65 PINE ST BLDG 4.pdf-FIRE PREV ENTIO* N,
INSPECTION REPORT
Serving Brier, Edinoricis, und 12425 Meridian Ave S
SN6 ISH CO. 0 EDMONDS
Mountlake Terrace Everett, WA 98208 0 BRIER
FIR Phone (425) 551-1200 0 MOUNTLAKE TERRACE
DISTT www.FireDistrictl.org Fax (425) 551-1272 0 UNINCORPORATED
FREQUENCY I STATION 1, SHIFT
LOCATION: 65 Pine Street 98020 Annual 17-C
BUSINESS NAME: Pt Edwards Condos Bldg 4 SCHEDULED Apr 2017
PHONE: DATE DUE 0
MAILING UFIR � 424
ADDRESS: 65 Pine Street, Edmonds, WA 98020
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: -HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: 17' CITY YES NO
BUSINESS
EMAIL: LICENSE
INITIAL INSPE6TION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: AS 11/15 (A 11/1 �)FEA-Vr6 12:00:00 AM
Date Last Serviced:. 4�i � Ito `_4% 1 � I (a
-Serving Brier, Edmonds, and 12425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl.org Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
[JIEDMONDS
E313RIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
r FREQUENCY
T" & SHIFT
LOCATION:
[STATION
65 Pine Street 98020
Annual
17-B
BUSINESS NAME:
Pt Edwards Condos Bldg 4
PHONE:
SCHEDULED
DATE DUE ' Apr 2016
MAILING
UFIR
424
ADDRESS:
1%.
'65 Pine Street, Edmonds, WA 98020
—
BUSINESS OWNER:'
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
011 CURRENT —'s
KEY ACCESS-2:
HOME PHONE:
CITY YES,'.�,. NO
EMAIL:
BUSINESS F71.:�
LICENSE
PERSON CONTACTED:
NAME OF INSPECTOR:
INITIAL INSPECTION DATE
FIRE SYSTEMS:
AS 10114 FA 10/14 FE 1/15 FID Lk Boxv/
E�M 58ATIONS
IlCt�PMNWA
J11tItO /COMMUNICATIONS
L
�j
2
.'2
3
3
4
4
'5,
- --- - -----
5
6
7
7
I AGREE4 '60' RR�EQTT-T'HE 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
N'�A�T��-._
CONTACTED:
CONTACTED:
ECTOR:
J�SPI—T—__
INSPECTOR:
INSPECjqR:'
2
3
DATE:
E:
DATE:
VIOLATIONS
VIOLATIONS%
PRE -CITATION
CITATION ISSUED
1 15
1 5
LETTER SENT
NUMBER:
4
6
2
6
DATE:
__�ETLIRN
CODE 12N:
5
RECOW
3
7
3
7
ECEIV�O
7
4
8
4
DATE:
7
LETTER NE EDED [3 YES 0 NO]
LETTER NEEDED 0 YES [:1 NO
8
FIRE PREVENTION
Sei-vina Bi'-ie*t; Edt;io�nds, and
12425 Met-idian Ave S
INSPECTION REPORT
SNOIJI, 4t) ...
Moittitlake Tet-i-ace
FJL"JL:A
Everett, WA 98208
0 EDMONDS
0 BRIER
DISTR T
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[I UNINCORPORATED
.,.i4lli,ii�Fii-eDi'sti-ictl.oig
Fax (42-5) 551-1272.
