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#1.14Y,----.4 <br /> CITY OF EVERETT <br /> 3 PIPING TEST AFFIDAVIT <br /> Lel- q <br /> Owner I joi;INI., 6- Li> Devao-ru-,-1------ <br /> Job Address ® 1 3 ` 7 p i 5 Permit No. TA /MoD 6 ci <br /> R 5" <br /> The refri.-ra line/ natural / LP / medical gas system (circle one) was tested at 7 psi for a <br /> tota o -ice i-7 min es. <br /> .......- 6;, _ <br /> WITNESSED BY / Date L <br /> ) (7 <br /> (Signet of oc. ,(t reques'ng gas ice) —/ <br /> INSTALLED BY (9 Date <br /> (Signature of installing 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 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 <br /> dill <br /> PWPTA(5/17) <br />