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imprr <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner <br /> Z�U n ( <br /> Job Address V O& v� �,r��� c -r Permit No. {R" �,t��,5 `Q 4 <br /> The refrigerant line / natural / LP/ medical gas system (circle one) was tested at I S psi for a <br /> total of minpf. <br /> WITNESSED BY Date 57,,P( M( <br /> (Signature of occup requesting gas service) <br /> INSTALLED BY . S L.— 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 /> • <br /> Hard Copy -Job Site Pink Copy - Contractor White Copy - Inspector <br /> 41115::// <br /> PWPTA(5/17) <br />