Loading...
HomeMy WebLinkAboutWet Fire Sprinkler System Inspection Report - 8/9/12 . ., , � 21°173 Form for Inspection, Testing and Maintenance of ��{� QN�s'a Wet Pipe Fire Sprinkler Systems ` ��a�»Fl���^�� This form covers the minimum requirements of NFPA 25-2008 for wet pipe fire sprinkler systems connected to water supplies without tanks or fire pumps. Separate forms are available for inspection, testing and maintenance of fire pumps, tanks, and other fire protection systems. More frequent inspection, testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. The work covered on this form is (check one): ❑ Monthly ❑ Quarterly �i( Annual ❑ Third Year a Fifth Year Owner: 5��� �WST�� '�`I.�..� Owner's Phone Number. q�2 — 2�i "��� Owner's Address; 2� HZ �� ST� � �gl_ !V �V r 'J ' �� � Property Being Evaluated: � w lUt�2.0 F� v� N A�.�.11�5 ANE ��oR LAi� M ��-' Properiy Address: • Date of Work: g'� —2U�� All responses refer to the current work (inspection, testing and maintenance) performed on this date. Notes: 1) All questions are to be answered Yes, No, or Not Applicable. All "No" answers are to be explained in Part III of this form. 2) Inspection, Testing and Maintenance are to be performed with water supplies (including firepumps) in service, unless the impairment procedures of Chapter I S of NFPA 25 are followed. Part I- Owner's SeCtion 3. Quarterly Inspection Items (continued) A.Is the building occupied? �Yes ❑ No c. Pressure reducing valves in open position, not leaking, B.Has the occu anc and hazard of contents with downstream pressure per design criteria, and in good p y condition with handwheels not broken? ❑ Yes �] No � N/A remained the same since the last inspection? � Yes ❑ No d. Hydraulic nameplate (calculated systems) C. Are all fire protection systems in service? � Yes ❑ No securely attached to riser and legible? � Yes ❑ No 0 N/A D.Has the system remained in serv without 4. Annual Inspection Items (in addition to abov items) modification since the last inspection? � Yes ❑ No a. Proper number and type of spare sprinklers?�Yes ❑ No O N/A E. Was the system free of actuation of devices b. Visible sprinklers: or alarms since the last inspection? °' � Yes ❑ No 1. Proper position (upright, pendent, sidewall)�Yes ❑No ❑ N!A F. Name and address of property insurance contact 2. Free of corrosion and physical damage? Yes O No ❑ N/A G. Policy number (if known): 3. Proper clearance below sprinklers? �� Yes ❑ No O N/A 4. Free of foreign materials including paint. �i Yes ❑ No ❑ N/A �//� n,,,�� P 1" �`^ �'1��� � 5. Liquid in all glass bulb sprinklers? `f � Yes O No ❑ N/A �-�L-� �� � � ` � c. Visible pipe: Owner or Representative (print name) Signature and Date 1. In good condition/no extemal corrosion? �Yes ❑ No 0 N/A Part II — Inspector'S SeCtion 2. No mechanical damage or leaks? � Yes a No ❑ N/A A. Inspections 3. No external loads? Yes O No ❑ N/A 1. Dailyand Weekly Items d. Visible pipe hangers and seismic braces a. Control valves supervised with seals passed in pection not damaged or loose? l� Yes O No O N/A in accordance with II.A.2.a below? �Yes ❑ No 0 N/A e. Hose, hose couplings and nozzles on sprinkler b. Backflow preventers: system passed inspection per NFPA 1962? ❑ Yes ❑ No �l N/A 1. Accessible and isolation valves open? ❑ Yes ❑ No N/A f. Adequate heat in areas with wet piping? '�Yes ❑ No 0 N/A 2. Sealed, locked or supervised? ❑ Yes ❑ No N/A g. Intemal inspection of the pipe performed in the 3. Relief port on RPZ not discharging? ❑ Yes [] No N/A last 5 years (remove a flushing connection and 2. Monthly Inspection Items (in. addition to above items) one sprinkler near the end of a branch line)? ❑ Yes 1� No ❑ N/A a. Control valves and valves on backflow (If `No ", conduct internal inspection) preventers with locks or electrical supervision: 5. Fifth Year Inspection Items (in addition to above items) 1. In correct (open or closed) position? � Yes ❑ No ❑ N/A a. A1arm valves and associated strainers, filters and 2. Lock or supervision in place? '1�1 Yes 0 No ❑ N/A restricted orifices passed intemal inspection?❑ Yes C] No'� N/A �,C �, 3. Accessible and free from external leaks? � Ye�N91❑ N/A b. Check valves internally inspected, all parts 4. Provided with appropriate wrenches? `�7 Yes� � 0 0 N/A operate properly and are in good condition? ❑ Yes'6Q No ❑ N/A 5. Provided with appropriate identification? Yes ❑ No ❑ N/A c. Internal pipe inspection performed per 4.g? ❑ Yes �, No ❑ N/A "" b. Sprinkler wrench with spare sprinklers? � Yes G] No a N/A B. Testing a Gages on system in good condition and Report any failures on Part III of this form. showing normal water supply pressure? � Yes 0 No ❑ N/A 1. Quarterly Tests d. Alarm valve free from physical damage, trim a. Mechanical waterflow alarm devices passed in correct (open or closed) position and no tests by opening the inspector's test connection leakage from retarding chamber or drains? ❑ Yes ❑ No�J N/A With alarms actuating and flow observed? � Yes ❑ No ❑ N/A 3. Quarterly Inspection Items (in addition to above items) b. Post indicating valves opened until spring or torsion a. Fire department connections visible, accessible, felt in the rod then closed back'/a turn? ❑ Yes 0 No�, N/A couplings and swivels not damaged, gaskets in c. Main drain test for system downstream of b kflow evice or place and in good condition, identification sign(s) pressure reducing valve: 3 W,�� �����j in place, check valve is not leaking; clapper in place � and operating properiy and automatic drain valve Q in place and operating properly7 `� Yes ❑ No ❑ N/A 1. Record static pressure t7� psi, residual pressure� psi (If plugs or caps are not in place, inspect interior for obstructions) 2• Was flow observed? � Yes 0 No ❑ NfA b. Alarm devices free from physicaL damage? �1 Yes C ] No ❑ N 3. Are results comparable to previous tests? Yes ❑ No 0 N/A �2009National Fire Sprinkler Association, 40 Jon BarrettRoad, Patterson, NY 12563 (845) 878-4200 Form 25-13W-08 Sheet 1 of 2 � ,4 ' " . M_ . .. . ., <. . . . . . . _ . .. . . . . . . _ _ � ..�,' � , . ".�.. � . . � ;. . ., . ' � ' $ � . _ . . =J .. � . . • � . _ . . . .. . . . �. . � p . . . � . . . . . :' . .- . Y'f . J . . .. . �5 � � . . . . � . « � � ,� � F� v� N A�CS �t.LGt�er�"t�P+�"�� � Z 1q13 2. Semiannual Tests (in addition to previous items) 8. Abnormally frequent false-tripping of dry-pipe valves a. Valv� supervisory switches indicate 9. System is returned to service after an extended period of time movement? � Yes 0 No O N/A out of service (more than one year) b. Electrical waterflow alarm devices passed 10. There is reason to believe the system contains sodium silicate tests by opening inspector's test connection or its derivatives or highly corrosive fluxes in copper pipe with alazms actuating and flow observed? � Yes 0 No 0 N/A g. If conditions were found that required 3. Annual Tests (in addition to previous items) flushing, was flushing of system conducted? O Yes a No� N/A a. Main drain test for systems not