504 HOLLY DRFIRE PREVENTION
INSPECTION REPORT
Serving Brier, Edmonds, and 12425 Meridian Ave S
SNOHOMISH Co. Wountlake Terrace Everett, WA 98208 OEDMONDS
0 BRIER
FIR Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DIS T www.FireDistrictl.org Fax (425) 551-1272 E3 UNINCORPORATED
FREQUENCY FATION & SHIFT
F
LOCATION: 504 Holly Drive 98020 Annual 17-C
SCHEDULED
BUSINESS NAME: Shellabarger Creek Bldg/Condo's PHONE: 4256721118 DATEDUE 00ct2015
MAILING FIR o 422
ADDRESS: 504 Holly Drive, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
r "N
EMERGENCY-1: TLC Mgmnt/Michelle Fellows HOME PHONE: 2062805253 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
go BUSINESS
EMAIL: LICENSE
PERSON CONTACTED: INITIAL INSPECTION �E,
NAME OF INSPECTOR: f
FIRE SYSTEMS: -AS.3/14jF�A 3/ 5
Q3 F V1 11 '1 F, D_ LkB_ bx
Date Last Serviced:.
HAZARDS FOUND AND LOCATIONS COMMUNICAII`IONS—_�
_A, 4 _U _-7sy ---- -----
2
2
3
3
4
4
5
511
6
Z7 L)
6
7
............
7
V
I AGREE To.cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE-INSPECTIOR
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS:-
PRE -CITATION
CITATION ISSUED
5
1
2
5
6
LETTER SENT
NUMBER:
4
5
6
DATE:
CODE
SECTION:
RETURN RECEIPT
3
7
RECEIVED
. . ... ....... ..
18
4
8
R�T E:
7
LETTER NEEDED [] YES NO
LETTE R N EEDED [] YES NO
�,7,7s �qtx
fIRE -PREVENTION
INSPECTION REPORT
-d' 12425. Meridian Ave S
Serving Bri& Edmonds, an
SNOHOAIISII
Mountlake Terrace Everett, WA 98208 0 BRIER
F1 E (125) 551-1200 0 MOUNTLAKE TERRACE
[I UNINCORPORATED
-1272
DISTL T www.FireDistrictl'.org Fax(425)551
FREQUENCY I STATION& SHIFT
LOCATION: 504. Holly Drive 98020 Annual 17-D
Shellabarger Creek Bldg/Condo's 4256721118 SCHEDULED Oct 2016
BUSINESS NAME: PHONE: nA7C n"C �
MAILING 504 Holly Drive, Edmonds, WA 98020
ADDRESS:
422
LIFIR
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: TLC Mgmnt/Michelle Fel I ows' HOME PHONE: 2062805253 CURRENT
KEY ACCESS-2: HOME PHONE: CITY NO
EMAIL: BUSINESS
14 .- LICENSE
INITIAL INSPECTION DATE
RSON CONTACTED:
0-
ME OF INSPECTOR:.
3/14 FA 2/16 FE 3/15 1'2:00:00 AM
Da . te Last Serviced: 511 Lp lq-�j r2
HAZARDS FOUND AND LOCATIONS/ COMMUNICATIONS
J/A
.1 WQ 0 -1 kt -r- (A-) NiTib 5?RIAA10-M
AojAmAt- 7z-"51'
2 -7,6S_
2 EO
JWOL
3 XF( lot-(O.( 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
EXTENSION j FINAL RE -INSPECTION VIOLATIONS
DATE DUE:
DATE DUE:
GRANTEDTO: DATE DUE: CITED:
PERSON
PERSON
PERSON
CONTACTED,
CONTACTED,
C ONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR: 2
DATE'
DATE:
DATE -i3
VIOLATIONS
VIOLATIONS
CITATION ISSUED
PRE -CITATION
1 5
1 5
LETTER SENT NUMBER
CODE 5
2
2
DATE: SECTiON.
RETURN RECEIPT
3
3 7
RECEIVED 6
DISPOSITION
4 8
4 8
DATE
LETTER NEEDED YES NO
LETTER NEEDED [] YES NO
8
This is a Federal Building 0
FIRE
CONFIDENCE TEST *"
BotheY Fire & Securi
PO Box 2085 Bothell WA 98021
(425) 286-2144
info@bothell-fire-security.com
FAIL-F-A R M Status Given
REACCEPTANCE TEST 0 RED 0 YELLOW 0 1
WHITE 11�-
Occupancy Address: lbtiv 1pr hW Occupancy Name:!5)j,,dabACcj e-Cr- Co
Responsible Person
Ajk 1 14/?) 1 P
First & Last Name: Phone Number:
Responsible Person
Address, City, State, Zip:
Technician's Name.Dam-A Ij Mvyuia
(Please Print legibly)
Responsible Party
E—Mail Address
SFD Certification No. SCP-I)C-2>c
Quarterly 0
Date of Test: .,Test Frequency:
Annual.,
System Make: System Model:
System Identification No.
System Location:
SFD ID No. (Call 386-1448 for this No.)
Central station monitoring? Ye s Mr' No CI Monitoring Company
Monitoring Required? Yes No 0 1 Name 1-e-�
DEFICIENCIES FOUND? Yes C3 No M-*tist items that were not corrected at the time of the confidence test. Use
the Deficiencies section or attach itemized sheet
REPAIRS: All deficiencies �have been corrected 0
Corrected By: SFD Certific'ation Number: SCIP —
System Status changed to White (including the -tag on the system) C3
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 actiom
Signature of Technician
��hone #
Name of Testing Company Are- 42�
Building Representative (signature) Date
Print Name and Title Direct Phone #
1 Building Rep unava ilableV�t`uilding Rep declined to sign report C3
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
6-2013 Ver.1.4 Page 1 of 4
This is a Federal Building 0
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
PRE -TEST CHECK
Prior to starting work precautions were taken to prevent an alarm from going to
the fire department by making notification of the test to: (check all that apply)
1. The building occupants
N/A C] Yes
No 0
2. The onsite supervisory station
N/A Yes
No 0
3. The Central Station Monitoring Service
N/A Yes ET
No 0
GENERAL
4. The key tothe panel is-aVailable at the FACP. N/A C1 Yes No 0
5. The oReratin- instructions are available at the FACP. Yes No 0
6. Materials and equipment 'needed to restore pull stations ar6 available at the
main panel, e.g. glass rods, and plates; keys and allen*wrenches; -etc. N/A 0 Yes No 0'
ALARm PANEL
F�qpe e on&C
7. All si nals on the,'EAC , __!At
No 0
_power.
8. All sigqnals on the FACP op ate ower.
�L 9n ppttery p
Yes
No 0
.
.9. AllsignalsontheFACP erateoneme'eng
.y ggperator/§tpndby�p er
/A,,, Ye
No"
10. The trouble indicators function properly and a trouble signal comes on with AC
power off. V&-
No 0
INITIATING DEVICES AND ALARm APPLIANCES
11. All initiatin s tested op npgrly,�on AC power.
9 and annunciating,device _grate p
Y es, NoO
12. All initiating and annunciating devices tested operate p!�op�plyqn g!�neratorjg�ndby_power.
Yes
13. All initiatin 9
g and annUn�iatin devices tested opeLate ploperly on battery power.
Yes Er No 0
14. 100% of the INITIATING DEVICES per circuit were tested in accordance with 2007 NFPA
72 Chapter 10. (NOTE: 2 or 20%, whichever is greater, of restorable fixed -temperature,
spot -type heat detectors need to be tested annually. Records shall be kept to ensure that every
detector is tested eve�X 1,ye years.)
Yes gel' No 0
15. 100%,of the AUDIBLE�'ALARMAPPLIANCES per circuit were-,test6d in
accordance with 2007.NFpAJ2 ChapAer, 10'
�Yes� No 0
16. The audible alarm appliances tested o rate at the levels desiqned by the manufacturer.
Yes No 0
47. The audible appliafice�:tested in residential units generate'a,mihimum of
60dBA in the sl!*pihg areas., . . .. t-11 1, 1 . � --� NLA Ef
y6sll
No 0
18. 100% of the VISUAL ALARM APPLIANCES per circuit were tested in
accordance with 2007 NFPA 72 Chapter 10
Yes No 0
19. The visual- alaii-n —appriaRes testec[ perate as des*igned. by the,'
manufacturer.
Yes No 0
BATrERIES
20. The batteries are rai6dlor- hours minOtes'
21. Battery voltage (no load) —Z7 olts
22.. Battery operating
.yoLlt��ggffu
L11, Coid �2'rip;y 5volts (signals
23. Charge circuit voltage -,91
I A 19volts
Fire Alarm
6-2013 Ver. 1.4 Page 2 of 4
This is a Federal Building 0
INTERFACE DEVICES
The FACP received signals from the following Interface devices:
Tested bv: Simulation IV Ope
24. Emerqqncy_qenerator(s
N/A
Yes C3 No 0
25. flow Switch(ps
N/A
C3
Yes Mr'
26. Supervisory Switch(es
N/A
0
Yes W'
No 0
27. Range Hood Suppression �yAem(�)
N/A
Yes C3
No 0
28. Spray_�ooth Sup ression System S)
N/A
C31'
Yes C3
No 0
29. Clean gf�nt Sy
Aem(s)
N/A
M"'
Yes C3
No 0
30. Pre -action Systems s
N��4�_
Yes Ell
No [I
31. Pull Stations
N/A
0
Yes 12r
No 0
OTHER EQuiPMENT CONTROLLED By FACP
The following Fire Safety Functions responded to signals from the FACP. Tested by
Simulation C3 Operation C3
Note: This Section replaces the Sequence Test Form. The checks in this section are only required during one of the quarterly
tests. The
functions in this section require testing during the annual confidence test for other buildings.
-all
Fan controls
N/A
P 0
No C3
33. Smoke Dampers
N LA
—Yes
M�' Yes C3
No C3
34. Elevator Reca�l sygem
N/A
[03 Yes
No C3
35. Elevator Shuftt Swit�h(f�s).
Of Yes n
No C3
36. Door holder releases
N/A
ED_ es
No CII
37. Door Lock devices
N A
2 Yes [I
No C]
38. Fire Pump(s)_
N/A
M--, Yes C3
No C3
39. General alarm automatic time delay __(q):inutes
N/
No 1711
40. Remote Annunciator Panels
N/A
Yes C3
No 0
COMMUNICATION EQuiPMENT
Test Be<ults Acceptable
41. All phone sets function properly.
N/A
Mr Yes 0
No [I
42. All phone jacks function properly.
N/A
Yes 173
NoO
43. All phone indicating devices at the FACP work properly
N/A
Yes 0
No 0
44. The public address equipment at the FACP works properly.
N/A
CY' Yes C3
No 0
45. The in building Emergency Radio Communication Systems function
throughout the building in accordance with 2009 SFC Sec. 510 and
Appendix I Annual Test 0 5-Year Test C3
N/A
lv,_�Yes C3
No C3
ALARM PANEL MONITORING
46. A signal was received at the Central Station monitoring, company. N/A C3 Yes IK No 0
FINAL CHECKS
47. The Fire Alarm was removed from test mode and/or other precautionary
measures were removed to restore the fire alarm system to normal
operation (includes removal of protective coverings).
