530 DAYTON ST (2)'FIRE Pi4i' VE"N'TION
J0 DAY;-
IN§PECTION REPORT
Serving Brier, Edinonas, ana 12425 Meridian Ave S
SWOHON11SH Co. 41 EDMONDS
Mountlake Terrace Everett, WA 98208 BRIER
'FI >9
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
0 UNINCORPORATED
T www.FireDistrictl.org Fax (425) 5511-1272
LOCATION: 530 Dayton Street 98020 FAfi�VRCY STAf �)V SHIFT
BUSIN . ESS NAME: Dayton . Condos PHONE: SCHEDULED
DATE DUE �
422
MAILING 530 Dayton Street,L, Edmonds, WA 98020 FIR 0
ADDRESS:
BUSINESS OWNER: HOME PHONE:
Wambolt, Ron- 4257766501
EMERGENCY-1: HOME PHONE:
qr Ll 7 �i7 (41 L 17 �URREN
T
KEY ACCESS-2: HOME PHONE: I YES NO
BUSINE
ej_ d Z C of, cr_? el LIC S SS
E MAIL: EN E
PERSON CONTACTED -
INITIAL INSPEC ION DATE
NAME OF INSPECTOR:
Da teLastServiced: 61,� 15111 'Or+
I . J� .. %
SNOHOMISH CO.
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION:
530 . Dayton Street 98020
BUSINESS NAME:
Dayton Condos
MAILING
ADDRESS:
530 Dayton Street, Edmonds, WA 98020
BUSINESS OWNER:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
[3EDMONDS
0 BRIER
[3 MOUNTLAKE TERRACE
[I UNINCORPORATED
.EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: Wambolt, Ron HOMEPHONE: 4257766501 CITY YES NO
EMAIL: '4V BUSINESS P:E'
LICENSE 11
INITIAL INSPECTION DATE
PERSON CONTACTED: 1A
NAME OF INSPECTOR:
/-'* 5_//
FIRE SYSTEMS: AS 6/15 FA 6. FD Lk Box
LAftftWtd)jftAWEbCATIONS / COMMUNICATIONS
etz 5uw I �r
2
2
3
3
1A C
4 ------
-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
w ith 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.
Con-fi'de-nce Testing Company:
WTPIWolfe. Fire
Protection, Inc.
17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Fax: 360.794.3080 9 Ph.: 360.794.8621
Fire Department
Confidence Test Report
SPRINKLERS - WET
Certification Given
RED TYELLOW
WHITE
(ONE SYSTEM PER REPORT)
CONFIDENCETEST: I I REPAIRS:1 0
1-2 r -a4L
Occupancy Address: Occupancy Name:
Building Owner: 14. 0. I-q Phone Number:
Responsible Person: A-zc, Phone Number:
Building Owner
Address: 5' -30 S+-, FE mnoa-.� wr-4- 6 �Rn 6
Date of Inspection:- 4 — M/- Inspection Frequency/ Type: Annual
Tester's Name (print): 2,--sri LKra--rArna4 Certification Number: SCP- 275f) 0212 5; CA71-
Central Station monitoring? Yes 04 No Monitoring Co. Name: Al,�-vlti
Primary Component:- L-P' Wei L'SCI System Make: Tx/ C z>
System Model: -Mc>J
System Location: �2,-tf K43,�� Identification Number:
ProblemsFound: (1fadditional room is required, please add a separate sheet.) 4
Corrections Made: Date Corrected: Corrected by:
(if additional room is required, please add a separate sheet.) 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 the Authority Having Jurisdiction's Fire Department Fire Code standards.
All discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: Phone #: 360.794.8621
Testing Agency: Wolfe--�ire Protection* Inc
Mailing Address: 17321 Tye St. S.�,,Ste' "B".- Monroe WA 98272
'�
Building Representative (signature): r- X/1-1 1� ) . -
Sprinklers - WET �p Page: 1 of 2
The below items on the check list 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 Authority Having Jurisdiction's
Fire Department Fire Code for inspecting and testing requirements.
General
1. Flow Test conducted? ........................................................................... .................... 1 1 ....... Yes Q"' No
2. Static Pressure: psi Flow Pressure: psi
3. Total number of sprinkler heads on this system?
4. Was 2" Main Drain checked? ............................................................................ Other 0 � Yes �T- No
5. Flow Switches, Supervisory Switches and Alarm Sells tested? ......................... N/A El YesE3— No Fj
6. Pressure regulating valves tested? .............................................................................. N/A-G-- Yes F-I No LI
7. Alarm Bell operates? ............................................................................................. N/A L) Yes,-U- No L)
8. System inspected and lubricated ? .................................................................................. Yes No L]
9.Vlalves sealed or supervisedl ....................................................... ..................... Yes Q—No Ej
10. Signs provided on all valves? ................................................................................................... Yes,-Q- No Q
11. Pumper Connections and Clapper valves unobstructed and turn freely ? ............... Yesa—No U
12. Sprinkler head coverage acceptable? .......................................................... Yes -El-, No L)
1 13. Have the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yes-U-- No L)
14. Proper number spare sprinkler heads available with appropriate wrenches for each? ...... Yes Lj-,- No L)
15. System left in service? ............................................................................................................ Y 9 s-Q---N o L]
16. System gauges been replaced or calibrated within the last 5 years? ....... -
....... . ...... Yes Q-- -No U
17. Sprinkler heads f roe of corrosion, point, obstructions and/or physical damage? .... Yes-U-, No F-I
18. Was any debris found in the Fire Department Connection (FDC)? ........................ Yes C) No-O
19. Was the Fire Department Connection (FDC)- been back flushed in thellast 5 years? ... Ye'sU-"-No L]
20. Was an internal pipe anAlvalve inspection performed within the last 5 years? ................. Yes.,ZL_,., No LI
Date Performed:
21. Was a signal received at the Central Station monitoring company? .................... N/A Q Y e s -j-N o El
Sprinklers - WET Page: 2 of 2
CbAdence Testing Company:
Fi�e Departrhent
wTPJWolfe Fire
Protection, Inc.