65 PineStreet 98020
9
" FREQUENCY
Annual
I STATION &SHIFT-"*'
17-A
LOCATION:
Pt Edwards Condos Bldg 4
SCHEDULEDApr 2015
BUSINE SS NAME:
PHONE:
DATE DUE
424
MAILING 65 Pine Street, Edmonds, WA 98020
LIFIR �
ADDRESS
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
"'CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
EMAIL:
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
-STENIS. A -IU/-Ij rA 1UI/ t:� �lyj I j
iC*4
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
------ --- ---- — ---------
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
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
E DUE:
EXTENSION
GRANTEDTO:
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
3
6
7
DATE:
CODE
SECTION:
5
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
8
DATE:
DISPOSITION:
7
--------
LETTER NEEDED C] YES F-1 NO
LETTER NEEDED F] YES NO
8
FIRE DEPARTMENT COPY
SNOI
Fl
b
Serving Briet: Edmonds, and
Mountlake Terrace -
11
. www.FireDistrictl.org
12425 Meridia n Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
El BRIER
El MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY
STATION & SHIF'*"
LOCATION:
65 RimStraet 98=
Aillual
17-D
I
BUSINESS NAME:
Pl. himirdb Ckywimi Bkb 4
PHONE:
SCHEDULED�pr 2014
DATE DUE
MAILING
U FIR P4
ADDRESS:
E.15 M ric Slmcl, Ldmormis. VVA 0W2D
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
"—CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY YES NO
BUSINESS
El
EMAIL:
LICENSE
0
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
Il+-SVSR=kG.
AS 10112 FA I(V 12 FE 10112 FOLk- Box
HAZARDS FOUND AND LOCATIONS/
OMMUNICATIONS
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
GRANTEDTO:
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
�3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
11 LETTER NEEDED [-] YES N
rLETTER NEEDED E] YES I-] NO
1
8
FIRE DEPARTMENT COPY
'4WRIFNEVENTION
SNOHOMISH C
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
FIRE
A46untlake Terraceand
-7
Everett, WA 98208
DEDIVIONDS
0 BRIER
the Town of Woodway
Phone (425) 551-1200
E]WOODWAY
DISTRtrMr
wwu).FireDistrictl.org
Fax (425) 551-1272
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
i
" FREQUENCY STATION&SHIFT
LOCATION:
,
65 Pine �;t
365 17 C
I
BUSINESS NAME:
Pt Edwards Condos Bldg 4
PHONE:
SCHEDULED 04/01/13
nA-rc nHC �
MAILING
ADDRESS:
BUSINESS OWNER:
HOME PHONE:
UFIRo 424 4152
EMERGENCY-1: Copeland Grp(Prop Mgr) HOME PHONE: 2063880180 CURRENT
KEY ACCESS-2: Hendricksen, D./Maint. HOMEPHONE: 2064234433 CITY YES NO
BUSINESS
LICENSE 1:1 1:1
PERSON CONTACTED: mA L INITIAL INSPECTION DATE
NAME OF INSPECTOR: '3o' 1C, r,��:z t--- �t 3
FIRE AS 9/11 FA 9/11 FD LkBx FE (c) 0
SYSTEMS: 10112— lc;,lt3 bv— ANNUAL
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
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
vibLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTERSENT_
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
14
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED C] YES F-1 NO
LETTER NEEDED [-] YES F-1 NO
8
FIRE DEPARTMENT COPY
FIRE PREVENTION
Serving Brier, Edmonds
12425 Meridian Ave S
INSPECTION REPORT
SNOHOMISH CO.
Mountlake Terraceand
Everett, WA 98208
OEDMONDS
0 BRIER
4 eo: the Town o bodway
I fW
DISTkMT
Phone (425) 551-1200
I-] WOODWAY
0 MOUNTLAKE TERRACE
www.FireDistrict].org
Fax (425) 551-1272
0 UNINCORPORATED
65 Pine St
e- FREQUENCY
365
I STATION 1, SHIFT-)
17 6
LOCATION:
BUSINESS NAME: Pt Edwards Condos Bldg 4
PHONE:
SCHEDULED 04/01/12
DATE DUE II'
MAILING
LIFIR o 424 4152
ADDRESS:
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1: Copeland Grp(Prop Mgr)
HOME PHONE: 2063880180
CURRENT
KEY ACCESS-2: Hill, j@q0ftWA1h*.
