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Home My WebLink Aboutinspections by Grinnell Fire Protection Systems � !�� tyco Fire & Simp/exG�inne// � Securit ��°i�;� INSPE T `6QN�RACT 'INSPECTION REPORT Y Np. � /,�;i� No. REPORT OF INSPECTION SEP 1 5 �004 BUREAu Fi�E ____ _ ,;, ;CON�ERRED WITH NO. __ ' •. �. � 'r . F.z C��I�Y C7r C)}�t�Aln SET 1 OF 2 `� r � � .�-e. �' `v�� -�� j ` ' S "` BUILDING OR LOCAT}ON INSPECTED ---}% ��'L' '•_ REPORT TO i ` '� � r STREET i � ' '` -� t INSPECTOR �' ` �' t��--� ;CITY& STATE '•� +�� "� � r1 `. �' J ZIP GRINNELL OFFICE 'ti� - PHONE NO. =�� - `"'`' '� 'ATT. DATE � � I �-- Y 1.GENERAL Yes N.A.$ No` 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? v 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 300°F? 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 deflector7 ` 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 o enin s rotected a ainst the entrance of cold air? "' . 2.CONTROL VAWES 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 Vaivesl of Type Accessible Signs Open If yes,how? �Sealed?j Operational Locked? Valves Yes No Yes No Yes No Yes No Supvd.?) Yes No CITY CONNECTION � j ',/ v �-'" �:;=% � �/`- ✓ TANK PUMP SECTIONAL .,r::.. _i `. '✓` ✓ l/ (i. � L� .'�i i. SYSTEM ALARM LINE � 3.WATER SUPPLIES ( (�� j u k� •-- Pressure Fire Pump&Tank a. Water supply source? Ciry �`t-' '`�� r t `U�`Gravity Tank Pressure Fire Pump&City Waterflow Test Results Made During This Inspection Pressure Fire Pump&Pond Test Size Static Static Test Size Static Static Pipe Test Pressure Flow Pressure Pipe Test Pressure Flow Pressure Located Pipe Before Pressure After Location Pipe Before Pressure After c:_. i) 4.TANKS,PUMPS,FIRE DEPT.CONNECTIONS Yes N.A.$ No* Ia. 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? v� d. Are fire dept.connections visible and accessible? � : 5.WET SYSTEMS � � ,� / a. No.of systems Make&Model �-� �� '�� `'� t �"`�� =-� 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? v d. Have all the antifreeze systems been tested? v e. Date antifreeze systems were tested f. The antifreeze tests indicate protection to: system 1 2 3 4 5 temperature g. Did alarm valves,waterflow alarm indicators and retards test satisfactorily? $Not Applicable �l�r SG4550�-R1-1 INSURANCE BUREAII COPY 'EXP�ain(No�A�sWe�s o�Back of Sheet 2 - �} ; tyco Fire & Sin�p/exG�inne// Security INSPECTION CONTRACT , , r..j „ NO. � � INSPECTION REPORT REPORT OF INSPECTION BUREAU FI�E _ _ ' NO. NO. :E SET20F2 : 6.DRY SYSTEMS Yes N.A.$ No' _ a. No.of systems Make&Mqdel � f ' ' " � � � 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 ail 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 heated7 7.SPECIAL SYSTEMS a. No.of systems a � Make&Model ' Type b. Were valves tested as required? c. Did all heat responsive systems operate satisfactorily? d.'Oid the supervisory features operate during testing? Heat Responsive Devices: Type Type of test Valve No. 1......2......3......4......5......6...... Valve No. 1 ......2......3......4......5......6...... ; Valve No. 1......2......3......4......5......6...... Valve No. 1 ......2......3......4......5......6...... Valve No. 1......2......3......4......5......6...... Valve No. 1 ......2......3......4......5......6...... 4 , Valve No. 1......2......3......4......5......6...... Valve No. 1 ......2......3......4......5......6...... Auxiliary equipment: No. � Type •�=� �' 1=k.