500 SEAMONT LNSNOHOMISH Co.
#500 S',C41navr /_/J
Serving Brier, EdtnorlW, Uri" 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
IN,SPECTION REPORT,
UEDMONDS
0 BRIER
D MOUNTLAKE TERRACE
[I UNINCORPORATED
500 Seamont Lane 98020
r_ FrQUEafY
nnU
STATI�N SHIFT
LOCATION:
Seamont Place Condos
4257121211
SCHEDULED Oct 2016
BUSINESS NAME:
PHONE:
DATE DUE �
MAILING 500 Seamont Lane, Edmonds, WA 98020
423
UFIR
ADDRESS:
Gee, James
BUSINESS OWNER:
HOME PHONE:
Gee, James #302
4257121211
EMERGENCY-1:
HOME PHONE:
URRENT
iy
KEY ACCESS-2:
HOME PHONE:
YES NO
BUSINESS
ary
EMAIL: 14y_g IL 0
2t3_
LICENSE
el- vj=
PERSON CONTACTED: L, (_ (,
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
L 25Q��!�
5-7 b—L,
5,_____STEMSe AZ5b/1VAb/ t-t=U/1J 12:UU:UUAM
IMC OT
LDLY, L�0�1 til)DA
_J
Date Last Service
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
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 Cities
covered by Snohomish County Fire District 1.
You are to be congratulated on the relative good condition of your occupancy in regards to fire safety. Above 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 above jurisdictions.
Any overlooked hazards or violations of the fire regulations does not imply approval of such conditions or violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
C 6
11"'Nt
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
(One System per Report)
Certification Given
RED
YELLOW
WHITE Z
CONFIDENCE TESTT01
REPAIRS
10
Sprinkler Monitoring Panel?
Occupancy Address. 500 Seamont Ln Edmonds
Responsible Person
First & Last Name:
Responsible Person
Address, City, State, Zip:
Date of Inspection:
6/3/16
Testers Name
(Please Print): DOUG AUSTIN —Number:
Identification
Number:
Central station monitoring? Yes No E]
Monitoring Required? Yes FX_1 No
System Make: FC1 —System
Occupancy Name: Seamont pi condos
Phone Number:
Responsible Party
E—Mail Address
Inspection Quarterly (High-rise Only)
Frequency/Type: Annual
SFD Certification
SCP - A-07115
System Location 2nd fl electrical
Monitoring ' * Local only
Company Name: -
Model: fire alarm control
SEATTLE FIRE CODE VIOLATIONS FoUND: (if additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) SFD Certification Number: SCP -
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: Phone #
Building Representative (signature) 111W 2 0 ZOE
VW1. W
500 Seamont Ln Edmonds
R
Fire Alarm Systems Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Seattle Fire Department Fire Code for inspecting and testing requirements.
Alarm Svstem Functionali
1. Trouble signal with AC power off?
2. System operates properly on battery backup?
3. Battery voltage (no load) 26.8 volts
4. Battery voltage (full load) 26.1 volts (signals operating)
5. Charge circuit voltage 27.2 volts
6. System operates properly on standby power?
7. All signals operate on AC power?
8. Number of initiating circuits
9. Number of signal circuits
10. Does alarm system meet audibility standards as accepted?
11. All circuits checked for electrical supervision?
12. All auxiliary equipment operates (Elevators, fans, dampers)?
13. Ventilation controls operate?
14. Key to panel available?
15. Materials and equipment needed to restore pull stations are available at the
main panel, e.g. glass rods, and plates; keys and alien wrenches, etc?
16. Operating instructions at panel?
17. Trouble indicators function properly?
18. Remote Annunci - ator Panels function properly?
-19. Elevator Call Down functions properly?
20. Test record posted at panel?
21. General alarm automatic time delay (minutes)
22. Was a signal received at the Central Station monitoring company?
23. Other Devices (Specify)
N/A X
N/A X
N/A
N/A
YesLn
No LJ
Yes
No El
Yes FXI
No
Yes E9
No El
Yes X
Yes X
Yes
Yes
Yes X
Yes X
No
No
No
No
No
No
Yes X
No
Yes X
No
N/A
Yes X
No
N/A X
Yes
No
Yes
No,
N/A
N/A
Yes X
No
Yes
No -
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
4
4
N/A
Yes X
No
25. Voice Speakers (Voice Clarity)
N/A
Yes
No
26. Visual Alarm Devices
N/A
X
Yes
No
27. Smoke Detectors
4
4
N/A
I
Yes X1
No
28. Heat Detectors
N/A
Yes
No -
29. Duct Detectors
N/A
X
Yes
No -
30. Sprinkler Flow Switches
N/A
Yes X
No
31. Sprinkler Supervisory Switches
N/A
X
Yes
No
32. Manual Pull Stations
N/A
X
Yes
No
33. Annunciator(s)
N/A
X
Yes
No
34. Beam Detectors
N/A
X
Yes
No
35. Automatic Door Unlocks
N/A
X
Yes
No
36. Automatic Door Release
N/A
X
Yes
No
1 37. Fire Dampers
N/A
X
Yes
No
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A X Yes No
39. Phone Jacks
N/A X Yes No
40. Call -in Signal
N/A 57< Yes No
Fire Alarm Systems Page 2 of 2
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
M. FAX: 253-852-2049
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED-0
I YELLOW 1:17
WHITE
CONFIDENCE TEST R I REPAIRS
Occupancy Address: 500 Seamont Ln Edmonds Occupancy Name: Seamont pl condos
Responsible Person
First & Last Name: Phon��,Number:.
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Date of Inspection: 6/3/16 Inspection Annual
FrequencyfType:
Testers Name SFD Certification
(Please Print): DOUG AUSTIN Number: SCp-A-07115
Identification
Number: System Location'.
Central station monitoring? Yes M NoEj Monitoring
Monitoring Required? Yes NoD Company Name:
System Make: System Model-
SEATTLE FIRE CODE VIOLATIONs FOUND: (If additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected.- Corrected By:
(If additional room is needed, please add a separate sheet) SFD Certification Number- SCP -
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have -been reported to the building Owner/Manager for corrective actio
V
Signature of Tester: Phone #
Building Representative (signature)
500 Seamont Ln Edmonds
Sprinklers - Wet
JUN. 8 0 2016 Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department Fire Code for inspecting
and testing requirements.
General
1. Main Drain and Inspector's Drain flow test conducted?
2. Static pressure: 45 - 40
p.s.i. Flow pressure. P. S. i.
3. Number of Sprinkler Heads:
4. 2-inch drain? Other
5, Flow switches, supervisory switches and alarm bells tested? N/A
6. Pressure regulating valves tested? N/A
7. Alarm bell operates? N/A
8. System inspected and lubricated?
9. Valves are sealed or supervised?
10. Signs are provided on valves?
11. Pumper connections and clapper valves unobstructed and turn freely?
12. Sprinkler coverage is acceptable?
13. Have the sprinkler heads been replaced or successfully sample test in the
last 50 years? Date of last test:
14. Proper number of spare sprinkler heads available with appropriate wrenches
for each?