17321 Tye St., S.E., Ste..."B" - Monroe, WA 98272
Fax: 360.794.3080 Ph..:. 360.794.8621
Confidence Test Report
SPRINKLERS - DRY
Certification Given
(ONE SYSTEM PER REPORT)
RED L)
YELLOW Ll
WHIT'E Q—
T-
CONFIDENCE TEST: 10 1 R E P A I R S: L) I
Occupancy Address: S7Y�> CX,�Jcja S+. Occupancy Name: Nt-V 60rlt�0'5
Building Owner: rlx�Ann Phon4lNu�"a-rb'e-(
Responsible Person: 4��, r k I Phone Numb�f:
Building Owner'
Address -P)
Date of Inspection:-g- Inspection Frequency Type: Annual
Tester's Name (print): ROA 6-re-&l 44,,�M Certification Number: SCP-C/Z51,>-nq'�S -C r,-
Central Station monitoring? Yes No El Monitoring Co. Name: ,9 1&rm
Primary Component: hr�� 2�<ee' System Make: T \16r�)
System Model:
System Location: ['CA C Identification Number:
Problems Found: if additional room is required, please add a separate sheet.
Corrections Made: Date Corrected: Corrected by:
(If additional room is required, please add a separate sheet.) 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 the Authority Having Jurisdiction's Fire Department Fire Code standards.
All discrepancies are noted and have been reported to the building Owner/Manager for corrective action.
Signature of Tester: - 2 Phone #: 360.794.8621
Testing Agency: Wolfe Fire Protection, Inc
1--
Mailing Address: 17321 Tye St. S 46 1-
13" �on,�oe, WA 98272
Building Representative (signnturel* A
\�/V,v VV-
Sprinklers - DRY Page: 1 of 2
The below items on the check list 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. Trip Test conducted? AlrAl"
...................................................................................................................................... Yeg-U-No El
2. System tripped in, seconds.
3. Flow Test conducted? ..................................................................................................................................... Yes-,-a-"No 0
4. Static Pressure:, psi Flow Pressure: 'psi,
5.. T.otal.numberof.sprinkler,,heads onjhis system?.
2 'in? Other C) Yesro- No E)
ra . ...................................................................................... ............................................
7. Flow Switches, Supervisory Switches and Alarm Bells tested?
8. Alarm Bell opera tes? ...............................................................
....................................... N/A LI Yes=No C3
..................................... N/A E) Yes-U-No El
-9.. Air compress refill the system in 30 minutes or less? ............................................................................ Yes -EI-No LI
16.1-, Heat', 4�tuation devices te�ted-oii the pee -action and deluge systems? ............ NIA-0-Yes El- No E)
1.1,. 'System inspected and Imbricated ? ............... ...........................
..................... .............. Y ks� N o'. Ej
.- 1 Valves sealed or, supervised? ................................. ............................................ .......... * ......................... . Yes t3- No (3'-
2
13. Signs provided on all valves? ...................................................................................................... Yes-Ey No 0
14. Pumper Connections and Clapper valves unobstructed and turn freely ? .................................................. Yes-d-- No C)
15. Sprinkler heads been replaced or successfully sample tested in the last 10 years? ................................. Yes-0- No C1
16. Sprinkle,r head coverage'acceptable? ....................................................................................... Y e s'Q-N o 0
17. Proper number spare sprinkler heads available with.appropriat e wrenchs for each? ................... Y e s-0- N o 0
18. System left in service? ............................................................................................................... Yes-EI-No [I
19. System gauges replaced or calibrated within the last 5 years? ..... ?�eL� ....................................... Yes U-No LI
20. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ........................ Yes-CY-No C3
.21, System drained and restored to normal operation? ................... ............................................. Yes-M-No E)
22. Was any debrisjound in the- Fire Department Connection (FDC)? ..... : .................................... Y e s Q N o,'U-
23. Was the Fire Department Connection (FDC) been back flushed in the last 5 years? .................. Y e s -El--N o U
24. Was a signal received at the Central Station monitoring company? ........................ N/A E) Yes LI-N o [I
25. Was an internal pipe and valve inspection performed within the last 5 years? Date Performed: Yes E3- No 0
Sprinklers * DRY Page: 2 of 2
SN04OWA CO.
'FIRE
Serving Briei: Edind)n;ds, and
Mountlake Terrace
LlbJL%.# A wwwFireDistrictl.org
LOCATION:' 530 Dayton Street 98020
Dayton Condos
BUSINESS NA(AE:
MAILING
ADDRESS: 530 Dayton Street, Edmonds, WA 98020
BUSINESS OWNER:
Wpmbolt, Ron
i EMERGENCY-1:
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
I NAME OF INSPECTOR: -r:7,. q-1 4 -L,
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
FIRE PREVENTION
IN§PECTION REPORT
21='DMONDS
0 BRIER
El MOUNTLAKE TERRACE
El UNINCORPORATED
,' FREQUENCY I STATION & SHIF'**'
Annual 17-D
SCHEDULED May 2015
DATE DUE
UFIR 11, 422
CURRENT
CITY
BUSINESS
LICENSE
INITIAL INSPECTION DAT9
q.r7,1
FIR SYSTEMS. Ab 0/14 �'A b/1 I FE 1g, - I
FD Lk Box
tells -
HOME PHONE:
HOME PHONE: 4257766501
HOME PHONE:
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
7
3
3
4
4
5
5
6
6
7
7
1 JAGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 R&INSPIECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION
VIOLATIONS
E DUP:
.,.PERqON
DATE DUE:
GRANTEDTO:,
DATE DUE:
CITED:
PE5SON'
PERSON""'.4'
COqTA6TED-.,�w.1
CONTACTED.
CONTACTED:
INSPECTOR:
INSPECTOR:
INIPECTOR:
!2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
CODE
)16
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
HhUhIVhIJ
DISPOSITION:
4
8
4
8
DATE,
LETTER NEEDED [:] YES NO
LETTER NEEDED [-] YES [j NO
-6
11
FIRE DEPARTMENT COPY
Cdnfideflce Testing' -Company:
IWTW lfe Fire
0
P Protection, Inc.
