615 GLEN STCot�
-i—:&j Sr
FIRE PREVENTION
Serving Brier, Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISFI CO
Mountlake Terrace
FIRE
Everett, WA 98208
0 EDMONDS
[3 BRIER�.,
DISTR
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
www.FireDistrictl.ork
Fax (425) 551-1272
FREQUENCY
STATION & SHIFT
LOCATION
615 Glen Street 98020
Annual
17-A
BUSINESS NAME: Community Christian Fellow'shio
PHONE: 4257440160
SCHEDULED 5
E �'�
DATE DU _AUg__Z0jj
MAILING
LIFIR 0 133
ADDRESS: 615 Glen Street, Edmonds, WA 98020
BUSINESS OWNER: Whitley, Dave
HOME PHONE: 4 Z5'- -2
EMERGENCY-1: e-
HOME PHONE: q �5-- 713 - 3 Z
CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES .,NO
BUSINESS
EMAIL:
f::�j
LICENSE
19j
PERSON CONTACTED: AJ /A-
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
<�'
[/� (I., �. -)_� n
,
a
FIRE SYSTEMS: F 4/15_FE-j0_ Lk Bi
A
-4 v
Date Last Serviced- &40'- q 1 1_4
HAZARDS FOUND AND LOCAlFIONS/COWUNf"ONS
2
1 1A
2
__
3
3
4
4
- - --------
5
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
DATE DUE:
DATE DUE:
GRANTED TO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CON TED-
CONTACTED:
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
3
DATE:
— ------
DATE:
VIOLATIONS:,
DATE:
�[_OLATIONS
PRE -CITATION
_61 D
5
1 5
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
RETURN RECEIPT
3
7
RECEIVED
DISPOSITION:
4
8
4
DATE:
I
7
LETTER NEEDED 0 YES [I NO
LETTERNEEDED YES El NO
1
8
rotection &Communications, Ind.
(800) 774-,9099 * Fax (425) 774-6317
www. pro-comm-onfine. com
MAR 2 6 2016
CONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST REPORT
NAME OF FACILITY
Cc, w, vv,,.0 k% f6iar' FC I 6A's k�
��N ( 1%
PHONE NO.
q -1,5- 1'� q 10 c)
D INSPECTION
hlb(o
ADDRESS
(.0 In,
CITY
E QAA
—
o Z.6
OCCUPIEDAS
MOXTORED BY
loya., CTRZ
ACCT#
95- 4771
TYPE OF TEST
MONTHLY QUARTERLY SEMIANNUAL ANNUALCR ACCEPT [:1 1
PRO-COMM LICENCE
BATTERY VOLTAGE VOLTS
BATTERY UNDER VOLTS
IFULLILOAD
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 I
---T
EQUIPMENT TESTED
NO. OF UNITS
SATISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
I N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
I NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
2.Z
'X
ANNUNCIATORS
VISUAL ALARM DEVICES
'Z
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
.SMOKE DETECTORS
X
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER NAL
CENTRAL STATION
OTHER
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL
OTHER
SERVICE TECHNICIAN NOTES Fire Watch touired, threat level 1 2 3 (see reverse for a threat level explaination)
y0blt UA r
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. NONE YES
OWNER OR FACILITY REPRESENTATIr
DATE
TECHNICIAN
4VX--"
NSE NO.
:3pa 4:12
r--W):!�
SIGNATURE I "
�� --V*�
Confidence Testing Company:
Wolfe Fire
Protection, Inc.
17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Fax: 360.794.3080 0 Ph.: 360.794.8621
Aec v'-b) e-p a r t m e In t
/I onfidence
Test Report
SPRINKLERS WET
Certification Given
RED
YELLOW
WHITE
(ONE SYSTEM PER REPORT)
CONFIDENCE TEST: R E P A I R S:
Occupancy Address: i�l Occupancy Name:
Building Owner: (-OA041 t(f7JV c(lq Phone Num ber:
Responsible Person: �)rAUJ- Phone Number:
Building Owner
Address: ("15 0, C
Date of Inspection: 2 - 16 - 16 Inspection Frequency Type: Annual
Tester's Name (print): A — rVic" Certification Number: SCP- /tP045
Central Station monitoring? YesX No U Monitoring Co. Name: -Pro
// 14, e 4 P, -CK' -
Primary Component: System Make:
Syste m Model:
System Location: (C001 Lr7fel-UP(CK Identification Number:
Problems Found: vadditional room is required, please add a separate sheet.)