15. System left in service?
16. System gauges replaced or calibrated within the last 5 years?
Year changed: 2011
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical
damage?
18. Was debris found in the Fire Department Connection (FDC)?
19. Was the Fire Department Connection (FDC) back flushed within the last 5
years? Date of last back flush 2011
20. Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed 2011
21. Is the hydraulic nameplate installed and visible on riser, if No then Yellow Tag
(Ref: NFPA 25 5.2.7)
22. Was a signal received at the Central Station monitoring N/A
company?
500 Seamont Ln Edmonds
M.
Yes V\l NoF.
Yes
Yes V\l
YesF
Yes
Yes
Yes
Yes
Yes
Yes
NoF
Noo
NoF
NoF
NoF
NoF
NoF
No"
NoF
Yes 0
NoD
F71
Yes V\1
NoD
Yes M
NoF
Yes 11
Nom
Yes M
NoF
Yes M
NoF
M
Yes V\1 NoEl
M
Yes V\1 NoD
1771
Yes No V\l
r771
Yes V\1 NoEl
Sprinklers - Wet Page 2 of 2
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
(One System per Report)
Certification Given
RED
YELLOW [:] I
WHITE
CONFIDENCE TEST
Z
I REPAIRS
Sprinkler Monitoring Panel? 0
Occupancy Address: 500 Seamont lane Edmonds,Wa.98020
Responsible Person
First & Last Name: Jim
Responsible Person
Address, City, State, Zip:
Date of Inspection:
6-11-15
Testers Name
(Please Print): Jason Tucker —Number:
Identification
Number-
Central station monitoring? Yes El No
Monitoring Required? Yes E:1 No
System Make: FC1
Occupancy Name: Searnont Place Condos
Phone Number: 425-712-1211
Responsible Party
E—Mail Address
Inspection Quarterly
Frequency/Type: Annual
Nicet
N116973
2 ne floor under stairs
System Location
Monitoring Na
Company Name:
System Model: FC-72
FIRE CODE VIOLATIONS FOUND: (if additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected: Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Fire Department Fire Code standards, and that
discrepancies are noted and have been re�orteid to the building Owner/Manager for corrective action.
Signature of Tester: Phone4 253-852-1962
Building Representative (signature)
500 Seamont lane Edmonds,Wa.980 JUN 16 2015
Fire Alarm Systems Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements.
Alarm System Functionality
1. Trouble signal with AC power off? Yes No 0
2. System operates properly on battery backup? Yes nX No [I
I Battery voltage (no load) 26.6 volts
4. Battery voltage (full load) 26.1 volts (signals operating)
5. Charge circuit voltage 27.4 volts
6. System operates properly on standby power?
7. All signals operate on AC power?
8. Number of initiating circuits 2
9. Number of signal circuits 1
10. Does alarm system meet audibility standards as accepted?
11. All circuits checked for electrical supervision?
12. All auxiliary equipment opprates (Elevators, fans, dampers)?
13. Ventilation controls operate?
14. Key to panel available?
15. Materials and equipment needed to restore pull stations are available at the
main panel, e.g. glass rods, and plates; keys and alien wrenches, etc?
16. Operating instructions at panel?
17. Trouble indicators function properly?
18. Remote Annunciator Panels function properly?
19. Elevator Call Down functions properly?
20. Test record posted at panel?
21. General alarm automatic time delay _ (minutes)
22. Was a signal received at the Central Station monitoring company?
23. Other Devices (Specify)
N/A,X
N/A X
N/A
N/A
Yes
Yes
Yes X
Yes X
Yes
Yes
Yes X
Yes X
No C1
No 0
No
No
No
No
No
No
Yes X
No
Yes X
No
N/A X
Yes
No
N/A
Yes X
No
Yes X
No
N/A MX
N/A X
Yes
No
Yes
No
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
3
3
N/A -
Yes X
No
25. Voice Speakers (Voice Clarity)
N/A
Yes
No -1
26. Visual Alarm Devices
1
1
N/A
Yes X
No 1
27. Smoke Detectors
4
4
N/A
I Yes XI
No
28. Heat Detectors
N/A -
Yes
No -
29. Duct Detectors
N/A
Yes
No -
30. Sprinkler Flow Switches
1
1
N/A
Yes X
No
31. Sprinkler Supervisory Switches
N/A
Yes
No
32. Manual Pull Stations
N/A -
Yes -
No
33. Annunciator(s)
N/A
Yes
No -
34. Beam Detectors
N/A
Yes -
No
35. Automatic Door Unlocks
N/A
Yes
No
36. Automatic Door Release
4
4
N/A
Yes X
No
37. Fire Dampers
I
N/A
Yes
No
Communication Equipment
Total Number of Units
in Buildinq
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A Yes No
39. Phone Jacks
N/A Yes No
40. Call -in Signal
N/A Yes No
Fire Alarm Sysferns", Page 2 of 2
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
)W
-
WHITE
CONFIDENCE TEST REPAIRS F�
- 500 Seamont lane Edmonds,Wa.98020
Occupancy Address.
Occupancy Name -Seamont Place Condos
Responsible Person
First & Last Name: Jim
Phone Number, 425-712-1211
Responsible Person
Address, City, State, Zip:
Responsible Party
E—Mail Address
Date of Inspection, 6-11-15
Testers Name
(Please Print): Jason Tucker
Inspection Annual
Frequency/Type:
Nicet Certification
Number: N116973
Identification
Number:
System Location: Under stairs 2nd floor
Central station monitoring? Yes NoN
Monitoring Required? Yes NoN
Monitoring
Company Name* Na
System Make: Shotgun
System Model, 2 11
FIRE CODE VIOLATIONs FOUND' (if additional
room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected,
Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life safety system has been
properly inspected for reliability to cover the
Items listed in this report and is consistent with Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester:
Phone # 253-852-1962
Building Representative (signature)
500 Seamont lane Edmonds,Wa.98(
Sprinklers - Wet
NE!-- JUN I "
62015Page I of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
General
1. Main Drain and Inspector's Drain flow test conducted?
2. Static pressure- 85 __p.s.i. Flow pressure* 70
P.
3. Number of Sprinkler Heads-
4. Full Flow? 2" Drain 1-1
5. Flow switches, supervisory switches and alarm bells tested?
P N/A F
6. Pressure regulating valves tested? N/A
7. Alarm bell operates? N/A
8. System inspected and lubricated?
9. Valves are sealed or supervised?
10. Signs are provided on valves?
11. Pumper connections and clapper valves unobstructed and turn freely?
12. Sprinkler coverage is acceptable?
13. Have the sprinkler heads been replaced or successfully sample test in the
last 50 years? Date of last test:
14. Proper number of spare sprinkler heads available with appropriate wrenches
for each?