HOME PHONE: 20642,14433
CITY YES NO
f�A_;\k-N V�C�j cyz'f_%ej
BUSINESS
El El
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
cr)0's
�4 zo
FIRE AS 9/11 FA 9/11 FD LkBx
FE H f ij
SYSTEMS:
ANNUAL
HAZARDS FOUND AND LOCATIONS /COMMUNICATIONS
ro 4e)K T 'Th 3 07,
nos,
7_36
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
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: (4-7L-
DATE:
DATE:
3
VI NS
1 15
1
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
—11-1
2
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES C1 NO
LETTERNEEDED F] YES NO
7
8
FIRE DEPARTMENT COPY
Revised Date 6/16109
SMITH FIRE SYSTEMS MANAGEMENT, LLC
DATE
AUTOMATIC SPRINKLER SYSTEM JOB # 4,YS-6( ,
1106 54th Avenue East, Tacoma, WA 98424 PERFORMANCE EVALUATION
Phone: (253) 248-2000 Fax: (253) 248-2360
Site Name POINT EDWARDS CONDOMINIUMS- BLDG 4
Address: 65 PINE STREET, EDMONDS, WA 98020
Contact Person TOYAN COPELAND Telephone# (206)388-0180
System # I Type WET Area Covered
System # 2 Type DRY Area Covered
System # Type Area Covered
System # _ Type Area Covered
System # Type Area Covered
Type of Occupancy (CIRCLE): Other:
Assembly Storage Industrial Offices Retail Apartments CondomIniums Residential
A. OWNERS SECTION
1. Has there been any fire protection modifications since the last inspection?: Yes El No 0 Describe below:
2.
Describe any fire(s) since last inspection:
3.
Date (approximate if unknown) sprinkler system was installed:
2005
4.
Name of installation company:
or V, .5 Ovv-
B.
INSPECTOR'S SECTION
(All responses reference current Inspection)
1.
GENERAL
YES NO N/A
a.
Does the system have a hydraulic plaque?
b.
Are the risers labeled and what are the specifies?
Discharge density .65 Per 4 HDS
Sq. Ft residual pressure at riser 60.7
psi.
Gallons per minute 73.4 (WET)
c.
Is the building fully sprinklered?
d.
Is the entire sprinkler system in service?
e. Record water pressure at riser 4) T Psi
2. CONTROL VALVES YES NO N/A
a. Are all sprinkler system control valves and all other valves in the appropriate
open or closed position?
b. All control valves operated through full range of motion and returned to normal position?
c. Are all control valves In the open position?
Locked 2* Sealed Z Tampered
d. Are all control valves property signed?
POINT EDWARDS CONDOMINIUMS- BLDG 4 Page 1 of 4
Revised Date 6116/09
3. FIRE DEPARTMENT CONNECTIONS
a.
Are fire department connections in satisfactory condition (Unobstructed view,
couplings rotate freely, caps are in place)?
b.
FDC backflushed in e'-T .(Required every 5 Years)
4. WET SYSTEMS
a.
Have antifreeze system solutions been tested? Solution %
b.
Were the antifreeze test results satisfactory? Specific Gravity Reading(s). Deg
c.
Does the building appear to be adequately heated at time of inspection?
e.
Internal exam of piping conducted In CPVC (Required every 6 Years)
5.
DRY SYSTEMS
a.
Is the air pressure and priming water level in accordance with manufacturer's instructions?
b.
Has the operation of the air or nitrogen supply been tested?
Is it in service?
c.
Were the low points drained during this Inspection? How Many? 2
d.
Did quick -opening devices operate satisfactorily?
e.
Did the heating equipment in the dry pipe valve room operate at the time of inspection?
f.
Was the dry valve tripped during this inspection?
DRY PIPE
OPERATING
TEST
DRY VALVE
O.O.D.
MAKE
MODEL
SERIAL NO.
MAKE
MODEL
SERIAL NO.
Tyco
DPV-1
Q.O.D. TRIP
OK
TIME TO TRIP
THRU TEST PIPE
WATER
PRESSURE
INITIAL AIR
PRESSURE
TRIP POINT
PRESSURE
TIME WATER REACHED
TEST OUTLET
ALARM
OPERATED
LOCAL
ALARM
OPERATED
REMOTE
MIN.
SEC.
PSI
PSI
PSI
MIN.