Yes V// No 0
48. The test record was pogted gt pAnel.
Yes No CT
49. A copy of the confidence test report was given to the owner and a current status tag was
posted on the Alarm Panel.
Yes No 0
50. The confidence test report was sent to the fire marshal's office I
Yes Qy No C3
Fire Alarm
6-2013 Ver. 1.4 Page 3 of 4
This is a Federal Building C3
Deficiencies
Resolved
Location:
Deficiency:
I Recommended Resolution:
SFC and/or 2007 NFPA 72 reference:
Resolved 0
Location:
Deficiency:
Recommended Resolution:
SFC and/or 2007 NFPA 72 reference:
Resolved 0
Location:
Deficiency:
I Recommended Resolution:
I SFC and/or 2007 NFPA 72 reference:
Resolved 0
Location:
Deficiency:
Recommended Resolution:
SFC and/or 2007 NFPA 72 reference:
Resolved 0
Location:
Deficiency:
Recommended Resolution:
SFC and/or 2007 NFPA 72 reference:
Fire Alarm
6-2013 Ver. 1.4 Page 4 of 4
Seper, Edmonds, and
12425 Meridian Ave S
SNOHOMISH tCO.
FIRE
M( Terrace
Everett, WA 98208
ST
T
Phone (425) 551-1200
Fax 551-1272
www.FireDistrictl.org
(425)
LOCATION:
504 Holly Drive 98020
BUSINESS NAME:
Shellabarger Creek Bldg
PHONE: 42567211fl
MAILING
ADDRESS:
504Holly Drive, Edmonds, WA 98020
BUSINESS OWNER:
Christophilis
HOME PHONE:
EMERGENCY-1:
TLC Mgmnt/Michelle Fellows
HOME PHONE: 206280525'
KEY ACCESS-2:
HOME PHONE:
EMAIL:
(I -
PERSON CONTACTED:
A-)n i., c—
NAME OF INSPECTOR:
.4 A , - A--5 /-0 "
FIRE SYSTEMS:
E I/ Lk Box
AS 11/04 FA 3/134 1-hi v �P_ 6
'jV
"A
-
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
00 FREQUENCY STATION & SHIF_*1
Annuall 17-A
SCHEDULED
DATE DUE � Od 2013
422
CURRENT
CITY NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
/ / — .1 -- J 3
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
V_11
1
f
_S_e_,o-tj1c_c 25t elr_ )C_x
r-15 -
2
6 ir I-Ly C t "S 0 k /Cc,
2A5
3
3
4
r-1.
4
1A
5
5
6
V
6
7
4
7
In I q 00 LQ OVD-V*4 /\'
i I 11
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN T[IE 6XT 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 or the Town of Woodway, call (425)
775-7720; for Mountlake Terrace or Brier, call (425) 754-0434.
BUSINESS COPY
n Zw6ber
From:
Kevin Zweber
Sent:
Friday, January 31, 2014 8:59 AM
To:
'Michele Fellows'
Subject:
Update Please
Michele,
Could I please get an update on:
Sprinkler system certification at 504 Holly
Fire alarm panel upgrade at 2 loth Street Condos
Also, after some thought and difficulties, we will need a new box at 504 Holly. Go to www.knoxbox.com model 3261 or
3262 required.
Kevin Zweber, CFl
Captain/Deputy Fire Marshal
Fire Prevention Services
Snohomish County Fire District #1/
City of Edmonds
Office 425-775-7720
Fax 425-775-7721
in ZWeber
From: Michele Fellows [michelefellows@yahoo.com]
Sent: Friday, January 24, 2014 3:28 PM
To: Kevin Zweber
Subject: Re: 504 Holly
Thanks for checking everything out Kevin. I'll get you an update next week!
Michele Fellows
Association Management Specialist
TLC Management
michele@tic-manac7emenLcom
4251280.5253
From: Kevin Zweber <kZweber(cD-firedistrict1.orq>
To:'Michele Fellows' <miche1efellows(@yahoo.com>
Sent: Friday, January 24, 2014 12:24 PM
Subject: 504 Holly
Michele,
I inspected 504 Holly today and the following infractions were noted:
Sprinkler system has not been serviced for 3 years....required annually.
Need I Red with white lettered sign, approximately 12"xY (whatever is off the shelf), stating "Fire Sprinkler
Riser" or "Riser Room" placed on the riser room door.
Need a FACP key. One is hanging from the side of the box which is in a common area. I looked for a spare
and couldn't find one. This will go in the FD lock box.
Fire Extinguishers on floor one haven't been serviced for 3 years.....required annually.
I looked at the door situation. That door is the required exit for the bottom floor and cannot be locked from the
residential common area side. One of the occupants for suite 101 gave me a key to suite 102. 1 have the
following keys: 12 nd floor main entrance door key, which I believe opens the electrical room also. I Fire riser
room key, one Suite 10 1 key, one Suite 102 key, and one elevator key.
Depending upon the key situation, I ma ed a new "Knox Box". The current box is too small. I will let you
know on this.
www.knoxbox.com model 3262 required.
Please let me know when the above is taken care of and call me when you have a FACP key and I will come out
and place it in the box. I will evaluate the box size at that time.
Thanks for your help in resolving these issues.
Kevin Zweber, CFI
Captain/Deputy Fire Marshal
Fire Prevention Services
Snohomish County Fire District #1/
City of Edmonds
Office 425-775-7720
Fax 425-775-7721
M
Ke.vin Nveber
From:
Sent:
To:
Subject:
Michele,
Kevin Zweber
Friday, January 31, 2014 8:59 AM
'Michele Fellows'
Update Please
Could I please get an update on:
Sprinkler system certification at 504 Holly
Fire alarm panel upgrade at 2 loth Street Condos
Also, after some thought and difficulties, we will need a new box at 504 Holly. Go to www.knoxbox.com model 3261 or
3262 required.
Kevin Zweber, CFI
Captain/Deputy Fire Marshal
Fire Prevention Services
Snohomish County Fire District #1/
City of Edmonds
Office 425-775-7720
Fax 425-775-7721
1
3201 Muldlteo Blvd.
Everett� WA 98203
Office 42S-355-3089
Fax 425-353-0508
Confidence Test Report
206-3WJ448 Caffidence Tesfing Offtff
206-615-1068 (fax)
206-233-7219 Red Tag HoUlne
[FOREALARN SYSTEk
(One System !�,Report)
--7 Certification Given
RE6 a
YELLow a
I -
WHrrE
CONFIDENCE TESTJ_
W1
REPAIR
Sprinkler Monitoring Panel? 13
Occupancy Address: ApAccupancy
Name: cra f - 2
Responsible Person
First & Last Name:
Phone Number:
Responsible Person
Address.! City, State, Zip:
Responsue Party
E411all Address
Date of Inspechon:
Inspection Quartedy (fth-riseonv)
Frequencyrrype: Annual
Testers Name
(Please Print):
Identification
SFD Certification
Number SCP
Number V, -7 :T��
System Location
Central station ffmitoring? Yes No ED
Monitoring Required? Yes No 0
Monitoring
Company Name: (ot )AA a-4 c
System Make:
System Model:
C&r,rL—E FIRE 2.02—W VIOLATIONS FOUPID (if additional room is needed, please, add a separate sheet)
jak) eq
KM: Date Correctted
Coffected By-
(ifeddmowmmlsmeded.pwmeawasepmwo4" SFDCerfification Number SCP-
This certifies that this fire and life safety system has been propedy 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 th7e�bb,"Ing Owner/Manager for corrective action.
Signature of Tester
Phone#
Building Representative (signature)
I--
IL
The Items on the d Ists below shaD be Inspected and tested. 7bIs Ust: does not CNOUbAs all of the required Inspecting and
tBOV of the fire and Ofe saretV system Refer W the Seattle Rne Departntent Fire Code fbr Inq*dfM and tes" requh�
I. Trouble signal with AC power off?
Yes
NO
2.. Sgst.em�ooii�Ipmpely.bhbaft�l*,badcup?
Yes ED
No J3
I _�4ttwy voltage (no load volts
-
-load
4. BOttvyv40tjW- i
yul Z111,:11 volts(slinalsoperatingO
5. C.h.arge..drcult vottage volts
System operates properly on: standby: power?
Yes
No
7. All signals operate on AC power?
'8.'
Yes
NO
Number ofinitlatitig �.drcults�
9. Number of signal circuits
10. Does alarm system meet audibift standards as -accepted?
Yes
No 13
11. All drcults checked for electrical,supervislon?
Yes
NO 13
12. All auidllary equipmentopdrates'(Elevaitor$, fans, dampers)?
I
N/A [5
Yes
No (31
13. Ventila tion controls operate?
N/A
Yes
No CP
14. to, Panel1,,aval1ableT-..
Yes
is.- Materials and e'ul
, q Pment needed to restore pull statJons are available at the
N/A
Yes G
No G
rTplp pand, e.g. glass rods, and. plMes, keys and alien wrenches, etc?
Pp"riginsbUctionsiat' nel
Oa , ?.
Ves
No,U.
.17.. Trouble Indicators ftjncuqn.prqpW.
Yes
No J3
'Remotet, Ou Panels 11:111C) 11311 .*?
N/A
YeSIO.
-NO,
19. Elevator Call Down functions properly?_
N/A
Yes
No'jj
20ijestiecord�posbed.at, parjel?,
Ye&&
24. General alarm.automatic time delay _7_m_�.(mlqutes)
N/A 13
-a-'sic fididved Qhtrtal-Statlon� mon'jjj�iring�'bomparry?
N/A G
Yes U__�
1,1b.
23. Other Devices (SpeclN)
Yes (3
No
3"Un DSIACW
Total Number of
Units In
TOW NumtW
Unb TWed
Test: Resufts 802—tft
24.. MIS, Hornsthimes
N/A G
Yes ir
No G
25. Voice Speakers (Voiceclaft)
N/A
Yes Ek
NO G
26� Msual Alarm Devices
27. Smoke DebeCbDrS
N/A
N/A G
Yes G
Yes U'-'
No G.