17321 Tye St. S.E., Ste. "B" 0 Monroe, WA 98272
Fax: 360.794.3080 a Ph.: 360.794.8621
Fire Dep.artment
Confidence Test Report
SPRINKLERS WET
Certification Given
(ONE SYSTEM PER REPORT.Y
RED
YELLOW j
I WHITEA�-
CONFIDENCE TEST: I Ja I R E P A I R S: I u I
Occupancy Address: �7)369 Dowion F-Amnrij-5 OccupancyName: E�A�+Ori C-0ii,10's
Building Owner: '14e)(1 co�i,!6's O.C-)A. Phone Number:
Responsible Person: A1CAcAcA.*f- Phone Number:
Buildirig Owner'
Address: 3(,�, D(,,J6yi 1;-K iA 11 4 Z- r7 cA !v;�o ? 0
Date of I nspection: Inspection Frequency Type: Annual
Tester's Name (print): A-Lllml L)alk- Certification Number: SCP- qnq6-c
Central Station monitoring? Yes �jj No U Monitoring Co. Name: Alr,,�-ai
Primary Component: V 'System Make:
System Model:
I
System Location: "str f oo /fl '00 f Ko I entification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected: Corrected by:
(If additional !M-m is required, please add a separate sheet.) 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 le Authority Having Jurisdiction's Fire Department Fire Code standards.
All discrepancies are noted and h e r ed-t-o-the bu'ilding Owner/Manager for corrective action.
Signature of Tester:,Ztgv��" Phone #: 360.794.8621
Testing Agency: 64olfe Fire- Prottction, Inc.
Mailing Address: 17321 Tye St. S.E., Ste. "B" * Monroe, WA 98272
Building Representative (signature):
Sprinklers - WET
Page: I of 2
'4(:
Thd,,,,bd'bw items on the check list 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 Authority Having Jurisdiction's
Fire Depaftmervt Fire Code for inspecting and testing requirements.
General
1. Flow Test conducted? ............................................................................................................ Yes C1 No 0
2. Static Pressure: joc� psi Flow Pressure: psi
3. Total number of sprinkler heads on this system?
4.- Was 2" Main Draiwchecked? . . . . . . . . . . . :71 . . . . . . . . . . . . . . 1 . . . . . . . . . . . r . . . ... . � 0 t h e r Ej *I-YesV. , No El -
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ......................... N/A LI YesQ_ No El
6. Pressure regulating valves tested? ..............................................................................
N/A j2p
Yes El
'No E)
7. Alarm Bell operates? .............................................................................................
N/A (j
Yes 23
No EI
61
.8.'System inspected and lubricated ? .................................................................................. Yes CW No 0
9..Valves sealed or supervised? ............................................................................ ... Yes 01 No Q
10. Signs provided on all valves? ................................................................................................... Y e s,37 N o E)
11. Pumper Connections and Clapper valves unobstructed and turn freely ? ................ Yes j2j No 0
12. Sprinkler head coverage acceptable? .......................................................... Yes (jr No El
13. Have"the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yes No
W E)
14. Proper number spare sprinkler heads available with appropriate wrenches for each? ....... Yes ff No C)
15. System left in service? ............................................................................................................ Yes Ej No E)
16. System gauges been replaced or calibrated within the last 5 years? ..................... Yes 9-7 No L)
17. SpriInkler heads free of corrosion, paint, obstructions and/or physical damage? .... Yes �w No El
18. Was any debris found in the Fire Department Connection (FDC)? ........................ Yes LI No ZI
19. Was,' the Fire De me n-t Cdnjjec-,tioh (F.D'C) been back flushed in the last 5 years? ... Yes��V No El
W V F7,
p
20. Was an internaj'pipe'�and valve inspection performed within the last 5 years? ................. Yes No E)
Date Performed:
1. Was a signal received at the Central Station monitoring company? .................... N/A Ej Yes L) No 0
Sprinklers - WET Page: 2 of 2
...,Gbp1fidence Testin4 Com'pany:
Wolfe Fire
Protection, Inc. --
17321 Tye St. S E., Ste. "B" - Monroe, WA 98272
Fax: 360.794.3080 Ph.:, 360.794.8621
Fire Department
Confidence Test Report
S PIR I N KLE ks -D RY,
Ceriffication. Giv.e'n
(ONE SYSTEM PER REPORT)
RED Ll
YELLOW LIT—wHITE
-tf
CONFIDENC . E TEST: I -REPAIRS: I
Occupancy Address: FlMcL,�
OccupancyN'ame: Po(lv�0"t Coil,-1015
Building Owner: Dc,\vtoirl hoA
Phone Number:
Responsible Person: /VIA ce
Phone Number: 112 5 - q12 - 3/, 7!V
Building-b�vner
Address:
Date of Inspection:-
Inspection Frequency / Type: Annual
Tester's Name (print): h +06 \Al' I f t
Certification Number: SCP- qoq;
,Central Station monitoring? YesAff No Q
Monitoring Co. Name: A16,�-L
Primary Component:
System Make: T/ r)
System Model:
System Location: - R,L r,-,,t4 1 17410- r, L ' ;�/ '--'Identification
Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Uolr)
Corrections Made: Date Corrected:
Corrected by:
(If additional room is required, please add a separate sheet.)
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 the Authority �6ing Jurisdiction's Fire Department Fire Code standards.
All discrepancies are n=otedrndhave b e reported t t
building Owner/Manager for corrective action.
Signature of Tester:
Phone #: 360.794.8621
Testing Agency: Wolfe Fire Protection, Inc.41"
Mailing Address: 17321 Tye St. S.E., Ste. "B" - donroe, WA 98272
Building Representative (signature):
Sprinklers - DRY Page: 1 of 2
The;be-low items on the check list shall be inspected and tested. This list,does-not constitute all of the
014t��
fe�L&d 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'. Trip Test conducted? ....................................................................................................................... .................... Yes,@ No El
2. System,tr 'd seconds.
!ppe in
3. Flow Test conducted? ...................................................................................................................................... Yesv No 0
4. Static Pressure: psi Flow Pressure: psi
5. Total number of sprinkler heads on this system?
T
6. 2" Main Drain? .......................................................... ......................................................................... Other El Yes45 No U
7. Flow Switches, Supervisory Switches and Alarm Bells tested? .......................................... N/A C3 Yes No (3
8. Alarm Bell operates? ......................................................................................................... N/A El Yesff No El
9. Air compress refill the system in 30 minutes or less? ............................................................................ Yes El No U
10. Heat actuation devices tested on the pre -action and deluge systems? ............ N/A
Yes C1
No El
11. System inspected and lubr icated ? ............................................................................... I ......
Yes&
No Q
12. Valves sealed or supervised? .............................................................................................................
Yes)a,
No Q
13. Signs provided on all valves? ......................................................................................................
Yes-0
No 0
10"Pumver Connections and Clapper valves unobstructed and turn freely ? ..................................................
