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ASSOCIATED PERMITS
05-F-186 D05-331
TUKWILA FIRE ' EVENTIQN BUREAU
444 Andover Park East, Tukwila, WA 98188 -Phone 206-575-4407 - Fax 206-575-4439
E-mail: tukfdprv@ci.tukwila.wa.us
Fi LECONTRACTORS MATERIAL AND TEST CERTIFICATE
FIRE ALARM AND FIRE DETECTION SYSTEMS
Fire alarm System is ready for Fire Department acceptance testing. Failure of test will result in
termination of the testing and additional fees will be assessed. Contractor is responsible for
supplying manpower for. Final Acceptance Test with two-way communications.
Date 1:(3(10(0C Pe nit # O S. —( /8
Installing Company
,Installing Contractor's Address 6710 S
City N ZL Phone # LOL 762_ I q, _
Installer'rs Name (PRINT) C AG( Ozz0
License and/or Certificate 5Gp Q —o 215-
Name
ssName of Facility VA', %-/- r SPItc
Address t j��� 4' iJ(
Property
City TUkwlla/ Zip Code
Occupied as VireANT /
Phone # --0 a,
General Contractor TrE9 =(`}S LoC IP •
Electrical Contractor
Owner or Representative -Qt 3L g�y iS
FRCP. Equiprnent Manufacturer
n (U
This system has been installed, -2F -tested and 9perates in accord\aj}c-e'w'ith,,Xhe standards listed below and
was inspected by Fc, �r t W0 f) IcE IfVS 1 r� _'( �
On (date) ' t �( (01 Q and includes the devices listed on back.
Circle all that apply:
NFPA 72, Chapter 1 2 4 5 6 7 and/or UFC STD 10-2:SBC L7.1.2, 1997 ED.
'�/ NFPA 70, National Electrical Code, Article 760 Manufacturer's Instructions
Manufacturer's Instructions
Other (specify:) .,
Tukwila City Ordinance Numbers 1900, 1901
UL Central Statin u e • ' 1 ti`b tl Agf5111 System is monitored by 41 m \16// 4 e -la
SIGNED — /0/10 /c-
System
Firmware: (�l f (..��L (ck-
Installed version hecksum Date
Initial program
Installation Date
Model #
Date
Revisions and Reasons
Programmed by
Tukwila Fire Prevention Bureau- Material and Test Certificate
_EQUIPMENT INSTALLED AND TESTED:
Control Panel of
Manual Station of
Smoke Detectors 1 of
Heat Detectors of
Duct Detectors of
Make/Model
Make/Model
Make/Model es L a I
Make/Model
Make/Model •
- f
A/V Devices ofL-J Make/Model
Audio Devices of Make/Model.
Visual Devices j of Make/Model w a -Loci(
Auto Door Release of
Trouble Indictors of
Batteries
Readings Battery
Generator of
HVAC Controls of Make/Model ,
Fire Alarm Dialer of Make/Model
Make/Model
Make/Model
Full Load Charge
Make/Model
Monitored by
Annunciator of
Make/Model
Sprinkler System. (Fire Alarm connections only)
Water Flow Sw.
Valve Tamper Sw.
PIV
Elec. Alarm Bell
of Make/Model.
of Make/Model
of Make/Model
of Make/Model
Automatic time Delay of Water Flow Alarm
seconds. None Installed
Do you meet audible/visible requy6ments of WAC 51-44, UFC STD 10-2, 1997 ED., and/or NFPA 72,
1999 edition; Chapter 6? Yes No
A
Test of alarm System on emergency power, satisfactory? Yes . No
Test Witnessed by Title Date
Comments:
A-1) d`l
g_\JO-j
ANO (t) .3cot
TFD FP Form #110
2
City of Tukwila
Fire Department
NOV 1 4 2005
TUKWILA FIRE DEPARTMENT
FINAL APPROVAL FORM
Permit No. 00r-31 )
Project Name th't vo 2
Address ?/ \--/ 0Y- Suite #
Retain current inspection schedule
Needs shift inspection
Approved without correction notice
Approved with correction notice issued
Sprinklers:
Fire Alarm:
Hood & Duct:
Halon:
Monitor: kJ,— Cc -1
Pre -Fire:
Permits:
Occupancy Type:
leo e i(-- k -off
Authorized Signature Date
Final Approval Frm
Rev. 5/2/03 T.F.D. Form F.P. 85
Headquarters Station: 444 Andover Park East • Tukwila, Washington. 98188 • Phone: 206-575-4404 • Fax: 206-575-4439