A A`271 'e—
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 Agenc.y--"Wolfe Fire'Orotection, Inc.
Mailing Address: 17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Ruilding Representative (signature):
Sprinklers - WET 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
FlowTest conducted? ............................................................................................................. Yes No C3
c�
Static Pressure: psi Flow Pressure: psi
3. Total number of sprinkler heads on this system?
4.Was 2" Main Drain checked? ......
...................................................................... Other[] b:5--N'b-Cj
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ......................... N/A Ej Yes No [I
6. Pressure regulating valves tested? .............................................................................. N/AIKr, Yes [I No (j
r
?:Alarm Bell operates? ............................................................................................. N/A C) Yes El No E)
8. System inspected and lubricated ? ................................................................................... Yes No El
9.Valves sealed or supervised? ............................................................................... Yes No L)
10. Signs provided on all valves? ................................................................................................... Yes,Q, No C3
11. Pumper Connections and Clapper valves unobstructed and turn freely ? ................ Yes No 0
12.Sprinkler head coverage acceptable? .......................................................... Yes,a- No Ej
A_H�AVe the sprinkler heads been replaced or successfully sap pie, ted in the last 50 years? Yes
14. Proper -number spare sprinkler heads available with ap�roplir`ia)te wrench es for each.? ...... Yes?G
15. System left in service? ................................................
Yes (0-
16.;System gauges been replaced or calibrated within the-l-ast 5 years? . ................. Yes
17. Sprinkler heads free of corrosion I , paint, obstructions'and/or physical damage? .... Yes,O
18. Was any debris found in the Fire Department Connection (FDC)? ........................ Yes El
No 0
No Q
No 0
No 0
No Q
No-W.')l
1§. Was the Fire Department.,Connection (FDC) been back flushed in the last 5 years? ... Yesla, No El
20. Was an internal pipe and valve inspection performed within the last 5 years? ................. Yes,8_ No (j
Date Performed: '2011 -
21. Was a signal received at the Central Station monitoring company? .................... N/A LI Yes No (3
S'rinklers - WET
P Page: 2 of 2
JUN 1-0 2015
CONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST REPORT
NAME OF FACILITY
PHONE NO.
4/2 r- -7.7c/- elder
DATE INSPECTIPN
��10&r
ADDRESS
01"If
CITY STATE
I
".
ZIP
5�;024
OCCUPIEDAS
MONITQRED BY
C;*A
ACCT #
F< . 77F7
TYPE OF TEST
MONTHLY [:1 QUARTERLY El SEMIANNUAL El ANNUAL &11 ACCEPTE] I
PRO-COMM LICENCE
BATTERY VOLTAGE VOLTS
1.5-3
BATTERY UNDER VOLTS
IFULLLOAD 151, 6
CHARGE CIRCUIT VOLTS
1 .2,73
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
000000��
SYSTEM OPERATES
ON STANDBY POWER
CONTROLPANELCHECKED
PER NFPA & MFG INST
KEY TO PANEL
AVAILABLE
SIGNALS OPERATE
ON AC POWER
AUXILIARY EQUIP.
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
1 1
OPERATING INSTRUCTIONS
AT PANEL
JOTHER
EQUIPMENTTESTED
NO. OF UNITS
S ISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
TYPE OF EOUIPMENT
IN BLDG.
TESTED
YES
NO
I N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUAL ALARM DEVICES
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
L(
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER
CENTRAL STATION
OTHER
.77 IL/
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL
OTHER
SERVICE TECHNICIAN NOTES Fire Watch required, threat level 1 2 3 (see reverse for a threat level explaination)
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.
