401 PINE ST (3)5020�7
'q 0 1 Cr7-
TE ////[I/// I
AAA Fire & Safety, Inc C/TY OF EDMONDS
3013 3rd Ave N Seattle, Wa 98109 A Department of Fire Prevention
:A 9ft,
Ph:206-284-1721 Fx:206-284-1769 121 5th AVE N
AAAFIS114ODS EDMONDS, WA 98020
111 ' ')EPA RLIV-1-
FIRE ALARM INSPECTION REPORT
(One System Per Report)
Today's Date: 05-08-2017
Inspected Date: 05-05-2017
Due Date: 02-15-2017
Service Test 0 Repairs
Inspection Frequency: Annually
SystemLocation: Nearlaundryroom
Coverage Area Building
Certification REDO YELLOWD WHITE[jj
Given:
PROPERTY CONTACT INFORMATION
Occupant Information
Responsible Person
Bldg Name: PARKVIEW APTS
Name: ROBERT DINES
Address:
401 PINE ST
EDMONDS, WA 98020
Address:
401 PINE ST
EDMONDS, WA 98020
Phone:
Email:
INSPECTION AND TESTING CONTRACTOR INFORMATION
Contractor Information,
Inspector/Tester Information
Company Name: AAA Fire
Protection, Inc.
Name: MICKEY HILDERBRAND
Phone#: 206-284-1721
Phone:
Address:
3013 3RD AVE N
SEATTLE, WA 98109
Email: mickey@aaafire.com
CERTIFICATIONS
State SCP H-06762
Certification:
7805-IT-021407
National/NICET
State Contractor License #: AAAFIFP841 N3
HILDEMR904NB ELEC
Other Cert: TYPE:
License #:
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5/812dl 7
TEGRIS Fire'
MONITORING INFORMATION
Central Station Monitoring? 0 y 0 N
Phone
Monitoring Company
System Model:
System Make:
DEFICIENCY1 CORRECTION DETAILS
Any Deficiencies Found? 0 Y 0 N
Any Deficiencies Y 0 N
Remaining?
Deficiency Found
Comments
Corrected?
Correction
Date:
Corrected B y
NOTES
Authority Re\4ew Notes? 0 Y 0 N
Inspection Company Remarks? 0 Y 1:1 N
No access to units 107, 207, 305,104, 203, 304, 201, 307
1 1
Refer to the local and state standards for a complete description of the inspection, testing,
and maintenance requirements. The inspection results provided in this report are based only
on the system's current ability to operate and shall not be construed as an evaluation of the
system's performance capabilities to adequately protect the property. Information in this
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502617
TEGRIS Fire"A
report may or may not include possible performance concerns and should not be
considered all inclusive. It is solely the property owner's responsibility to determine if a
separate investigation should be done to ensure the system will perform as designed and
that the property is adequately protected. It is also the property owner's responsibility to
maintain the system, property and any possible environmental conditions that may affect the
system's operability and performance.
SYSTEM FUNCTIONALITY
ALARM SYSTEM
Trouble signal with AC power off?
#
Yes
0
No
0
N/A
System operates properly on battery backup?
*
Yes
0
No
0
N/A
Battery voltage(no load):
26.72
volts
Battery voltage(full load with signals operating):
26.51
volts
Auyjlary power supply panel (no load):
N/A
volts
Auyjlary power supply panel (with load):
N/A
volts
Charge circuit voltage:
27.77
volts
System operates properly on standby power?
*
Yes
0
No
0
N/A
All signals operate on AC power?
0
Yes
0
No
0
N/A
Number of initiating circuits:
1
Number of signal circuits:
1
Does alarm system meet audibility standards?
*
Yes
0
No
0
N/A
All circuits checked for electrical supervision?
*
Ye s
0
No
0
N/A
All auyjliary equipment operates (Elevators, fans, dampers)?
0
Ye s
0
No
*
N/A
Ventilation controls operate?
0
Ye s
0
No
#
N/A
Key to panel available?
*
Ye s
0
No
0
N/A
Operating instructions at panel?
*
Ye s
0
No
0
N/A
Pull Station restore tools at main panel (rods, keys, etc)?
#
Ye s
0
No
0
N/A
Trouble indicators function properly?
*
Ye s
0
No
0
N/A
Remote Annunciator Panels function properly?
0
Ye s
0
No
*
N/A
Elevator Call Down functions properly?
