540 DAYTON ST (2)Tn
"Ir
qr FIRE PREVENTION
INSPECTION REPORT
Serving Brier, amuriu), and 12425 Meridian Ave S
01VIISH Co.
A 98208 EDMONDS
Mountlake Terrace Everett, W >9BRIER
FIRE 0 MOUNTLAKE TERRACE
Phone (425) 551'.1200 0 UNINCORPORATED
STR T Www.FireDistrict]. org Fax (425) - 551-12 72
LOCATION: 540 Dayton Street 98020
Dayton Place Condos
BUSINESS NAME:
MAILING 540 Dayton Street, Edmonds, WA 98020
ADDRESS:
BUSINESS OWNER:
EMERGENCY-1: Jim Chalupnik
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Date Last Serviced
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SCHEDULED 20-1 1
DATE DUE
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CITY
YES NO
BUSINESS
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LICENSE
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INITIAL INSPECTION DATE
6_2
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SNOHOMISH CO.
FIRE
DIST]
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION:
540 Dayton Street 98020
BUSINESS NAME:
Dayton Place -Condos
MAILING
ADDRESS:
540 Dayton Street, Edmonds, WA 98020
BUSINESS OWNER:
.EMERGENCY-1:
KEY ACCESS-2:
Jim Qialupnik
EMAIL:
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PERSON CONTACTED:
NAME OF INSPECTOR: 'C)
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FIRE SYSTEMS/1--f-r
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE:
4257765544
HOME PHONE:
HOME PHONE:
HOME PHONE: 4257765544
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
r-FREQUENCY STATION & SHIF`�
Asimitial q ?-rl%
SCHEDULED
DATE DUE 0
May 2016
UFIR 0
422
CURRENT
CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
WidilFba$bUMVIT!CbcAjiou&rfo-MMUNICATIONS
2
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2
—3
3
4
4
5
5
6
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7
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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 th 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 y u
will find the item(s) that were noted during, our inspection which require attention to bring them into compliance
with the minimum standards adopted by the above jurisdictions.
Any overlooked hazards or violations, of the fire regulations does not imply approval of such conditions or violation.
If you require additional information or to schedule a re -inspection for Edmonds, call (425) 775-7720; for
Mountlake Terrace or Brier, call (425) 744-6231.
'SNOHOMISH
FIR
'DIS R
0 rOAJ 1'7- FIRE PREVENTION
Serving Briet: Edmonds, ad 12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
N, Phone (425) 551-1200 0 MOUNTLAKE TERRACE
Twww.FireDistrictl.org Fax (425) 551-1272 [1 UNINCORPORATED
FREQUENCY
STATION & SHIFT
LOCATION:
541) Dayton Street 08020
Annual
17-C
BUSINESS NAME:
Dayton Place Condos
PHONE: 4257765544
SCHEDULECfviay 2014
DATE DUE
MAILING
FR It122
ADDRESS:
540 Da�ton Street, Edmonds, WA 98020
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
Jm Chalupnik
HOME PHONE: 425776-5544
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS 0 El
EMAIL:
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
t
FE
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
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I A I GREE TO CORRECT THE ABOVE VIOLATION(Sy IN THE NEXT 30 DAYS X
lst RIE-IN �PECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
DATE,EOE:
DATE DUE:
EXTENSION
GRANTED TO:
DATE DUE:
VIOLATIONS
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTA&ED:
CONTACTED:
1
INSPECTC�:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
5
1 5
LETTER SENT
NUMBER:
4
CODE
5
6
2
6
DATE:
ECTION:
RETURN RECEIPT
7
3
7
RECEIVED
6
DISPOSITION:
14
18
4
8
DATE:
7
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
.
1
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FIRE DEPARTMENT COPY
7
FIRE PRE VEN,
SNOHOMISH CO.