NE WA,5 INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. NONE YES
OWNER 01=EPRESEN E
�AU
DATE
TECHNICIAN
LICENSE NO.
IGNATURE
SNO
F
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
OBRIER
r-1 hAr)HKITI AV[: TPQPAr.F=
DISTRal�mimm I ' . Phone (14.2.5) .5.51-1200 [1 UNINCORPORATED
IUT wwwFireDistrict].0'rg Fax (425) 551-1272
FREQUENCY STATION &SHIFT—')
LOCATION: 6 IS Gen Street 99020' 17-D
BUSINESS NAME: lCammunity ChrizilJan F-cllawihip .42111574401 SCHEDULED Auq 2014
1
PHONE: DATE DUE
MAILING LIFIR 11 133
I ADDRESS: E16 Gicri SlrocL, Ldrnond,%, �-.VA 08020
'BUSINESSOWNER: HOME PHONE:
EMERGENCY-1: HOME PHONE: 'CURRENT
KEY'ACCESS-2: HOME PHONE: CITY YES NO
CC(: E-SrmrA or(' BUSINESS F__j
EMAIL: 09 LICENSE 1 1, 7Fn-1
INITI,AL INSPECTION DAT
10
PERSON CONTACTED: f)
NAME OF INSPECTOR:
JW, r4 t I,\ 5 vl�
FIR I= I b IMS: I FE._Ll I [�YWM? F D L k Ra x — IAW 51
J�
:4, Serving Brier, Edmonds, and'
Mountlake Terrace
12425 Meridian Ave S
Everett, WA 98208
HAZARDS FOUND AND LOCATIONS COMMUNIPATIONS
A
0 (66
2
2
4-Anc,
V"L I
3
3
4
5
5
6
6
7
7
I AGREE TO CORREOT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1 st RE -INSPECTION
2nd RE -INSPECTION
-
FINAL RE -INSPECTION'
EXTENSION
VIOLATIONS
DATE DUE:
D E DUE:
GRANTEDTO:
DATE DUE:
CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
-INSPECTOR
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE-CIT'ATION
CITATION ISSUED
1 5
1 5
LETTER SENT
NUMBER:
4
CODE
5
2
6
2
6
DATE:
SECTION:
RETURN RECEIPT
3
7
3
7
RECEIVED
6
DISPOSITION:
4
18
4 4`t
8
DATE:
7
LETTER NEEDED E] YES El NO
LETTER NEEDED [] YES El NO
\1
8
FIRE DEPARTMENT COPY
Confiden.ce Testing Company:
D " A NCED
7
- -�FIRE �PROT�ECTIO�NINC,-
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
F.ire Department
Confidence Test Report
Confidence Testing: 206.793.0936
SPRINKLERS - WET
Certification Given
RED
YELLOW
WHITE
(NOTE. ONE SYSTEM PER REPORT)
CONFIDENCETEST: Ila-+REPAIRS--FU I
Occupancy Address: Occupancy Name:
Building Owner: Phone Number:
Responsible Person7 Z? Phone Number:
Building Owner
Address:
Date of Inspection: Inspection Frequency Type: Annual
Tester's Name (print): SY6-;-2A'Vd11 Certification Number: SCP%'�� OC90�17-51
C-Tip,
Central Station monitoring? Yes -a No D Monitoring Co. Name: 14eh')
Primary.Component: System Make:
System Model:
System Location: Identification Number:
ProblernsFound: (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 ar�nq nd . ,/,Irted to ihe building Owner/Manager for corre�tiv'6�,Action.
,have,7,n
Signature of Tester: Phone #: 425.483.5657
Testing Agency: /Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 - Woodinville, WA 98072
N?�40(�C-1 L�� r�
Building Rep re se ntati ve (signature): I&I I
Sprinklers * WET Page: 1 of 2
The below on the check list shall be inspected and tested. This list does not constitute all of the required
j .ems
insp ftz firi-Ond 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? .......................