Yes Ef
No
15. Sprinkler heads been replaced or successfully sample tested in the last 10 years? .................................
YesljI
No (3
16. Sprinkler head coverage acceptable? .................... ................................
Y e s
N o D
17. Proper number spare sprinkler -heads available with appropriate wrenchs for each? ..................
Yes
No 0
18. SysJem left in service? ...............................................................................................................
Yes
No D
19. System gauges replaced or calibrated within the last 5 years? ...........................................................
Yes;D
No D-
20. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ........................
Yes
No D
21. System drained and restored to normal operation? ..................................................................
YesI3
No E)
22. Was any debris found in the Fire Department Co�riection (FDC)? ........................... .................
Yes (j
No JZ
p, 7
23. Was the Fire Del,,, 6nf',`Coc*t6 Ell ...
4rtr n,,IF,6ejr'bfeeo'..b,�Wfid-!�red in the last 5 years? ..... ....
Yes a,
No EJ
24. Was a signal received at the Central Stata:�_�o�'n�it�oring company? ........................ N/A Ej
Yes
No C1
25. Was an internal pipe and valve inspection performed within the last 5 years? Date Performed:
Yes
N b E)
Sprinklers - DRY Page: 2 of 2
Testing Company:..
APMVANCED
FIRE PROTECTION, INC.
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657v,
I . Seattle -Fire Department
Confidence Test Report
206.386.1448 Confidence Testing Officer
206.615.1068 (fax)
206.233.7219Red Tag Hotline
SPRINKLERS DRY
Certificati-on Given
RED
YELLOW
WHITE
(ONE SYSTEM PER RE;ORT)
CONFIDENCE TES . T: I.JJ-FREPAIRS-T Q
Occupancy Address: _Q6.�/7rA/
Building Owner.-.
Responsible Person:
Building Owner
Occupancy Name:
Phone Number:
Phone Number:
Address:
Date of Inspection: 2-2-11
Tester's Name -(printy >0 4
Inspection Frequenc// Type: Annual
SFD Certificatio Number: SC P_ 5-
Central Station monitoring? Yes-0 No El
Monitoring Co. Name:
Primary Component:
System Make:
System Model:
System Location:
Identification Number:
Problems Foun.d: (if additional room. is required, please add a separate sheet.)
Corrections Made: Date Corrected:
Corrected by:
(If additional room is required, 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 the Seattle FJre
Department Fire Code standards, and all discrepancies
are noted and have been reported to the bundin 0
q wner/Manager for corrective action.
Signature of Tester: Phone #: 425.483.5657
Testing Agency: Ad"vanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 - Woodinville, WA 98072
Building Re presentative (signature):
Sprinklers * DRY
Page: 1 of 2
N_
The.be.low items on the check list 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
V-14
Piro"Cbde for inspecting and testing requirements.
General "�
1. Trip Test conducted? ..........................................................................................................................................
Yes U
No L1
2. System tripped -in seconds.
3. Flow Test conducted? ..................... ....................... ..........................................................................................
Yes U
No 0
4. Static Pressure- psi Flow Pressure: psi
5. Total number of sprinkler heads on this system?
6. 2" Main Drain? .................................................................................................................................... Other Q
Yes Cj
No Q
7. Flow Switches, Supervisory iwitch 6s"and Alarm Bells tested? .......................................... N/A 0
Yes L)
No 0
8. Alarm Bell operates? .......................... I ................... I .............................................................. NIA'[3'
Yes Q
No El
9. Air compress refill the system in 30 minutes or less? .......................................................... ........
Yes El
N o C3
10. Heat actuation devices tested on the pre -action and deluge systems? ............ N/A Q ,Yes
El
N o Q
11. System inspected and lubricated. ?; .....................................................................................
Yes Q
No LI
12. Valves sealed or supervised? .............................................................................................................
Yes LI
No Q
13. Signs provided on all valves? .............................................................. ........................................
Yes El
No L)
14. Pumper Connections and Clapper valves unobstructed and turn freely ? ...................................................
Yes E)
No El
15. Sprinkler heads been replaced or successfully sample tested in the last 10 years? .................................
Yes LI:
No El
16. Sprinkler head coverage acceptable? ........................................................................................
Yes (3
No Q
17. Proper number spare sprinkler heads available with appropriate wrenchs for each? ..................
Yes (j
No LI
18. System left in service? ...............................................................................................................
Yes E)
No C3
19. System gauges replaced or calibrated within the last 5 years? ...........................................................
Yes L)
No L)
20. Sprinkler heads free of corrosion, paint, obstructions and /or physical damage? .......... ............... Yes E) No Ej
21. System d rained and restored to normal operation? .................................................................. Yes C] No C]
22. Was any debris found in the Fire Department Connection (FDC)? ............................................ Yes El No Q
23. Was the Fire Depart'in6in"(toinnection (FDC) been back flushed in the last 5 years? .................. Yes-LI No C1
24. Was a signal received at the Central Station monitoring company? ........................ N/A [I Yes Q No C)
25. Was an internal pipe and valve inspection performed within the last 5 years? Date Performed: Yes U No El
Sprinklers o DRY Page: 2 of 2
Cohfidehce Testing Company.
'A
j -�--;M�--ABVANCED
. -1 -
P.O. Bok 1543 - Woodinville, WA 98072
Oh.: 425.483.5657
a ofi ment
llit re Depart '
Confidence Test Report *
206.386.1448 Corifidence.Testing Officer
206.615.1068 (fax)
206.233.7219Red Tag Hotline
SPRINKLERS - DRY
(ONE SYSTEM I PER, REPORT)
Certification Given
RED
YELLOW 07W
H I T E--a—
c6NFIDENCE TEST: 1,0--j-11 EP' A I R S:
Occupan.cy.,�ddress:-,,53�C>-,Z,;,�)4/3/7e2`/�/��/ Occupancy Name:.
Building Owner: Phone Number:
Responsible Person: Phone Number:
B6ffdin!4'Owh6F
Address:
Date of Inspection: Inspection- Frequency/ Type: A,!ijn,ua,1
.Tester's Name (print): F D Certif ication. N u m ber: SCP-
Central Station monit oring? .-Yes-13---- No El Monitoring Co. Name:
Primary Component: System Make:
System Model:
System Location: Identification Number:
..Problerns Found: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected: Corrected by:
(if additional room is required, 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 the Seattle Fire Department Fire Code standards, and all discrepancies
are noted and have been,reporl6d,to the buildigng Ow-her/Manager for corrective action.
