HomeMy WebLinkAboutFire Sprinkler Report 04.24.14 ih MINNESOTA CONWAY FICHE AI INSPECTION and MAINTENANCE REPORT
575 MINNEHAHA AVENUE WEST • ST. PAUL, MN 55103
651- 288 -0777 • 1 -800- 223 -2587 PRE - ENGINEERED FIRE SYSTEM
ANNUAL SEMI- ANNUAL RECHARGE INSTALLATION RENOVATION
NAME r V
LOCATION OF SYSTEM CYLINDERS
ADDRESS ,, c , r . ' ' 1r .. .,t
MANUFACTURER MODEL NUMBER WET CHEMICAL DRY CHEMICAL
i "r
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A
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLNDER SIZE SLAVE
CITY L r t- • _ 1 ; .c . • , r -
MANIFOLDED . PIRANHA WATERFLOW PRESSURE
TELEPHONE ; '',' ' '' i- - - STORE NO. ❑ YES ❑ NO
FUSE LINKS 360° F FUSE UNKS 450° F FUSE LINKS 5OO° F OTHER
OWNER OR MANAGER "�'
( ' - MECHANICAL GAS VALVE(S) & SIZE(S) ELECTRICAL GAS VALVE(S) & SIZE(S) MANUAL RESET RELAY
� : -. <1. YES ❑ NO
NON- COMPLIANT SYSTEMS MAY FAIL TO LAST HYDRO TEST DATE ELECTRIC CONNECTED
EXTINGUISH /SUPPRESS A FIRE.
L'YES ❑ NO
I I
COOKING APPLIANCE LOCATIONS and SIZES (LEFT TO RIGHT)
.
- , ' - ,
i
YES NO N/A YES NO N/A
1. System interlocked with building fire alarm ❑ ❑ „p (29.IProper separation between fryers and flame ❑ ❑ ❑
i 2. Duct and plenum covered with correct nozzles ❑ ❑ ❑ 21. Proper clearance - flame to filters ❑ ❑ ❑
3. Check positioning of all nozzles ❑ ❑ ❑ 22. Exhaust fan in operating order ❑ ❑ ❑
4. Systems installed per U.L. 300 standards and meets 23. All filters replaced ❑ ❑ ❑
manufacturer's U.L. listing and N.F.P.A. standards ❑ ❑ ❑ 24. Fuel shut -off in on position ❑ ❑ ❑
I 5. Hood /duct penetrations sealed with weld or 25. Manual and remote set/seals in place ❑ ❑ ❑
U.L. device ❑ ❑ ❑ 26. Replace system covers ❑ ❑ ❑
6. Check if seals intact, evidence of tampering ❑ ❑ ❑ 27. System operational and seals in place ❑ ❑ ❑
7. Pressure gauge in proper range (if gauged) ❑ ❑ ❑
28. Slave system operational ❑ ❑ ❑
8. Check cartridge weight (if applicable) ❑ ❑ ❑
9. Dry system 6 - year maintenance date 29. Clean cylinder and mount ❑ ❑ ❑
Wet system 12 -year hydro test date ❑ ❑ ❑ 30. Fan warning sign on hood ❑ 0 ❑
10. Inspect cylinder and mount ❑ ❑ ❑ 31. Proper signage and personnel instructed in
11. Operate system from terminal link ❑ ❑ ❑
manual operation of system ❑ ❑ ❑
12. Test for proper operation from remote ❑ ❑ ❑ 32. Proper hand portable extinguishers ❑ ❑ ❑
33. K -Class fire extinguisher in cooking area ❑ ❑ ❑
13. Check operation of micro switch ❑ ❑ ❑ 34. Portable extinguishers properly serviced ❑ ❑ ❑
14. Check operation of gas valve ❑ ❑ ❑
15. Clean nozzles ❑ ❑ ❑ 35. Service & Certification tag on system ❑ ❑ ❑
16. Proper nozzle covers in place ❑ ❑ ❑ 36. Safety chains on all gas appliances attached and secured ❑ ❑ ❑
37. Status of grease build -up in the hood and duct opening
17. Replaced fuse links ❑ ❑ ❑
18. Check travel of cable ❑ ❑ ❑ 0 CLEAN 0 LIGHT 0 MEDIUM 0 HEAVY 0 EXCESSIVE
19. Piping and conduit securely bracketed ❑ ❑ ❑ * NOTE DISCREPANCIES OR DEFICIENCIES BELOW *
COMMENTS / a ' r } ;
I
, sr r r `
r f ,' f'f r' I I t fi t
X SER TECHNICIAN PERMIT NO. DATE qv i'sAOTHORIZED A ENT
r
THE ABQ)/E TECHNICIAN CERTIFIES THAT THE SYSTEM WAS PERSONALLY INSPECTED AND CONDITIONS WE Z F = UND TO BE AS INDICATED ON THIS REPORT.