................................................................................ ................................ NO o
2. Static Pressure: -iFl6w-Pressur�` psi
3. Totalnumber of sprinkler heads on this system?
Y
4, Was 2" Main Dralin-'6fie6ked? ................ ................................................................................. 06er' [I e�i��, No Ll
5. Flow Switches, Supervisory Switches and Alarm Bells,tested? ..................................... N/A (3 YesIQ No E)
6. Pressure regulating. -valves tested? .................................................................. . �,N A,-Fk
........... Y-e 6. 0 No El
A
m Bell operate? ................. I ........... . .............. . ............................................... It.. jA 13 Y, e s!�Q-- No Cl
7. Alar
8. System inspected and -lubricated ? ........................................................................................ Yes-E3�-- No 0
9. Valves sealed oesupervised? ............... ................................................................................ Yes4a—: No EI
7
10. Provided on all valves? ............................................................................................................. Yes.E)-- No 0
11. Pumper Con n-ection-s and C I a pper valves unobstructed arid turn freely? ..................... . Yes<U_ No- LI
12. Sprink
ler coverage acceptable? .............................................................................................. Y e sc:2�— N o C]
13. Have the sprinkler heads been replaced or successfully sample tested in the last 50 years? yezogg--No C]
14. Proper number spare sprinkler heads nvailable with appropriate wrenchs for each? .............. Y e soqg--N o E)
15. System left in service? ............................................................................................................. Yes=9--No 0
116. &Y-stem gauges been replaced or calibrated within the past 5 years? ............................. Yes=D— No (3
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Y e sZ3. No 0
18. Was debris found in the Firei Department Connection (FDC)? .... ................................... ....... Yes Q No-9
19. Was the'Fire DepartrTfOl n , t connection (FDC) back flushed within the last 5 years? ................. Yes LI *No
20. Was an internal pi'Pe and valve inspection performed within the last 5 years? ................. Yes 5---, No
Date Performed:
121. Was a signal received at the
mpany? ..; ................. NIA LI Yes S--No LI
Sprinklers * WET Page: 2 of 2
4
CONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST REPORT
PHONE NO.
N I N
ADDRESS
61 V 41- fAJ
CITY STATE
ZIP4:if�
OCCUPIED AS
MONITORED BY
ACCT#
?S__
TYPE -OF TEST
MONTHLY 0 QUARTERLY [:1 SEMIANNUALE] ANNUAL."w ACCEP
PRO-COMM LICENCE
BATTERY VOLTAGE VOLTS
BATTERY UNDER VOLTS
FULLLOAD a -2- ''
CHARGE CIRCUIT VOLTS
.3
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 NFPA7&MFG-INST
KEY TO PANEL
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
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUAL ALARM DEVICES
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
y
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCkES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER #N/A-
cm -p
CENTRAL STATION
OTHER
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL
I'J'alefti :5,2-oe
OTHER
SERVICE TECHNICIAN NOTES Fire Watch required, threat level 1 2 3 (see reverse for threat level explaination)
1112(fp, e- -
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. NONE El YES [:1
OWNER OR FACILITY
REPOEWNTATIVE
k� JV-k�4,4AA. yj
I
DATE
TECHNICIAN
4 � � �/,
LICENSE NO
/3 qodl-6
SIGNATURE
Confidence Testing Company:
'AABVANCED
P.O.. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
Seattle Fire Department
Confidence Test Report
206.386.1448 Confidence Testing Officer
206.615.1068 (fax)
206.233.7219Red Tag Hotline
SPRINKLERS - WET
Certification Given
RED
YELLOW DT—WHITE—a—
(ONE SYSTEM PER REPORT)
-F-
CONFIDENCE TEST.—ku- I REPAIRS, U
Occupancy A ddress:elo/�,--��I��V S7— "O'd cu pan cy N a me,:Q�/' 4,4 /Y
Building Owner: Phone Number:
Responsible Person:PA-t/Ze' Phone Number: z
Building Owner
Address:
Date of Inspection: Inspection Frequency Type: Annual
Tester's Name (print): SFD Certification Number: SCP
Central Station monitoring? Yes -a No El Monitoring Co. Name:
Primary Component —7 System Make:
System Model:
System Location: Identification Number:
ProblernsFound: (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.) SF0'Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the itkn�j
listed in this report and is consistent with the �pattle Fire Department Fire Code standards, and all discrepancies
are noted and have; to the bu.ildi O�;nler/Manager for corrective action.
