The URL can be used to link to this page

456 ADMIRAL WAY (2)OIRE'PREVENTION INSPECTION REPORT Serving Briei, r-unwnds, and 12425 M�ridian Ave S SNOHONIISH CO. EDMONDS Mountlake Terrace Everett, WA 98208 0 BRIER F JM Phone (425) �51-1200 0 MOUNTLAKE TERRACE 0 UNINCORPORATED D1. www.FireDistrictl.org Fax (425) 551.-1272 456 AdmiralWay 98020 LOCATION: BUSINESS NAME: Anthony's Restaurant MAILING 456 Admiral Way, Edmonds, WA 98020 ADDRESS: -BeWu,D~ BUSINESS OWNER: &A 0&-50/1 EMERGENCY-1: Burns, Steve 4- KEY ACCESS-2:0,A EMAIL: PERSON CONTACTED: NAME OF INSPECTOR: 1 4257714400 PHONE: HOME PHONE: 2067930649 HOME PHONE: 17 HOME PHONE: --5,�,lv T ( A A�6 FAEQuE STAJ�V SH I FT nnU alcy SCHEDULED Aug 2017 DATE DUE UFIR 0 CURRENT CITY - YES NO %. BUSINESS� 2. E] LICENSE INITIAL INSPECTION DATE Sqr,��ing,,Qrier, Edmonds', 'and SNOHOMISH CO. buntlake Terrace F1 DISTRwww..FireDistrict].org 12425 Meridian Ave -S Everett, WA 9k08"_ Phone (425) 551-1200 Fax (425) 551-1272 LOCATION: 456 Admiral Way 98020 BUSINESS NAME: PHONE: Anthony's Restaurant 4257714400 MAILING ADDRESS: 456 Admiral Way, Edmonds, WA 98020 FIRE PREVENTION' INSPECTION REPORT 0 EDMONDS 0 BRIER [3 MOUNTLAKE TERRACE [3 UNINCORPORATED FREQUENCY STATION & SHIFT S C H019 D DATE DUE 2916 U u FIR 161 BUSINESS OWNER: HOME PHONE: Bergau, Dawn EMERGENCY-1: HOME PHONE: "CURRENT KEY ACCESS 2- YES NO J�,rns Steve HOME PHONE: 2067930649 CITY BUSINESS EMAIL: I LICENSE El PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: FIRE SYSTEMS: AS 441�iFA'06R/1)4FE-.)4oYt[114%FD Lk Box HD UL300 1 /15 A< q/11- %[%&p&%!DCATIONS /COMMUNICATIONS LH, 'A 5 2 FF . . ... ....... .... 2 3 3 4 QZ 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 -INSPECTION EXTENSION FINAL RE -INS - PECTION VIOLATIONS DATE DUE: DATE DUE- GRANTEDTO: DATE DUE; CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: INSPECTOR: tk)kk)c�-MA) INSPECTOR: INSPECTOR: 2 DATE: 10-1 DATE: '____7j6LAT1IONS,�,1'% DATEm S -let" PRE -CITATION CI 4 J'_',)arz fkeoo —1 Wy 1 5 LETTER SENT NUMBER: 2 2 6 DATE: CODE SECTION: 5 3 7 RETURN RECEIPT ____�ECEIVED 6 DISPOSITION: 8 DATE: 7 tLETTERNEEDED-n— YES, NO LETTER NEEDED 0 YES &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: — Occupancy Address: Responsible Person: Building Owner: N COMPLETE Certification Given: RED El YELLOWEI WHITE�� FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD High Pressure Hood Cleaning SYSTEM TEST REPORT Fire Suppression Installation & Service CONFIDENCE TEST C?' Fire Extinguisher Sales & Service REPAIRS Range Hood and Fan Service & Repair Filter Sales & Service DATE: City, State, Zip: t;~n Cks W4 7 lyo;L 0 Phone Number: t25- 2,- 1 -11Z100 Phone Number: Building Owner Address: A F City, State, Zip: Testers Name (Please Print): &T SFD Certification Number: SCP- SystemAlarm? Yes2( NoF� Central station monitoring.? Yes E��No Monitoring company name: 5-C,";:Zr Control Panel manufacturer: Model Number: Location of Alarm Panek pn--r /9PeA=1 1`-90 t? EJ Y41�1 LI.L.3P0System?Ye.E31N'oE] U.L.30OComplian.YesEleNoF Extinguishing System Manufacture" Fr A7 System ize Chemical Type: Wet CTD Location / Height of Range hood: is pressure gauge indicator in operable range? Yes E-11*, No F1 Is there chemical inside of the cylinder? CO2 Yes ET' Noo NAI!I' Weigh or nitrogen cartridge. ff, No visible signs of a system fire or system tampering (if signs check no). Yes No E] Check all piping and conduit. Are all piping and conduit immobilized with Yes Z Noo proper hangers and brackets? ' Are all protective covers present on nozzles? Yes EI' No E] Are all nozzles checked in the proper position? Yes No Does system have adequate volume and/or nozzle coverage? Yes No Are all appliances inside of the hood protection area? Yes Z No L] Have fuse links been replaced? Yes E!�' No Ej Was system operational from terminal link? Yes Z No F-1 Was system operational from manual remote? Yes E?r Non Was system and micro switch operational? NA [:] Yes E?' No Ej Is system visible and free from obstruction? Yes E?- No E] Is the inspection and service tag on the cylinder? Yes UV No 0 i oll-7 12 year hydro date of cylinder. Were hand portable extinguishers properly serviced? NAE] Yes[�- Noo Were all cooking surfaces protected? If not, give owner full Yes ET' No Ej information. Was operating procedure verbally given to restaurant personnel? YesE5' No[j Was LIL WO compliance explained to owner or manager? Yes F!T' No 0 Gas shuts down upon system activation? NAF-1 Yes E�jl No [j Electric power shuts down upon system activation? NA F] - Yes E?' No E] Range hood tied to building alarm panel? NAO Yes [?j- Non Range hood activation signal received at building alarm panel? NA E] Yes,�tNo[] Class K extinguisher present? Yes ffjo No F1 Grease buildup in group: Light M dil Heavy, recommend cleaning Date of last cleanin X5��- 'IN — -,,- Are cleaning intervals within NFPA standards? Y1.0-, o 0 OV401AI-9 Previous Confidence Test Company &Technician No 0 NON ON - on 00 0 0 ON on 0 EENON No N �N E N 1111111101111111111 Non No NONE No ----OMENS MOMMEM MEN 0 0 ME so OEM M M 011111110101110111 ENNE MEE11111 ONE mmmmmmmmmmmmmmmm mmmmmmmmmmmmmmm M ONE ONE ON M M 1111111111111101011111 ININNINNINIIIIIIIIIININ MaINME 11011111110111 ME 01111111011111 126m,ll- NMI M ME ME ON ME ON ON 110111ININNE1111 111101111101101011111 mmmmmmmmmmmmmmm NO Problems Found: (If additional room is needed, please add a separate sheet) Corrections Made: Date Corrected: Corrected By: Customer has declined rei)airs X SFD Certification Number: This certifies that th f re�nd lit safety sy t h bee pe y i ed for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code is a. F�rb�eri r 0 Irtle standards. Disc epan.le e d t( �h-rldmg Owner/Responsible Person for corrective action. -0940 Signature of Tester: Phone # (206)726 Testing Agencv: .--R&T Hood and Duct Inc. MailingAddress: 610012thAve.S..Seaftle,WA98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately intended use. 9. A record of the mo thly i ections ipbe ke t fl t' the date inspected, inititals of s pt sp & sp 0 j �> b a rrect�jje ec ing 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing AthZ a rectons required. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED '5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT CUPY V COMPLETE ...... FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD High Pressure Hood Cleaning SYSTEM TEST REPORT &THood and Duct Services, Inc. Fire Suppression Installation & Service CONFIDENCE TEST 2' REPAIRS[] Fire Extinguisher Sales & Service 6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE: r2- (0 Occupancy N me.. V-1 VJ I I Occupancy A:dress: - L45LO City, State, Zip: Responsible Person: 'SNCA�Imz� Phone Number: Building Owner: Phone Number: Building Owner Address: City, State, Zip: Testers Name (Please Print): SFD Certification Number: SCP4(36&Lfg System Alarm? Yes Ed No Central station monitoring? Yes 52( No[-] Monitoring company name: 6�D Cont�ol Panel manufacturer: Model Number: Location of Alarm Panel: MG19-1:0 P, cweie +'� LI.L. 300 System? Yes dNoE:] I.I.L. 300 Compliant? Yes 52�No El Chemical Type: Wet [R'Dry El Extinguishing System Manufacturer IJ&2 ;�smvize�41 Location / Height of Range hood: Is pressure gauge indicator in operable range? Yes E&Ao 0 Is there chemical inside of the cylinder? Yes 5f No E] Weigh CO2 or nitrogen cartridge. NA [:] 0-�L— No visible signs of a system fire or system tampering (if signs check no). Yes No F-1 Check all piping and conduit. Are all piping and conduit immobilized with Yes No proper hangers and brackets? Are all protective covers present on nozzles? Yes No Are all nozzles checked in the proper position? Yes No Does system have adequate volume and/or nozzle coverage? Yes F21 No E] Are all appliances inside of the hood protection area? Yes Noo Have fuse links been replaced? Yes No E] Was system operational from terminal link? Yes F/j ffX Noo Was system operational from manual remote? Yes No E] Was system and micro switch operational? NA E] Yes El/ No F-1 Is system visible and free from obstruction? Yes 1j, Noo Is the inspection and service tag on the cylinder? Yes V Noo 12 year hydro date of cylinder. Were hand portable extinguishers pr I operly sery . iced? NAE] YesV, No El Were all cooking surfaces protected? If not, give owner full Yes No E] information. Was operating procedure verbally given to restaurant personnel? Yes No Was UL 300 compliance explained to owner or manager? Yes No Gas shuts down upon system activation? NAE] Yes DV&-' No E) Electric power shuts down upon system activation? NA El Yes FV, No [-I Range hood tied to building alarm panel? NA [] Yes Noo Range hood activation signal received at building alarm panel? NAE1 Yes En No El Class K extinguisher present? Yes R" No Ej Grease buil p in group: Heavy, recommend cleaning Date of last cleaning Are cleaning intervals within NFPA standards? Previous Confidence Test Company & Technician —0-L-121211— Yes B/ No EI11111 ON No ME m�mom — MEN MINNIE MIN MENEM 1ff11EN1N1 No ME ME 111 ME 111 111 NOME"M mmmmm mmmmm ON 0 MENEM mom No No MESON ME ENEENEWE EMME 101 mmmoommom mmmoommmom 1111 111 0 0 11101 0 MENNEN NONE IIJ Problems Found: (if additional room is needed, please add a separate sheet) N-k3xk Customer koas dealimsel Fe---i . Corrections Made: Date Corrected: Corrected By: SFD Certification Number: This certifies th is fir and lift at sl s been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code -9W s standards. Disc and s are note av;Rn reported to the building Owner/Responsible Person for corrective action. Signature of Tester: L _ Phone # (206) 726-0940 Testing Agency: 8ZAlood and Duct §&�ices, Inc. Mailing Address:. 6100 12th Ave. S.. Se4e.. A 98108 The owner is to perform and keep a written record of the following "quick check" fire s stem n ectio to erify the following: I . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and th ir sea a intact ynd aged andhig.> r place and has not been removed or tampered with. 7. The inspection tag or certific te is i pl ctand c nt. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, ppro ri e correctiv action shall be taken immediately intended use. 9. A record of the monthly ins tions i o b kept flecting the date inspected, inititals of tic s r .1 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the ins c a tny c tions required. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY R ALM &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: A COMPLETE FIRE PROTECTION High Pressure Hood Cleaning Fire Suppression Installation & Service Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Sales & Service Occupancy Address: 'J" J (,2 f"' D W1 i je A L-0 Responsible Person: Lj -/ /Z g3 I& "- , f= Building Owner: Building Owner Address: Testers Name (Please Print): c26 A !!S Certification Given: REDO YELLOWE] WHITE41 CONFIDENCE TESTING RANGEHOOD SYSTEM TEST REPORT CONFIDENCE TEST Z REPAIRS[:]l DATE: !f — 2- 1-- 1 (— — City, State, Zip: 2-0�' n M 6 eV V1 5 Phone Number: Ivaz 'S-- -7-)/ Z4 &I ep C-,.) Phone Number: City, State, Zip: SIFD Certification Number: SCP- e!:) System Alarm? YesX No E] Central station monitoring? Yes C� F� I -- ,K No Ej Monitoring company name: 5- il,-, ralie ) L Control Panel manufacturer: Model Number: Location of Alarm Panel:- A—=7701- C- /Zexp.�, -:)U.L. 300 System? YesiKNo[:] U.L. 300 Compliant? Yes Lallo F Chemical Type: WetR ory 1:1 Extinguishing System Manufacturer System Size,:e;!f;,t-34 Location / Height of Range hood: k- Wku L L 1c) Is pressure gauge indicator in operable range? A Is there chemical inside of the cylinder? YesX No[] Weigh CO2 or nitrogen cartridge., NAD No visible signs of a system fire or system tampering (if signs check no). YesR No F-1 Check all piping and conduit. Ar ' a all piping and conduit immobilized with Yes No f--j proper hangers and brackets? Are all protective covers present on nozzles? Yes No E] Are all nozzles checked in the proper position? Yes No 1:1 Does system have adequate volume and/or nozzle coverage? YesX No E] Are all appliances inside of the hood protection area? Yes 1 No Have fuse links been replaced? Ye s No Was system operational from terminal link? Yes No F-I Was system operational from manual remote? Yes No Was system and micro switch operational? NAE] YesX. No Is system visible and free from obstruction? YesX No Is the inspection and service tag on the cylinder? YesF j No 12 year hydro date of cylinder. ol-� L 0 A. - -, Were hand portable extinguishers properly serviced? NAE] Yes Xi No E] Were all cooking surfaces protected? If not, give owner full Yes [X No F-1 information. Was operating procedure verbally given to restaurant personnel? Yes j)-a No Lj Was UL 300 compliance explained to owner or manager? Yes Fe, Non Gas shuts down upon system activation? NAD YesTA No Lj Electric power shuts down upon system activation? NA F1 Yes �C' No Ej Range hood tied to building alarm panel? NAC:] Yes 3Z Non Range hood activation signal received at building alarm panel? NA[] Yes Noo Class K extinguisher present? Yes No F-1 Grease buildup in group: Light �-X' Medium— Heavy, recommend cleaning Date of last cleaning -JK—R-r—'7--R// 41 Are cleaning intervals within NFPA standards? YesX- Non Previous Confidence Test Company & Technician 0 ME mmoomm No �mms ME IN IN IN No M 111111011111 mmoon 11111111110111101 Emom�m 0 0 smommmmmomom ME MENEM= MMMEMEN mammon 01 0 MMMMMMMMMMM NOMINEE= M10 NUNN ON 0 MEMEMMEN 11 MEMO MMMMMMMM MEM NINE IMENMEMEM 0 No M IN NON OMENS= Problems Found: (if additional room is needed, please add a separate sheet) NO Customer has declined repairs X Corrections Made: Date Corrected: Corrected By: SFD Certification Number: This certifies that this fire andAte sNtty s te bai6kn properly �ynspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancies a notqV.-md- beled repd?rad-to-t11'& building Owner/Responsible Person for corrective action. Signature of Tester: I Phone # (206) 726-0940 Testing Agency: R&T Hood and Duct Services, Inc. Mailing Address: 6100 12th Ave. S., Seattle, WA 98108 The owner is to perform and keep a written record of the following 1. The extinguishing system is in its proper location. The extinguishing cylinder is in place and has not been removed or tampered with. 2. The manual pull stations are unobstructed and in clear view and are labeled for intended use. 3, Insure that all tamper seals are intact and that system is in a ready condition. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. 5. The pressure gauge reading on the cylinder shall be in the green operable range. "quick check" fire tern in ection to verify the following: 6. The nozzle disc and t ei seals a intact, undamaged and tight. 7. The inspection t o ertifi at sin pl and current. 8. If any deficienci are un a,�i`ropriat orrective actio �e taken immediately. 9. A record of the monthl *nsp ti�nsistob keptrefle g the date inspected, inititals of person performing the an any c ecti required. AUTHORIZED SIGNATURE FIRE DEPARTMENT COPY R &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: "n I 17C-*7!r L.2't Occupancy Address: LJ,5 6 r Responsible Person: COMPLETE Certification Given: RED E] YELLOW E] WHITE FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD SYSTEM TEST REPORT High Pressure Hood Cleaning I Fire Suppression Installation & Service -CONFIDENCE TEST 9--' REPAIRS Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Sales & Service DATE: 0 L/ Building Owner: Building Owner Address: Testers Name (Please Print): rIL4(-% h i -0) 4 System Alarm? YesjjNo.[77j Central station monitoring? Yes 1;�—N6 D Control Panel manufacturer: ModelNumber:' T_-/1J Extinguishing System Manufacturer Location / Height of Range hood: 300 r Is pressure gauge indicator in operable range? Y�s No Is there chemical inside of the cylinder? Yes No E] Weigh CO2 or nitrogen cartridge. NAa__� No visible signs of a system fire or system tampering (if signs check no). Yes�Z No F-1 Check all piping and conduit. Are all piping and conduit immobilized with Yes Non proper hangers and brackets? Are all protective covers present on nozzles? Yes 0_�No Are all nozzles checked in the proper position? Yes ff/-,No F2_1'No Does system have adequate volume and/or nozzle coverage? Yes E] Are all appliances inside of the hood protection area? Yes E;?-�o El Have fuse links been replaced? Yes ��'No El Was system operational from terminal link? Yes ffl--No Ej Was system operational from manual remote? Yes No F] Was system and micro switch operational? NA Yes No E] Is system visible and free from obstruction? Yes E�K No E] Is the inspection and service tag on the cylinder? Yes2r No n City, State, Zip: Phone Number: Phone Number: City, State, Zip: , j SFD Certification Number: SCP_ tl— Monitoring company name: 4 A# I Location of Alarm Panel: A o i- RLI-7-h &KJO"L�— Ilf 5tem?Ye&;�i<E] LI.L. 300 Compliant? Yes EiVo-o' Chemical Type: Wet 1911�1:1 12 year hydr'o date of cylinder. / 1 Were hand portable extinguishers properly serviced? NA F� Yes No Were all cooking surfaces protected? If not, give owner full Yes No[-] information. Was operating procedure verbally given to restaurant personnel? Yes E?- No[-] Was UL 300 compliance explained to owner or manager? Yes E�'— No 0 Gas shuts down -upon system activation? NA F_� Yes [��No F-1 Electric power shuts down upon system activation? NAn Yes Ej_ No n Range hood tied to building alarm panel'? NAn Yes Ej-'*' No n Range hood activation signal received at building alarm panel? NAE3 Yes El"' No E] Class K extinguisher present? Yes E4-"'No 0 Grease buildup in group: 'up' Light Medium Heavy, recommend cleaning Date of last cleaning Are cleaning intervals within NFPA standards? Yes 2---N. E] Previous Confidence Test Company& Technician 1. mommommomommm MEMMEMMEN MEEMEME I ONEMMENESNN=Em Mo ONNE 0 0 EMMONS MENEEMEM MEN 0 SON MEN NOON MEN 0 ME 1 ON M 0 ON Mo !MM ME so M NM==MMMMMMMM Mo 0 0 NOON 0 0 M E 0 ISMONMEN MEMO SENN Ems so so 0 00 Ems NONE= ".MMEMEMEMMENME 1MMMMMMMMMMMNMM MENEM V %_,, - -- - k, - - Problems Found: (if additional room is needed, please add a separate sheet) Corrections Made: Date Corrected: Corrected By: Customer has declined repairs X SFD Certification Number: This certifies that this fire and lif ib pip Rimt(ity-4ys as W:3'xSpggyins acted for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code ;__ M standards. Discrep&rm4�TVdV-rrfd'h PG4(xLtQ the bue, M310WReff/ftsponsible Person for corrective action. Signature of Tester: Phone# (206) 726-0940 Testina Aciencv: R&T Hood -------.Mailing Address: 6100 12th Ave. S., Seattle, WA 98108 landbuct Services, Inc. _Tbe-emerit t'd Obrioirimaind keep a written record of the I '17-T—he extinguishing system is in its proper location. The extinguishing cylinder is in place and has not been removed or tampered with. 2. The manual pull stations are unobstructed and in clear view and are labeled for intended use. 3. Insure that all tamper seals are intact and that system is in a ready condition. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. 5. The pressure gauge reading on the cylinder shall be in the green operable range. Niffg-tfutil check" fire system inspection to verify the following: 6. The nozzle disc caps and their seals are iftt, undamaged and tight. p 'l.c i u re t 7. The inspection tag or certicat 'e ' ' - dcl - j - in . 8. If any deficiencies are fou a ro natAorlecttive action shall be taken immediately. 9. A record of the monthly in, ct. ns s to bd�Lept rej>Wg the date inspected, inititals of person performing the ins , a d any cprrevtMs required. AUTHORIZED SIGNATURE FIRE DEPARTMENT TRUCK NUMBER R 6100 12th Ave. S. Seattle'NA 9 '8 Phone (206),726�008940 High Pressure Grease Exhaust System Service Fire Suppression Installation & Service Fire Extinguisher Sales & Service A A, O'E T Fax (206) 767-2607 Range Hood and Fan Service & Repair (1'234 & Hood and Duct Services, Inc. www.rthood.com Filter Sales & Service SUMMARY: CONDITION OF SYSTEM RED E YELLOW 0 WHITE AiNTHONY'S - HOMEPORT EDM'ONDS SHAWN - KI TC JOB NAME CONTACT LOCATION- 415b ADMIRAL WAY EDMONDS, WA 9802-0 SERVICE DATE 1'R&T HOOD DATE OF LAST SERVICE [__1 OBSERVABLE 7113 111 -3- INACCESSIBLE AREAS LOCATICOPHONE . NO k4:,_y5) 77i-A,400 �BACKUP PHONE N 0. (253) 302-784-8, SCHEDULED JOB TIME SALFSPFRSON Hr-)USr-: # OF HOODS 4 NAME #1 IV�AIN #2 -MAW #3 BAt;K _ #4 OVEN HOOD # OF ACCESS PANELS LENGTH#, j FEET #2 9 FEET #3 4 FEET- _ #4 b FEET BEST ROOF' INSIDE ROOF ACCESS: */YES /NO ACCESS LOCATION: 2ND FLOOR REAR OF KITC'HEN - SET UP PRESSURE WASHEa ON EAS-T'SIDE OF BUILDING, qPFr.lAl IKI.qTPI IrMnWc, 2 SILVERS" LEAVE STIcXERS WITH PAPERWoRK CLEAN UP SPRAY OFF CIN ROOF BIR.ING3 EACK-GREASY.-WATER�T0 THE SHOP, EXHAUST HOOD(S) HOOD # 1 2 3 jr4 WRAP HOODj N ' N'j N DRAPE APPLIANCEj D RNN �, N CHEMICAL SPRAYE N N N �� PRES�SURE WASHED N N CHEMICALWIPE CHEMICAL SCRUBBE WATER WIPE POLISHE SOAK FILTER SHOOT FILTER % OF GREASE REMOVED /NO DO HOOD(S) LEAK (DRIP)? GY �V/ FILTERS REINSTALLED DINO BURNT GREASE� WATER -WASH HOOD UV HOOP4 # OF MISSING FILTERS. FILTED--G-014DITION '7G'=GOO 67,70,117AI R, 2 3 4 MOON 0101000i 01011MMMIMP =WA!LA__w 0 9 Fri, 71 A", wk L M-A DUCT SYSTEM(S) CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEM IdACSCRUBBED # OF ACCESS PANELS. # OF INACCESSIBLE APs DUCT LENGTH IN FEET POST SERVICE, CONDITION SEALED ACCESS PANELS YES/AO 0% OF GREASE REMOVED % OF AREA NOT ACCESSIBLE NUSUAL CONDIT] 1 2 3 BURNT GREAS7 ROUND DUC CLASS 11 DUCTS LEAKING DUCTS FIRE WRAPPED INACCESSIBLE AREAS NOUR"Mm EDWIN= Fill ff! 91 W. I M WENIVOIAM MORMI&M MrOw, j_,M CHEMICAL SPRAYE� PRESSURE WASHE I SCRAPE CHEMICALWIPED .. k CHEMICAL SCRUBBED FAN REMOVABLIEi REMOVEFAN ' # OF ACCESS PANELS FANS - OPERATION 9 1 a 0 I WPM ww"MIEW WNPADOMM 10MRO10113M "MOAPEM M M M wjammlolm =01"Zmmm FANS - LEFT RUNNING TO DR)��IPNO FAN DAMAGE,,OBSERVED YE INDICATE UNU`sUAbff6_N5i; Cf-I DISASSEMBLE TO CLEAN EXPOSED WIRES NEED FLEX -CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE DUCT 1 PHYSICAL CONDITION DUCT 2 CLEANING ACCESS DUCT 3 ELECTRICAL CONDITION DUCT 4 k_ FAN BELT CONDITION - 1- 2 3 4 FLA 11, 1 W VA 01 M no I AWWAM FAMIUM I Z a IMPORT= MI&FARTim GO W_ I M VORMAM w WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE*HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BEL COMMENTS TO CUSTOMER: y-inze 11�/ CUSTOMERJ SERVICETECH:__ fif 14Z\ AL%-_ SIGNATUBfff_--�� DATE: FIRF nFPARTmFNT (nPY COMPLETE Certification Given: REDD. YELLOWO WHITEE]] FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD R High Pressure Hood Cleaning SYSTEM TEST REPORT &THood and Duct Services, Inc. Fire Suppression Installation & Service CONFIDENCE TEST REPAIRSE] Fire Extinguisher Sales & Service 6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE: to Occupancy Name: IKN3 1 %40 M-1 -..'