658 GLEN STkii�
FIRE PREVENTION
.Serving Brier, Edmonds, and
12425 Meridian Ave S
INSPECTION REPORT
Mountlake Terrace
Everett, WA 98208
0 EDMONDS
0 BRIER
r1rT
Phone (425) 551-1200
0 MOUNTLAKE TERRACE
[3 UNINCORPORATED
www'. FireDistrict]. org
Fax (425) 551-1272
e' FREQUENCY
STATION & SHI
LOCATION: 658 Glen Street 98020
Annual
17-A
BUSINESS -NAME
Glenbrook Condos
PHONE:
SCHEDULED
DATE DUE o Aug 2015
MAILING
IR o 424
ADDRESS: 658 Glen Street, Edmonds, WA 98020
__j
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-1:
HOME PHONE:
"CURRENT
KEY ACCESS-2:
HOME PHONE:
CITY
YES NO
EMAIL:
BUSINESS
LICENSE
01
PERSON CONTACTED: V IA.
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: rAS-1�0/1-3-FA,10/14-r—E--1-0"rl-47�—F-b-L-k�B--
_�l LK
n.qtp i q_qt.c;pn/ir_pri-
HAZARDS FOUND AND LOCATIONS �OMMUNICATIONS
C) r r
2
2
3
3
-
4
4
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1stRE-INSPECTION -
DUE
2nd RE -INSPECTION
DATE
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
VIOLATIONS
RATE
DUE:
DATE DUE:
CITED:
PERSON
PERSON
ED:
PERSON
. . .................
INSPECTOR:
INSPECTOR:
CONTACTED:
2
DATE:
_!��ECTOR:
DATE:
DATE
3
AOLIATIONS
VIOLATIONS:,-,
PRE -CITATION
CITATION -ISSUED
5
1
LETTER SENT
NUMBER:
4
2
6
2
6
DATE:*
CODE
SECTION:
5
RETURN RECEIPT
3
7
RECEIVED
6
_FS_POSITF6N__
'8
DATE.
ETTER NEEDED [:] YES NO
LETTER NEEDED 0 YES NO
8
Confideace Testing Company:
Wolfe Fire
Protection, Inc.
17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Fax: 360.794.3080 Ph.: 360.794.8621
Fire Department
Confidence Test Report
OCT 3 1 20S
SPRINKLERS - WET
Certification Given
(ONE SYSTEM PER REPORT)
RED
YELLOW QI
WHITE
CONFIDENCE TEST-7FLI-l' REPAIRS: 0,
Occupancy Address: �,-,_55�_-_ 1/7- 1 e, I _S + E ck rrico j 5
OccupancyName: L-jt�,-j grocK
Building Owner: -Co. S r ( (D,- Jo H, o A
Phone Numb'e r:
Responsible Person: PLL� R_t�5k
Phone Number:
Building Owner cl
Address:
Date of Inspection: 2, 7
Inspection Frequency / Type: Annual
Tester's Name (print): ROO,
Certification Number: SCP-27'S0--t,'_2iqL--1fL_
Central Station , m , o nitoring? Yes No
Monitdrin'gCo. Name: PIW,10
Primary Com ponent: u")-c L
System Make: 1, r c,
V
System Model:
Systqnli� Location
Identification Number:
Problems Found: (if additionai room is required, please,idd a s?pa sheet.
+ j
r
f.;2
Corrections Made: Date Corrected:
Corrected by:
(If additional room is required, please idd a separate sheet.)
Certification Number: SCP-
This certifies that this Fire anti 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.
%rof Tester:
Signaturs'
P h o n eI�'j
'0.794.8621
Testing Agency- Wollfe.fireP-rotection, Inc.
Mailing Address 17321 Tye St.,§.E., Ste. "B" Monroe, WA 98272
Building*epresAitative (signature):'
Sprinklers - WET
Page: 1 of.2
r_
The below item's on the check list shall be inspected and tested,< -,This list Ooes not rpo . nstitute all of the required
fe - t U LIF j1`6 Of"t
'o t e(
inspecting and testing of the Fire and Life Safety system. �fi J-/tfo �t Ority Having Jurisdiction's
r
Fire Department Fire Code for inspecting and testing requirements.
2016
General
1. Flow Test conducted? ............................................................................................................ YO�S-U7 No Q
2. Static Pressure: 11 0 psi Flow Pressure: psi
3. Total number of sprinkler heads on this system? /j/ A
4. Was -2" Main Drain checked? ...... ....... I ....... .......... I.... ; . I .. .
........................................ Other C1, , Yes -El— No 0
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ......................... N/A El Yes-0— No El
6. Pressure regulating valves tested? .............................................................................. N/A_Q_—Yes E) No L)
a
7.Alarm Bell operates? ............................................................................................. N/A C3 Yes El— No El
8. System inspected and, lubricated ? .................................................................................. Yes -EJ�l No U
9.ya Ives, sealed or supervised? ........... I .................................................................... Yes-0- No El
10.
Signs provided on'all valves? ...................................................................................................
Yes-(3-
No El
11.
Pumper Connections and Clapper valv.es unobstructed and turn freely ? ................
Yes-(J-
No El
11
12. Sprinkler head coverage acceptable? ......................................................... : Y e s--U No (3
13. Have the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yes-
U- No El
14. Proper number spare sprinkler heads available with appropriate' wrenches for each? ...... Yes No El
15. System left in service? ............................................................................................................ Yes -El' No Ej
16. System gauges been replaced or calibrated within the last 5 years? ..................... Yes-9-_ No Ej
17. Sprinkler heads free of corros,ion, paint, obstructions and/or physical damage? Yes-tj— No 0
18. Was any debris found in the Fire Department Connection (FDC)? ........................ Yes E) N
19. Was. the Fire Department Connection (FDC) been back flushed in the last 5 years? ... Yes-Ej— No Ll
20. Was an internal pipe and valve inspection performed within the last 5 years? ..... 4,h Yes 0 No 0
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-
ConfideVe Testing Company: Fire-D-epartm-ent
�EIFPWolfe Fire
-Protecti
. on., Inc.