�byee)/reoCted
r
Signature of Teste Phone 425.483.5657
Testing Agency: -,-A'dvance-d Fire Protection, Inc.
Mailing Address: P.O. Box 1543 odinville, WA 98072
Building Representative (signature): LA
--------------
�0
Sprinklers o WET
Page: 1 of 2
below items on the check list shall be inspected and tested. This list does not constitute all of the.
10, �.%�Auired inspecting and testing of the Fire and Life Safety system. Refer to the Seattle Fire Department
Fire Code for inspecting and testing requirements.
General
_�:I�conduc
Ow fisi'condu
1. Fl i ted? ............. YXs..@- No 0
................................................................................................................
i. F Pressure: VO
2. Static Pressure: ps.:� low psi
3. TotatAturnberof -sprinkler heads on this system?
4. Was 2" Main Drain check�'d?'� ........................................................................ 'Y'es-El-;� No 0
........ .................... OtherO
5. Flow�Switches', Supervipory-Switches and Alarm Bells tested? ..................................... N/A El
YASZ] No C3
6. Pressure regulatin --ya Ives, tested?,' Yes Q. No Q
g .........................................................
N /A-,G�
7. Alarm!"bell operate? ............ Y-p
................................................................................. �o@- N o CJ
8. System inspected and lubricated ?,..': .......................................................... ....... ............. Yes-0- No C3
9. Valy�`shiia'led� or supervised? ................. .......................................................... Y e seU' No 0
10. Provided on all valves? ............................................................................................................. Y e 9-5- No El
11. Pum p-,, ne'c'tions and Clapper valves unobstructed and turn freely ? .............................................. Yes_-W_ No Q
12. Sprinkler coverage acceptable? .............................................................................................. Y eA-Q—N o E)
13. Have'thd spri_nkler heads been replaced or successfully sample tested in the last 50 years? Yw-U- No C3
14. Proper number spare sprinkler heads available with appropriate wrenchs for each? .............. Y e_s:m- No [I
15. System"i'left in service? ............................................................................................................ Y�� No 0
16. System gauges been replaced or calibrated with!6 the past 5 years? ............................................. Yes -El- No E]
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Y e 94a-- N o L)
18. Was debris found in the Fire Department Connection (FDC)? ................................................ Yes El N`oLj
19. Was the Fire-Dc�JA`, s ?
p Ament Connection (�DC) back flushed within the last 5 year .... Yes Q No 0
20. Was an internal pipe and valve inspection performed within the last 5 years? ................. Yes-B—No E)
Date Performed:
21. Was a signal received at the Central Station monitoring company? .................... N/A 0 Yes=�� No 0
Sprinklers * WET Page: 2 of 2
CONFIDENCE TESTING
11 1 71 J
Protection &Communications, Inc. FIREALARWSYSTEM
(800)� 774-9099 Fax (425) 774-6317 TEST REPORT
www.pro-comm-online.com
NAME OF FACILITY
Commvn;ft.4 ChriSf',mol' F-dinw5hr
PHONE NO.
U15 774-616o
DATE INSPECTION,
3
ADDRESS
Is GJ,4,6+
CITY
STATE
wa,�
ZIP
-9102 01
OCCUPIEbAS
MONITORED BY.
14
AC T#
TYPE OF TEST
M NTHLY 0 QUARTERLY El SEMIANNUAL 0 'AN N*UAL 0 ACCEPT
PRO-COMM LICENCE
BATTERY VOLTAGE VOLTS
2s.
BATTERY UNDER': VOLTS. .'�JICHARGE
FULLLOAD, JI.-tJ
CIRCUIT VOLTS
ITEM
YES
NO
N/A
ITEM
YES
NO,
N/A
ITEM.. .
YES.
NO.
