636 DALEY ST (2)let
(0 3 D FI E PREVENTION
SN1011ON11SH Set -�it' Brier, Edmonds, ana
12425 Meridian Ave S
IWECTION REPORT
; 1,7g
& MoOntlake Terrace
T1 E
Everett, WA 98208
10 EDMONDS
0 BRIER
T
Ph one (425) 55,1-1200
0 MOUNTLAKE TERRACE
[1 UNINCORPORATED
-DIST www.FireDistrictl.org
Fax (425) 551-1272
LOCATION: 636 Daley Street 98020
FREQUENCY I STATION 1, SHIFT
Annual 17-D
BUSINESS NAME:.Shelbourne Condb's 9 c3 0`11
PHONE:
SCHEDULED Aug 2017
DATE DUE II'
427
MAILING
LIFIR
ADDRESS: 636-DatL-y-Street,-F--dmonds,�A �0]120
BUSINESS OWNER: Bened itson, Tom unit 8
HOME PHONE:
EMERGENCY-1:Garner, Rob
HOME PHONE: 2063552626
CURRENT W#,NO
KEY ACCESS-2:
rM )1A,
17
HOME PHONE: - -
CITY
BUSINESS
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF -INSPECTOR:
Y
FIRE
SYSTEMS: AS 10/16 FA 10/16 FE. 10/16 12:00:00 AM
Date Last Serviced:
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
,2
2
3
3,
4
4
5
.......... ...........
........ ..
5
6 ............
7 7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
2nd RE -INSPECTION
FINAL RE -INSPECTION
EXTENSION VIOLATIONS
DATE DUE;
DATE DUE:
GRANTEDTO:
DATE DUE: CITED:
PERSON
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
INSPECTOR:
INSPECTOR:
2
INSPECTOR:
DATE:
DATE:
3
DATE:
VIOLATIONS
VIOLATIONS
CITATION ISSUED
PRE CITATION
1 5
5
LETTER SENT NUMBER 4
CODE 5
2 6
2 6
DATE SECTION.
RETURN RECEIPT
3 7
3 7
RECEIVED
DISPOSITION*
7
4
4
DATE'
LETTER NEEDED YES NO
LETTER NEEDED E] YES NO
n . . h
kkk AAA FIRE & SAFETY, INC
0.11A. 3013 3RD AVE NORTH
(800) 223-3473 SEATTLE, WA 98109
INF00AAAFRESOM
EDMONDS
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
FIRE ALARM SYSTEM
Status Given
(One System per Report)
RED _FTJ
YELLOW _F
FFWHITE
L
CONFIDENCE TEST
I LX
[ REPAIRS
Sprinkler Monitoring Panel?
Occupancy Address: 636 DALEY ST
Occupancy Name: SHELBOURNE CONDOS
Responsible Person Rob Garner
First & Last Name:
Phone Number: (425) 239-5905
Responsible Person
Address, City, State, Zip:
Responsible Party rob@garnerpm.com
E-Mail Address
Date of Inspection:
10/21/16
Annual
Inspection rx
Frequency/Type: Quarterly F I
Testers Name Mickey Hilderbrand
(Please Print):
Nicet 118752
Number: -
Identification
Number:
System Location Fire control closet
Central station monitoring? Yes El No [I
Monitoring
Monitoring Required? Yes El No 11
Company Name: Alarm Center
System Make: Silent Knight
System Model: 5808
FIRE CODE VIOLATIONs FOUND: (If additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification Number: -
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 F'W Department Fire Code standards, and that
discrepancies are noted and have been rWorteo the building Owner/Manager for corrective action.
Signature of Tester:
Building Representative (signature)
Phone # (206) 284-1721
-
!1�d \" Z11�
I:;,/, f �- j
Fire Alarm Systems Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required inspecting and
testing of the fire and life safety system. Refer to the Fire Code for inspecting and testing requirements.
Alarm Svstem Functionali
1.
Trouble signal with AC power off?
Yes FX
No
2.
System operates properly on battery backup?
Yes
No
3.
Battery voltage (no load) 25.41 volts
4.
Battery voltage (full load) 25.19 volts (signals operating)
5.
Charge circuit voltage 27.38 volts
6.
System operates properly on standby power?
Yes
No
7.
All signals operate on AC power?
Yes
No
8.
Number of initiating circuits Point ID
9.
Number of signal circuits 4
10.
Does alarm system meet audibility standards as accepted?