0
Ye s
0
No
*
N/A
Test record posted at panel? Yes 0 No 0 N/A
General alarm automatic time delay:
I N/A
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51812017
TEGRIS FireTm
Central Station monitoring company received signal?
Was a full walkthrough done?
System left in service?
STAIRWAY DOOR LOCKS
minutes
0
Yes
0
No
N/A
0
Yes
*
No
0
N/A
*
Yes
0
No
0
N/A
0
Yes
*
No
0
N/A
System Devices
TotallNumberof
Units in Building
Total Number Units
Tested
Test Results Acceptable
Electric Strike
0
N/A
0 Yes
0
No
Electric Bolt
N/A
0 Yes
0
No
Other Locking Devices
N/A
0 Yes
0
No
System Devices
TotalNumberof
Units in Building
Total Number Units
Tested
Test Results Acceptable
Bells, Horns, Chimes
28
28
ON/A
*Yes
ONo
Horn Strobes
N/A
0 Yes
0
No
Voice Speakers (Voice
Clarity)
N/A
0 Yes
0
No
Smoke Detectors
N/A
0 Yes
0
No
Heat Detectors
N/A
0 Ye s
0
No
Duct Detectors
N/A
0 Yes
0
No
Sprinkler Flow Switches
N/A
0 Yes
0
No
Sprinkler Supervisory
Switches
N/A
0 Yes
0
No
Visual Alarm Devices
N/A
0 Yes
0
No
Manual Pull Stations
4
4
0
N/A
* Yes
0
No
Automatic Door Unlocks
N/A
0 Yes
0
No
Automatic Door Release
N/A
0 Yes
0
No
Annunciator(s)
N/A
0 Yes
0
No
Beam Detectors
N/A
0 Yes
0
No
Fire Dampers
N/A
0 Yes
0
No
Communication
Equipment
Total Number of
Units in Building
Total Number Units
Tested
Test Results Acceptable
Phone
N/A
0 Yes
0
No
Cellular
N/A
0 Yes
0
No
-Radio
N/A
0 Yes
0
No
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5/8/2617
TEGRIS Firelm
INSPECTOR'S DECLARATION
By checking here you are certifying, under penalty of perjury, that you are a valid agent of
your company representing that the company maintains all the necessary licenses and/or
certifications to perform this service for this system in this jurisdiction AND THAT the
company has properly inspected this system consistent with state and local standards AND
THAT the system has been properly tagged or labeled and the property owner or responsible
person has been notified of the inspection results, the system status, and any corrective
actions. I
AUTHORITYSYSTEM INFORMATION
AUTHORITY REVIEW REPORT COMMENTS
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t, - ;4
This is a Federal Building 13
AAA Fire & Safety, Inc.
30133 rd Ave N
kilSeattle, Wa 98109
one206-284-1721
itifo@aaal-ii-e.coni
Edmonds
Fire Department
Confidence Test Report Acct
Inv
STANDPIPE TYPE I M 1113 11113 / AuTOMATIC 113 MANUAL (3 / DRY (3 WET (3 / COMBINED 0
Status
CONFIDENCE TEST REACCEPTANCE TEST RED YELLOW WHITE
Occupancy Address: 401 Pine Street
Occupancy Name: Parkview Apartments
Responsible Person
Phone
First & Last Name: Debbie
Number: (360) 662-1178
Responsible Person
Address, City, State, Zip:
FDC Location: parkvieweptsl@yahod.com
Technician's Name Morgan Brassfield
(Please Print legibly)
Certification No. SCP-00431
Date of Test: 05/0412016 11:15am PDT
Test Frequency: 5-Year
Riser Valve Make: N/A
Riser Valve Model: N/A
System Identification No..-
System Location: All four stairwells
ID No.
FDC Location- North end
central station monitoring? Yes 0 No M
Monitoring Company
Monitoring Required? Yes G No N
Name -
DEFICIENCIES FOUND? Yes 0 No (9 List items that were not corrected at the time of the confidence test. Use
the Deficiencies section or attach itemized sheet
REPAIRS: All deficiencies have been corrected (3
Corrected By: Certification Number:
System Status changed to White (including the tag on the systemij C3
This certifies that this fire and life safety system has been properly inspected for functional operation in NFPA Standards.
The discrepancies found are noted in the report and have been reported to the building Owner/Manager for corrective ac
Signature of Technician
Name of Testing Company AAA FIRE & SAFETY INC
Building Representative (Signature)
Phone # .206-551-5681
Date
Print Name and Title Direct Phone #
Building Rep unavailable C1 Building Rep declined to sign report C3
Standpipes
9-2012 Ver.1.3 Page 1 of 7
of - 1�
This is a Federal Building C3
The items on the checklists below shall be inspected and tested. This list may not constitute all of the required
inspecting and testing of the fire and life safe!y sntem.