N/A
TROUBLE AC, OFF-
CIRCUITS CHECKED
_SON
SYSTEM WIRING.CONFORMS
TO NFPA STANDARDS
SYSTEM OPERATES
ON STANbBY'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
S ISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YEL_
- NO
N/A
TYPE.OF EQUIPMENT
IN BLDG.
TESTED
�YES
'NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
2-2
ANNUNCIATORS
VISUAL ALARM. DEVICES
2 'S
ELEVATOR CALL DOWN
HEA T DETECTORS
DOOR RELEASE .
SMOKE DETECTORS,
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
AUTO DOOR UNLOCKS.
(FAIL-SAFE).
SPRINKLER
FLOW SWITCHES
OTHER LiVtf. Dt4.
CENTRAL STATION
OTHER
+
-od
%�a
c-14 0
VENTILATION CONTROLS
OPERATE
'OTHER,
-7
PANEL AND MODEL
IOTHER
SERVICE TEC HNICIAN NOTES Fire Watch required, threat level 1 '2 3 (see reverse for.a threat level explaination�
THIS IS�TO CERTIFY THAT THIS FIRE A . LARM HAS'B . EEN PROPERLY -TESTED AND INSPECTED FOR RELIABILITY
TO COVER ITEMSLISTED IN THIS REPORT, IS CONSISTENT WITH FIRE,ALARM MAINTENANCE STANDARDS,,'.
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIR�SbR�D'IkREPANCIES. NONE YES,'El
OWNER OR F��YILITY REPRESEN IVE _7E
TECHNICIAN
4_� IrAAZ4Afle_�
LICENSE NO
V
Confidence Testing Company:
-1,1C011VANCED
aFIREPZOTECTION, INC.
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
-5S It Fire Department
Confidence Test Report
206.386.1448 Confidence Testing Officer
206.615.1068 (fax)
206.233.7219Red Tag Hotline
SPCertification
- WET
Given
RED
YELLOW 0
1 WHITE-0—
.,RINKLERS
(ONE SYSTEM PER REP . ORT)
_F_
CONFIDENCETEST: REPAIRS
Occupancy Address: Occupancy Name:CO/".
Building Owner: Phone. Number:
V
Responsible Person: J�914 vl,!�' Phone Number:
Building Owner
Address:
Date of Inspection: Inspection Frequency / Type: hDau.ZL
Tester's Name (print): SFD Certification Number: SCP-
Central Station monitoring? Ye-s-ff No [I Monitoring Co. Name: E:
Primary Component: System Make:
System Model:
System Location: Identification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Correctiofis Made: 13ate Corrected: Corrected by:
(if additional reoom 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 bee red to the bull ing r/Manager for corrective action.
P
Signature of Tester-"','� / Phone #: 425.483.5657
#'
�7A
Testing Agency: dvanced Fire Protection, Inc.
,,Mailing Address: P.O. Box 1543 -Woodinville, WA 98072
Building Representative (signature): 'Cu- J. /V1'\
Sprinklers -, WET Page: 1 of 2
The below items.on the check list shall be inspected and tested. -This list does not constitute all of the
h -�.
,��_.re4iqired 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. Flow Test conducted? ...........................................................................
............................................................. Yes 13—No Q
2. Static Pressure: _ZO psi Fl.pW.Pressure:__- 9��psi
3. Total number of sprinkler heads on this system?
4. Was 2" Main Drain cl*,c�ed?
..................... ......................... ......... . ......... Y e N o Q
0 t he.r
Q,
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ..................................... N/A (J Yes_�2— No 0