` �� i :v l.-- Location - ? . • t.;... Test results l �- �f' ' �' . �- � R�' S.ALARMS Yes N.A.$ No' a—Did the water motors and gong operate during testing? ' b. Did the electric alarms operate during testing? c. Did the supervisory alarms operate during testing? 9.SPRINKLERS—PIPING a. Do sprinklers generally appear to be in good external condition? b. Do sprinklers generally appear to be free of corrosion,paint,or loading and visible obstructions? c. Are extra sprinklers available on the premises? d. Does the exterior condition of piping,drain valves,check valves, hangers, pressure gauges,open sprinklers and strainers appear to be satisfactory? e. Does the hand hose on the sprinkler system appear to be in satisfactory condition7 10.EXPLANATION OP"NO"ANSWERS(For Sections 1B thru 9): �. 11.THE INSPECTOR SUGGESTS THE FOLLOWING NECESSARY IMPROVEMENTS,HOWEVER,THESE SUGGESTIONS ARE NOT THE RESULT OF AN ENGINEERING SURVEY: + ( �� 12.ADJUSTMENTS OR CORRECTIONS MADE: l ;it «f� 13.LIST CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPMENT,AS ADVISED BY THE OWNER IN SECTION 1A: i 14.INSPECTION AND SUGGESTED IMPROVEM�NTS WEFjE�fSCUSSF�D WITH THE UNDERSIGNED OWNER OR OWNER'S REPAESENTATIVE? Signature of owner or owner's representative �'� �� '% �"��'"�"� Date DUPLICATE TO: STREET CITY&STATE ZIP ATT. #Not Applicable SG4550R1-2 `Explain(No)Answers on Back of Sheet � INSURA,NCE B�li��i� CO�'Y � � - tyco Fire & Simp/exGrinne// Security DRY PIPE VALVE TRIP TEST REPORT t : FOR �� ,tij JV " �L��--=s�ti `t � �4 ' � 4 � �� .�r::. �� : _ _ , j�-"� E `` INSPECTION NO. ' STREET f ��"� J � � x � ` CITY �`N�1�"�{ T-!�� STATE CONTRACT NO. ] � � ;; DATE OF TRIP TEST �� ` � u 4 INSPECTOR _TLL-�_,��y��DAY WORK NO. a NOTE: BEFORE ANY DRY PIPE VALVE IS TRIP TESTED,THE WATER SUPPLY LINE TO IT SHOULD BE THOROUGHLY FWSHED. THE TWO INCH DRAIN BELOW THE VALVE SHOULD BE OPENED WIDE, AND WATER AT FULL PRESSURE SHOULD BE DISCHARGED LONG ENOUGH TO CLEAR THE PIPE OF ANV .. ACCUMULATION OF SCALE OR FOREIGN MATERIAL IF THERE IS A HYDRANT ON THE SUPPLY LWE,THIS ITYDRANT SHOULD BE FWSHED BEFORE THE TWO INCH DRAIN IS OPENED.THE DRIP VALVE ON THE DRY PIPE VALVE SHOULD BE CHECKED BEFORE TRIPPING THE DRV PIPE VALVE.TO SEE THAT IT IS IN OPERATING CONDITION. d DRY PIPE VALVES SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) VALVE SERIAL NUMBER �-�^` MANUFACTURER(NAME) s� � VALVE MODEL � VALVE SIZE INCH INCH INCH INCH (LOCATION) � CONTROLLWG SPRINKLERS -� (NUMBER) � .._ -�� (APPROX) � - (AAPROX) - - .�(APPROX� .. . .� ...(APPROX) DATE LAST TRIP TESTED? � - � � �C_ ' , , DATELAST OPERATED? '� AIR LBS LBS LBS LBS PRESSURE BEFORE TEST WATER � LBS LBS lBS LBS SIZE AND LOCATION OF TEST VALVE � �� WAS GATE VALVE BELOW DRV VALVE OPEN WIDE AT TEST? 9 � � 1 �) S (IF NOT,HOW MANY TURNS?) 1J F��N AIR PRESSURE LBS LBS LBS LBS �.-: VALVE TRIPPED AT WATER PRESSURE LBS LBS LBS LBS � � � TIME . MIN ��"' SEC MIN SEC MIN SEC MIN SEC iF SVSTenn F�000e�,uS7 rinne waTEa MIN ..