Laserfiche WebLink
CITY ��F FVERETT <br />PIPING TEST AFFIDAVIT <br />-� / � <br />Owner --�=-` — ��/—�_- - — -- — <br />Job AJdress � `�-'�� _�Y1 � � __ __ _ Permit No. <br />The refriyerant e/ natural / LP <br />total of �_� minu �,/�i <br />WITNESSED BY %//.i�1O,L <br />medical yas system (circie one) was tested at <br />% �//�(�� <br />� <br />� <br />�-'i=---�---�� <br />/ <br />� � psi for a <br />_aL Date /�� <br />u �arn rcyuest�ng yas servicc� -- <br />INSTALI_FD BY (� ��. `. y��` Date ��� � � <br />—��S�ur�arssrstr7zj y�rsrtt� <br />Please arrange (or someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />F[FRIGERANT CONTAINING PARTS OF THE SYSTEId THAT IS FIEID ERECTED SHALL 0[ TEST[U FOR LEAK AT TEST PFESSURES NOT <br />LESS THAN THE LOl"�ER OF THE DESIGN PRESSURFS OR THE SETTGVG OF THG PRESSURF RELIEF DEVICES. THE DESIGN PRESSURE <br />FOH TESTING SHALL BE THOSL IiSTED OtJ THE COP:DENSING UNIT OR COMPRESSOR UNIT NA6IEPLl�TE (W�C 51�42�110H) <br />Hard Copy - Job Site <br />Pink Copy - Contractor White Copy - Inspector <br />