> X Occupancy Address: 5 ADmmgAL L,)A City, State, Zip: 6-t4matic�S q 36 20 Responsible Person:��,-Q!� Phone Numbe4q2!5) j7ri(-44/vi Building Owner: Phone Number: — Building Owner Address: City, State, Zip: -- Testers Name (Please Print): �,1�qbt,oj SFD Certification Number: SCPCY,03q 9 System Alarm? Yes d No F� central station monitoring? Yes 20/ No Ej Monitoring company name: Control Panel manufacturer: Model Number: Location of Alarm Panel: Extinguishing System Manufacture'rAO(WC — System Siz&3jr3�� I.I.L. 300 System? Yes &�/No El U-1. 300 Compliant? YesoNo E( Chemical Type: Wet El I Location I Height of Range hood: 'ZA641 LJA 11 (09, t Is pressure..gatigeAndicat9ir,in operable-ranqe? Is there chemical inside of the cylinder? Yes No F-1 12 year hydro date of cylinder. Were hand portable extinguishers, properly serviced? NA Yes No [j Weigh�CO2�or,nitro .gen cartridge., Were all cooking surfaces protected? If not, give owner full Yes No No visible signs of a system fire or system tampering (if signs check no). s Ye- NoF-I---- Check - -a . I( pipin - g and conduit. Are I all piping and cc nduit immo I bilized - With yes No M information was operating procedure verbally given to restaurant personnel? Yesfo' Noo prope r'hangers and brackets? Was UL 300 compliance explained to owner or manager? Yes �o Ej Are all protective covers present on nozzles? Yes o tD Gas shuts down upon system activation? NA F-1 Yest�� No NoO Are all nozzles checked in the proper position? Does have Yes No Yesw Noo Electric power shuts down upon system activation? NA F] tied t . building NAD YesY- Yes F!r, F-1 system adequate volume and/or nozzle coverage? Are lappliance inside, hood tio ffarge-hood o alarm panel,?, Range hood tivati building NAE1 -No Ye3 No E] al s ofthe p rotec n ar e a? Have fuse links been Yes No ac on signal r eceived at alarm panel? Class K extinguisher'present? Yes C NoE] replaced? - X- Was sySterntoperational from terminal Ii nk? yes E� NOQ Grease buildup in group: Was system operational from m anual remote? Yes E/ No E] Light ZT commend cleaning re�ium Heavy, re Date of last cleaning A(4) Was sys�tem-,,,ancl micro switch operational? NA Yes No Is system visible and free from obstruction? Yes EV No E] Are cleaning intervals within NFPA standards? Previous confidence Test Company chnIcian Yesv Noo ctic Is the�inioe' n and service tag on the cylinder9 Yes No(a I I I , t ti 1*1 " + A- Y, �14 L G- - i-1 J-= -,Vt?J—V —1r"-Nr-Aj - -J- i A. I-- �11-!-J�-j Problems Found: (If additional room is needed, please add a separate sheet) 13+ ip%J &JTe, 6ow-0 Lj(w,�j Sf %o,-1 i 1; ��9p� qU 1?P-QULXe3 cn((-ecA-,Je- k4io�,j SC" iAtj eteC±r,'e,,1aj\1 I Customer Corrections Made: Date Corrected: Corrected By: SFD Certification Number: Thi certifies th t this f' d life safe as' properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code . D ?nVb 7- rted to the building Owner/Responsible Person for corrective action. standards iscrep�c2iesre noted a d hav en -0940 Signature of Tester: Phone # (206)726 Testing Agency: A IyHood and Duct Services, Inc. MailingAddress: 610012thAve. S., Seattle, WA 98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1. The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, pp riate corr tive action shall be -taken immediately. intended use. 9. A record of the monthly ins ti is to be k I reflecting the�Xe inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the ins tio any c ections require 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE . . . ............ . ..... FIRE DEPARTMENT COPY TRUCK NUMBER 6 100 Iftk Ave. S. Seattle,WA 9 8'08 Z06-0940 Phone 06 72 High Pre . ssure Grease Exhaust System Service Fire Suppression Installation & Service Fire Extinguisher Sales & Servic A ':�ft R Mood Fax �'2 6� 767-2607 and Duct Services, Inc. WWW.rthood.com Range Hood and Fan Service & Filter Sales & Service I �jyj A, , J L JOB NAME mm�= CONTACT L06ATION 9'5(P i\LQ -V,' L14NAA 14 h N�Dt Ll ?'5 - L/ IjCjC1, LOCATION PHONE NO. SERVICE DATE BACKUP PHONE NO. F 'KR&T HOOD DATE OF LAST SERVIC OBSERVABLE - SCHEDULED JOB TIME INACCESSIBLE AREAS SALESPERSON. 0�� # OF HOODS NAME #1 #2 01t\Ikk3 #3 #4 'tA'C L # OF ACCESS PANELS C) HOOD LENGTH #1 #3 6FLI_�A_ #2 #4 INSIDE ROOF ACCESS S'/ NO BEST ROOF ACCESS LOCATION: SPECIAL INSTRUCTIONS. -YL - e I Y) [-: f- f:-- r-AA LAN( W -Ra -PAc_L -P,, 5NzC-- EXHAUST HOO HOOD # 1 WRAPHOOD DRAPE APPLIANCE CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBE WATER WIPED POLISHE SOAK FILTER SHOOT FILTERS Obitt-s St'Vidt-CON DITION % OF GREASE REMOVED DO HOOD(S) LEAK (DRIP)? FILTERS REINSTALLED 4 NO NO -IMEHICATE UNUSUAL CONDITIONS A 2 3 4 BURNT GREASE WATER -WASH HOOD UVHOOD # OF MISSING FILTERS FILTER g=ITION _e-f(V-G'06D,P=FA1R, DUCT SYSTEMM' 1 2 3 4 CHEMICAL 3PRAYED PRESSURE WASHED CHEMICALWIPED CHEMICAL SCRUBBED # OF ACCESS PANELS # OF INACCESSIBLE APs DUCT LENGTH IN FEEf _.dd� SEALED ACCESS PANELS YES7NO) % OF GREASE REMOVED % OF AREA NOTACCESSIBLE.; UND ICAT E-11h U9 UA L C-614DITIONS 1 1 2 3 4 BURNT GREASE ROUND DUP CLASS 11 DUCTS LEAKING DUCTS FIRE WRAPPED INACCESSIBLE AREAS DUCT 1 DUCT 2 DUCT 3 DUCT 4 780TRIMMM watilywamm mi-5051115M W, _51 MAI 0 7, i1i z 84PLAVIOM WAMAIDWAM EXHAUST F) 2 3 4 CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICAL WIPEO, CHEMICAL SCRUBBD FAN REMOVABLE REMOVE FAN # OF ACCESS PANEL9 FANS -OPERATION TES7,- �SO FANS - LEFT RUNNING TO D 0 e FAN DAMAGE OBSERVE Y&57M �O INDICATE UNUSUAL (6'0*0NDIMNS 1 2 3. 4 DISASSEMBLE TO CLEAN EXPOSED WIRES NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE - 00 =FAIR, P jyj 1�� OND HY LGA ONDITION CLEANING ACCESS. ELECTRICAL CONDITION FAN BELT CONDITION 0010101VITM 111MOV11ozi 0=4911033 IMINA-01wilm 000FOAMMI VA 0 0 IV NO M wili Val M am On WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS TO CUSTOMER: C-41C' SERVICETECH:' ,',',,"-tUSTOME SIGNATUP FIRE DEPARTIVIFINIT COPY DATE: R AAA" &THood and Duct Service , Inc. C� 6100 12th Ave. S. Phone (206) 72 -0940 Seattle,WA 98108 Fax (206) 76 -2607 Occupancy Name: f) in v Occupancy Address: Wtz Responsible Person: I ae Building Owner: COMPLETE Certification Given: RED E] YELLOW[?"' WHITEE]] FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD High Pressure Hood Cleaning SYSTEM TEST REPORT Fire Suppression Installation & Service CONFIDENCE PAIRS El Fire Extinguisher Sales & Service TEST RE Range Hood and Fan S Ice & Repair Filter Sales & Service7' DATE: Building Owner Address: 0 Testers Name (Please Print): &fe,, F_.91 - - / I System Alarm? Yes K No E] Central station monitoring? Yes [3"N- El Control Panel manufacturer: Model Number: Extinguishing System Manufacture System Size3 -6 16 LI.L. 3( Location / Height of Range hood: ,"C; k 164—.)tt /0 City, State, Zip: Phone Number: Phone Number: City, State, Zip: SFD Certification Number: SCP- Monitoring company name: 4 Location of Alarm Panel: F.9ty- 6 +41C e- ,terp? Yes E3<El LI.L. 300 Compliant? Yes D<- El Chemical Type: Wet [�KEI Is pressure.qi&bqe,indicato� i�operabla� ran e? _9 Ye<3 12 year hydro date of cylinder. Is there chemical inside of the cylinder? Yes E�' No Were hand portable extinguishers p yoperly serviced.) NAE) r_NOE:l Weigh,Cb2o6;itr61gen cartridge.' NAEj Were all cooking surfaces protected? If not, give owner full Yes [�Jr No F-1 No visible signs of a system fire or system tampering (if signs check no). Yes E��" No F-1 information. Was ting to restaurant yescl, NOE] Check all pioin6.'and conduit. Are all, piping and conduit immobilized with Yes No opera Rrocedure,Verbally,given personnel? proper hangers and brackets? Was LIL 300 compliance explained to owner or manager? Yes E2e No F] Are all protective covers present on nozzles? Yes No -as sh u-ts d own u pon s'y.s't'e' m-a-c-ii—vatio-n? NAF�__ -Yes E�r'_ 46 El Are'all nozzles checked in the proper position? Yes No Electric power shuts down upon system activation? NAF Yes [�?' No Does system have adequate volume and/or nozzle coverage? Yes E] No Range hood tie d to bu ilding alar m pa n e I? NAF Yes [? No Are,all appliances inside of the hood pr otecti on area? Yes [?" No Range hood activation signal received at building alarm panel? NA F-1 Yes[?" No Ej Have fuse links been replaced? Yes E?r- No Class K extinguisher present? Yes D100No E] Was system operational, from terminal link? Yes - Noo Grease builduplirigroup: Was system operational from manual remote? Yes No fj Light edium— Heavy, recommend cleaning Date of last cleaning Was system arid micro switch operational? NA YesE!r No[] Is system visible and free from obstruction? Yes E?"' No F-1 Are cleaning intervals within NFPA standards? Yes No Is theinspecti n and ervice tag on the cylinder? Yei� No Previous Confidence Test Company & TechNician L A 0 --- X ti -7 44! I L S. V Af T 11 -U I H&V A A f, - Problems F,"nd* jfc1clitional room is needed, please add a separate sheet) T,*A h,aij w.�Aeq T.5 -e , , - t -0 -e -hl-�c ta, A t A �e vr A cY6 uo,1A;tas, -orred7ita, &,c:t,AL4 i, cm v4r, t Corrections Made: Date Corrected: Corrected By: Customer has declined SFD Certification Number: This certifies that this fire ang life safety system has been pro;perLi nspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancies a oted ave fo al ,, �n reptred uilding Owner/Responsible Person for corrective action. Signature of Tester: Phone # (206) 726-0940 Testing Agency: &T Rood and Duct vices, Inc. Mailing Address: 6100 12th Ave. S., Seattle, WA 98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective action shall be taken immediately. intended use. 9. A record of the monthly inspections is to be kept reflecting the date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspection and any corrections required. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY T LtCK IRLICK 6100 12th Ave S High Pressure Grease Exhaust System Service NUMBER Seattle,WA 9�1 68 Fire Suppression Installation & Service t Phone (206) 726-0940 Fire Extinguisher Sales & Service A .46 Fax 2 6) 767-2607 Range Hood and Fan Service & Repair Www!rt000 C0 IN E_:,�-, VIR-, Ti- �T Hood and Duct Services, Inc. h d m Filter Sales & Service - Ll I ANTHONY'S HOMEPORT JOB NAME� CONTACT ' WID . 456 ADMIRAL WiNt - EPMONP&VI Wbi-Itf LOCATION �A9 '61 >�IPPHONE NO. (425 441A SERVICE DATE 2ND PHONE J\AIA I LIA EAT HOOD 0112812015 DATE OF LAST SERVICE El OBSERVABLE — SCHEDULED JOB TIME INACCESSIBLE AREAS SALESPERSON HOUSE # OF HOODS 4 NAME #1 - mAfm #2- MAIN #3 OVEN #4 RA HIDOD C � "T 112 FW 12 FEE;N # CCESS PANEL LENGTH #1 — #2 #3— FEE. 6 FEET BEST ROOF . 0- 2ND FLOOR RRUIR DF KITCHI=N - IDE ROOF ACCESS: IIYE`6�4 0 ACCESS LOCATIO'. LVERS,i < ff�CIAL INST S R SURE WASRP -'D -AST-SIDE-GE BL11[NN(;- vc INSTRUCTIO 1,�EAVE STICKERS a PAIDERV33P"t, UP SPR" OFF, BRING BACK GREASY \A/AtFR T BEGINNING GJEASE BUILDUPV� 'IN-14AUST HOOD HOOD # . WRAP HOOD DRAPE APPLIANCE( CHEMICAL SPRAYED( PRESSUREWASHED1 W. SCRAPED( EMICALWIPEDi SCRUBBED (CHEMICAL) WATER WIPED( POLISHED (*�AIQDISH FILTERS SHOOT FILTERS -LI 4 9113 �1424 Ou M RN-MR31M @411MVIR382 43020am 011DR-11.0-Am M N RM a a INAMN-M valumm POST SERVICE CONDITION % OF GREASE REMOVED V I DUCT(S) - LIGHT / HEMICAL SPRAYED RESSURE WASHED ..SCRAPED CHEMI CALWIPED CHEMICAL kRUBBED # OF ACCEA-PANELS DUCT LENGT4."IN FEET .-1 2 -.1 4 ff 101 N a NA 0 FaIR1.101MM 7k SEALED ACCESS PANELS YES/NO % OF GREASE REMOVED % OF INACCESSIBLE AREAS / HEAVY I FAN(S) - LIG CHEMICAL SPRAYED I PRESSURE WASHED( SCRAPED CHEMICALWIPED CHEMICAL SCRUBBEb, FAN REMOVAULEf REMOVEFAR # OF ACCESS PANELS -1 -2 ��2 4 POST SERVICE CONDIMN FANS - OPERATION TESTKAI�- NO YES LEFT RUNP Y, Y COWLING - DAMAGE OBSERVED\'Y rSl'NV DO HOOD(S) LEAK (DRIP)? NO INDICATE UNUSUAL CONDITIONS __W ?,— 9--, 4 DISASSEMBLE TO CLEAN'lp I _,My 1 (3.,, 4 i 092M� FILTERS htll'JZ> 1ALLt YE / NO BURNT GREASE ROUND DUCT CLASS 11 DUCTS INDICATE UNUSUAL CONDITIONS LEAKING DUCTS !,, ?,<Zf3-N 4 FIRE WRAPPED BURNT GREASE WATER -WASH HOOD # OF MISSING FILTERS FILTER CONDITION r_ArU0r_lJ VVINMO NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE ffe-1 I 10 11 "M M OT124TROW w-w- FIRM MOV00014am MIME, M MOOMMM '4' , , '_" ku=GOOD, r=FAIR, P= Uri) PHYSICAL CONDITION p r CLEANING ACCES! (G=GOOD, -F_�FAA, �LP06R) 3 r-Lr-U I NIUAL UUNUI I It.) 4 FAN BELT CONDITION WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND i �DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS TO CUSTOMER: UINNIM7 MOM iffidimm 111119imm fialtral—MIM INACCESSIBLE AREAS wt 011 IT M_ Oil M WASOMMM M11,11111MM IWIDRAIMMM calnut'.10.2m r0rzamm SERVICE TEC R W711MC Ur-f-M!"i I IVICIM I LoUf- T 77 TRUCK NUMBER 6100 12th Ave. S. Seattle,WA 98 1 O�8 Phone (206) 726-0940 Offlk— High Pressure Grease Exhaust System Service F�re Suppression Installation & Service F Extinguisher Sales. & Service A J_U klk-;9 441' R Fax (206) 767-2607 Mood and Duct SerAces, Inc. www.rthood.com re Range Hood and FanService & Repair Filter Sales & Service NF E 1Y L7 JOB NAME f-)rAVV-y\�,A5- C1 LOCATION 'ICU eC-\yyY) N 2N SERVICEDATE &J R&T HOOD DATE OF LAST SERVICE El OBSERVABLE INACCESSIBLE AREAS CONTACT JOBPHONENO. ','AjS)7_1\ 9AS10 2ND PHONE t IS- �)- *; .. �r,jD 778L49` SCHEDU LED JOB TIME SALESPERSON `4 #OFHOODS NAME #1 V-V-nln #2 #3 OWn #4 # OF ACCESS PANELS HOOD i. LENGTH #1 - 12- f #2 #3 #4 BEST ROOF INSIDE ROOF ACCESS: I(ES./ NO ACCESS LOCATION: -)r" SPECIAL INSTRUCTIONS BEGINNING GREASE BUILDUP: HOOD(S) - LI HTk�Ebl��2,HEAVY I DUCT(S) - LIGHT40E UM HEAVY I FAN(S) - LIGH EWDI HEAVY EXHAUST DUCT SYSTEM(5) .EXHAUSTHOOD(M I EXHAI G HOOD # 1 -2 .3 4 p-N1 ; -2 , 3 4 1 —1 2 3 4 WRAP HOOD.' DRAPE APPLIANC CHEMICAL SPRAYED� PRESSURE WASHED4 SCRAPEDz CHEMICALWIPED SCRUBBED (CHEMICAL) WATER WIPED POLISHED� SOAK/DISH FILTER!4 SHOOT FILTERS MEM-01013 WAMMOU13 0191mmic MMMUM MM90WE MCIMMID DIMPERM wDaMPM13 AIMAN61191M DEMMUM &EMIZai-0 k"f V I % OF GREASE REMOVED DO HOOD(S) LEAK (DRIP)? fYES`1 NO FILTERS REINSTALLED NO fl INDICIANT 1E4UNUS-jWAL CONDITIONS 1 2 2 4 BURNT GREASEt WATER -WASH HOOD # OF MISSING FILTERS FILTER CONDITION WINUMM ow"Sul, wiiiiiiw' - 010120M OLM Of 54F 1 IN _.(q--GZ'05D�=FAIR, P='P6ErR;-V CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED # OF ACCESS PANELS DUCT LENGTH IN FEET E MRZPAM ASSID103m VREMIC-am k*9901am 9C "MMI a 1') - <f-4u^ X SEALED ACCESS PANELS YES /COO % OF GREASE REMOVED 'S _SL% OF INACCESSIBLE AREAS BURNT GREASE ROUND DUCT CLASS 11 DUCTS LEAKING DUCTS FIRE WRAPPED INACCESSIBLE AREAS 1- 2 -3- 4 �Mfyukkmm MIV211wilm [oil PC VAIM MM17,91M 0=10M WOMADFUM CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED FAN REMOVABLE REMOVEFAN # OF ACCESS PANELS IMOD'am NUMOM 04130nm MEN= MYVIMAMM Mwwom V-2123,71am w_ F—A-0 0 M FANS - OPERATION TEST LEFT RUNNING TO COWLING - DAMAGE OBSERVED DISASSEMBLE TO CLEAN - EXPOSED WIRES NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE 1 P H Y Sc 0 �N 1:0: 2- CLEANING ACCESS 3- ELECTRICAL CONDITION 4 FAN BELT CONDITION YESI/ NO YES /-NO YEY/ �O M119mom NUVAIM 1WINDAwrim W willum mull 10, Ulm ff WIMMIM mWaillm WE APPRECIATE YOUR BUSINESS ANDWELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT. -THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS TO CUSTOMER: CUSTOMERXI SERVICIETECH: SIGNATURELAr DATE: FIRE DEPARTMENT COPY TRUCK NUMBER . . . . . . . . . . . . I 6100 12th Ave. S. ERIC- - High Pressure 'Grease Exhaust System Service Seattle,WA 98108 - Fire Suppression Installation & Service 0 EG Ptiv FE Phone (206) 726-0940 Fire Extinguisher Sales & Service A 4Kk, R Fax (206) 767-2607 Range Hood and Fan Service & Re Mood � ;/ N E 0 R 7, and Duct Services, Inc. www.rthood.com Filter Sales & Service SUMMARY: CONDITION OF SYSTEM RED E YELLOW WHITE 0 JOBNAME 1+) � I A E PiCil:r_ CONTACTLI'A'�_, NE 0 LOCATION J OB PHONE NO. SERVICE DATE hj 0 2ND PHONE IZR&T HOOD DATE OF LAST SERVICE 'El OBSERVABLE �1 q SCHEDULED JOB TIME A). .1 Al INACCESSIBLE AREAS A, j 1A SALESPERSON # OF HOODS NAME #1 IVU #2 1111+1LO — #3 Cutv #4 1 '-5+C-6 HOOD -A # OF ACCESS PANELS I LENGTH #1 #2 — #3 BEST ROOF INSIDE ROOF ACCESS: E /NO ACCESS LOCATION:—,Z"O /q�-O(Z_ ILL-k-W- CE SPECIAL INSTRUCTIONS _/,b 15 1-7 1 J 1) 'L&V,51Qr� NJ k,\j L i`yl \1 s0i� v4t.4 6 P--r 4 '0-f I L o SERVICES PERFORMED BY TECHNICIANS BEGINNING GREASE BUILDUP: HOOD(S) -LIGHT /..MEDIUM /.HEAVY DUCT(S) -LIGHT ��EPIUM.'/ HEAVY FAN(S) -LIGHT EDIUM)HEAVY .'_1EXHAU85T9HOOD(Sf_ EXHAII191 -DUCT SY9TEM(S) I EXHAUST FAN(W: HOOD # Cl'.'!i (2) 6) n4 '1) (2 3 4 1 (1) a (3) 4 WRAP HOOD i DRAPEAPPLIANCE, CHEMICAL SPRAYED, PRESSURE WASHED, SCRAPED, CHEMICAL WIPED SCRUBBED (CHEMICAL) WATER WIPED POLISHED SOAK/DISH FILTERS SHOOT FILTERS CHEMICAL SPRAYED PRESSURE WASHED SCRAPED� CHEMICALWIPED� CHEMICAL SCRUBBEDt # OF ACCESS PANELS DUCT LENGTH IN FEET mom M M ammimm WMEMM MIMMUM MM-31-310 mmmm CHEMICAL SPRAYED � PRESSURE WASHED� SCRAPED CHEMICALWIPEDj CHEMICAL SCRUBBED FAN REMOVABLE REMOVE FAN( # OF ACCESS PANELS 10iffluo 3M 00303M bmm w#M WWRIM imulmmm wwb13M mplArrim POST SERVICE CONDITION POST SERVICE CONUMMON FANS - OPERATION TEST SEALED ACCESS PANELS YES/Ab . ��S / NO % OF GREASE REMOVED LEFT RUNNING TO DRY (CES)/ NO COWLING - DAMAGE OBSERVED YES %OF INACCESSIBLE AREAS C ATf E - U N, U, -9 U A L QQN,:[ D - % OF GREASE REMOVED __j1rT,1ON8_ 0) (1 '�b ) ( 4 UV nUULJkO) Lr-Mr% V114 11 11VA110 DISASSEMBLE TO CLEAN (-2) _' (i) 4 NLI tMi Mr-IINIZZ), IALLt:U T��: / NU BURNT GREASE ROUND DUCT CLASS 11 DUCTS P,,IN'17DIVA�T��E�UNP�.gW-'ALCONO.I!Ti(GNS LEAKING DUCTS 'V t-) (3) 4) 2 FIRE WRAPPED BURNT GREASE WATER -WASH HOOD # OF MISSING FILTERS FILTER CONDITION �) N N 0 N �P N J� N, N N & N 1) N 3�_N N :PN, 'V N J�, N N a'k 'Y ,)NYNCq)N ,t N N 11 N;,? N �� N N 3)NjW'DN N 1)N V N,Y 6) N N'�) N N INY N LiDN Tj N IYN q N K .7 N INACCESSIBLE AREAS j)N b N 25 N Y N Y (g Y(V� Y 1Y Y N Y�Np&y@ I � N, :�N '�p N:�)N Y N y IR yru" y Y N. Y, ly(1---d' Y I Y N I r_ArU0r_U Wifir-Z-3 NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE Y�_CR, Y& Yd� Y N A: K ) Y N YM 11 Y Y Y N y (9 Y� 4 �(#P N Y Y N yGk Y Y Y N YCRY- - Y ' Y N 1 PHYSICAL CONDITIUN i__ -ly- -I �_ I 2 CLEANING ACCESS C7 _1,__j�1T_t 07 3— ELECTRICALCONDITION (G=GOOD, �=�FAIRI P=POOR) 4 FAN BELT CONDITION WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS � 4 Vj jjc-ss� TO CUSTOMER: 7__(_,1AJJ U-QQ �QE (-((20 CUSTOMER 70.. V4 SERVICE TECH:dA\_?-7 —SIGNATURE, (�A DEPAR-WE'INT COPY V01=91 [mum M MIA M w R &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: I kV I Occupancy Address: 1.51 AA%;Zt!nL4 Responsible Person: 10 C,-\o K Building Owner: COMPLETE Certification Given: RED E] YELLOW E3'0' WHITE E] FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD SYSTEM TE!�T REPORT High Pressure Hood Cleaning Fire Suppression Installation & Service FG-ONFIDENCE TPST REPAIRS 0 Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Sales & Service DATE 0/12 '5 /14' Building Owner Address: Testers Name (Please Print): System Alarm? Yes 3" No E] Central station monitoring? Yes 110, No El Control Panel manufacturer: Model Number: Extinguishing System Manufacture System SizW1413 I.I.L. 300 Location / Height of Range hood: ay,,� tj mT1____L p _& �r City, State, Zip: Phone Number: Phone Number: VY00 - City, State, Zip: SFD Certification Number: SCP_ 4�,80-4n Monitoring company name: 501.4t�rlrco Location of Alarm Panel: F&P T4i7c-tv ,t9m?Yes[fj`NoF� I.I.L. 300 Compliant? Yes[] No Eff'�_Chemical Type: Wet E�� EI a larpssyregauge1ndicator in operable range? )�/C(� No 12 year hydro date of cylinder. Is there chemical inside of the cylinder? Yes No Wdre.hand portable extinguishers property serviced?. NAO W-eigt P02 or nitrogen, cart�idgq. _NA0 Were all cooking surfaces protected? If not, give owner full No visible signs of a system fire or system tampering (if signs check no). Yes [�T No E] information. Check all piping arfd,cdnduit. Are all piping and conduit immobilized with Yes NoC3 W as operating procedure verbally given to restaurant personnel? proper hangers and brackets? Was UL 300 compliance explained to owner or manager? Are all pro tective covers present on'nozzles? Ye I s No E] Gas shuts down upon system activation? NAM Are all npztles.checked in the proper position? Yes E] No Electric power shuts down upon system activation? NA Does system have adequate volume and/or nozzle coverage? Yes E] No Range hood tied to building alarm panel? NA Are all appliances inside of the hood protection area? Yes E�r' Noo Range hood activation signal received at building alarm panel? NAE1 Have fuse links been replaced? Yes E?' NoM diass"K-e-'xtinguis-h-erpr-ese-n-t? Was system operational from terminal link? Yes a N60 Grease buildup i _L�.woup: 10 Yes F�Noo, Yes[:] No Yes F;�— No Yes [?r�'No E:1 Yes E4-�'No F-1 Yesj�_- NoEl Yes [2- No El Yes [�-�No El Was system operational from manual remote? Yes No Light um_ Heavy, recommend cleaning Was system and micio s`w'itch,operitional? NAE] yes No Date of last cleaning 716 V Are cleaning intervals within NFPA standards? YasE�t- No[] Is system visible and free from obstruction? Yes b�_N' Ej ician Is the inspectior) and j;ervice tag on the cylinder� YeSE?'No'O Previous Confidence Test Company & Techn* Corrections Made: Date Corrected: Corrected By: j-1 Customer has declined SFD Certification Number: This certifies that this fire and life satety-system has, b4 pro rly in pected for reliability to coy�r the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancital ,,%ed,r havprteen r rted t a building Owner/Responsible Person for corrective action. Signature of Tester: Phone # (206) 726-0940 Testing Agency: ftnood and Ducf'9I6rv1ceZ Inc. Mailing Address: 6100 12th Ave. S., Seattle, WA 98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are. intact, undamaged and tig t: place and has not been removed or tampered with. 7. The inspection tag cert f. to isin place a ��rre 8. If any deficiencies or fo 'ncla popnate, ec ijvree iion s e taken immediately. 