15. System left in service?
16. System gauges replaced or calibrated within the last 5 years?
Year changed: 2014
IT Sprinkler heads free of corrosion, paint, obstructions and/or physical
damage?
18. Was debris found in the Fire Department Connection (FDC)?
19. Was the Fire Department Connection (FDC) back flushed within the last 5
years? Date of last back flush 2014
20. Was an internal pipe and valve inspection performed within the last 5 years?
Date Performed NA
21. Is the hydraulic nameplate installed and visible on riser, if No then Yellow Tag
(Ref: NFPA 25 5.2.7)
22. Was a signal received at the Central Station monitoring N/A
company?
500 Seamont lane Edmonds,Wa.98
I1z;1
Yes V\l NoR
Yes F71
V\1
F�771
Yes V\I
Yes
Yes
Yes
Yes
Yes V\l
Yes [/\I
Yes 1^1
f�q
Yes 1/\l
NoF
F71
Yes V1\l
NoF
r7l
Yes V 1-1
NoF]
Y m
es v-\l
N o
f�71
Yes V\1
NoEl
YesM
No[/\I
r777
F\-71
Yes [/\I Nor—]
f�l
Yes V\l NoEl
Yes NoF
F;71
1^1 YesEl No
Sprinklers - Wet Page 2 of 2
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032 JUN 0
PHONE: . 253-852-1962 62014
FAX: 253-852-2049 �
RRE ALARM SYSTEM
Certification Given
(One System per Report)
RED [:11
YELLOW F-17WHITE
0
CONFIDENCE TEST
IN
1 REPAIRS
El
Sprinkler Monitoring Panel? 0
Occupancy Add reSS: 500 Seamont lane Edmonds,Wa.98020
Occupancy Nam . e: Seamont Place Condos
Responsible Person
First & Last Name: Yvonne Gumnick
Phone Number: 425-672-0296
Responsible. Pers - on -
Address, City, !State, Zip:
Responsible Party
E—Mail Address
Date of Inspection:
6-4-14
Inspection QuarterlyEl
FrequencyfFype: Annual
Testers Name
(Please Print): Jason Tucker
Nicet
Number: N116973
Identification
Number:
2 ne;floor under stairs
System Location
Central station monitoring? Yes No Fx-1
Monitoring
Monitoring Required? Yes EJ No Fx-1
System Make: FC1
Company Name: -a
System Model: FC-72
FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification
Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Fire Department Fire Code standards, and that
discrepancies are noted and have been re��xtedto the building
Owner/Manager for corrective action.
Signature of Tester:
Phone 4 253-852-1962
Building Representative (signature)
500 Seamont lane Edmonds,Wa.980
Fire Alarm Systems Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements.
Alarm Svstem Functionality
1.
Trouble signal with AC power off?
Yes Z
No El
2.*
Sy* t6m okates.� properly.pr: b ttery back6p?.�
Yes
Ej
3.
Battery voltage (no load) 26.5 volts
4
Battery voltage (full load) 26. volts (signals operating)
5.
Charge circuit voltage 27.7 volts
6.
S stem oi)era . tes properly. on standb power?
y y
Yes,
NPIEll...'
7.
.
All signals operate on AC power?
Ye , s
No El
8
Numbe�'of initiating circuits.:.,
9.
Number of signal circuits
b"' I """tem-rhee, audibi*Iity:'sta'nd'aeds asacceptedT-':':`
oes'alarm-sys t
:,,.Yes" K
...No
11.
All circuits checked for electrical supervision?
Yes X
N,o,
uipmenfooeirates (Elevators -fans; dam' .... ..
q pers)?,
IN'
0
13.
Ventilation controls operate?
N/A X
Yes
No
i4.
Kpy_to panel, available?
N/A
Yes X
No_"�
15.
Materials and equipment needed to restore pull stations are available at the
N/A.
Yes X
No
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?
16.
Op'erating instructions at panel?
Yes X
No
17.
Trouble indicators function properly?
Yes X
No
18.,
ke, mote Annunciator Panels . fu nction properly?
NIA X
Yes
No
19.
Elevator Call Down functions properly?
N/A
Yes X
No
20'.1-Test
record pqsted at.p nel?
Yes X
No
21.
General alarm automatic time delay (minutes)
N/A
22.
W qsq, signa received at theCentral -Station monitorihQ,compgny?t
N A, X::
Yes_.__�
N o,
23.
Other Devices (Specify)
Yes
No
Total Number of
System Devices Units in Building
24. Bells, Horns, Chimes: 3',
25. Voice Speakers (Voice Clarity)
Vis6al'Al6rm Devices,
1 -7 C L n 4 4
S
28. Heat Detector
29. Duct Detectors
301. Sprinkler Flow, Switches
31. Sprinkler Supervisory Switches
32. Manu'al. Pull, Stations
33. Annunciator(s)
34. Beam Detectors
35. Automatic Door Unlocks
36. Automatic Door Release'
37. Fire Dampers
Total Number
'Yes X.� �No.
N/A
Yes
No
Yes >
No
N/A
Yes XI
No
N/A,
:_.:.�Yes
No
N/A
Yes
No
N/A,
Yes X
No
N/A
Yes
No
N/A:.
:Yes
No
N/A'
Yes
No
N/A
.,:.q Yes
No;
N/A
Yes
No
N/A
Yes X
No_
'A Yes No
Total Number of Units
Total Number Units
Communication Equipment
in Building
Tested
Test Results Acceptable
38. Phone Sets:
N/A Yes �No
39. Phone lacks
N/A Yes No
40., Call -in Signal,
N/A Yes No
Fire Alarm Systems Page 2 of 2
.;4
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032 JUIV '0 6 2014
PHONE: 253-852-1962
FAX:-253-852-2049
SORINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED
___�WHITE
YELLOW
.CONFIDENCE TEST I Z I REPAIRS7
Occupancy Address 500 Seamont lane Edmonds,Wa.98020 Occupancy Name: Searnont Place Condos
Responsible Person
First & Last Name: Yvonne Gurnnick Phone Number: 425-672-0296
.Responsible -Person — Responsible Party - -----
Address, City, State, Zip: E—Mail Address
Date of Inspection: Inspection Annual z
6-4-14 Frequency/Type:
Testers Name Nicet Certification
(Please Print): Jason Tucker Number: N116973
Identification Under stairs 2nd floor
Number: System Location:
Central station monitoring? Yes Nom Monitoring
Na
Monitoring Required? Yes El No rX_1 Company,Name:
System Make: Shotgun System Model: 2
FIRE CODE VIOLATIONs FOUND: (If additional room is neede/d, please add a separate sheet)
FDC due
CORRECTIONS MADE: Date Corrected: Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Fire Code standards, and that
discrepancies are noted and have been r orted to the building Owner/Manager for corrective action.