Signature of Tester- Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 - Woodinville, WA 98072
Building Representative (signature):
Sprinklers * DRY
Page: 1 of 2
-The below items on the check list 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
Code for inspecting and testing requirements.
General
1 Trip Test conducted? ............................................................. . .......... ................................................................ Y e s o C)
Z'Systelm tripped in seconds.
3. Flow Test conducted? ............................................ ............................................................... ......................... Yd—stl—No C3
4. Siatic,Press - ure: psi Flow Pressure: 5�5�_ psi
5. Total number of sprinkler heads on this system?
7
7E) es 610-
6. 2" Main Drain? ................................................................................................................................... Other Y
7. Flow Switches, Supervisory'Switches and Alarm Bells tested? ........................... i ............... . N/A.D Yes tjINo Q
-No Cl
8. Alarm Bell operates? . ............... ................................................. I .............................. NIA tj
9. Air compress refill the system in 30 minutes or less? .................................................. .......................... Y e s-EI—Nb CIr
10-. He'at actuation devices tested on the pre -action and deluge systems? ............ N/A-aGr—Y-es C3 No L)
11. System inspected and __ lubricated ? ............................................................................. .......... Yes�9—No C3
12. Valves sealed or supervised? ............................................................................................................. Yes.Q.-NoU
13. S-igns provided on all valves? ...................................................................................................... Yes -@—No L)
14. Pumper Connections and Clapper valves unobstructed and turn freely ? .................................................. Yesas.—No 0
15. Sprinkler heads been replaced or succpssfully sample tested in the last 10 years? ................................. Yes--JD—,No (3
16. Spr�nk(er head cover ge acceptable? ........................................................................................
Yes
o
17. Proper number spare sprinkler heads available with appropriate wrenchs for each? .................. Y e s _QZgL_N o (3
18. System left in service? ............................................................................................................... Yes t,�No (j
19. ystem gauges replaced or calibrated within the last 5 years? ...................... qz,.,,L ................. Yes W—No Q
20. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ........................ Yes'05-- No L)
21. System drained and restored to normal operation? .................................................................. Yes-4n No E]
22. Was any debris found in t he Fire Departm ent Connection (FDC)? ............................................ Yes Ej NoIEJ
23. Was the Fire Departin ent Connection (FIDP). b e6n back flushed in the last 5 years? .... Y e s C) N o EI
24. Was a signal received at the Central Station monitoring company? ........................ N / A C1 Y e s 1:1-�N o C1
25. Was an internal pipe and valve inspection performed within the last 5 years? Date Performed: Ye§,�D,No Ej
Sprinklers a DRY Page: 2 of 2
Serving Briet: Ednionds
SNOHOMISH CO.
,FIRE Mountlake Terraceand
the Town of Woodway
DISTRT www.FireDistrictl.org
LOCATION: 530 Dayton Street
BUSINESS NAME: Dayton Condos
MAILING 530 Dayton St
ADDRESS: Edmonds
BUSINESS OWNER: Wambolt, Ron
EMERGENCY-1:
KEY ACCESS-2:
I -�
PERSON CONTACTED: t94 4 7�,'AA
NAME OF INSPECTOR:
FIRE AS 6/11 FA 6/11 FD LkBx -5-/-/ Z_
SYSTEMS:
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[]MOUNT ' LAKE TERRACE
0 UININ0013000ATED
e' FREQUENCY STA TION & SHIFT
3 17 A
SCHEDULED
DATE DUE 1` 05/01/12
UFIR 11, 422 5203
93020
HOME PHONE: 4257766501
HOME PHON E:(4(Z r) _Z-3f6__,*-)" CURRENT YES NO
HOME PHONE: CITY
BUSINESS
LICENSE
INITIAL INSPECTION DATE
ANNUAL
M
2—
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
c'
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
lst RE -INSPECTION
DATE DUE,
2nd RE -INSPECTION
DATE DUE,
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
IC
VIOLAT ONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
8
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES [I NO
LETTER NEEDED [-] YES El NO
8
FIRE DEPARTMENT COPY
Confidence Testing Company:
_,_-.A"e?VDVANCED
'T'�FIRE PROTECTION, INC.
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
Seaftel-v F i r Is - D e p a rt m e n t
Confidence Test Repoff
206.386.1448 Confidence Testing Officer
20.6.615.1068 (fax)-
206.233.7219Red Tag Hotline
SPRINKLERS DRY
Certification Given
RED
YELLOW
WHITE
(ONE SYSTEM PER RE;ORT)
CONFIDENCETEST: I-EH-REPAIRS-F C1
Occupancy Address: -5�ZO 1,724YTO.L.1 -57
Occupancy Name:
Building Owner:
Phone Number:
Responsible Person:
Phone Number:
Building Owner
Address:
Date of Inspection:
Inspection Frequency/ Type:
Tester's Name (print): IOAFM_�
SFD Certification Number: SCP� C,67
Central Station monitoring? Ye -%--El. No El
Monitoring Co. Name:
Primary. Component:
System Make:
System Model:
System Location:
Identification Number:
ProblemsFound: ofadditional room is required, please add a separate sheet.)
Corrections Made: Date. Corrected:
Corrected by:
(If additional room is required, 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 the Seattle Fire Department Fire Code standards, and all discrepancies
are noted and have been- r to the ujidin er/Manager for corrective action.
Signature of Tester:
Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 - Woodinville, WA 98072
Building Representative (signature):
Sprinklers - DRY Page: 1 of 2
LThe below items on the check list shall be inspec . ted 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
V_ire�bbde for inspecting and testing requirements.