2. The manual pull stations are unobstructed and in clear view and are labeled for are nd p -- -_- intended use. 9. A record of the monthly s ion is to kept re ct a date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the i s 0 d corre required. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY This is a Federal Building C3 SONTRO VERIFIED ELECTRONIC SECURITY SON ITROL PACIFIC A Sound Security. Inc. Company 1.800.898.1899 2221 California Street Everett, WA 98201 Seattle Fire Department Confidence Test Report (use one form per Sys.) 206-386-1448 Confidence Testing Officer 206-615-1068 (fax) 206-233-7219 Red Tag Hotline FIRE ALARM Status Given CONFIDENCE TEST ;41 REACCEPTANCE TEST 0 RED YELLOW WHITE Occupancy Address: 11S41,4K-,tr,)i OccupancyName: Responsible Person First & Last Name: Phone Number: Responsible Person Responsible Party Address, City, State, Zip: E—Mail Address Technician's Name:::::: SFD Certification No. SCP- )k-O-)-tko (Please Print legibly) Date of Test: Test Frequency: Quarterly PA Nigh4i" Only) Annual - System Make: Ela,4:k. System Model: - -, I(t<,,,. 10 a 0 System Identification No. 173 System Location: et SFD ID No. (Call 386-1448 for this No.) Central station monitoring? Yes No 0 monitoring Company Monitoring Required? No 0 Name Q, ioa/- 3-lc Yes P DEFICIENCIES FOUND? Yes)v No 0 List items that were not corrected at the time of the co37npd nce test. Use the Deficiencies section or pttach itemized sheet Vjd U�5*� I\j 0 V� A REPAIRS: All deficiencies have been corrected 0 Corrected By: SFD Certification Number: SCP — -qv--tpm Atatiliq r-hanued to White fincludina the taq on the system) 0 This certifies that this fire protection system has been properly inspected for functional operation in accordance with the curre Seattle Fire Code (SFC), Administrative Rules, and NFPA Standards adopted by the SFC for this system. The discrepancies found are noted in the report and have been reported to the building Owner/Manager for corrective action. Signature of Technician Name of Testing Company Phone # ?-PIP - Building Representative (signature) A & Date 4- Direct Phone # Print Name and Title 4�,Wcjlj-) c 'k — - Building Rep unavailable [I Building Rep declined to sign report 0 THIS REPORT WILL BE SENT TO THE SEATTLE FIRE DEPARTMENT BY THE TESTING AGENCY IN ACCORDANCE WITH ADMINISTRATIVE RULE 9.02.09 ALL DEFICIENCIES RECORDED ON THIS REPORT SHALL BE CORRECTED WITHIN 30 DAYS OF THE TEST DATE Fire Alarm Page 1 of 4 9-2012 Ver. 1.3 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. Alarm Svstem Functionali 1. Trouble signal with AC power off? Yes f"n No El 2. System operates properly on battery backup7 97- Yes5 No El 3. Battery voltage (no load) 5 volts 4. Battery voltage (full load) volts (signals operating) 5. Charge circuit voltage volts Yes,& No 13 6. System operates properly on standby power? 7. All signals operate on AC power? Yes M 7- No 13 8. Number of initiating circuits 9. Number of signal circuits Yes No 13 10. Does alarm system meet audibility standards as accepted? 11. All circuits checked for electrical supervision? YeAA No 13 12. All auxiliary equipment operates (Elevators, fans, dampers)? N/A C3 Yesp No 13 13. Ventilation controls operate? N/A ;R Yes 0 No (3 14 Key to pan . el available? N/A C3 'N/A YesffJ No C3 15. Materials and equipment needed to restore pull stations are available at the C3 Yes No.0 main panel, e.g. glass rods, and plates; keys and alien wrenches, etc? 16. Operating instructions at panel? Yes No 13 17. Trouble indicators function properly? Yes 13 N oJW 18. Remote Annunciator . Panels- function propedy? N/A 13 Yes E3 N� 0� 19. Elevator Call Down functions properly? N/A Cl Yes 0 No 20, Test record posted at panel? time delay (rinutes) N/A N, Ye . s Ift No C3, 21. General alarm automatic 22. Was a signal received at the Central Station monit . oring company? N/A 13 Yes/9 No [3. 23. Other Devices (Specify) Yes 0 No 13 System Devices Total Number of Units in Building Total Number Units Tested Test Results Acceptable 24. Bells, Horns, Chimes N/A 13 Yes 13 No 13 25. Voice Speakers (Voice Clarity) N/A 13 Yes 0 No 0 26. Visual Alarm Devices q N/A C3 Yes 13 No 13 27. Smoke Detectors I N/A 13 Yes 13 No 13 28. Heat Detectors N/A 0 Yes 13 No 13 29. Duct Detectors N/A El Yes 13 No 13 30. Sprinkler Flow Switches N/A 0 Yes 0 No 0 31. Sprinkler Supervisory Switches N/A 13 Yes C3 No 13 32. Manual Pull Stations N/A 13 Yes 0 No 13 33. Annunciator(s) N/A Yes 13 No 0 34. Beam Detectors N/A Yes 0 No 13 35. Automatic Door Unlocks N/A C3 Yes C3 No C3 36. Automatic Door Release N/A C3 Yes 13 No CI 37. Fire Dampers N/A 0 Yes 0 No (3 Total Number of Units Total Number Units Communication Equipment in Buildinq Tested Test Results Acceptable 38. Phone Sets N/A 13 Yes El No C] 39. Phone lacks N/A 13 Yes 13 No 13 40. Call -in Signal N/A 13 Yes 13 No 13 Fire Alarm Systems Page 2 of 2 '. 41 FIRE PREVENTION INSPECTION REPORT Serving Briet: Edmonds, and 124 Meridian Ave S SNOHOMISH,CO. f 1 0 EDMONDS Mountlake Terrace Everett, WA 98208 0 BRIER FIRE' A�40_0.ot_ 0 MOUNTLAKE TERRACE Phone (425) 551-1200 [1 UNINCORPORATED DIST Rl T www.FireDistricti.org- Fax (425) 551-1272 FREQUENCY I STATION &�SHIF`�' LOCATION: 456 Admiral Way Suite 10 1 93020 Annual 17-C BUSINESS NAME, ' Arilliony's Bccw.;h Calc PHONE: 42577144iDE SCHEDULED "p, DATE DUE Ii. Aug 2014 li MAILING UFIR ll� ILI 201 ADDRESS: 45E AdFTliral Way, Suitc 1101, Edmiridti, WA 03020 BUSINESS OWNER: B=MW2 Dawn HOME PHONE: EMERGENCY-1: .,Burrm, SLmr_ HOME PHONE: . 20E703CE40 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO BUSINESS EMAIL:i LICENSE PERSON CONTACTED: DOI-w- INITIAL INSPECTION DATE NAME OF INSPECTOR: � V (A V-.V- 1 1. 0 FIRE SYS ILIMS. FE 10112 FIDUL3004114 HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS 100 Lyx.&.wd� a,., 2 2 3 7� 3 4 4 5 5 6 6 7 7 1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X lst RE -INSPECTION ' E DUE: 21 .2nd RE -INSPECTION DATE DUE: EXTENSION GRANTEDTO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PtRSON CbNTACTED: PERSON CONTACTED: PERSON CONTACTED: INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 6 2 DATE: CODE SECTION: 5 3 7 3 _6 7 RETURN RECEIPT RECEIVED 6 4 18 4 18 DATE: DISPOSITION: 7 LETTER NEEDED [] YES NO LETTER NEEDED [:] YES El NO 8 FIRE DEPARTMENT COPY SNOHOMISH CO. Serving Briek'EdnzonA �nd 12425 Meridian Ave S Mountlake Terrace Everett, WA 98208 FIRE Phone (425) 551-1200 DIST R Twww.FireDistrictl.org Fax (425) 551-.1272 LOCATION: 456 Admiral Wav QW.,20 BUSINESS NAME: Arillionv's RcsLauraril. PHONE: 42,5577144101 MAILING ADDRESS: 46E, AdmiralWay, hdrnan&-, VVA DBD20 FIRE PREVENTION INSPECTION REPORT 0 EDMONDS El BRIER 0 MOUNTLAKE TERRACE 0 UNINCORPORATED FREQUENCY STATION & SHIFT" Anflual 17-C SCHEDULED DATE DUE k Aug 2014 UFIR 1, Itil BUSINESS OWNER: ih=pl+, DAwn HOME PHONE: EMERGENCY-1: Burm, SLcw, HOME PHONE:' ZDE7031DE49 CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO EMAIL: BUSINESS El El LICENSE PERSON ONTACTED: p 6-w L,% INITIAL INSPECTION DATE NAME OF INSPECTOR: 0,,,, �� I'&((, A 9[-zo /� I FIRE: SYS li=MS: AS 4113 FA 1113 FIE IIDI 12 FD Lk Raw HD LIL3DO 1111 Ak&,n-t U /,, I , , I . , -71,4 & /,, I HAZARDS FOUND AND LOCATIONS I 3MMUNIC"ArlOONS '1 1 2 7" 2 3 z 3 4 4 5 5 6 6 7 7 I AGREE TO CORRECT THE ABOVE VICLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION DATE DUE: 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTEDTO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: E: DATE: 3 VIOLATIONS 1 5 VIOLATIONS 1 5 PRE -CITATION LETTER SENT CITATION ISSUED NUMBER: 4 6 2 6 DATE: CODE SECTION: 5 7 3 7 RETURN RECEIPT RECEIVED 6 4 18 4 8 DATE: DISPOSITION: 7 LETTER NEEDED [-] YES NO LETTER NEEDED [:] YES El NO 8 FIRE DEPARTMENT COPY &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: -4 Occupancy Address: Responsible Person: COMPLETE Certification Given: REDO YELLOW[Z WHITED] FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD SYSTEM TEST REPORT High Pressure Hood Cleaning Fire Suppression Installation & Service [CONFIDENCE TEST [�J- REPAIRSE] Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair FiltAr Sales & Service DATE: rV a4�-, - - City, State, Zip: Building Owner: Building Owner Address: I Testers Name (Please Print): _K" & d 2mus-hi'tZI System Alarm? YesE�No r-1 Central station monitoring? YeseNo El Control Panel manufacturer: Model Number: — Extinguishing System Manufacturer," &LO2- Sy Location / Height of Range hood: Phone Number: -Z � 4 Phone Number: City, State, Zip: Z SFD Certification Number: SCP- Monitoring company name: (,ni, Location of Alarm Panel: LI.L. 3�O System? Yeselq-o-[] I.I.L. 300 Complian ?Yes El No E�J—Chemical Type: Wet 216� El Is pressuregau indicator in operable rangeR -No 12 year hydro date of cylinder. Is there chemical inside of the cylinder? Yes 1 0 F-� �__)y "rhandporta_ extingis ;hp�rspinoperlysewic_ ? yes NOEI-'., Wei h db2 or nitrogd-kartridge�, NAO 9 Were all cooking surfaces protected? If not, give owner full Yes [3' No No visible signs of a system fire or system tampering (if signs check no). yest- oL T _j Check all piping -and conduit. Are all piping and conduit immobilized with-- Y-es NoEl information. Was opqrati9g,prqcedure verbally given to restaurant personnel? --- _ -- �1 - - -c- proper'hangers, and bt6ckets? , Was UL 300 compliance explained to owner or manager? Yes f� No E] Are all protective covers present on nozzles? Yes No E] as shuts down up9p s am activation? NA 1771 _Yst- -- I ... - � - - _ *s&. 00 j Are all nozzles checked in'the,7proper Rosition? lv�sjO' V No Electric power shuts down upon system activation? NAD YesE�J". No El Does system have adequate volume and/or nozzle coverage? Yes No[:] Range hood tied to building alarm panel? NAF Ye s Areall appliances inside of the hood protection area? Yes No Range hood activation signal received at building alarm panel? NAE3 Yes NoF -1 Have fuse links been replaced? Yesa No E] Class K extinguis er present? Yes g;- Wo Was system operational from terminal link? Yese-_ No =n group: Grease builclu Was system operational from manual remote? Yes[2- No[-] Lig M dil ea recommend cleaning Was system and, micro, switch oRerational? NAEJ Yes Date (A last cle-a-'ng- --------- Is system visible and free from obstruction-?- Yes[:;I- NoE] Are cleaning in - tervals w - ithin NF - PA standards? es, Nqq Is the inspection and service tag o he cylinder9 -Yes'— No Previous Confidence Test Company &Technician L&04S A :-A. T F- J- -i L 14 1%j — Proble Found: (if additional roo 1�eded, please add a separate sheet) U-/ =0010- Zie 1111 -;;1 I My — -- /-) ! r . P -- 1.11! - - 1 ..7/7- , ., ,-. k-z-� Customer has declined repairs X Corrections Made: Date Corrected: Corrected By: SFD Certification Number: This certifies that this fire and life safety system has -0-14ef:Mliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepanci In Owner/Responsible Person for corrective action. Signature of t . vtl 7- Phone # (206) 726-0940 Testing Agency: R&Thaqd.344Q"�� MailingAddress: 610012thAve.S.,Seaftle,WA98108 L The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. d curr place and has not been removed or tampered with. 7. The inspection tag or certific a i ce an are I u 2, The manual pull stations are unobstructed and in clear view and are labeled for 8. It any deficiencies ppropriate corrective actio� shall be taken immediately. intended use. 9. A record of the monthIl s ctions is to be kept reflecting the date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the s tAn and any corrections require 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY TRUCK 6100 12th Ave. S. WIt High Pressure Grease Exhaust System Service NUMBER Seattle,WA 98108 0 Fire Suppression Installation & Service SERVICE Phone (206) 726-094 Fire Extinguisher Sales & Service R Fax - (206) 767-2607 Range Hood and Fan Service & Repair A 1 3 1 Mood and Duct Services, Inc. www.rthood.com N Filter Sales & Service - I RE/,P/ORT JOB NAME�,\Nk\\1A0VAQ'5 AQC�U) %cuce_ CONTACT L 01 tA S1110 C0 0 LOCATION (IS (�7 A. P-k'% (a ( fki E c,� PLA Y'd - '212 ft — �� 7-71 -14U) JOB PHONE N0/_L-11 4S SERVICE DATE 2ND PHONE 1 1 R1 R&T HOOD DATE OF LAST SERVICE DOBSERVABLE� f SCHEDULED JOB TIME INACCESSIBLE AREAS SALESPERSON # OF HOODS L NAME #1 #2 — *3 #4 CAC HOOD # OF ACCESS PANELS LENGTH#1 '11; 10" #2 — #3 10 #4 BEST ROOF INSIDE ROOF ACCESS- fE'S NO ACCESS LOCATION:z xx /CA r 0� 0-an SPECIAL INSTRUCTIONS OD T WC 0 n FCkcA S-ldc- c;rc bQ0 'OXI r, - Le UO2- '51h !,�C-r<� U..s / �Xi lllckof 1�� C k (s-il n fXQ ("I GREASE BUILDUP: HOOD(S) - HOOD# WRAP HOOQ DRAP EAPPLIANCE CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED SCRUBBED (CHEMICALj WATER WIPED POLISHED SOAK/DISH FILTERS SHOOT FILTERS 1 .2 w3 4 % OF GREASE REMOVED DC.HOOD(S) LEAK (DRIP)? FILTERS REINSTALLED DUCT(S) - LIGHT / CHEMICAL SPRAYED( PRESSURE WASHED SCRAPE CHEMICALWIPED4 CHEMICAL SCRUBBED0 # OF ACCESS PANELS DUCT LENGTH IN FEET 1 2 3 4 MIZIMM IV -1 C HE7NY I FAN(S) - LIGHT / MEDIUtO / H CHEMICAL PRESSURE CHEMICALWIPED� CHE�ICAL SCRUBBED FAN REMOVABLE REMOVEFAN # OF ACCESS PANELS 1 2 3 ]N - I P80 T S liffig, ffil: 700700 9 1 M 170 MN 0 M7 N N ..,.��§CECGWfflfflqs FANS -OPERATION TEST� YES' NO SEALED ACCESS PANELS�`YES NO !SLP LEFT RUNNING TO'DRY "' ES Y NO "j umy % OF GREASE REMOVED COWLING - DAMAGE OBSERVED Yps,� % OF INACCESSIBLE AREAS U LC 1 2 -3 4 11=S BURNT GREAS . ROU N D DUCT CLASS 11 DUCTS LEAKING DUCTS' 1 2 -3 4 FIRE WRAPPEDI BURNT GREAS I41*MNI'Y N 1K1Ar1t-=CC1Q1 M ADC:AC N Y, N, Y N Y �N Y jRjy-� N- Y N Y'�A IY Y/ff IY N Y N -�Y, N. Y N Y N:Y*,N- N . N Y N . Y N- t DISASSEMBLE TO CLEAN. . EXPOSED WIRES NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE/ 1 2 2 4 ROMIRMINI WIMMIM IRDMIE" MOMIZIM MAIMMU %A1AT11=0_%A1A(ZW Wnnn Whi tu� 1Gr=GOODiF=FAIR, P,--POOR) I PHY&CALjGeNDITION I # OF MISSING FILTERS FILTER CONDITION 2 CLEANING ACCESS 3 ELECTRICAL CONDITION, e� - �OOD, FAIR, =K 4 FAN BELT CONDITION WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. '. 11 COMMENTS VA IVA _A41 7w TO CUSTOMER: CUSTOMER SERVICE TECH: SIGNATURE DAT I f / CIMC nCOADYRACKI-Ir fr'.0V TRUCK 6100 12th Ave. S. High Pressure Grease Exhaust System Service 11 Seattle,WA 98108 Fire Suppression Installation &.Service NUMBER SERVICE R Phone (206) 726-09,40 lire Extinguisher Sales & Service A Fax- (206) 767-2607 Range Hood and Fan Service & Repair Mood and Duct SerrAces. Inc. www.rthood.com Filter Sales & Service REPPRT JOBNAMEAWOICAMUC, L LOCATIONI" 'N5V-ki.f-C1( Ect4,koM�, t"JA 9-2f"A SERVICEDATE / El R&T HOOD DATE OF LAST SERVICE 0 OBSERVABLE JOB PHONE NO. 2ND PHONE SCHEDULED JOB TIME INACCESSIBLE AREAS SALESPERSON hi. # OF HOODS NAME #1 #2 N\ CA S V) — #3 #4 # OF ACCESS PANELS HOOD LENGTH #1 #2 — #3 #4 6,' INSIDE ROOF ACCESS: 7 'Vt' BEST ROOF c ACCESSLOCATION: (A -,-Icls -f, , -y-F Ar SPECIAL INSTRUCTIONS - S, -1 \ t 11 e f <, " . <::� (7 k I 1 -1) f C`�_,q A �f_ (A)0��OCC Q Y1 Q C�S-k i b i,� N � cl� �k C \ C-' " CI, 0 L, k D S, �) -f * a U 0 4, C 0. U, w/ 0CI_o2fU)0fK,. '��4 i v_1 A (*1 a!-'�,_ fi-,.) C4 e r t b c.4 + n -C <0 0 0. 6 1 I BEGINNING GREASE BUILDUP: HOOD(S) HOOD # 1 2 3 4 WRAP HOOD( DRAPE APPLIANCE CHEMICAL SPRAYED) PRESSURE WASHED� SCRAPED CHEMICALWIPED� SCRUBBED (CHEMICAL) WATER WIPED POLISHED SOAK/DISH FILTER - SHOOT FILTERS 0-2 k IA M_ M, M M M 9 Ul F7jM 1721WRAilaw 42=60 WIRPMR1 M12MILE-0 FATAI a%,-, wa i M w4wirk,71" MMEM0 MA02*0 % OF GREASE REMOVED DO HOOD(S) LEAK (DRIP)? YEI(IN"'6- FILTERS REINSTALLED /NO BURNT GREASE WATER -WASH HOOD # OF MISSING FILTERS FILTER CONDITION 1 2 2 4 OWN RAM (G=GOOD,F=FAIR,0�=POOR)�' 1 / HEAVY I DUCT(S) CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED # OF ACCESS PANELS DUCT LENGTH IN FEET 1 2 3 4 91MM6119-9 P-PUM16210A 029901116-2 MUMMA 021611110KIN Man, revil KIN f M_ N �j I'm SEALED ACCESS PANELS YES-fNO % OF GREASE REMOVED % OF INACCESSIBLE AREAS 1 2 3 4 BURNT GREASE ROUND DUCT CLASS 11 DUCTS LEAKING DUCTS FIRE -WRAPPED INACCESSIBLE AREAS 1 2 3 4 / HEAVY CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED FAN REMOVABL� REMOVEFA # OF ACCESS PANELS LIM / HEAVY 1 2 3 4 FANS - OPERATION TEST YESV/ NO yt G TO DRY ( nYES7 LEFT RUNNIN _ NO COWLING -DAMAGE OBSERVED YESNO DISASSEMBU� TO CLEAN EXPOSED WIRES NEED FLEX CONDUIT - NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE (G=GOOD, F=FAIR, PHYSICAL CONDITION CLEANING ACCESS ELECTRICAL CONDITION FAN BELT CONDITION 1 2 3— 4 ff j"MY002M INUALIUM ffM_ maim MIT-% Wlai m1i n ®R K 9 WEAMM ffWrfjMNM WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS TO CUSTOMER: CUSTOMER SERVICEE TECH! SIGNATURE(_'_!E:-_:-: DATE: FIRE DEPARTMENT COPY R AAA" &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: — Occupancy Address: Responsible Person: Building Owner: — COMPLETE Certification Given: RED Ej YELLOWD WHITEM FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD High Pressure Hood Cleaning SYSTEM TES3 REPORT Fire Suppression Installation & Service CONFIDENCE TEST E?' REPAIRS Ej Fire Extinguisher Sales & Service W4 Range Hood and Fan Service & Repair 'a Filter Sales & Service DATE: 5 TJY Building Owner Address: Testers Name (Please Print): . . . eV -1 fS U, )I C System Alarm? Yes Rf No ell Central station monitoring? Yes E3"- Nqf] Control Panel manufacturer:_�I_r L� TIP/ 4 )Wqb r _qew5ivc g -O."J.4v� ir 7 Extinguishing System Manufacturer Location / Height of Range hood: 300 City, State, Zip: Phone Number: Phone Number: City, State, Zip: SFD Certification Number: SCP- Monitoring company name: _56 ��o 1000 Location of Alarm Panel:- 14490 3tem?.Yes[]f`NoEj U.L.300C.mpIi.nt?Y.sffTNoE1 Chemical Type: Wet Ef �DD Is pressure ga . uge indicator in ope - table rang - e? Yes No 12 year hydro date of cylinder. 10 Is there chemical inside of the cylinder? Yes -No E] guishers. properly serviced�_ Were hand -portable extin- YesEl_ No[] Weigh CO2 or nitrogen cartridge. Were all cooking surfaces protected? If not, give owner full Yes No No visible signs of a system fire or system tampering (if signs check no). Yes E?' No F-1 - - I -- - - - -- -- - -r?, — - - Check all piping and conduit. Are all piping and conduit immobilized with Yes No F-1 information.,- Was operating procedure verbally given to restaurant personnel? Yes _1' No C] -1 . proper hangers and brackets? Was LIL 300 compliance explained to owner or manager? - I Gas mk Yes E?' No F -Yes L?'- Are all protective covers present on nozzles? Yes No shuts down upon s y ste m activation? Lj No [:I Are all nozzles checked in the proper position? N Yes o Electric power shuts down upon system activation? NAEJ Yes D— No E] Does system have adequate volume and/or nozzle coverage? Yes No[:] Range hood tied to building alarm panel? NA E] Yes E��- No Are all appliances Inside of the hood protection area? Yes No Range hood activation signal received at building alarm panel? NA Yes E?' No E] Have fuse links been replaced? Yes E?" No Ej dass K extinguisher present? Yes No F� Was system operational from terminal link? Yes No ____ E] Grease buildup in group: Was system operational from manual remote? -ET" Yeso No[] Light Heavy, recommend cleaning .Was system -and micro switch operatio-n-al? _NAF1 Yes Er No _Ej Date of last cleaning i:4 intervals NFPA Yes No .Is system visible and free from obstruction? Yes No _Are cleaning within standards? 7 9 the cylinder? "is the inspection an ice tag or es 0 Previous Confidence Test Company & Techniciank - MEE MIMMM09 MINIM MMI 0 MEE Problems Found: (if additional room is needed, please add a separate sheet) Corrections Made: Date Corrected: Corrected By: Customer has declined SFD Certification Number: This certifies that this fire and It set t�yyste h e ot, lyms?ected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code , p n 'eLr, e 'as b p standards. Discrepanciepar ;an a �bbaan rj rted t _14-b Iding 0 ner/Responsible Person for corrective action. ,4, , , . Le6-nf -0940 Signature of Tester: 41: IL Phone # (206)726 Testing Agency: R&TWod arid Ducftrv�ices,_Inc. MailingAddress: 610012thAve.S.,Seaftle,WA98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1. The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are foun,�Catpqopsriate ve ct:on shall be taken immediately. tiv )nthly in i, s to W cl intended use. 9. A record of the mc p I �reel I ee g the date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the i equired. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY i CHEMICAL SPRAYE PRESTLi%WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED # OF ACCESS PANELS DUCT LENGTH IN FEET MMMI I ISIMMI mmmw WMIMM mmmw 1094-Mon IMMMM GHEINCAL SPRAYEDl, ORESSURE WASHEDQk SCRAPED:�Y)N CHEMICAL WIPEDi CHEMICAL SCRUBBED,:�N,"�Y FAN REMOVABLE REMOVE FAN Y� N bN& N I Y N N 0 N1,3 N Y 9 &k.X N Y N Y/N &A�Y N Y N N Y N LYj No �JY N Y N N Y N # OF ACCESS PANELS st ictbbNDITf6h_ Post RV POST SERVICE CONDITION ___1________._.. . . .... - ---- - -- __ - 0 q.AVS - -OPERATION TEST YES NO SEALED ACCESS PANEL<_Y?9/ NO 6D LEFT RUNNING TO DRY YES N J0/6 OF GREASE REMOVED E44;e-] Q POST SERY,,CE CONDITIQ,�,_�__, r RSOWLINQ NAMACEASER�,� YEky� % OF GREASE REMOVED %";O:p^l ACNC0S\SIBLEA"R'?X% INDICATE U NUSUAL -CONDITIONS 1 2 3 4 -.--DO HO wpoul-I 1�4 ii,,&D�S), LEAK-(DRIP)2- YT � _! " %--l' 9� Mff*'�\ - " - -Z, � � V� 9 ' A.- 1 �2 FILTERS REINST�LLED- E ,(L A�INO Tid_" I�RU R N W§F ROUND DUCT CLASS 11 DUCTS INDICATE UNUSUAL C6NDITIONS' LEAKING DUCTS 1 2- 3. 