17321 Tye`.;�C S.E.,.Ste. "B7'- Monroe, WA 9,8272,1.
"Fax � .360.7914.308&-' Ph.; 360'.794.862-1.
C -onfiAb.n c�e -Te-s.t, --.R:e.P.Q,rt
OCT 31
.,SP.R.1NK.LERS WET
Certif ication'Gi Ven-
REb 0.
1- YtLL0W.2.j
W:HITE
(ONE SYSTEM PER REPORT)
CON . FIDENCE TEST, TJYT REPAIRS F LT.
Occupancy A00ress:.(45k (71 1-1.1 S + 1E A Mon A 5 -Occupancy Name: Cey7 do '-1,
Building Owner: (rl-rn Broor c-oido H.o. A; Phone Num . ber:
A,
Responsible Person: DC J- 1Z A 5 k Phone Number:
Building OWner
' 5K 6
Address: S wor
Date of Inspection: q-17- I (c Inspection Frequency Type: Annual
Tester's Name (printy-,20(1 L-Kf-121120r-4 Certification.N umber:. SQR-27150-�-Q-CIRC-, -6F- -
Central Station mc'hi1b'Q"6g? Yes 2-� No C3 �Monitoring Co. Name: C-60
Primary Componen: CC4
System Make:
V
S,ystem Model:
-a z 1 5 rn. 0 rl
Sy�tdrn Loc,tion: ldentification.Number:
'd.
P If additional room is required; please ad
IrLlems Foun d a separate sheet
f7D( , k/ k-ecA A. c1pr r,�A V n PL-4 r /1, (64 C4 �n e) t-1 11
4-if C, + e- a e-4-
`0,
<
Corrections Made: Date Corrected: Corrected,by:
(1fadditional room is;required, please add a separate sheet.) Certification Number- SCO-7
ZI !,�-7
TV" P..
This certifies that this Fire an'd LV efS,&%�' -sy o e
QC pfet..Y I`- stem. be ein prqp�erly frispec-tedJ r. r liability,to cover the items
listed in"this e6polri, and is consistent with the Authority Havingjd4sdicit�i'o'n's' Fire bepa'rim"e.n't' Fire Code standards.
All discrdpancie,s are not.pd and have been reported'to the buill6fing Owner/Manage . r for. corrective action.
,n
Signaturt-f- PhbneW, 6 .794.8621
'jIbf Tes er:
Testing *gency We, 11, f Qf Ft�e Fr6te.6tion, Inc.
MailingA,,,ddress 17321 Tye St. S.E.;'Ste. "B'! - Monroe, WA 98272
h-
Buildi gl�f.Rp r,&se !ative (signature):
-"�,Ilrinlklers - WET Page: I of 2
0"gula
z
Ptd�Comrnllnc; I t963O 40th Avenue W.,LYNNWOOD.,,.WA, 98036, N01V 0 2 2015
ANNUAL FIRE ALARM INSPECTION Today's Date: 06-30-2015
REPORT
One System Per Report) Inspected Date: 1ps—
[I'Service Test 0 Repairs Due Date:
rystem Location Certification RED 0 YELLOW 0 WHITE
p4tL", I Given :
mcupant intormation Responsible Person
Bldg Name: C.,&j Name:
Address: <;Z,� Address:
Phone:
1 Email:
INSPECTION AND TESTING CONTRACTOR INFORMATION
Contractor Information Inspector/Tester Information
Company Name: Name:
Address:
Email:
State Contractor License #:
License #:
CERTIF
State
Certification:
National/NICET:
Other Cert:
MONITORING INFORMA 77ON
Central Station Monitoring? 13'Y N Phone #:
Monitoring Company: SystemModel:
SystemMake: 1) -1 S�)
E:
4 �
%M."4w I;j
DEFICIENCY1 CORRECTION DETAILS
Any Deficiencies Found? Ely ErN---
Any Deficiencies
Remaininq? Y E) N
DeficigM Found
Comments
C rrected?
Correction
Corrected
B
y
NOTES
Add lReview Notes? Y EY N
rAdd Special Instructions? Y N
Wr
firJu4no
M
Refer to the local and state standards for a complete description of the Inspection,
testing, and maintenance requirements. The Inspection results provided In this report
are based only on the system's current ability to operate and shall not be construed
as an evaluation of the system's performance capabilities to adequately protect the
property. Information In this report may or may not Include possible performance
concerns and should not be considered all inclusive. It Is solely the property owner's
responsibility to determine ff a separate investigation should be done to ensure the
system will perform as designed and that the property Is adequately protected. It is
also the property owner's responsibility to maintain the system, property and any
possible environmental conditions that may affect the system's operability and
performance.
SYSTEM FUNCTIONALITY
LARM SYSTEM
rouble signal with AC power off?
ystem operates properly on battery backup?
if
voltage(no load):
voltage(full load with signals operating):
harge circuit voltage:
stem operates properly on standby power?
signals operate on AC power?
of initiating circuits:
of signal circuits:
es alarm system meet audibility standards?
circuits checked for electrical supervision?
auxiliary equipment operates (Elevators, fans, dampers)?
flation controls operate?
to panel available?
rating instructions at panel?
rouble indicators function properly?
'emote Annunciator Panels function properly?
&'Yes 0 No
Q , -Ye's 0 N o
volts
volts
V(5-fts-
0--Yes
0
No
0-1-es
0
No
i Er- -6
&-Yes
0
No
er-Yes
0
No
GrYes
0
No
0 NIA
0 Yes
0
No
"/A
Gr"Yes
0
No
0 Yes
0
No
&--�e-s 0 No
(��es 0 No 0 N/A
Wr
&3=5
Ievator Call Down functions property?
est record posted at panel?
neral alarm automatic time delay:
ntral Station monitoring company received signal?
is a full walkthrough done?
item left in service?
