HomeMy WebLinkAboutFire Inspection Report 3/6/2008
A business unit of Tyco Fire & Security
REPORT OF INSPECTION
per NFPA 25
REPORT TO~t.. \N ~ L ~ 'S' , c:.. ~ LF CL\A. &
STREET ~ I ~ I "'-i: L~'" R. \ ~ --.. 8: <.. -r _ N';,.J ,
CITY & STATE ~ "6R Lf\ k~ M; ~\~ _ ZIP 'S:')3 fJd.
ATT. )
INSPECTION REPORT
NO....
CONFERRED WITH
Silllp~xGrinnell BE SAFE.
~
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BUREAU FILE ...
NO.
5G OFFICE
DATE
1. GENERAL
A. (To be answered by the Owner or Owner's representative)
a. Have there been any changes in the occupancy classification, machinery or operations since the last inspection?
b. Have there been any changes or repairs to the fire protection systems since the last inspection?
c. If a fire has occurred since the last inspection, have all damaged sprinkler system components been replaced?
d. Has the piping in all dry systems been checked for proper pitch within the past five years?
Date last checked (checking is recommended at least every 5 years)
e. Has the piping in all systems been checked for obstructive materials?
Date last checked (checking is recommended at least every 5 years)
f. Have all fire pumps been tested to their full capacity through the use of hose streams or flow meters within the past 12 months?
g. Are gravity, surface or pressure tanks protected from freezing?
h. Are any of the sprinklers 50 years old or older? (testing and/or replacement is recommended for such sprinklers)
i. Are any extra high temperature solder sprinklers regularly exposed to temperatures near 3000F?
B. (To be answered by the inspector)
a. Have the sprinkler systems been extended to all visible areas of the building?
b. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector?
c. Are the building areas protected by a wet system, heated, including its blind attics and perimeter areas, where accessible?
d. Are all visible exterior 0 en in srotected a ainst the entrance of cold air?
2. CONTROL VALVES
a. Are all sprinkler system main control valves and all other valves in the appropriate open or closed position?
b. Are all control valves sealed or supervised in the open position?
No. Easily Valve Secured? Supervision
Control of Type Accessible Signs Open If yes, how? (Sealed?) Operational
Valves (Locked?)
Valves Yes No Yes No Yes No Yes No (Supvd. ?) Yes No
CITY CONNECTION
TANK
PUMP "\ rt '::::::::',^~1 J I i::. Nlffi ~I
SECTIONAL
SYSTEM
ALARM LINE
Gravity Tank
t--j f\
Pressure Fire Pump & Tank
Pressure Fire Pump & City
Pressure Fire Pump & Pond
3. WATER SUPPLIES ,
a. Water supply source? City ~\ D~ J -f'\ K~
Waterflow Test Results Made During This Inspection
NA
Test Size Static Static Test Size Static Static
Pipe Test Pressure Flow PreSSUi'e Pipe Test Pressure Flow Pressure
Located Pipe Before Pressure After Location Pipe Before Pressure After
"";:: a ~I^ IF)W/l=- M~:"N\ d _
5
temperature
4. TANKS, PUMPS, FIRE DEPT. CONNECTIONS
a. Do fire pumps, gravity, surface or pressure tanks appear to be in good external condition?
b. Are gravity, surface and pressure tanks at the proper pressure and/or water levels?
c. Are fire dept. connections in satisfactory condition, couplings free, caps or plugs in place and check valves tight?
d. Are fire dept. connections visible and accessible?
5. WET SYSTEMS I II'
a. No. of systems Make & Model .,
b. Are cold weather valves in the appropriate open or closed position?
If closed, has piping been drained?
c. Has the owner or owner's representative been advised that cold weather valves are not recommended by NFPA?
d. Have all the antifreeze systems been tested?
e. Date antifreeze systems were tested
f. The antifreeze tests indicate protection to:
system 1 2 3 4
g. Did alarm valves, waterflow alarm indicators and retards test satisfactorily?
ORIGINAL
SinJplexGrinnel1 BE SAFE.
INSPECTION REPORT
NO.
A business unit of Tyeo Fire & Security
REPORT OF INSPECTION
PER NFPA 25
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BUREAU FILE
NO.
6. DRY SYSTEMS
'2-
a. No. of systems
Date last trip tested
b. Is the air pressure and priming water levels normal?
c. Did the air compressor operate satisfactorily?
d. Were all low points drained during this inspection?
e. Did all quick opening devices operate satisfactorily?
f. Did all the dry valves operate satisfactorily during this inspection?
g. Do dry valves appear to be protected from freezing?
h. Is the dry valve house heated?
7. SPECIAL SYSTEMS . .//h..
a. No. of systems~ Make & Model
Type
b. Were valves tested as required?
c. Did all heat responsive systems operate satisfactorily?
d. Did the supervisory features operate during testing?