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION RE�,
Mountlake Terrace, and
Everett, WA 98208
EIEDMONDS
0 BRIER
e Town o bodway
f W
Phone (425) 551-1200
El WOODWAY
DISTR
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[1 MOUNTLAKE TERRACE
wtww.FireDisirictL org
Fax (425) 551-1272
El UNINCORPORATED
FREQUENCY
STATION& SHIFT)
LOCATION: 540
Dayton Street
366
17 A
I
BU;INESS NAME: Dayton Place Condos
PHONE: 4257765544
'SCHEDULED
DATE DUE 1' 05/01/12
MAILING
540 Dayton St #201
LIFIR 1,, 422 5203
ADDRESS:
Edmonds
98020
BUSINESS OWNER: Jim
Chalupnik
HOME PHONE: 4257765544
ACTIVE
EMERGENCY-1:
HOME PHONE:
"CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
0
0
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
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FIRE AS 8/06
FA 8/11
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SYSTEMS: 1112,
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ANNUAL
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1 AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
7
3
7
RETURN RECEIPT
RECEIVED
6
8
4
'8
DATE:
DISPOSITION:
[I YES NO
LETTER NEEDED C] YES El NO
8
FIRE DEPARTMENT COPY
Central Sprinkler Voluntary Replacement Program
Incomplete Claims -Washington State
Pro erty
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CONDOMINIUMS
CONDOMINIUMS
CONDO
550005913
Stevens Healthcare
I R2diology
121601 76th Ave. West
Edmonds IWA
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Central Sprinkler Voluntary Replacement Program
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CONDOMINIUMS
CHALUPNIK
102098042
SHELLABARGER CREEK
SHELLABARGER
504 HOLLY DRIVE
EDMONDS
WA
98020
Condominium
CONDO ASSOCIATION
CREEK
ASSOC.
CONDOMINIUM
2/16/2005
FIRE PREVENTION
SNOHOMISH CO. Serving Brier, Edmonds 12425 Meridian Ave S INSPECTION REPORT
Mountlake Terraceand. Everett, WA 98208 OEDMONDS
0 BRIER
FIRE the Town of Wbodwiay. Phone (425) 551-1200 OWOODWAY
- ._ . [] MOUNTLAKE TERRACE
DIST T www.FireDistric'tl'.o'ij Fax (425) 551-1272- 0 UNINCORPORATED
FREQUENCY I STATION & SHIFT"'
'),"A" LOCATION: 540 Dayton Street 366 17 D
BUSINESS NAME PHONE: 4257765544 SCHEDULED
: Dayton Place Condos DATE DUE 0 05,101/11
MAILING 5 LIFIR 0 422 0203
ADDRESS: 540 Dayton St #201,
Edmonds 98020
BUSINESS OWNER: HOMEPHONE: 42577655U ACTIVE
Jim Chalupnik
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: CITY .YES NO
BUSINESS —1
LICENSE' El. E
INITIAL INSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR: 0,\Q,) 0-�,C,-'
FIRE AS 8/06 FA 5ffie— FE-Q-10
SYSTEMS: 16[10 00 rA aw.� Vu,.zs,, A L
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4
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I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
11st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
D TE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOL_AT1_0_ff9__
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DA E:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
—LETTER
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
,4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED 0 YES C3 NO
LETTER NEEDED C] YES [I NO
1
8
FIRE DEPARTMENf COPY
CONFIDENCE TESTING
-SYSTEM:.�
Protection.& Coinmunications, Inc. FIRE ALARM,
'(8QO') 77*4r9O99.. FAx;(425) 774-.�631-7; -EST'REPORT
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NAME,QF-�ACILITY
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-ADDRESS,
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7TATE
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.00CUPIED AS,
MONITORED BY
ACCT #
TYPE OF TEST ,,IPRO-COMM
k MONTHLY 0 QUARTERLY [:1 SEMIANNUALE] ANNUALX ACCEPT
LICENCE
BATTERY VOLTAGE VOLTS
BATTERY UNDER VOLTS
IFULILLOAD
CHARGE CIRCUIT 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
I NO
I N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES_
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUAL -ALARM DEVICES
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER
CENTRAL STATION
OTHER
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL
A4_,-) ftV-� &I e&W:64THER
SERVICE TECHNICIAN NOTES Fire Watch,�rrejulred,ttrbat level 1 2 3 (see reverse for a threat level explaination)
THIS IS TO CERTIFY THAT THIS FIREALARM HAS BEEN PROPERLY TESTED AND INSPECTED FOR RELIABILITY
TO COV&Z-1TEMS LISTED IN THIS REPORT, IS CONSISTENT WITH FIRE ALARM MAINTENANCE STANDARDS.
OWNER WAS INFN,'O'RMEND ABOUTANYNEEDED F3E9,A'IRS OR DISCREPANCIES. NONEX YES
0 ERIO �fFACILITY REPRESENTATIVE
DATE
TOCH ICIAWN
LICENSE 0
SIGNATURE