO.
Heat actuation devicesA6sted,on pre.action,and deluge systems? N/A
Yes El
No F
I.I.
System inspected and lubricated?
Yes L?f
No 171
[1:,:;
.,ValvQ$:: are��seale6 or:supervis d?,.::
e
Y.
es.k .
No 0�
Signis are provided on valves? .
... ...
Yes
No- 0
p v
Pumper connections and:: cla 'perl alVes:�unobstructecl: and:tu' rh freel y.
Yes
No 171�:
5 ---Sprinkler-heau'S--replace�d-Gr-su*cces-sr'cfily—sa-r-rFpl-e-tE-Fste—d-i-ffldff-fG-v6dr-§?--------
---- ----- ---
T(E�
No
116..:
Sprinkler coverage i's acceptable?
Yes4kfL
No. 171
'Prioper number of spare sprinkler heads available with appropriate wrench for
each?
.8 System lelft in service?:
.9. System gauges replaced or calibrated within the last 5 years?
0. Sprinkler heads free. of. co*rrosibn, pa : i,n..,, obstruction . s and/ . r physical
t/ 0
amag��,
I. System drained and restored to 'normal operation?
2. Was debris found in the Fire.Depa me Co ned
nt n ion. (FQC)?
Was the Fire Department Connecti . on (FDC) back flushed in the last 5 years?
Was a signal received at the Central Station monitoring
Company? N/A 0
Was an internal pipe and va!ve inspection performed within the last 5 years?
Date Performed czo//
Yes
No 0
Yes
No F]
Yes El
No
YePA
No- El
Yesx
No 0
Yes 0
No
Yes)4,
No
Yes 1�
No 0
I
Yes No
AAA Fire �&;�afety, Inc
3013 3r' Ave N
Seattle, Wa 98109
Ph: 206-284-1721 Fx: 206-284-1769
Email: info@aaafire.com
&&nonc-16 Fire Department
Acct# 30/021
Inv # loq7"
FIRE ALARM SYSTEM
(One System per Report)
Certification Given
RED
YELLOW
WHITE
CONFIDENCE TEST
I;gl
REPAIRS__T
C3
Sprinkler Monitoring Panel?'Sf
I Occupancy Name:
Occupancy Address: V09 0,0&,�
Responsible Person
First & Last Name: Phone Number:
Responsible Person Responsible Party
Address, City, State, Zip: E-Mail Address
Date of Inspection: Inspection Quarterly (High-rise Only)
rill 611 Frequency/Type: Annual
Testers Name SFD Certification
(Please Print): M164 � a A/&W Number: SCP -
Identification
Number: System Location
Central station monitoring? Yes No C3 Monitoring V
Monitoring Required? Yes No C1 Company Name:
System Make: System Model:
SEATTLE FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) SFD Certification Number: SCP -
A.
f A Of
U
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: #
Building Representative (signature)
915
Fire Alarm Systems Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and 0-
testing of the fire and life safety system. Refer to the Seattle Fire Department Fire Code for inspecting and testing requirements.
Alarm Svstem Functionali
1.
Trouble signal with AC power off?
Yes 91
No 0
2.
System operaiel, properly on battery backup?
J1
Yes
No 0
3.
Battery voltage (no load) volts
4.
Battery voltage4�'(full load) volts (signals operating)
5.
Charge circuit voltage volts
6.
System operate's properly on standby power?
Yes
No 0
7.
All signals operate on AC power?
0
Yesg
No 0
8.
Number of initiating circuits
9.
Number of signal circuits
10.
Does alarm system meet audibility standards as accepted?
Yes 12(
9
No 0
11.
All circuits checked for electrical supervision?
Yes
No 0
12.
All auxiliary equipment operates (Elevators, fans, dampers)?
N/A 0
Yes'd
No 0
13.
Ventilation controls operate?
N/A 0
Yes.Rf
No 0
14.
Key to panel ay.@ilable?
N 13
Y e-�-X,-
No
15.
Materials and equipment needed to restore pull stations are available at the
N/A 0
Yes
No 13
main panel, e.g. glass rods, and plates; keys and alien- wrenches, _etc?_
16.
Ope i S
UL
ratirig:instra anel?-
ition -it p
Ye s2f
No 0
17.
Trouble indicators function properly?
Yes 17
No 0
18.
Remote Annund* tor Pa els furiction"pro
-- ta n
N/A 13,
Yes7,,,�,I'
No 0
19.