SEC.
g. Date dry pipe valve trip tested (control valve fully open).
h. Internal exam of piping conducted in 03� (Required every 5 Years)
CALARMS
a. Did water motor gong test satisfactorily?
b. Did electrical bell test saUsfactorily?
c. Is the system supervised with alarm? Who? SFSM @A VANTGUARD— 89-6949
Operator #
cl. Did alarm monitoring service test sabsfactorily?
e. Waterflow alarm?
f. Valve tamper monitoring?
g. HVI-o Air Switch
POINT EDWARDS CONDOMINIUMS— BLDG 4
2009
Page 2 of 4
Revised Date 6/16109
7. SPRINKLERS. GAUGES & MIC TESTING
a. Are all sprinklers free from corrosion, foreign material, or paint? ----
b. Are there any non -dry sprinkler heads manufactured prior to 1920?
c. Are all non -dry sprinkler heads less than 75 years old? Date of last sample testing:
d. Are all non -dry sprinkler heads less than 50 years old? Date of last sample testing:
e. Are all dry type sprinkler heads less than 10 years old? Date of last sample testing: 2004
f. Are all FAST RESPONSE sprinkler heads less than 20 years old? Date of last sample testing: 2004
g. Is there fluid in the glass bulbs?
h. Is a head wrench, stock of spare sprinklers and Teflon tape available?
L Does the exterior condition of the sprinkler system appear to be saUsfactory?
j. Date of last MIC testing? UNKNOWN
8. WATERFLOW TEST AT MAIN DRAIN MADE AT SPRINKLER RISERS
TEST PIPE
DATE
TEST PIPE
LOCATION
SIZE
TEST PIPE
STATIC
PRESSURE
RESIDUAL (FLOW)
PRESSURE
I
cl-';I-1-11
RISER
11.
95
2
RISER
2'
3
4
9. Explain any "No" answers and comments:
POINT EDWARDS CONDOMINIUMS- BLDG 4 Page 3 of 4
Revised Date 6/16/09
10. Adjustments or corrections made during this inspection:
Although these comments are not the result of any engineering review, the following desirable improvements are recommended:
System I
System 2
System 3
System 4
System 5
F]
F1
is operational
is operational
is operational
is operational
is operational
is operational with defects
is operational with defects
is operational with defects
is operational with defects
E] is operational with defects
F]
F1
is not operational
is not operational
is not operational
is not operational
is not operational
SMITH FIRE SYSTEMS MANAGEMENT, LLC
=21
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253)248-2000 Fax: (253)248-2360
al-il
�A —",o VtA<Cr
Inspector Prim Name WA SFMO 1Tr # Date
of Owner or Representative Print Name —date—
POINT EDWARDS CONDOMINIUMS— BLDG 4 Page 4 of 4
;3
SMITH FIRE SYSTEMS MANAGEMENT, LLC
DATE
CONFIDENCE TESTING FIRE ALARM JOB# q4tt;6/0
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253) 248-2000 Fax: (253) 248-2360
SITE NAME POINT EDWARDS CONDOMINIUMS— BLDG 4
ADDRESS 65 PINE STREET, EDMONDS, WA 98020
CONTACT TOYAN COPELAND PHONE (206) 388-0180
NAME OF TESTER CERTIFICATION NO. I tqqD-7
DATE OF INSPECTION C>%— kcN—�% TYPE OF INSPECTION A V% V,
CONTROL PANEL MANUFACTURER SILENT KNIGHT MODEL NO. 5820
NUMBER OF INITIATING CIRCUITS ADDR NO. OF SIGNAL CIRCUITS
6
BATTERY VOLTAGE VOLTS CHARGE CIRCUIT VOLTAGE VOLTS
BATTERY VOLTAGE UNDER FULL LOAD a Is -9z!$ VOLTS (SIGNALS OPERATING)
1.
Trouble signal with AC power off
YES
gj
NO
E]
N/A
2.
System operates satisfactory on standby power
YES
NO
N/A
3.
All signals operate on AC power
YES
NO
N/A
4.
Have all alarm notification appliances been checked for proper operation?
YES
NO
N/A
5.
All circuits checked for electrical supervision
YES
NO
N/A
6.
Control panel checks made per manufacturer's instructions
YES
�9L
NO
0
N/A
El
7.