Heat Responsive Devices: Type Type of test
Valve NO.1. . . . . .2. . . . . .3. . . . . .4. ....5......6. Valve No.
Valve No. 1 ..2. ..3. .4......5.. .6. Valve No.
Valve NO.1. . . . 2 . . . . . . 3 . . . . . . 4 . . . 5 . . . . 6 . Valve No.
Aux~:~e:~iPment: No. 1 ..\.2......3.T~~~.4..~~TG/~~NO~cL
~:~:~~:Ults~~ ~ fL~t.U LUbl\.if1& Ib PA-l\i~ L , ~ T 'D IIA k\r;T Sl-/()T Drp 6A-S () ~
tL~c..\f\) c...
1
1.
1.
1
.. 2 .
.. 2.
...2.
.2.
.....3......4. ..5.. ...6..
.....3. 4......5......6.
3. ....4......5 .....6.
....3. ...4. ....5. .6.
a. Did the water motors and gong operate
b. Did the electric alarms operate during t
c. Did the supervisory alarms operate dur
Yes N.A.:j: No
during testing? ......
esting? .......,
ing testing? ...-
good external condition? .......-
e of corrosion, paint, or loading and visible obstructions? ....-
mises? ~ 7
ain valves, check valves, hangers, pressure gauges, open sprinklers
stem appear to be in satisfacto condition? ./
ry
8. ALARMS
9. SPRINKLERS - PIPING
a. Do sprinklers generally appear to be in
b. Do sprinklers generally appear to be fre
c. Are extra sprinklers available on the pre
d. Does the exterior condition of piping, dr
and strainers appear to be satisfactory?
e. Does the hand hose on the sprinkler sy
12. ADJUSTMENTS OR CORRECTIONS MADE:
, S ~DVISED BY THE OWNER IN SECTION lA:
13. LIST CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPM
14. INSPECTION AND SUGGESTED IMPROV
Signature of owner or owner's representatj
SIGNED OWNER OR OWNER'S
Date
?
DUPLICATE TO:
STREET
CITY & STATE
ATT.
SG4550R22 (04/06)
ZIP
tNot Applicable
ORIGINAL
tqc:ajFire &. /SimPleXGrinnell
Secunty
DRY PIPE VALVE TRIP TEST REPORT
FOR 'Th.~ 'v'-J ~ L~S c;.. (Co, Lt: c...LV\.~
STREET~\ S' I \1\/ ~ ~'S ~;~'-E... CI ~~ CITY ~~~R LAt<.~
DATE OF TRIP TEST '"3 - <:.. - 6 ~ INSPECTOR I
NOTE: BEFORE ANY DRY PIPE VALVE IS TRIP TESTED, THE WATER SUPPLY LINE T IT SHOU 0 BE THOROUGHLY FUJSHED. THE TWO INCH DRAIN BELOW
THE VALVE SHOULD BE OPENED WIDE, AND WATER AT FULL PRESSURE SHOULD B DISCHARGED LONG ENOUGH TO CLEAR THE PIPE OF ANY
ACCUMULATION OF SCALE OR FOREIGN MATERIAL IF THERE IS A HYDRANT ON THE SUPPLY LINE. THIS HYDRANT SHOULD BE FWSHED BEFORE
THE TWO INCH DRAIN IS OPENED. THE DRIP VALVE ON THE DRY PIPE VALVE SHOULD BE CHECKED BEFORE TRIPPING THE DRY PIPE VALVE. TO SEE
THAT IT IS IN OPERATING CONDITION.
INSPECTION NO.
~CPN~A~~NO.
~l.. n-'h~~ VV~RK NO.
13~,~~~~~
DRY PIPE VALVES SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( )
VALVE SERIAL NUMBER
MANUFACTURER (NAME) (;.E:fV'\
VALVE MODEL F - ~ OJ
VALVE SIZE 411 INCH INCH INCH INCH
(LOCATION) An, c-
CONTROLLING SPRINKLERS
(NUMBER) - (APPROX) (APPROX) (APPROX) (APPROX)
DATE LAST TRIP TESTED? 3- ,~J - 6)(
DATE LAST OPERATED? -
AIR y~ LBS LBS LBS LBS
PRESSURE BEFORE TEST K-S-
WATER LBS LBS LBS LBS
SIZE AND LOCATION OF TEST VALVE ~ '\ ,1-\(
WAS GATE VALVE BELOW DRY VALVE OPEN WIDE AT TEST? Lf
(IF NOT, HOW MANY TURNS?)