• SEC MIN SEC MIN SEC MIN SEC REACHED TEST OPENING " PERFORMANCE INTERIOR OF BODY MOVING PARTS �� VALVE CONDITION RUBBER FACING SEATS RESET? DID ALARMS OPERATE AT TRIP TEST? \ �� ALL LOW POINT DRAINS BLOWN OUT? WATER CONTROL VALVE LEFT OPEN AND SEALED? ALARM CONTROL VALVE LEFT . � ' OPEN AND SEALED? � QUICK OPENING DEVICES SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) DEVICE SERIAL NUMBER �� MANUFACTURER(NAME) ' i TYPE AND MODEL AIR PRESSURE IN UPPER CHAMBER LBS LBS LBS LBS QUICK OPENING DEVICE TRIPPED AT SEC LBS SEC LBS SEC LBS SEC LBS PERFORMANCE QUICK OPENING DEVICE LEFT IN SERVICE '"' 1' AND CONTROL OPEN AND SEALED? LIST ANY UNSATISFACTORY CONDITIONS: :i: ;ti REMARKS :� SG 4274 R2 8 n Grinnell �� `"^��'` FIRE PROTECTION SYSTEMS COMPANY 41997 INSPECTION REPORT SF� INSPECTION CONTRACT ; No. ....,�-.....:...:�.............. REPORT OF INSPECTION No._;�'�:. ,.�...% .:.:.�' ? : CONFERRED WITH �,�j'; U�- ��ONO BUREAU FILE ................ ' - N0. ................................ ', ..................................................................... PHONE N0. ........................................... SET 1 OF 2 :, REPORT TO ' � '� � �-��2 X BUILDING OR IOCATION INSPECTED � ^ - STREET ,L7DO �UX �� T INSPECTOR ��r�""�� =-%'�' ='��?f/Z CITY&STATE _��/� %� /3'Z 1-- ZIP S`�� GRINNELL OFfICE_ -�`fCl` PHONE NO.��'�� . 11TT. DATE � "— �—`�� 1. GENERAL Yes N.A. No• 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 inspectionT - b. Have there been any changes or repairs to the fire protection systems since the last inspectiont ` c. If a fire has occurred since the last i�spection,have all damagea sprinkler system components been replacedt d. Has the � in �n all dr s stems been checked for ro er itch within the ast five ears7 � � P�P B� Y Y P P P P Y Date last checked (checking is recommended at least every 5 years) e. Has the piping in all systems been checked for obstructive materialst ✓r Date last checked (checking is recommended at least every 5 years) f. Have all fire pumps been tested to their fuil capacity through the use of hose streams or fiow meters within the past 12 monthst g. Are gnvity,surface or pressure tanks protected trom freezing7 �n - h. Are any of the sprinklers 50 years old or olderT (testing and/or replacement is recommended for such sprinklers) i. Are�ny extre hig}�temperature solder sprinklers regularly exposed to termperotures near 300°Ft B. (To be answered by the inspector) a. Have the sprinkler systems been extended to all visible areas of the buildingt ' !` b. Dces there appear to be proper clearance between the top of al)storage and the sprinkler deflectorT c. Are the building areas protected by a wet system,heated,including its blind attia and perimeter areas,where accessiblei d. Are all visible exterior openings protected against the entrance of cold air� Y. CONTROL VALVES a. Are all sprinkler system main control valves and all dther valves in the appropriate open or closed positiont b. Are all control valves sealed or supervised in the open positiont Control No. Easily Valve Securedt Supervision Valves of Type Accessible Signs Open If yes,howT (�aledt) Operational Valves (Locked�) Yes No Yes No Yes No Yes No (Su vd.�) Yes No CITY CONNECTION TANK�ui Ac� i�teiw�li1/ - r,� 1,./" PUMP SECTIONAL ! •t - �.M>i / (�,.i`- SYSTEM C,,�„� '7" (�5 +... %+ 1 ALARM LINE =� 3. WATER SU►rLlES !� f'`�:' _;'<.:rr PressuraFiw.euwp.&Tank a. Water supply sourceP City ,,GcavitYTank ��1� r7�t�s<- `� Pressure Fire Pump&Ciry Waterflow Tat Resu�ts Made During This Inspedion Pressure Fire Pump&Pond Test Size Static Static Test Size Static Static Pipe Test Pressure Flow Pressure Pipe Test Pressure Flow Pressure Located Pi e Before Pressure Aher Location Pi e Before Prasure Aher K ' ` � .T ` l :! �. TANKS,rUM►S,fIRE DE►T.CONNECTIONS Yes N.A.