Signature of Tester: Phone # 253-852-1962
Building Representative (signature)
500 Seamont lane Edmonds,Wa.98C
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
General
No
1 KAain brain and lnspect6r's.Drain fl6w,test conducted? Yes MX El
2. Static pressure: 85 p.s.i. Flow pressure: 70 p. S. i.
3—
Number of Sprinkler Hea
4.
Full Flow? 2" DrainE]
Yes FX
No El
.5.
w switches, ory switches and alarm bells tested'? A
Flo supervis
Ye L/\
s -j
NoEl
6.
Pressure regulating valves tested? N/A F\71
YesE]
NoEl
T.
Alar m', bell "'operates?,'.: El''
Ye
E]
8.
System inspected and lubricated?
y F71
es
NoEl
..9.
ValVes,are:se 1;'d:':
?
a e ised.
—:or supery
es Ix
No
10.
Signs are provided on I valves?
Yes
NOE]
11.�,Pumper
I obstructed:and turn'freely?
connections and clapper va,ves un
.-D
�No
12.
Sprinkler coverage is acceptable?
Yes 1^1
NoEl
1 8.�
H ave the: s rinkle(fieads bben:eeplaced,:or successfully sample test inAhe
p
e S::[/,\I:, �
N,
-1 0
last 50 years. bate' of last test -
14.
Proper number of spare sprinkler heads. available with appropriate wrenches
Yes
No
for each?
System left'ih seNice?:,".
Y
No
16.
System gauges replaced or calibrated within the last 5 years?
Y e s
No El-,
Year changed: 2011
I
17.
...........
..:_'&l r,keads fr6e:of'c'orrosion, paint, 6bstructions"an, or�phy.
:S . prin e d/ sical
:Yes
N 6 ED
dama eT..'
'g.
18. Was debris found in the Fire Department Connection (FDC)? YesEl Nom
within the �t
Was the'Fire-Depa r rtr-hent Connection (FDC), back'flushed I.as
YesEl .:NON
years?: Date of last back flush
20. Was an internal pipe and valve inspection performed within the last 5 years? Yes No
Date Performed NA
21. Is the h draulic nameplate installed and visible oin'riser, if No then Yellow Tag.
Y, Yes NoEl.
A 25 5.2.7)
(Ref: NFP
22. Was a signal received at the Central Station monitoring N/A Yes F� NoEl
company?
500 Seamont lane Edmonds,Wa.98
Sprinklers - Wet Page 2 of 2
SN01
F1
D
Zlt
Serving Brier, Edmonds, and
Mountlake Terrace
Twww.FireDistrictl.org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fav (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
OBRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
-500 Seamont Lane 98020
Annual
17-A
BUSINESS NAME:
Seamont Plac* Condos
PHONE:
4257121211
SCHEDULED Oct 2013
DATE DUE
MAILING
LIFIR � 423
ADDRESS:
500 Seamont Lane, Edmonds, WA 98020
BUSINESS OWNER:
Gee, James
HOME PHONE:
EMERGENCY-1:
4257121211
CURRENT
Gee, James A1302
HOME PHONE:
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
nN
NAME OF INSPECTOR:
—N
FIRE SYSTEMS:
AS 5113 FA 5/13 FE 6�_A FD Lkeox
HAZARDS FOUND AND LOCATIONS COM
UNIC
�TIONS
(OAS
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
1 st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
0 E:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
'8
4
8
DATE:
LETTER NEEDED E] YES El No
LETTER NEEDED E] YES F-1 NO
8
FIRE DEPARTMENT COPY
" R
W
AR
�lllliliill�ni it_X MAIN
MAY 10 2013
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
SPRINKLER — WET SYSTEM
Certification Given
(One System per Report)
RED
YELLOWNTWHITE
CONFIDENCE TE7ST 0 REPAIRS —1
Occupancy Address: 500 Seamont lane Edmonds,Wa.98020 Occupancy Name: Searnont Place Condos
Responsible Person
First & Last Name: Yvonne Gumnick Phone Number: 425-672-0296
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Date of Inspection: 5-6-13 Inspection Annual
Frequency/Type: El
Testers Name Nicet Certification N116973
(Please Print): Jason Tucker Number:
Identification Under stairs 2nd floor
Number: System Location:
Central station monitoring? Yes F71 Nom Monitoring
Monitoring Required? Yes 0 NoM Company Name: Na
System Make: Shotgun System Model: 2
FIRE CoDE VIOLATIONs FoUND: (if additional room is needed, please add a separate sheet)
FDC due
CORRECTIONS MADE: Date Corrected: Corrected By:
(if additional room is needed, please add a separate sheet) Nicet Certification Number:
This certifies that thi's fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Fire Code standards, and that
discrepancies are noted and have been rl 7orted to the building Owner/Manager for corrective action.
Signature of Tester: Phone # 253-852-1962
Building Representative (signature)
500 Seamont lane Edmonds,Wa.98C
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
General
1 .
Main Drain and Inspector's Drain flow test conducted?
Yes z
2.
Static pressure: 85 P.S.i. Flow pressure: 70 p. S. i.
3.:,
'Number of Sprinkler HeAds'.
4
1. F . u I I . I Flow? 2" DrainF]
Yes
No
5.
Flow switches, supervisory switches and alarm bells tested? N/A
1,71
Yes 1^1
NoLj
6.
Pressure regulating valves tested? N/A 12\1
-1
Yes F
NoR
.T.':
-op ? F7
Alarm �bell. Orates.
YeS!
0 i
8
Sys . te , m I ins . p e I cted an . d I I I ubricated?
Yes
NoEl
9.
?
Valves are Seale d or,su"pe'' rvisedv'.,.�
Y
[77
V\l
No LLJ-�--�:
10.
Signs are provided on valves?
Yes [/\I
Noo
A: 1 .-PUmp6r
nectons-and, ahjes.�666b�t�ucted and t ely?
con urn
es'
Y [Al.
Sprinkler coverage is acceptable?
Yes [XI
No
El12.
Have the sprinkler heads been replaced or successfully sample test.in the
F71
Yes L�Nj
NoEl
last 50 years? Date of last test-..
14.
Proper number of spare sprinkler heads available with appropriate wrenches
M
Yes rl/\l
NoEl
for each?
Ye
ol.
15.,�.�System
n e e
16.
System gauges replaced or calibrated within the last 5 years?
Yes
F711
No
Year changed: 2011
A 7.,
`:'Aamage?
§p�jnkler heads.free.of corrosion paint; -o struc.ti,ons an or p y id'al
1. _71
1K
JAI
:No
18.
Was debris found in the Fire Department Connection (FDC)?
Yes
Nol^l
:19.
Was the Fire Department Connection (FDC) back flushed within the last 5.,,.,
Yes E]
N o ['/71
years? Date of last back flush
20.