All auxiliary equipment operates (Elevators, fans, dampers)
YES
�1
NO
E:1
N/A
El
8.
Central station or remote connection
YES
Sd
NO
0
N/A
1:1
Name OT Monitoring Company
SFSM@AVANTGUARD 89-6949
9.
Key to panel available
YES
No El
N/A El
10.
Operating instructions at panel?
YES
NO [:1
N/A [:1
11.
Service Label or Tag (SFC Appendix III-B)
YES D5
NO F-1
N/A El
12.
Did you sign off Item 8 on the Elevator Log
YES V
NO [:1
N/A n
POINT EDWARDS CONDOMINIUMS— BLDG 4 1 of 2
EQUIPMENT TESTED
TYPE OF EQUIPMENT
NUMBERS OF
UNITS TESTED
SATISFACTORY
NO. OF UNITS
IN BUILDING
YES
NO
_j
Bells, Horns, Chimes
Voice Alarm Speakers
55
Visual Alarm Device
15
Trouble Indicators
1
Super. Switch (Auto. Spr.)
5
Auto Spr. Flow Switches
4
Smoke Detector(s)
20
Heat Detector(s)
Manual Pull Stations
10
Ventilation Controls Operate
Central Station
I
Annunciators
1
Elevator Call Down
1
Fire Damper/Smoke Dampers
Phone Jacks
2
Auto. Door Unlocks - (Failsafe)
Auto. Door Release
Other
A
PROBLEMS FOUND:
CORRECTIONS MADE:
DATE CORRECTED
BY
THIS IS TO CERTIFY THAT THE FIRE ALARM SYSTEM HAS BEEN PROPERLY TESTED AND INSPECTED FOR
RELIABILITY TO COVER THE ITEMS LISTED IN THIS REPORT.
SMITH FIRE SYSTEMS MANAGEMENT, LLC
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253)248-2000 Fax: (253)248-2360
Ll , - 6'." - 9-11-11
Ignature 1nsjr Print Narne Date
ignature of Owner or Representative uprint Parne Date
POINT EDWARDS CONDOMINIUMS- BLDG 4 2 of 2 J.
Revised Date 6/16/09
Awl SMITH FIRE SYSTEMS MANAGEMENT, LLC
DATE
AUTOMATIC SPRINKLER SYSTEM JOB #
1106 54th Avenue East, Tacoma, WA 98424 PERFORMANCE EVALUATION
Phone: (253) 248-2000 Fax: (253) 248-2360
Site Name POINT EDWARDS CONDOMINIUMS— BLDG 4
Address:
65 PINE STREET, EDMONDS, WA 98020
Contact Person TOYAN COPELAND
Telephone # (206) 388-0180
System #
I Type WET
Area Covered
System #
2 Type DRY
Area Covered
System #
Type
Area Covered
System #
Type
Area Covered
System #
Type
Area Covered
Type of Occupancy (CIRCLE): Other:
Assembly Storage Industrial
Offices Retail Apartments Condominiums Residential
A. OWNER'S SECTION
1. Has there been any fire protection modifications since the last inspection?: Yes. No E] Describe belovir
2. Describe any fire(s) since last inspection:
3. Date (appro)dmate if unknown) sprinkler system was installed: 2005
4. Name of installation company:
B. INSFECTOR'S SECTION (AH responles reference curmt Inspecdon)
I GENERAL YES NO N/A
a. Does the system have a hydraulic plaque?
b. Are the risers labeled and what are the specifics?
Discharge density .65 Per 4 HDS Sq. Ft. residual pressure at riser 60.7 -psi.
r-allons er minute 73.4 IWFTI
r—
c. Is the building fully sprinklered?
d. Is the entire sprinkler system in service?
e. Record water pressure at riser
2. CONTROL VALVES
a. Are all sprinkler system control valves and all other valves in the appropriate
open or closed posifion?
b. All control valves operated through full range of motion and returned to normal positioril
c. Are all contr9l valves in th tion?
Rqgpen post
Locked. V Sealed P Tampered
d. Are all control valves properly signed?