No 13
48..: Heit-Detectors
N/A
Yes G
NoU
.29.. Duct Detectors
WA
Yes G
No
Flow Switches
N/A:. G
Yes I
Mob
3Lq S ' pri ' nkl� Supervisory Switches
N/A U
Yes'YK'
No G
31. Manual Ptjll:Statidns
WA G
YesV-_'No'CP
33. Annundator(s)
-
N/A
Yes G
No 0
14.
N/A-
Yes G
No
.35....Au.b.-ornatic Door Urd.o.dcs
N/A
Yes G
NO G
'36. Automatic Door -Release
:N/A
YeS.G
No G
1 37. Rre Dampers
N/A.
Yes 13
No G
Cppmuno;Won
TOW Number of Unb
in BWWbM
TOW Number Unfts
Tested.
3�01 Resuft Acceptable
38. Phone Sets
N/A NO 13
39. Phone Jacks
N/A Yes No
.40. CalHn Signal
j
N/A_a�< Yes No
Fire Alarm Systems Page 2 of 2
All Events Report
Report forperfod: 813112015 12:00:OOAM to 813112015 10:27:00PM
Shellabarger Creek Condos 89,4774
504 Holly Dr
Edmonds
Snohomish
Washington
98020
Date and Time, Zone and Restore 77me
Evert,Actions Taken, Completion Tine and Operator
8131/2015 10:51:14AM
Details Opened for Editing (Opr)
DM
8131/2015 10:54:38AM
Details Opened for Editing (Opr)
RGH
8/31/2015 11:16:51AM
Details Opened for Editing (Opr)
KSC
8/31/2015 11:18:33AM
Linda Lightfoot called in unable to reach service. Transfered.
KSC
813112015 7:46:20PM
Trans Test O'due (1) N1
813112015 7,46:20PM
Trans Test O'due (1) T: 1 A: 1
8131/2015 10:25:58PM
Acton Started N1 Bothell Fire & Secudty
HLG
8/31/2015 10:25-58PM
Actioned NI (Done)
HLG
8/31/2015 10:26:02PM
Details Opened for Editing (Opr)
HLG
Actions Legend: P = Police, K = Keyholder Group, S = Site, A = Special Action, F = Fire, G = Gen Agency, / = Installer, M = Medical
Alarm Center Inc. 1-800-752-2490
Securio First Protection
94118 Odin Wy.
Bot�ell WA 98011
0: 42;-286-2144
F: 425-286-2098
Contact 866-816-7700 (240)
. www.se!curitvfirstpro.com
FireAlarm' Inspection & Sen�ifivity Test Repprt
Inspection Date:&_2y_'�k/34 Ann"uallyXI 61 uarterly 0 Monthly 0 Acct. #
Facility NameAje /I CC A.,eOeS Phone:
City/State/Zip:
Address:
Fire Alarm Control: Manufacture 4 Model,
Number of Initiating Circuits: Initiating Circuits Supervised:
Number of Signaling Circuits: 2. Signaling, Circuits Supervised:
NO Breaker, Locations Posted:
Trouble with AC Off: W, I
Communicator: YES C munication Type:
07
V61 s Battery Voltage Under Load/
Battery Voltage:
Charging Circuit Voltage: Vol Cha'raing Circuit , Current
Key to Panel Available 'NO Location: Vi X�
Operating Instructions Posted YES Location:
NO.
NO
YES
Dial -up ..edicated TU
No A/C ,Vol
AMPs.
Equipment Type
Numberbf Units
Satisfactor
y
Manufacturer
Comments
Total Tested
-Total
Tested
YES or NO
Bells
N
Horns
N
es
Strobe Horns
(Y N
yes
Strobes
-N
Manual PullStations
Y N
YIL
Smoke Detectors
N
V'0
Duct Smoke Detectors
Y N'
AMC
Heat Detectors
Y N
PIV Valves
Y N
Tamper Valve Switch
2
Y N
IL i
Water Flow Switch
2-
Y N
Air Pressure Switch
Y N
Sensitivity Test
Y N
7
Problems Found:
!1'.Ve
License #
IQ
Security First Protection,
9418 Odin Wy. -
Mhelf, WA 9_�() 11,
0: 425r286-2144��!,
F- 1415-286-108"
C
.,.,�,ontact�866-81.6-7700 (24x7.).,
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epo
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.'Marterly'll -Mont I hly 0 Accf` #4597* VIY91y
Inspection Date:13' 2 AnnuallyB.''.
V
Facility C 1)W Phone:
A s City/State/Zip: t-f 0
cl� es .0
7— 77. - - — -
06
Fire'Alarhi'6 rit'rol: tu 'A Model:
Manufac' re: S,
7
N 'M' i6ting_Crcuits:____,_ Initiating eir6uits Supervised: NO
u bq��df_lnit. GyE
r* 6f S'ignalin' QLS NO
Numbe 9 cults: 'r, Sig"rialing-Circuits:, Supervised:
Trouble'with AC Off: NO. Breaker Locations Posted: YES-._,�:
YES NO Communication Type:', Dial-u Dedicate "Syd
Communicator:
V Itage Und6i�,Loadf' N6A/C Vol
Volta
Battery gq Battery.. o
Circuit Current,' — AMPs
�o s Cha'r- 9 �7,
'Chargi'ng,'Ci��c'uitV'olt.a:g'!�e" 'it ging
"Y
L 0
0
cati n::
key,to'Panel Available.
ction
0- iting� lrfst�6 s �6sw NO' Location
pere
6nt,typel;-t�l f 7
E b' r,�' Uni s.
quipm Nu�n e f ;Satisfactory aquacturer C-ommbnts
T6tal �,T t d
��b-"tal Tested � . '. 1� " " :. ", ".
_.es e ES�or,NO
Bells..'. Y_N��
N
P
ts
Horns e_,C> q
to N, -
—Strobe Horns; N
Strobes
ManuaR_Pu`II.Stat1ons__
S moke Detectors
_,N_
Duct Smoke Defectors-
Y N
Heat. Detector§.
Y N
PIV Valves,
Y N
Tamper Valve Switch
N
)�;bvg
Water Flow Switch
()y N
LOCI,
Air Pressure Switch.
Y N
Sensitivity Test
Problems Fo'uhd:,
00 A
r,7 -e e c -c A
0
r 5 77A 1, /4- 6 v
/?Of
_/-/0
ue -fl,4 L) Cq�&
Coub;�? /�-,p 0
problems-
7-A EO�, A-rre ley,
4-
this report
is to certify the above listed fire alarm equipment has been properly tested and inspected for �,eliability
Owner/Representative Signature
Tp.-hnician
License #
MR
FIRE PREVENTION
"INSPECTION
Servihg Brier, Edmonds
12'4'�5� A4�ridian' Ave- S"
REPORT
MISH CO.
FIRE
Mountlake Terrace, and.
Ev6rett, W4 98208
O'EDMONDS
0 BRIER
ST T I
e Town. of Woodway.
w"'ww.FireDistrict-1. or2�
Phone, (425) 551-1200
Fax (425) 551-1272
E]WOODWAY
[I MOUNTLAKE TERRACE
0 UNINCORPORATED
I 1i
FREQUENCY
STATION& SHIFT—,
LOCATION:
504 Holly Drive
365
17 D
BU�INESS NAME:
Shellabarg6r Creek Bldg
PHONE:
425672,1118
SCHEDULED
DATE DUE
10/01112
ji MAILING
130 Box 25
LIFIR o 422
509* 1(153
ADDRESS:
Edmonds
98020
BUSINESS OWNER:
TLC MgmntAMicheIIe Pellows
HOME PHONE:
2062805253
ACTIVE
EMERGENC.Y-1:
McKay, Greta #202
HOME PHONE:
4257781428
CURRENT
. KEY ACCESS-2:
PERSON CONTACTED:
-�4;"��',PAME OF INSPECTOR:
Aar�7n'
FIRE AS 11 /014 FA 1/12 FD LkBx
SYSTEMS:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE *, 1:1
INITIAL INSPECTION DATE
F
f
ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
ALO
2 ��e_ rul c e Fire
2 PSO
3 If r U I C 9- ,02C rq f h
C. Ini In 34 FloorrI-6,--
lg?4
3,EkO<_
4
—A-- C?!N
r-2
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 -INSPECTION
VIOLATIONS
DATE DUE.
DATE DUE:
GRANTED TO,
DATE DUE:
CITED.
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
2 ATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTIOM
RETURN RECEIPT
6
3
7
3
7
RECEIVED
DISPOSITION:
4
18
4
18
I
DATE:
7
LETTER NEEDED [] YES NO
LETTER NEEDED E] YES 0 NO
I
1
8
FIRE DEPARTMENT COPY
Fire Alarm Inspection & SensitiVity Test Report
Inspection Date:
Annually Quarterly 0 Monthly 0
Acct. #,4�
Facility Name:—<� A4 LIA Q vgufA
Phone:
Address:-.
city/st-t6/zip..
a
?Z2
Fire Alarm Control:
Manufacture: 51 lz_a 7,Z 9 ',/,�7 Model:
Number of Initiatilng Circuits:
Initiating Circuits Supervised:
NO
Number of Sig4ing Circuits:
Signaling Circuits Supervised;
(DS NO
Trouble with AC Off: ES NO
Breaker. Locations Posted.:,
YES N.0
Communidatbr:';' YE N,O.
S
Communication, Type:
.-Dial-up0edicatedISTU
Battery. Volta'g�:,. Volt;
Battery ot.agp Under Load/.1',
I
o
Charging Circuit Voltage': V"It
'o S
Char ing.Circu,it Current�
.9
Key to Panel Available�`
Operbting.Inst - riuctions Posted- 'ES No
y 8�_
Location:
.Equipment Type
Number.of Units
-Manufa6turer-
'Comments:��,4,�-��,,
Total Tested
Total
Tested
YES or NO
Bells
NO 7- r.?
Horns
Y N
VN
8trb orns .
11Y
Strobes
Manual Pull Stations
N
Smoke Detectors
N
Duct Smoke Dete�tors
"�-_,Nl
Heat Detectors
ecz�)
N
Y� N
PIV Valves
'Y�, N
Tamper Valve Switch
y N
yp
Water Flow Switch
Y N
Air Pressure Switch
Y N
Sensitivity Test
_Af)
N
Problems Found: /z Z_,5-/2 ep re'a
14�1
1?r��blernq(Foij�d_.-,.