WHITE - CUSTOMER YELLOW - DISTRIBUTOR PINK - AUTHORITY RING JURISDICTION
MINNESOTA CONWAY FIRE Er SAF INSPECTION and MAINTENANCE REPORT
575 MINNEHAHA AVENUE WEST • ST. PAUL, MN 55103
651 - 288 -0777 • 1 -800- 223 -2587 PRE-ENGINEERED FIRE SYSTEM
ANNUAL SEMI - ANNUAL RECHARGE INSTALLATION RENOVATION
NAME
LOCATION OF SYSTEM CYLINDERS
ADDRESS , � - , -. - .. L . - . - r - , , - , ,i
MANUFACTURER MODEL NUMBER WET CHEMICAL DRY CHEMICAL
.
v '
i
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
.!
CITY ? , ? -, ) ' t , - r _) '
MANIFOLDED PIRANHA WATERFLOW PRESSURE
-
❑ YES 0 NO
TELEPHONE I ' STORE NO.
FUSE LINKS 360° F FUSE LINKS 450 F FUSE LINKS 500° F OTHER
OWNER OR MANAGER r - - -- 3 •
MECHANICAL GAS VALVE(S) & SIZE {S) ELECTRICAL GAS VALVE(S) & SIZE(S) MANUAL RESET RELAY
NON - COMPLIANT SYSTEMS MAY FAIL TO 4.: ', r [ ( YES O NO
LAST HYDRO TEST DATE ELECTRIC CONNECTED
EXTINGUISH /SUPPRESS A FIRE. . w.. ]YES ❑ NO
COOKING APPLIANCE LOCATIONS and SIZES (LEFT TO RIGHT)
!'
YES NO N/A YES NO N/A
1. System interlocked with building fire alarm ❑ ❑ ❑ 20. Proper separation between fryers and flame ❑ ❑ ❑
2. Duct and plenum covered with correct nozzles ❑ ❑ ❑ 21. Proper clearance - flame to filters ❑ ❑ ❑
3. Check positioning of all nozzles ❑ ❑ ❑ 22. Exhaust fan in operating order ❑ ❑ ❑
4. Systems installed per U.L. 300 standards and meets 23. All filters replaced ❑ ❑ ❑
manufacturer's U.L. listing and N.F.P.A. standards ❑ ❑ ❑ 24. Fuel shut -off in on position ❑ ❑ ❑
5. Hood /duct penetrations sealed with weld or Manual and remote set /seals in place ❑ ❑ ❑
❑ ❑ ❑
U.L. device 26. Replace system covers ❑ ❑ ❑
6. Check if seals intact, evidence of tampering ❑ ❑ ❑ 27. System operational and seals in place ❑ ❑ ❑
7. Pressure gauge in proper range (if gauged) ❑ ❑ ❑
8. Check cartridge weight (if applicable) ❑ ❑ ❑ 28. Slave system operational ❑ ❑ ❑
9. Dry system 6 -year maintenance date 29. Clean cylinder and mount ❑ ❑ ❑
j Wet system 12 -year hydro test date ❑ .A ❑ 30. Fan warning sign on hood ❑ ❑ ❑
10. Inspect cylinder and mount ❑ ❑ ❑ 31. Proper signage andpersonnel instructed in
11. Operate system from terminal link ❑ ❑ ❑ manual operation of system ❑ ❑ ❑
12. Test for proper operation from remote ❑ ❑ ❑ 32. Proper hand portable extinguishers ❑ ❑ ❑
13. Check operation of micro switch ❑ ❑ ❑
33. K -Class fire extinguisher in cooking area ❑ ❑ ❑
14. `Check operation of gas valve ❑ ❑ ❑ 34. Portable extinguishers properly serviced ❑ ❑ ❑
15. Clean nozzles ❑ ❑ ❑ 35. Service & Certification tag on system ❑ ❑ ❑
16. Proper nozzle covers in place ❑ ❑ ❑ 36. Safety chains on all gas appliances attached and secured ❑ ❑ ❑
17. Replaced fuse links ❑ ❑ ❑ 37. Status of grease build -up in the hood and duct opening
18. Check travel of cable ❑ ❑ ❑ ❑ CLEAN ❑ /TEDIUM ❑ HEAVY ❑ EXCESSIVE
e
19. Piping and conduit securely bracketed 0 0 ❑ * NOTE DISCREPANCIES OR DEFICIENCIES BELOW *
COMMENTS : - , ` )
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` 7 ' I ' ' vilt .! , i / , f / , y fif
SER)CE TECHNICIAN PERMIT NO, DATE STOMER'S AUTHORIZED AGENT
THE ABOVE SERVICE TECHNICIAN CERTIFIES THAT THE SYSTEM WAS PERSONALLY INSPECTED AND CONDITIONS WER FOUND TO BE AS INDICATED ON THIS REPORT.
WHITE - CUSTOMER YELLOW - DISTRIBUTOR PINK - AUTHORITY HAVING JURISDICTION