4 FIRE WRAPPED BURNT GREASE. WATER -WASH HOOD� # 0 F MISSING FILTERS FILTER,CONDITION TRUCK 6100 12th Ave. S High 04issure Grease Exhaust System Service ' . . , _. ") f _�� '[_191 )\ / ] �C' ' 7L--- NUMBER Seattle,WA 98 '6' Ft ' re Suppression Installation I& Service RPhone (206) 726-0940 Fire Extinguisher Sales & Service A Fax (2 Filter Sales & Service 06) 767-2607 Range Hood and Fan Service & Repair &T Ces, Inc. www.rthood.com SUMMARY: CONDITION OF SYSTEM RED 0 YELLOW 0 WHITE/14 JOB NAME CONTACT LQ1,uf%A _1'3�ONE NO.'L� 11Y LOCATION LA CD 11 rA M JiZI B' f V211"qb�5110NE SERVICE DATE \ -Q 6, M Q'R&T HOOD DATE OF LAST SERVICE 0 OBSERVABLE SCHEDULED JOB TIME INACCESSIBLE AREAS SALESPERSO # OF HOODS NAME #1 _"R #2 C\ # f �rj HOOD # # OFdCESS PANEL LENGTH #1 #2 BEST ROOF Ck I(DIDE ROOF ACC�SS: YE 110 ACCESS LOCATIO CIAL INSTRUCTION, _C� I w'pu(5. )!-A �h-,,kr ,rs -P r. _U S �Z) - - - I I— c n, ry-�k-xo e; n�r cw o C��A V� NX_)111aJr: DO A :5n C-D SERViCE-S PERFORMED BY TECHNICIANS BEGINNI EASEBUILIDUP: HOOD(S)-LIGHTeV_ IU HEAVY I DUCT(S) - LIG4T4k5_1U_ HE�M FAN(S) -LIGHT/ MEDIU /HE-- kv �,M E HAUST HOOD(S) MHAUST DUCT SYSTE S'j \-EXHAUST FAN(S) �.HOQD # 3 4 1 2 4 41 (WIRO'ROO DRAPE APPLIANC�E CHEMICAL SPRAYED. PRESSURE WASHEDj SCRAPED CHEMICALWIPED SCRUBBED (CHEMICAL) WATER WIPED POLISHED OAK/RISH FILTERS., SHOOT FILTERS� Ma M—MOM MME Maw omm immm wamsel MOW mmmm mmmon MOVEMOM INACCESS16LE AREAS 0119M Impal nd M100103 ffEWHAV43 MUM amm OMWARMIARM, rr_,ArU0r_ vvir-IC7 \..4 1 e 4ED FA (56NDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRRELCAGE I Y N Y'�,N�?& I Y N N 6 Y 6 Y N' Y N lr,yi Y & Y N Y YK� Y N, Yo Yc:N, Y(_N Y N y N Y N, kQ=UUULj, F=F-Minl 1 PHYSICAL.,90NDITIqN T CLEANING 2 'ACCESS 6 + 'A J 4___� do 4 j; 1, rZILM, r1it, L IUIM .4- (6--GOOD, F=FAI�, P�--I?00R), 4- 'FAN,_BELT CONDITION :WE APPRt6IATE YOUR BUSINESS AND WELCOME:ANY COMMENTS AS TO HOW WE. -CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS TO CUSTOMER: CUSTOMER SERVICE TECH: SIGNATU D FIRE DEPARTMENT COO MMMIFE WMEWT Mmmm ==Oka TRUCK 6100 12th Ave. S. walc- High Pressure Grease Exhaust System Service NUMBER Seattle,WA 98 Fire Suppression Installation & Service R Phone (206� 7100'946 Fire Extinguisher Sales & Service - A lax 2 6 767-2607 Range Hood and Fan Service & Repair www!rt 0 Filter Sales & Service I L) 146 Mood and Duct Services, Inc. hood.com %� I F1 E LI )111"71 JOB NAME LOCATION I - - - -) I SERVICE DATE N a C) - A YR&T HOOD DATE OF LAST SERVICE El OBSERVABLE _M Aq)- \fb INACCESSIBLE AREAS # OF HOODS t O��CCESS PANEL k 0 RN'SIDE ROOF ACCESS: E'9 n (f �a CIAL INSTRUCTIONS XOCA CA,( Q �BEGIINIINII GGREASEBUILDUP: HOOD(S)- W-1AILIST HOOD(S) HOOD # 1 2 3 4 WRAPHOOD DRAPEAPPLIANCE CHEMICAL SPRAYEDj PRESSURE WASHED� �,ZSCRAPED EMICALWIPED SCRUBBED (CHEMICAL)� WATER WIPED POLISHEDJ (%K/DISH FILTERS SHOOT FILTERS NAME #1 MCA A r\ HOOD (A' LENGTH #1 .4 ()" BEST ROOF �r%o ACCESS LOCATION-, d Af -If. - C9_� , [)I f, MGM= w k 10 = Q ialibmbffl%']� 61187,0290 M, 9 9w Mam 0,200 a 000MIAZO-Z =011000 RZ0138M MAIN8730 DENA6110 P6 ST___ S-ERVICE . CONDITIO -------- --__ - % OF GREASE REMOVED DO HOOD(S) LEAK (DRIP)? YES FILTERS REINSTALLED(3S / NO wmcmt AusUAL-coNDITIONS 1 2 3- 4 BURNT GREASE WATER -WASH H09D OF MISSING FILTE RS FILTER CONDITION (G=GOOD, F=FAIR, P=POOR) CONTACT JOBPHONENO. 2ND PHONE 4 __" �D_-309M SCHEDULED JOB TIME SALESPERSON #2 fY\(A-A n #3 #4 #2 #3 N. �5/ HEAVY I DU�T(S) LIG D 11 AUST DUCT SYSTEMIS) - 1 9 1 4 CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED # OF ACCESS PANELS� DUCT LENGTH IN FEET W, P_ f Q L; r1f POSTSERVICE qkbItI0Lk_- SEALED ACCESS PANELS % OF GREASE % OF INACCESSI MOO - 1 2 3 4 BURNT GREASE ROUND DUCT CLASS 11 DUCTS LEAKING DUCTS FIRE WRAPPEC INACCESSIBLE AREAS CJ(*bftf6N_S 1 2 3 4 WIMAL11 WE MIMMA"Ma I ro W w im MOMMM aq], w wj M mmmm Y HEAVY N(S),� CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED, FAN REMOVABLE REMOVE FAN # OF ACCESS PANELS AEDIUM / HEAVY WS) - ___ - _- 1 2 3 4 Y N Y - Y N Y N YNqYYNYN YFINYNYNYN Y.NYPYNYN � N Y �J Y N Y N y N Y N Y N Y -JN Y N Y N 0_1 P 0- S _T _ S - E. - _R_' - V. IC. E C.ONDLITION- FANS - OPERATION TEST ES ' NO LEFT RUNNING TO DRY 5YE / NO Z COWLING - DAMAGE OBSERVED YESd"'N f - __1 -I N D I C AT E U N U S_ U A L C 0- N b I T 10 N! 1 2 .14 4 DISASSEMBLE TO CLEAN EXPOSED WIRES NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRRELCAG Y N Y N Y N y 4 Y N Y N Y N JYy% Y(*RYNYNYN Y(�, Y N Y N Y N Y(N,- I Y N Y N Y N ZN,'YNYNYN �PNYNYN (G=GOOD, F=FAIR, P=POOR) PHYSICAL CONDITION CLEANING ACCESS ELECTRICAL CONDITION FAN BELT CONDITION WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN -DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS TO CUSTOMER: C TOMER us - SERVICE TECH: SIGNATURE 4- DATE: FIRE DEPARTMENT COPY TRUCK gh re 6100 12th Ave. S. qmK_ , Hi X mire G,,.,, Exhaust Sy,,e Service --Fird Suppression Installation & Service ? . [E [I 9-t , AY Seattle,Wi� r26�0 NUMBER Phone �2206� 7 094 -'Fire Extinguisher Sales & Service W R Fa)e-- 06 �67-2607 Range Hood and Fan Service & Repair A 9F EIL A 1�_5 Mood and Duct Services, Inc.' wwwrthood.com- Filter Sales & Service j I JOBNAME LOCATION _qr=Pvir.i= r �E R&T HOOD DATE OF LAST SERVICE El OBSERVABLE -n-i3 CONTAcTLq-U__'1t_ - JOWP I HONE NOLJV;� 2ND PHONE SCHEDULED JOB TIME LYN INACCESSIBLE AREAS SALESPERSON j #2 #3 lfljtO #4 # OF HOODS NAME #1 HOOD # OF ACCESS PANELS LENGTH #1 #2 #3- (0 #4 BEST ROOF INSIDE ROOF ACCESS: (_�ES /NO ACCESS LOCATION: ok SPECIAL INSTRUCTIONS np tuaslwr OiA cct�j 54C cl� _1 CO A -1C L A \A, li;2 S t2 vo,�A U-Lmif SA k 5 \,u t2�,q �!tir w t 1(- BEGINNING GREASE BUILDUP: HOOD(S) - LIG WATER WIPE SHOOT FI P60"SERVICE daNbITIoW <OF GREASE REMOVED DO HOOD(S) LEAK (DRIP)? YES / NO FILTERS REINSTALLED YES / NO INDICATE UNUSUA L_ C__0__ ND -IT10- N-S- 1 2 3 4 BURNT GREASEQ N Y N Y N Y N WATER -WASH HOOD Y& Y N Y N Y N # OF MISSING FILTERSI:> FILTER CONDITION F (G=GOOD, F=FAIR, P=POOR) 2!� / HEAVY I DUCT(S) - LIGH(�jMl EXHAUST DUCT SYSTEM($)- - 1 2 3 4 CHEMICAL SPRAYEQ PRESSURE WASHED SCRAPED CHEMICAL"I E_q CHEMICAL SCRUBBER # OF ACCESS PANELS DUCT LENGTH IN,FEET 1 2 3 POST SERVICE C6ND-ITION SEALED -ACCESS PANELS� �ES NO % OF GREASE REMOVED % OF INACCESSIBLE AREAS BURNT GREASE ROUND DUCT CL ASS 11 DUCTS LEAKING DUCTS FIRE WRAPPED INACCESSIBLE AREAS 2 3 4 mahomm SHOOT FI P60"SERVICE daNbITIoW <OF GREASE REMOVED DO HOOD(S) LEAK (DRIP)? YES / NO FILTERS REINSTALLED YES / NO INDICATE UNUSUA L_ C__0__ ND -IT10- N-S- 1 2 3 4 BURNT GREASEQ N Y N Y N Y N WATER -WASH HOOD Y& Y N Y N Y N # OF MISSING FILTERSI:> FILTER CONDITION F (G=GOOD, F=FAIR, P=POOR) 2!� / HEAVY I DUCT(S) - LIGH(�jMl EXHAUST DUCT SYSTEM($)- - 1 2 3 4 CHEMICAL SPRAYEQ PRESSURE WASHED SCRAPED CHEMICAL"I E_q CHEMICAL SCRUBBER # OF ACCESS PANELS DUCT LENGTH IN,FEET 1 2 3 POST SERVICE C6ND-ITION SEALED -ACCESS PANELS� �ES NO % OF GREASE REMOVED % OF INACCESSIBLE AREAS BURNT GREASE ROUND DUCT CL ASS 11 DUCTS LEAKING DUCTS FIRE WRAPPED INACCESSIBLE AREAS 2 3 4 mahomm ru IF I 17C M, m rommTrm MMOM w m4b MI. m MWOM HEAVY I FAN(S) - LIG<r/ MEDIU%/ HEAVY ---EXHAUST FAW(S) 1 2 3 4 CHEMICAL SPRAYEDO gg�� PRESSURE WASHE911t P6k 11D NI CHEMICALWIPEQ CHEMICAL SCRUBBEQ FAN REMOVABLE REMOVE FAN # OF ACCESS PANELS POST SERVICE CONDITION FANS - OPERATION TEST ES NO LEFT RUNNING TO DRY NO COWLING - DAMAGE OBSERVED YE8Z N 3 (N- 131 CAT E U N U S UAIL 00 MIT 10 N S 1 2 3 4 DISASSEMBLE TO CLEAK--t N 4n Y N EXPOSED WIRES itS 5�n Y N NEED FLEX CONDUIT _0 C1 Y N NEED ACCESS PANE,L r5 ad1`111 Y N NEED HINGE� . Y.N POLLUTION CONTROL UNIT _a )n )nj Y N SQUIRRELCAGE Y42,)(3101Y N. (G=GOOD, F=FAIR, P=POOR) PHYSICAL CONDITIO�f j' CLEANING ACCESS' ELECTRICAL CONDITION�' - t FAN BELT CONDITIONe' ;IL_ APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU.PETTER IN THE FUTURE. )UR EFFORTS TO ENSURE THATTHE H06P AND DUCT CLEANING HAS BEEN D NE 0 YOUR SATISFACTION, WE REQUEST ff YOU APPROVE OF THE SERVICE B* SIGNING BELOW. CUSTOMER: III- - 1--�',USTOMEF13d— R 96 VICE TECH:( —SIGNATURE 45., QT E P CIDP r)f=DADTlkAr—KITt%r)DV 1J, TRUCK 6100 12th Ave,,S,8 NUMBER Seattle,WA 9E 6 09�6 Phone (206),721 - '(206)z.767-2607 High Pressure Ge�,, Exhaust System Service -*Fire Suppression Installation & Service Fire Extinguisher Sales & Service A Fax &T Range Hood and Fan Service & Repair Hood and Duct Se rvices, Inc. www.rthood.com Filter Sales & Service SUMMARY: CONDITION OF SYSTEM RED 0 YELLOW,�;� WHITE 0 8111 1,A �6 CONTACT��\M IJ J OB NAM E C14 I I I, . 4:- LOCATION 1 _15' JOB PHONE N SERVICE DATE 2ND PHONE '>Kl R&T HOOD DATE OF LAST SERVICE' El OBSERVABLE SCHEDULED JOB TIME 10 RM INACCESSIBLE'AREAS �Fc SALESPERSON # OF HOODS NAME #1 VX #2 k\\0\k0 #3 1j #4 HOOD #OF ACCESS PANELS LENGTH#1 01 101' I #2 #3 77' 10" #4 BEST'ROOF nix t INSIDE ROOF ACCESS:,! -YES,/ NO ACCESS LOCATION: _12k_" SPECIAL INSTRUCTIONS `2 S 1 \',I -e �Z Z, U 0 Ve w L _S pqfx< wo I U Ln L-�K7C--Asc �A)HJE?' BACK -(_\veay% w J_-:s S �fjf SERVICES PERFORMED BY TECHNICIANS BEGINNING GREASE BUILDUP: HOOD(S) - Q. M�jDUCT(S)-LIGHy1kDIU HEAV I FAN(S) - LIG yLf n'-U2 JHEAVY EXHAUST'HOOD 1EXHOST DUCT SYSTEM EXHAUSTFAN (S) HOOD 1,., 2 3 4 1 2 3 4 1 2 4 3 WRAP HOO DRAPE APPLIANC CHEMICAL 8PRAYE� PRESSURE WASHE SCRAPE CHEMICALWIPE SCRUBBED (CHEMICA WATER WIPE . POLISHE - SOAK/DISH FILTER SHOOT FILTER CHEMICAL SPRAYET' PRESSURE WASHEE� SCRAPE CHEMICALWIPE CHEMICAL SCRUBBE FAN REMOVABL REMOVEFAN # OF ACCESS PANELS F-E bITIbN 06Sf SEMV��ICCE C POST SERVICE CONDITION FANS - OPERATION T T YES NO SEALED ACCESS PANEV9- Y-Et / NO V %.r % OF GREASE REMOVED LEFT RUNNING TO D=S NO POSTSERME COk_Dff16f4__ V COWLING - DAMAGE OBSERV % OF INACCESSIBLE AREAS HND CC Aft _U N U! S U A L c 6' -_ S % OF GREASE REMOVED ON a� n A 2 3 4 Lj%_/ ko) L-r- r\ �Unlr-j. �Tr__ f INJU 111411LIFROMI F_ U11MUOUML. %.F I-Aul 11 1-4%-) — -------- DISASSEMBLE TO CLEAN "-\1 2 3 4 NILI thZ:) HLINO IALLtz YE / NO BURNTGREAS , ROUND DUC( CLASS 11 DUCTS I N b I c AT E u Mu t UA C t 6 Wffit I_0__ N__ S_ LEAKING DUCT FIRE WRAPPE BURNTGREASq y'A)_9)L41Y N INACCESSIBLE ARE WNW= W19AM WIDEM MAMOMM zVoMmm MONNEM FAFE MM !AMMINAM-M ZMAMM liffiUMM MINFEUBM CHEMICAL SPRAYED� PRESSURE WASHE SCRAPE, CHEMICALWIPE CHEMICAL SCRUBBE # OF. qACCESS PANEL DUCT LENGTH IN FEET 103MMM IMMMM wmmm FAMMM IMMON 01I.P.Mm Y) N Y NjY NjY N 'g� iY N Y N Y N LPY71' 1Y I Y N, Y N Y N Y N Y N Y N Y N Y N N N YNYNY,N tAtlubtzu vvlhtz> NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGV N Y N Y N Y N N Y NjY N Y N I N Y NjY N Y N ZNYNIYNYN YNYNIYNIYN Y N Y N Y N YINJY NjY N Y N w"Mmm FAIMMM Wmmm Ke-AMMM FAr"IMMMM ROMMM FAMMM WATER -WASH HOOD CflVC 'iv- f�!-Uurl) ,Vj Y N I I /I # OF MISSING FILTE9_&4je:-2:jt- 1 T_)_ PA -C-0-NDITIONi 2 CLEANING ACCES FILTER CONDITION-Pbl S; 3 ELECTRICAL CONDITION I(G=G6076_'F=FA Pz-POOIA) V_ FAN BELT CONDITION WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGt4IjNG BELOW. COMMENTS TO CUSTOMER: V -CUSTOMER SIG DATE: SERVICE TECH!— NATURE':yf' FIRr- DEPARTMENT COPY R &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 COMPLETE FIRE PROTECTION High Pressure Hood Cleaning Fire Suppression Installation & Service Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Wes & Service Certification Given: REDD YELLOW[] WHITE CONFIDENCE TESTING RANGEHOOD SYSTEM TE5T REPORT [Z�ENCETESTZ REPAIRSE] Occupancy Name: 4�4 / rl Of 1-1 City, State, Zip: Occupancy Address: 41!�z UA�jw; Responsible Person: C)J2 UJ22 Phone Number: Building Owner: Phone Number: Building Owner Address: e, City, State, Zip: Testers Name (Please Print): n L&r�17,,5( khy-,:zk1d SIFD Certification Number: SCP 4 9 5,� — --- -------- System I Alarm? Yes [2�'No 0 Central station monitoring? Yes2r'—No E] Monitoring company name: d. Control Panel manufacturer: Model Number: 'y Location of Alarm Panel:- 66 f7 if ag I Extinguishing System ManufacturE A- - MAIP-2--systern- -size � 11:-6-U.L. 300 System? �es Q-Ncf�j- LI.L. 300 Compliant? Yes Chemical Type: Wet 2V�E] Location / Height of Range hood: FN go e-- V% 1.124JI 112 Is pressure gauge indicator in o arable range? p 1 12 year hydro date of cylinder. Is there chemical inside of the cylinder? -Yes KNoE3 Were hand portable extinguishers property serviced? -Yesc�--N -1 Weigh CO2 or nitrogen cartridge. NA(j -2' —were all cooking surfaces protected? If not, give owner full information. YesEg--� No E] No visible signs of a system fire or system tampering (if signs check no). Yes .�,NoEl Check Are immobilized Yeso No- Was op I? �!ratiiqg.p ocedure verbqlly to restaurant p sorj_ . L_ Rel .9s all piping and conduit. all piping and conduit proper hangers and brackets?_________ with - - — , _ _given -- - -- _!kr Was LIL 300 compliance explained to owner or manager? . ....... ------ Yes E�— No -- Are all protective covers present on nozzles? Ye s L I A Gas shuts down upon systern activa !on? N Yes Are all nozzles checked in the pipqer_position?--- Yes Electric power shuts down upon system activation? NAF] Yes No F-1 Does system have adequate volume and/or nozzle coverage? Yes [fr No E] Range hood tied to building alarm panel? NA "a No 1 Are all appliances inside of the hood protection area? -Yes- No 0 Range hood activation signal received at building alarm panel? NAFJ Yes E�' No F _] Have fuse links been replaced? Yes Er' No n - --- - -- - - - -- -- - - - - - - - - - -- --- - - - - ---- - - --- - - - - - - has !mriO �K extinguisher Rrt - - -- - , Yes 140 [D i -Was systern-operational from terminal link? Yes Grease buildu * ' V group: L Medium— Heavy, recommend cleaning onal from manual remote? Was system operati- Yes 0 ght last nCn Was sy and micro switch operational? atei of clea i g _NIA0 r 1 - . - A -1 - - - i KICDA r Problems Found: (if additional room is needed, please add a separate sheet) Corrections Made: Date Corrected: Corrected By: Customer has SFD Certification Number: This certifies that this fire and life safety system has qee ft rt j)4uoperly it ispe ed for reliability to cover the items listed in this report and is consistent with Sea le Fire Depa ment Fire Code standards. Discrepancies are noted angLW e rted to the building Owner/Responsible Person for corrective action. Signature of Tester: 4:�� =--, Phone # (206) 726-0940 Testing Agency: oOR-Mioud-1—nd-Ilubt-Services, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108 is to perfor and keep a written record of the following "quick check" fire system inspection to verity the following: o r location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. 1 . The extinguishing system is in its pirt., place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriat hall be taken immediately. 7; a r�,, a h intended use. 9. A record of the monthly iNecti kept reflecting t ate inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing 1117 a, ly 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY Serving Briet; Ednionds www.FireDistrictl.org --SNOHOMISH CO. Mountlake Terrace, and FIRE SI t th� Town of Woodway TWff LOCATION: 456 0 Way 101, Edmonds 98020 BUSINESS NAME: Anthonys Beach Cafe 12425 Meridian Ave S Everett, WA 98208 Phone (425) 551-1200 Fax (425) 551-1272 PHONE: 4257714400 FIRE PREVENTION INSPECTION REPORT A EDMONDS f L3 BRIER E]WOODWAY [I MOUNTLAKE TERRACE 0 UNINCORPORATED FREQUENCY STATION & SHIFT7'� Annual 17-6 SCHEDULED DATE DUE o Aug MAILING UFIR ADDRESS: 458 Admiral 'Way, , BUSINESS OWNER: HOME PHONE: Email: EMERGENCY-1: part Of Edmonds HOME PHONE: 42577409T@— e' CURRENT KEY ACCESS-2: HOME PHONE: CITY YES NO (4 4 BUSINESS LICENSE RI 1:1 PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: CN FAE SYSTEMS: FE.L11_.:/_2L HAZARDS FOUNDANO LOCATION UNICATIONS 2 2 3 3 4 4 5 5 6 6 7 7 1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION DATE DUE: 1 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE: VI&LATIONS CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: D E: DATE: 3 VIOLATIONS 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 18 4 18 DATE' DISPOSITION: LETTER NEEDED C] YES El NO LETTER NEEDED [] YES NO 8 FIRE DEPARTMENT COPY FIRE PREVENTION 2MM711, Serving Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT SNOHOMISH CO. FIRE Mountlake Terraceand Everett, WA 98208 EDMONDS 18BRIER DISTRT the Town of Woodway Phone (425) 551-1200 OWOODWAY 0 MOUNTLAKE TERRACE www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED FREQUENCY STATION & SHIFT LOCATION: 456 0 Way , Edmands 98020 Annual 17-B BUSINESS NAME: Anthony's Restaurant PHONE: 4257714400 SCHEDULED DATE DUE o Aug MAILING LIFIR 0 593 ADDRESS: 456.6,dmiral Way — BUSINESS OWNER: HOME PHONE: Email: EMERGENCY-1: HOME PHONE: +2&1555T%2 CURRENT KEY ACCESS-2: HOMEPHONE: CITY YES NO BUSINESS OfL'4 LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: c� - FIRESYSTEMS: 6S4/13eA4/13* ,ktE \0 Nj�_ al 2:00:00 AM HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS vl 2- 2 3 3 4 4 5 5 6 6 7 7 1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X 1st RE -INSPECTION DATE DUE: 2nd RE -INSPECTION DATE DUE: EXTENSION GRANTED TO: FINAL RE -INSPECTION DATE DUE: VIOLATIONS CITED: PERSON CONTACTED: PERSON CONTACTED: PERSON CONTACTED: 1 INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS 1 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, 18 4 18 DATE: DISPOSITION: 7 ET-rER_NEEDED_ E] YES [I NO LETTERNEEDED [] YES NO 8 FIRE DEPARTMENT COPY TRUCK 6100 12th Ave. S. High Pressure Grease Exhaust System Service Seattle,WA 9 Fire Suppression Installation & Service 17E,,, _jR,1, /I Cc� 1E NUMBER 8108 RPhone (206) 726-0940 Fire Extinguisher Sales & Service A 1-0 �:Cj) MAllg� Fax (206) 767-2607 Range Hood and Fan Service & Repair oodandDuctk ices,inc. www.rthood.com Filter Sales & Service JOB NAME LOCATION CONTACT / � -(I k 0( ke�- JOB Pf HONE NO. �,i 15 L�IA f) D SERVICE DATE r� 0- G \�'- ' q 42, f 10 t�) '--2ND'PHONE [;�fl&T HOOD DATE OF LAST SERVICE El OBSERVABLE V� SCHEDULEP JOB TIME INACCESSIBLE AREAS SALESPERSON # OF HOODS NAME #1 — #2 Cf\r, A r*N #3 Ch) &'D #4 HOOD # OF ACCESS PANELS LENGTH #1 2L' — #2- 12' #3 #4 BEST ROOF a INSIDE ROOF ACCESS: NO ACCESS LOCATION: SPECIAL INSTRUCTIONS r BEGINNING,_WASE BUILDUP: HOOD(S) - LIGHT E ,.�,,UST HOOD(S)- � _H # 11 2 3 -.4 � , ---H - - - I DRAP ,eHEMI( PRESSI .- 'CH SCRUBBI 1AP HOOD ( I PPLIANCE� 'SPRAYED 4 :WASHED11 SCRAPED,,� ;ALWIPE , HEMIdAL)1� ER WIPEE�� ;IOLISHEDi j,-FILTERS� T FILTERS� WMIZIN-20 RANDOM amammma 000w M4109MM MEMP-3 9MM013101M 06110fin P20203301 MEMO= wMamw POST --RVICE CONDITION % OC&REASE REMOVED D t_D 0 (S) LEAK (DRIP)? ,YES / NO F 11 RS REINSTALLED / NO, INDIC�A- UN-Usu-A-L -CO N-DITIONS '3�� - - - 1 23 4-1- ,:URNT GREASE WA I , . R-WASH HOOD� 11 OF_eSING FILTERS E F ER CONDITION WE IN ( CO TO MMMOM klawamm MONUM i3wam =GOOD, F=FAIR, P=POOR) �V / HEAVY I DUCT(S) - LIGHT 1,ME M HEAVY I FAN(S) - LIGHTfN��211 HAUST DUCT SYSTEFA(S) - � -1 - - - --- EXHA - U - ST FAN(S) 1 2 3 4 1 2 CHEMICAL SPRAYE PRESSURE WASHED� SCRAPED. CHEMICALWIPE6, CHEMICAL SCRUBBED, # OF ACCESS PANELS DUCT LENGTH IN FEET WE= ONE= =1003M PUP-20M 00013M "FAFRAWFAM Ifflomm POST SERVICE CONDITIOftj� J-� SEALED ACCESS PANELS YES % OF GREASE REMOVED % OF INACCESSIBLE AREAS INDICATE. U-NUSUAL CONDITION, 1 2 3 4 BURNT G.REASE ROUND DUCT CLASS 11 DUCTS LEAKING DUCTS FIRE WRAPPED INACCESSIBLE AREAS 1 - 2 3 4- Y) It 3) I�J'Y )NIY N Y N, f - -14'Y N Y /N' Y/ "'D Y Y N Npm , Y N n/Y Y N -�&N ";T Y( N� T:N] CHEMICAL SPRAYED� PRESSURE WASHE SCRAPED� CHEMICALWIPE CHEMICAL SCRUBBED FAN REMOVABLEJ REMOVE FAII� # OF ACCESS PANELS HEAVY -1 4 10-000M WAMOM 0-ap-Mom L72DIMMM WDOW M momm MAMM DIMMM POS . T - SE . RVI - CE C0'-ND`ITION OPERATION -TEST �YE� NO FANS - LEFT RUNNING TO DRY NO COWLING - DAMAGE OBSERVED YESOO ....... .. ... INDICATE UNUSUAL CONDITIONS 1 2. 3 4 DISASSEMBLE TO CLEAN EXPOSED WIRES NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE YN Y, YN Y N Y- t� Y!-'R- Y N Y111 Y�, N, Y5` Y N Y)N YMP Y N Yl) YI.N Y N Y/ 0 Ri 14 y Y N Y'N Y(N wl Y N . (G=GOOD, F=FAIR, P=-PO9,8)— PHYSICAL CONDITION' CLEANING ACCESS ELECTRICAL CONDITION FAN BELT CONDITION mmmm NNOM 10MMM IMMMM ECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. FFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST JI APPRO 0 HE SERVICE BY ELOW. n I= TS 3M ER . SERVICE TECH: STOM SI FIRE DEPARTMENT COPY DATE: TRUCK 6100 12th Ave. S. ll�. High Pressure Grease Exhaust System Service ---% 11"_ � (7c, 17"::--:1 0 S, T/11 NUMBER Seattle,WA 98108 Fire Suppression Installation & Service I Phone (206) 726-0940 Fire Extinguisher Sales & Service Fax (206) 767-2607 Range Hood and Fan Service & Repair A!, E___ :1y 0 1 19, 11' �T Hood and Duct Services, Inc. www.rthood.com 0 Filter Sales & Service JOB NAME LOCATION CONTACT / �_alu x \e' JOB PHONE NO. Yia 5 - 71 k - L�A DD SERVICE DATE Q _\3 2ND PHONE 2'R&T HOOD DATE OF LAST SERVICE El OBSERVABLE4 SCHEDULED JOB TIME INACCESSIBLE AREAS # OF HOODS #OFACCESSPANELS INSIDE ROOF ACCESS: (/YESY NO SPECIAL INSTRUCTIONS SALESPERSON NAME #1. (A'N(A�C�ii_ #2 #3 L4 62r — #4 HOOD I C)" LENGTH#1_ #2 #3 — #4 BEST ROOF 10 ACCESS LOCATION: pr _�t BEGINNING GREASE BUILDUP: HOOD(S) —LIGHT/ MEDIUM/ HEAVY I DUCT(S) —LIGHT/ MEDI M/ HEAVY FAN(S)— LIGHT/MEDIUM/ HEAVY --E-XH.AUST HOOD(S) EXHAUST DUCTSYSTEM(S). - E - XHAUSTFAN(S) HOOD # 1 2 3 4 1 1 2 3 4 1 2 3 4 WRAP HOOD( DRAPE APPLIANCE� CHEMICAL SPRAYEN PRESSURE WASHED, SCRAPED CHEMICALWIPED( SCRUBBED (CHEMICAL) WATER WIPED( POLISHED SOAK/DISH FILTERSi SHOOT FILTERS to 101 q_ M M Zu il AM Fj M M POST SERWICE-CONDITION % OF GREASE REMOVED DO HOOD(S) LEAK (DRIP)? ("'Y�E NO FILTERS REINSTALLED�_ /NO -mbickrOuk-usUAL, CONDITIONS 1 2 3 4 BURNT GREASE WATER -WASH HOOD # OF MISSING FILTERS FILTER CONDITION �p (G=GOOD, F=FAIR, P=POOR) U01 ffkqj I M1 M 122, Rol M murAm mmmm CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED # OF ACCESS PANELS DUCT LENGTH IN FEET N Y N Y N Y N N Y N Y N Y N N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N POST SERVICE CONDITION SEALED ACCESS PANELS (�JE/ NO % OF GREASE REMOVED [3 % OF INACCESSIBLE AREAS INDICATE U-Nusuk-L to N_DI_T_IO N__S_ 1 2 1 4 1 2 3 4 BURNT GREASE ROUND DUCT CLASS 11 DUCTS LEAKING DUCTS FIRE WRAPPEC INACCESSIBLE AREAS Y Y N Y N Y N Y Y NjY N Y N Y(UYNIYNYN YUY#NYNYN YR,YN y NYN nN Y N Y N Y N CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED FAN REMOVABLE REMOVEFAN # OF ACCESS PANELS ('�,NYNYNYN Y N Y N Y N Y N Y N Y N YAYNYNYN YOYNYNYN N y y N .01 P - 0 - ST S - ERVICE CONDITION FANS - OPERATION TEST PES / NO �E LEFT RUNNING TO DRY YESJ NO COWLING -DAMAGE OBSERVED YES/@ imcAft-b-h-UsUAL CONDITIONS 1 2 3 4 DISASSEMBLE TO CLEAN EXPOSED WIRES NEED FLEX CONDUIT NEED ACCESS PANEL NEED HINGE POLLUTION CONTROL UNIT F=FAIR, P=POOR) PHYSICAL CONDITION CLEANING ACCESS ELECTRICAL CONDITION FAN BELT CONDITION WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROV� OF THE S ICE BY SIGNING BELOW. COMMENTS --n f__ TO CUSTOMER: X = �� V�v S 1�� DATE: SIGN_ � ME69n_-.2�'_ CUS 0 1 SERVICETEkH: �� P I'Al 1-111t UtIl"Arl I MUNI I Loury TRUCK 6100 12th Ave. S. High Pressure Grease Exhaust System Service NUMBER Seattle,WA 98108 Fire Suppression Installation & Service '7 RPhone (206) 726-0940 Fire Extinguisher Sales & Service A cc Filter Sales & Service 9:20P) lax 206) 767-2607 Range Hood and Fan Service & Repair 3'3o ffftod and Duct Se ices, Inc. www!rth "d C' M 11 t 17 [91"71 SUMMARY: CONDITION OF SYSTEM RED 0 YELLOW W.', WHITE 0 A )J�N JOB NAME f)('� I k '-) V\TA_%fN D () D 1 CONTACT LOCATION 'T"Am � JOBPHONENO. SERVICE DATE �A- 2ND PHONE El R&T HOOD DATE OF LAST SERVICE El OBSERVABLE SCHEDULED JOB TIME INACCESSIBLE AREAS SALESPERSON 'A # OF HOODS LA NAME #1 fyYk,.