Lh
1 .
this report is to certify the above listed fire alarm equipment has been properly tested and inspected for reliability
Own e'r/ke presentative Signature ��Iechn`�iiavh License #
/Y e&o
- 1�ra I- C_ 7 P,<,' Mo el 5208
nn �on rolMParnel with
Digital Communicator
The Fire Alarm Control Designed to Grow with
Your Systems Needs, Without The Growing
Pains.
lu WWAU_", The SK-5208 is a microprocessor based control panel with built-in UL
OA
isted communicator designed for applications requiring smoke detection,
A manual pull stations, and sprinkler supervision. It features an easy to read
IEU LCID display with programmable English readout and user friendly tactile
keys. The basic unit offers 10 zones of initiation and is expandable up to
30 zones for larger applications. The SK-5208 has a complete line of supervised accessories that provide
remote annunciation, auxiliary control zone expansion. Ideal for new and retrofit applications, the SK-5208
delivers the performance to handle your installation.
Features
* 10 zones, 8 Class B (Style B) and 2
Class A (Style D) or Class B (Style
B) zones, expandable to 30 zones
* Supervised zone expanders and 1/0
modules can be mounted remotely
from the main control panel
* Event History Buffer (150 events)
with date/time stamp
* All zones are compatible with 2- or
4-wire detectors
* 8 selectable/programmable output
patterns for notification appliance
circuits
* Built4n Digital Alarm Communicator
Transmitter (DACT)
* 4 Notification Appliance Circuits
* 4 programmable general purpose
relays
* Programmable smoke verification,
pre -alarm delay, cross zoning and
enhanced verification mode features
that can help minimize false, alarms
* Programmable from the built-in
control panel touchpad, remote
annunciator, or WindowsO SKSS
downloading software
• Direct connect port for on -site
up/downloading with WindowsO
SKSS downloading software
• Built4n walk test feature
• Single or dual interlock water
releasing capability
• Plex door option combines a dead
front cabinet door with a clear
window, limiting access to the panel
while providing single button
operation of the reset and silence
functions
• Programmable AC trouble relay
• BuiltAn synchronization for
appliances from AMSECOO,
GentexO, Faraday, System SensorO,
and Wheelock@
• Programmable date settings for
Daylight Saving Time
• Clock source setting options for 50
Hz, 60 Hz, or intemal (uses the
panel's internal clock)
Specifications
Operating Voltage: 24 VDC
Primary AC: 120 Vrms @ 60Hz, 2A
Total DC Load: 6 Amp
Current Draw:
Standby: 140 mA
Alarm: 460 mA
Flush Mounting Dimensions:
Height: 24.75" (62.9 cm)
Width: 14.5" (36.8 cm)
Depth: 3-7/16" (8.73 cm)
with 5/8" protruding
Overall Dimensions:
Height: 26-3/8" (67 cm)
Width: 17-3/16" (43.66 cm)
Total Depth: 4" (10.16 cm)
Operating Temp: 32* to 120' F
(0* to 49* C)
Humidity: 10 - 93% noncondensing
Optional Accessories
* SK-5235 LCD Remote Annunciator'
* SK-5217 10 Zone Expander
(2 max. per system)
* SK-5280 Status Display Module (8'
max. per system) -
* 7181 Fire Zone Converter
* 5220 Direct, Connect Module
* 5824 Serial/Parallel Printer Interface
Module
SK-5208
• SKSS Downloading Software
• Plex-2 Door Option
Listings and Approvals
• UL Listed
• CSFMListed:.
• MEA approval 429-9 2-E Vol. XI I I
JSILENT
-."KNIGHT
by'H60' i W'e`il!`�'-
ey
Model 5208
Fire Alarm Control Panel with Digital Communicator
Engineering Specification
The system shall contain a fire alarm control panel to supervise and operate heat and smoke detection devices,
manual fire alarm devices, alarm notification devices and visual annunciators. The system shall also be capable
of monitoring for sprinkler supervisory and water flow conditions. The system must have a built in UL listed'fire
communicator that can be enabled/disabled as needed on a per job basis. In addition, the system will sound
alarms locally for purpose of evacuation.
Telephone Line 1
2 Class A (Style D)
or Class B (Style B)
Initiation Circuits
8 Class B (Style B)
Initiation Circuits
To AC
Y
Telephone Line 2
irect Connect
For On -Site, Programming
Programmable
Form C Relays
Notification
Appliance Circuits
5235 Remote
E E. 3. Annunciators
SBUS Devices
5280,5217, & 5824
SILENT This document is not intended to be used for installation purposes. We try to MADE IN AMERICA
keep our product information up-to-date and accurate. We cannot cover all
KNIGHT specific applications or anticipate all requirements. All specifications are FORM# 350318 Rev B, 11/05
me subject to change without notice. For more information, contact Silent Knight
by Honeywell 7550 Meridian Circle Suite 100, Maple Grove, Mn 55369-4927. Copyright @ 2005 Silent Knight
Phone: (800) 328-0103, Fax: (763) 493-6475.
Central Sprinkler Voluntary Replacement Program
Incomplete Claims -Washington State
Claimant.!,.-
-PropAddress
Dro O'City�'-.
PropState
--'--'PropZip,
C
m er:
100478162
ERNEST G COLLINS
ROSE MONTE
8127 212TH ST SW #1
EDMONDS
WA
�_80267467
Condominium
CONDOMINIUMS ________8125212THSTSW
400032.335
ERNEST 6 COLLINS
ROSEMONTE
EDMONDS
WA
98026
Co _d_o_mini6_m
CONDOMINIUMS
101412177
AVALON HOME OWNERS ASSOC
232 4TH AVE S AVALON
EDMONDS
WA
98020
Qo_ndor�i n--iumrrownhome
CONDO
102520963
RITE AID CORPORATION #5183
RITE AID
22515 HWY 99
EDMONDS
WA
98026
Retail
550005913
Stevens Healthcare
I Radiology
121601 76th Ave. West
Edmonds
WA
98026
Hospita—I
Central Sprinkler Voluntary Replacement Program
Complete Claims - Washington State
Claim
Claimant.
Property
PropAddress
PropCit
P ropState
Pror)ZiD
BldgCode
Number.
'y
102136294
RAY E METTER
ATRIUM
229 3RD AVE S #201
EDMONDS
WA
980208409
Condominium
200055829
CREEKSIDE CONDOMINIUMS
CREEKSIDE
609 7TH AVE NORTH
EDMONDS
WA
98026
Condominium
CONDOMINIUMS
101581804
JAMES D CHALUPNIK
JAMES D
540 DAYTON ST 201
EDMONDS
WA
98020
Condominium/Townhome
CHALUPNIK
SHELLABARGER
102098042
SHELLABARGER CREEK
504 HOLLY DRIVE
EDMONDS
WA
98020
Condominium
CONDO ASSOCIATION
CREEK
100260279
SEAGATE HOMEOWNERS
SEAGATE
263 4TH AVE SO #102
EDMONDS
WA
980208405
Condominium/Townhome
—
ASSOC.
CONDOMINIUM
'Condominium/Townhome
210232314
FOREST ISLE
BLDG #1
14714 53RD AVE —JEDMONDS
�WEST
ff__]�_8026
1
ICONDOMINIUMS
UNIT 103
2/16/2005
SIHIELLABARGER CREEK CONDOMINIUM ASSOCIATION
City of Edmonds Fire Department
121 Fifth Avenue N
Edmonds, WA 98020
RE: 504 Holly Drive
c/o TLC Management
P.O. Box 25
Edmonds, WA 98020
I D ECEOV FE
I AUG 12 2005
L
EDMONDS FIRE DEPT.
I wanted to ensure your records were up to date on contact information for this address.
The business name is Shellabarger Creek Building.
The mailing -address is c/o TLC Management, PO Box 25, Edmonds, -WA 98020.-
The main contact phone number is 425/280.5253 (Michele Fellows, Manager).
An onsite contact phone number is 425/778.1428 (Greta McKay, owner of unit #202).
Please give me a call at 425/280.5253 with any questions. Thanks!
Warm Reg ds,
Michele Fellows, AMS
Association Manager
504 Hotly Street, Edmonds, WA 98020
MEMORANDUM
ID TRACKING # DATE I
REPORTED BY: OF f�4*5A4:0-T!j 2o6 Mr 987
SUBJECTADDRESS: -6 4 flo. I- - L/
CONCERNS/ HAZARDS: aCpV-ATv4_ 46*/� 7)#A to
SM&A6 w*J mAcA�.,t Xo�
5PA S)� 6 cl 77r9S<_ PC FiN_- /'_fEi:454_ le&'O-A-Q
SIGNED
FOLLOW-UP:
V LA)
0 j� I C-C I'-Jl ,)) LL_ fA0,3Lc_^-1 �
Wl LL_ S7�4,',JV—t.6< VAVt_,&_ ID eL_�e4�_r__
SIGNED:
City of Edmonds Sb Fire Prevention Bureau
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SEP 08 '99 16:13 FR GRINNELL FIRE PROTECT253 859 5255 TO 14257757?21
Xt,
P. 01/01
FIRE FROTFCnON SYSTEMS COMPANY
Service Department
1215 Central Avenue SQ., Sulle 125
Kent, WashirigtQn 98032-7425
Tel: (263) 859-5066
Fax: (253) 859-5307
Contramrs License No. $Fq1NNFPi37LE
MEMO LETTER
Date, . September 8, 1999
To, John Westphal I Ednwnds Fire Dqmxtmmt
Job Name: Shellabarger Creek Condos
504 Holty
Edmonds, WA.
Subject; Fire Sprinkler System
Dear: John
As you know we haw been worldug on this project to try to Come up with a
Solution that would take care of the firc proteolion. According to our most recent
Findings we have a couple of alternatives, The first calculation we have made is for
Retail mercantile, which we designed as an (ordinary hazard group II). This reqdies
250 gah flowing. The water vieter that is on the T' line coming in may not allow this
mucb flow. If however we go to (ordinary hazard group 1) the requirement goes do"
to 160 gas, This would probably work just fine but we need your blessing on our plan,
I am forwarding the calculations based of the (ordinary gtoup 11), Please call me as soon
As you can after your review.
Thank You
6�01ZA�G
Clark Potter
Sales Representative
Grinnell nre Protection
Mec)
(g 4.