PRE -TEST CHECKS
1 . The Fire Alarm Was put into test mode and/or other precauflons were N/A 0 Yes C3 No 13
taken to avoid preventable alarms.
2. This is the only Standpipe System at this address. Yes M No 0
If "No"What is the unique ID number?
3. AJI signs, placards, and labels are provided on doors and system controls. Yes N No 07777�
I TESTING AND INSPECTION CHECKLIST I
4. The bldg. is: Fulfy Sprinklered 0 Partially Sprinklered (i.e. basement or egress sys.) 0 Not Sprinklered M
5. The standpipe is located in areas that could be damaged by water if a leak
occurs, and passed the air pressure test at 25 psi (1.7 bar) prior to NIA 0 Yes a No C3
introducing water to the system,
6. The standpipe posed the hydrostatic test in accordance with 2008 NFPA 25
Sec. 6.3.2 NIA 0 Yes 6 No 0
The inspector did not find recalled devices during the visual inspection.
Note: This inspection is a cursory visual assessment from the floor level N/A M Yes 0 No C3
In accessible areas.
____F�TESTS
7.
The req flow for this standpipe is: 0 500 gpm @ 65 psi (installed prior to 1980)
0 300 gpm @ 150 psi 25 psi
(Installed 1980-2005)
0 300 gpm @ 175 psi 25 psi
(Installed after 2
0 50 gpm @ 35 psi minimum
(Class 11)
8,
The standpipe passed the Flow
Yes 0
No 0
. _p.s.i. R
Static pressure: sidual sure; _ p.s.i. Flow gp
9,
For automatic standpipes: The tem passe main drain test, d in
accordance with,2008 NFPA 25 Chapter 13.
Note: This 5-ye4t test is satisfied fbr combination st s when it
is N/A 0
Yes 0
No 0
done for the automatic sprinkler system and notneed
repeated to sa6ify this requirement.
10.
Pressure regulating valves (PRV) pr i acceptable flow and pressure.
/A 0
Yes 0
NoO
(Document results on separat e)
11.
The flow svAtch(es) o as properly.
NIA 0
as 0
No C]
12.Theflow
(s) operates properly.
NIA 0
Yes 0
No C1
1
re pump(s) started from roof flow.
NIA 0
Yes 13
No
013STRUCTION INVESTIGATION
14. The 5-year obstruction investigation of Fire Department Connection (FDC) piping is up-to-
date in accordance wilth 2008 NFPA 25 Chap. 14. (eff. 1012112012)
Date for next FDC obstruction investigafion 5-2021 Yes N No C3
Note: This test is satisfied for combination standpipes when it is done for the
automatic sprin , kler system.
15. The 5-year obstruction investigation for the FDC(s) included testing and
operation of the check valve and auto drain in accordance with 2008 NFPA 25 N/A 0 Yes a No 11
Sec. 13.4.2
GAUGES
Standpipes
9- 2012 Ver. 1. 3 Page 2 of 7
This is a Federal Building 13
16. The maintenance on the system gauges is up-to-date.
Due date for the next comparison test: N/A 3 Yes 0 NIA 0
Note: The system gauges are to be compared with a calibrated gauge
every five (5) years. ff a gauge Is not within +/- 3% of the calibrated
gauge It must be replaced or recallibrated. This check can be done for
multiple floors at static pressure usina one calibrated nauge and
VALVES AND HOSE CONNECTIONS
17. The water supply control valves are secured or electronically supervised N/A 2
Yes 0
No C3
18. The Fire Department ConneGfion(s)(FDC) is clear of bushes, guards, or other debris and is
Yes a
No 0
visible from the street
19. AJI FDCs have protective plugs or covers.
Yes M
N oO
20. If a plug or cover was missing from a FDC the piping was inspected for debris N/A 11
Yes 0
No 0
in accordance with 2011 NFPA 25 Sec. 13.7.2,13.7,4, and Table 13.8.1
21. AJI swivels turn freely
Yes 0
No 0
22, AJI hose connection valvestports have a protective cap with a 1/8" relief hole
