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' tl�CO Fire & Simp/exG/'%/�/�e// <br /> Security INSPECTION CONTRACT <br /> SPECTION REPORT NO. .-.___ '__ :� , _ <br /> No. REPORT OF INSPECTION BUREAU FILE _ __ _ ; <br /> CONFERRED WITH NO. <br /> per NFPA 13 & 25 <br /> SET 1 OF 2 ,: <br /> � REPORT TO BUILDING OR LOCATION INSPECTED <br /> ' STREET INSPECTOR <br /> CITY&STATE ZIP SG OFFICE PHONE NO. <br /> ATT. DATE ' <br /> 1.GENERAL Yes N.A.$ No" <br /> A. (To be answered by the Owner or Owner's representative) <br /> a. Have there been any changes in the occupancy classification,machinery or operations since the last inspection? <br /> b. Have there been any changes or repairs to the fire protection systems since the last inspection? ''j <br /> c. If a fire has occurred since the last inspection,have all damaged sprirrkler sqstem components been replaced? <br /> d. Has the piping in all dry systems been checked for proper pitch within the past five years? �'` <br /> Date last checked (checking is recommended at least every 5 years) <br /> e. Has th'e piping in all systems been checked for obstructive materials? -�'�� <br /> Date last checked (checking is recommended at least every 5 years) <br /> f. Have ali fire pumps been tested to their full capacity through the use of hose streams or flow meters within the past 12 months? —�' <br /> s <br /> g. Are gravity,surface or pressure tanks protected from freezing? <br /> h. Are any of the sprinklers 50 years old or older? (testing and/or replacement is recommended for such sprinklers) <br /> i <br /> i. Are anq extra hi5ti temperature solder sprinklers regularly exposed to temperatures near 300°F? <br /> B. (To be answered by the inspector) <br /> a. Have the sprinkler systems been extended to all visible areas of the building? <br /> ; b. Does there appear to be proper dearance between the top of all storage and the sprinkler deflector? !^ <br /> c. Are the building areas protected by a wet system,heated,including its blind attics and perimeter areas,where accessible? ' <br /> d. Are all visible exterior o enin s rotected a ainst the entrance of cold air? <br /> 2.CONTROL VALVES <br /> a. Are all sprinkler system main control valves and all other valves in the appropriate open or closed position? <br /> b. Are all control valves sealed or supervised in the open position? <br /> No. Easily Valve Secured? Supervision <br /> Control Sealed? <br /> Valves of Type Accessible Signs Open If yes, how? (Locked?) Operational <br /> Valves Yes No Yes No Yes No Yes No (Supvd.?) Yes No <br /> CITY CONNECTION q + �( j" � ' <br /> TANK <br /> PUMP <br /> SECTIONAL <br /> SYSTEM � �� / �� ,.0 -,: ; <br /> ALARM LWE � <br /> 3.WATER SUPPLIES Pressure Fire Pump&Tank <br /> a. Water supply source? Ciry Gravity Tank Pressure Fire Pump&City <br /> Waterflow Test Results Made During This Inspection Pressure Fire Pump&Pond <br /> Test Size Static Static Test Size Static Static <br /> Pipe Test Pressure Flow Pressure Pipe Test Pressure Flow Pressure <br /> Located Pipe Before Pressure After Location Pipe Before Pressure After <br /> �.. , .-., <br /> 4.TANKS,PUMPS,FIRE DEPT.CONNECTIONS Yes N.A.$ No` <br /> a. Do fire pumps,gravity,surface or pressure tanks appear to be in good external condition? <br /> b. Are gravity,surface and pressure tanks at the proper pressure and/or water levels? <br /> c. Are fire dept.connections in satisfactory condition,couplings free,caps or plugs in place and check valves tight? <br /> d. Are fire dept.connections visible and accessible? <br /> 5.WET SYSTEMS � 1 <br /> f , � -) <br /> a. No.of systems Make&Model <br /> b. Are cold weather valves in the appropriate open or closed posifion? <br /> if closed,has piping been drained? <br />= c. Has the owner or owner's representative been advised that cold weather valves are not recommended by NFPA? <br /> d. Have all the antifreeze systems been tested? <br /> e. Date antifreeze systems were tested <br /> f. The antifreeze tests indicate protection to: <br /> system 1 2 3 4 5 temperature <br /> .�, � , <br />� g. Did alarm vhbes,wa;�rflow alarm indicators and retards test satisfactorily? " <br /> #Nbt Applicable� <br /> � SG4550-R1-1 �z�os> INSURANCE BUREAU COPY "Explain(No)Answers on eaok ot sheet z `� <br />