A tql=17 INTERNATiCtJAL LT0. CC)MPANY
** TOTAL PAGE.01 **
SEP 08 '99 16:48 FR GRINNELL FIRE PROTECT253 859 5255 TO 14257757721 P.01/06
-INNOVATION, QUALITY, AND SERVICE SOCE 1850"
Grinnell Fire Protection Systems Company
1215 CAnb* Awnue $m4h, SWte 128
Kent, WA 98032-7425
Ph: M 8594M
24 Hour EmeNency Service Fox, (M) 8%-6=
Automeac WnkW Sys*m
Fire AWm & Detec5on
Fire Wnguishws
9 Inspeebon
9 Repr
9 BaWaw Preventws
• Haz2rd NoWs
• lmvw & C(h Systenz
• SysteM Detq� ModftbW,
am specffimfion
• FM-200 & Dry awnicd
system
Over 100 offices in P*00
c4tes ftvjgW NOM Apwdca
For Fire PmWWn Brodvzw*
Cd ow Ado-ftim D4PwMwt
at (440) $99-54M
Elconwonual 0 Urgent. [--I Call On Rweipt
IFAXCOVERSHEET NUMBER OF PAGES_ (including this sheet)
TO'
F:j 17-0 Mv
5
A WCAF INTERNA77ONAL LTD COMPANY
SEP 08 '99 16:49 FR GRINNELL FIRE PROTECT253 859 5255 TO 14257757721 P.02/06
SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 1
DAT'S: 9/8/1999 C:\HASS71\SHELLI.SDF
JC§ TITLE: SHELLABARGER'CREEK CONDO'S,SASEMENT, 0.20/900+250
WATER SUPPLY DATA
o"
SOURCE STATIC RESID. FLOW AVAIL. TOTAL REQ'D
NODE PRESS, PRESS. @ PRESS. @ DEMAND PRESS.
TAG (PSI) (PSI) (GPM) (PSI) (GPM) (PSI)
SOURCE 110.0 100.0 1494.0 108.7 499.4 85.4
AGGREGATE FLOW ANALYSIS:
TOTAL
FLOW AT SOURCE
499.4
GPM
TOTAL
HOSE STREAM ALLOWANCE AT SOURCE
250.0
GPM
OTHER
HOSE STREAM ALLOWANCES
0.0
GPM
TOTAL
DISCEARGE FROM ACTIVE SPRINKLERS
249.4
GPM
NODE ANALYSIS DATA
NODE TAG
ELEVATION
NODE
TYPE
PRESSURE
DISCHARGE
(FT)
(PSI)
(GPM)
SOURCE
0.0
SOURCE
85.4
249.4
1
10.0
K=
5.60
18.4
2�.O
2
10.0
K�
5.60
18.6
24.1
3
10.0
Kw
5.60
19.4
24.6
4
10.0
Kw
5.60
19.9
25.0
5
10.0
Km
5.60
18.6
24.1
6
10.0
K�
5.60
18.8
24.3
7
10.0
Km
5.60
19.6
24.8
8
20.0
K=
5.60
20.1
25.1
9
10.0
K=
5.60
22.6
26.6
10
10.0
K=
5.60
22.7
26.7
A
9.5
- -
- -
22.7
- - -
Al
10.0
- -
- -
21.5
- - -
B
9.5
- -
- -
22.9
- - -
Bi
10.0
21.7
- - -
C
9.5
- -
- -
23.7
- - -
Cl
10.0
- -
- -
23.2
- - -
D
9.5
27.4
- - -
TOR
9.5
37.0
- - -
BOR
1.0
47.1
- - -
BF1
2.0
- -
- -
41.3
- - -
5FZ
2.0
- -
- -
45.3
- - -
DOM
0.0
- -
- -
53.5
- - -
METEPI
0.0
58.1
METER2
0.0
70.1
- - -
SEP 08 '99 16:49 FR GRINNELL FIRE PROTECT253 859 5255 TO 14257757721 P.03/06
SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 2
DATE: 9/8/1999 C:\HASS7l\SHELLl.SDF
JCI� TITLE: SHELLABARGER CREEK CONDO-S,BASEMENT, 0,20/900+250
PIPE DATA
PIPE TAG Q(GPM) DIA(IN) LENGTH PRESS.
END ELEV. NOZ. PT DISC. VEL(FPS) HW ( C ) (FT) SUM.
NODES �FT) (K) (PSI) (GPM) FL/FT (PSI)
Pipe: 1 -24.0 1.687 PL 12,00 PF 0.2
1 1010 5.6 18.4 24.0 3.4 120 FTG ---- PE 0.0
2 10.0 5.6 18.6 24.1 0.018 TL 12.00 PV 0.1
Pipe: 2 -48.1 1.687 PL 12.00 PF 0.8
2 .10.0 5.6 18.6 24.1 6.9 120 FTG ---- PE 0.0
3 10.0 5.6 19.4 24.6 0,065 TL 1-2.00 Pv 0.3
Pipe: 3 72.8 2.154 PL 12.00 PF 0.5
3 1010 5.6 19.4 24 6 6.4 120 FTG ---- PE 0.0
4 10.0 5,6 19.9 25.0 0.043 TL 12,00 PV 0.3
Pipe: 4 -97.8 2.154 PL 9.63 PF 1.6
4 10.0 5.6 19.9 25.0 8.6 120 FTG
T PE 0.0
Al 10.0 0.0 21.5 0.0 0.074 TL 22.05 PV 0.5
pipe! 5 -24.1 1.687 PL 12.QQ PF 0.2
5 10.0 5.6 1816 24.1 3.5 120 FTG ---- PE 0.0
6 10.0 5.6 18.8 24.3 0.018 TL 12.00 PV 0.1
Pipe: 6 -48.4 1.687 PL 12.00 PF 0.8
6 10.0 5.6 18.8 24�3 6.9 120 FTG PE 0.0
7 10.0 5.6 19.6 24.8 0.066 TL 12.00 Pv 0.3
Pipe: 7 -73.2 2.154 PL 12.00 PF 0.5
7 10.0 5.6 19.6 24.8 6.4 120 FTG ---- PE 0.0
8 10,0 5.6 20.1 25.1 0.043 TL 12.00 PV 0.3
Pipe: 8 -98.3 2,154 PL 9.83 PF 1.6
8 10,0 5.6 20.1 25.1 8.7 120 FTG T PE 0.0
31 10.0 0.0 21.7 0.0 0.074 TL 22.05 PV 0.5
Pipe: 9 -26.6 2.154 PL 12.00 PF 0.1
9 10.0 5.6 22.6 26.6 , 2.3 120 FTG PE 0.0
10 10.0 5.6 22.7 26.7 0.007 TL 12.00 PV 0.0
Pipe: 10 -53.3 2.154 PL 9.83 PF 0.5
10 10.0 5.6 22.7 26.1 4.7 120 FTG T PE 0.0
Cl 10.0 0.0 23.2 0.0 0.024 TL 22-05 Pv 0.1
Pipe; 11 -97.0 2.154 PL 0.50 PF 0.9
Al 10.0 0.0 21.5 0.0 8.6 120 FTG T PE 0.2
A 9.5 0.0 22.7 0.0 0.074, TL 12.72 Pv 0.5
Pipe: 12 -98.3 2,154 PL 0.50 PF 0.9
Bl 10.0 0.0 21.7 010 8,7 120 FTG T PE D.2
B 9.5 0.0 22.9 0.0 0,074 TL 12.72 PV 0.5
Pipe: 13 -53.3 2.154 PL 0.50 PF 0.3
Cl 10.0 - 0.0 23.2 0.0 4.7 12o rTG T PS 0.2
c 9.5 0.0 23.7 0.0 0.024 TL 12.72 PV 0.1
SEP 08 '99 16;49 FR GRINNELL FIRE PROTECT253 859 5255 TO 1425??5??21 P.04/06
SPRINKLER SYSTEM HYQZAULIC ANALYSIS Page 3
DATE: 9/8/1999 C:\HASS71\SHELL1.SDF
JOB TITLE:,SHELLABARGER CREEK CONDO'S,BASEMENT, 0.20/900+250
PIPE TAG Q(GPM) DIA(IN) LENGTH PRESS.
END ELEV. NOZ. DISC. VEL(rP$) RW(C) (FT) sum.
NOD8S (FT) (K) (PSI) (GPM) FL/FT (PSI)
Pipe: 13A -97.e 2,727 PL .10.00 PF 0.2
A 9's 0.0 22.7 0.0 5.4 120 FTG ---- PE 0.0
B 9,5 0.0 22.9 0.0 0.023 TL 10.00 PV 0.2
Pipe: 13B -196.0 2.727 PL 10.00 PF 0.8
S 9.5 0.0 22.9 010 10.8 120 FTG ---- PE 0.0
C 9.5 '0.0 23.7 0.0 0.065 TL 10.00 PV 0.8
Pipe: 14 -249.3 2.727 ?L 8.25 PF 3.7
C 9.5 0.0 23.7 0.0 13.7 120 FTG T, PE 0.0
D 9.5 0.0 27.4 010 0.132 TL 27-72 PV 1.3
Pipe; 15 -249.3 2.727 PL 43.79 PF 9.6
D 9.5 Q-0 27.4 13.7 120 FTG , 3E PE 0.0
TOR 9.5 0.0 .37.0 0.0 0.132 TL �3,00 PV 1.3
Pipe- 16 -249.3 2,727 PL 7.50 PF 1.0
TOR 9.5 0.0 37.0 0.0 13.7 120 FTG ---- PE 3.2
Sri 2A 0.0 41.3 0.0 0.132 TL PV 1.3
Pipe: 17 FIXED PRESSURE LOSS DEVICE
BF2 2.0 0.0 45.3 0 0 4.0 p5i, 249.5 gpm
BF1 2.0 0.0 41.3 010
Pipe: 18 -249.3 2.727 PL PF 1.4
BF2 2.0 0.0 45.3 0.0 13,7 120 FTG E PE 0.4
BOR 1.0 0.0 47.1 0.0 0.132 TL 10,74 PV 1.3
Pipe: 19 -249.3 2.727 PL 6.00 PF 5.9
BOR I' * 0 0.0 47.i 0.0 13.7 120 FTG 2ET PE 0.4
DOM 0.0 0.0 53.5 0.0 0.132 TL 44.94 Pv 1.3
Pipe: 20 -249.3 2,067 PL 4.00 PF 4.6
DOM 0.0 010 53.5 0.0 23.8 120 FTC E PE 0.0
METER1 0.0 0.0 58.1 0.0 0,509 TL 9.00 FV 3.8
Pipe: 21 FIXED PPESSURE LOSS DEVICE
METER2 0.0 0.0 70.1 0.0 12.0 psi, 249.3 gpm
METERI 0.0 0.0 5811 0.0
Pipe: 22 -249.4 2.067 PL 20.00 PF 15.3
METER2 0.0 0.0 70.1 0.0 23.8 120 FTC T PE 010
SOURCE 0.0 SRCE 85.4 (N/A) 0.$09 TL 30.00 PV 3.8
NOTES,
(1� Calculations were performed by.the HASS 7.1 computer pz-ogram
under license no. 4906013211 granted by
HRS Systems, Inc.
