Laserfiche WebLink
! ' K:. � <br />-k S+ .�. <br />r7 <br />Q <br />� Y ��'r. 1f4��<i�._ . <br />'� i9 <br />h <br />N r <br />f <br />�• -: <br />✓, <br />�l}Y <br />i ,�,:1 <br />i, r � � <br />f <br />.� <br />:� Y � <br />�. ... ... �� . <br />Owner <br />Job Address <br />�,'� , -�vs� <br />. ' y . 4J'�r.."�, <br />h A3t) y,� <br />wnr ' Ylt <br />� r <br />d �j � <br />� � i J ''�*�'r' /i <br />.l� � <br />�� � <br />' a� <br />}' �.. <br />t <br />+'� :�.' � � . '_ <br />CITY OF E1/ERETT <br />PIPING TEST AFFIDAVII' <br />.�� <br />Permit No. .0 `7a 2-n � � <br />STh��/� T�Si'_ <br />Tlie refrigerant line / natural / LP / medical gas system (circle one) was tested at �� psi for a <br />total of _� minutes. '�/�$ T-P_� �i <br />/e�tc�2c1}r i�/� <br />WITNESSED BY Date � N'`' �� <br />i c pant reques gas servicT— 7 <br />INSTALLED BY � ,%�.� Date 9�j6��� <br />stg�S�tar�-ar�m��gas � <br />Please arrange for sorrieone to be present on the date of requested inspection to provide access for <br />the inspection. <br />AFFRIGERANT CONTAIN�NG PARTS OF THE SYSTEM THAT IS FIELD ERECTLD SHALL BE TESTED FOR LEAK AT 7EST PRESSURES NOT <br />LESS THAN THE LOWER OF THc DESIGN PRESSURES OR THt SETTI�IG OF THE PRESSURE RELIEF DEVICES. THE DESIGfJ PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COt.1PRESSOR UNIT NAMEPLATE. (WAC 51-42-1108) <br />��� Harc! Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />�- <br />