General
1. Trip Test conducted? .......................................................................................................................................... Yes4-No D
-tripped'in
2. System -seconds.
3. Flow Test conducted? ...... .............................................................................................................................. Yes-E�-No D
4. Static Pressure: 0 psi Flow Pressure: psi
5. Total number of sprinkler heads on this system?
6. 2" Main Drain? ................................................................................................................................... Other El Yes-Q--No El
7. Flow Switches, Supervisory Switches and Alarm Bells tested? .......................................... N/A LI Y e s-EI—N o LI
8. Alarm Bell operates? ......................................................................................................... N/A El Yes-e- No EJ
9. Air compress refill the system in 30 minutes or less? ............................................. I ............................... Yes-d—No D
10. Heat actuation devices tested on the pre -action and deluge systems? ............ N/A'0-"Yes 0 No [I
11. System inspected and lubricated ? ..................................................................................... Yes-Ej- No D
12. Valves sealed or supervised? ............................................................................................................. Y esod--N o D
13. Sign,.sprovided on all valves? ...................................................................................................... Y es-512-wo El
14. Pumper Connections and Clapper valves unobstructed and turn freely ? .................................................. Y e s-5--N o E)
15. Sprinkler heads been replaced or successfully sample tested in the last 10 years? ................................. Y e soEI'N o (3
16. Sprinkler head coverage acceptable? ....................................................................................... Y e s,,&—N o E)
17. Proper number spare sprinkler heads available with appropriate wrenchs for each? .................. Yes-ff No Ej
18. System left in service? ............................................................................................................... Y e s-t�]'N o L)
19. System gauges replaced or calibrated within the last 5 years? ........................................................... Yes-E]'No C1
20. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ........................ Y e s--B- N o Ll
21. System drained and restored to normal operation? .................................................................. Yes-0- No El
22. Was any debris found in the Fire Department Connection (FDC)? ............................................ Y e �'Q' N da
L 11
23. Was the Fire Department Connection (FDC) been back flushed in the last 5 years? .................. Yes (j No [I
24. Was a signal received at the Central Station monitoring company? ........................ N / A Ej Y e 9-(TN o El
25. Was an internal pipe and valve inspection performed within the last 5 years? Date Performed: Y 11 No L)
Sprinklerse DRY Page"i 2 of 2
iq
IIIIIIIIIIIII
FIRE PREVENTION
Serving Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT
SNOHOMISH CO. 0 EDMONDS
Flin-10 - - - Mountlake Terraceand Everett, WA 98208 0 BRIER
."MA 0 WOODWAY
the Town of Woodway Phone (425) 551-1200
0 MOUNTLAKE TERRACE
DISTR T www.FireDistrictl.org Fax 551-712 72- - 0 UNINCORPORATED
FREQUENCY I STATION & SHIF`�
��OCATION: 530 Dayton Street 2 17 D
BUSINESS NAME PHONE: SCHEDULED
Dayton Condos DATE DUE 05101/11
MAILING 530 Dayton St UFIR "' 422 5203
ADDRESS: Edmonds 98020
BUSINESS OWNER: Wamboft, Ron HOME PHONE: 4257766501
EMERGENCY-1: HOME PHONE: —CURR-E—NT
KEY ACCESS-2: HOME PHONE: CITY YES 'NO.
BUSINESS
LICENSE 1:1 El
PERSON CONTACTED: INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE AS 6/10 FA 6/10 FD LkBx FEG 110
SYSTEMS: A 14-N �Ul
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
1 1) A) 4-119 [-,q
17) 11 C Ce S 5PRI A_�,<
;fti Pr4 kPI,
_S LE72-
2 T-9 �Jelzlrzv
-A
3
3
4
Ile
4
5
5
6
6
7
7
I Uj
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE�"TION.
VIOLATIONS
DATE DUE:
D E DUE:
GRANTED TO:
DATE ME.
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
D TE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
1 5
1 15
SENT
NUMBER:
4
—LETTER
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
6
3
7
3
7
--RECEIVED
DISPOSITION:
4
, 8
4
8
DATE:
7
LETTER NEEDED F] YES F-1 N 0
rLETTER NEEDED YES El NO
8
Nali-dEPARTMENT COPY
Protectioft 91 Communications, Inc.
(800) 774-9099 9 Fax (425)..77 -6317.--
.4
.,www. pro-comm-online..6b'm
QONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST REPORT
NAME OF FACILITY
PHONE NO.
DATE IN I SPECTI N
ADDRESS
S36 MJ
CITY �STATE
Al
ZIP -4..
rj
OCCUPIEDAS
MONITORED BY
1:1.e 'V'a- /.3�' cr /;P-
ACCT#
a S7 - V 7 76
TYPE OF TEST
m6NTHLY 0 QUARTERLY [:1 SEMI ANNUAL El ANNUAL Pd ACCEPTE] �'
PRO-COMM LICENCE
BATTERY VOLTAGE VOLTS
.2
BATTERY UNDER VOLTS
FULLLOAD -7 ,Ic
HARGE CIRCUIT
;2 -T, VOLTS
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A'
ITEM
YES
NO
N/A
TROUBLE AC OFF
CIRCUITS CHECKED
FOR SUPERVISION
SYSTEM WIRING CONFORMS
TO NFPA STANDARDS
SYSTEM OPERATES-
ON STANDBY POWER
CONTROLPANELCHECKED,-
PER NFPA & MFG INST.
KEY TO PANEL
AVAILABLE
SIGNALS OPERATE
ONACPOWER
AUXILIARY EQUIP.
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
OPERATING INSTRUCTIONS
AT PANEL
OTHER
EQUIPMENTTESTED
NO. OF UNITS
SATISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
-7
I
ANNUNCIATORS
_N/A
VISUALALARM DE VICES
-7
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
f
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
6
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
P,
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
14 'Fd.f /jCVAj-(
TJ2
OTHER
CENTRAL STATION
OTHER
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL
_51ef'All- k/t/14HI— _�rao 71
OTHER
SERVICE TECHNICIAN NOTES Fire Watch required, threat level 1 2 3 (see reverse for a threat level explanation)
A,,,, e DI I
THIS IS TO CERTIFY THAT THIS FIRE ALARM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY
TO COVER ITEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS.
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. N6NF0_ YES
OWNER OR FACILITY REPRESENTATIVE %, -
A_,ol 91A.-I,
DATE
TECHNICIAN
LICENSE NO.
5-e '9 g 00
SIGNATURE k.
City of S V00116, Fire Department
�/7D V
DVANCED
CONFIDENCE TEST REPORT
Seattle Fire Department Confidence Testing Officer: 206.386.1448, Fax:206.615.1068
WET - AUTOMATIC SPRINKLERS 1 Certification Given
(NOTE: ONE SYSTEM PER REPORT) I RED 0 IYELLOWE) WHITE
Date of Inspection: CONFIDENCE TEST. Annua!15�- Quarterly 0 Acceptance 0 1 REPAIRS: El.
