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*[�CO Fire & Simp/exGrinne// � <br /> ,�VSPECTION REPORT Security INSPECTION CONTRACT <br /> : : <br /> NO -- ,: . � ___. <br /> No. REPORT OF INSPECTION BUREAU FILE _ _ <br /> CONFER�WtTH NO. <br /> r per NFPA 13 & 25 -- ` <br /> ,r SET 1 OF 2 : <br /> : REPORT TO �� -' ' " ` BUILDING OR LOCATlON 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? <br /> c. If a fire has occurred since the{ast inspection,have all damaged sprinkler system componenfs been replaced? <br /> d. Has the piping in all dry systems been checked for proper{>itch within ihe past five years? <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,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. 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? <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 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 /> Control No. Easily Valve Secured? � Supervision <br /> of Type Accessible Signs Open If yes,how? (Sealed�) Operational <br /> Valves Valves (Locked.) <br /> Yes No Yes No Yes No Yes No (Supvd.?) Yes No <br /> CITY CONNECTION <br /> TANK ✓ j , , <br /> PUMP <br /> SEC710fdA ''=� : , - v' � <br /> SYSTEM � 1 c.-'" <br /> -A6AF-�Ah�-IfyE . .� _ v <br /> 3.WATER SUPPLIES Pressure.f�s�Pump&Tank ✓' <br /> a. Water supply source? City Gravity Tank Pressure Fire Pump&City <br /> Watertlow 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 /> r r <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 condition7 �' <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 � <br /> a. No.of systems r Make&Model <br /> b. Are cold weather valves in the appropriate open or closed position? t" <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? R�^' <br /> d. Have all the antifreeze systems been tested? <br /> e. Date antifreeze systems were tested <br /> f. The antifreeze tests jndicate 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-R1-1 �zios> INSURANCE BUREAU COPY 'Explain(No)Answers on Back of' <br />