� No• a. Do fire pumps,gravity,surface or pressure tanks appear to be in good external condition? b. Are gnviry,surface and pressure tanks at the proper pressure and/or water levels7 , c. Are fire dept.rnnnedions in satisfadory condition,couplings free,caps or plugs in place and check valves tightt d. Are fire dept.connections visible and accessiblet S. WET SYSTEMS f a. No.of systems�Make d Model �- � � �c..-=_�-. . ,�.� r' b. Are cold weathcr valves in the appropriate open or closed positiont If closed,hu piping been drained� c. Has the owner or owner's representative been advised that cold weather valves are not recommended by NFPAt d. Have all the antifreeze systems been tested? �„ e. Date antiheeze syitems were testtd ' f. The antifreeze tests indicateprotectlon to: system 1 � 3 4 S temperature g. Did alarm valves,waterflow alarm ind�cators and retards test satisfadorilyt tNot AppUcable G4550-1 •Explain(No)Answers on Cack of SAa�t 2 � INSURANC� BUREAU COPY n Grinnell° `"^��'' FIRE PROTECTION SYSTEMS COMPANY • INSPECTION CONTRACT �� N0.�C�.,-.:.�".7..`.�.c, tf.?. " INSPEG'�ON�i�RT No. _...... .. _. _ REPORT OF INSPECTION BUREAU FILE _ ............. '� N0. ........__..... .............. r SET 2 OF 2 i. DRY SYSTEMS ' Yes N.A.� No' a. No.of systems�Make& odel '= � Date last trip tested ` �' " - b. Is the air pressure and priming water levels normalt c. Did the air compressor operate satisfactorilyt k d. Were all low points drained during this inspeaion� e. Did all quick opening devices operate saFisfactorilyt ` f. Did all the dry valves operate satisfadorily during this i�spedion� L-'' g. Do dry valves appear to be protected from freezing� - h. Is the dry valve house heaied� 7. SrEC1AL SYSTEMS � a. No.of systems�Make&Model Type b. Were valves tested as requiredt c. Did all heat responsive systems operate satisfactorilyt d. Uid the supervisory features operote during testingt Heat Re;ponsive Deyices: Type Type of test- Valve No. 1...... 2...... 3......4...... 5......6...... Valve No. 1...... 2...... 3......4......5......6...... !; Valve No. 1...... 2...... 3......4...... 5......6...... Valve No. 1...... 2...... 3......1...... 5......6...... Valve No. 1...... 2......3......1...... 5......6...... Valve No. 1...... 2......3......4......5......6...... Valve No. 1...... 2...... 3......4...... 5......6...... Valve No. 1...... 2...... 3......4...... 5......6....... Auxiliary equipment: No. Type Location Test results - _ L ALARMS Yes N.A.; No• a. Did the warer motors and gong operate during testing� = b. Did the eledric alarms operate during testingt c. Did the supervisory alarms operate during testingt ^ !. SrRINKLERS—rIMNG a. Do sprinklers generally appear to be in good external conditiont b. Do sprinklers generally appear to be free of corrosion,paint,or loading and visible obstructions� c. Are extra sprinklers available on the premisest ✓�_ d. Does the exterior condition of piping,drain valves,check valves,hangers,pressure gauges,open sprinklers ' and strainers appear to be satisfactoryt e. Ooes the hand hose on the sprinkler system appear to be in satisfactory conditiont 10. EXrI.ANATION OF"NO^A[VSWERS(Fw Sections 1S thru 9): -�l; ,d/c1 f; : t . � .^ �/f�D'� 1J..THE INS/KTOR SUGGE.ST$TFiE FOLLOWING NECESS RY PROVEMENTS.HOWEVE THESE SU�GESTIONS ARF NOT THE RESULT OF AN ENGINEERING SURVEY: �_�� .