Laserfiche WebLink
Owner <br />Job Address /U,�"� <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />The refrigerant line natural P/ medical gas system (circle one) <br />total of �-(J minutes. <br />/�l <br />WITNESSED BY ?����� '-�, 1 �I��,L <br />(Signature,of occup�nt reque ting gas service) <br />/ �",, / <br />INSTALLED BY _.-�:'_t_`��t-�>�a��.. .(��� = <br />� ( ignature of installing gas fittex}` ` <br />U <br />� Permit No. Y \ �G� ��l �`' <br />� �, <br />was tested at s� � psi for a <br />Date � i ��. � � 6 <br />/ <br />� <br />Date l — <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE. (WAC 51-42-1108) <br />Hard Copy - Job Site Pink Copy - Contractor White Copy - Inspector �t <br />PWPTA (5/17) <br />