AIRWAY DOOR LOCKS
umber of stories?
o all locking devices release upon activation of the fire alarm
(stem?
o all locking devices release upon power failure?
oes the door to roof unlock?
o doors unlock but not unlatch?
there an access key at the control panel for doors that fail to
ilock?
eyes 0
No 0 N/A
Gr,Yes
0
No
minutes
a-les
0
No 0 N/A
6,,/
Y
Yes
0
No
&-'�es
0
No
0 Yes
-G-lqo
0 Yes 0 No 0 N/A I
0
Yes
0
No
0
N/A
0
Yes
0
No
0
N/A
0
Yes
0
No
0
N/A
0 Yes 0 No 0 N/A I
System Devices
Total Number of Units In
Building
Total Number Units
Tested
Test Results
Acceptable
Electdc Strike
(DN'/A 0 Yes 0 No
Elec . tric Bolt,
/A OYes ONo
Other Locking Devices
94/A 0 Yes 0 No
System.Devices
Total Number of Units In
Building
Total Number Units
Tested
=14
Test Results
Acceptable
Bells, Horns, Chimes
32
ON/A QYe-s 0 No
Voice Speakers (Voice Clarity)'
ON'/A 0 Yes 0 No
Smoke Detector's
1
0 N/A Gr'�es ONo
Heat Detect ors
01�/A 0 Yes ONo
Duct Detectors
G</A 0 Yes ONo
Sprinkler Flow Switches
&</A 0 Yes ONo
Sprinkler Supervisory Switches
G</A 0 Yes ONo
Visual Alarm Devices
ONIA GKYes 0 No
Manual Pull Stations
0 N/A Cr�es 0 No
Automatic Door Unlocks
014/-A 0 Yes 0 No
Automatic Door Release
QN/A 0 Yes ON o
nunciator(s)
QN/A Wes Q No
0 -1� a 46
Fire Dampers
0</A 0 Yes No
Communication Equipment
Phone Sets
Phone Jacks
Icall4n Signal
Total Number of Units In Total Number Units I Test Results
Building I Tested I Aecanfthlei
A OYes ONo
A OYes ONo
A OYes ONo
INSPECTOR'S DECLARATION
By checking here you are certifying, under penalty of perjury, that you are a valid
agent of your company representing that the company maintains all the necessary
licenses and/or certifications to perform this service for this system in this
jurisdiction AND THAT the company has property inspected this system consistent
with state and local standards AND THAT the system has been property tagged or
labeled and the property owner or responsible person has been notified of the
inspect -ion results, the system --status, and any corrective actions.
C
Confidence Testing Company:
- w[F:P1Wo1fe Fire
Protection, Inc.
17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Fax: 360.794.3080 e Ph.: 360.794.8621
Fire Department
Confidence Test Report
X/
SPRINKLERS - WET
Certification Given
RED
YELLOW
WHIT
(ONE SYSTEM PER REPORT)
CONFIDENCETEST: I ff I REPAIRS:1 0 _
Occupancy Address: (a&V 65-IfV\ 5t FJMQy101,9 OccupancyName: Lkil Sfhar= LMdL-5
BuildingOwner: i6f)-P-n Rr,10K /nalo R-0-AL.- Phone Number: q 75 - -77q - 27251q,/
Responsible Person: Phone Number:
Building Owner
Address: 6-1-(,-n 5h, Scv'hS, 2-pol Eadioad�, WC4 Cl�—'OaO
f
Date of Inspection: Inspection Frequency / Type: Annual
Tester's Name (print):- MeA ISLI21V Certification Number: SCP- lqloy,5
Centrakstation monitoring? Yesi�:V' No [I Monitoring Co. Name: �IlrAfWl
Priniary C�Fmponent: - J -L-System Make:
System Model: -
System Location: Identification Number:
ProblernsFound: (if additi6nal room is required, please add a separate sheet.)
A �rqii
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�e�notea.nd have been reported to the building Owner/Manager for corrective action.
Signature of Tester: Phone #: 360.794.8621
Testing Agency,,--VVAfe FirCP-rotection, inc.
Mailing Address: 17321 Tye St. S.E., Ste. "B" - Monroe, WA 98272
Building Representative (signature): ^A --"a
Sprinklers - WET
Page: 1 of 2
- LO
Tfie 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
rire Department Fire Code for inspecting and testing r IZ -
,equirements.
General
1. Flow Test conducted? ............................................................................................................. YesIV No'E]
2. Static Pressure: / 00 psi Flow Pressure: 75 -psi
3. Total number of sprinkler heads on this system?
4. Was 2" Main Drain Oocked?_...... ........... a .... . ....................................................... Oth.ey,E] -Yes-V-,f No L),
11
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ......................... N/A C3 Y e s JET f No C1
6. Pressure regulating valves tested? .............................................................................. N/A,Er__Yes U No C1
7.Alarm Bell operates? ............................................................................................. N/A Q Yes)4) No (3
I
8. System inspected and lubricated ? .................................................................................. Yes No El
9. Valves seal.eld- or supervis ed? ................................................................................ Yes &D No Q
10. Signs provided on all valves? ..................................................................................................... Y e s No C3
11. Pumper Connections and Clapper valves unobstructed and turn freely ? ................ Yes 00 No E)
12. Sprinkler head coverage acceptable? .......................................................... Yesd-- No El
NIS.—H"a've the sprinkler heads been replaced or successfully sample tested in the last 50 years? Yes No
14. Proper number spare sprinkler heads available with appropriate wrenches for each? ...... Yes)j No
li,&Nyistern left in service? ............................................................................................................ Yes aT No 0
16. System gauges been replaced or calibrated within the last 5 years? ..................... YesjEj:S, No (j
I - A
17..Sprilnkler heads free of corrosion, paint, obstructions and/or physical damage? .... YesQr," No (j
18. Was any debris found in the Fire Department Connection (FDC)? ........................ Yes 0 No
19. Was the Fire�'Deipartment Connection (FDC) been back flushed in the last 5 years? ... Yes-:4 N*-,�
20. Was an internal pipe a d valve inspection performed within the last 5 years? ................. Y e s 9 L_--* No Q
Date Performed:
21. Was a signal received at the Central Station monitoring company? .................... N/A (3 Yes'O�� No [I
cl-
Sprinklers - WET Page: 2 of 2
Prntertonn &Communications, Inc.