6. Pressure regulating valves tes . ted? N/A-d-7� Ye�s E) -NO' 0
7. Alarm Bell operate? ................................................ ...
. .. ........................................... No
717V. FNIA� Ij
�Ye:s,
............................................................ ................ Yes-d'No El
8. System inspected and lubrii6dted.�?'�
9. Valves sealed,.or supelrvig6d? ............................................................ ........................................ Yes-U�No C3
10.. Provided on all valves? .............................................................................................................. Yes -El —No U
I I �P 6 MR, per Connections and Clapper valves unobstructed and turn freely ? .............................................. Yes-U— No Q
12. Sprinkler coverage acceptable? ............................................................................................. Yes -El —No (3
13. Have the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yest*9— No
14. Proper -number spare sprinkler heads available with appropriate �Vrenchs for ea"ch? ............ Y ej;:qD—N o Ej
15. System left in service? ............................................................................................................ Ye-s-1�3—No El
16. System gauges been replaced or calibrated. within the past 5 years? .............................................. Y-es--U- No 0
4i;V
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Y es= -a- N o [I
18. Was debris found in the Fire Department Connection (FDC)? ................................................ Yes Ej Ne-a
e .. * Yes U No 0
19. Was the Fire Department Conn 6tion (FDC),back,fl4shed within the last 5 years? ..... .....
20. Was an internal p.ipe.aridAva(I�e' in"'spectio'n pe t rfo r med . within the last 5 years? ................. Y es.=O=-N o C1
Date Performed:
21. Was a signal received at the Central Station monitoring company? .................... N/A 0 Yes-5— No (I
Sprinklers * WET Page: 2 of 2
Confidence Testing Company:
—.APODWANCED
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
.Stftttfe Fire Depa n�t
Confidence Test Rep or &TEIVED
AUG 2 4 mi
206.386.1448 Confidence Testing Officer
206.615.1068 (fax) Mons ciTy cLERK
206.233.7219Red Tag Hotline
SPRINKLERS - WET
. Certification Given
RED
YELLOW
WHITE
(ONE SYSTEM PE.R REPORT)
CONFIDENCETEST: I-a-1 REPAIRS- Q
,
Occupancy Address:
0 c c u p a n c y N a m e: r ovlw, c .41�ers
Building Owner:
Phone Number:
Responsible Person: _L9,4 �/47 i��l 7WA�5
Phone Number: /)6Z-- 7��- 0116_�V
Building Owner
Address:
Date of Inspecti on:
Inspection Frequency/ Type: _4DjivaL
Tester's Name(print):
SFD Certification Number: SCP- 571
s
Central Station monitoring? Yes -El— No El
Monitoring Co. Name: 1pvl_A&1�1 ze�,7'e
Primary Component: 7-
system make:
System Model:
System Location: 2-2 _r-�
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.)
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 rted to the b ilding Owner/Manager for corrective action.
Signature of Tester: I V�p 1, 1 WD7V_1e&12./_4__,_) Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 -Woodinville, WA 98072
Building Representative(signature): � *, J im �
0
Sprinklers - WET 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
I,. Flow Test conducted? ........................................................................................................................................ YeeEl- No Q
p
2. Static Pressure: si Flow Pressure: 70 psi
3. Total,,n'umber of sprinkler heads on this system?
4. Was 2" Main Drain checked? ......................................................................................................
OtherQ
Y. d,�-&
No 0
5. Flow Switches, Supervisory Switches and Alarm Bells tested? .....................................
N/A Q
Yes-9--
No Q
6. Pressure regulating valves tested? ............................................................................... N/A --a- Yes Ll No Ll
7. AlarmBell-, dlerate? ..' ...................................................................................................... NIA E] Yes--5- No El
8. System inspected and lubricated ? .................................................................................. Y e SWG].- N o Ej
9. V61ve&,se,aled �or,supervlsed? .................................................................................................. I ...... I ....... Yes -El
:�No Q
10. Provided on all valves? ............................................................................................................. Yes-0- No El
.11. Pum p-OvConnections and Clapper valves unobstructed and turn freely ? ...............................
.. ........... Ye�s-(Zl No Oy_
12. Sprinkler coverage acceptable? ............................................................................................. Yes -El- No E)
13. Have th O�sprinkler heads been replaced or successfully sample tested -in the last 50 years? Yes-0- No 0
14. Proper number spare sprinkler heads available with appropriate wrenchs for each? .............. Y e s-5- No [3
15. System left in service? ............................................................................................................ YeV90- No 0
16. System gauges been replaced or calibrated within the past 5 years? ............................................. Y e sr-5- N o El
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Y ee-5- N o4jil
18. Was debris found in the Fire Department Connection (FDC)? ................................................ Yes Ll No-@
19. Was the Fire Department Connection (FDC) back flushed within the last 5 years? ................. Y e s-&- N o El
20. Was an internal pipe and valve inspection performed within the last 5 years? ................. Y e s-E5- N o C)
Date Performed:
21. Was a signal received at the Central Station monitoring company? .................... N/A LI Y e s-C3- N o Q
Sprinklers e WET Page: 2 of 2
NAME OF FACILITY.'