(_7ii #2 MCAA(7� #3 CA-Fn — #4 . \00 HOOD #2 #3 #4 # OF ACCESS PANELS LENGTH #1 BEST ROOF INSIDE ROOF ACCESS: E /NO ACCESS LOCATION: (9 �Auor / f C n lr SPECIAL INSTRUCTIONS S' INI &VS ��')e k__ A r) (_)f P Q:� t LC LA fr)� �bjAA�d Af\Q A 1i) A MP AA UC V, _�ff 10 ON CAI P A )0 �r C SERVICES PERFORMED BY TECHNICIANS BEGINNING GREASE BUILDUP: HOOD(S) — LIGHT HEAVY I DUCT(S)— LIGHT M IU HEAVY FAN(S) — LIGHTtf��_HEAVY EXHAUST HOOD(S) EXHAUST DUCT SYSTEM(S) EXHAUST FAN(S) HOOD # 1 2 3 4 12- 3 4 1 2 3 4 WRAPHOOD DRAPE APPLIANCE, CHEMICAL SPRAYEM PRESSURE WASHED4 SCRAPED� CHEMICALWIPED SCRUBBED (CHEMICAL)� WATER WIPED POLISHED SOAK/DISH FILTERS SHOOT FILTERS CHEMICAL SPRAYED PRESSURE WASHED SCRAPED CHEMICALWIPED CHEMICAL SCRUBBED FAN REMOVABLE REMOVE FAN( # OF ACCESS PANELS ____ - ...... .. — ------ POST SERVICE CONDITION POST S E RVIC E CONDITION SEALED ACCESS PANELS e'Y_E'�@/ NO FANS - OPERATION TEST NO % OF GREASE REMOVED LEFT RUNNING TO DRY (jDl NO POST stmaE c6NbiTiON COWLING - DAMAGE OBSERVED YES /i PNO % OF INACCESSIBLE AREAS ------ % OF GREASE REMOVED IN61-WE-UNUSUML C_O_ND_ITI NS 1 2 3 4 DOHO0U(Z�,)LEAK(DRIr)( YES/ 1NU1%�A1CU1)1UZ)UALto DAU111 1-40 - - ----------- ---- - - UISASSEMBLETO CLEAN 1 2 3 4 FILTERS REINSTALLED U NO BURNT GREAS ROUND DUCT CLASS 11 DUCTS INDICATE UNUSUAL caribitioNs LEAKING DUCTS 1 2 3 4 FIRE WRAPPED BURNT GREASE WATER -WASH HOOD # OF MISSING FILTERS FILTER CONDITION MIZIMS =01008 MWIM101 MIMIMIM MMMIM, w1pr1l"m wifflivin IMINZIGM 9=14MM MMIMM Of M01,209M CHEMICAL SPRAYED PRESSURE WASHE SCRAPE CHEMICALWIPED CHEMICAL SCRUBBED # OF ACCESS PANELS DUCT LENGTH IN FEET INACCESSIBLE AREAS MUMM OMMMUM MWOMIM w3r4gam ff RUN 0109M Rainow "Immo mmmm MMOMA W&I V V, I WE. PC! Nwaffaff2d EC'lgmgzlo ffm I nA I N 01 W r_ArU0r_U MrIM0 NEED FLEX CONDUIT NEED ACCESS PANEL )I NEED HINGE POLLUTION CONTROL UNIT SQUIRREL CAGE i ME, —0 AM. 0 M '41MM WAS MAN M 901.0999M mmmm Y (y Y (N- VIN, Yli`N,Y�N) Y&!A 16 Y N A!:D� Y (N) Y N y 1� Y N N .YM Y6� Y N Y (0 Y (—S Y(N,, Y N ku=u U r=r-m =r-uun) uu r=rm 'J'j PHYSICAL CONDITION r I 2 CLEANING ACCESS (G=GOOD,Cf'fXI3? 6=POOR) 0 MLCU I MIUML UVIAL)l 1 1UN 4 FAN BELT CONDITION WE APPRECIATE YOUR BUSINESS AND WELCOME ANY COMMENTS AS TO HOW WE CAN SERVICE YOU BETTER IN THE FUTURE. IN OUR EFFORTS TO ENSURE THAT THE HOOD AND DUCT CLEANING HAS BEEN DONE TO YOUR SATISFACTION, WE REQUEST THAT YOU APPROVE OF THE SERVICE BY SIGNING BELOW. COMMENTS TO CUSTOMER: 4 L- CA 2 7 7 L/ CUSTOMER SERVICE TECH: SIGNATURE D ATE: " / 'f Jel 4 ;1 141— FIRE DEPARTMENT 106�Y UMMIZOM wmmm MONEM Momm ..6066.. C C Fire Protection 15000 Woodinville- Redmond Road, Suite B-800, Woodinville, WA 98072 Building Details Sprinkler System Description Page I of 2 Rev. 01104;2007 Building Name Anthony's Restaurant (Edmonds) Address 456 Admiral Way City or Town Postal Code Date Edmonds Wa 98020 04-12-2013 Building No. Contact Person Telephone Diana 206448-6688 System Description Control Valves Control Valve Type Number Supervised Yes No City Connection El Tank 0 0 Pump El 0 System 0 f-1 Sectional El Q [Indicator Post Yard PIV N 0- Fire Pumps No. Item Yes No N/A I Type N/a 2 Number 3 Driver - Electric 101 C1 0 4 1 Driver - Engine 1-3 1:1 9 L5 1 Test Header El El Z Fire Department Connections No. Item 1 Number Wet Systems - Alarm Check Valves No. Item I Number 2 Make Rasco 3 Size 4-1 E Wet Systems - Anti -freeze Systems No. Item 1 1 Number N/a '06660", -"11 ts a a a 0, - C 'Ilk' )SCO 0 00 *:: *Goo Fire Protection Dry Systems Sprinkler System Description Page 2 of 2 No. Item No N/A I Number Nia 2 Make 3 Model 4 Size of Valve 5 1 Quick Opening Device El I El Special Systems - Pre -Action No. Item Yes No N/A I Number N/a 2 Make 3 Size of Valve 4 Supervisory Air 0 Z Special Systems - Deluge No. Item I Number N/a 2 Make 3 Size of Valve Special Systems - Other No. Item 1 Type N/a 2 Make Alarms No. Item Yes N NIA 1 Water Gong 2 Flow Switches N/a 3 Pressure Switches 4 Did the central station rec; eive all signals 5 1 Did Electric alarm operate and test satisfactory End of Section '.0686., --'11 -" llf� #00006. C OSI(JU ::0 00 0e: 00000 Fire Protection 15000 Woodinville- Redmond Road, Suite B-800, Woodinville, WA 98072 Building Details Sprinkler System Description Page I of 5 Rev. 01/04112007 Building Name Anthont's Restaurant (Edmonds) Address 456 Admiral Way City or Town Postal Code Edmonds Wa 98020 Building No. Contact Person Telephone Diana 206-448-6688 Inspector Date Trisha Sorenson 04-12-2013 General No. Item Yes No N/A 1 Are all systems in service? 2 Have there been any changes or repairs to the system since the last inspection? 3 Do all areas protected by the wet system appear to be properly heated? El M 4 Gauges checked against calibrated gauge and show normal water pressure in past 5 years? -1 I Date of ast Full Trip: N/a 6 Sprinkler system installed in year: Control Valves Are all sprinklering control valves and all other valves in the appropriate open or closed positions? Are all control valves in the open position and locked, sealed, or equipped with a tamper switch? Yard PIV "MMM MOM MMMMMMMMMM Page 2 of 5 Water Supplies I I Water supplied from Edmonds Test Pipe Location Size Pressure Before Flow Pressure Pressure After At Riser 2- 140 psi 120 PSI 135 PSI Tanks, Pumps, and Fire Dwartment, Connections No. Item Yes No NIA I Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition? 1:1 E] 2 Have fire pumps been tested to their full capacity in the past 12 months? E] 11 3 Are fire department connections in satisfactory conditions? El El 4 - couplings free 5 - caps in place 6 - and check valves tight E] El 7 1 Are fire department connections accessible and visible? Wet Systems No. Item Yes No N/A I Number of Systems 2 Make Rasco 3 Model 4*s E 4 Are cold weather valves in the appropriate open or closed position? 5 Have antifreeze solutions been tested? El Z 6 Were antifreeze test results satisfactory? Page 3 of 5 Dry Systems No. Item Yes I No NIA 1 Number of Systems N/a 2 Make 3 Model 4 1 Date of Last Test 5 Are the normal air and priming water levels normal? El 9 6 Is the air supply satisfactory? El El (0 7 Were all the low points drained during this inspection? El F1 8 Did the quick opening devices operate satisfactorily? El 1:1 9 Did the valve trip properly? El El Z 10 Did the dry valves appear to be protected from freezing? 0 1:1 Dry Svstems Schedule Location Trip Time Water Pressure Air Pressure Trip Point Air Pressure Time of Water to Test Point Alarm System Provided Comments Yes No Yes No N/a El C3 El El El C3 1:1 El 1:1 El F] 0 1:1 1:1 F1 0 El E3 El 0 0 0 0 0 0 DID 0 010 0 .0 0 010 0 0 0 11 0 0 0 —0. 0 0 0 0 01 0 0.0 0 0 DID 0 Io 1 0 1 0 0 Wet Kitchen Hood System No. Item Yes I No N/A 1 Number of Systems NIA 2 Make 3 Model 4 Type 5 Were valves tested? Z' OS&Y 6 Did valves operate properly? 2"OS&Y 7 Did all heat responsive devices operate? 8 Did all supervisory functions operate properly? El 1 13 Page 4 of 5 Special Systems (Pre -action. Delucie. etc) Type of System memo Manual Tip 1 Operative Super- visio n I Alarm Functional I 1, System I Alarm Functional Heat i Activated Dev ic Operating Trip Time System i Drained Alarms No. Item Yes No N/A I Did all water motors and gongs operate? E] 1:1 2 Did all electrical alarms test satisfactorilp. D 3 Did all supervisory alarms operate satisfactorily? 4 Did the central station receive all signals 5 1 Did Electric alarm operate and test satisfactory EJ D 0 Special Svstems (Pre -Action. Deluae. etc) Location Type of Device Alarm Time Delay Comments Yes No N/a 11 0 Cl 0 El El 1:1 1:1 El 1:1 11 El 1:1 El Page 5 of 6 Sprinklers No. Item Yes No NIA 1 Do sprinklers generally appear to be in good condition? E) D 2 Is any of the fast response heads 20 years or older? 3 Are any of the standard heads 50 years or older? 4 Do sprinklers appear to be free of corrosion, paint, grease and damage? El 5 Is all stock or storage properly below sprinklers & piping? 0 6 1 Is there sufficient stock of spare sprinklers available? El El 7 Does th exterior condition of the sprinkler system appear to be satisfactory? E] 0 8 Are sprinklers the proper temperature rating for their locations? 1:3 El Explanation of "No" Answers: 1) Dry pendent head in first floor cooler has been in service for 10 year (Dated 2003) & needs to be replaced 2) Two Dry sidewall heads heads in front canopy have been in service for more then 10 years (Dated Late 1980) & are also on the Central manufacturs recall list. Need be replaced. Adjustments or Corrections Made: None Signature�__. Inspector Owner's Repr e Date 04-12-2013 :9049000. . "O�Osco Fire Protection Occupancy Name: Anthony's Restaurant Occupancy Address: 456 Admiral Way Edmonds WA 98020 15000 Woodinville — Redmond Road, Suite B-800 Woodinville, WA 98072 For Service Call: 800.422.2031 or 425.670.2724 Pe,. it'-W2,^ "' Date of Report: 04-12-2013 Recommendation Revort Recommend Adding Or Relocating Fire Sprinkler Heads In These Areas. Note: Do Not Send To Fire Dept, Only Send To Owner's Rep. 1)) 2nd Floor kitchen- One fire sprinkler head in front of grill is blocked by duct work and should be relocated. 2) 2nd Floor Behind Bar- No fire sprinker head coveage in 6ft x 8ft hood & triangular space at west end of bar. Recommend adding one head in each space. 3) 2nd Floor Office Area- One fire sprinkler head is over 8'-6" off the wall. (Max T-6" allowed). Recommend Relocating one head. 4) 2nd Floor- No fire sprinkler head coverage in exterior entrance from sun deck. (5'x5' Space) Recommend adding one head. 5) 1 st floor outside front entrance to the Beach Cafd- No fire sprinkler head coverage. (1 2ft X 8ft Outside Canopy) Customer Signature: Date: 04-12-2013 Page I of I R &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 COMPLETE Certification Given: REDEJ YELLOW F] WHITE FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD High Pressure Hood Cleaning SYSTEM TIEV REPORT Fire Suppression Installation & Service F-CONFIDENCE TEST 2' REPAIRSO Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Sales & Service DATE: iDya4Z) Occupancy Name: Aftl-heO)�( r If Occupancy Address: q54 Responsible Person: Building Owner: Building Owner Address: f Testers Name (Please Print): SystemAlarm? Yap,�NoEl Central station monitoring? YesE�--No Control Panel manufacturer: Model Number: City, State, Zip: Phone Number: FOMOU-0i Phone Number: City, State, Zip: SFD Certification Number: Scp- J L -10�1 C// -7- - - - — - - , - i 0- Monitoring company name: k7 -Jrj1-1 Location of Alarm PaneI7 01)re, Cc 01 Extinguishing System Manufacture hs (.�Isystem Size -S-k?4 U.L. 300 System? Yes ETgo-E] U.L.30OCompliant'7 Chemical Type: Wel��ry C] Location / Height of Range hood: C I in Is pressure gauge indicator in opierable range? N o�-,' 12 year hydro date of cylinder. o --j Is there chemical inside of the cylinder? Yes ?Cwo 0 Ls -re. hand p - a- x -i- - -- -shers- -o - ------ i-e - ceV— �A M Yes P: No Weigh CO2 Or nitrogen cartridge. NiA were all cooking surfaces protected? If not, give owner full Yes E:J, No E] No visible signs of a system fire or system tampering (if signs check no). Yes E�� No F-1 information a I pip ng and conduit immobi d-W, s�- all —p t.- Are Ii i li; W th Ye No n Was operq!ing pmcedure arpally given to restaurant sonnel? Yesg� - No, i Check iping ind condui ptr__ proper hangers and brackets? Was UL 300 compliance explained to owner or manager? Yes a- No El - -------------- Are all protective covers present on nozzles? Yesf5-NoE] �_Pas_�huts down upon system activation? NA Are all nozzles checked in the proper position?__ ___Yes -Noo Electric power shuts down upon system activation? NA[:] Yes[�J- NoF] Does system have adequate volume and/or nozzle coverage? Yes D- No [j Ranqe hood tied to building alarm panel? NAD Yesa N0.0] Are all appliances inside of the hood prortection area? YesR- NOD Range hood activation signal received at building alarm panel? NAD Yesa No[] Have fuse links been replaced? Wassystem operational from term! - nal li - nk? Was system operational from manual remote? Wassystem and micro switch opqrational?_--------.-- Is system visible and free from obstruction? Yes Eft- No E] I ss --extirg-W�hwp -sen!9 �es P�7 re_ -----YesEfr-_ Non_ Grease buildup in group: Yes Ej- No F� Light i Heavy, recommend cleaning Date of last cleani Yes E3- No[:] Are cleaning intervals within NFPA standards? Problems Found: (if additional room is needed, please add a separate sheet) Corrections Made: Date Corrected: Corrected By: Customer has declined SFD Certification Number: 10 Zted-(Gr-�eliabilit This certifies,that this fir e safe- systonyllas been prope�rly!Fg-p-e �_�y to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code screpan 0 * standards. D s are %noe an a in Owner/Ftesponsible Person for corrective action. Signature of Tester/ C Phone # (206) 726-0940 & 00 a iC Testing Aqgw . -W --- rV S. Inc. *--�-_&-T-Hood angrDuct Se e MailingAddress: 6100 12th Ave. S., Seattle, WA98108 Act Services, Inc. The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. It any deficiencies are found, a o ' a corre ive action shall be taken immediately. intended use. 9. A record of the monthly in c s is to be ke reflecting the date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the ins n and any corr ctions requir 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY I I I -- .--. "I'll-, R Afiama &THocid and Duct Services, Inc. C 9 6100 12th Ave. S. Phone (206) 726-09Z Seattle,WA 98108 Fa. (206) 767-2607 Occupancy Name: — Occupancy Address: Responsible Person: Building Owner: COMPLETE Certification Given: RED[:] YELLOWE] WHITE WT FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD High Pressure Hood Cleaning — SYSTEM TEST REPORT Fire Suppression Installation & Service FCONFIDENCETEST;a' REPAIRSO Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Sales & Service DATE:----1—e- GAMOnds W, City, State, Zip: 144 M20 Phone Number: Phone Number: Building Owner Address: City, State, Zip: Testers Name (Please Print): 490A&44e�r SFD Certification Number: SCP- �5 -07,FZ3 SystemAlarrn? Yes[20' NoM Central station monitoring? Yeo No E] Monitoring company name: Control Panel manZacturer: Model Number: Location of Alarm Panel: Extinguishing System Manufacturarlf-q-Aamftystem 1 .10 Size ;6!ie I.I.L. 300 System? Yes;eNoo 1.11.30OCompli.nt?YesR�N.E] Chemical Type: Wet/Dy Location / Height of Range hood: A4,6711— A AAVI 11,',7— y Is pressure qauge indicator inoperable range?_ N4Q 12 year h ydro date of cylinder. ZX /0 Is there chemical inside of the cylinder? YesX No E] NA L__Wqre han - d portable extinguishers properly serviced? Y6sZ N-0-0 gh CO2 or nitro Wei cartridge._ NA r Were all cooking surfaces protected? If not, give owner full Yes No E] No visible signs of a system fire or system tampering (if signs check no). Ye NoM information. Was operating procedure verbally given to restaurant personnel? Yes No Check all pi ping and conduit. Are all piping and conduit immobilized with Y-e, No proper hangers and brackets? Was UL 300 compliance explained to owner or manager? Yeso No E] Are all protective covers present on nozzles? YesZ1 No[] i Gas shuts down upon system activation? RAM Yes2l No 0— it _ 'Are all nozzles checked in the proper pos tiion� _ Yes _ ---- No n -- Electric power shuts down upon system activation? NA[] Yes 0 No __ __ ___ Does system have adequate volume and/or nozzle coverage? _ _ _ __ 10 * No - ------ -- -- -- --- - -- - -- Ran * NA ge hood tied to buiIding_aIarm1paneI?________ 1yes No -E1 t Are all appliances inside of the hood protection area?- —)�esx Yesz] 0 Range hood activation signal received at building alarm panel? NAE1 Yes Z No E] 1. fuse links been replaced? YesoHave No F-1 J' K e X-tinguisher present? Yeso No 'Was system ope - rational from - termi - nal - link? Was from ye Noo Grease buildup in group: Light Nle�io- Heavy, recommend cleaning 2t::f-- system op erational manual remote? stern and micro switch operational? Was sy - I Date of last clea6lnng - Is system visible and free from obstruction? __yesZ Yes E] No E] Are cleaning interva with Is in &A standards? y sZ No E] Problems Found: (if additional room is needed, please add a separate sheet) Customer has declined repairs X Corrections Made: Date Corrected: Corrected By: — SFD Certification Number: This certifies that this fire and life safety system has been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancies are noted qU041a3p bee p t th b 'Id' Owner/Responsible Person for corrective action. Signature of Tester: Phone # (206) 726-0940 Testing Agency: R&THoPff—andAV(-5e Ice% -,Inc. MailingAddress: 610012thAve.S.,Seaftle,WA98108 �ry -OF The owner isfo perform and keep a written record of the following "quick check" fire system inspection to following. I The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals act, undamag place and has not been removed or tampered with. 7. The inspection tag r certificat i in place and current. seals 0 or 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. It any deficiencies are fou , ppropriate c�vective action shall taken immediately. e fou intended use. 9. A record of the monthil ' p tions is e kept reflecting the ate inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the y ti any corrections requ' d 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY COMPLETE Certification Given: REDE] YELLOWE] WHITE E�� FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD R High Pressure Hood Cleaning — SYSTEM TEST REPORT &THood and Duct Services, Inc. Fire Suppression Installation & Service FCONFIDENCE TEST E2--' REPAIRSE] Fire Extinguisher Sales & Service 6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE: 140zo?,112- Occupancy Name: Occupancy Address:y 5-6 uAe:hn' 1��— City, State, Zip: 10 Responsible Person: Dwie- Phone Number: 771 - qqOo Building Owner: Phone Number: Building Owner Address: 0 City, State, Zip: I Testers Name (Please Print): b,'j L SIFD Certification Number: SCP- H---3 System Alarm? Ye42--Noo Central station monitoring? YesE�r- No[:] Monitoring company name: so Control Panel manufacturer: Model Number: Location ofAlarmPanel:- nc:,,n1 j /) - 11- - -V Extinguishing System Manufacturer Location / Height of Range hood: rol .L. 300 System? YesE�t�on LI.L.300CompIiant?YesE!j'NoE1 Chemical Type: Wet Ea-5r-y El Is pressure gauge indicator in,operable range,?- yj .0, -A�ON -tj- 12 year hydro date of cylinder. to Is there chemical inside of the cylinder? Yes ET, No E) hand portable extinguishers properly serviced? NAE) -_Yes C� No Weigh CO2 or nitrogen cartridge. NAU. I Were all cooking surfaces protected? If not, give owner full Yes No [j No'visible signs of a syste m fire or system tam _ pe _ ring (if signs check no). Check all piping and conduit. Are all piping and conduit immobilized wit Yes No Yen— No information. _Was operating_p_r9cedure v rbally given to restaurant personnel? --- -e Yes; No proper hangers and brackets? I Was UL300 compliance explained to owner or manager? Gas Yes 1?11� No E] Are all protective covers present on nozzles? Yes No El shuts down upon- system activation? NAF-1 Yes[f' _NoL] Are all nozzles checked in the proper position? Yes No Electric power shuts down upon system activation? NA Ej Rarge hood Yes [�J" No El Does system have adequate volume and/or nozzle coverage? Yes No tied to-b—,uild-ing'a [arm- panel? NAR Yes No El Are all appliances inside of the hood protection area? Yes No Range hood activation signal received at building alarm panel? NA F� Yes No F] Have fuse links been replaced? Yes Noo -Class K extinguisher piresent? sf?' No Was sy-stem-operational from terminal link? Yes No0 Grease buildup in group: Was system operational from manual remote? Yes No Light e d H commend cleaning Was system and micro switch operational? NAM Is system visible and free from obstruction? Yeso- NoF Yes No Date of ,2�� "�Or -last clea i Are cleaning intervals within NFPA standards'? Yes?T NoE] - a Previous Confidence Test Company & Technician Is I on a e pp the cylinder? 65 ---- --- I - .. -1 _9 I MIME Problems Found: (if additional room is needed, please add a separate sheet) Customer has declined repairs X Corrections Made: Date Corrected: Corrected By: SFD Certification Number: This certifies that this fire and �Iifes em ha �enroperly>ipfe`cfe-d for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepancies �are e an T-b n u esponsible Person for corrective action. Signature of Tester: Phone #, (206) 726-0940 Testing Agency: MailingAddress: 610012thAve.S.,Seaftle,WA98108 The owner is to perform -and keep a written record of the following "quick check" fire system inspection to verify the following: 1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificateAin place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are fc�und monthly 'nsp�*yfropnate corrective action shall be taken immediately. intended use. 9. A record of the i I flpnfing thp (Inte inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the in rections required. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED �5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY :000606. 15000 Woodinville -Redmond Rd, #B800 *40040. cosco Woodinville, WA 98272-4502 :soof Phone: (425) 82 7-9654 Fax: (425) 82 7- 7474 or (425) 486-1367 * '" $:: Fire Protect -Ion Toll Free: (800) 487-2947 WA State Contractor's License: C0SC0FPll0NM e WA State Electrical License: COSCOFP935MS Page 1 of Cosco Work Order #: 1209-0546 Dept. / Jurisdiction: Edmonds Date of Corrections: 1-119-2012 Technician: -71- Certification No.: 3��& Name of Building: Anthonys l4estaurant Address of Building: 456 Admiral Way Edmonds State: WA Zip: 98020 Attention: Phone: R REPAIRSMORRECTIONS OF DISCREPENCIES: Fire Sprinkler System(s) [:1 REPAIRSICORRECTIONS OF DISCREPENCIES: Fire Alarin Systemis dry—, Signature of Technician: 7-7-A i,,J!'A� Date: �—M—Zolt .0006 —0111IM: COSCO Fire Protection 15000 Wood[nVUIO- Redmond Road, Sufte 8.800. WoodinV1119, WA 98M Buildina Details Sprinkler System Description Page I of 2 Rev. 01104/20D7 Building Name Anthony's Restaurant (Edmonds) Addrew 466 Admital Way City or Town Postal Code Do% Edmonds Wa 98020 04-25-2012 Building No. I Contact Person Telephone -- Diana 1 206-448-ase System Description Control Valvan Control Vafve Type Number Yes No City Connection 1:1 Tank — 0 Pump system Sectional Indicator Post Yard PIV Fire Purnon No. Rom -W— Yes NO A I Type wa 2 Number 3 Driver - Electric 0 4 Mar - Engine 5 Test Header Wait 9VAternst . Alnrrn Mae-& U-1-- NO. item I Number 2 Make Rasco 3 Size 4" E Wet gVniamok - Anfl-fmov. .4. INO. Itern I Number wa .0000 .0000::: COSCO 00 I Fire Protection Dm 8vatems Sprinkler System Description Page 2 of 2 No. Item yes No i Number Wit 2 Malw 3 MWel 4 sko Of Valve 5 QUIC* Opeftg MOM IJ SO9C1W SV&tanm — Pm.&MInn No. Iftm yes No N/A I Number wa 2 Make 1 3 1 SIM of Valve 1 4 1 Sup ervisory Air 80eclal SVSMMR — nallon" No. Item 1 Number N/a 2 Make 3 1 SIM of Valve sceew guaftma — nthar No. IhM I Type N/A 2 Make I Alarine No. Rom -T- WA I WaterGang 2 Flow Switches N/a 3 Pressure Swftes 4 -r r6 Dld the ceMml station maelve all signals Did EhKWC alafm Operate and test sallsfactory Cl 0 0 End of Section .***Go ' COSCO :000* Fire Protection 15000 Woodinville- Redmond Road, Suite "00, Woodinville, WA 98M Buildina Details Sprinkler System Description Page I of a Rev. 011OU2007 Building Nam AnthonVs Restaurant (Edmonds) Address 456 Admiml Way CUY or Town Postal Code Edmonds Wa 198020 1 Building No. Contact Person I Telephone Wane 206-448-6688 Inspector Date [TrIsha Sorenson —04-25-2012 General No. Item Yes No NIA I Am all! system in seryloe? 0 2 "ave ftre been any changes or repairs to the system since the last Inspection? 5--b- 3 Do all areas protected by the wet system appear to be properly heated? 0 0 4 Gouges checked against calibrated gauge and show normal water prossure In past 6 years? 0 0 L 5 Date of Led Fulll Top: We 6 Sprinkler system Installed In year Control Valves PrInklaft O(MU01 valves and all other valves In the appropriate open or dosed positions? MEW frolvalvesintheopen-position and locked, sealed, crequfted; atempers~ Mr-4 MM OMMOME MMMMMMMMMM MMMMMMMMMM MMMMMMMMMM MMMMMMMMMO MMMMMMMMMM MMMMMMMMMM MMMMMMMMMM Page 2 of 5 Water Supplies I I I Watweuppilectfrorn I Edmonds I Tanks, Pumas. and Fire Npartment nnnat-flo%ne NO. I ftern yes No WA I j Are ffm pumps, gmvny tgnM. A)SOMIA1 and PMMM tanks In good canditlon? 2___ Hm fke Punvs been Wecl to their fun capadty in the pEM 12 m~ 3 Are fife depmbnM cmnadjons In 509faftry condMons? D 4 - couplings fres 6 -caps In plaos, a 6 and ohm* "wes.ftht 7 ctepawnert coff"ons accessilfle and vftft? 00 Wet S"Ums no. Item YO& I No - NIA I Number of System 2 Make Rasco 3 Model r E 4 Are cold weather valves In the 0010prIate open or dosed posftfon? 0 6 HOW OrdftOZO sohdions been tested? 0 8 Were aniffreeze test maufts saqs%ctory? 0 Dry Svstems Page 3 of 5 No. Rom Yes NO NIA I Number of Systems We 2 Make 3 Model 4 Date of Last Test 6 Are the normal air and prbnfng water levels nomud? 6 Is the sk supply satisfactory? 0 0 7 Were all the low points dralned during thils Inspectlon? 11 0 8 Did the quick openiq devices operate sdiffectodly? 0 0 9 Did the valve trip property? 1:1 0 10 Old the dry valves appear to be protected from ftezing? 0 0 MY Systems Schedule ZEN Wet Kitchen Hand Sviatom No. Item Yet No NIA I Number of System NIA 2 Make 3 Model 4 Type 6 WOO valves tested? 2' OS&Y 0 0 0 Did Valves oPerSts promrly? 2* OS&Y 0— 0 7 Did 811 heat fesponalve devIces operate? 0 0 8 Old 00 $Wfvisory functions operate pWqdy? 0 -p—i-0 SPeCl8l SVStems (Pfe-action. Dolque. ofel Page 4 of 6 Alarms No. Item Yes No WA I Did all water nwton; and gongs operate? 0 2 Did all efeWcal afwyne ted su"Sft&"W 0 3 Dld all supervbM elanns Operate Satisfactodly? 0 4 1 Did the contmi mdon rec9l" all slpgls 5 1 Did Electdo alium opwate and tat satWactory 1:1 0 SPGClal Svstoms (Pre-Actinn- nolungb- ofel Page 5 of 5 ftrinklem No. Item Yes no WA 1 00 BWWftM g0ftenilly appear to be In good condition? 2 is any of the fast rasponse has& 20 years of older? 0 3 Are any of the standard heads 50 years or oWer? 0 4 DO sprinklers appear to be fte of corrosion. POIK grease and damage? 5 Is 80 stook or sorage property below sprinklers & piphV? F-1 6 Is Viefe Sufficleirt dock of spare sprinklers available? 7 Efts the e3derlog condition of the sprinkler syslam appear to be ssgsfaftry? 8 Are OPflnkl= the proper tempenidure rat" for Mir Imilons? El 1) 2m floor- Five fire sprinkler heads have excessive corrosion around the sest & need to be replaced. (1W Vlldnq M ias* chrome). j-e 3- In restroom hallway. 2- In women's restroom. 2) e floor kitchen- Two fire sprinkler heads In the cooking emu, In front of grill are covered with grease & Should be cleaned. Note: Two Dry sidewall heads heads In front canopy are an the Central manufacture recall list & should be reolaced. Adjustments or Cofiect-Fow— Waft None .**GO** cosco Fire Protection 15000 Woodinville — Redmond Road, Suite B-800 Woodinville, WA 98072 For Servioe Call: 800-422-2031 or 425-670.2724 ROV. UMAN Occupancy Name: Anthony's Restaurant Date of Report: 04-25-2012 Occupancy Address: 456 Admiral way . Edmonds WA 98020 Recommendation Recommend Adding Or Relocating Fire Sprinkler Heads In These Areas. Note: Do Not Send To Fire Dept Only Send To Owner's Rep. 11)) 2nd Floor kitchen- One fire sprinkler head in front of grill is blocked by duct work and should be relocated. 2) 2nd Floor Behind Bar- No fire sprinker head coveage in 6ft x 8ft hood & triangular space at west end of bar. Recommend adding one head In each space. 3) 2nd Floor Office Area- One fire sprinkler head is over 8'0 off the wall. (Max 7'-V'allowed). Recommend Relocating one head. 4) 2nd Floor- No fire sprinkler head coverage In exterior entrance from sun deck. (5x5' Space) Recommend adding one head. 5) 1 st floor outside front entrance to the Beach Cali& No fire sprinkler head coverage. (I 2ft X 8ft Outside Canopy) Customer Signature: Date: 04-26-2012 page I of I APPLICATION FOR PERMIT FOR MATERIALS OR PROCESSES January 3, 20.12 rreP 7 Please verify and correct the following information: Name of Company (DBA): Anthony's Homeport Edmonds Location : 456 Admiral Way In conformity with the -terms-of-the-International—l— - Fire Code, application is hereby made to store, use Places of Assembly - Occupant Load: 215 or maintain the following activity, storage or pro- cesses: c/o Anthony's Restaurants Mailing Address: P.O. Box 3805 Bellevue, WA 98009 EFD UFIR #: 1612150813201 (for office use) Your Signature Your Name (print) LLL-t,0TT_ Your Title /f V,04W - If Please make corrections, attac n19-0ayable to the City of Edmonds and mail to: Fire Marshal Department of Fire Prevention 121-5 th Avenue North Edmonds, WA 98020 FOR OFFICE USE ONLY Rec'd 2,11 D Check# mI06 COMPLETE Certification Given: RED[:] YELLOWO WHITE FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD R High Pressure Hood Cleaning — SYSTEM TEST REPORT &THood and Duct Services, Inc. Fire Suppression Installation & Service FCONFIDENCETESTIZ REPAIRSE] Fire Extinguisher Sales & Service 6100 12th Ave. S. Phone (206) 726-0940 Range Hood and Fan Service & Repair V- Seattle,WA 98108 Fax (206) 767-2607 Filter Sales & Service DATE - Occupancy Name: 7- Occupancy Address: ��;'%L , I -lase Responsible Person: L.1 A/ Building Owner: city,state,zip: &dA16AJdX Li"); M04LO Phone Number: 417.5-- 72-1 -!V" C) Phone Numben. Building Owner Address: City, State, Zip: Testers Name (Please Print): -6"Aj SFD Certification Number: SCP- iie I'Lo System Alarm? YesZ NoE] Central station monitoring? Yesvr NoE] Monitoring company name: J1111-0 C Control Panel manufacturer: Model Number: Location of Alarm Panel: Pain �, 6 V - Extinguishing System Manufacturer ' AA1-SV System Location/ Height of Range hood: J�� r, AA 1'i"U.L. 300 System? Yes�Aoo U.L. 300 Compliant? Yes E] NoX Chemical Type: WetjM Dry[:] e64 / I A It pressure gauge indicator in operable range? Ye4C bO�No 12 year hydro date of cylinder. Is there chemical inside of the cylinder? Yes 0 No F� a NAC] Wereharidport. ble extinguishers properly_serviced._ _ Ye No-E] 0 Weigh CO2 or nitrogen cartridge. NA [:) Were all cooking surfaces protected? If not, give owner full Yes;;�- No E] No visible signs of a system fire or sy.stem.tampe.ring, (if signs check no). Yes ;? No - F-1 it Check all piping and conduit. Are all piping and c6nclui immobilized with Yes� N�o information. Was operating procedure verbally given to restaurant personnel? Yes 2- No proper hangers and brackets? Was LIL 300 compliance explained to owner or manager? YesRr No F� Are all protective covers present on nozzles? Yes [�t' NoE] Gas sh-- down upon system activation? NA F-1 4ts Yes2- NoE] A re a] no es checked in the proper position? I zzl Yes No Electric power shuts down upon system activation? NA Yes - Noo Does system have adequate volume and/or nozzle coverage? Yes No _Rarigiehoo tied to building alarm panel? NAE] Yesj��- No Cl Are all appliances Inside of the hood pjotectl6n area? Yes No Range hood activation signal received at building alarm panel?- NA Yese No7 Have fuse links been replaced? Yes No F-1 -lasi K--extinguisherp-resent9- Yeskr Noo Was system operational from terminal link? Yes No Grease buildup in group: Was system operational from manual remote? -operational? Yes ff- No Ej Light Medium— Heavy, recommend cleaning r - Date last Was system and micro switch NAF� Yes NoE] of cleaning Are intervals NFPA Yes E!r No F Is system visible and free from obstruction? -the Yes Ej� No Ej cleaning within standards? Test Techrician—kr-.o�i-ik-- Is inspection and service tag on the cylinder? Yes �r No[3 Previous Confidence Company& �A-4d L tl V -L-Um-4- 7 L 1 �1�1 -a —r 'All wo r 7 i -7- -7-1 17', 1 1 1 ot(o Problems Found- (If additional room is needed, please add a separate sheet) or d6 LJA) 06,&-�N 4�6&oW7 ,015 - Ap,- 96% 26�,-O� J,0 Re-OLA-s 61%gar-C7 Corrections Made: Date Corrected: Corrected By: SFD Certificath9n Number: This certifies that this fire and life s ety 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. Discrepapp and d to the building Owner/Responsible Person for corrective action. , "r W �?een reporte -0940 Signature of -% 11 Phone # (206)726 Testing Agar.-,. i& ffHod-d AFEFUct Se-rvzices, Inc. MailingAddress: 610012thAve.S..Seaftle,WA98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight. place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appropriate corrective act9n shall be taken immediately. intended use. 9. A record of the monthly inspections is to a k-,pT refl in(01`15�date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspec frec' s uired. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY I ..� R &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: j Occupancy Address: Responsible Person: Building Owner: COMPLETE FIRE PROTECTION High Pressure Hood Cleaning Fire Suppression Installation & Service Fire Extinguisher Sales & Service Range Hood and Fan Service & Repair Filter Sales & Service FC—ertification Given: RED E] YELLOW ,12- WHITE CONFIDENCE TESTING RANGEHOOD SYSTEM TEST REPORT CONFIDENCE TEST ,0 REPAIRS Phone Number: Building Owner Address: City, State, Zip: Testers Name (Please Print): a 7t &Aq,'8-J- SFD Certification Number: SCP- SystemAlarm? Yese' -EJ s;21" N Central station monitoring? Ye No E] Monitoring company n ame: Control Panel manufacturer: Model Number: Location of Alarm Panel: ht-f— C, a-, Extinguishing System Manufacturer ' Syst m Siz U.L. 300 System? Yes,�-eKoE] LI.L. 300 Compliant? Yes E] No2T— Chemical Type: Weo Dry[] Location / Height of Range hood: is pressure gauge' indicato - r in, . o a , ra . bl , a r . ange? p N 0 12 year hydro date of cylinder. Is there chemical inside of the cylinder? �y N __Were hand. portable extinguishers property serviced? A We!jO,CO2 or nitro an cartridge. , . - 9 NA Were all cooking surfaces protected? If not, give owner full YesF!fj No No visible signs of a system fire or system tampering (if signs check no). Yes No information. Check all piping and conduit. Are all piping and conduit immobilized with Yes -N -0 0 Was operating_ procedure verbally given to restaurant pers_onnel_? — o .,proper hangers and brackets?, 1 Was LIL 300 compliance explained to owner or manager? Yeso- No E] Are all protective covers present on nozzles? Yesg No Ej L-- Gas shuts down upon system activation? NAF� Yes ;�J- NiolE]j Ar . a I all n ozzle s - chec I ked in the proper po I sition . ? Ye SK -N. oo .. - . -- — Electric power shuts down upon system activation? NAO--Ye _ No Does system have adequate volume and/or nozzle coverage? YesZ No E] Range hood tied to buildin alarmpanel? NAF� 9 Yese No E] Are all appliances inside of the hood protection area?- yes2T N9101- Range hood activation signal received at building alarm panel? NA E] Yeso- No E] Have fuse links been replaced? Yes No F-1 Class K extinguisher present? IN 0 Ye a 0 Was system operational from terminal link? Ye No Grease bV'Idup in group: Was system operational from manual remote? YesZ Nor-1 Light Heavy, recommend cleaning 'W a s system and micro switch o iperafional? NAEJ --No F� Date of la s t cle an ino Is system visible and free from obstruction? - ------- Yeso Noo Are cleaning intervals within NFPA standards9 I . -fecknician- kr- YesL;�--NoE] ts thelqspection and service tag_pilthe cyjinder? YOsl]�' . 0. Previous Confidence Te st Company& if F J7 If zw -IJ F ro,41 This certifies that this I and lit te syste Fas jeen properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepa$" s are n I a rted to the buildin Ow esponsible Person for corrective action. Signature of Test . J_y� - Phone # (206) 726-0940 8, OC Slict Services, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108 Testing Agency: A Heil The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: 1. The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seal are nt ad and tight. S ir place and has not been removed or tampered with. 7. The inspection tag or certificate is ill 6 and current. 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, appir . ate corrective action all be taken immediately th, clun , app intended use. 9. A record of the m inspe ns to be kept reflecting a date inspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performin nspe o a an orrections-ir ired. 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE 7 FIRE DEPARTMENT COPY . 0 0 0 0 0 : : i - COSCO Fire Protection 15000 Woodinville- Redmond Road, Suite B-800, Woodinville, WA 98072 Buildinq Details Sprinkler System Description Page I of 2 Rev. 01104/2007 Building Name Anthony's Restaurant (Edmonds) Address 456 Admiral Way City or Town Postal Code Date Edmonds Wa 98020 04-26-2012 Building No. Contact Person Tale hone I Diana 206-448-6688 System Description Control Valves ConW Valve Type Number - Supervised No City Connection 0 Tank El Pump El I Q System 1 0 0 Sectional C1 n Indicator Post Yard PIV I j Im I n Fire PumDs No. Kern yes No NIA I Type N/a 2 Number 3 Driver - Electric 4 Driver - Engine 0 5 Test Header 11 El Fire Department Connections �ftem I I I Number Wet Systems - Alarm Check Valves No. Item 1 Number 2 Make Rasco 3 Sim W'E Wet Systems - Anti -freeze Svstems No. Item I Number —TNIA I .000006 .00000 Dry Svstems COSCO Fire Protection Sprinkler System Description Page 2 of 2 No. Item Yes No I NIA I Number N/a 2 Make 3 odel 4 St7e of Valve 5 Quick Opening Device Soeclal Svstems — Pre -Action No. Item Yes No I N/A I Number N/a 2 Make 3 Size of Valve 4 Supervisory Air Soecial Svstems — Dallune No. I Item 1 Number N/a 2 Make 3 Size of Valve Soeclal Svstems — Other No. Item 1 Type N/a 2 Make Alarms No. Item Yes No I NIA I Water Gong 2 Flow Switches N/a 3 Pressure Switches 4 Did the central station receive all signals 5 Did Electric alarm operate and test satisfactory End of Section .000604 *0000: 1 COSCO Fire Protection 15000 Woodinville- Redmond Road. Suite MOO, Woodinville, WA 98072 BuildinA Details Sprinkler System Description Page I of 5 Rev. 01104/2007 Building Name AnthoniVs Restaurant (Edmonds) Address 456 Admiral Way City or Town Postal Code 1 Edmonds WA 198020 Building No. Contact Person I Telephone Diana 206-448-6688 Inspector Date Trisha Sorenson 04-25-2012 General No. Item Yes No NIA I Are all systems in service? 0 0 2 Have there been any changes or repairs to the system since the last inspection? 0 0 3 1 Do all areas protected by the wet system appear to be properly heated? El El 4 Gouges checked against calibrated gouge and show normal water pressure In past 6 years? El 6 Date of Last Full Trip: N/a 6 Sprinkler system Installed In year Control Valves M -- Are ansprinklering control valves and all other valves In the appropriate open or dosed positions? Ze all control valves In the open position and looked, seated, or equipped with a tamper switch? 0-M, Page 2 of 5 Water Supplies F7—water supplied from Edmonds Tanks, Pumilis. and Fire Deoartment Connections No. Kom Yes No NIA I Are fire pumps. gravity tanks, reservoirs and pressure tanks In good condition? 11 11 2 Have fire pumps been tested to their full capacity In the past 12 months7 0 0 3 Are fire department connections In satisfactory conditions? ED 11 0 4 - couplings free 0 0 0 5 - caps In place ED 0 0 6 - and check valves.11ght 19 0 0 7 Are fire department connections accessible and visible? 19 0 0 Wet Svstems No. Item yes I No NIA I Number of Systems 2 Make Rasco 3 Model 41r E 4 Are cold weather valves In the appropriate open or dosed position? 5 Have aniffreeze solutions been tested? 1:1 El S 6 Were antifreeze test results satisfactory? 0 0 0 Page 3 of 6 Dry Systems No. Item NIA 1 Number of Systems N/a 2 Make 3 Model 4 Date of Last Test 5 Are the normal air and priming water levels normal? 6 Is the air supply satisfactory? 11 El Z 7 Were all the low points drained during this Inspection? 1:1 E] 8 Did the quick opening devices operate satisfactorily? E] 11 9 Did the valve trip properly? 1:1 1:1 10 Did the dry valves appear to be protected from freezing? 1:1 El Z Dry Svstems Schedule Comments Wet Kitchen Hood Svstem No. Item Y" No I NIA I Number of Systems NIA 2 Make 3 Model 4 Type 5 Were valves tested? 2"OS&Y 0 0 6 Did valves operate properly? 2'OS&Y 0 11 ED 7 Did all heat responsW devices operate? 0 0 !] 0 8 1 Did aUsupervisoryfunctionsapamtepropedy? 0 0 Page 4 of 5 ftecial Svstems (Pre -action. Deluae. etc) manual Tip Operative Heat Activated Device Operating System Drained Alarms No. Item Yes No NIA I Did all water motors and gongs operate? 0 0 El 2 Did all electrical alarms test satisfactorily? El C] 0 3 Did all supervisory alarms operate satisfactorily? ED El 0 4 Did the central station receive all signals 9 0 0 5 i Did Electric alann operate and test satisfactory 11 1 C] 0 SDecial Svstems (Pre -Action. Delu-qe. etc) Page 5 of 6 Sprinklers No. Item Yes No WA I Do sprinklers generally appear to be in good condition? El IQ El 2 Is any.of the last response heads 20 years or older? El 3 Are any of the standard heads 50 years or older? El 4 Do sprinklers appear to be free of corrosion, paint, grease and damage? 1:1 5 Is all stock or storage properly below sprinklers & piping? El 1:1 6 Is there sufficient stock of spare sprinklers available? 0 7 Does the e)derior condition of the sprinkler system appear to be satisfactory? [I 8 Are sprinklers the proper temperature rating for their locations? El El EXPI W." on of 'No" Answers: 1) 2 floor- Five fire sprinkler heads have excessive corrosion around the seat & need to be replaced. (112" Viking M 155* Chrome). re 3- In restroorn hallway. 2- In women's restroom. 2) 2d floor kitchen- Two fire sprinkler heads In the cooking area, In front of grill are covered with grease & Should be cleaned. Note: 7wo Dry sidewall heads heads In front canopy are on the Central manufacturs recall list & should be replaced. Adjustments or Corrections Madez None Signatures Inspector Ministe s re nta Date 04-25-2012 I V IT .*00006 cosco Fire Protection 15000 Woodinville — Redmond Road, Suite B-800 Woodinville, WA 98072 For Service Call: 800.422.2031 or 425.670.2724 Rev. 1/24=7 Occupancy Name: Anthonys Restaurant Date of Report: 04-25-2012 Occupancy Address: 456 Admiral Way Edmonds WA 98020 Recommendation Reg)ort Recommend Adding Or Relocating Fire Sprinkler Heads In These Areas. Note: Do Not Send To Fire Dept, Only Send To Owner's Rep. 1)) 2nd Floor kitchen- One fire sprinkler head in front of grill is blocked by duct work and should be relocated. 