�.��1.��_L �rf r��, �",�;y �-./�� !(� S` �� i.�r�, r�l�'�� i r��t� 12 ADJI�ISTMENTS O�t CORRECTIONS MADE: f` •! { :r�;�l/ �..�..�17 �/1 i i� ��/1 f SS[ .�� !•` �— r / �� J� 13. UST CHANGES IN THE OCCU�ANCY HAURD OR FIRE PROTECTION EQUI►MENT,AS ADVISED SY THE OWNER IN SECTION 1A: �': �'� ,.� _ 14. INSrECT10N AND SUGGESTED IMPROVEMENTS WEIt�DISCU656D WITH THE UNDEitSIGNED OWNER flR OWNER'S RE►RESENTATIVE-I�7 � < , ��_"� / Signature of owner or owner's representative ,LS,:�,� �„Z�-_�%�-��/ Date DUPLICATE TO: STREET CITY d�STATE ZIP ATT. G4550-2 tNot Applicable •Explain(No)Answers on Back o(Sheet 9NSURANCE BURE�1l1 COPY � 64274 Prinfad in U.S.A. DRY PIPE VALVE TRIP TEST REPORT . nG�,� P�oN �� ° EXECUTIVE OFFICES • 10 DORRANCE STREET • PROVIDENCE,R.I.02901 • 401-456-5600 v.`.� ��tioio`O, �-- FOR .�'�,�!�.. f�: `: i�l :�.- -�/ �it � � .-" rJt� � INSPECTION NO. ?(�_(� � S�� STREET - � �'-- �t r`� CITY <�� `�/' STATE '�� CONTRACT NO. OATE OF TRIP TEST �`�� ""�?,L— INSPECTOR f'��-'�!�'�n'✓'►F�? DAY WORK NO. p� NOTE: BEFORE ANY DRY PIPE VA�VE IS TRIP TESTEO, THE WATER SUPPL.Y LINE TO IT SHOULD BE TMOROUGHLY FLUSMED. THE TWO INCH EF�`' ORAIN BELOW TME VALVE SHOULD BE OPENED WIDE, AND WATER AT FULL PRESSURE SNOULO BE DISCHARGED LONG ENOUGH TO CLEAR THE PIPE OF ANV ACCUMULATION OF SCALE OR FOREIGN MATERIAL. IF TMERE IS A HYDRANT ON TME SUPPIV LINE, TMIS MVDRANT SMOULD BE FLUSHED BEFORE TME TWO INCH DRAIN IS OPEHED. THE DRIP VALVE OH TME DRY PIPE VALVE SHOULDBE CHECKED BEFORE TRIPPING TME DRV PIPE VALVE, TO SEE TNAT IT IS IN OPERATING CONDITION. DRY PIPE VALVES SYSTEM N0. ( ) SYSTEM N0. ( ) SYSTEM NO. ( ) SYSTEM N0. ( ) VALVE SERIAL NUMBER ��[j MANUFACTURER (NAME) ' i VALVE MODEL ' � i VAIVE SIZE L- INCH INCr+ iNCN i INCH (LOCATION) CONTROLLING SPRiNKLERS f✓�? / s (NUM8ER1 �� (APPROX�) . ! (APPROX) (APPROX) (APPqOX) ' DATE LAST TRIP TESTEDT L \ DATE LAST OPERATEDI - . � 1 AIR �ss �\ �es �ss �si -: PRESSURE BEFORE TEST WATER ►.ss ` �es �es �ss SIZE AND LOCATION OF TEST VA�VE � ! WAS GATE VALVE BELOW DRV VALVE OPEN / WIDE AT TEST1 (IF NOT NOW MANV TURN 1 '':i�- AIR PRESSURE � �es �es �es �es VALVE TRIPPED AT WATER PRESSURE ,,� �es �es �es , �as TIME ` MIN �' �. SEC MIN SEC MI 3EC MIN fEC IF SYSTEM FLOODED, LIST TiMfi WATER � REACHED TE57 OPENING MIN .--�-�- sEc MINt sec yilN sec MIN sec PERFORMANCE ,- :; J INTERIOR OF BODY MOVING PARTS _ ;+ VALVE CONDtTION RUBBER FACING � 't SEATS RESET? i" - � OID ALARMS OPERATE AT TRIP TEST7 („- � 4 ALl LOW POINT DRAINS BLOWN OUT1 WATER CONTROL VALVE LEFT OPEN AND SEALEDI i ALARM CONTROLVALVELEFT OPEN AND SEALED? � OUICK OPENING DEVICES SYSTEM N0. ( ) SYSTEM N0. ( ) SYSTEM 0. ( ) SYSTEM MO. ( ) ' DEVIGE SERIAL NUMBEFi ! MANUFACTURER (NAME) r' TYPE AND MODEL AIR PRESSURE IN UPPER CHAMBER �es �ss �es �ee QUICK OPENING DEVICE TRIPPED AT s �ea sE Lss sE �ss seC �es PERFORMANCE J QUICK OPENING DEVICE LEFT IN SERVICE AND CONTROL OPEN AND SEALEDI LISTrAHY UNSATISFACTORV CONDITIONS: Ll � rf� �""��: �,,L; ^_�.'�„ ! �,� ;/f f�� : �f a � !i'r" �'� �7�f/;-'" :�L:.✓�� i.' t��/��"�.1, f� !' ,G ! '}.�..�,JY'�.%'��/� � �� 9 N E M A R K 5: �,P.�O/./G/� a;, Sf F- s'� ,%....� �.