Yes 2
No C3
23. AJI caps and plugs have at least 12" clearance for operating wrenches.
Yes 9
No 0
MONITORING
24. A signal was received at the Central Stafion monitoring company. N/A E Yes 0 No 0
RECALLS
25. The inspector did not find recalled devices during the visual inspection.
Note: the Inspector's Inspection Is a visual cursory Inspection from Unk 2. Yes 0 No 0
the floor level in accessible areas
----�Y�DP�IPES
T
26. The hose cabinet(sRs��table Condition in accordance with 2008
Yes 0 No 0
NFPA 25 Tables 6.1 and 6.2J-----l-
27, The hose storage device(s) is in acceptable con i cGo I
Yes 0 No 11
2008 NFPA 25 Tables 6.1 and 6.2.2.
28, The hose is in acceptable conditio r ance with 20OR NFPA 25
Yes 0 No 13
Tables 6.1 and 6.2.2
29, The r�q�i�acceplable condition in accordance with 2008 NFPA 25
Yes
----TvOe—s 61 and 6.2.2.
FINAL CHECKS
30. The Fire Alarm was removed from test mode and/or other precautionary
measures were removed to restore fire alarm system to normal NIA 2
Yes 0
No 0
operation (includes removal of temporary protective coverings).
31. The standpipe was left in service.
Yes a
Noo
32. If "No", why.
33. The confidence test report was given to the owner and a current status tag was posted as
Yes A
No 173
proscribed in SFD Administrative Rule 09.02.09,
34, The confidence test report was sent to the fire marshal's office.
Yes A
No 0
DEFICIENCIES:
Standpipes
9-2012 Ver.1.3 Page 3 of 7
.0-- - -1
This is a Federal Building 1:1
Inlet Static and Residual pressures from the top standpipe gauge and fire pump discharge gauge shall be reported on this
Standpipes
9-2012 Ver.1.3 Page 4 of 7
Serving Brier, Edniends, and 12425 Meridian Ave S
.SNOHOMISH CO.
Mountlake Terrace
Everett, WA 98208
FIRE I—*
Phone (4215) 5.51-J-100
DIST www.FireDistrictl.org Fax (425) 551-1272
LOCATION: 401 Pine Street 98020
BUSINESS NAME: Parkview Apts PHONE: 4254222412
MAILING
ADDRESS: 401 Pine -Street, Edmonds, WA 98020
BUSINESS OWNER: Dines, Robert HOME PHONE:
EMERGENCY-1: Appleby, Mike/Debbie HOME PHONE: 3606521178
KEY ACCESS-2: HOME PHONE:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR: 6 jAAM0A 0 lf�) _hq U
FIRE SYSTEMS: FA 2/15 FE 2/14 S P 8'
Datp L;;.qt SpnArpri- �211 '7 '�44� - '%Z'
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY STATION & SH111-
Annual 17-A
SCHEDULED
DATE DUE I, Nov 2015
LIFIR � 428
CURRENT
CITY :YES NO
BUS NES
LICE NSE 1:1 1:1
INITIAL INS7ECTION DATE
/ 217 i�_.
HAZARDS FOUND AND LOCAT16NS COMMbNICATION6
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
1 st RE -INSPECTION
2nd RE-INSPECTIOW
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
CONTACTED:
CONTACTED:
PERSON
CONTACTED:
I SPECTOR:
I!_SP__
INSPECTOR:
INSPECTOR*
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS,"
CITATION ISSUED
5
PRE -CITATION
LETTER SENT
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
8
DATE:
7
LETTER NEEDED [] YES NO
LETTER NEEDED F] YES NO
_j
8
....... Certification Given
RED YELLOW VVH9TE
W.
CONFiDEMCE TF-s-r
1911 lk�"' k, W, �;tiilv U, Lv=�,k.%tA IV.A, VNc,3t, i
a I p 1 n s. S' E d a, o n 04
arne. Occupancy Addre-Go-
Occupancy N Pprkvii;�W A11117111011c, 656-0,
Building Ownor: bmutli .:
Owner Agznt'. Phons klumber:
Date oflnspection: (12r/M2015 lnspeek3on Typj-. t/ AnnU441
M /--Z> SFD fftmibor'
1 UeSLOUZ.1� Clal a -
Monitoring; Phone 0:-
FACP ManuFacturetr- Modes
hn of lniqicting Circuits: Of Sian6D
C
S- C-
Account ��: ' m IA
Locaiiort,
r— i
ALARM SYSTEM FUMC110NALETY
%f— I M— i MiA
A91 notification circuiqs operation -I?
All circuits chocked for eleaqrIcai supervision?