2) 2nd Floor Behind Bar- No fire sprinker head coveage in 6ft x 8ft hood & triangular space at west end of bar. Recommend adding one head in each space. 3) 2nd Floor Office Area- One fire sprinkler head is over 8'-6!off the wall. (Max 7'-6" allowed). Recommend Relocating one head. 4) 2nd Floor- No fire sprinkler head coverage in exterior entrance from sun deck. (5'x5' Space) Recommend adding one head. 5) 1 st floor outside front entrance to the Beach Cafd- No fire sprinkler head coverage. (12ft X 8ft Outside Canopy) Customer Signature: Date: 04-25-2012 Page I of I va Ml- vif 14N A �l W .. ......... 4 �r— W!, ..... ..... X, V fat -'- I. 'm Zt gi V�A 24 M,N .1 IM 41 Jk I om �r wkv 1. d-i ..&& 00 00: 41% rl C cuo 0*0000 ::000,9:: '60*46 FireProtection 15000 Woodinville- Redmond Road, Suite B-800, Woodinville, WA 98072 Buildinq Details Sprinkler System Description Page I of 2 Rev. 01AX4ZW Building Name Anthony's Restaurant (Edmonds) Address 456 Admiral Way City or Town Postal Code Date Edmonds Wa 98020 04-11-2011 Building No. Contact Person Telephone David Olson 425-771-4400 System Description Control Valves Control Valve Type Number Supervised Yes No City Connection 0 1:1 Tank 1:1 El Pump System 1:1 El Sectional El E I Indicator Post Yard PIV z I— Fire Pumps No. Item --FN/a Yes No I WA I TWO 2 Number 3 Driver - Electric 4 Driver - Engine 0 5 Test Header 0 Fire Department Connections No. Rom 1 Number T T Wet Systems - Alarm Check Valves No. ftern 1 Number 2 Make Rasco 3 Size 49w E Wet Systems - Anti -freeze Systems No. Item I Number N/a Sprinkler System Description &.00 00 00. Page 2 of 2 C 0 No"I C ( 311 Fire Protection Dry Systems No. Item Yes I No N/A I Number N/a 2 Make 3 Model 4 Size of Valve 5 Quick Opening Device Special Systems — Pre -Action No. Item Yes No NIA 1 Number N/a 2 Make 3 Size of Valve 4 supervisory Air Special Systems — Deluae No. Item I Number N/a 2 Make L- 3 1 Size of Valve Special Svstems — Other No. Item I Type Nia 2 L- Make Alarms No. Item Yes No NIA 1 Water Gong 2 Flow Switches N/a 3 Pressure Switches 4 Did the central station receive all signals El El 5 Did Electric alarm operate and test satisfactory End of Section C.000004. ft dr-1 0 .060000- coatu .:60006: Fire Protection 15000 Woodinville- Redmond Road, Suite B-800, Woodinville, WA 98072 Buildina Details Sprinkler System Description Page I of 5 Rev. 0IM4M7 Building Name Anthont's Restaurant (Edmonds) Address 466 Admiral Way City or Town Postal Code Edmonds Wa 98020 Building No. Contact Person Telephone David Olson 426-771-4400 Inspector Date Trisha Sorenson 04-11-2011 General No. Item Yes No NIA I Are all systems in service? Z El 0 2 Have there been any changes or repairs to the system since the last inspection? 0 0 .0 3 Do all areas protected by the wet system appear to be properly heated? 4 Gauges checked against calibrated gauge and show normal water pressure in past 5 years? 00::: 5 Date of Last Full Trip: Nia 6 Sprinkler system installed in year: Control Valves Are all sprinklering control valves and all other valves in the appropriate open or closed positions? JMM Are all control valves in the open position and locked, sealed, or equipped with a tamper switch? Easily Accessible Page 2 of 5 Water Supplies 1 1 1 Water supplied from I Edmonds -1 Test Pipe Location Size Pressure Before Flow Pressure Pressure After At Riser 2- 140 psi 120 PSI 135 PSI Tanks, Pumps, and Fire Department Connections No. Item Yes No NIA 1 Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition? 0 0 2 Have fire pumps been tested to their full capacity in the past 12 months? 1:1 3 Are fire department connections in satisfactory conditions? 0 4 - couplings free 1:1 El 5 - caps in place El El 6 - and check valves tight El 7 I Are fire department connections accessible and visible? E El Wet Systems No. Item Yes 1 Number of Systems 2 Make Rasco 3 Model 49' E 4 Are cold weather valves in the appropriate open or closed position? 5 Have antffreeze solutions been tested? 6 1 Were antifreeze test results satisfactory? Page 3 of 5 Dry Svstems No. Item Yes No N/A I Number of Systems Nia 2 Make 3 Model 4 Date of Last Test 5 Are the normal air and priming water levels normal? 6 Is the air supply satisfactory? El 0 z 7 Were all the low points drained during this inspection? El r-1 8 Did the quick opening devices operate satisfactorily? 1:1 9 Did the valve trip properly?. E] 10 Did the dry valves appear to be protected from freezing? Dry Systems Schedule Trip Point Air i Pressure I ime of Water to Test I Point Wet Kitchen Hood Svstem No. ttern Yes F No WA 1 Number of Systems N/A 2 Make 3 Model 4 Type 5 Were valves tested? TOS&Y 0 6 Did valves operate properly?. 2* OS&Y n 7 Did all heat responsive devices operate? E] 8 Did all supervisory functions operate properly? Page 4 of 5 Jal Systems (Pre�acfion, Deluge, etc) elm Manual Tip Operative I u vi S !II?el- vision Alarm a, lol- 101t,11111 Heat Activat Device Operating 0000000MMMIMM Alarms No. Rom Yes No NIA I Did all water motors and gongs operate? El 2 Did all electrical alarms test satistctorily? 3 Did all supervisory alarms operate satisfactoriv. 4 Did the central station receive all signals 11 El 5 I Did ElecWc alarm operate and test satisfactory I El El ED Special Systems (Pre -Action, Deluq-e. etc) Location Type of Device Alarm Time Delay Comments Yes No N/a 0 E] El 1:1 . El 11 1:1 El [I 1:1 1:1 E] 11 1:1 El 0 El El 1:1 Page 5 of 5 Sprinklers No. Item Yes No NIA 1 Do sprinklers generally appear to be in good condition? 2 Is any of the fast response heads 20 years or older? 3 Are any of the standard heads 50 years or older? El 0 El 4 Do sprinklers appear to be ftee of corrosion, paint, grease and damage? E] 0 5 Is all stock or storage property below sprinklers & piping? -E] 6 Is there sufficient stock of spare sprinklers available? 7 Does the exterior condition of the sprinkler system appear to be satisfactory? U 8 1 Are sprinklers the proper temperature rating for their locations? C1 El Explanation of 'No"Answers: 1) Fife department connection five year flush is due. (CV & Riser). 2) Internal piping & valve exam is due. (Piping 1 Oft Off Floor). 3)2 nd floor- Five fire sprinkler heads have excessive corrosion around the seat & need to be replaced. ( 112" Viking M 155* Chrome 3- In restroom halfway. 2- In womens restroom. 4) ls'& 2rd floor kitchen- Eight + fire sprinkler heads in the cooking & dishwashing area's are covered with grease & debris need to be cleaned & or replaced. 4- 112" Rosco 212* Brass SSU. 4- 112" Viking M 250* Chrome SSP. 6) Two Dry sidewall heads heads in front canopy are on the Central manufacturs recall list & need to be Adjustments or Corrections Made: 1)) 2� Floor kitchen- One fire sprinkler head in front of grill is blocked by duct work and should be relocated. 2)2 nd Floor Behind Bar- No fire sprinker head coveage in 6ft x 8ft hood & triangular space at west end of bar. Recommend adding one head in each space. 3) 2nd Floor Office Area- One fire sprinkler head is over 8'-6" off the wall. (Max 7'-6" allowed). Recommend Relocating one head. 4) 2nd Floor- No fire sprinkler head coverage in exterior entrance from sun deck. (6'x5' Space) Recommend adding one head. 5) Vt floor outside front entrance to the Beach Caf6- No fire sprinkler head coverage. (12ft X 8ft Outside Canopy) Signatures Inspector Minister's Representative Date 04-11-2011 AML VERIFIED ELECTRONIC SECURITY SON ITROL PACIFIC A Sound Security, Inc. Company SONITROL PACIFIC FIRE ALARM 200"SEATTLE El PORTLAND 1:1 BOISE 1406 140th Place NE Ste # 107 \8220 N. Interstate Ave. 3657 W. Wright Street Bellevue, WA 98007 Portland, OR 97217 Boise, ID 83705 Bus: 425-641-8948 Bus.- 503-223-5822 Bus: 208-426-9367 Fax: 425-641-8958 Fax: 503-973-7773 Fax: 208-426-9369 INSPECT; E] EVERETT " k 2221 California Street Everett, WA 9820.1_,� Bus.- 425-258-3655 'Fax: 425-258-3658 ORM 1:1 TACOMA 2115S.56 1h Street, Suite 308 Tacoma, WA 98409 Bus: 253-383-5051 Fax: 253-627-1622 Inspection Date: I/q 404 2� Annually Quart , erlyE] MonthlyE] Acct, 7 -73 Facility Name: (U4%ayL.W,,C Phone - Address: q 5(y' A &'v wvcd W"— City/ST/Zip: Ec)w0&v(, 0C A Fire Alarm Control: PAO Manufacturer: Fire- I ITS Model: Ser�sj 3CAJ oco Number of Initiating Circuits: Initiating Circuits Supervised: dr�) NO Number of Signaling Circuits: Signaling circuits Supervised: OD NO Trouble with AC Off: C11501 Communicator: 51ZS DlAkC (Zn Battery.Voltage: zq Charging Cii�cuit Voltage: Zq Key to Panel Available 4!55 Operating Instructions Posted: ep NO Breaker Locations Posted:- �. YES (:0 NO Communication Type: Dedicated/ STU volts. Battery Voltage Under Load/ No A/C Volts: I z -Ul- V-110 Volt .14, Chi�rging Circuit Current AMPs f-ai NO LL obtioneV jApra,'JA ogj�'x N 0) L o c a t i o n I-) ...... Equipment Type Numb yvits 10 ,,er,of atisi9_00.' Mahufacturer Comments -�'Total J�V;sted —YES or t�q% I' .Bells Y_ _N_ uw4+s Dtat&r 6) lm&Aali, k0l PV�0141 eM C)0Wh54*1e( Strobe Horns Cl 4es Strobes A Manual Pull Stations !*I,x (V N INC, -A tA Smoke Detectors N Heat Detectors -4�)l -t 6) N s PIV Valves �(2)_ N _5_1 VK Tamper Valve Switch N Waterflow Switch N �CP �Y"'; Air Pressure Switch Y N Problems Found: B(110 -CAAS 40 P-t,00ir I brA3 PA-M Y �'( '2) P9 KA-12 Vb0p ssir.0-4 W OLD el"b ';�Ccc ?'%0 -T%,.o i^-b !�tp,%ok Corrections Made: &IOrIAet) 9 gt)hj4Aj I I This report is to certify the above listed fire alarm equipment has been properly tested and inspected for reliabili MAIT *nA M vi�ro Owner/Represe�n-fafi�e—Si'gnature License # FIRE PREVENTION Serving Bt-iet: Edmonds. siqbHdmiSH CO. 12425 Meridian Ave S INSPECTION REPORT Mountlake Teiiaceand TIRE' Evei-ett, WA 98208 El EDMONDS [1 BRIER DISTR- T th e Town of Woodway Phone (4-95) 551-1200 E]WOODWAY [I MOUNTLAKE TERRACE www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED e- FREQUENCY STATION 1, SHIFT'*) LOCATION: 456 Admiral Way 365 17 D BUSINESS NAME: Anthenys Restaurant PHONE: 4257714400 SCHEDULED DATE DUE � 08/01/11 MAILING P013 #3805 UFIR � 161 8� 201 ADDRESS: Bellevue 98009 BUSINESSOWNER: Mad Anthonys Inc. HOME PHONE: 42545511:732 PREFIRE 215 EMERGENCY-1: HOME PHONE: CURRENT" KEY ACCESS-2: HOME PHONE: CITY YES BUSINESS LICENSE PERSON CONTACTED: INITIAL INSPECTION DATE NAME OF INSPECTOR: c> RRE AS 4,�l 1 FA 11/10 HD 4/11 Z_ F2,) SY�TEMS: % , 'k HAZARDS FOUND AND LOCATIO7 COMMUNICATIONS 4� 7 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 EXTENSION -INSPECTION VIOLATIONS DATE DUE: DATE DUE: GRANTED TO: DATE DUE: CITED: PERSON PERSON PERSON CONTACTED: CONTACTED: CONTACTED: INSPECTOR: INSPECTOR: INSPECTOR: 2 DATE: DATE: DATE: 3 VIOLATIONS VIOLATIONS PRE -CITATION CITATION ISSUED 1 5 5 LETTER SENT NUMBER: 4 -1 CODE 5 2 6 2 6 DATE: SECTION: RETURN RECEIPT 3 7 3 7 RECEIVED 6 DISPOSITION: 7 4 18 I 4 8 1 DATE: LETTER NEEDED E] YES El NO LETTER NEEDED E] YES El NO 8 FIRE DEPARTMENT COPY R &THood and Duct Services, Inc. 6100 12th Ave. S. Phone (206) 726-0940 Seattle,WA 98108 Fax (206) 767-2607 Occupancy Name: AA))r4oma� h Occupancy Address- !/5-6 �Idm I? - COMPLETE Certification Given: RED[:] YELLOWW WHITE01 FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD High Pressure Hood Cleaning SYSTEM TEST REPORT Fire Suppression Installation & Service ONFIDENCE TEST,2' REPAIRSE] Fire Extinguisher Sales & Service Fc Range Hood and Fan Service & Repair Filter Sales & Service DATE: /0 Responsible Person: 57A ciI. ,j tJ Building Own:r: Building Own r Address: Testers Name (Please Print): SystemAlarm? YesL?- NoE] Central station monitoring? YesEr NoEl Control Panel manufacturer: ___ Model Number:— City, State, Zip: PhoneNumber: 1-/LS--77/-VV00 Phone Number: City, State, Zip: SFD Certification Number: SCP- Monitoring company name: _114 AIII'J"tr a — Location of Alarm Panel:- Fo.-71 of Fit-e- zo Extinguishing System Manufacturer AWSOL . _ System Size-3t-3 I.I.L. 300 System? Yes/No F-1 I.I.L. 300 Compliant? Yes E] No/ Chemical Type: Wet [ZDry F-1 Location / Height of Range hood: k /,,I& Y/ W ` Is.pressure gf�ygejndici�tqr in, Perable ranqe? ZL YeIl,� No E3 12 year hydro date of cylinder Is there chemical inside of the cylinder? Yes No[-] 1 Were-ha'n-d,-p-o-rt-a-bl-e.—e'x- - gui-shers properly serviced? INA F� tin Yes ;;4w NO 13-1 Weigl� CO2 qE In roge�cartridge. NAE] _7_9_�_CLT. Were all cooking surfaces protected? If not, give owner full Yes [;J- No El No visible signs of a system fire or system tampering (if signs check no). Yes No F� Check aJI'pipinganJ c'"ond-u-it-Are all piping and conduit immobilized with Yes i�io� information. Was operating. procedure verbally given to restaurant personne ? Yes[�Jm No[]_1 1 proper hangers and brackets? Was LIL 300 compliance explained to owner or manager? Yes No E] Are all protective covers present on nozzles? Yes [�J- No E] 1 Gas s uts down upon systemactivation? NAE] Nbs 0 Are all nozzle�k-chdcked in the,proper�,po�ition? Yes W� Electric power shuts down upon system activation? NA F_� Yes Noo Does system have adequate volume and/or nozzle coverage? Yes [I" No E] ange hood t ad tobuilding alarm1pariel? N R I A Yes No r_�7i Are all appliqipncds� inside of the:hood protection area? Yes No Range hood activation signal received at building alarm panel? NA[:] Yes No Have fuse links been replaced? W - assystembi3p Tatii�nai[ from terminal link? Yes El' No E] No -Class,K extingu!_�h�r present? Grease buildup in group: Yes No El i Was system operational f . rorn manual remote? i Was system.- d inic sw tch operational? Yes No F-I NAE] Yes E No Light Medium_4�� Heavy, recommend —Date of last cleaning 1111" 4i _` 7_0 c - lea . n . ing Is system visible and free from obstruction? Yes [��e Noo hi NFPAstandards? Are cleaning intervals wit 4 Yes No Is theJnspectiian�and-service tag'on the cylinder? Previous, Co.nf-iden'ddTes.t-Comp@pyATe(;!�nician Li 7_1 A i _4 + 6 L4 Problems Found: (if additional room is needed, please add a separate sheet) 7C'Z Aj-r—opw Lor Corrections Made: Date Corrected: Corrected By: SFD Certification Number: This certifies that this fire and life sTety system has been properly inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code standards. Discrepan 0 and hAua-.byxn reported to the building Owner/Responsible Person for corrective action. -0940 Signature of Tester: 0dr, Phone # (206)726 Testing Agency: _R&T Holid and Duct Services, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108 The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following: I . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are� ac ' iunrd maged and tight. , P� _" place and has not been removed or tampered with. 7. The inspection tag or certificate is ii and r:nt 2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, a rop e correc ive action hall be taken immediately. intended use. 9. A record of the monthly inspe i s t be ke retlectin he �Uarefhspected, inititals of 3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspec o an or ct ns re 4. Observe system, checking that no obvious physical damage or condition exists that might prevent operation. AUTHORIZED 5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE FIRE DEPARTMENT COPY APPLICATION FOR PERMIT FOR MATERIALS OR PROCESSES March 7, 2011 Please verify and correct the following information: E� ( , - == M q V MAR 't, rA�10[ - - L.,-, � EDMONDS F�i4�DEPT- Name of Company; DBA Anthony's Homeport Edmonds Location 456 Admiral Way In conformity with the terms of Places of Assembly - Occupant Load: 215 the International Fire Code, application is hereby made to store,. use -or maintain. the - following activity, storage or processes: Mailing Address: Anthony's Restaurants P.O. Box 3805 Bellevue WA 98009 EFID LIFIR #: 1612150813201 (for office use) Your Signature Your Name (print) Your Title Please make corrections, attach $40 payable to the City of Edmonds, and mail to: Fire Marshal Department of Fire Prevention 121-5 th Avenue North Edmonds, WA 98020 i� CITY OF EDMONDS DEPARTMENT OF FIRE PREVENTION PERMIT January 1, 2011 161-215-0813-201 December 31, 2011 Date of Issue UFIR Number Date of Expiration I This PERMIT is issued to: I Anthony's Homeport I located at: 1456 Admiral Way I Edmonds, WA = I To engage in the business, occupation or pr cess of: I I And shall constitute permission to maintain, store, use or handle materials or to conduct process which produce conditions hazardous to life or property or to install equipment used in connection with such activities as follows: Places of Assembly - Occupant Load: 215 ---F- Allowed Occupant Load, 215 Pursuant to the provisions of the International Fire Code, any violation of the Code may be grounds for the revocation of this PERMIT. This permit does not take the place of any license required by law and is not transferable. Any change in the use or occupancy of premises shall require a new permit. rtment of Fire Pr6ention This Permit Must Be Posted At All Times in The Premises Identified Above City of Edmonds Community Development Code 19.25.020 UP- I, & e) a,, c,) Fire Protection 15000 Woodinville- Redmond Road, Suite B-800, Woodinville, WA 98072 Buildina Details Sprinkler System Description Page I of 2 R---,7- =3Q=7 Building Name Anthony's Restaurant (Edmonds) Address 456 Admiral Way City or Town Postal Code Date Edmonds Wa 98020 04-11-20 11 Building No. Contact Person Telephone David Olson 425-771-4400 System Description Control Valvas ConW Valve Type Number Yes No -City Connection El Tank 11 11 Pump 0 System El 0 Sectional ED I Indicator Post Yard PIV z + F1 0 Fire Pumns No. Item Yes I No I N/A 1 Type /a 2 Number 3 Driver - Electric 4 Driver - Engine El 0 5 Test Header 11 z Fire Denartment Connactinns No. I " I I Number Wat Svstams - Alarm Chai-k VnIvem No. Rom 1 Number 2 Make Rasco 3 Size 4" E Wat Svstems - Anti-frm7a Svittamit No. Item 1 Number N/a /:Vll� 11�� :06 60 at) 4310 06 *C, Fire 1"rotection Dry Systems Sprinkler System Description Page 2 of 2 No. Item Yes A I Number Nia 2 Make 3 Model 4 Size of Valve 5 Quick Opening Device El Special Svstems — Pro -Action No. Itern Yes A 1 Number N/a 2 Make 3 Size of Valve ,-4 TSupervisoryAir EI:FZ Special Systems — Deluae No. Item 1 Number N/A 2 Make L 3 Size of Valve Special Systems — Other No. Item 1 Type N/a 2 Make Alarms No. Item Yes —TWA t_ No 1 Water Gong 2 Flow Switches N/a 3 Pressure Switches 4 Did the ntral station rece I ive all signals El 5 Did Electric alarm operate and test satisfactory FIE:11 End of Section CG C.Q. C, CO" 0 (g, C"(D G 0: 0 C' 00 C-1 11 Fire Protection 15000 Woodinville- Redmond Road, Suite B-800, Woodinville, WA 98072 Building Details Sprinkler System Description Page I of 5 Rs�t 01reQM37 Building Name Anthont's Restaurant (Edmonds) Address 456 Admiral Way City or Town Postal Code Edmonds Wa 98020 Building No. Contact Person Telephone David Olson 425-771-4400 Inspector Date Trisha Sorenson 04-11-2011 General No. ftem Yes No N/A 1 Are all systems in service? 2 Have there been any changes or repairs to the system since the last inspection? El 3 Do all areas protected by the wet system appear to be properly heated? 11 —[1 0 4 Gauges checked against calibrated gauge and show normal water pressure in past 5 years? L5 Date of Last Full Trip: N/a 6 Sprinkler system installed in year Control Valves 077 MMM MM mom M MM MMMM M MW MMM MMM mom M MM mom M MW MMM M MOME MMM so M—MM MMMMMM- Page 2 of 5 Water Supplies I I Water supplied from Edmonds Test Pipe Location Size Pressure Before Flow Pressure Pressure After At Riser 2- 140 psi 120 PSI 135 PSI Tanks. Pumns. and Fire Danartmant r-^nn,&.-#i,%n. No. Item Yes No I N/A 1 Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition? F- 2 Have fire pumps been tested to their full capacity in the past 12 months? 3 Are fire deparbnent connections in satisfactory conditions? 4 - couplings free El 5 - caps in place 0 6 - and check valves tight El 7 1 Are fire department connections accessible and visible? El Wet systoms No. Item Yes No I N/A 1 Number of Systems 2 Make Rasco 3 Model 491 E 4 Are cold weather valves in the appropriate open or dosed position? 5 Have antifreeze solutions been tested? El El 0 6 Were antifteeze test results satisfactory? 11 [1 0- Page 3 of 5 Dry Systems No. Item Yes No N/A 1 Number of Systems N/a 2 Make 3 Model 4 Date of Last Test 5 Are the normal air and priming water levels normal? 6 Is the air supply satisfactory? 7 Were all the low points drained during this inspection? El 8 Did the quick opening devices operate satisfactorily? E] 9 Did th valve trip properly? 10 Did the dry valves appear to be protected from freezing? Dry Systems Schedule M i Trip Point Air Pressure Tir ne I 1 01 Waiter to Test Point Wet Kitchen Hood System No. ttern N/A I Number of Systems WA 2 Make 3 Model 4 Type 5 Were valves tested? 2"OS&Y El 6 Did valves operate properly? 2'OS&Y El 7 Did all heat responsive devices operate? El 8 Did all supervisory functions operate property? El 13 Page 4 of 5 .Jal Systems (Pre -action. Delype- etcl F Type of System Ma E Operativ Super- vision Super - vision Alarm Functional Heat Activated Device Operating:1M MOMM WOMMMMM MMMMMM M MMMMM WOMM MIUMMMME Alarms No. Item Yes No N/A I Did all water motors and gongs operate? 0 E] 2 Did all electrical alarms test satisfactorily?. EJ 0 -0 Z 3 Did all supervisory alarms operate satisfactorily?. 4 id the central station receive all signals El 5 Did Electric alarm operate and test satisfactory 0 z Special Systems (Pre -Action. Deluge- atel Location Type of Device Alarm Time Delay Comments Yes No N/a 0 El El El 13 1:1 El El 13 El 13 El 1:1 1:1 El E] Page 5 of 5 Sprinklers No. Item Yes No NIA I Do sprinklers generally appear to be in good condition? El 0 El 2 Is any of the fast response heads 20 years or older? E] 3 Are any of the standard heads 50 years or older? 4 Do sprinklers appear to be free of corrosion, paint, grease and damage? El 5 Is all stock or storage property below sprinklers & piping? 0 El 0 6 Is there sufficient stock of spare sprinklers available? 7 Does the exterior condition of the sprinkler system appear to be satisfactory? 