�;,��"L �1��L�-^_. c ` � , r;z� /�i / ,' � � - / S ,� �.: 11 , " f-' _ ,,,�-`- � � :. � � � . _ , . ,'? / �,�, �= , �' ,�,.., ;� f'sS , ,` -- r--; � : _ _ . , .. f✓''/c'�1/ E=`f :�;'� '''`��`".LR-- .: � . INSURANCE BUREAU COPY _ _�►� Grinnell° � r �`"`^��^'�' FIRE PROTECTION SYSTEMS COMPANY F INSPECTION REPORT INSPECTION CONTRACT � No. ..........:....:................ REPORT OF INSPECTION No. .::...:......:............:...., � CONFERRED WITH BUREAU FILE ................ � PHONE N0. �:..':..:..... ..:.. . NO. .....,.::;...::�:................ � ................................................ ................. - SET 1 0F 2 � REPORT TO ' - 'r � ' BUILDING OR LOCATION INSPECTED STREET - �NSPECTI�R � '` " CITY&STATE -" -� C �`� ZIP GRINNEIL OFfiCE� • PHONE NO ''`-�' �-= - � ATT. - DATE ' 1. GENERAL Yes N.A. No• A. (To be answered by the Owner or Owner's repraentative) 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 inspectiont ' c. If a fire has occurred since the last inspection.have ail damaged sprirkler system components been replacedt ` - d. Has the piping in al�dry systems been checked for pro�er pitch within the past five yearst Date last checked (checking is recommended at least every S years) e. Has the piping in all systems been checked for obstructiva materialst Date last checked _ (checking is recommended at least every S years) 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 g. Are gnwity,surface or pressure tanks proteded from freezingt �' � h. Are any of the sprinklers 50 yean old or older? (testing and/or replacement is retommended for such sprinklers) '"'�� i. Are a�y extra high temperature solder sprinklers regularly exposed to termperotures near 300°R ��- 8. (To be answered by the inspector) � a. Have the sprinkler systems been extended to all visible areas of the buiiding� 8 b. Ooes there appear to be proper clearence between the top of a!)storag�and the sprinkler defiectorT ---" � c. Are the building areas proteded by a wet system,heated,including its blind attics and perimeter areas,where accessibleT •4�'" d. Are all visible exterior openings protected against the entrance of coid airt � 1 �ONTROL VALVES � a. Are all sprinkler system main control valves and a�l other valves in the appropriate open or closed position� � b. Are all control valves sealed or supervised in the open position? � Secured7 No. Easily Va�ve Supervision Control of Type �ccessible Signs Open If yes,howt l�aledt) Opentional Valves Valves (Lockedt) Yes No Yes No Yes No Yes No ($u vd.T) Yes No � CITY CONNECTION ` TANK PUMP SECTIONAL•.:. r -, , - .,�� ..._- - - . ; ...� �,,- SYSTEM :;R - ALARM UNE - � 3. WATER SUKLIES Pressure.Fire Pump&Tank�T _ � a. Water supply sourceT __Cky` �-Gnvity Tank ` Pressure Fire Pump h Gty � f � � Waterflow Test Resu�ts Made During This Inspection Pressure Fire Pump&Pond � Test Size Static Static Test Size Static Static Pipe Test Pressure Flow Pressure Pipe Test Pressure Plow Pressure �� Located Pi e Before Pressure Aher Location Pi e Before Pressure Aher _ .. _ ,`✓.- �� 4. TANKS,rIIMK,flRE DEIT.CONNECTIONS Yes N.A.� No• � a. Do fire pumps,gravity,surface or pressure tanks appear to be in good external condition?_ "` b. Are gravity,surface and pressure tanks at'rhe proper pressure and/or water levelst '' � c. Are fire dept.connedions in satisfactory condition,couplings free,caps or alugs in place and check valves tight? d. Are fire dept.connections visible and accessiblet S. WET SYSTEfNS ! A� r .