(800) 774-9099 e Fax (425) 774-6317
www. pro-comm-online. com
I I ! i t
CONFIDEN CE TESTING
-OCT 3 12014 FIRE ALARM SYSTEM
TEST REPORT
NAME7 FACILITY
PHONE NO.
DATE0,PECTIO N
cr-
ADbRtgs
C,TyS"",_"
OCCUPIEDAS
MOMIOR
AC
TYPE OF TEST
MONTHLY El
QUARTERLY El SEMIANNUALE] ANNUALI;� ACCEPTEJ
PRO-COMM LICENCE
BATTERY VOLTAGE
j5-, 1
0 S
t;
BATTERY UNDER q f
IFULLLOAD vOT7
CHARGE CIRIC17, - VOLTS
1 07
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
TROUBLE AC OFF
CIRCUITS CHECKED
FOR SUPERVISION
X
SYSTEM WIRING CONFORMS
TO NFPASTANDARDS
SYSTEMOPERATES-
ON STANDBY POWER
CONTROLPANELCHECKED
PER NFPA & MFG INST.
y
KEY TO PANEL
AVAILABLE
SIGNALS OPERATE
OMACPOWER ; --;'
AUXILIARY EQUIP.
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
OPERATING INSTRUCTIONS
AT PANEL
j _1
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.
1<
ANNUNCIATORS
VISUAL ALARM DEVICE S
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
qMOKE.DETECT�ORS
4S MOKE 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
I 1��4,,;rtA+
JOTHER
SERVICE TECHNICIAN NOTES
FireWatqh Ui
.)req red,thfeatlevel 1 2 3 (see reverse for a threat level explaination)
A
rA- 41 _4A, _D 1
THIS IS TO CERTIFY THAT THIS FIRE ALAhMIH,�8,BEEN.PRQPffAL-ietTESTEE�AND�INSPtCl',ED FOR RELIABILIYY
TO COVER ITEMS LISTED IN THIS REPOFlf,'I��CNS6TENT WITHTIRE ALARM MAINTENANCE STANDARDS
OWNER WAS J14F;QRMED ABOUTANY NEEDED REPAIRS.ORPISCREPANCIES. "NAONEE], YES
C4
1 — 11 .
OW R R ACI 'REP t' :f I A
a 141 p - . I [
DATE
� 4 . 4 A
TEcHNICfA
liv
04
- . I I
1, ip,� AA 110ENS 'i ,A- Al"
tj
Z_IE� �41 /1 41
Y-e SIGNATURE :-1 ;2 IN f (1'. ,-,1 1 "?J-x
f)
SNOHOMISH CO.
FIRE
DISTR
7
Serving Brier, Edmonds, and-, -1,2425 Meridian Ave S
Mountlake Terrace Everett, WA 98208
Phone (425) 551-1200
T wiviv.FireDistrictLorg Fax (425) 551-1272
LOCATION: 6.58 Gati Street 98020
BUSINESS NAME: Gicnbrack Cancim
MAILING
ADDRESS: EA138 flicri Slrccl, Edmoricls-, \JVA 08020
PHONE:
FIRE PREVENTION
INSPECTION REPORT
EDMONDS
BRIER
0 MOUNTLAKE TERRACE
0 UNINCORPORATED
I'- FREQUENCY
STATION & SHIF'*"
Atithfal
17-D
SCHEDULED
II'
Aug 2014
DATE DUE
LIFIR 11, 424
BUSINESS OWNER: HOME PHONE:
EMERGENCY-1: HOME PHONE: CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES
BUSINESS
EMAIL: LICENSE 0
ONTACTED: X610 *z-o'l INITIAL INSPECTION DATE
PERSON C
NAME OF INSPECTOR: 1p, 401
FIRE SYS IEMS: 0113 FELO t
1pfA
HAZARDS FOUND AND LOCAfIONS / COMMUNICATIONS-
0
2 YA 14 Ar- -A'-4'(-e 61le 1--
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN TFJE NEXT 30 DAYS X
lst RE -INSPECTION
DATE DUE,
2nd RE -INSPECTION
E DUE,
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOL`A'TIONS
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
14
18
4
8
DATE:
DISPOSITION:
7
LETTER NEEDED Ej YES El NO I
LETTER NEEDED E] YES [:1 NO
8
FIRE DEPARTMENT COPY
Confidence Testing Company:
Fire Department
DVANCED
_Alv�
%,FIRE PROTECTION, !NC,
- P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
Confidence Test Report
Confidence Testing: 206.793.0936
SPRINKLERS - WET
Certification Given
RED 0
YELLOW U
I WHITE -S—
(NOTE: ONE SYSTEM PER REPORT)
CONFIDENCETEST: �Q—j REPAIRS:1 [I
Occupancy Address:4��_57 - 6--_�_Al
Occupancy Name: a �5�00
Building Owner:
Phone Number:
Responsible Person:
Phone Number:
Building Owner'
Address:
Date of Inspection:
Inspection Frequency/ Type: An n u al
Tester's Name (print): �_2�,e/�4rtification
Number: Scp-,S- - r'�b2(::5?_5F
Central Station monitoring? Yes -a No C)
Monitoring Co. Name:
Primary Component:
System Make:
System Model:
System Location:
Identification Number:
ProblernsFound: (if additional room is required, please add a separate sheet.)
Z
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 wflltent with the Authority Having Jurisdiction's Fire Department Fire Code standards'
All discrepancies are no a ave been 7rport d7 PA/the
building Owner/Manager for cor.rectiVe action.
Signature of Tester: 0/1 Phone #: 425.483.5657
Testing Agency: ,,A_d6nc`ed Fire Protection, Inc.