8 Are sprinklers the proper temperature rating for their locations? 1) Fire department connection five year flush is due. (CV & Riser). 2) Internal piping & valve exam is due. (Piping 1 Oft Off Floor). 3) 2nd floor- Five fire sprinkler heads have excessive corrosion around the seat & need to be replaced. ( 112" Viking M 155* Chrome 3- In restroom hallway. 2- In womens restroom. 4) Ist & 2nd floor kitchen- Eight + fire sprinkler heads in the cooking & dishwashing area's are covered with grease & debris need to be cleaned & or replaced. 4- 112" Rosco 212* Brass SSU. 4- 112" Viking M 250* Chrome SSP. 6) Two Dry sidewall heads heads in front canopy are on the Central manufacturs recall list & need to be Adjustments or Corrections Made: 1)) 2� Floor kitchen- One fire sprinkler head in front of grill is blocked by duct work and should be relocated. 2) 2nd Floor Behind Bar- No fire sprinker head coveage in 6ft x 8ft hood & triangular space at west end of bar. Recommend adding one head in each space. 3) 2nd Floor Office Area- One fire sprinkler head is over 8'-6" off the wall. (Max T-6" allowed). Recommend Relocating one head. 4) 2nd Floor- No fire sprinkler head coverage in exterior entrance from sun dock. (S'xS' Space) Recommend adding one head. 5) 1" floor outside front entrance to the Beach Caf6- No fire sprinkler head coverage. (12ft X 8ft Outside CanoDv1 Signatures Inspector inister's Representative Date 04-11-2011 ,cX(( et C S 15000 Hloodinville-Redmond Rd, #B800 :OE4(,(�Cc: U ZO Woodinville. HIA 98272-4502 hone: (425) 827-9654 Fox: (425) 827-7474 or (425) 486-1367 Fire Protection 'Toll Free: (800) 487-2947 WA State ConfractorsLicense: COSCOFPIIONM e MIA State ElectricalLicense: COSCOFP935MS Page 1 of Cosco Work Order #: (Io -7 Dept. / Jurisdiction: Date of Corrections: I I Technician: -k) 4 F0,L Certification No.: 0 0 -ez? --Name of Buil0ig_--___._ Av,,Nk,\Lm V'f (4o b-t Pc� Address of Building: ;j P5 (a A ,,kyn �h ( vUA State: �k) zip: r-ck %,- C2 V\_ A.) Attention: Phone: REPAIRS/CORRECTIONS OF DISCREPENCIES: Fire Sprinkler System(s) F� REPAIRS/CORRECTIONS OF DISCREPENCIES: Fire Alarm System(s) eOL,(— F C 7, c kc k= (U-S L-1 0 v Signature of Technician: Date: SONITROL VERIFIED ELECTRONIC SECURITY SON ITROL PACIFIC A Sound Security, Inc. Company SON ITROLPACI, F1C.F1 REALARM INSPECTION FORM F� SEATTLE F� PORTLAN . D BOISE EVERETT �E]'TACOIVIA ' 3657 W. Wright Stree Yalifornia Street 2115 S. 56th Street, Suite 308 1406 140th Place NE Ste # 10 8220 N. Interstate Ave. t 22 1 CC Bellevue, WA 98007 Portland, OR �97217 Boise, ID 83705 Everett, WA 98201 Tacoma, WA 96409 Bus: 425-641-8948 Bus: 503-223-5822 Bus: 208-426-9367 Bus: 425-258-3655 Bus: 253-38.3-5051 Fax: 425-641-�958 Fax: . 503-973-7773 Fax: 208-426-9369 Fax� 425-258-3658 Fax: 253-62771622 Inspection Date, /14'esbo Annually 'qK Warterly Monthly F-1 Acct Facility Name.: A"12MN4 _y, Phone: Address: q5(0 j4OW19,61- City/ST/Zip- W A Fire Alarm Control: Manufacturer: rilp Model: Number of Initiating Circuits: Initiating Circuits Supervise,d: Y ZEN 0 NO Number of Signaling Circuits: Signaling circuits Supervised: ES Trouble with AC Off: Y NO Breaker Locations Posted'. Y S. ('nrhmi inirntnr- NO Co munication Type: i_qI_HP' Prjir_qfizrj1 qTH Battery,Voltage: Charging Circuit Key to Panel Ava Operating Instruc Voltage: ilable tions Poste.d::: OYES Volts: Volts: 422-ba:� Battery Voltage Under Load/ 0 C volts: Charging Circuit Current NO Location: NO Location: AMPs *7 Equipment Type Number of, Units Satisfactory Manufacturer Comments Total Tested YES or NO N N Strobe Horns (y) N Strobes -Y N —4 Manual Pull Stations N Smoke Detectors N Duct Smoke Det Y N Heat.Detectors N PIV Valves Y. N Tamper Valve Switch Y N Waterflow Switch N Air Pressure Switch Y N Problems Found: Corrections M6de: -- ----- - ------ - - This report is to certify the above listed fire alarm equipment has been properly tested and inspected for reliability. Owner/Repre-6ntative Signature hnic n 7;c;h"n`c; License # Th . . . . . . . . . . MEMORANDUM "r Date: June 5, 1996 To: File From: John Westfall, Fire Inspector Subject: Use of LPG -Fueled Portable Space Heaters in Assembly Occupancies Study prompted by T.J. McCaa of Scott's Bar and Grill, 8115 Lake Ballinger Way. 4/29/96 Mr. McCaa requested a site inspection of four 6 1/2' tall propane fueled upright heaters for use on the outside wooden deck dining area. 4/30/96 Inspected site. Mr. McCaa informed me that other jurisdictions utilize this type'of appliance and demonstrated its use for me. The deck is approx. 10' wide to the eaves of the building. A 6'wooden fence surrounds the deck and decorative brush rises above the fence from outside the perimeter. 4 spare LPG tanks stood on the deck adjacent to the building. I asked Mr. McCaa if the spares could be stored elsewhere, away from the restaurant building perhaps in an exterior storage building. He told me they could. In departing I viewed the structures on the property and could find no detached storage areas from the main assembly building. The portable appliances were Sun-Glo brand Model A270 "Construction Heater" for indoor/outdoor use. Each appliance stands approximately 6 1/2' high. The lower portion holds a common barbeque size (DOT -type) propane tank of 48 pound water capacity (approx. 6 gallon). One tank fuels each appliance. The burner is at about 6' high, covered by a cone - shaped radiant reflector. The appliance with tank installed is not prone to spillage due to its heavy bottom weight, when fully fueled. The appliance is, however, meant for portable applications and can be moved relatively easily. I left site and Mr. McCaa with a tentative approval pending further research and contact with jurisdictions who have approved these type of appliances in assembly occupancies. The occupant load for Scott's is 265, in varying states of alertness and inebriation, due to the full bar area inside to where the deck is adjoining. The deck is combustible, as is the building siding, fence and reaches of brush over the fence. The appliance is I.I.L. listed as a construction heater (not intended for heating assembly areas?). UFC 2501.18.3 describes use of "candles and other open flame decorative lighting" in places of assembly. Although this section may not be an exact reference to this particular use, one item noted in section I states "Class I and 11 liquids and LP -gas shall not be used" for these processes. City of Edmonds * Office of Fire Prevention I reviewed UFC Article 82 and Standard 82-1 for LPG requirements. A high level of restrictions are imposed upon storage and use of LPG containers. UFC 8203.2.1.2 exempts portable LP -gas containers in areas of buildings undergoing construction. Buildings as such are not generally occupied and mostly new uninhabited until work is complete. UFC Standard 82-13-4.4.1 allows for use during minor construction renovations while a building is open to the public. Exemption is limited to one 50 lb W.C. (20 lb. LP -gas capacity) per each worker assigned to using the LP -gas. Construction is acknowledged as a temporary process, and does not imply a continual use. Once construction is complete, the appliances would be removed. UMC Section 504 (0 prohibits uLPG appliance" installation in pits, basements or similar locations. The installation at Scoff's is at ground level, the deck is perhaps less than one foot off the ground level, the kitchen area is reached, however by stepping down from the bar area. UMC Section 506 requires shut offs on such LPG fuel heating appliances. I am unaware if the Sun-Glo Model A270 contains a fuel -shutoff. I called Mr. McCaa back and told him of my concerns and that I could not approve his installation. I relayed to him the preferred "gas -fired heater installations" per UMC Section 19 with submission and approval of plans for their installation. Natural gas fuel is already piped to the site, fueling the restaurants cooking appliances. I also mentioned that I would be willing to consider the safety restrictions employed by other jurisdictions in order to safely implement and jurisdictionally approve this type of use in his type of occupancy. Mr. McCaa explained to me that Seattle Fire Department allows these appliances at uCucina Cucina's", and that "Anthony's" in Edmonds also utilizes them. I contacted Captain Wick, of Seattle Fire Marshal's Office, 386-1355. Captain Wick denied that such a use is approved in Seattle and could offer no safeguards for its approved use. I contacted Everett FD, who also could provide no approved safeguards for such a use. 5/9/96' Met with Eric, General Manager of "Anthony's" to view his LPG fueled heater use. Two of these appliances were standing on the second floor exterior deck dining area. I explained that this was not a Fire Department approved use and that he must remove the LPG storage from the building and discontinue use of the propane heaters. Eric mentioned that to the north of the building on the concrete patio were gas -fueled heaters similar to the propane -fueled appliances -of concern. These appliances are Sun-Glo brand Model A242 "Construction Heater" for indoor/outdoor use and were plumbed with natural gas from beneath the concrete patio in what appeared to be an orderly and approved mechanical installation. I explained to Eric the behaviors of the various fuel gases; LPG vs. natural gas. The fire department has no problem with the natural gas appliance installation. 5/9/96 Left message for Mr. McCaa 5/20/96 Mr. McCaa returned call with information regarding a usage in San Ramone, CA, at a restaurant called "Maestro's". He mentioned that Costco also, has these appliances now for sale. I made mention of the fact that this type of LPG use is similar to the use of non-commercial barbeque appliances, used commonly in R3 occupancies. I contacted George Devendorf, Inspector for Valley Fire District (510)838-6600. George acknowledged that these appliances are in use at "Maestro's" restaurant and that the heaters are: 1) clear of exit pathways, 2) used outside of building only, 3) used on an open patio, and 4) used on ground level. George has 5 years of experience for Valley Fire in his current capacity and recalls that this type of use had never been disapproved or disputed. I contacted a Deputy Fire Marshal from San Diego Fire Department (619)533-4400. He explained to me that UBC Table 3-D is utilized to set exempted quantities for liquified flammable gases. San Diego's interpretation provides that assembly occupancies can have up to four control areas where LPG may be stored or used (closed system) to a quantity of 15 gallons per control area. This amount may double in a fully -sprinkled building, and double again if storage is within approved cabinets. My thoughts regarding this interpretation are that these appliances are actually "open-systerrin use, as the fuel vapors are liberated to atmosphere prior to combustion. UBC Table 3-D provides no exemption for open -system use for liquified flammable gases. I contacted Ingrid Alston of the CA State Fire Marshal's Office (916)262-1963. Ms. Alston shed some light on the CA State Fire Code system. The 1994 Uniform Fire Code is not utilized in whole. UFC Article 82 is not adopted at all. CA State has a Public Safety Code which appears to be not as restrictive as the UFC toward LPG storage and use. National Fire Protection Agency (NFPA) standards address as follows: NFPA 1, 30-5.3. 1: LP -gas storage within buildings frequented by public is limited to a maximum 2.5 lb W.C. Allowance is made for temporary emergency heating: NFPA 1, 30-3.3.6. Allowance is made for buildings under construction or undergoing major or minor renovation: NFPA 1, 30-3.3.2 & 3. UFC Standard 82-1 is an adoption of NFPA 58, and the Standard has been so referenced. cc: File: 8115 Lake Ballinger Way File: 456 Admiral Way- 0 MEMORANDUM DATE 57N & (,, I.D. REPORTED BY OF SUBJECT ADDRESS: 't -56 CONCERNS/ 70 HAZARDS: 7-0 T. T SIGNED — FOLLOW -UP: rj. CT-"M L -16C4,0X— &AII -/Z— r! I r Sum -CLo MI-LO SIGNED V City of Edmonds * Office of Fire Prevention A i wA P di,dite'si W/DIGITAL' ig 6 mou V ,�.muse, Anti -shock oil 6WO s:clas means your CD ' s,AdvA'n-d Vw,4W to runor ski. Als'(6jj* 'o ud�: ran Bass) 1-bit dual - a of.fte remote -control cagffi. - gold-6d� filter, 24-selectibn ran,.- he' 'ess rechargeable baii9ty'ks't� $129— abaw, dinhei-oh 1. 1_11 ..* . 1�, teacuo ana sauci KIRKLAND SIGNsrURE STEAKS (Our famous tender, succulent and hand -trimmed U.S.D.A Choice grade meats. This steak pack includes: - Choice beef New York (strip loin) Steaks. Firm textured and hand -trimmed to a maximum of 1/4" exterior fat, cut from the flavor -packed loin section. 2 pieces; 14-16 oz. each steak. - Choice beef Lip -on Ribeye Steaks: Often considered the most flavorful, containing ample marbling and a distinctive texture. Wonderful grilled, saut6ed or broiled. 2 pieces 14-16 o- each steak. Choice beef Tenderloin Steaks (Filet Mignon): This thick, rich cut of meat is the most tender of all steaks. -1 pieces 7-.9 oz. each steak $4999 ITEM #131707 (S & H $15.00) PHOENIX PATIO HEATER By DCS GRj�andy and cost-efficient, fashioned from polished stainless ste Phoenix features a 40,000 BTU bumer system with 1000% safety shi t o a 20-fi electric ignition, and adjustable heat control, providing up t !!"Cl cle, of heat. The unit houses a 5-gallon, 20-pound LP/propane and i equipped to utilize 5 LPA quick -disconnect system. Tank not included. 92"H. Model #DCS PHIS $69999 ITEM #130415 V hAd a )rder IS W =955-2292'* Your-,: receive -.77.: J. Mau aptage:q.even o value . .9 P) t ee,your,5aMWU6A*, nc ever b P W �o�,,h h0' .ypro a Y 1'n Oe;; W hdf your meni ipfi it &U J14, ,�e o inspirat!ort, P sa t - tqldg 6ff0;"(1 ja,_, W�� W_.WV_0F,'1 77 0. � I 0 February 2, 1989 MEIM0 TO-: All Personnel Fire Department FROM: Gary L. McComas Fire Marshal SUBJECT: ANTHONY'S HOME PORT Sprinkler system problems.occured at Anthony'.s Home Port and resulted in a broken.pipe. The system will be,out until further notice and a 24 hour. sentry will be on site until the system is restored. GLM.: be cc: Police Department I Insurance BrokersISurety Bonds 1700 First Interstate Center1999 3rdAvenue Seattle, Weabington 98104 (206) 382- 7900 Telex (71) 296332 PSFS UR Parker, Smith &Feek, Inc. December 15, 1986 Mr. Gary L. McComas .Fire Marshall City of Edmonds Civic Center Edmonds, WA 98020 Re: ANTHONY'S-HOMEPORT, EDMONDS Dear Mr. McComas: Following up on our conversation of the 21st when I said I thought the claim against Safeco had been closed and paid, I was almost correct. There is still a small amount in dispute, but other than that Safeco and Homeport are in agreement, and we expect that item to be resolved. What remains is Safeco's right of subrogation against the manufacturer of the device that apparently was involved. We expect Safeco to vigorously pursue this matter, and as you pointed out it could drag on indefinitely. But as,far as Safeco and Homeport are concerned, that matter is practically settled. Now as to the confidence test, I finally have talked with Jay Yanic of AAA, and he confirmed that he will conduct the annual confi.dence test before the first anniversary which should be at least by the first of April. The Washington Surveying & Rating Bureau has been presented with all of the necessary plans and documents except this last one. Since they are running almost 12 months behind on their sprinklered subjects, our paperwork should be completed before they arrive on the scene. aYours ve r 11 ce D Corbett WDC/jps cc: Victor E. Parker Parker, Smith & Feek, Inc. -R EC E IV ED DEC 17 1986 EP J,A-OND,S FIRE DERT. I December 8, 1986 MEMO.TO: Jeannine Graf Permit Coordinator FROM: Gary L. McComas Fire Marshal SUBJECT: ANTHONY'S HOME PORT Here is the Anthony's Home Port plans back. Everything down there was approved by Stan Olsen. GLM: be RECEIVED mAy 2 11986 EpMO.NDS, FIRE DERLI May 16, 1986 City of Edmonds Building Division 200 Dayton Road Edmonds, Washington Attn: Mr. J.L. Graf, Permit Coordinator Re: ICBO Plan Check #1888, Anthony's Fire Sprinklers Dear Mr. Graf, The automatic sprinkler design appears to meet the UBC Standard 38-1, (NFPA No. 13) requirements. Approval subject to field inspection and the following' -comments is recommended: 1. The temperature rating of the cooking hood sprinkler heads is lower than normal. Installation of 350 degree heads or use of a temperature measuring device per Section 4-4.18.2 to verify actual temperatures are 50 degrees below sprinkler rating is recommended. 2. Sprinklers in the plenum and duct should be higher temperature than those under the hood and 325 degrees minimum, per 4-4.18.2. 3. The first floor inspectors test connection is redundant. The 2na floor test satisfies Section 3-9. 4. The ball valves on the elevator shaft sprinkler lines should be sealed open with a strap or plastic tie. Section 3-14.2.3. 5. Verify there is a four-way earthquake brace at the top of the riser, per 3-10.3.5.4. 6. The water flow alarm should be connected to an7 approved central station or other 24-hour manned location per Section 10.309 of the Fire Code. BUILDING John Haig� Fire Code Consultant MAY 19 1986 I -"/ RECEIVED mAy 2 11986 W-NMONDS- FIRE DEPS May 16, 1986 City of Edmonds Building Division 200 Dayton Road Edmonds, Washington Attn: Mr. J.L. Graf, Permit Coordinator Re: ICBO Plan Check #1888, Anthony's Fire Sprinklers Dear Mr. Graf, The automatic sprinkler design appears to meet the UBC Standard 38-1, (NFPA No. 13) requirements. Approval subject to field inspection and the following* --comments is recommended: 1. The temperature rating of the cooking hood sprinkler heads is lower than normal. Installation of 350 degree heads or use of a temperature measuring'device per Section 4-4.18.2 to verify actual temperatures are 50 degrees below sprinkler rating is recommended. 2. Sprinklers in the plenum and duct should be higher temperature than those under the hood and 325 degrees minimum, per 4-4.18.2. 3. The first floor inspectors test connection is redundant. The 2nd floor test satisfies Section 3-9. 4. The ball valves on the elevator shaft sprinkler lines should be sealed open with a strap or plastic tie. Section 3-14.2-3. 5. Verify there is a four-way earthquake brace at the top of the riser, per 3-10.3.5.4. 6. The water flow alarm should be connected to an�_ approved central station or other 24-hour manned location per Section 10.309 of the Fire Code. BUILDING John Haig� MAY 19 1986 Fire Code Consu I ltant A�k _Q _0 _i; 6 _(7, w 2bS7__,a_4M_ IL e JPOII 57. 4 P el, _FF A -5-4 MA-:101-Z-ol _S - SJO _4w_ r J&J fL LO L-P April 8, 1986 MEMO TO: Hal Reeves Building Official FROM: Gary L. McComas . Fire Marshal SUBJECT: ANTHONY'S HOME PORT - MECHANICAL PLAN, HOOD SYSTEM After review, the Fire Department has the following comments: 1. The ceiling penetrations are required to be one hour shafts. These ' shall be inspected and approved by the'Building Department. 2. The automatic fire extinguishing system for the hood system shall have plans reviewed and approved prior to approval of installation. 3. Any internal welds in shall be ground smooth grease. GLM: be the hood, duct and vent shaft .to reduce accumulation of March 11, 1986 MEMO TO: Hal Reeves Building Official FROM: Stan Olsen Senior Inspector SUBJECT: ANTHONY'S H014E PORT After review of the plans, preliminary approval was given for installation of the post indicator valve, fire department connection, and riser location for the sprinkler system. The installation will be by Tony Cegan for Cosco Fire Protection, Division of Zuran Industries, Inc. I approve the issue of a permit for installation of the above and for the second floor piping only. This is subject to approval of the total.plans by the Washington Survey and Rating Bureau, and an on site inspection after installation. A final acceptance.test will be required on completion of the project. SO: be City of Edmonds INTER -OFFICE CORRESPONDENCE TO FROM 717(6��_ DATE a/(, Z?? SUBJECT g�, u4s� c> Y;>- c j A — 0 0 DOUBLE R ELECTRIC SERVICE 21915 Villa Drive Snohomish, Washington 98290 483-578,8 I i April-'..11, 1984 Anthony's Restaurants P. 0. Box 3805 Bellevue, WA 98009 RE: Fire*Department Inspection of Homeport Edmonds To Fire Matshall Please.,"!.be advised that measures are being taken to repair the restaurant exit sign and pathway light. The parts required to effect repairs have been on order since you first found they did,not work. The replacement parts are coming from Y. New York via the factory.' Please understand that;7�.as soon as the parts come in we will repair the fixtures. Thank you DOUBLE R ELECTRIC SERVICE CITY OF EDMONDS LARRY S. NAUGHTEN MAYOR CIVIC CENTER * EDMONDS, WASHINGTON 98020 * (206) 775-2525 FIRE DEPARTMENT DATE: February 9, 1984 TO: Attn-Herbert M. Gould Anthony's Home Port P 0 Box 3805 Bellevue, WA 98009 SUBJECT: ANTHONY'S HOME PORT; FILE CODE:. 161-000-056 PERSON CONTACTED: Dick Opsahl In our continuing effort to promote Fire Safety and Prevention within the community, your Fire Department conducts regularly scheduled "Fire Safety Survey Inspections" of all businesses and multi -family occupancies in the City of Edmonds. You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Attached you will find the item(s) that were noted during our inspection which require attention to bring them into compliance with the minimum standards adopted by the City of Edmonds. A re -inspection will be conducted in 30 days to confirm that the listed item(s) have been corrected. Any overlooked hazard or violation of the fire regulations does not imply approval of such condition or violation. If you require additional information or assistance, please contact'this office by calling 775-2525, Ext. 231, between the hours of 8 a.m. and 5 p.m., Monday through Friday. Yours for a safer community through fire prevention, Stan Olsen Senior Inspector Enclosure cc: Dick Opsahl