Psi
YES NO N/A
POINT EPWARD&CONDOM1.NIUM.&-.BL.DG 4
Page 1 of 4
Revised Date 6/16/09
3. FIRE DEPARTMENT CONNECTIONS
a. Are fire department connections in satisfactory condition (Unobstructed view,
couplings rotate freely, caps are in place)?
b. FDC backflushed in awQSVT-- . (Required every 5 Years)
4. WET SYSTEMS
a. Have antifreeze system solutions been tested? Solution %
b. Were the antifreeze test results satisfactory? Specific Gravity Reading(s)
c. Does the building appear to be adequately heated at time of inspection?
e. Internal exam of piping conducted in CPVC (Required every 5 Years)
5. DRY SYSTEMS
a. Is the air pressure and priming water level in accordance with manufacturer's instructions?
b. Has the operation of the air or nitrogen supply been tested?
Is it in service?
c. Were the low points drained during this inspection? How Many? 2
d. Did quick -opening devices operate satisfactorily?
e. Did the heating equipment in the dry pipe valve room operate at the time of inspection?
f. Was the dry valve tripped during this inspection?
Deg
W-Y
DRY PIPE
OPERATING
TEST
DRY VALVE
O.O.D.
MAKE
MODEL
SERIAL NO.
MAKE
MODEL
SERIAL NO.
TYCO
D1PV-1
I
I
G.O.D. TRIP
OK
TIME TO TRIP
THRU TEST PIPE
WATER
PRESSURE
INITIAL AIR
PRESSURE
TRIP POINT
PRESSURE_
TIME WATER REACHED
TEST OUTLET
ALARM
OPERATED
LOCAL
ALARM
OPERATED
REMOTE
MIN.
SEC.
PSI
PSI
PSI
MIN.
SEC.
g. Date dry pipe valve trip tested (control valve fully open).
h. Internal exam of piping conducted in "211111111116 (Required every 5 Years)
6. ALARMS
a. Did water motor gong test satisfactorily?
b. Did electrical bell test satisfactorily?
c. Is the system supervised with alarm?
Operator #
d. Did alarm monitoring service test satisfactorily?
e. Waterflow alarm?
f. Valve tamper monitoring?
9. Hi./Lo Air.Switch
Who? SFSM @A VANTGUARD— 89-6949
POINT. EDWARDS. CONDOMINIUMS— BCDG 4,
2009
Revised Date 6/16109
7. SPRINKLERS, GAUGES & MIC TESTING
a. Are all sprinklers free from corrosion, foreign material, or paint?
b. Are there any non -dry sprinkler heads manufactured prior to 1920?
c. Are all non -dry sprinkler heads less than 75 years old? Date of last sample testing:
j d. Are all non -dry sprinkler heads less than 50 years old? Date of last sample testing:
e. Are all dry type sprinkler heads less than 10 years old? Date of last sample testing: 2004
f. Are all FAST RESPONSE sprinkler heads less than 20 years old? Date of last sample testing: 2004
g. Is there fluid in the glass bulbs?
h. Is a head wrench, stock of spare sprinklers and Teflon tape available?
1. Does the exterior condition of the sprinkler system appear to be satisfactory?
j. Date of last MIC testing?
8. WATERFLOW TEST AT MAIN DRAIN MADE AT SPRINKLER RISERS
. UNKNOWN
TEST PIPE
DATE
TEST PIPE
LOCATION
SIZE
TEST PIPE
STATIC
PRESSURE
RESIDUAL (FLOW)
PRESSURE
RISER
lot
2
RISER
2"
foo
q0
3
5]
9. Explain any "No" answers and comments:
—P��,7e tx� --gy--Vva, 'ES �A,2!e�
IlLb
iiiio�i 2! M — =4
Revised Date 6/16/09
10. Adjustments or corrections made during this inspection:
1. Although these comments are not the result of any engineering review, the following desirable improvements are recommended:
System I
is operational
is operational with defects
E]
is not operational
System 2
is operational
is operational with. defects
E]
is not operational
System 3
is operational
is operational with defects
E)
is not operational
Sys tem, 4
F1
is operational
E] is operational with defects
is not operational
System 5
is operational
is operational with defects
E]
is not operational
r
SMITH FIRE SYSTEMS MANAGEMENT, LLC
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253) 248-2000 Fax: (253) 248-2360
.,90/011
Print Name
-POINT EDWARDS CONDOMINIUMS— BLDG 4.