Was an internal pipe and valve inspection performed within the last 5 years?
Yes F7
No[]
Date Performed NA
:.21.
Is::.the hydraulic nameplate installed:, and.visible -on riser,.if N.P.then Yellow..Tag.,
es El
No
(Ref: NFPA 25 5.2.7)
22.
Was a signal received at the Central Station monitoring N/A [777
YesF
No [I
company?
500 Seamont lane Edmonds,Wa.98
Sprinklers - Wet Page 2 of 2
0 2013 Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
(One System per Report)
Certification Given
RED [j
I YELLOW
WHITE
CONFIDENCE TEST
101
REPAIRS
Sprinkler Monitoring Panel? Z
Occupancy Address: 500 Seamont lane Edmonds, Wa.98020
Responsible Person
First & Last Name: Yvonne Gumnick
Responsible Person
Address, City-, State, Zip:
Date of Insp ection .
5-6-13
Testers Name
(Please Print): Jason Tucker
Identification
Number:
Central station monitoring? Yes El NoZ
Monitoring Required? Yes E] No Z
System Make: FC1
Occupancy Name: Seamont Place Condos
Phone Number: 425-672-0296
Responsible Party
E—Mail Address
Inspection Q u a rte rly
Frequency/Type: Annual FX
Nicet N1 16973
Number: —
2 ne floor under stairs
System Location
Monitoring Na
Company Name:
System Model: _FC-72
FIRE CODE VIOLATIONs FoUND: (If additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected: Corrected By:
(If additional room is needed, please add a- separate sheet) Nicet Certification Number:
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Fire Department Fire Code standards, and that
discrepancies are noted and have been re )orted to the building Owner/Manager for corrective action.
Sign . ature of Tester: 177 Phone4 253-852-1962
Building Representative (signature)
500 Seamont lane Edmonds,Wa-980
Fire Alarm Systems
Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safetV system. Refer to the Fire Code for inspecting and testing requirements.
Alarm System Functionality
1. Trouble signal with AC power off?
Yes L�g
No El
2.. SV tes,pr.bp&ly:pn battery ,backup?.,.
stem,,opera
Yes
-No El
3. Battery voltage (no load) Vol ' ts
'26.2
... 25.T Its (signals oper�ating).
4.:'- Battery ybliage (full [bad) vO
5. Charge circuit voltage 27.7 volts
Yes
N
Systernoperates properly: on, standby. power?
Yes
NoD
7. All signals operate on AC.power?
8.,::* Number of initkin'g circuits�:. . 21
9 umber of si gna I circuit s
No
M' b66�.alartn.��stem,:rtie,�t:�Odibilitv standards as accepted?
Y es
11. All circuits checked for elect rical supervision?
Yes X
No
12. A I ad iliar fes (Elevators fans, dampers)?,:
y.equi . � I � - . I .
111� .. �X 1. pMen. opera
-1-1 e
N
1
13. Ventilation controls operate?
N/A X
Yes
No
-1 . K ey tp�ppqp Oyail.ab.le?,
Yes X,
No:--,
15. Materials and equipment needed to restore pull stations are available at the
N/A
Yes X
No
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?
i6. Or)erating S6�qjp Ot, �_eli
J�L ns _P@PE�1.
Ye s X:
No 7"
17. Trouble indicators function properly?
JT
Yes X
Yes:
No
N 0
18. Remote Ann Ficiai&,Panels fuhction.pr9perl' 7
y.
19. Elevator Call Down functions properly?
N/A
Yes X
7X
No
No'
20' " Test d
record pgstt(_.2�t_pa[jq!?
Yes
21. General alarm automatic time delay (minutes)
N/A
FX�
777-7-.
22; Wa*s'a Neceiv6d'kthe Central Station monitoring,c
�Yes
NO:
23. Other Devices (Specify)
Yes
No
System Devices
Total Number of
Units in Buildinq
Total Number
Units Tested
Test Results Acceptable
24 Be s H6rhs,:Chimes'
A
N/A=�,
e
Y S,r.
2 . 5. Voice Speakers (Voice Clarity)
N/A
Yes
No-.,
26-.:.Visual Alarm b
N/ A
Y X
es
No''
27. Smoke Detectors
4
4
N/A I
Yes X1
No..--.
28. Heat D I etectors
N/A
Yes
No
29. . D uct Detectors
N/A
Yes
No
30. Sprinkler Flow Switches
j
N/A
Yes
No,
.1 - . i .
31. Sprinkler Supervisory Switches
N/A
Yes
No
32. Manual Pu Stations
N/A
Yes
No
33. Annunciator(s)
N/A
Yes.,-
No
34. Beam Detectors
N/A
Yes.
No
35. Automatic Door Unlocks
N/A
Yes
-,No...-
36. Automatic Door Release
4
N/A
Yes X
No
37. Fire Dampers
N/A
Yes
No
Total Number of Units
Total Number Units
Communication Equipment
in Buildinq
Tested
Test Results Acceptable
38.' P one ets:..
N/A'�. Yes. No
39. Phone 3acks
N/A Yes No
i �.40.,�Call_in Signal:�:
N/A. N o
Fire Alarm Systems Page 2 of 2
FIRE PREVENTION
CITY OF EDMONDS SAFETY SURVEY
1215- AVtNUE N. - EDMONDS, WASHINGTON 98020 (425) 771-0215
FIRE 6EPARTMENT
t
LOCATION: 500 Se!amont Lane,"
BUSINESS NAME: Seamont Place Condos PHONE: 4257121211
MAILING 500 Seamo.nt Ln #302
ADDRESS: Edmonds 98020
FRE,
jj_g N C'� STATW & 04IFT'
SCHEDULED
DATE DUE
LIFIR I� 423 1053
BUSINESS OWNER: Gee, James,#302 HOME PHONE: 4257121211 Ar__nVE
EMERGENCY-1- Gumnick, Yvonne #201 HOME PHONE:
KEY� ACCESS-2: HOME PHONE:
INITIAL INSPECTION DATE,
PERSON CONTACTED:
NAME OF INSPECTOR'
FIRE A ti 21 99FA—,ZW t- L) L K lJX
SYSTEMS: NU
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
bj
ENTER CODE ONLY ONCE ll�
VIOLATION CODE"
.
2
2
3
4
4
5
5'
6
6
7
7
8
rl
8
Ist RE -INSPECTION
DATE DUt:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
.�AfIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR-;
INSPECTOR:
2
DATE:k
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
7
4
18
4
18
DATE:
DISPOSITION:
8
LETTER NEEDED E] YES NO
LETTER NEEDED F! YES NO
FIRE DEPARTMENT COPY
MAY _q 1 71"117
Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
SPRINKLER ---:WET SYSTEM
Certification Given
RED
L]
I YELLOW
�WHIITE
[X]
(One System per Report)
CONFIDENCE TEST [X—] I REPAIRS
I
.500 Seamont Lane, Edmonds I
Occupancy Addres .