Mailing Address: P.O. Box 1543 - Woodinville, WA 98072
Building Representative (signature):
Sprinklers o WET Page: 1 of 2
The hp�' ifems on the check list shall be inspected and tested. This list does not -constitute all of the required
i%s6ft-'ricj�,and testing Qf;the Fire and Life Safety system. Refer to the Authority Having Jurisdiction's
Fire Department Fire Code for inspecting and -testing requirements.
General
1;��Flo`w Teiitcoriducted? ...... ...... . ........... I ................ I ............ ............... ...........................
Y e'sQ— No Q
2. Static Pressure: CP psi,,.- Flow,Pres§Ure: ;7 psi
3. Total number of sprinkler heads on this system?
A, Was 2" Main Qrpimchecked, ........ ........ ...................... . ..... .......... ........... ........... .............. Oit-h,e,r_Q',- '.Yes�Q_', No Q
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ..................................... NIA L] YesAl- No Q
6. Pressure regulating,.'va"I-Vesi,ftested?
............... ........ /At No 0
...........................................
No Q
Y'
7. Alarm Bell operate? ..................... .......................................................................... -NJIA
No El
8. System inspected and lu"b'dcated ? ................................................................................ ... s-9
9. Valves sealed or supervised?..7 ... ...................................................................................... z .......... Yes-C� No C3
-----------
10. Provided on all valves? ............................................................................................................. Y e s-Ei— N o 0
Ak
11. Pumper Connections and Clapper valves unobstructed and turn freely ? .................... Yes::Q— No L)
12. Sprinkler coverage acceptable? .............................................................................................. Ye§,,� No 0
13. Have the sprinkler heads been replaced or successfully sample tested in the last 50 years? Ye.-,.Q— No Q
14. Proper number spare sprinkler heads available with appropriate wrenchs'for each? .............. YeAa No Cj
15. System left in service? ............................................................................................................ Yes-E�— No 0
116. System gauges been replaced or calibrated within the past 5 years? ............................. Y egaipa- No (j
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Y e s-@—N o F-I
18. Was debris found in the Fire Department Connection (FDC)? ................................................ Yes [I No'U
19. Was the Fire Departm.efi_tZ onnection (FDC) back flushed within the last 5 years? ... Yes El No 0
20. Was an internall..Ilipe'and valve inspection performed within the last 5 years? ................. YescQ— No C]
Date Performed:
121. Was a signal received at the Central Station monitoring company? .................... N/A El Ye5,9— No (j
Sprinklers - WET Page: 2 of 2
-A=W-1-ffA..
CONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST REPORT
NAME OF FACILITY
G-6f /-./&o f)/<-
PHONE NO.
y2f-- 461,75
DATEjkjSPECTI
V.7- ?
ADDRESS
CITY Siz�_
zlpo�r
1
OCCUPIEDAS
MONITORED
71-412A, 5- 7P
ACCT
Z� -
TYPE OF TEST
MONTHLY QUARTERLY SEMIANNUAL ANNUAL Q9 ACCEPTE] �
PRO-COMM LICENCE
BATTERY VOLTAGE yom
BATTERY UNDER VOLTS
IFULLLOAD
CHARGE CIRCUIT VOLTS
-2-
ITEM
YES
NO
N/A
ITEM
YES,#J,
NO
N/A
ITEM
YES
NO
N/A
fe
TROUBLE AC OFF
CIRCUITS CHECKED
FOR SUPERVISION
SYSTEM WIRING CONFORMS
TONFPASTANDARDS
-SYSTEM OPERATES--
ON STANDBY POWER
CONTROL PANEL CHECKED-
PER NFPA & MFG INST.
gYT9PANEL_
AVAILABLE
SIGNALS OPERATE
ON AC POWER
AUXILIARY EQUIR
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
OPERATING INSTRUCTIONT_[.,�;;j
AT PANEL
TOTHER
EQUIPMENTTESTED
NO. OF UNITS
SATISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
I NO
I N/A
TYPEOFEQUIPMENT
INBLDG.
TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUALALARM DEVICES
/S'
E LEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
FIRE & SMOKE DAMPERS
MANUAL PULL STATIONS
`7
PHONEJACKS
SPRINKLER
SUPERVISORY SWITCHES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER
CENTRAL STATION
OTHER
VENTILATION CONTROLS
_PPERATE
O*THER
PANEL AND MODEL
bTHth -
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.
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. NONE YES
OWNER OR FACIIJ)REPRE NTATIVE
DATE
LICENSE NO
406�'
sl�/30
TUI:3E
FIRE PREVENTION
Serving Briei: Edmonds 12425 Meridian Ave S INSPECTION REPORT
SNOHOMI91i CO. OEDMONDS
Mountlake Terrace, and Everett, WA 98208 0 BRIER
FIRE the Town of Woodway Phone (425) 551-1200 E]WOODWAY
[I MOUNTLAKE TERRACE
DIST R W, tf* IT www.Firet)istrictl.org Fax (�25) 551-1272 0 UNINCORPORATED
FREQUENCY STATION &,SHIFT-')
OCATION: 658 Glen St 365 17 6
BUSINESS NAME: Glenbrook Condos PHONE: SCHEDULED 08/01/12
DATE DUE
MAILING LIFIR 1, 423 8253
ADDRESS:
BUSINESS OWNER: HOME PHONE:
4257128646
EMERGENCY�1: Giles., Jack #101 HOME PHONE: URRENT
KEY ACCESS'�: Votemann, M #301 HOME PHONE: 4257756616 ITY YES NO
BUSINESS NEI
FLICENSE
PERSON C . ONTACTED: /,///4-- INITIAL INSPECTION DATE
o
NAME OF INSPECTO�: 54,4( 7-9 0,L-)0 I �112
FIRE AS 9/07 FA 9/11 FD LkBx FE 4f I_L�?
3�STEMS: ANNUAL
HAZARDS FOUND AND LOCATIONS / COMMUNICATIONS
4 ZAA16 r__A Q AJ
2
2
3
3
4
4
5
5
6
6
7
7
I AGRE7E 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:,
DA E:
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
8
4 18
DATE:
DISPOSITION:
7
LETTER NEEDED E] YES [I NO
LETTER NEEDED [] YES C1 NO
8
FIRE DEPARTMENT COPY
Confidence Testing Company.
