HomeMy WebLinkAboutCOM2016-00050 - COM Permit / Conditions - 4/8/2016 s
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Range Hood System Report
_T S V E COMPAN DATE OF SERVICE TIME A.M. P.M.
ANNUAL SEMI-AN UAL RECHARGE INSTALLATION RENOVATION
A e r a (� /LPC TIIOfN�OF YSTEM CYWIDERS; UL 300
3 Ave. SW " ' Pr1C Y0 ❑YES NO
Tumwater, WA 98512 MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
360-943-5634
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
_ FUSE LINKS 360'R FUSE LINKS 450'F. FUSE LINKS 500'F. OTHER
CUSTOMER
Name
FUEL SHUT-OFF ELECTRIC GAS SIZE
Address
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
City State ZIP 2.00 +
MANUFACTURER'S MANUAL REFERENCE
Telephone Store No.
PAGE NUMBER: DRAWING NUMBER: DATE
Owner or Manager
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
1. All appliances properly covered w/correct nozzles 20. Replaced fuse links
2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks J
3. Check positioning of all nozzles. 22. Piping&Conduit securely bracketed J
4. System installed in accordance w/MFG UL listing 23. Proper separation between fryers&flame J
5. Hood/duct penetrations sealed w/weld or UL device 24. Proper c earance-flame to filters J
6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order
7. If system has been discharged, report same 26. All filters in place
8. Pressure gauge in proper range (If gauged) 27. Fuel shut-off in on position
9. Check cartridge weight(If applicable) 28. Manual remote set/seals in place
10. Hydrostatic test date 29. Replace systems covers J
11. 6 year maintenance date _ 30. System i perational&seals in place
12. Inspect cylinder and mount 31. Slave system operational
13. Operate system from terminal link 32. Clean cylinder&mount
14. Test for proper operation from remote 33. Fan warning sign on hood
15. Check operation of micro switch 34. Personn 'I instructed in manual operation of system
16. Check operation of gas valve 35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly servic@d
18. Proper nozzle covers in place __ 37. Service&Certification tag on system
19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW
COMMENTS:
On this date, this range hood fire suppression system was inspected and operationally tested in accordance with the fire
suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual, with the re ults indicated above.
SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMERS AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected a Ind found conditions to be as indicated on this report.
AUTHORITY HAVING JURI ICTION
3
s,
MASON COUNTY PFERMIT NOS ,,"f:
! DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING-PLANNING-FIRE MARSHAL
-., WWW,CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg.111,426 West Cedar Street (360)275-4467 Belfair ext..352
PO Box 279, Shelton,WA 98594 (360)482-5259 Eime ext.352
PLUMBING & MECHANICAL PERMIT APPLICATION
QVvNERMORNUTION. CONTRACTOR INFORMATION--
rV
NAME: NAME:
MAILIN .ADDRESS: MAILING RE S:
STATE-
CITY: STATB: �_ZIP: CITY: U STATE:_ft'0" '
PHONE... I I CELL: PHONE: q9y LL:
EMAIL: EMAIL Q �`
L&I REG# E)T-Q1.1�/L
M!gEL IIVFORMATIQN-
PARCEL NUMBER(I2 DIGIT NUMBER):
I�t—1 j 5-7�&R
LEGAL DESCRIPTIO ABB �7�D>:
SITE ADDRESS: CITY:
DIRECTIONS TO SITE ADDRESS:
TYPE OF JOB
NEW -- ADD AI,T REPAIR OTTER USE OF BUILDING
LOCATION OF MTVFE 1s'r FLOOR 2�'FLOOR BASEMENT GARAGE OTHER
PLUMBING p'DMWS(SHOW NUMBER OF EACH) NIECRAMCAL UNJ'I,'S
Type of Fixture No.of FLxqr-p5 ELM Fuel Type:Electric LPG Natural Gas Heat Pump—
Toilets _Type of Uait No nits Fees
Bathroom Sink Furnace
Bath Tubs Heatpump
Showers Spot Vent Fait
Water Heater —� Propane Tank —
Clothes Washer Gas Outlets
Kitchen Sinks Wood/Gas/Pellet Stove
Dishwasher — — Kitchen Exhaust Hood
Hoscbibs e'er Vent
Other Other —
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER/BUILDER acknowledges submission of inaccurate information may mutt in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that 1 am the owner,owners legal representative,or contractor.I further declare
that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including
any easement holder or parties of interest regarding this project The owner or authorized agent represents that the information provided is
accurate and grants employ of Mason County access to the above described property and structure(s)for review and inspection,This
parmit/application becomes n I &void If worts or authorized construcdon is not commenced within 180 days or if construction work is
suspended fora period of 180 d ys.PROOF OF CONTINUATION OF WOkK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS
PE ATIO OF 4 0 DAYS WILL INVALIDATE THE APPUCATION-
irb,of Ap icant Date
X �` ;� >,A Owner/Owners RepinegentafivelContra2tor
Print 14ame (indicate which one)
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE NJARSHAL
ZB/Za 39Vd JNIiV3H DIdNA70 99bLLZb09C 00 :ST 9Z07,/L0/b0