Occupancy Name: Seamont Condos
Responsible Person Yvonne Gumnick
First & Last Name.
Phone Number: 425.672.0296.
Responsible Person
Address, City, State, Zip:
Responsible Party
E—Mail Address ,
Date of Inspection: 5.17.12
Inspection Annual
Frequency/Type:
Testers Name
(Please Print): Michael Walsh
SFD Certification W-06946
Number: SCP_
Identification
Number:
System Location: 2nd floor closet
Central station monitoring? Yes El No [ 77
Monitoring Required? Yes NoO
Syste rn Make: Shotgun
Monitoring
Company Name:
System Model: 2
SEATTLE FIRE CODE VIOLATIONs FoUND: (If addition a[ room is needed, please add a separate sheet)
None.
No access to units.
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet) SFD Certification Number: SCP -
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code, standards, and that
discrepancies are noted and ilding Owner/Manager for corrective action.
Signature of Tester:
Phone # 253.852.1962
Building Representative (signature)
500 Seamont Lane, Edmonds
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department Fire Code for inspecting
and testing requirements.
General
1 Main Drain and Inspector's Drain flow test conducted? Yes IAI No El
2.
Static pressure: 90 p.s.i. Flow pressure: 70 P.S.i.
3.
Number of Sprinkler Heads:
4.
17�717
2-inch drain? Other 1^1
Yes
NoF�
5.
s n t d?, N/A
Flow Witches, supervisory switches a d alarm bells tes e El
L!�-j
No
6.
Pressure regulating valves tested? N/A L:�f\j
YesE]
NO-E]
7.
Alarm, bell operates? N/A. E]
Yes 1^1
No
8.
System inspected and lubricated?
Yes
NoEl
9.
Valves are: sealed or supervised?.
Ye S I MY
N 0
10.
Signs are provided on valves?
F71
Yes IAI
No
11.
cte a r
Pumper connections and clapper valves unobstru d nd lu n freely?.
es [7x
N611
12.
Sprinkler coverage is acceptable?
Fm
Yes 1^1
NoEl
13.
H8ve the sprinkler heads been reNaced.or successfully sample test in the.:�-
Ye& FX-T
NoE],,
la' .:$O,years. Date.of last.test:,
st ?
14.
Proper number of spare sprinkler heads available with appropriate wrenches
F71
Yes L�nj
NoEl
15.
for each?
SVsterri left in service.?
:Yes
No7
16.
System gauges replaced or calibrated within the last 5 years?
Yes Z
NoF—I
Yearchanged:
1:7.'Sprinkler
heads free'of corrosion, paint,. obstructions and/or physica[.
-Yes F7
'NoE]--*
damage?
18.
Was debris found in the Fire Department Connection (FDC)?
Yes
No Z/-\j
19.
Was the Fire Department I Co rinection (FDC) back flushed. within the last 5..
YesEl
No Al
years? Date of last back flush
20. Was an internal pipe and valve inspection performed within the last 5 years? No 17771
Date Performed Yes L:L\i
21. is the hydrauli*c nameplate installed and on'ris'er, if No tken Yellow Tag.
Yes No
(Ref: NFPA 25 5.2.7)
22. Was a signal received at the Central Station monitoring N/A Yes No[]
company?
500 Seamont Lane, Edmonds
Sprinklers - Wet Page 2 of 2
31 2012 Confidence Test Report
1002 CENTRAL AVE NORTH
KENT WA 98032
PHONE: 253-852-1962
FAX: 253-852-2049
FIRE ALARM SYSTEM
Certification Given
(One System per Report)
RED El
I YELLOWE] .1
WHITE
CONFIDENCE TEST
REPAIRS—TE-1
M
Sprinkler Monitoring Panel? 1^1
Occupancy Address. 500 Seamont Lane., Edmonds
Occupancy Name: Seamont Condos
Responsible Person
First & Last Name: Yvonne Gumnick
Phone Number: 425.672.0296
Responsible Person
Address, City, State, Zip:
Responsible Party
E—Mail Address
Date of Inspection:
5.17.12
Inspection Quarterly O(High-rise Only)
Frequency/Type: Annual
Testers Name
(Please Print): Michael Walsh
SFD Certification
Number: SCP - W-06946
Ide ' ntification
Number:
2nd floor closet
System Location
Central station monitoring? Yes F-1 No
Monitoring Required? Yes F1 No
Monitoring
Company Name�
System Make: FCI
System Model: FC-72
SEATTLE FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
None.
No Access to units.
Note: (4) mag doors drop upon waterflow only.
CORRECTIONS MADE: Date Corrected:
Corrected By:
(if additional room is needed, please add a separate sheet) SFD Certification Number: SCP -
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed, in thisreport and 'I ns tent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and v n p rte o th ding Owner/Manager for corrective action.
Signature of Tester:
Phone # 253.852.1962
Building Representative (signature)
500 Seamont Lane, Edmonds
Fire Alarm Systems Page 1 of 2
14
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 System Functionality
I.
Trouble signal with AC power off?
Yes Ux
Yes
No El
No El
2.
System operates properly on battery backup.?
3.
Battery voltage (no load) 26.12 volts
........ . :25.60 volt (signa s op
Bafte'ry*volta0e (full load): I erating)
5.
Charge circuit voltage 27.77 volts
Yes�N..
No El'
6.
System operates properly on standby.06W.er?
.
Yes nx
N DO
7.
All signa Is operate on AC power?
"its
.
8.
u e o nitiating circui
N nib" r f i
91
I'd;
Number of signal circuits
n system'meet audibility. �ds.as
Does ala'&' stalndq -Occep.00
S
Ye X
No.0
11
All circuits checked for electrical supervision?
A
Yes nx
Ye's,[X
No El
No
All auxiliar y equipment operates (Elevators, fans, dampers)?
13.
Ventilation controls operate?
N/A
Yes
No
11
liable?,
Kqytp panel avq..
N/A E]
Yes [9
No.E1
15.
Materials and equipment needed to restore pull stations are available at the
N/A El
Yes X
No
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?_
-
16.
Operatihg-instr6ctions at panel?
Yes RX
0
N.. F
17.
Troub . le indica tors fu nc tion properly?
-Yes X
No
18.
Remote Annunciator Panel's function properly?
',yes L]
19.
Elevator Call Down functions properly?
N/A
Yes.X
No E]
.�20.
Test record posted. at panel?,
Yes, X
No El.
21.
'22
General alarm automatic time delay (minutes)
ing :7..
-N.I/A 01
X
YqsEl
El
t
Wa s a sici na I received at�the.Centra[ Stati on m onitor cornpany?z.�,
�:N/A
_NP
23. Other Devices (Specify)
Yes El
NoX
System Devices
Total Number of
Units in Buildinq
Total Number
Units Tested
Test Results Acceptable
24'., Bells Horns Chimes
2.-
2
EJ
Yes rX
No E
.......