AWED
;(bV
N0U=z02LL1!L
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
-Sme-1,55',60e Fire Department
Confidence Test Report
206.386.1448 Confidence Testing Officer
206.615.1068 (fax)
206.233.7219Red Tag Hotline
SPRINKLERS - WET
Certification Given
—TYELLOW
RED
L)
I WHITE4�1—
(ONE SYSTEM PER REPORT)
CONFIDENCETEST: I-a-1 REPAIRS:1 C1
Occupancy Address- 4�cp
Occupancy Name:
Building Owner:
Phone Number:
Responsible� Person:._,7�4///2�) - 5etL5,/-/
PhoneNumber:
Building Owner
Address: 20��af-�—
Date of Inspection:
Inspection Frequency/ Type: Aaaua.L
Tester's Name (print): /045;�04> --'�WZSP14116W
SFD Certification Number: SCP- '5 -e9c24�>_'5'
Central Station monitoring? Yes-5— No Q
Monitoring Co. Name: 7�0
Primary Compone
System Make: Cdx;:A7,11_7PA
System Model: -r 7 r, F
System Location:
Identification Number:
ProblemsFound: (if additional room is required, please add a separate sheet.)
Corrections Made: Date Corrected:
Corrected by:
(If addifional 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
r
are noted and have been y.e orted to the b ildm- Wner/Manager for corrective action.
Signature of Tester:
Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 -Woodinville, WA 98072
Building Representative (signature):
Sprinklers 9 WET Page: 1 of 2
The belc,,N items on the check list shall be inspected and tested. This list does -not constitute all of the
reAtdre&qnspeGfing and testing of the Fire and Life Safety system. Refer to the Seattle Fire -Department
Fire Cci,'dj for inspecting and testing requirements.
I
General
"I. Flow test"ponducted? ......................................................................................................................................... Yes-U-�- No C1
2. Static Pressure: psi Flow Pressure: psi
3. Total nuRber of spri nkler heads on this system?
4. Was 2" Main Drain checked? ...................................................................................................... OtherCI Yes -a- No El
5. Flow Switches, Supervisory Switches and Alarm Bells tested? ..................................... N/A Q Y e No C1
6. Pressure regulating valves tested? ............................................................................... N/A-0— Yes U No C3
7. AlarM'Pell "operate9, . ........................................... ................... No L)
........................................ N/A Q Y e s,.i
8. System inspected and lubricated ? .................................................................................. Yes-0- No 0
9. Valves sealed or supervised? ......................................
..................... . ..... ........................................ Yes`� No El
10. Providdd"Gn all valves? ............................................................................................................. Yes--d- No C3
11. Pumper Connections and Clapper valves unobstructed and turn freely ? .............................................. Y es-C3- No Q
12. Sprinkler coverage acceptable? ............................................................................................. Y _es- L j No LI
14. Proper number spare sprinkler heads available with appropriate wrenchs for each? .............. Y es -a- N o Ll
15. System left in service? ............................................................................................................ Yes�Q- No E)
16. System gauges been replaced or calibrated within the past 5 years? ............................................. Yes Q No 0
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Yes-Ej- No E)
18. Was debris found in the Fire Department Connection (FDC)? ................................................ Yes [I No -a
19. Was the Fire Department Connection (FDC) back flushed within the last 5 years?./Y Yes U No 0
20. Was an internal pipu d valve inspection performed within the last 5 years? ................. Y e s-E]�- N o C1
Date Performed: .' -2 ;6" -
21. Was a signal received at the Central Station monitoring company? .................... N/A E) Ye,%-F
No 0
Sprinklers * WET Page: 2 of 2
C&nfidence Testing Company:
�-AABVANCED
P.O. Box 1543 - Woodinville, WA 98072
Ph.: 425.483.5657
Steftibe 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
WHITE
(ONE SYSTEM PER REPORT)
CONFIDENCE TE$,,T-:/ REPAIRS:1
Occupancy Address.
Occupancy Name: (9.4&_A�1900A-
Building bwner:
Phone Number:
Responsible Person: Z�-"A vz�;p
Building Owner CJF
Phone Number:
Address:
Date of Inspection: ;, 00
Inspection Frequency Type:
Tester's Name (print): /;-,��42L_(;d��SFD
Certification Number SCP-_,S,:-Q5?425_�'
Central Station monitoring? Yes-@— No
Monitoring Co. Name:
Primary Component:
System Make:
System Model:
System Location: (;O� A C/:i--,
Identification Number:
ProblernsFound: (if additional room is required, please add a separate sheet.)
Corrections Made Date Corrected:
Corrected by:
(If additional room is required, please add a separate sheet.)
SFD Certification Number: SCP-
This certifies that this Fire and Life Safety system has been properly inspected for reliability to cover the items
listed in this report and is consistent with the Seattle Fire Department Fire Code standards, and all discrepancies
are noted and have been 61d to the buil ng 0 � r/Manager for corrective action.
Signature of Tester:
Phone #: 425.483.5657
Testing Agency: Advanced Fire Protection, Inc.
Mailing Address: P.O. Box 1543 -Woodinville, WA 98072
Building Representative(signature):
zg=L_��
Sprinklers -, WET Page: 1 of 2
The below items on the check list shall be inspected and tested. This list does not constitute all of.the
requirdd- inspecting and testing of the Fire and Life Safety system. Refer to.the Seattle Fire Department
Pire Code for inspecting and testing. requirements.