tested quarte y: h. Was a drain test conducted after opening any �?j��{��5�1r►^ � closed valves? ❑ Yes O No�1 N/A 1. Record Static psi and Resid Pressure psi i. Adjusted, repaired, reconditioned or replaced components 2. Was flow observed? Yes O No ❑ N/A had the associated tests and/or inspections required 3. Are results comparable to previous tests? Yes O No ❑ N/A by Table 5.5.1 of NFPA 25 performed? ❑ Yes 0 No`RI N/A b. Are all sprinklers dated 1920 or later? Yes 0 No ❑ N/A 2. Annual Maintenance Items (in addition to previous items) c. Sprinklers with fast response elements 20 years a. Operating stem of all OS&Y valves old or more replaced or successfully sample lubricated, completely closed, and reopened? �Yes O No 0 N/A tested in last 10 years? ❑ Yes O No'�I N/A b. Sprinklers subject to recall replaced? ❑ Yes ❑ Nci� N/A d. Standard response sprinklers 50 years old or more replaced or c. Sprinklers and spray nozzles protecting successfully sample tested in last 10 years? ❑ Yes 0 No`�1 N/A commercial cooking equipment and ventilating e. Standard response sprinklers 75 years old or more replaced or systems replaced except for bulb-type wluch successfully sample tested in last 5 years? ❑ Yes ❑ NoJ(i N/A show no signs of grease build-up? �1 Yes ❑ No a N/A f. Dry-type sprinklers replaced or successfully sample tested in last 10 years? ❑ Yesj(1 No ❑ N/A Part III — COmmeIIts (Any `1Vo" answers, test failures or other g. Antifreeze solution specific gravity: problems found with the sprink[er system must be explained here. 1. Correct at most remote point? ❑ Yes O No N/A Also note here arry products noticed on the system that have been the 2. Correct at interface with wet system? ❑ Yes 0 No N/A subject of a recall or replacement program.) 3. Correct at other test points (over 150 gal)? O'Yes a No N/A h. All control valves operated through full range � o� � � and returned to normal position? �i Yes C] No � N/A � �� � � ��, i. Bacl�low devices passed backflow test? ❑ Yes 0 No N/A j. Backflow devices passed forward flow test? O Yes O No N/A k. Pressure reducing valves passed partial flow? aYes O No N/A � i� 'l / , 4. Test for every third year (in addition to previous items) ,► `J /' � S�' �" ✓l� J{ � f .�''� Hose more than 5 years old connected to the system (,V� �j� �ju � O/�-� Uf� f�orv- S has been service tested per NFPA 1962. Water � discharged and water flow alarms operated7 ❑ Yes O No� N/A O� %��5� -� S PA�S� 2 a i� . 3- 5. Tests for every fifth year (in addition to appropriate items) a. Sprinklers above lugh temperature tested? ❑ Yes O No N/A b. Gages checked by calibrated gage or replaced? ❑Yes �Io /A �j Z� � 5 / i,J � � c. Pressure reducing valves passed full flow test? OYes �To /A �v�c � o (� �5 �/�. C. Maintenance Z H p� ��`�" 1. Regular Maintenance Items a. If any sprinkler failed the sampling testing of Parts II.B3.c, d, e or f of this form, were all sprinklers � � C % �� ,� � represented by that sample replaced. ❑ Yes 0 No jrJ N/A b. If sprinkler have been replaced, were they � �� ` � �f t j� �, �� proper replacements? ❑ Yes 0 No� N/A c. Used hose was cleaned, drained and dried before being placed back in service? ❑ Yes O No`f� N/A d. Hose exposed to hazardous materials was disposed of or decontaminated in an approved manner? OYes �To'�I N/A e. Systems normally filled with fresh water were drained and refilled twice if raw water gotinto the system? ❑Yes �Td�i/A Part IV — Inspector's In�ormAtion f. If any of the following were disc�overed, was