4792 LaVista Road
Tucker, GA 30084
(2) The system ha5 been c alculated to provide an average
imbalance at each node of 0.008 gpm, and a maximum
imbalance at any node of 0.180 gpm.
SEP 08 '99 16:50 FR GRINNELL FIRE PROTECT253 859 5255 TO 14257757721 P.05/06
SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 4
DATE: 9/8/1999 C:\HASS71\SHELL1.SDF
JOB TITLE: SHELLABARGER CREEK CONDO'S,BASEMENT, 0.20/900+250
(3) velocity pressures are printed for information only, and are
not used in balancing the system. Maximum water velocity
is 23.8 ft/sec at pipe 22.
(4) PIPE FITTINGS TABLE
Pipe Table Name: STANDARD.PIP
PAGE: MATERIAL: S40 HWC: 120
Diameter Equivalent Fitting Lengths in Feet
(in) E T L C B G A 0 N
Ell Tee LngEll ChkV1v BfyVIv GatVlv AlmChk DPVlv NPTee
1.667 5.02 10.04 2.51 11.30 7.53 1.26 12-55 12.55 10.04
2.154 6.11 12.22 3.67 13.45 7.33 1.22 12-22 12.22 12.22
2.727 9.74 19.47 6.49 22.72 11.36 1.62 16.23 16.23 19.47
PAGE: A MATERIAL: 540 HWC: 120
Diameter Equivalent Fitting Lengths in Feet
(in) E T L C B . G A D N
Ell Tee LngEll ChkVlv BfyVlv GatVlv AlmChk DP%71V NPTee
2.067 5.00 10.00 3.00 11.00 6.00 1.00 10.00 lo.00 io.co
SEP 08 '99 16:50 FR GRINNELL FIRE PROTECT253 859 5255 TO 1425??5?721 P.06/06
SPRINKLER SYSTEM HYDRAULIC ANALYSIS Page 5
DATE: 9/6/1999 C:\HASS71\SHELL1.SDF
JOB TITLE: SHELLABARGER CREEK CONDOI.S,BASEMENT, 0.20/900+250
WATER SUPPLY ANALYSIS
120.(
100.0
G
E 80-0
P
R
E
S
S 60.0
U
R
E
40.0
-14.7
Static: 110,00 psi Resid: 100.00 Psi FlOw: 1494.0 qpm
4 0060 0 8 0 0 10 00 12 00 1400 1600 1800
FLOW (GPM)
2000
LEGEND
10 Available Pressure
108.68 psi @ 499.4 gpm
2M Reouired Pressure
65.36 psi @ 499.4 gpm
** TOTAL PAGE.06 **
" I 'I'll
Grinnell"'
FIRE PROTECTION SYSTEMS COMPANY
1215 Central Avenue So., Suite 128
Kent, Washington 98032-7425
Te I -! (253) 859-6066
Fax: (253) 859-5255
Contractor's License No. GRINNFP137LE
AVIC
. I !". A � /� 4---e�: H N C - f r--
)14
(3b"JW16 -� 7 Q. - 3 J-1
OtL&
&
OtL Cl
V to C,
A tqUCID7 INTERNATI'07V�L LTD. COMPANY
.r7
A--�z t,�4
6 -70 — tq&'Ce
Equi
4.
5.
6.
7
8.
4-
10.
11.
12.-
13.-
14.
15.
16.
17.
18.
19.
stD bLO&Ly )PVZ /;�.t
GRINNELL FERE PROTEMON SYSTEMS COMPANY, INC.
ALARM & DETECTION EOUIPMENT TEST REPORT PAGE 2 OF 2
pment
Total
Number
No. Tested
Prev. Reports
No. Tested
This Report
0 rational
yes
N.A.
No
.Remote -Annunciators
170-
"",—
Zones
Manual Stations (Pull)
A. Coded
B. NonCoded
Petectors (See # 13)
A. Photoelectric
B. Ionization
C. Thermal
D. Flame
E. Duct (See # 14)
Audible Alarms
(R6mote & at base)
A. Bell
B. Siren
C. Horn
D. Horn and Light
Video Alarms
(Remote & at base)
Aut6mAtid Door Release -
Water F16w Switches
AZG
A . PaddId
B.-Pressure
lampei Switches —
.Were Tested Detectors Cleaned? No.
If "no" answer, explain under comments
.Were Tested Detectors Calibrated? No.
If "no" answer, explain under comments
Did test of Duct Detectors shut down air handling units?
Did the monitoring center (Fire Dept. Central Station,
LeaseLine) receive signal?
Is system reset for normal conditions?
Is system restored to operational service?
Have proper authorities (See #1) been notified system
is back in service?
20. Indicate % of equip. tested.this report 25 50 75 <i—ov
,21. Indicate % of equip.-tesied YTD 25 50 75 100
.-C6mments'for any "No" answers, or explanations:
ORIGINAL
GRINNELL FIRE PROTECTION SYSTEMS COMPANY9 INC.
ALARM & DETECTION EQUIPMENT TEST REPORT PAGE 1 OF 2
Test Report No. r t 05' Il- q q — Contract -No.
Property Name rQ AJ 1) 0 - 8L D
Street I—V h Az
City & State A
NAME
1. Before Test Notify Proper Authorities -7
A. Owner or Owner's Rep. 3bij Aj
B. Fire Dept.
C. Central Station A, C-T
2. Control Panel Status Before Test
A. is the Panel connected to the Fire Dept. Master Box
Lease Line
B. Is the Power Light On?
C. Does the Panel indicate Normal Conditions?
D. Are all Indicating Lamp Bulbs in Operating Order?
E. Does the Trouble Light Operate?
F. Does the Silence Switch Operate?
G. Does the Panel have Active Zones? No.
H. Does the Panel have Inactive Zones? No.
1. Does the Panel have Battery Backup?
J. Do the Batteries indicate they are Properly Charged?
K. Have Fire Dept. and/or Lease Lines been disconnect
continuing tests?
Comments: C)J/.,
3. Extinguishing Systems
A. Are Halon Systems installed on Property? No
Is Halon at Recommended Pressure?
B. Are CO2 Systems installed on Property? No -
IS CO2 at recommended pressure?
C. Are any other Type Systems installed on Pror
Comments:
contact 'Tt) H
Phone No.-Z�G -7q3 7217
PHONE NO.
YES
N,A,
NO
:i-d before
Af
Al
)erty? No.
YES
N.A.
NO
Test Verification Name A Llm L
signature
(By owner or Title
owner's rep.) Inspector
Phone Number
Date
Date
printed
cc: Owner (Name) A
Address
insurance Co.
Address
Fire Marshall
Address
ISO
Address Printed in U.S.A.
PIPY 11 '99 14: 10 FR GR I NNELL F I RE PROTECT253 859 5255 TO 142574%IJO §;/V14
I CONTRACT FOR AUTOMATIC SPRINKLER EOUIPMENT INSPECTION 0
11 CONTRACT FOR TESTING, OF FIRE ALARM AND DETECTION EOUIPMENT 0
III COMBINED CONTRACT FOR THE ABOVE PROGRAMS I & 11 0
AGREEMENT made this .......... P .................... day of .......
SYSTEMS COMPANY. hereinafter called the CONTRACTOR, and . ........
................................................ — ..............
locatedat ......................................... ***---,---* ............
hereinafter called the SUBSCRIBER. for the above indicated contract option,
I qql, between GRINNELL FIRE PROTECTION
.......................................... .1, ......... I ....... I .
WITNESSETH. that: ed at — 11(a6-4—y 114-- 1 ........................
Subscriber owns and J of occupies premises IOCat .......... I ................ ........ wherein
in the city of ................... .................... state of.10-50 ............ !: 2, �- 1, F -> ............... .
there is now installed certain automatic sprinkler and ire alarm and det ti 1i ecluipment, to wit A) - I
. . ......... ...........
.......... 7ec - ho
00 . ..........
D.0 .........
...... Ir.w-'c ..... t�Mj..
L L . .....
D
Scope of Work
Contractor shall inspect and/or test the equipment described herein in accordance with the contract option selected above and the
Contractor's then current Report Form. All in accordance with the terms and condibons contained herein and on the*reverse side hereof.
Number of Inspections t regular intervals.
The'Contractor shall inspect and/or test said installation ... I ................................ I ........... 11.... times per year a
Term
The term of this Agreement shall be one (1) year from date hereof and qhall be plut�matically renewed each year thereafter until the
same shall be terminated by either party on at least thirty (30) days wrltten�iotice 6eing given to the other party prior to the anniversary
date thereof. Contractor's then current charges shall apply for eich renewal period,
Cost of Inspection and Payment
The Subscriber shall pay to Contractor within 10 days after the first inspection has been made the Sum of ............
...................... Dollars (S. - -r ... . ............... I ........... I .......... ... .....
11 the Subscriber fails to pay the full amount due, Contractor, may at its option. terminate this contract, and. in any event. will not be
obligated to perform any additional work unVI payment of the amount past due has been received by contractor.
Report of Inspection of inspection and/or test will be forwarded by the Contractor to . . ..........
Notice of this agreement and copies of all Reports
...... . the insurance authority having jurisdiction and to the Subscriber.
Notice of termination or change in number of inspections per year by the Contractor shall be given to the insurance authority.
Limitation of Liability RESS, OR IMPLIED, INCLUDING. WITHOUT LIMITATION, WARRANTIES OF
The Contractor makes No WARRANTIES, EXP ESS FOR A PARTICULAR PURPOSE. No promise not contained herein or
MERCHANTABILITY AND WARRANTIES OF FITM
affirmation of fact made by any employes, agent OF rOprosent3live of the Contractor shall constitute a warranty by the Senor or give (We
to any liability or obligation.
Contractor's liability to Subscriber for personal Injury, death, or property damage arising from performance under this contract shall
harmless from any and an third party claims for personal Injury' death
be limited to the contract price. Subscriber shall hold Contractor her
becriber's failure to maintain them systems or keep them In operative condMon, what based
or property damage, arising from Su cW be Hable for any special, lndiro4 incidental,
upon conlyact. warranty. torl, strict liability or otherwise. in no event shall the Contra loss of use of the
consequential or liquidated, pe" or any economic loss damages of any character, Including btd not limited to
Subscriber's ProPeft lost profits or lost producdon, whether claimed by the Subscriber or by any third party. Irrespecfte of wholther
are based upon contract, warranty, r otherwise.
claims or actions for such damages n!V
GRIN LL FIRE PROTECTIO STEMS COMPANY
.......................
BY . ...... . ...... .. .... .... . ........
TITL ... ........
Z!!Y77 ............
ADD ESS -4.1-- ................ j!��
�P,tEPTED BY:
.........