A9 auxiNary equipment operates (cievagorz, fans, damperz)?
Key to panuP avaUaUo?
operzting instructions at pana?
Trouble indicators function propedy?
Tezt record pozL-d ea portcl?
Signals irera.lved at contral s2atlon? Opanitar P�__
Problamz Found:
Cavrected &V:_ ___-
Corrections Made- Daeo Corrected: SFD Cerfification #:
This CoFtifts that this We and ION Saq9ty syztam has been piapGsIy ln,��pe-,2ed rf-1,902hlmy
to covoF the items I ls�od in thDs ropon and 9z wQ41i SQat0o e-Ure Fivo
Code standardz, and that discrepancies are noaed and have been Irepened to the building
ovvnov-knanagor fafr conracNvo acHon-
Phone 8.- 1 L* V
Signature og Tester-_ -77L-a
Signaturo of Ownw,
SYSTEM DEVICES
MODEL I
UOM�,L ITESTED' SAM3,F-AC TORY?
yus Co NYA
Hcvn/Strobe��
MhTone #74201
Strobo Ongy
Worn on2y
J—
Speaher/Strobau
Spoakor Only
Scmndsr Base
4
fflantW Puft
ilyRUI-RONICS UVIIS-5
Photo Smohe Detectors
IC6,A smofto Detoctows
CombinaUon Smolieffleat
13 5* Rato of Rino Hoat
2001 ReTe o? Rloo Heat
135" FINGd Tenip Heat
200' Fixed Temp Heat
Duct Smoke Detectors
Deter -ter Remote Indirstors
Remote AnnunckitorG
Eava2or Raea!5 Output
Fan PresourIzation
Door HCAdDrs
Door Ungoct;
Curtain6lRoff-down Doom
Fire Fighter Phonas
Main FACP
Tr6ubOe with AC ofP No
Batkary hncicup operotionEl?
No
Bzttery vahage (no 0oad)
volts
Bzttovy vog2n90 (-fuD
Chargo cIrcuKvo5tagn
ofts
Battery Sflze
Panel Type:
Tro u We vu ith AC oW?
Yes No
Battery bmckup operotional?
Yes Wo
Battery voltage (no goad)
Vohs
Battery voltage (fU,'l food)
Ch-nrq:!� gIrpWtvcAe-qo
voito
Battery 8flzo
ype"-
i
--
Af'; aff?
T -
- -I
a
LI-a i I n r (ron Inad)
v t..A ts,
vap,2nr Q (fu'] Qnznd�
chmr:33 circuit V051--20
BatUiry Size
IPaneiType: i
TruWj�p With f4c -,U5-7
N 0
Blztv��ry tmchvp
Battery vchaqc ChA0.1oid)
olattery SI;Ra
FIRE PREVENTION
�erving Briei: Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
OMISH Co.
—grEDMONDS
MoYntlake Terraqe,
FIRE
Everett, WA 98208
0 BRIER
DI'Mrr
h
Phone (425) 551-1200
Fa, 551-1272
0 MOUNTLAKE TERRACE
El UNINCORPORATED
,��& ww.FireDistrictl.org
x (425)
FREQUENCY
STATION & SHIFT
LOCATION:
10 1 Pitie Streat M120
Antit
17-G
BU�INESS NAME-f
PHONE:
SCHEDULED
ParknAc%hiAmW
4254222412
DATE DUE No/ 2014
MAILING
UFIRt28
ADDRESS: 401 Pinc SLrcot, Edmanchi, VVA 08020
BUSINESS OWNER: F.,
HOME PHONE:
EMERGENCY-1: Appicby, Mil-clDobbic
HOME PHONE: Mff,16,21178
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
BUSINESS
F]
LICENSE
PERSON CONTACTED:
INITIAL I CTI0f DATE
NAME OF INSPECTOR:
FA2114F sp IIN
(�_
HAZARDS FOUND AND LOcATibNt 60MMUNICATIONS
2
2
3
3
4
4
I
5
5
6
uQVII al
6
7
7
I AGREE TO CORRECTTHE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
sPERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRErCITATION
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:
LETTER NEEDED [] YES El NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
FE k&llrfj n I Mrs
Occupancy I ams:
Building owner
Owner Agant:
Certification Given
RED
YELLOW
I WHITE V
CON FIDEN CE TEST I/
REPAIRS
FIRE ALARM SYSTEMS
(One System per Report)
Parkvlcw -Vfft=nt6 Occupancy AddMSS: 401 Pine St, EdMunde
PaWew Apuments Phonellumber. 360-632-1178
Mbbiu Applvby Phone N Limber 360-652-1179
Date of Inspection: 0211512014 InspecdonType: -/ Annual Quarterly
Testers Name: -FA Cam SFD Certification Number. Sm-L-0-773
Monitoring: Phonef: Account#.-
FACP Manufacturw-.-FU Model #: Fr, I Location:
#of Initiatina Circuits: I #of Sisnal Circuits: I Notes:
ALARM SYSTEM FUNCTIONALITY
Yes
No
NIA
AN notification circuits operational?