Tester's Name (print): SFD Certification Number.. SCP - -r
4��42 ,967 2;2 _j
-
Occupancy Name, Z34 VZa
Occupancy Address: e�o z;ak722"111
91A.'980-22
Responsible Person:
Phone Number:
Building.Owner's Name:
Building Owner's Address.
Contact Person:
Phone Number:
Central Station monitoring? Yes-@-- No 0 Control Panel Manufacturer' Y, /V
e-1
Monitoring CO. Name: -PRO. Model Number: -X-IL
Problems Found: (if additional room is required, please add a separate sheet)
Corrections Made: (Ifaddifional room is required, please add a separate sheet) DateCorrected: Corrected by:
The below items on the check list shall be inspected and tested. This list does not constitute all the required inspecting and testing
of the Fire and Life Safety system. Please refer to the Seattle Fire Department Fire Code for inspecting and testing requirements.
80. Was a Flow Test conducted?
81. Static Pessure: _200 — psi Flow Pessure: psi
82. Was 27 Main Drain checked?
83. Were -all Flow Switches, Supervisory Switches and Alarm Bells; tested?
84. Does the Alarm Bell operate ?
85. Were all valves inspected and lubricated ?
86. Were Pressure Regulating valves tested?
87. Were all valves "sealed" or supervised?
88. Are signs provided on. all valves?
89. Are the Pumper Connections and Clapper valves unobstructed ?
90. Are the sprinklef headiflbss than 50 years old?
91. Is the sprinkler head coverage acceptable?
92. Are spare sprinkler heads available?
93. Was the system left in service?
Yes-@--
No E]
Yes-@-
No Q
OtherE] Y e 9-9-
No Q
N/A Q Y e s-Ej-
N o Q
N/A (j . Yes-@-
No E]
Yes -a-
No E]
Yes C]
No-@-
Yes43-
No E]
Y e s.4�
No C3
Yes-8-
No Q
Yes-5-
No Q
Y e $.-�
No Q
Yes�a-
No El
Yes-9-
No Q
This certifies that this Fir * e and Life Safety system- has been properly inspected for
reliability to cover the items listed in this report and is consistent with the Seattle
Fire Department Fire Code standards and discrepancies are noted and have been
reported to the building Owner/Manager for corrective action.
Signature of Tester.
Testing Agency: Advanced. Fire Protection, Inc. Phone: 4,25.483.66571
Mailing Address: P.O. Box 1543 , Woodinville INA 98072
Confidence Testing Company:
A,
e-;P'V,,1FIRE PROTECTION, INC.
P.O. Box- 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
SGI I ft
M e- Fire Department
Confidence Test: Report
206.386.1448 Confidence Testing Officer
206.615.1068.(fax)
206.233.7219Red Tag Hotline
SPRINKLERS DRY
Certification Given
RED
YELLOW
WHITE
(ONE SYSTEM PER REPORT)
CONFIDENCE *TEST: R E PA I R S
Occupancy Address: -5730 .27'K/V4M/&/�97_
Occupancy Name:PA 1'17-OAI 5 T 4:--
Building Owner: Phone Number:
"A'
Responsibe P&s61n.- Ph6ne'Ndmber*:
Building Owner
Address:
Date of Inspection:
Inspection Frequency Type: Annual
Tester's Name (print):
Central Station monitoring? Y e s-EJ--_ No D
SFD r,Certification Number: scp-
Monitoring Co. Name:
Primary Component: �41 �'PR14`0' I�DISA;—C_F
System Make:
Systern Modet�
System Location:
Identification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected:
Corrected by:
(if additional room is required, 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 the Seattle Fire Department Fire Code standards, and all discrepancies
I
are noted and have e/ i�g�Owner/Manager for corrective action.
Signature of Tester: ��
Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 - Woodinville, WA 98072
Building Rep rese nta ti ve (signature):
Sprinklers - DRY
Page: 1 of 2
The below items on the check list -shall be inspected and tested. This list'does not constitute all, of the
__r
,equired inspecting -and testing of the Fire and Life Safety system. Refer to the Seattle Fire Department
F,�ire Cade for inspecting and testing requirements.
General
1. Trip Test conducted? .......................................................................................................................................... Yes-tj�No (3
2. System tr ipped in seconds.
3. Flow Test conducted? ..................................................................................................................................... Yes-U- No LI
4. Static PressU re:, psi Flow Pressure: psi
5. Total n"umber of sprinkler �heads on thislisystbrn?
6. 2" Main Drain? ................................................................................................................................... Other 0 Yes-5- No El
7. Flow Switches, Supervisory Switches and Alarm Bells tested? .......................................... N/A El Yes tn- No L]
8. Alarm Bell -operates? .......... .............................................................................................. N/A El Yes-0-Wo Q
9. Air compress refill the system in 30 minutes or less? ............................................................................ Y e s1fj- N o L]
10-. Heat actuation devices tested on the pre -action and deluge systems? ............ N/A-El'Yes 0 No U
11. System inspected and lubricated ? ..................................................................................... Y e s-tj- N o (3
12; . ValVes,,sealed or supervised? ............................................................................................................. Yes-j� No C]
13. Signs provided on all valves? ...................................................................................................... Y e s-tj- N o C3
14. Pumper Connections and Clapper valves unobstructed and turn freely ? .................................................. Yes tj- No LI
15. Sprinkler heads been replaced or successfully sample tested in theIast 10 years?,, .............. Y es-U-` No Ll
...................
