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grrCITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner eO ?J126 <br /> Job Address 3oo.3 t ) 0A-5i/tub. yes--6M) Permit No. )( 13 0 7 "- --- <br /> C_C.,... <br /> The refrigerant line /natural / LP / medical gas system circle one was tested at < `psi for a <br /> total of itAO minutes. <br /> WITNESSED BY Date <br /> (Signature <br /> of occupant requesting gas <br /> service) - <br /> INSTALLED BY �L �` � SC — Date j l / 3 <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.(WAGS'-I-42-1108) <br /> Hard Copy -Job Site Pink Copy - ContracU White Copy - Inspector oe <br /> PWPTA(5/17) <br />