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4[77- CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />Owner i J/ <br />/j 0/ <br />Job Address / gr 6 �- Permit No. ( Q,� / �LO (5 '- 0.^-- , 12 - <br />The refrigerant line <�� LP / medical gas system (circle one) was tested at psi for a <br />total of minutes. <br />WITNESSED BY <br />Date <br />nature o o ant r ting gas service) <br />INSTALLED BY .0- <br />Date <br />Signature OT-Insiwng gas fitter) <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 LEAK 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 NAMEPLATE. (WAC 51-42-1108) <br />Hard Copy — Job Site Pink Copy — Contractor White Copy — Inspector <br />