Yes
No
11.
All circuits checked for electrical supervision?
Yes
No
12.
All auxiliary equipment operates (Elevators, fans, dampers)?
N/A
Yes
No
13.
Ventilation controls operate?
N/A
Yes
No
14.
Key to panel, available?
N/A
Yes FX
No
15.
Materials and equipment needed to restore pull stations are available at the
N/A
Yes nX
No 1:1
main panel, e.g. glass rods, and plates; keys and allen wrenches, etc?
16.
Operating instructions at panel?
Yes
Nom
17.
Trouble indicators function properly?
YesFX]
NoF1
18.
Remote Annunciator Panels function properly?
N/A
Yes 9
No[:]
19.
Elevator Call Down functions properly?
N/A
YesX
Noo
20.
Test record pbsted at panel?
Yes
No
21.
General alarm automatic time delay - (minutes)
N/A
22.
Was a signal received at the Central Station monitoring company?
N/A
Yes
NoM
23.
Other Devices (Specify)
Yes
No E]
System Devices
Total Number of
Units in Building
Total Number
Units Tested
Test Results Acceptable
24. Bells, Horns, Chimes
18
18
N/A F-1
Yes 9
No Ej
25. Voice Speakers (Voice Clarity)
N/A
Yes
No
26. Visual Alarm Devices H/S
8
8
N/A
Yes
No
27. Smoke Detectors
12
12
N/A
YesFX-j
No [:1
28. Heat Detectors
N/A
Yes
No
29. Duct Detectors
N/A
Yes
No
30. Sprinkler Flow Switches
1
1
N/A
Yes
No
31. Sprinkler Supervisory Switches
N/A
Yes
No F�
32. Manual Pull Stations
1
1
N/�,
Yes
No [-]
33. Annunciator(s)
1
1
N/A
Yes
No
34. Beam Detectors
N/A
Yes
No
35. Automatic Door Unlocks
N/A
Yes
No
36. Automatic Door Release
3
3
N/A
Yes
No
37. Fire Dampers
N/A
Yes
No
Communication Equipment
Total Number of Units
in Building
Total Number Units
Tested
Test Results Acceptable
38. Phone Sets
N/A Yes No
39. Phone lacks
N/A Yes No
40. Call -in Signal
N/A Yes No Q
Fire Alarm Systems Page 2 of 2
litAAA FIRE & SAFETY, INC
30133RDAVENORTH
(600) 223-3473 SEATTLE, WA 98109
04FOCAAAFRE.COM
EDMONDS
FIRE DEPARTMENT
"THE NORTHWESTS MOST TRUSTED NAME IN FIRE PROTECTION"
SPRINKLER - WET SYSTEM
Status Given
(One System per Report)
RED
I YELLOWF]
I WHITE
fX7
CONFIDENCE TEST JXJ I REPAIRS F7
,
Occupancy Address: 636 DALEY ST
Occupancy Name: SHELBOURNE CONDOS
Responsible Person Rob Garner
First & Last Name:
(425) 239-5905
Phone Number:
Responsible Person
Address, City, State, Zip:
Responsible Party
E—Mail Address
Date of Inspection: 10/21/16
Inspection Annual
Frequency/Type: Quarterly El
Testers Name Mickey Hilderbrand
(Please Print):
Nicet Certification 118752
Number:
Identification
Number:
Fire control closet
System Location:
Central station monitoring? Yes El No 13
Monitoring
Monitoring Required? Yes E No 0
Company Name: Alarm Center
System Make: 1.5" ready riser
System Model:
FIRE CODE VIOLATIONs FOUND: (If additional room is needed, please add a separate sheet)
CORRECTIONS MADE: Date Corrected:
Corrected By:
(If additional room is needed, please add a separate sheet) Nicet Certification
Number: -
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 Fire We standards, and that
discrepancies are noted and have building
Owner/Manager for corrective action.
Signature of Tester:
Phone #
Building Representative (signature)
Sprinklers - Wet Page 1 of 2
The items on the checklists below shall be inspected and tested. This list does not constitute all of the required
inspecting and testing of the fire and life safety system. Refer to the Fire Code for inspecting
and testing requirements.
I General
1.
Main Drain and Inspector's Drain flow test conducted?
Yes
0
No El
2.
Static pressure: 82 p.s.i. Flow pressure: 72 P. S. i.
3.
Number of Sprinkler Heads: 100+
4.
2-inch drain? Other
0
Yes
1:1
No El
5.