GENERAL SPRINKLER CORP. an obstruction investigation conducted? ❑ Yes ❑ No� N/A Inspector N�J� 1� Company: ��g3 BUERKLE RD . Explain reasons(s) and obstruction irrvestigation findings in Part Ili �(� gEqR LAKE, MN 55110 1. Defective mtake screen on pump supplied from open sources Company Address: 2. Obstruerive material discharged durittg flow tests I state that the information on this form is correct at the time and 3. Foreign material in dry-pipe valves, check valves or pumps place of my inspection, and that all equipment tested at this time 4. Foreign material in water during drain test or plugging of was left in operating condition upon completion of t}us inspection inspector's test connection except as noted in Part III above. 5. Plugging of pipe or sprinklers found during activation or work ' 6. Failwe to flush yard piping or surrounc�ing mains following Signature of Inspector• t�^'"' Date: - � Z new installation or repairs p � 7. Record of bmken mains in the vicinity License or Certifica Number (if applicable): D �2009 Natlonal Fyre Sprinkler Association, d0 Jon Barrett Road, Patterson, NY 12563 (84� 878-4200 Form 25-13W-08 Sheet 2 of 2 .�..��,..;� � °.a , . " ., '� . �t; �, . � , , ;�:-� _.. _ ., . , �. . ... � -. � . ,�.. . , t.:�; t � :�� . . _ . .; � : v� � ENE��A�. � � Z 19�3 SFRINKLER r �v � � �kWY.,,� �,�„,�ET��Q� ��a-�-E2� CC�RFORATIt3N CONTRACTORS FOR ALL TYPES OF FIRE SUPPRESS ON SYSTEMS MH ��c. # coo2 TRIP TRIP WI Lic.#222173 INITIAL POINT TIME ia uo # FP-046 ZONE # TAMPER ALARM STATIC RESIDUA AIR PSI PSI SEC. REMARKS ,l�] Z 1 ❑ Main Office: � � t „�i� V � 1Y � / � . Y � 1863 Buerkle Rd. Z�NE #1 White Bear Lake MN 55110 �Q (651) 484-5903 � � � � � ' n � �/ � D � (aoo� s�a-s�n ZONE #2 u� )r (651) 4&4-9514 (f) �.� 2c� ❑ Wisc. Office: ZONE #3 � � � � J� � . � LQcQ•VK 494184 Street Osceola W I 54020 (715) 294-4387 �aoo� a�e-s��� ZONE #4 ZONE #5 ZONE #6 ZONE #7 ZONE #8 ZONE #9 ZONE #10 ZONE #11 ZONE #12 ZONE #13 t ,,,,�,,�, � ZONE #14 s�m�� w:��� ZONE #15 ZONE #16 >' �.�� ., _p • .,, -- ❑ Main Office: ❑ Wisc. Officp: 1863 Buerkle Road 494 184' Street, White Bear Lake, MN 55110 Osceola, WI 54020 ENEI�AL (800) 888-6907 (800) 878-6777 SPRINKLER (651) 484-9514 (Fa�c) C�RPORATIUN CONTRACTORS FOR ALL TYPES OF FIRE SUPPRESSION SYSTEMS MN Lic. # C002 WI Lic. # 222173 IA Lic # FP-046 Job # 0?, -2� °1�3 KITCHEN HOOD INSPECTION REPORT Inspection Name: �� V� 1� Ak�� �1..�"?�-?�"��.y Date: L� '�1' � �Z Street: ��o�o� 4 F� V� N�N� � r'�►� Inspector: ���Pt►��0 h� 1M� �0 tJ City/State• p R�OQ- �.�-�� .�� 5 ��� Bldg/Location: �1 T�L.Nt� Is supply to hood system taken from existing fire sprinkler system? Yes � No Does gas or electric shut off with flow? ,,�-�, Yes No 7� Does gas or electric shut off with control valve tamper? Yes No � Is hood system monitored? L , ,� \ Yes �_ No If yes, which company monitors? �1P �,u �2 ��� l.erCC(�,0, �'����"+�`�� Are sprinklers above grease fryers in proper position above grease? Yes � No Is there a manual reset to restore gas or electric to cooking unit? Yes No � How was tlow obtained? Water Flow: Manual Trip of Flow Switch: "J '�f� . Control Valve Type: �� � t� � � Ul �C � , Condition of Control Valve: Good X Fair Need to Replace Condition of Sprinklers & Automatic 5pray Nozzels: Good _� Fair Need to Replace Condition of Pipe and Fittings: Good � Fair Need to Replace Location of reset for gas or electric? � ���- Comments / Recommendations: Inspector Signature l, . wU1 u�— �� U ,:;�� �. _ :. _ _ _ w � ; � , . .