AN circuits chocked for electrical supervision?
AN auxiliary equipment operates (elevators, fans, dampers)?
Koyto panel avallAble7
operating instructions at panel?
Trouble indicators function propedy7
Test record posted at panel7
Signals received at central station? Operator 8_
Problems Found:
COFFected By.
Corrections Made: Date Coffected: SFD Certification t.
This certifies that this fire and life safety system has been properly Inspected for reliability
to cover the Items I sted In thin report and Is consistent with Seattle Fire Department Fire
Code standards, and that discrepancies are noted and have been reported to the bulking
Owner/Manager for corrective actio m.
Signature of Tauten.
Signature at Owners..
Phone*: q �'( 7 1.4e H—
SYSTEM DEMCES
MODEL#
TOTAL
TESTED
SATISFACTORY?
yes
No
NA
HomiStrobas
hfidan,:�81'4.201
28
V
Strobe OrAy
Ham Only
SpodkeriStrobas
Speakw Only
Sounder Base
Beall
Manual Pulle
PYRUIVONIrS M.q-5
4
Photo Smoke Detectors
Ion Smoka Detectom
Combination SmaksHeat
13W Rate of Rise Heat
201r Rated FUse Heat
139' Fixed Tamp Heat
20ir Fixed Tamp Heat
Duct Smoke Detectors
Datedor Remote Indcators
Pjwnote Annunciators
Sevator Reedl Output
Fan Pressurization
Door Holders
Door Unlock
Curtainaft:4-down Doors
Fire Fighter Phones
Main FACP
Trouble vft AC off?
No
Battery backup operational?
No
Battery voltage i1no lead)
TUa-avolts
Battery voltage fhA load)
4L25"Its
Charge circuit valtane
2��Vclts
Battery Size — 2-1 I-L
(Zj 3A x I-
PanelTvpe:
Trouble with AC off?
Yes No
Battery backup operational?
Yes No
Battery voltage (no load)
—volts
Battery voltage full load)
volts
Charge circuit voltage
Vohs
Battery Size
PanelTvpa:
Trouble with AC off?
yes NO
Battery backup operadonal?
yes NO
Emery voltage (no load)
Volta
battery voltage (full load)
volts
Charge circuit voltage
Volts
Battery Size
PanelTvDe:
Trouble with AC ofr?
Yes No
Battery backup operational?
You No
Battery voltage Ina loacl)
Volts
LBaftery voltage (full loacQ
volts
Cliarge circuit voltage
Volts
Battery Size
3013 3rd h.VE NORTH
Ak)
SEATTLE, WA 98109
284-1721
. 0
R' Al
(900) 223-FIRE
(�06) 2'94-1769 FAX
Fm"` AAA.FfRE.COM
FIRE DEPARTMENT INVOICE # //Xs;z-
d2
Confidence Testing ACCOUNT # nlk).0 -0 "
FIRE ALARM DATE /__0/zA/j_a
Address 1-tul - City:
.412=127 Zip Code
Occupied
as:
Building Owner: Ph. #
Address: _J� 0, City:
Zip Code: W7_0
Date of Inspection: y e of Inspection: Quarterl
Zpe of
%?
