610 5TH AVE S STE A�4�') -d
o9 41q FIR*
Jr E PREVENTION
Serving Brier, Eurriuriw,'and 12425 Meridian Ave S INSPECTION REPORT
'EDMONDS
Mountlake Terrace' Everett, WA 98208 0 BRIER
FIAMJVJ El MOUNTLAKE TERRACE
Phone (425) 551-1200
UNINCORPORATED
DIST T www.FireDiS'trict1.-67,g Fax (425) 551-1272 1.
"_ FREQUENCY I STATION& SHIFT
LOCATION: 610 5 th Avenue S Suite A 98020' Annual 17-D
BUSINESS NAME: Hamburger Harrys PHONE: 4257766666 SCHEDULED Nov 2016
DATE DUE
MAILING UFIR� 161 152
ADDRESS: 610.5th Avenue S, Edmonds, WA 98020
BUSINESS OWNER: Mitchel, Bobb HOME PHONE:
EMERGENCY-1: Mitchel, Mike HOMEPHONE: 2063549568 "'CURRENT
KEY ACCESS-2: HOME PHONE: CITY NO
BUSINESS
EMAIL: LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED: ez, z
NAME OF INSPECTOR:
FIRE SYSTEMS: FE 4/16 UL300 3/16
Date Last Serviced: fl� I �1'1 I C)
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
w-r af r,) mo C of�s
2
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4
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4 11.
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X / / I K / /V
1st RE -INSPECTION 2nd RE -INSPECTION V ( t "
EXTENSION FINAL RE -INSPECTION A
V16(ATIONS
GRANTED TO: I
DATE DUE: DATE DUE: DATE DUE, //CITED:
PERSON PERSON
PERSON
CONTACTED- CONTACTED:
ER'SO
D*
2
INSPECTOR: INSPECTOR; INSPE
DATE: DATE: DATE.. 3
VIOLATIONS VIOLATIONS CITXI U14-D
PRE -CITATION i 4
5 5 LETTER SENT NUMBER
CODE 5
2 6 2 6 DATE SE TION
RETURN RECEIPT 6
3 7 3 7 RECEIVED
DISPOSITION
4 8 4 8 DATE*
LETTER NEEDED [] YES NO LETTER NEEDED [:] YES NO 8
&THood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle,WA 98108 Fax (206) 767-2607
Occupancy Name: /
Occupancy Address:
Responsible Person:
Building Owner: —
COMPLETE Certification Given: RED[:] YELLOW[:] WHITEO
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TEST REPORT
Fire Suppression Installation & Service CONFIDENCE TEST Z REPAIRSE11
Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
Filter Sales & Service DATE: 12-09-16
City, State, Z �17
1p: Mh— 19(79
Phone Number:
Phone Number:
Building Owner Address: City, State, Zip:
Testers Name (Please Print):
SlFD Certification Number: SCP- C'S—,'4 &�,j
? Yes
System Alarm FeK'No F� Central station monitoring? Yes E] No E] Monitoring company name:
Control Panel manufacturer: Model N b Location of Alarm Panel:
Extinguishing System Manufacturer System Size )JI.L. 3019 System? Yes E2<o El ��,L. 300 Compliant? Yes.eNo El Chemical Type: Wet 2KDry El
Location / Height of Range hood:
Is pressure gauge indicator in operable range? Ah&—
Yes F]
No [j
Is there chemical inside of the cylinder?
Yes*4,0 E
Weigh CO2 or nitrogen cartridge. NAD
,7
No visible signs of a system fire or system tampering (if signs check no).
YeS4��J-
Non
Check all piping and conduit. Are all piping and conduit immobilized with
Yese
Non
proper hangers and brackets?
Are all protective covers present on nozzles?
Yes E�J'
Noo
Are all nozzles checked in the proper position?
YesE�-
No []
Does system have adequate volume and/or nozzle coverage?
Yes ffl
No E]
Are all appliances inside of the hood protection area?
Yesf�j
No []
Have fuse links been replaced?
Yes M-
No E]
Was system operational from terminal link?
Yes E7
No Cj
Was system operational from manual remote?
Yes ff]
No E]
Was system and micro switch operational? NA
Yes
No [:]
Is system visible and free from obstruction?
Yes
Non
Is the inspection and service tag on the cylinder?
Yes 2
No E]
Problems Found: (If additional room is needed, please add a separate sheet)
Corrections Made: Date Corrected:
Corrected By:
12 year hydro date of cylinder.
Were hand portable extinguishers properly serviced? NAF-1
Yes tl No
Were all cooking surfaces protected? If not, give owner full
Yes [7r No F-1
information.
Was operating procedure verbally given to restaurant personnel?
Yes [?' Noo
Was UL 300 compliance explained to owner or manager?
Yes-Rr Noo
Gas shuts down upon system activation? NAF�
Yes ?I NoM
Electric power shuts down upon system activation? NA,2
Yes F] No E]
Range hood tied to building alarm panel? NAE5
Yes E] Noo
Range hood activation signal received at building alarm panel? NA.Fj
Yes F] No Ej
Class K extinguisher present?
Yes.L2 Noo
Grease buildup in group:
Light Medium Hea—mcomme cleaning
Date of last cleaning
Are cleaning intervals within NFPA Aandards' ?