16. Sprinkler head coverage acceptable? ....................................................................................... Yes-0- No LI
17. Proper number spare sprinkler heads available with appropriate wrenchs for each? ................... Yes -=-No LI
18. System left in service? ................................................... . .......................................................... Yes-0- No L)
19. System gauges replaced or calibrated within the last 5 years? ........................................................... Yes-U-No Ll
20. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ........................ Y e S-ea- N o C3
21. System drained and restored to normal operati on? .................................................................. Y e s-ET N o 0
22. Was any debris found in the Fire Department Connection.(FDC)? ............................................ . Yes Q Nd= I
23. Was the Fire Department Connection (FDC) been back flushed in the last 5 years? .................. Yes-0- No Q
24. Was a signal received at the Central Station monitoring company? ........................ N/A Ll Yeg-U-No Q
25. Was an internal pipe and valve inspection performed within the last 5 years? Date Performed: Y e Vff—N o Ej
tsprinKiers o uFiy Page: 2 of 2
artmdnt
City of Se ft Fire Dep
�IDVANOCED
CONFIDENCE TEST REPORT
beattie rilre ueparxrnenE LonTiuence ie.5xinq viiivvr; cuo.000. i-4-4o, riiAA-..cvo.o i a. iuoo
WET - AUTOMATIC SPRINKLERS I Certification Given
(NOTE: ONE SYSTEM PER REPORT) I RED El IYELLOWC03 HITE -B
Date of Inspection: eS'p -//-j 0 ICONFIDENCE TEST., AnnuarF51- Quarterly El Acceptance 0 1 REPAIRS: 0
Tester's Name (print): 11AP04-17 -!��IQC
7M�4 Al FSFEICertification Number. 9CP -,5- L6?�
Occupancy Name: PAJ' Talil -s 7- rt�) -fyx� -s
Occupancy Address: -S--3oAQ4V74-41
'64-042W -7
Responsible Person: -/ Raw
Phone Number:
Building Owner' s ,Name:
Building Owner's `�Iddress:
Contact Person:
Phone Number: -
Central Station monitoring? Yes-B— No C3 Control Panel Manufacturer:
Monitoring Co. Name: - e-'OA� Model Number:
ProblernsFound: (if additional room is required, please add a separate stieet.)
torrections, Made: (if additional room is required, please add a separate dmt) DateCorrected: Corrected by:
The below items on the check list shall be inspected and tested. This list does not constitute all the required inspecting and testing
of the Fire and Life Safety system. Please refer to the Seattle Fire Department Fire Code for inspecting and testing requirements.
80. Was a Flow Test conducted?
Yes-9—
No E]
Flow Pessure: — 5�
81. Static Pessure: JV 0 — psi psi
Yes-9—
No Q
82. Was 2" Main Drain checked? OtherE]
Yes-@—
No E]
83. Were all Flow Switches, Supervisory Switches and Alarm Bells tested? N/A Ej
Yes-e—
No El
84. Does the Alarm Bell operate ? N/A (j
Yes-8—
No Ej
85. Were all valves inspected and lubricated ?
Yes-E]---
No El
86. Were Pressure Regulating valves tested?
Yes El
No-El-
87. Were all valves "sealed" or supervised?
Yes-Ej--
No L]
88. Are signs provided on all valves?
Yes-E�—
No El
89. Are the Pumper Connections and Clapper valves unobstructed ?
Yes-64—
No Q
90. Are the sprinkler heads less than 50 years old?
Yes-E)—
No El
91. Is the sprinkler head coverage acceptable?
Y e s-d—
N o Q
92. Are spare sprinkler heads available?
Y e s-B—
N o E]
93. Was thes9stem-16ft in sdNide?
'Y e s-B—
No Q
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 the Seattle
Fire Department Fire Code standards and discrepancies are noted and have
been
reported to the building Owner/Manager for corrective action.
0
Signature of Tes. 7A��
Testing Agency: Advanced Fire Protection, Inc. Phoner/425.483.5657
Mailing Address: P.O. Box 1543 , Woodinville, WA 98072
I
Cityi:ofS"-,&.tffv Fire Department
V
DVANCED
.-.�A
CONFIDENCE. TEST REPORT
Seattle Fire Department Confidence Testing Officer: 206.386.1448, Fax:206.615.1068
DRY AUTOMATIC SPRINKLERS I Certification Given
(NOTE:'ONE SYSTEM. PER REPORT), I -R-ED El IYE'LL'0WQ1 WHITE. --a
REPAIRS: C3
te of InspectI6
Da [CoNFIDENCE TEST. Annu'a44El—iZuarteiIyQ, Acceptancie�-O.
SFD Certification Numb - SCP-S1eq>&_r4�;7'
Tester's Namg,6212t): 1-1,1�L96P or.
Occupancy Name: 184kmil Building Owner's Name:
Occupancy Address:--,(—.30 Ziad,?�Vlv Building Owner's Address:
14,1,4. 9�Fvozz
Responsible Person: Contact Person:
Phone Number: Phone Number:
-77-77
7, _7 77 7 -T
%
Central'Station monitoring? Yei-'Q- No El Control Panel Manufacturer:
Monitoring Co. Name: 43po C ��M/j Model Number:
ProblemsFound: (If additional room is required, please add a separate sheet)
Corrections Made: (Ifadditonal room is required, please add a separate sheet.) DateCon-6cted: Corrected by:
I
The below items on the check list shall be inspected and tested. This list does not constitute all the required inspecting and testing
of the Fire and Life Safety system. Please refer to the Seattle Fire Department Fire Code for inspecting'and testing requirements.
94. Was a.Trip Test (dry,trip) conducted?
95. The Dry System tripped in — 141 seconds.
-96. Wasia Flow Test conducted?.,
97. Static Pessure: psi Flow Pessure: Psi
98. Was 2" Main Drain checked?
99. W ere all FlowSwitches, Supervisory Switches and*Alarm Bells tested?
'100.. Does the Alarm Bell operate ?
101. Does the'Air Compressor refill the system in 30 minutes or less ?
102. Were all Heat Actuation Devices tested*on the Pre -action and Deluge systems?
103. Were all valves inspected and lubricated ?
104. Were all valves "sealed" or supervised?
105. Are signs provided on all valves?
106. Are the Pumper Connections and Clapper valves unobstructed ?
y 107-..Arethe-sprinkler-heads, less. than 50-yeart old?
108. Is the sprinkler head coverag�� acceptable?
109. Are spare sprinkler heads available?
110. Was the system drained and restored to normal operation ?
Yes-5 No El
Yes -a- No El
OtherEl Yes-5- No El
N/A 0 'Yes-@-. No. C3
N/A Q Ye s-@-
No- Ll
-'Yes-4@-
No Q
N/A -0— Yes El
No C3
Yes -El-
No El
Yes-B-
No Q
Yes-B-
No C]
Yes -a-
No Q
Y�es -U"
:-No,C]
.Yes-B---
-, No Cl
Yes-5-
No C3
Yes-5-
No El
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 the Seattle
Fire Department Fire Code standards and discrepancies are noted- and have been
reported to the bu Ing Own /Man ger for corrective adtioni
Signature Of Tests
Testing Agency: Advanced Fire Protection, In c. Phone: 425.483.6667
Mailing. Address: P.O. Box 1543 , W`0ddinvIlle:,4WA 98072