Flow switches, supervisory switches and alarm bells tested? N/A
11
Yes
R
NoEl
6.
Pressure regulating valves tested? N/A
7X
Yes
El
No El
7.
Alarm bell operates? N/A
El
Yes
Z
No 1:1
8.
System inspected and lubricated?
Yes
0
No El
9.
Valves are sealed or supervised?
Yes
RX
No El
10.
Signs are provided on valves?
Yes
0
No F-1
11.
Pumper connections and clapper valves unobstructed and turn freely?
Yes
El
No 0
12.
Sprinkler coverage is acceptable?
Yes
Z
No El
13.
Have the sprinkler heads been replaced or successfully sample test in the
Yes
X
No El
last 50 years? Date of last test:
14.
Proper number of spare sprinkler heads available with appropriate wrenches
Yes
X
No El
for each?
15.
System left in service?
Yes
0
No El
16.
System gauges replaced or calibrated within the last 5 years?
Yes
Z
No El
Year changed: 2014
17.
Sprinkler heads free of corrosion, paint, obstructions and/or physical
Yes
0
No El
damage?
18. Was debris found in the Fire Department Connection (FDC)? Yes El No 0
19. Was the Fire Department Connection (FDC) back flushed within the last 5 Yes 0 No El
years? Date of last back flush 2014
20. Was an internal pipe and valve inspection performed within the last 5 years? Yes 0 No El
Date Performed CPVC
21. Is the hydraulic nameplate installed and visible on riser. Yes No
(Ref: NFPA 25 5.2.7)
22. Was a signal received at the Central Station monitoring N/A El Yes Z No El
company?
Sprinklers - Wet Page 2 of 2
SNO110MISH CO.
FIRE
D11 n"'
St.
Servink Brier, Edmonds, and
Mountla.ke Terrace
www.FireDistrictl.org
LOCATION:
636 Daley Street 98020
BUSINESS NAME:
Shelbourne Condo's
MAILING
ADDRESS:
637a�IeStreet, Edmonds, WA 98020
BUSINESS OWNER:
FIRE PREVENTION
12425 Meridiah Aye S
INSPECTION REPORT
Everett, WA 98M
t(EDMONDS
[I BRIER
Phone (425) 551 1 -1200
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
Fax (425) 551-1272.-.
- Oe
FR9:AHP:Klr'V v �ui�_-�
PHONE:
HOME PHONE:
Aigig.-I
SCHEDULED
DATE DUE � Aug,= 61
FIR 0
427
EMERGENCY-1: HOME PHONE: 2413w2bZ10.
'CURRENT
KEYACCESS-2: �W(M#rSOOITV04 t41Jrr#$ HOME PHONE: ql� qW /'?go
CITY YES NO
EMAIL:
BUSINESS
LICENSE
PERSON CONTA I CTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR: Akw (YL A
104 10//& )4
()ftftLe*w ftT? Ix vt'- 3
FIRE SYSTEMS: AS F FE FD Lk Boxvl
DaMakastcGia"sedocATIONS COMMUNICAI ION5
r,.wvi Le
2
3
3 ____
4 CA)19'�' I)AaCteW 4:nk R"1jD&_T_ 1A 4- 17- AV?, 0�v 7b
4
_<�4(6
III-16i- 7W 1 ^.1eT7q5 S6yz 14 C I^i'
5
5
6
6
7
7
I AGREE TO.CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
2nd RE -INSPECTION
EXTENSION
FINAL RE -INSPECTION
VIOLATIONS
_�ATE DUE.
PERSON
CONTACTED:
DATE DUE:
PERSON
CONTACTED:
GRANTEDTO:
DATE DUE:
PERSON
CONTACTED:
CITED:,
INSPECTOR:,
INSPECTOR:
INSPECTOR:
2.
DATE:
LATIONS
DATE:
VIOLATIONS
PRE -CITATION
'SEN"T
DATE:
UfAfION ISSUED
I _NU R:
3
&V�_
2
1 5
2 6
L E TT E-R,
DATE:
M__B E,
CODE
SECTION:
4
5
RETURN RECEIPT
7
3 7
RECEIVED
-ITION:
6
18
7
4
DA
LETTERNEEDED [] YES ONO
LETTERNEEDED [] YES No
C
U.RI.TY Securi . ty First Protection
9418 0' in Wy.