I es,;2"' No 0
'
Previous Confidence Test Company & Technician -�'74
Customer has declined
SFD Certification Number:
This certifies that this fire and e safety system has been propelly,,inspected for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepancies ar a, he e been6,,eported to 0 er/Responsible Person for corrective action. -0940
Signature of Tester: L Ilk 4; !A Phone# (206)726
T -9 A=
0 'abuii e6ices, Inc. MailingAddress: 6100 12th Ave. S., Seattle, WA98108
Testing Agency: R T o ;A
The owner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1 . The extinguishing system is in its proper location. The extinguishing cylinder is in 6. The nozzle disc caps and their seals are intact, undamaged and tight.
place and has not been removed or tampered with. 7. The inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 8. If any deficiencies are found, approprjate cDrrective action shall be taken immediately
intended use. 9. A record of the monthly inspectionsYs. e kept reflecting the date inspected, inititals of
3. Insure that all tamper seals are intact and that system is in a ready condition. person performing the inspecti, ny corrections re
4. Observe system, checking that no obvious physical damage or condition exists 'Ic -
that might prevent operation. AUTHORIZED
5. The pressure gauge reading on the cylinder shall be in the green operable range. SIGNATURE
FIRE DEPARTMENT COPY —LIX,
(C
X
Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountla.ke Terrace Everett, WA 98208
Phone (425) 551-1200
www'.FireDistrictl.org Fax (425) 551-1272
LOCATI ON:
611 'e t . h-� . ye S Suite A 98020
BUSINESS NAME:
Hamburger Harry's
MAILING
ADDRESS:
610 Avenue S, Edmonds, WA 98020
BUSINESS OWNER:
Mitchel, Bobb
EMERGENCY-1-
'
VA, (4-1,
KEY ACCESS-2:
EMAIL:
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS:
FE 12/1 UL300 7/1
�
n.qtp 1 nszt Sprvirpri- tA Qep, j / I&- -%,I( I —
FIRE PREVEN ' TION
INSPECTION REPORT
LgEDMONDS
DBRIER
13 MOUNTLAKE TERRACE
[3 UNINCORPORATED
FREQUENCY STATION & SHIFT
Annual 17-C__�
SCHEDULED
DATE DUE 11' Nov 2015
161 152
HOME PHONE:2�0(0_ (
-7 901
HOME PHONE: T5-tf- 7 "'CURRENT
HOME PHONE: CITY YES NO
BUSINESS
LICENSE
INITIAL INSPECTION DATE
PHONE: 4257766666
HAZARDS FOUND AND LOCATIONS / CO�MUiTICATIONS
T,-��4 10 I_tz,4-r;z-J
C—+
.7
cl%- C,�L_f<
2
2
3
3
4
4
5
6
.6
7
7
I AGREE to cbRRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
_RATE DU E
DATE DUE-
GRANTEDTO:
DATE DUE:
CITED:
PERSON
CON TED: (,*glc
PERSON
CONTACTED:1 jtw
PERSON
.
CONTACTED:
INSPECTOR: WiAJ57DA)
INSPECTOR: 0 A PI%W
2
DATE: q-274
-
INSPECTOR:
r Z_
PAT . E:
DATE:
3
VIOLATIONS
F�/45 - Ap7X- 6(-,)
VIOLATIONS."-,':
PRE -CITATION
CITATIONISSUIED__
4
5
LETTER SENT
NUMBER:
DATE:
CODE
SECTION:
5
2 6
2 6
RETURN RECEIPT
3
7
_.__��C
I E�D
DISPOSITION:
6
4
4
8-
DATE:
7
LETTER N EEDED C] YES 0 NO
LETTER NEEDED Q YES NO
., . 0
SNOHOMISH CO.
FIRE
-SMR
.L 11
Serving Brier, Edmonds, and
Mountlake Terrace
www.FireDistrictl.org
LOCATION: 610 5 th Avenue S Suite A 98020
BUSINESS NAME: A2Z Technology
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 2064127768
MAILING
ADDRESS: 610 5th Avenue S, Suite A, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
FIRE PREVENTION
INSPECTION REPORT
JfEDMONDS
0 BRIER
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
0' FREQUENCY I STATION & SHIF`�
2015 17-C
SCHEDULED
DATE DUE � Nov 2015
UFIR 0 549 152
EMERGENCY-11: Wolfe, Mark HOME PHONE: 2064127768 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
E I MAIL: BUSINESS F-1
LICENSE
INITIAL INSPECTION DATE
PERSON CONTACTED:
iL
NAME OF INSPECTOR:
FIRE SYSTEMS: FE
r);itp 1 ;i.qt.qPrvir.PH-
HAZARDS FOUND AND LOCATIONS/ COMMUNICATIONS
2
2
3
3
— 4
-4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
In our continuing effort to promote fire safety and prevention within the community, your fire department conducts
regularly sch * eduled "Fire Safety Survey Inspections" of all.businesses and multi -family occupancies in the Cities
covered by: Snohomish County Fire District 1.
You are tobe congratulated on the relative good condition of your occupancy in regards to fire safety. Above you
will find the itern(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.