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_ _�►� Grinnell° � <br /> r �`"`^��^'�' FIRE PROTECTION SYSTEMS COMPANY F <br /> INSPECTION REPORT INSPECTION CONTRACT � <br /> No. ..........:....:................ REPORT OF INSPECTION No. .::...:......:............:...., � <br /> CONFERRED WITH BUREAU FILE ................ <br /> � <br /> PHONE N0. �:..':..:..... ..:.. . NO. .....,.::;...::�:................ � <br /> ................................................ ................. - SET 1 0F 2 � <br /> REPORT TO ' - 'r � ' BUILDING OR LOCATION INSPECTED <br /> STREET - �NSPECTI�R � '` " <br /> CITY&STATE -" -� C �`� ZIP GRINNEIL OFfiCE� • PHONE NO ''`-�' �-= - � <br /> ATT. - DATE ' <br /> 1. GENERAL Yes N.A. No• <br /> A. (To be answered by the Owner or Owner's repraentative) <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 inspectiont ' <br /> c. If a fire has occurred since the last inspection.have ail damaged sprirkler system components been replacedt ` - <br /> d. Has the piping in al�dry systems been checked for pro�er pitch within the past five yearst <br /> Date last checked (checking is recommended at least every S years) <br /> e. Has the piping in all systems been checked for obstructiva materialst <br /> Date last checked _ (checking is recommended at least every S years) <br /> f. Have all fire pumps been tested to their fuli capacity through the use of hose streams or Flow meters with�n the past 12 monthsi �--'' e <br /> g. Are gnwity,surface or pressure tanks proteded from freezingt �' � <br /> h. Are any of the sprinklers 50 yean old or older? (testing and/or replacement is retommended for such sprinklers) '"'�� <br /> i. Are a�y extra high temperature solder sprinklers regularly exposed to termperotures near 300°R ��- <br /> 8. (To be answered by the inspector) � <br /> a. Have the sprinkler systems been extended to all visible areas of the buiiding� <br /> 8 <br /> b. Ooes there appear to be proper clearence between the top of a!)storag�and the sprinkler defiectorT ---" � <br /> c. Are the building areas proteded by a wet system,heated,including its blind attics and perimeter areas,where accessibleT •4�'" <br /> d. Are all visible exterior openings protected against the entrance of coid airt � <br /> 1 �ONTROL VALVES � <br /> a. Are all sprinkler system main control valves and a�l other valves in the appropriate open or closed position� � <br /> b. Are all control valves sealed or supervised in the open position? � <br /> Secured7 <br /> No. Easily Va�ve Supervision <br /> Control of Type �ccessible Signs Open If yes,howt l�aledt) Opentional <br /> Valves Valves (Lockedt) <br /> Yes No Yes No Yes No Yes No ($u vd.T) Yes No � <br /> CITY CONNECTION ` <br /> TANK <br /> PUMP <br /> SECTIONAL•.:. r -, , - .,�� ..._- - <br /> - . ; ...� �,,- <br /> SYSTEM :;R - <br /> ALARM UNE - � <br /> 3. WATER SUKLIES Pressure.Fire Pump&Tank�T _ � <br /> a. Water supply sourceT __Cky` �-Gnvity Tank ` Pressure Fire Pump h Gty � <br /> f � � <br /> Waterflow Test Resu�ts 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 Plow Pressure �� <br /> Located Pi e Before Pressure Aher Location Pi e Before Pressure Aher <br /> _ .. _ ,`✓.- �� <br /> � <br /> 4. TANKS,rIIMK,flRE DEIT.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'rhe proper pressure and/or water levelst '' � <br /> c. Are fire dept.connedions in satisfactory condition,couplings free,caps or alugs in place and check valves tight? <br /> d. Are fire dept.connections visible and accessiblet <br /> S. WET SYSTEfNS ! <br /> A� r .�: . � .. <br /> a. No.ot systems '�Make&Model ' - ' � <br /> b. Are cold weather valves in the appropriate open or dosed position7 `� � <br /> If closed,has pipirtg been drainedi j <br /> c Has the owner or owner's representative been advised that coid weather valves are not recommended by NFPAt � � <br /> d. Have all the antifreeze systems been tested7 � <br /> e. Uate antifreeze sy:tems were test�d <br /> f. The antifreeze t�ts indicateprotectio�to: � <br /> system 1 2 3 4_ 5- temperature <br /> g. Did alarm valves,waterflow alarm ind�cators and reards test satisfactorily� , � � <br /> =Not Applicable � <br /> c4sso-� (NSURANCE BUREAU COPY 'Eaplsin(No)Answers on 6ack o(ShNt 2 - <br /> ;� <br />