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h �� �[�CO Fire & Simp/exGrin � // <br /> � INSPECTION CONTRACT <br /> tNSPECTION REPORT Security '�.EC'� -- , - � <br /> NO _ <br /> � No. REPORT OF INSPECTION A� � 6 1_4Q5 BUREau Fi�E _ <br /> CONFERRED WITH '� O��N� NO. _ <br /> __ _ __ SET 1 OF 2 <br /> REPORT TO BUILDIN R LOCATION INSPECTED <br /> STREET ` INSPECTOR <br /> CITY&STATE ZIP GRINNELL 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? <br /> c. If a fire has occurred since the last inspection,have all damaged sprinkler system components been replaced? � <br /> d. Has the i in in all d s stems been checked for ro er itch within the ast five ears? ��' <br /> Pp 9 �Y Y p P P P Y <br /> Date last checked (checking is recommended at least every 5 years) <br /> e. Has the piping in all systems been checked for obstructive materials? <br /> Date last checked (checking is recommended at least every 5 years) <br /> 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? � <br /> g. Are gravity,surtace or pressure tanks protected from freezing? j-'" <br /> - h. Are any of the sprinklers 50 years old or older? (testing and/or replacement is recommended for such sprinklers) 1% <br /> i. Are any extra high 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? 1� ' <br /> b. Does there appear to be proper clearance 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 VAWES <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 of T e Accessible Si ns O en � (Sealed?) <br /> Valves YP 9 P If yes, how. (Locked?) Operational <br /> Valves Yes No Yes No Yes No Yes No (Supvd.?) Yes No <br /> CITY CONNECTION x ,, �. � - t �� <br /> TANK <br /> PUMP <br /> SECTIONAL <br /> SYSTEM L� . _ >L,i , i;j. ' <br /> ALARM LINE <br /> ' 3.WATER SUPPLIES Pressure Fire Pump&Tank <br /> a. Water supply source? City 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 /> 3 <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 /> i <br /> t 5.WET SYSTEMS <br /> 3 a. No.of systems_�Make&Model ' <br /> b. Are cold weather valves in the appropriate open or closed position? <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 /> g. Did alarm valves,waterflow alarm indicators and retards test satisfactorily? <br /> #Not Applicable <br /> '�SG4550-R2-1 ����R���+E BUR��� .�.4%�.�, 'Explain(No)Answers on Back of Sheet 2 <br />