General
1, Ftq%v,,Test�ponducted? ................................................................ * .............................................................................. -E9, No El
Yes
2. Static Pressure: ZOO/ psi Flow Pressure: psi
3. Total number of sprinkler heads on this system?
4. Was 2" Main Drain checked? ................................................ ...................................................... Other El Yes"IEr No 0
5. Flow --$witches, Supervisory' Y e s-&, N 0 El
jWfttch!!s and Alarm Bells te sted ? .............. . .. . .................. N/A
J;�- '/C ; I "' -
6. Pressure regulating valves tested? ............... * .............................................................. N/
Yes C1 No 0
T. Alarm, Bell operate? ............................................................................................... I ........ N/A Ye.s-9— No Ll
8. System inspected and lubricated ? .................................................................................. Yes'q5--No L)
9. Vol`
ypssealed or supervised? ........................................................................................................... Y
e- No 0
10. Provided on all valves? .............................................................................................................. Yes--M—' No Q
11. Pum Connections and Clapper valves unobstructed and turn freely ? .............................................. Ye5.6— No E)
pe
12. Sprinkler coverage acceptable? ............................................................................................. Ye.s--Ej— No C)
13-Have,the sprinkler heads been replaced or successfully sample tested in the last 50 years? Ye No E)
14 . Proper number spare sprinkler heads available with appropriate wrenchs for each? .............. Yes:::a� No L)
15. System left in service? ............................................................................................................. Y&s-El— No LI
%,,qyatem gauges been replaced or calibrated within the past 5 years? ............................................. Yes-� No C),
17. Sprinkler heads free of corrosion, paint, obstructions and/or physical damage? ..................... Yes-�No Ej
18. Was debris found in the Fire DepArtment Connection (FDC)? ................................................ Yes E] No-tfl
19. Was the Fire Department Connection (FDC) back flushed withint-thg lCi 5 years? A .. Yes Q No El
20. Was an internal pipe and valve inspection performed within the last 5 years? ................. Yes-0-- No C)
Date Performed:
21. Was a signal received at the Central Station monitoring company? .................... N/A El Y e s-Er- N o (3
Sprinklers 9 WET Page: 2 of 2
w_1_ V_ AF #_ 0-
I- A
-I- Ell
zt-4
CONFIDENCE TESTING
FIRE ALARM SYSTEM
TEST RE'PEIRT
,��O,F FACILITY
., le
PHONE NO r - '
ly z
�E INSPECTION
fa, / Z__
ADD
64 ell
cl
zle
790_71_��
OCCUPIED AS
MONITORED BY
ce P7 te r
ACCT #
It"113
TYPE OF TEST
MONTHLY 0
QUARTERLY 0 SEMIANNUAL El
ANNUAL a;--ACCEPTE:l
PRO-COMM LTCENCE
BATTERY VOLTAGE
2
VO4st
BATTERY UNDER
IFULLLOAD 2 Y,
VOLTS
;f/
CHA�EJC RCUIT VOLTS
. 7 !Z
ITEM
YES'
N/A
ITEM
Yl�s
NO
N/A
ITEM
YES
NO
N/A
_TROUBLE AC OFF
CIRCUITS CHECKED
FORSUPERVISION
VO"
SYSTEM WIRING CONFORMS
TO NFPA STANDARDS
SYSTEM OPERATES
ON STANDBY POWER
V100
CONTROLPANELCHECKED
PER NFPA & MFG INST
KEY TO PANEL
AVAILABLE
SIGNALS OPERATE
ONACPOWER
AUXILIARY EQUIP.
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
V000,
i
OPERATING INSTRUCTIONS
AT PANEL
OTHER
EQUIPMENTTESTED
NO. OF UNITS
S ISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
f_E§T�D
YES
NO
N/A
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
NO
BELLS, HO NS, CHIMES,
VOICE ALARM, SPEAKERS
-517nr-
27
ANNUNCIATORS
_N/A
VISUALALARM DEVICES
t
ELEVATOR CALL DOWN
HEAT DETECTORS
DOOR RELEASE
SMOKE DETECTORS
4-
:7-
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
13
OTHER
PANEL AND MODEL
OTHER
SERVICE TECHNICIAN NOTES Fire WatchiAuired, threat level
1 2 3 (see reverse for a threat level exp'lanation)
THIS IS TO CERTIFY THAT THIS -FIRE ALARM HAS BEEN PROPERLY TESTED AND'INSPECTEb FOR RELIABILITY
TO COVER ITEMS LISTED IN THIS REPORT, IS CONSISTENTWITH FIRE ALARM MAINTENANCE STANDARDS:
OWNER WAS INFORMED ABOUT ANY NEEDED REPAIRS OR DISCREPANCIES. NONE YES
OWNEFI'OR FACILITY EPRESENTATIVE
DATE
�7 Z__
TECHNICIAN
LICENSE NO.
'8rGWATORE
Protection & Communications, Inc.
(800) 774.79099� Fa.x (425) 77476317
M-T
-com �on I ine.com
pro
mqw
CONFIDENCE TESTING
..FIRE ALARM SYSTEM
TEST REPORT,
NAME OF F
.,.,:.PHONE
405P
ap"
9AT INSPECTI
ADDRE SS
CITY STATE
1.
ZI 15
OCCUPIED AS
MONITOR
A_Gr_7F�#
TYPE OF TEST
MONTHLY El
QUARTERLY El SEII ANNUAL 0
ANNUALV ACCEPT
PRO-COMM LICENCE,
BATTERY VOLTAGE
VOLTS
BATTERY UNDER.
FULL LOAD
VOLTS
CHARGE CIRCUIT VOLTS
ITEM
YES
NO
N/A,
ITEM,
�
K10
N/A
ITEM
-YES
NO
N/A
TROUBLE AC OFF
CIRCUITS CHECKED
FOR SUPERVISION
__YES
SYSTEM WIRING CONFORMS
TO NFPA STANDARDS
.SYSTEM OPERATES
ON STANDBY POWER
z�
CONTROLPANELCHECKED
PER NFPA & MFG INST
A(,—
KEYTOPANEL
AVAILABLE._
SIGNALS OPERATE
ONACPOWER
UXILIARY EQUIP.