.7
25. Voice Speakers (Voice Clarity)
N/A
Yes El
No El
26..V&aI Alarm Device - s
N/A
Y. x
es
No Q.
. v . I .
27. Smo . ke Detecto . rs
4
4
N/A El
Yes X
No 0
28.1-1 Heat-Detectors�
N/A,
Yes.:E]
No
29 ;: . D z uct Det . ectors
N/A
Yes El
No El
r e
30. Sprinkiwd Flow.Switch .,s
I ,
N/A
Ye's 19
No El.
3 . 1. S . prinkler S up . erviso ry S witches
N/A
Yes F-1
No [_1
32: Manual Pull Stations.
N/A,o
e
Ob
33. Annunciator(s)
N/A
Yes El
No [_1
34. Bea mi Detectors
e
Y s[
No El
35. A I uto I m atic I D oor Unlocks.
N/A
Yes El
No [I
36 A u I tom a I tic Do . or Rel : ease
4
NJA E]
Yes
No F-11
37. Fire Dampers
N/A
Yes El
No El
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets.
e
N/A: Y s NO F
39. Phone lacks
N/A Yes No El
.40. Call -in�Signal.
N(
Yes )EI _j
Fire Alarm Systems Page 2 of 2-
Serving' '-Edhio
12425 Meridian Ave S
FIRE PREVENTION
INSPECTION REPORT
riet; nds
SNOH6MISH CO.
Mountlake Terrace, and
1
Everett, WA 98208
0 EDMONDS
El BRIER
�'FIRE. the Town of Wdodway"
DISTRI T
Phone (425) 551-1200
0WOODWAY
[I MOUNTLAKE TERRACE
www.FireDistrictl.org
Fax (425) 551-1272
0 UNINCORPORATED
"_ FREQUENCY
STATION & SHIFF"'
LOCATION: 500 Seamont Lane
365
17 C
I
BUSINESS NAME: Seamont Place Condos
PHONE: 4257121211
SCHEDULED
DATE DUE 11' 10/01/11
MAILING 500 Seamont Ln #302
LIFIR 11, 423 1(153
ADDRESS: Edmonds
98020
BUSINESS OWNER: Gee, James #302
HOME PHONE: 4257121211
ACTIVE
EMERGENCY-1: Gumnick, Yvonne #201
HOME PHONE:
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El 1:1
LICENSE
PERSON CONTACTED: MO (.oOvI-ACE, 415POW-7- LF-Yfl Al 43c?--
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE AS & FA 6/1 1jFD LkBx
FE6 ill
SYSTEMS: 5) 11 \.,- �- co 14--
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
qA2_A"5 E21JA�� - -rffA/,J[/—S
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
4
8
4
'8
DATE,
DISPOSITION:
7
LETTER NEEDED [] YES NO
I LETTER NEEDED [:] YES El NO
r
1
8
FIRE DEPARTMENT COPY
JUN A 6 2011
C
lNrAsO
R-15
1002 Cent -at Ave H., Kent, WA 98032
(2631862-1962
:)PRINKLER WET SYSTEM
Cerfification Given
(One System per Report)
RED
YELLOW
WHITE
ONFIDENCE TEST [3 1 REPAIRS 13
ccupancy Address: '�e -, &4_4,,J I auxt
occupancy Name:
esponsible Person
irst & Last Name: V'0 et A f
Phone . Number: 07-- 6z-16
esponsible.Person
Jdress,-City, State, Zip:
Responsible Party
E—Mail Address
-ate of Inspection:
Inspection Annual
Frequency[Type:
E!sters Name
"lease Print):
SFD Certification
Number SCP_
ientification
lumber:
System Location:
entral station monitoring? Yes El No
:onitoring Required? Yes [3 N4
;ystern Make:
Monitoring
Company Name:
System Model: V �,A
;EATTLE FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
:ORRECTIONS MADE: Date Corrected: - Corrected By: -
f additional . room is needed, please add a separate sheet) SFD Certification Number: SCP-
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
;ignature of Tester:---- Phone # 2,� 3
�uilding Representative signature)
Page I of 2
)rinklers - Wet
IT
The items on the checklists below shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
.General
Flow test conducted?
-5's�)
Y
No
Static pressure: psi Flow pressure: psi
Number of Sprinkler Heads: 4K
0
Yes
No
2-inch drain?
Flow switches, supervisory switches and alarm bells tested?
No
Pressure regulating valves test ed?
Yes
No
Alar . m bell operates? N/A
No
System inspected and lubricate ri?
No
Valves are-seal'ed or supervised?
e
C92-s
No
Signs are provided on valves?
DYe s
No
Pumper 6 onnections and clapper-yal ves unobstructed and turn freely? IYIA
Yes
No
Wet type sprinkler heads replaced or successfully sample tested in last 50
CYes
No
years?
Sprinkler coverage is acceptable?
No
Have the sprinkle r heads been replaced or successfully sample test in the last
V�
No
50 years?
No
Proper number of spare sprinkler heads available?
(�r�es
System left in service?
E-e�s
No
System gauges replaced or calibrated within the last 5 years?
Oe
No
Sprinkler heads free of cor rosion, paint, obstructions and/or physical damage?
No
Was debris found in the Fire Department Connection (FDC)?
Yes
No
es!.
'Was' the, 'Fire 'De''p'artment,,Cbnnectibn-(FDC) back flushed..within'.Ahelast:5- year -YI
MY
No
Was an internal pipe and valve inspection performed within the last 5 years?
Yes
Date Performed
Was a signal received at the�Central Station monitoring company?� �N
Yes
No
Sprinkler wrench available for each type of sprinkler?
No
Page 2 of 2
Agun
CINEAS-0, no V\'
1002 Central Ave N., Kent WA 9W32
(2531852-1962
JUN Ve nu
FIRE ALARM SYSTEM
(One System per Report)
Certification Given
RED
YELLOW
WHITE
CONFIDENCE TEST]-0-
REPAIRS
Spdnkler Monitoring Panel?
Occupancy Address: Ai-00 SeAfi_jC)UN'� VhVEOccupancy Name:
Responsible Person
First & Last, Name: Phone Number: *25- jrR 2- 07-1
Responsible Person Responsible Party
Address, City, State, Zip: E—Mail Address
Inspection Quarterly (High-iise Only)
Date of Inspection: Frequencyrrype: Annual
Testers Name FD Certification
(Please Print): dtW-.y!LurNumber SCP - 0
Identificabon
Number System Location _FWlt
Central station monitoring?- Yes 13 NoM' Monitorling
Monitoring Required? Yes M No Company Name: 8--
System Make: System Modet:
F_ L —
SEATTLE FIRE CODE VIOLATIONs FOUND: (if additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected: Corrected By:
(if additional room is needed, please add a separate sheet) S FD Certification Number: SCP -
This certifies that this fire and life safety system has been properly inspected for reliability to cover the
Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, and that
discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: 2E___ �Is Phone # C7
V
Building Representative (signature)
Fire Alarm Systems
Page 1 of 2
I
The items on the checklists below shall be inspected and tested. This list does not constitute all of the
required inspecting and testing of the fire and life safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
Alarm System Functionality
Trouble signal with AC power off?