i -4
PHONE NO
'DATE IN$PECT N/
�4, _/15_7
,
ADDRESS.:
ully
ST�TE."!-:`ZIP
V4
SeV
OCCUPIED AS
MONITORED By —
ACCT #
95 _/
TYPE OF TEST
MONTHLYE] QUARTERLY El SEMIANNUALE] ANNUAL 5�, ACCEPTE]
PRU-COMM LICENCE
BATTERY VOLTAGE VOLTS
BATTER UNDER VOLTS
IFULLLOAD
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 I NST
KEY TO PANEL
AVAILABLE
SIGNALS OPERATE
ONACPOWER
AUXILIARY EQUIP.
OPERATES
-OTHER
SIGNALS OPERATE
STANDBY POWER
OPERATING INSTRUCTION S
AT PANEL
OTHER
EQUIPMENTTESTED
NO. OF UNITS
SATISFACTORY
,NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
I NO
N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUAL ALARM DEVICES
2
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
Y,
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER ,
SUPERVISORY SWITCHES
1��
AUTO DOOR UNLOCKS*
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER-7),,,-j 1.4,
CENTRAL STATION
OTHER
71.
VENTILATION CONTROLS
OPERATE
-OTHER
PANEL AND MODEL
OTHER
SERVICE TECHNICIAN NOTES Fire Watch required, threat level A 2 3 (see reverse for a threat level explaination)
4e. _�-, 4::
41' AA P
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. NONE YES
OWNER OR FACILITY REPRESENTATIVE
TECHNICIAN
�L ICENSE NO.
SIGNATURE-C:--
I
C=ZC=Z C-= r7r-7
Protection &Communications, Inc.
(800) 774-9099 - Fax (425) 77476317
www.bro-comm-online.com
CONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST REPORT
NAME OF FACILITY
C4*M��,,717
PHONE NO.
DATE INSPECTION
ADDRESS
40F (!r/_f;V S_)_
CITY
!Eww? )",Oj
STATE
ZIP
0
OCCUPIED AS
MONITORED BY
ACCT#
j
TYPE OF TEST
-MONTHLY 11 QUARTERLY El SEMIANNUAL [:1 ANNUAL Ok ACCEPT 70
PRO-CONAM LICENCE
BATTERY VOLTAGE VOLTS
BATTERY UNDER VOLTS
1� FULLILOAD -7 T-3
CHARGE CIRCUIT VOLTS
1 ;2-7� ?
ITEM
YES
NO
N/A
ITEM
Y E.S
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
ON AC POWER -
AUXILIARY EQUIP.
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
OPERATING INSTRUCTIONS
AT PANEL
OTHER
EQUIPMENTTESTED
NO. OF UNITS
S ISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
N/A
TYPE OF EQUIPMENT
IIN BLDG.
TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
2—
.2Z
ANNUNCIATORS
VISUALALARM DEVICES
ELEVATOR CALL DOWN
HEATIDETECTORS
DOOR RELEASE
SMOKE DETECTORS
FIRE & SMOKE DAMPERS
.MANUAL PULL STATIONS
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER Tf Vfr
CENTRAL78TATION
OTHER 1V+C
94-r.
Y,/
VENTILATION CONTROLS
OPERATE
OTHER
PANEL AND MODEL
OTHER
SERVICE TECHNICIAN NOTES Fire Watch required, threat level 1 2 3 (see reverse for a threat level explaination)
THIS IS TO CERTIFY THATTHIS 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. NONE YES
OWNER OR FA OILITY REPRESENTATIVE
0 "C,_� A
JV_� �
DATE
TECHNICIAN
LICENSE NO.
'SIGNATURE