Laserfiche WebLink
Owner �i� <br />CITY OF EVERETT � � <br />PIPING TEST AFFIDAVIT <br />�% <br />Job Address ��O ���`���i1 LL- Permit No. � t��~�Z <br />The refrigerant lin natural / LP / medical gas system (circle one) was tested at ��� psi for a <br />f1 rs /f � J <br />total of 2 y minutes. �—'\ ��\ <br />WITNESSED BY �i n��, a r, y S� ����s Date �� ��Z � 1�-{ <br />(Signature ol occupanl requesling gas service) <br />INSTALLED BY �—��� Date _ 7� �G � 2 a�'-1 <br />(Signd�reol insla ing gas itler <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFFlIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS ATTEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICtS. THE DESIGN PRESSUHE <br />FOR TESTING SHALI BE THOSE LISTEO ONTHE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE. (WAC 51•42-110B) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />PWPTA (5/17) <br />