AIR PRESSURE '7 LBS LBS LBS LBS
VALVE TRIPPED AT WATER PRESSURE S~ LBS LBS LBS LBS
TIME - MIN - SEC MIN SEC MIN SEC MIN SEC
IF SYSTEM FLOODED, LIST TIME WATER - MIN- SEC MIN SEC MIN SEC MIN SEC
REACHED TEST OPENING
PERFORMANCE ~~t ~ 10 o~ ~~~'i- ~ of f\ \1\ 'POP L$ "" \S NrA (.
INTERIOR OF BODY ~On~
MOVING PARTS t"/
VALVE CONDITION RUBBER FACING \
SEATS \\
RESET? " ~~.:\.
DID ALARMS OPERATE AT TRIP TEST? II
ALL LOW POINT DRAINS BLOWN OUT? \ \
WATER CONTROL VALVE LEFT \ \
OPEN AND SEALED?
ALARM CONTROL VALVE LEFT I
OPEN AND SEALED?
QUICK OPENING DEVICES SYSTEM NO. (1\} ~ ) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( )
DEVICE SERIAL NUMBER /
MANUFACTURER (NAME) /
TYPE AND MODEL ~ \L
AIR PRESSURE IN UPPER CHAMBER \y ~ LBS LBS LBS LBS
QUICK OPENING DEVICE TRIPPED AT / "EC \ LBS SEC LBS SEC LBS SEC LBS
PERFORMANCE /
QUICK OPENING DEVICE LEFT IN SERVICE /
AND CONTROL OPEN AND SEALED?
LIST ANY UNSATISFACTORY CONDITIONS:
REMARKS
tqCD
Fire &
Security
5400 Nathan Lane Suite 100
Plymouth, MN 55442
763-367-5000 1-800-292-4111
Fax: 763-367-5002
$lmpl..".,.,...,1
Job Name: ~ ~ ~ L~~ ~~ l r c~-&
Task Number: --.J 3~S"'~ CfSC, Date:
~ - CC ...<,,>~
Waterflow Supervisory
Valve Location Control . Signs Elec. Alarm Tamper Pipe Main Drain Water Flow Test
Valves Switch Size
Yes No iml Yes No Yes No N/A Static Residual Static
C\\"'{ 41~y / /
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In-spector:
J"
fqc:a!Fire &: /SimplexGrinnell
Security -:,. ~
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CONFERRED WITH SUPPLEMENTAL RECORD OF INSPECTION
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SG4550R1-3
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SERVICE REQUEST
FORWARD TO YOUR ACCOUNTS PAYABLE DEPARTMENT
BOOK # 10 1310 I~ 10 12? I
. Ire &
Security
TR # I
TASK/CALL #
PROJECT # I
SimplexGrinnell
I :~:~ ~ ~<jsi\01
5400 Nathan Lane Suite 100
PIymoirth, Mn 55442
P 763-367-5000 F 763-367-5002
Reg#
CUSTOMER PURCHASE ORDER
"PUT CUSTOMER STAMP ON ALL 3 PAGES"
LBR - REG
I I
TRAV - REG
I I
LBR - OT
II
TRAV - OT
1 I
MILES
I I
T
I~
ARRIVAL
.(~>)~
tJt1/ .lJif'
s ; '(IP
with the work as agreed to and outlined below:
3-'--0
Date
Customer signature
o Time and Material
o Price Not to Exceed $
IMMEDIATE D
o Fixed Price of $
CODD
NET 10 D
PAYMENT TERMS
DEPOSIT $
BALANCE DUE $
Ri.,R)
ON
GRP
PRODUCT 1.0.
SERIAL # / DESCRIPTION
QTY.
COST
NO. USG.
UNIT PRICE
SYSTEM TYPE/LOCATION
CONTACT NAME
TOTALS
IMPORTANT NOTICE TO CUSTOMER
Customer acknowledges and agrees to the terms and conditions on the reverse side of this Service Request, agrees that the services have been completed to Customer's satisfaction and that the system IS in good working order
and repair, unless services performed were of a temporary nature, in which case Customer acknowledges that part of customer's system may have been bypassed or is otherwise inoperable until service can be completed.
CU~'ro,!,ER'S ATTENTION IS OIREC!EO TO THE LIMITATION OF LIABILITY, WARRANTY, INOEMNITY ANO OTHER CONOITIONS ON THE REVERSE SlOE.
CU~qMER. ~CCEP,~ i 'CE . _ SIMPLEXGRIN~~LL lp ,
.---- """-" '-'''-'.~ C\~1'...(,d-, C i"Yd)Jv\;!.,\
(Qdslortw Acce,*ance)( " (Sim~~~ri~nell Representative) . ;, ., 1 .....,. ~ -"j'
:.> c" (J "" <,! co ~("'7S '=-p~, C'" f./\ I\. U.~ 'r
(Print Name) (Print Name)
@ S,mplexGrinnell@ LP 2006
All rights reserved
Service Request Form