Yes
��s
No
System operates properly on battery backup?
No
Battery voltage (no load) volts
Battery voltage (full load) volts (signals operating)
Charge circuit voltage e2 -7,1 volts
System operates properly on standby power?
Yes
No
All signals operate on AC power?
Yes
No
Number of initiating circuits
Number of signal circuits
Does alarm syste . m meet. audibility standards?
Ye
No
All circuits checked for electrical supervision?
ie�ss�'
No
All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
es
No
Ventilation controls operate?
No
Key -to panel available?
No
Operating instructions at panel?
/_��s
No
Trouble]ndicators; function properly?
/-Yzes�
�Ys
Remote Annunciator Panels function properly?
QN/
No
Elevator Call Down functions properly?
/A
'
s
'es
4�es
No
Test record posted at panel?
No
General. alarm automatic time delay _ (minutes)
N/A
Was a signal received at the Central Station monitoring company?
N/A
Yes
No
Other Devices:($06cify);
Yes,..,
No.
Total Number of
Total Number
System Devices
Units in Building
Units Tested
Test Results Acceptable
1.. Bells, Horns, Chimes
N/A
Yes,
No
2. Voice Speakers (Voice Clarity)
N/A
Yes
No
3. Smoke Detectors
N/A
Yes
No
4-. Heat Detectors
N/A
Yes
No
5. Duct Detectors
N/A
Yes
No
6. Sprinkler Flow Switches
N/A
Yes
No
7. Sprinkler Supervisory Switches
N/A
Yes
No
8. Visual Alarm Devices
N/A
Yes
No
9. Manual Pull Stations
N/A
Yes
No
10. Annunciator(s)
N/A
Yes
No
11. Beam Detectors
N/A
Yes
No
12. Automatic Door Unlocks
N/A
Yes
No
13. Automatic Door Release
N/A
Yes
No
Total Number of
Total Number Units
Communication Equipment
Units in Buildinq
Tested
Test Results Acceptable
14. Phone Sets
N/A
Yes
No
15. Phone Jacks
N/A
Yes
No
16. Call -in Signal
N/A
Yes
No
CTF- 0 1 Page 2 of 2
:�v alpci-1 - o,-A,
FIRS:
Fire Incident Report
" Edmonds Fire Department
incident Number: EF07000411 Exposure: 0 Incident Date: 2/3/2007
Jurisdictional Station: 17 Location Type: Street address
Address: RM&SUMem MW
City: Edmohid-9—State: WA Zip: 98020
IncldentType: Removal Of victim(s) from stalled elevator
Shift: A Alarms: 1 Grid: EF153
Aid Type: None jj,�,Jcrl
Alarm Time: (08:32:59) 2/3/2007
Arrival Time: (08:37:58) 2/3/2007
Last Unit Cleared Time: (08:48:56) 2/3/2007
Actions Taken: Rescue, remove from harm
HazMat Released: None
Property Value: 0 Contents Value: 0
Property Loss: 0 Contents Loss: 0
Fire Service Deaths: 0
Civilian Deaths. 0 ell,
.Fire Service Injuries: 0 Civilian Injuries: 0
Detector:
Officer In Charge:
TODD ANDERSON Assignment: Command
Mixed Property Use- Pesidential use
n
—Pefav, use: Mulutamily dwellings
'i/vte,bFIRS
Fire Incident Report
Edmonds Fire Department
Person('s) Involved
Role: Patient
Name: Gerald Spencer Phone Number: 4257,766907
Address: SOO SEAMONT LN 201 Edmonds, WA 98020
Apparatus and Personnel
Apparatus ID Personnel 11)('s)
E17 EF1425 EF2218 EF2271
,vvc(TIRS,
Fire Incident Report
Edmonds Fire Department
incident Number: EF0700041 I Exposur . e: 0 incident Date: 2/3/2007
Narrative
E17 arrived on scene to report of occupant . trapped in elevator. Upon our arrival E17 was met
by trapped occupant's son. He said that the elevator was stuck on the bottom floor. E17 crew
made voice contact with trapped occupant who was not in distress or having a medical
emergency. E17 crew attempted to use fire department key to recall elevator to the bottom
floor. This attempt failed. E17 crew was unable to locate elevator technician papers in the
elevator machine room per SOP 102.21. We then secured the power to the elevator and left
one crew member In the machine room. Elevator keys were then used to open the door to the
elevator, which was level with the ground, and let the occupant out. Trapped occupant was the
Homeowner President and said that he would contact the elevator company for repair.
I
FF JASON DICKINSON
02/03,407 18:24:17 PRINT REQUESTED BY TERMINAL EFPCO8
Incident History for: #EF0700041,1
C�se Numbers: $EF07000466 $S207002291
Entered 02./03/07 08:32:49 BY SCPC04 SC746
Dispatched 02/03/07 08:32:59 BY SCPCO2 SC721
Enroute 02/03/07 08:34:35
Onscene 02/03/07 08:37:58
Closed 02/03/07 08:48:56
Initial Type: SC Initial Alarm Level: 1 Final Alarm Level: 1
Final Type: SC (SERVICE CALL) Pri: 3 Dispo:
Police BLK: E028 Fire BLK: EFi53 Map Page: 454F-6 Group: EF1 Beat: MD17 Sr
Loc: 500 SEAMONT LN EDM low xst: 5 AV S (V)
Loc Info: SEAMONT PL CONDOS
Name: FM28E Addr: Phone: 4252105166
/0832 (SC746 ) ENTRY OCCID STUCK ELEVATOR
/0832 (SC721 ) DISP E17 #EF1425 ' ANDERSON,T-L [E,MI
#EF2218 DICKINSON,J-F [E,MI
#EF2271 FORDJ-F [E,MI
/0832 $ASNCAS E17 $EF07000466
/0832 ASST TAC21
/0832 $ASNCAS TAC21 $S207002291
/0833 AIQ TAC2'1
/0833 (SC746 ) CHANGE PHO: 4252105166,
TXT: RPIS DAD IS STUCK IN THE ELAVATOR 86/M
HE IS OK - RP SAYS BEST ACCESS TO PARK ON 5TH
/0834 (SC721 ) ENROUT E17
/0837 ONSCNt E17
/0848 AOR E17 OCCUPANT IS OUT
/0848 CLOSE E17