Elevator Call Down functions properly?
N/A C3
Yes ;,y
No 0
20.
Test record pos�'C&d at panel?
Ye,s,,9�'
No 0
21.
General alarm automatic time delay (minutes)
N/A
22.
- Was a signal�-i-qq_-piygd, at the Central,Station- monitoring company?
N/A CT
Ye��, El
No, Inj
23.
Other Devices (Specify)
-Yes.X
No 0
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
N/A
0
Yes
No C3
25. Voice Speakers (Voice Clarity)
N/A
C3
Yes
No 13
26. Visual Alarm Devices
N/A
0
Yes
No 13
27. Smoke Detectors
N/A
0
YesQO
No 13
28. Heat Detectors
N/A
0
Yes 0
No 13
29. Duct Detectors
N/A
Yes C3
No 0
30. Sprinkler Flow Switches
02
N/A
Yes Of
No 0
31. Sprinkler Supervisory Switches
N/A
C3
Yes
No 0
32. Manual Pull Stations-
N/A
C3
Yesq-
No 13
33. Annunciator(s)
N/A
0
Yes
No 0
34. Beam Detectors'.
N/A
0
Yes 13
No 0
35. Automatic Door Unlocks
N/A
0
Yes 173
No 0
36. Automa - tic Door-4keiease
N/A
0
Yes NJ
No 0
37. Fire Dampers
N/A
13
Yes 173
No 0
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A 13 Yes 13 No 13
39. Phone lacks
N/A C3 Yes 0 No 0
40. Call -in Signal
N/A C3 Yes 13 No 0
Fire Alarm Systems Page 2 of 2
Serving Brier, Edinonds"ii
SNOHOMISH CO.
10T Mountlake Terraceand
NALRE the Town of Woodway
DISTR' T www.FireDistrictl.org
LOCATION: 400 Walnut St
BUSINESS NAME: Emerald Place Co.ndos
MAILING
ADDRESS:
BUSINESS OWNER: Carroll, P.
EMERGENCY-1: Schaeffer, Ed #203
KEY ACCESS-2: Owen, Don
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE W631 F�9�1 F0
SYSTEMS: / !�)' __
4
1
Z2425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
HOME PHONE: 2063630235
HOME PHONE: 4257762686
HOME PHONE: 4257787373
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
LIENCY,
6
I STATION&SHIFT"
17
ILED
JE 11' 03/01/12
Q3
3202
CURRENT
CITY
YES NO
BUSINESS
El El
LICENSE
INITIAL INSP CTION DATE
7 7
� (?--
FE
11111
ANNUAL
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
07
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [-] YES _E3 No
LETTER NEEDED YES NO
a
I
FIRE DEPARTMENT COPY
eJM V-AJSFire Department
AAA Fire & Safety, Inc.
30133 rd Ave N Seattle, WA 98109
Ph: 206-284-1721 Fx: 206-284-1769
Ern: info@aaafire.com
Account#- -��-z -7
Invoice# 1,01-1 3P
Date: ?-Z-//
Five Year Internal Pipe Exam, FIDC Internal Exam and MIC Testing
Occupancy Name:
Occupancy Address:
1-21
--/00 W4/"7'9� 5e".
Responsible Person:
Phone Number:
Testers Name:
NICET & SFD#:
Aa<�,n,.Z
5- 3V - /-,X- - 160 5^0'7
Primary Component:
Sysiem make & Model:
-Dr-�j 5k:51'-fn
V, - /' -to// C- '5A75�5
Locition 'of System:
Certification Givewl
RED YELLOW WHITE 0
The following tests were performed: YES NO N/A
1. Five year internal pipe inspection on DRY pipe fire sprinkler system(s) Er 0 0
2. Five year internal pipe inspection on WET pipe fire sprinkler system(s) 0 11 13,
3. Water samples taken from sprinkler system(s) tested for
0
11
[B-
microbiological ly influenced corrosion (MIC)
4. Fire department connection 5 year internal obstruction investigation and
[a-
0
11
caps are in place and connections rotate properly
S. 5-year replacement 6f'gauges
Er
11
0
Problems found: A4,,,
Corrective Actions:
This certifies that the fire sprinkler system(s) have been properly inspected internally and chemically to cover the items listed in
this report and are consistent with NFPA standards.
Signature of TesterA -4 6: Phone:
Testing Agency: AAA Fire & Safety, Inc. Phone: 206-284-1721
Building Representative (signature):