Laserfiche WebLink
Owner <br />�ob Address <br />LL <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />� UL-' <br />rvo. 'h1 I 30 �� a`f Z <br />src tir. <br />The refrigerant lin� natural / LP / medical gas system (circle one) was test�d at �Q6 psi !or a <br />tota s. `�� �'�"' <br />WITNESSEDB �'�-F+� '��� Date ��ZS\Zo14 <br />( ture o occupant requesting gas service) <br />INSTALLED BY ��`�� ��'�c•� '��� Date _ �� S\Z"�`� <br />(Si a ure o ins a ing gas litler) <br />Please arrange for someone to be present on the date of requested inspection to Nrovide access for <br />the insNection. <br />REFRIGERANT CONTAINING PARTS OF THE SVSTEM THAT IS FI[LD ERECTEO SHALL BE TESTED FOR LEAKS AT TEST PRESSURES PlOT <br />LESS THAN THE LOWER OF THE DESIGN PRE£SURES OR THE SETTING OF THE PRESSURE RELIEF C'tVICES. THE DESIGN PRESSURE <br />�FOR TESTING SHALL BE THOSE LISTED ON THE �CYDENSING UNIT OR COMPRESSOR UNIT NAME PLl.TE. (WAC 51•42-1109) <br />�• Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />PWPTA (5/17) , <br />