SUBSCRIBER ...... ................. .....
BY...... I ................. ...... ......... I ...............................
TITLE......... ................................. m .................
.,$- jo -,?I .......................................
DATE SIGNED ... ... .... I ....
Wit �S .....
MRY 11 '99 14:09 FIR GRINNELL FIRE PROTECT253 859
AJ Af 61,&_
5255�TO 1425745'6554 2
t4-41 ( Rl� r �_
Monito information& Agreement
ring
This Agreement is made this I —i day of
corooration, hereinafter referred to as'ACI*, and
whose address iS: /7
StreetA 4ws_L!6_F0
.$Fly 1.1 -
Phone Number—( J 7 (of
N"E �Pjeaze psint)
Wto
—19q,l. by and between Alarm Center. Inc., a Washington
g P#+A -I hereinafter referred -,o as'Subscriber.'
't-Zipr de_TZR_z_-_AP_
City _fAp"% jjg.S__ State_��_' o
g Addres FIR E-
2& 63.,'� 34557_�
PHONE NumSER
IM AL"s 2 —a �* dre
L4&4EjL#4,*4#4t:
24:i 0 A
3. jxs--_7�_ 11 (O:z _1P
I`-
D I A_tmw
LA.7 tl
MON
TUE
MSWORD of NUMBER
AME (P160SO 0611ti Lldm%jm of 12 rh4LrbCW9)
'09 A IV e-r— =7 jz 17 Ir
condition does not exist. ACI Shall notify Dealer of each alarm received ff
1. DgALCR AGREEMENT; Sul�scriber has, or is about to contractwith Subscriber has submitted a written request to ACI for such notification.
("Dealer') for an alarrn J ACJ rinay attempt to verify the nature of the emergency by telephoning
system and/or service at the premises Lindicated on !his Agreement :§ubscriber's premises prior to notifying emergency personnel or anyone
(hereinafter called 'Premises'�. Dealer and Subscriber have entered into on Subscriber's notification instructions.
an Agreement wherein and whereby Dealer will provide monitoring
services for Subscriber, such services to consist solely of those described 3. RECEIPT OF COPY, SUBSCRIBER ACKNOWLEDGES RECEIPTOF
herein. Dealer has subcontracted such monitoring services to ACI which A COPY OF THIS AGREEMENT.
I SUBSCRIBER HAS READ AND UNDERSTANDS ALL 0
has agreed to perform the same solely as the agent of Dealer upon the FTHISAGREE
terms and conditions set forth in tMiS Agreement. All monitoring fm are MENT, PART11CULARLY PARAGRAPHS 4, 11 AND 12, WHICH SET
paid to ACI by 0eaier. FORTH ACI'S MAXIMUM LIABILITY IN THE EVENT OF ANY LOSS OR
2. MONITORING SERVICES PROVIDEIN ACI. upon receipt of a DAMAGE TO SUBSCRIBER OR ANYONE ELSE. SUBSCRIBER AC -
signal from Subscriber's premises, small make every reasonable effort to KNOWLEDGES THAT HE HAS DISCUSSED THE LIMITATION OF
notify the police. fire. or other authorities andjor the person or persons LIABILITY SET FORTH IN PARAGRAPH 11 WITH DEALER'S AGENT,
whose names and telephori4L numbers are set forth in the notification AND UNDERSTANDS THAT SUBSCRIBER MAY OBTAIN A HIGHER
instructions to be!completed by Subscriber and submitted to ACI, or as LIMITATION OF ACI'S LIABILITY By PAYING AN ADDMONAL PE01-
same may be changed on written jotitication by Subscriber from time to ODIC CHARGE. THE TERMS AND CONDITIONS SET FORTH ON THE
time, unless there is reasonable cause to assume that an emergency REVERSE SIDE ARE INCORPORATED HEREIN.
FIDEALER Ir-3SUBSCRIBER
a X -qq y x--
y X
By
ACt APPROVAL
By X
Date
Title oqmt��
c Corporation C] partnership M Sale ProprietOrShiP
-_ other (describe)
AutrlariZW Oft6f
THIS AOR99MENT SHALL NOT 05 DINDINa UPON ACI UNLESS APPROV60 IN WRITING BY AN OFFICER Of! ACL
AZarmCpnterlm P.O. Sm 3401. Lacey, WA 9850"401,Nation-widel-800-752-2490 QAlac4Aw.[A0-.(v11-uCmxcv1)(
.3 .
CONTRACTOR'S MATERIAL TEST CERTIFICATEABOVEGROUND PIPMEC E'": r)
MAR 0 8 1999
Washington State Fire Marshall EDMONDS FIPF f)Ff?i
Insurance Building AQ-21
Olympia, Wa 98504
PROCEDURE
Upon completion of won(, inspection and tests shall be made by the zontractors representative and witnessed by an owner's representative
All defects snail becorrected and system left in service before contractor's personnel finally leave the job.
A Certificate shall be filled out by and signed by both representatives- Copies shall be prepared for approving authorities, owners and contractor.
it is understood the ownees representative's signature in no way prettudicps any claim contractor for faulty material, poor workmanship, Or
failure to comply with approving authority's requirements or local orzinances.
PROPERTY NAME
SHELABAUGH CREEK CONDO'S
PROPERTY ADDRESS
504 HOLLY DRIVE EDMONDS, WA 98020
PLANS
ACCEPTED BY APPROVING AUTHORITIES
EDMONDS FIRE DEPARTMENT
ADORESS
250 STH STREET AVE N EDMONDS, WA 98020
INSTALLATION CONFORMS TO ACCEPTED PLANS EYES nNO
EQUIPMENT USED IS APPROVED EYES [:]NO
IF NO EXPLAIN DEVICES
INSTRUCTIONS
HAS PERSON IN CHARGE OF FIRE EQUIP%tE=NT BEEN INSTRUCTED AS TO LOCATION RM YES n NO
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
LOCATION
OF SYSTEM
SPRINKLERS
MAKE
MODEL
YEAR OF
MANUFACTURER
ORIFICE
SIZE
QUANTITY
TEMPERATURE
RATING
CENTRAL
GBR
1998
7/16"
8
-.155
PIPE AND
FITTiNGS
Type of Pipe CPVC GRINNELL FLAME AWAY
Type of Fittings CPVC GRINNELL FLAME AWAY
ALARM VALVE
OR FLOW
INDICATOR
ALARM DEVICE
MAXIMUM TIME TO OPERATE
THROUGH TEST CONNECTION
TYPE
MAKE
MODEL
MIN.
SEC.
NIA
DRY PIPE
OPERATING
TEST
DRY VALVE
Q.O.D.
MAKE
MODEL
SERIAL NO.
MAKE
MODEL
SERIAL NO.
N/A
TIME TO TRIP
THRU TEST
CONNECTION
WATER
PRESSURE
AIR
PRESSURE
TRIP POINT
AIR PRESSURE
TIME WATER
-REACHED
TEST OUTLET
ALARM
OPERATED
PROPERLY
WITHOUT
Q.O.D.
MIN. SEC
PSI
PSI
PSI
MIN. SEC. -
YES
NO
WITH
'MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED.
OPERATION
C3 PNEUMATIC 0 ELEC7'RIC 0 HYDRAULIC
PIPING SUPERVISED
0 YES 0 NO
—]NO
MEDIA SUPERVISED F-1 YES [_
DELUGE &
DOES VALVE OPERATE FROM THE MANUAL TFUP AND/OR REMOTE CONTROL STATUS DYES ONO
PREACTION
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING
IF NO, EXPLAIN
VALVES
CI YES 0 NO
DOES EACH CIRCUIT OPERATE
DOES EACH CIRCUIT
MAXIMUM TIME TO
MAKE
MODEL
SUPERVISION LOSS ALARM
OPERATE VALVE RELEASE
OPERATE RELEASE
HYDROSTATIC Hydrostatic test shall beat not !ess than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess
of 150 psi (10.2 tars) for two hours. Different cry-ooe valve clappers shall be left open during test to prevent damage. AJI aboveground piping
TEST
leakage shall be stopped.
DESCRIPTION
PNEUMATIC� Establish 40 psi (2 7 bars) air pressure and measure drop which shall not exceed i-lt2 psi (0 1 bars) in 24 hours Test pressure
tanks at normal water level and air pressure drop,hnich shall not exceed 1-1/2 psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TEST AT 200 PS4 FOR 2 HIRS. IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED C3 YES 0 NO
EQUIPMENT OPERATES PROPERLY . ..,- 191 YES 0 NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR
TESTS
DERIVATIVES OF SODIUM SILICATE, BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR
STOPPING LEAKS? 0 YES 0 NO
DRAIN
READING OF GAGE LOCATED NEAR WATER
ISUPPLY
RESIDUAL PRESSURE WITH VALVE IN TEST
1CONNECTION
TEST
TEST CONNECTION
OPEN WIDE
UNDERGROUND MAINS AND LEAD IN CONNECT)ONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING
VERIFIED BY COPY OF THE U FORM NO. 858 0 YES 0 NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND
SPRINKIL ER PIPING 0 YES 0 NO
BLANK TESTING
NUMBER USED
1LOCATIONS
NUMBER REMOVED
GASKETS
None
WELDED PIPING 0 YES E3 NO
IF YES
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3 M0 YES r —JNO
WELDING
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN EIYES FiNO
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D110.9, LEVEL AR-3
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH. THAT SLAG AND OTHER
WELDING RESIDUE ARE REMOVED. AND THAT THE INTERNAL DIAMETERS OF
PIPING ARE NOT PENETRATED EYES 1:1 NO
CUTOUTS
(DISCS)
DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS)
ARE RETRIEVED? EYES [:]NO
HYDRAULIC
NAME PLATE PROVIDED
IF NO, EXPLAIN
DATA
NAMEPLATE
0 YES 0 NO
DATE LEFT IN SERVICE WITH ALL CONTROL VA.LVES OPEN:
REMARKS
NAME OF SPRINKLER CONTRACTOR Grinnell Fire Protection System Co. Lic.# GRINNFPI 37LE
1215 Central Ave. S. #128 Kent, Wa 98032-7425
TEST WITNESSED BY
FO R SIGNED) TITLE DATE
F,,A.,6 i^,i/0j
SIGNATURES
I
FO� MPI LERCONTRACTO ( GiNED TITLE JDATE
I
ADDITIONAL EXPLANATION AND NOTES
CONTRACTOR'S MATERIAL TEST CERTIFICATEABOVEGROUND PIPING
Washington State Fire Marshall
Insurance Building AQ-21
Olympia, Wa 98504
PROCEDURE
Upon completion of work, Inspection and tests shall be made by the contractors representative and witnessed by an owner's representative
All defects shall be corrected and system left in service before contraictces personnel finally leave the job.