Bothell,.WA 980
F IRS
0: 425-.286-2144.
f��425-286-2098
c6nti &866-816-,77K(24�7)
BURGLARY
2: ww.w.security rstpro.com
.-Fire Alar m* Inspection Sensitivity Test Report
lnsoectioQ.��ate: `�Annu :Quarterly 0' Monthly P Acct. #Ra;y
Facility Name: e f3ou 9 L��e_ Phone:
Address'. z 6 bty/State/`Zip:..�
Fire Alarm Control: 4,17-
Model:
Nurnber of I nitiating:C i.rcu its:,—
Initiating Circuits -Supervised:
NO
Nuimber.of Signal ing'ci�cuits:,11
Signaling'Circuits Supervised:
No
Trouble with AC Off: S
$ES
NO
Breaker Locations Posted: -
ES NO d
9S
Communi'cator:_.,*�...
N&
Communication Type:
Dial-upIDedicatep/STU
Battery Voltaq e:
volts`.�'.
Battery Voltage'Ll nd e r Load/ No A/C V6
'6
-volt-,
st,
Cha ging Pircuit Current
AM.Ps t'
Key to'.P�an�!.Available'-'
Locat ion:
0 pp ra t ing, nstfycfion.§. PbstE4
NO
Locatiop"
I-,-- 1r__
Equipment Type
..'Number of Units
Satisfactory,
Manufacturer
Comments
Total Tested
�Tbtal
Tested
YES- or NO'.'
Bells
Wet w,)
"�6rns
Y,
Strobe -Horns.
Y N
y es
Strobes.
Y
7
Manual. Pull Stations
"Y N'
YES
3 K,
Smoke Detectors
Y N
YE9
Duct Smoke Detectors
Y N
Heat Detectors
Y N
PTV Valves—_
Y N
Tamper Valve Switch
�Y: N.-
Water Flow Swit�R
Y N
Air Pressure Switch
Y N
Sensitivity Test
Y N
Problems Found:-
;�� . �z ��e
Problems _F-pAq in di K /A- �tT /I C e.0, 7
this report is to certify the above listed fire alarm equipment has been properly tested and inspected for reliability
Owner/Re presentative Signature
-Fe&rnic'ia�, License ff
Y�' otec ion
-SEC-UR-IT Security First O�
W�-
9418pdin
-Bothell, WA 9,8011
-425
.0- -286-2144...,
F:'425-286-
OMP
-816-7700'(�40)
BURGLARY:& F1 RE� MONITORING Co'ntact,866,.
.,WWw.securityfirstpro.'c6m
Fire Alarm Inspection & Sensitivity Test'Rep"ort
Inspection Date: - A.) Annually\W_ Quarterly-0- Monthly 0 Acct. #
Facility Name: 1) -Phone:
s C'ity/State/fip.-
Addres
Fire.Alarm- Control'
Man acturb: i b-�,(J
Number of fitiating,Circuits: Initiating Circuits Supervised: YE -NO
Number of Signaling Circuits: a Signaling Circuits Supervised: I gYE S N 0
Y
Trouble with AC Off: drYES ) NO Breaker Locations Posted' YES NO:
'YES. NO. a
Communicator: Communic tion Type!.- D i a I - u p(Z:D:]q i c a �te
)STU
Battery'Voltage: V6,1ts, Battery Volta06* U(nder.Load/i �,KN' �V.81ts,-.-�-
Charging,pircuit.Voltage:."..''... V lt�
0 S Charging Circuit Current AMPs
key to.Panel Availabl Lodation;
e� S NO PA,
Operating, Instructions Posted - NO.* - Location:
Equipment Type
Number of Units
Satisfactory
Manufacturer
Comments'
Total Tested
Total
Tested
YES or NO
Bells
N
Horns
N�
Strobe Horns�
-Y N
Strobes
Y N
Manual Pull Stations
0Y _N
Smoke Detectors
N_
Duct Smoke Detectors
Y N
Heat Detectors
au�,_/ Of
PIVValves
Y N
Tamper Valve Switch
Y N
Water Flow Switch
Po J�e z
A .�.P_reqgw.e.Sm�tch7::,,__
Y N
Sensitivity Test Y N ze le-5/� f re
(S tLLIA729 A
Prob ems Found:
lzdae�w_ 6A zl� 1&14
670
Problems Found:
If
this report is to certify the above listed fii�e alarm equipment has been properly tested and inspected for reliability
Owner/Re presentative Signature -T6_chni;5ai�'---' License #