y nni!j� �Acceptance Other
Tester's Name (PLEASE PRINT) _
SFD Certification #
Control Panel _ FT,
Model # FO _1
No. of Initiating Circuits
Battery Voltage j T I Volts
No. of Signal Circuits
Charge Circuit Voltage
_ 6910, Volts
-
Battery Voltage Under Full Load . 0 Volts (signals operating)
I. Trouble Signal With A/C Power Off
Yes_X No
N/A
2. Systenn Operates Satisfactorily on Standby Power
Yes X No
N/A
3. All auxiliary equipment operates: (elevators, fans, dampers)
Yes No
N/A X
4. All Signals Operate On AC Power
Yes No
5. Have All Alarm Notification Appliances been checked for proper operation Yes No
6. All Circuits Checked For Electrical Supervision
Y, s No
N/A
7. Control panel checks made per manufacturer's instruc tions
Yes No
N/A
8. Central station or remote connection
Yes No
N/A
Name of monitoring company
9. Key to panel available
Yes Y_ -No
N/A
TYPE OF EQUIPMENT
# OF.UNITS TESTED
SATISFACTORY
# OF UNITS IN BLDG
YES
NO
N/A
BELLS, HORNS, CRIMES
VOICE ALARM SPEAKERS
VISUAL ALARM DEVICES
TROUBLEINDICATORS
SUPER SWITCHES (AUTO SPR)
SMOKE DETECTORS(S)
HEAT DETECTOR(S)
MANUAL PULL STATIONS
VENTILATION CONTROLS OPERATE
CENTRAL STATION
ANNUNCIATORS
ELEVATOR CALL DOWN
FIRE DAMPER/SMOKE DAMPERS
PHONE JACKS
F
AUTO, DOOR UNLOCKS (FAIL SAFE)
AUTO, DOOR RE -LEASE
OTHER
Date corrected
THIS IS TO CERTIFY THAT THE FIRE A[_AR_1%4,SYSTEN4 HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY TO COVER
THE ITEMS LISTED IN Tl��. MA&F -7q -0 do
Itp FU0
_44
S fGNATURE OF TESTER 1:;I,ECTRICAL LICENSF # 31
e-e."oo
b—bmoijos Seattle Fir -a Dep ctment
Confidence Test Report
206-386-1351 Confidence Testing Officer
206-615-1068 (fax)
. STANDPIPES
(One System per Report)
40k ?O-JS
Occupancy Address: Occupancy Name:
Responsible Person: C, -%5 Phone Number: L4,7--s
Building Owner: :5 prv%AIG7 Phone Number: SAWIZ
Date of Inspection: (.0- 11.,3- Type of Inspection: 5-Ydar JZ Annual'D'A-cceptan-ce 7Mther 7
Testers Name (Please Print): _j I 1%,t SFD Certification Number:
Class 1: (5-Year)
Hydro -tested 175 psi or 50 psi greater than head pressure
V
For2 hours: ......................................................................................... Yes No (77
All outlet valves and hose threads checked? .................................................. Yes No 7
Was 25 psi air test conducted? ................................................................... Yes El No 9
Are pumper connection clapper valves free of obstructions? ............................. Yes 9 No El
Class 11: (5-Year)
Are all hose!�,�alves and controlling nozzles in good
Condition? ....... "IN, .................................................................................. Yes El No
Have flow tests been c!,,,d icted at.highest level for at least
0;
30 seconds to make SL re n zNq will work at pressure
available (50 gpm at 35 psi miniphwziar ........................................................ Yes 7 No El
Have controlling valves been tested to v� that pressure
regulating valves operate properly (not to exNed 100 psi
Tippressure)? .............................................. . ........................................ Yes 17 No
Class III: (5-Year)
or '0 psi gre,
Hydro -tested at 175 p or 50 psi greater than hiahest
Operatingpressure? ......... ....................................................................... Yes No
Was 25 psi air test conducted?..... ............................................................... Yes [(7J NoZ1
CTF-3
STANDPIPES (continued)
All outlet valves and hos hreads checked? ....... Yes El No 71
Flow tests conducted to verify erating pressure of pressure
Regulating valves (not to excee 75-psi flowing)? ......................................... Yes M, No El
General:
300 GPM flow at roof through each riser? ..................................................... Yes S No FE
Fire pump(s) start from roof flow? ................................................................ Yes M No El WA
All Fire Department inlets and outlets equipped with
Approved plugs or caps (1/8 inch pressure relief hole in caps)? ........................ Yes 5 No
Class I & 11 standpipes have 12" wrench clearance? ......... ............. Yes �t No 7(-
Piping between Fire Department connectic"n and check valve
Hydro -tested'? ......................................................................................... Yes El No El �A
Verify that water flow switches operate ......................................................... Yes El No EI'N/A [9
Pumper connections are &bstructed ........................................................
Yes
3
No El
N/A
E,
All control valves left in open position (except normally closed valves)? ..............