Page 4 of 4.
SMITH FIRE SYSTEMS MANAGEMENT, LLC
DATE
MS
CONFIDENCE TESTING FIRE ALARM JOB #
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253) 248-2000 Fax: (253) 248-2360
SITE NAME POINT EDWARDS CONDOMINIUMS- BLDG 4
ADDRESS .65 PINE STREET, EDMONDS, WA 98020
CONTACT TOYAN COPELAND PHONE (206) 388-0180
NAME OF TESTER tiall CERTIFICATION NO.
1"'nill amLca
DATE OF INSPECTION % - '1-2) 0 0 TYPE OF INSPECTION AcQsalfo,�k
CONTROL PANEL MANUFACTURER SILENT KNIGHT MODEL NO. 5820
NUMBER OF INITIATING CIRCUITS ADDR NO. OF SIGNAL CIRCUITS 6
BATTERY VOLTAGE 1L. j() VOLTS CHARGE CIRCUIT VOLTAGE '—' I. V� VOLTS
BATTERY VOLTAGE UNDER FULL LOAD 06. d VOLTS (SIGNALS OPERATING)
1. Trouble signal with AC power off
YES
2. System operates satisfactory on standby power
YES
3. All signals operate on AC power
YES
4. Have all alarm notification applia nces; been checked for proper operation?
YES
5. All circuits checked for electrical supervision
YES
6. Control panel checks made per manufacturers instructions
YES
7. All auxiliary equipment operates (Elevators, fans, dampers)
YES
8. Central station or remote connection
YES
Name of Monitodng Company
9. Key to panel available
10. Operating instructions at panel?
11. Service Label or Tag (SFC Appendix 111-13)
12. Did you sign off Item 8 on-thP Elevator Log
POINT EDWARDS CONDOMINIUMS- BLDG 4
NO
[]
N/A
E]
NO
E]
N/A
[-]
NO
N/A
E]
NO
1-1
N/A
El
NO
El
N/A
1-1
NO
El
NIA
1-1
NO
1-1
N/A
El
NO
1-1
N/A
11
SFSM@AVANTGUARD 89-6949
YES
NO
N/A
YES
NO
N/A
YES
NO.
El
N/A.
El
YES
..'No
El
NiA
El
1 of 2
EQUIPMENT TESTED
TYPE OF EQUIPMENT
NUMBERS OF
UNITS TESTED
SATISFACTORY
N . OF UNITS
IN BUILDING
YES
NO
N/A
Bells, Horns, Chimes
Voice Alarm Speakers
55
55
Visual Alarm Device
15
15
Trouble Indicators
1
1
Super. Switch (Auto. Spr.)
5
5
Auto Spr. Flow Switches
4
4
Smoke Detector(s)
20
20
Heat Detector(s)
Manual Pull Stations
10
10
Ventilation Controls Operate
1
Central Station
1
Annunciators
1
1
Elevator Call Down
I
I
Fire Damper/Smoke Dampers
Phone Jacks
Auto. Door Unlocks - (Failsafe)
,Auto. Door Release
10ther
CORRECTIONS MADE:
DATE CORRECTED
BY
THIS IS TO CERTIFY THAT THE FIRE ALARM SYSTEM HAS BEEN PROPERLY TESTED AND INSPECTED FOR
RELIABILITY TO COVER THE ITEMS LISTED IN THIS REPORT.
p SMITH FIRE SYSTEMS MANAGEMENT, LLC
1106 54th Avenue East, Tacoma, WA 98424
Phone: (253) 248-2000 Fax: (253) 248-2360
S-30
sig.a't.re- Ins or Print Name Date
(J
We
Signatureof Ovvner or Representative lPrint Name,
POINT EDWARDS CONDOMINIUMS-* BLDG 4 2 Of 2