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CITY' OF EVERETT � <br />PIPING TEST AFFIDAVIT <br />� <br />oWne� <br />JobAddress 1050d d�tTh L1� �� �J�r��,9$aag PermitNo. m��q--p2� <br />� <br />The re(rigerant,line / natural / LP / medical gas system (circle one) was tested at �_psi for a <br />/ <br />totaf of _%__ minutes. <br />WITNESSED BY r� �V , L`���/ Date ������ �;� <br />—�ignaWre o occupant re estmg gas service — <br />INSTALLED BY Z ��.C-- Date �p��'3 l �� <br />i in�j �ti <br />Please arrange for someone to be present on the date of requested inspection to provide access for _; � <br />the inspection. ' ,,,�a <br />REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />LESS THAN THE I.OWER OF THE DESIGN PRESSURES CR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT Ofi COMPRESSOR UNIT NAMEPLATE. (WAC 51•42-7108) <br />Hard Copy — Job Site Pink Copy — Contractor White Copy — Inspector <br />