Yes
ED
No El
WA
06
Problems Found:
Corrections Made: Date corrected:
Corrected By
SIGNATURE OF TESTER
AGENCY A F5 M PHONE �L,+, 5-,yt
MAILING ADDRESS: IOL),)- 100, W*-
CTF-3
AKCo
LARMS
7833 - 19M ST. SW. EDMOND& wA sam
(206)367-1166
Name of Facility,
Par rkv iwo A pa rt n lta O's
Occupied As: AP rtrfent
Building S
401 Pim -St
County: hmlis U1
Address:
6durr-inds, 'IVA. cW-00
Annwil
Type of Inspection:
Representative:
Bot, Dlwz #108
Title:
Telephone X:
421W 105-9-04
Date of inspection:
Fire Alarm Inspector(s):
7
Certification #s
CO ROL PANEL
Manuftcturer: M I Number of Zone Circuits.
Model 0: FC-I Number of Bell Circuits:
Battery voltage ?-T-7 q VORS. Charge circuit voftp--2 7. 611 wils.
Bell Voltne on stand-by power --ZI- , 04,
Tiouble with A.C. off7 Yes No NIA
Sell voltage with A.C. on: Volts.
Son supervision? Yes ZNo N/A
Zones normal?
Zone supervision?
Battery voltage under full load
Complete control panel satis(Wory?
Operating instructions at FACP ?
z
0 Key to panel available?
C> Service label posted and Initiated ?
C>
Yes \// No NIA
Yes ZNo N/A
. 0 - vD.U.
Yes NO N/A
Yes No N/A
Yes No NIA
Yes \::/No
Twe of Ergivment
ri t b rm I PAH Strobes
(ft L" W
it?
Cr W'd
I Tttei
Z3
TEd
I Is
N3
RIA
Bells
1
Twutla "IcOus
7-
W
t4 PAWL
b-, fix. ao,,
135F-k19 of RWC)V.
Rh, of Rb;
MSFixod'llerap. DEC
MI)FIxWTO-inp- DA.
IMAVUal Pw.-
4
PyRrxRcN r-;z lWS-
Trerarnitter
CeWdSt:WCq--
Elevator Vomi
13wayz 1
2
Comments, Explanation of unsalisfactory results, action taken:
Owner or Representa*m
Oaft; / — :5- - V
Name of Facility:
Building #
Address:
Representative:
Telephone #:
P a kview Ap a rtm e nts
401 Pine St
Edmonds, WA 98020
Bob Dines #108
425/775-8794
V0 A , ';� I I
Fire Alarm Inspector(s):
Certification #s
CONTROL PANEL
�XBSCO
I
IILARMS INC.
7833 - 196TH ST. SW, EDMONDS, WA 98026
(206) 367-1166 . FAX: (425) 771-4422
Apartments
Snohomish
Annual
Occupied As:
County:
Type of Inspection:
Title:
Date of Inspection:
Manufacturerf Cl Number of Zone Circuits:
Model #: FC-1 Number of Bell Circuits:
Battery voltage VO Its Charge circuit voltage: volts.
Bell voltage on stand-by power: 9 zq . 7 volts.
Trouble with A.C. off? Yes ---*' N o N/A
Bell voltage with A.C. on: volts.
Bell supervision? Yes L--'N o N/A
Zones normal? Yes _ZNo — N/A
Zone supervision? Yes V No N/A
Battery voltage under full load
volts.
Complete control panel satisfactorp.
Yes L"'No N/A
Operating instructions at FACP ?
U/,**-
Yes No N/A
Key to panel available?
Yes V""No N/A
-0-
V
Service label posted and initialed ?
Yes No
Type of Eqi ipme it
N imbe r orl' U i ils
TICIal TeslDd
Satisiacbry?
Yes No NA
Uasibcwor
& kAode I N
We i-HoroAAH StrDbes
28
.2 9'
Mirbie N?4201
Both
x
Hores4o4o rs
x
Vis eel Alsim Dou ices
x
Troibb lidicebm
11 Paial
P korto lectric Smokes
x
be imtios Smokes
x
135 Rat of Rise Dot
x
200 Rat of Rise Dot
M Fixed Temp. Det
x
200 F ixsd Temp. Det
x
11131 gal P 111 stniols
4
Pyratroo im
ks. r
Dict Smoke DoUclbrs
x
Traism itb r
x
Ceitral Slatiov
x
Ae i i icigbra
Door Holders
x
Elaualor Recall Oflpit
x
Bath rV Size & Dab
2
yj
I
Ps 12?0 6W
Comments, explanation of unsatisfactory results, action taken:
Owner or Representativ
Date: 66 K— !?Uf
JSR? [I