A certificate shall be filled out by and signed by both representative& Copies shall be prepared for approving authorities, owners and contractor.
It is understood the owner's representative's signature in no way preiudices any daim contractor for faulty material, poor workmanship, or
failure to comply with approving authoritys requirements or local ordlinances.
PROPERTY NAME
PROPERTY
SHELABAUGH CREEK CONDO'S
504 HOLLY DRIVE EDMONDS, WA 98020
PLANS
ACCEPTED BY APPROVING AUTHORITIES (NAMES)
EDMONDS FIRE DEPARTMENT
AWRESS
250 5TH STREET AVE N EDMONDS, WA 98020
INSTALLATION CONFORMS TO ACCEPTED PLANS EYES FINO
EQUIPMENT USED IS APPROVED EYES nNO
IF NO EXPLAIN DEVICES
INSTRUCTIONS
HAS PERSON IN CHARGE OF FIRE EQUIPLMENT BEEN INSTRUCTED AS TO LOCATION
OF CONTROL VALVES AND CARE AND MA2iTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
EYES n NO
LOCATION
OF SYSTEM
SPRINKLERS
MAKE
MODEL
YEAR OF
MANUFACTURER
ORIFICE
SIZE
QUANTITY
TEMPERATURE
RATING
CENTRAL
GBR
1998
7/16"
8
155
PIPE AND
FITTINGS
Type of Pipe CPVC GRINNELL FLAME AWAY
Type of Fittings CPVC GPJNNELL FLAME AWAY
ALARM VALVE
OR FLOW
INDICATOR
ALARM DEVICE
MAXIMUM TIME TO OPERATE
THROUGH TEST CONNECTION
TYPE
MAKE
MODEL
MIN.
SEC.
N/A
DRY PIPE
OPERATING
TEST
DRY VALVE
O.O.D.
MAKE
MODEL
SERIAL NO.
MAKE
MODEL
SERIAL NO.
N/A
TIME TO TRIP
THRU TEST
CONNECTION
WATER
PRESSURE
AIR
PRESSURE
TRIP POINT
AIR PRESSURE
TIME WATER
REACHED
TEST OUTLET
ALARM
OPERATED
PROPERLY
WITHOUT
O.O.D.
MIN. SEC
PSI
PSI
PSI
MIN. SEC.
YES
NO
WITH
.
r��
*MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED.
OPERATION
13 PNEUMATIC 13 ELECTRIC C3 HYDRAULIC
PIPING SUPERVISED
C3 YES 13 NO
DETECTING MEDIA SUPERVISED DYES []NO
DELUGE &
DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATUS DYES [:]NO
PREACTION
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING
IFNO,EXPEAIN
VALVES
0 YES 0 NO I
DOES EACH CIRCUIT OPERATE
DOES EACH CIRCUIT
MAXIMUM TIME TO
MAKE
MODEL
SUPERVISION LOSS ALARM
OPERATE VALVE RELEASE
OPERATE RELEASE
HYDROSTATIC, Hydrostatic test shall be at not Iess than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess
of 150 psi (10.2 bars) for two hours. Different dry -pipe valve clappers shall be left open during test to prevent damage. AJI aboveground piping
TEST
leakage shall be stopped.
DESCRIPTION
PNEUMATIC� Establish 40 psi (2.7 bars) air pressure and measure drop which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours. Test pressure
tanks at normal water level and air pressure drop vA*:h shall not exceed 1-1/2 psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TEST AT 200 PSI FOR2HRS. IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED 0 YES 0 NO
EQUIPMENT OPERATES PROPERLY 0 YES 0 NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR
TESTS
DERIVATIVES OF SODIUM SILICATE, BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR
STOPPING LEAKS? 0 YES 0 NO
DRAIN
READING OF GAGE LOCATED NEAR WATER
RESIDUAL PRESSURE WITH VALVE IN TEST
1CONNECTION
TEST
SUPPLY TEST CONNECTION
OPEN WIDE
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING
VERIFIED BY COPY OF THE U FORM NO. 858 0 YES C3 NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND
SPRINKLER PIPING 0 YES 13 NO
BLANK TESTING
NUMBERUSED
1LOCATIONS
NUMBER REMOVED
GASKETS
None
WELDED PIPING 0 YES 13 NO
IF YES
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS ID110.9, LEVEL AR-3 FRIYES E]NO
WELDING
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN M-YES MNO
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9. LEVEL AR-3
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER
WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF
PIPING ARE NOT PENETRATED EYES []NO
CUTOUTS
DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS)
(DISCS)
YES [—]NO
ARE RETRIEVED? El
HYDRAULIC
NAME PLATE PROVIDED
IF NO, EXPLAIN
DATA
NAMEPLATE
0 YES 0 NO
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REMARKS
NAME OF SPRINKLER CONTRACTOR Grinnell Fire Protection System Co. Lic.# GRINNFP137LE
1215 Central Ave. S. #128 Kent, Wa 98032-7425
TEST WITNESSED BY
FOR PROPERTY OWNER (SIGNED) TITLE DATE
I I
SIGNATURES
SPRINKLER CONTRACTOR (SIGNED) TITLE DATE
ADDITIONAL EXPLANATION AND NOTES
Ll
HoL 41
Date:
To:
From:
Subject:
MEMORANDUM
August 24, 1998
Jeannine Graf, Building Official
Mike Smith, Fire Inspector
#98269/Christophlis/504 Holly Drive
The following are requirements and comments by the Fire Department:
1) Presently the 4 residential units and common areas in the building are
sprinkled. The conversion of the 2 business spaces to residential units
will also need to be sprinkled.(NFPA IYUBC Standard 9-3)
2) Sprinkler plans for the T.1 will need to be submitted. Note: The
original sprinkler plans submitted when the building was constructed
show these two spaces as not being sprinkled.
3) Calculations need to be provided to determine if the present sprinkler
system will support the above -required addition.
4) The building presently has a fire alarm system. Our department will
require an acceptance test on this system (UFC 1007.3.4. 1) and that the
system be monitored by an off site agency (UFC 1007.3.3.6. 1)
City of Edmonds Fire Department
Date:
To:
From:
Subject:
MEMORANDUM
NWI&SW
JohnWestfall AFM cctofile
Mike Smith Sl
504 Holly Drive Condos (Shellabarger Creek Bldg.)
On 3-23-98 some contractors set off the fire alarm in the mentioned
building. One of the condo owners thought it was odd that the fire dept.
never responded hence a phone call to me. (RP/Janis Corbett 744-6588)
I stopped in today and talked with John from Premier Builders 206-914-
1908. John was working on the upper floor/east side converting the two
commercial spaces into condos. John and I talked about the alarm system
and the fact that it was unmonitored. As we were talking, the alarm
company John had called re:monitoring called back with a bid for
monthly monitoring. John also explained the problems the owner
(Christophilis) had with the last contractor, basically leaving him with an
unfinished building and no approval for occupancy. John mentioned he
had been down to talk with the bldg. dept. and was in the process of
getting permits to complete the work (at least in the mentioned area
upstairs).
Major problems noted: lock box keys need updating/alarm panel key and
ele. room key are the only ones that worked
FA system works but there is no confidence test recorded or the installers
name(I suspect one of the electrical contractors wired it in)
Sprinkler system appears functional but no record of acceptance test or
any annual testing.
More to come. M. Smith
3-26-98 Recontacted John at 504 Holly Dr.. I advised John that the
following needed to be done ASAP if he was going to continue working
on the project: (1) get the fire alarm system working properly and tested
(2) get the sprinkler system tested and certified
(3) get an annual test done on all PFE's (last tested 4-95)
City of Edmonds Fire Department
Fire Marshal
(4) contact city hall and get the proper permits going for the remodel
I will contact John on Monday, 3-30-98, to verify his progress and to
straighten out the lock box. Smith
4-3-98 1 contacted John at the condos and went over the keys needed for
the F.D. lock box. I noted at this time the PFE's had been tested. John
advised probably next week the alarm would be certified and monitored.
For info, its John Uberuaga (son-in-law of the building owner). John also
stated the sprinkler system had been certified by Advanced on 3-7-95, city
permit #950006 and witnessed by Gary McComas. M. Smith
6-9-98 1 have been in touch with John off and on since my last entry. The
building was slated for sale but the deal fell through around 5-20-98.
Since that time I've talked with John twice. Keys to the building were
dropped off at my office last Thursday, 6-4-98, and were put in the key
box at 504 Holly. The keys mentioned fit all the specified doors that the
FD may need to get into in case of an emergency. I will continue working
with John on the previously listed items. The plan is to finish the two
units on the 2 d floor and try to sell the building. John was advesed to get
the proper permits prior to the start of any work.
John Westfall
From:
Sent:
To:
Cc:
Subject:
John Westfall
Friday, March 06, 1998 9:13 AM
Jeannine Graf
Lara Knaak
Shellabarger Creek Building-Christophilus
My understanding from previous discussion w/Bldg is that this building was never approved for occupancy(?)
With this in mind, the proposal for 6-unit R1 must be submitted and yes, a 9-3 system must be provided per 19.75.075
ECDC.
Smoke detection and fire protection requirements may change as well. I would like a chance to again review entire
building as proposed.
_-Z /6 /� I
P
I
I
MEMORANDUM
DATE 6 6 -, / � S'
REPORTED BY ji OF I -,-loge 7jzwZ'---
SUBJECT
ADDRESS: 554 *5t-L k/ 49119� colvigov)
CONCERNS/ Helj I ItA IUA Lu
HAZARDS:
-7Z
FOLLOW-UP:
SIGNED
�-D-p &A,/
- ----------
'7V 4 J 6 h4.r &F
L, /t- 6-7,eIW6-6�
1-k I-C �
(�'. C-491A t�5 77t) FcW—
Office of Fire Prevention
SIGNED
I.D.
CITY OF EDMONDS
FIRE PREVENTION
FILE MEMO/HAZARD FORM
DATE REPORTED BY 14 t
OF 40YA"Jc6d
SUBJECT
ADDRESS: 514-L AV
CONCERNS/
HAZARDS:
FOLLOW-UP:
SIGNED
/ 4,tl-f A)
PCs-., 0 S-25 S�
SIGNED
DATE
CITY OF EDMONDS
FIRE PREVENTION
FILE MEKO/HAZARD FORK
REPORTED BY W6 �ILL-
OF )�&U6
SUBJECT
ADDRESS:
CONCERNS/ //Z�-
HAZARDS
5-10-
q1q
i-d
Wl
SIGNED
7.ri
SIGNED