OPERATES
OTHER
SIGNALS OPERATE
STANDBY POWER
OPERATING INSTRUCTIO�`§
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/
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
VISUALALARM DEVICES
ELEVATOR CALL DOWN
HEAT,DETECTORS
DOOR RELEASE
SMOKE DETECTORS
V,
FIRE & SMOKE DAMPERS"
MANUAL,PULL STATIONS
-7
-7
PHONEJACKS
SPRINKLER
SUPERVISO ' RY SWITCHES
AUTO DOOR UNLOCKS
(FAIL-SAFE)
SPRINKLER
FLOW SWITCHES
OTHER
CENTRAL STATION
OTHER
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)
jz1-
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 ll�[FORMED ABOUT ANY NEEDED REPAIRS OR DIS!�REPANCIES. NONEL3K YES
OWNER OR'FACILITY. REPRESMTATIVE
7DATE
TECHNICIAN
7[��SE
NO./ 2
JRE
City-aWl Wfiffe Fire Department
-.., /m*�D VA N C E D
N==ZM2L!�� CONFIDENCE TEST REPORT
Seattle Fire Department Confidence Testing Officer: 206.386.1448, Fax:206.615.1068
WET - AUTOMATIC SPRINKLERS I Certification Given
(NOTE: ONE SYSTEM PER REPORT) I RED Ll I YELLOWE31 WHIT.E
Date of Inspection: CONFIDENCE TEST. Ann ua ILI Quarterly D Acceptance El I REPAIRS: 0
Tester's Name (print).1%4P 0/- SFD Certification Number. SCP-�5,00?49s-q
a,A-1 I __a
Occupancy Name:r,.-'1---A113)Pro-,1-- caiPo llo.,4
Occupancy Address: e4s�? r�14�
R ponsible Person'.
es
Ph one Number:
Building Owner's Name:
Building Owner's Address:
Contact Person:
Phone Number:
Central Station monitoring? Yes-B-- No El Control Panel Manufacturer: JV - 4
Monitoring Co. Name: f�?o COIA-7m Model Number: �Y-9d
1
ProblemsFound: (If additional room is required, please add a separate sheet)
CorrectionsMade: (Ifadditional room is required, please add a separate sheet.) DateCorrected: Corrected by:
The below items on the check list shall be inspected and tested. This list does not constitute all the required inspecting and testing
of the Fire and Life Safety system. Please refer to the Seatfle Fire Department Fire Code for inspecting and testing requirements.
80. Was a Flow Test conducted?
Yes,&-
No E]
81. Static Pessure: -2 0 0 psi Flow Pessure: 2-1- psi
Y e s -E3--
No 0
82. Was 2" Main Drain checked?
OtherLl Yes -a-
No El
83. Were all Flow Switches, Supervisory Switches and Alarm Bells tested?
N/A El Yes-9-
No El
84. Does the Alann Bell operate ?
N/A E] Yes-9-
No El
85. Were all valves inspected and lubricated ?
Yes-E�-
No j
86. Were Pressure Regulating valves tested?
Yes 0
No-a-
87. Were all valves "sealed" or supervised?
Yes-9-
No CJ
88. Are signs provided on all valves?
Y e s-8-
No 0
89. Are the Pumper Connections and Clapper valves unobstructed ?
Yes-Ej-
No L]
90. Are the sprinkler heads less than 50 years old?
Yes-ljl-
No C]
91. Is the sprinkler head coverage acceptable?
Y e s-5-
N o El
92. Are spare sprinkler heads available?
YesvE),--
No E]
93. Was the system left in service?
Y e s-@—
No 0
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 discrepancies are noted and have been
reported to the building Owner/Manager for corrective action.
Signature of Tests
Testing Agency: Advanced Fire Protection, Inc. Phone: 425.483.5657
Mailing Address: P.O. Box 1543 , Woodinville, INA 98072
V 0 P
AmZG;i� CONFIDENCE TESTING
i Prati6tion 4 Communications, Inc., FIRE ALARM SYSTEM
4�x (425) 774-6317' TEST REPORT
''(800) 774;-9099
www
nhne'.com
.-VO-qOMM70
NAMEOF L17
P
PHONE NO.
DATE INSP CTI N
ADDRE59-
CITY
�AIE
Zip
'99 (2)6
OCCUPIED AS
MONITORqD BY
ACCT,#
6., (1
TYPE OF TEST
MONTHLY,0 QUARTERLY El �SEMIANNUALE:] ANNUAL ACCEPTE1_r
PRO -CO M LICENCE
BATTERY VOLTAGE VOLTS
)15`3
BATTERY UNDE�,q YQJS
FULILLOAD Ll
I—
CHARGE CIRCUIT VOLTS
.0.11
g2l'
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
ITEM
YES
NO
N/A
CIRCUITS CHECKED
EQB�'UPERV'S'ON
y
SYSTEM WIRING CONFORMS
TO*NFPA STANDARDS
SYSTEM OPERATES
ON STANDBY POWER
CONTROLPANELCHECKED
PER NFPA & MFG INSI.
KEYTOPANEI:--'
SIGNALS OPERATE
ON AC POWER
AUXILIARY EQUIP.
OPERATES
-AVAILABLE
OTHER
-,SIGNALS OPERATE
�TANDBY POWER
OPERATING INSTRUCTIONS
AT PANEL
IOTHER
EQUIPMENTT�STED
NO. OF UNITS
SATISFACTORY
NO. OF UNITS
SATISFACTORY
TYPE OF EQUIPMENT
IN BLDG.
TESTED
YES
N/A
TYPE OF EQUIPMENT
I� BLDG.
I TESTED
YES
NO
N/A
BELLS, HORNS, CHIMES,
VOICE ALARM, SPEAKERS
ANNUNCIATORS
tx
VISUAL ALARM DEVICES
ELEVATOR CALL DOWN
�4-
HEAT DET EC TORS
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
YENTILATION CONTROLS
�_OaIERAJE_
OTHER
PANEL AND MODEL
A-1 �MZI
OTHER
SERVICE TECHNICIAN NOTES -1 Fird WatCh rWkdd, thniat level 1 2 3 (see reverse for a threat level explanation)
Il- r
A, 94
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 RISCREPANCIES. NONE YESkf;2�
OWNER,OFr7CILITY RE_PR SENTATIVE
DATE r
TECHN
LICENSE NO.
P
_SIGNATORE