�: . � .. a. No.ot systems '�Make&Model ' - ' � b. Are cold weather valves in the appropriate open or dosed position7 `� � If closed,has pipirtg been drainedi j c Has the owner or owner's representative been advised that coid weather valves are not recommended by NFPAt � � d. Have all the antifreeze systems been tested7 � e. Uate antifreeze sy:tems were test�d f. The antifreeze t�ts indicateprotectio�to: � system 1 2 3 4_ 5- temperature g. Did alarm valves,waterflow alarm ind�cators and reards test satisfactorily� , � � =Not Applicable � c4sso-� (NSURANCE BUREAU COPY 'Eaplsin(No)Answers on 6ack o(ShNt 2 - ;� � �� Grinnel�° � � �`"^�^'�' FIRE PROTECTION SYSTEMS COMPANY INSPECTION CONTRACT - NO. :........__. :,�. .:.....::...: '' INSPECTION REPORT REPORT OF INSPECTION BUREAU FILE ........ ....... � No. ... .... .. .... .. _..... � NO. ........ : ._.-._ ............ . SET 2 OF 2 � i. DRY SYSTEMS Ya N.A.; No' a. No.of systems '� Make&Model Date last triptested � b. Is the air pressure and priming water levels normal2 c. Did the air compressor operate satisfactorily? d. Were all low points drained during this inspectiont e. Did all quick opening devices operate satisfactorily7 f. Did all the dry vaives operate satisfactorily during this inspection? g. Do dry valves appear to be protected from freezingt - h. Is the dry valve house heafed7 �. S/ECUL SYSTEMS �. a. No.of systems - Make&Model ��'`�`'� ry� � _... b. Were valves tested as requiredt �-�- ' c. Did all heat responsive systems operate satisfactorilyT d. Did the supervisory features operate during resting� - Heat Responsive Deyices: Type Type of test Valve No. 1...... 2...... 3......4...... 5...... 6...... Yalve No. 1...... 2...... 3......4......5......6...... Valve No. 1...... 2...... 3......4...... 5......6...... Yalve No. �...... 2...... 3......4...... 5......6...... , Valve No. 1...... 2...... 3......4...... 5...... 6...... Va�ve No. 1...... 2......3......4...... 5......6...... � Valve No. 1...... 2...... 3......4...... 5...... 6...... Valve No. 1...... 2...... 3......4...... 5......6....... Auxiliary equipment: No. Type L� "'' __ Y �„ location Test results i. AURMS Yes N.A.x No• a. Did the water motors and gong operete during testingt b. Did the electric alarms operate during testing� c. Did the supervisory alarms operate during testing� 9. S►RINKLERS—MPING a. Do sprinklers generally appear to be in good external condition� b. Do sprinklers generally appear ro be free of corrosion,paint,or loading and visible obstructions7 �..---'" t. Are extra sprinklers available on the premises? d. Does the exterior condition of piping,drain valves,check valves,hangers,pressure gauges,open sprinklers and strainers appear to be satisfadory? '-�--" e. Does the hand hose on the sprinkler system appear to be in satis(actory condition? � � 10. EXrLANATION Of"NO"ANSWERS(Fo�Sections 16 thru 9): _ - +. 11. THE INSPKTOR SUGGE5T5 THE FOLLOWING NECESSARY IMPROVEMEPITS.HOWEVER,THESE SUGGESTIONS ARE NOT THE RESULT OF AN ENGINEERING SURVEY: 12 ADJUSTMENTS OR CORRECTIONS MADE: � 13. U5T CHANCES IN THE OCCUPANCY HAZARD OR FIRE PROTKTION EQUI►MENT,AS ADVISED BY THE OWNER IN SECTiON 1A: �.u ,_ : - i.... 14. lNSrKT10N AND SUGGESTED iMPfiQVfMENTS WERE DISCUSSED WITH THE i;RDER�:GNED OWNER DR OWNER'S RErRESENTATIVEt Signature of owner or owner's representative Date DUPLICATE TO: STRfET CITY 6 STATE ZIP ATT. tNot Applic�ble G45�0-2 •Explain(No)Answers oe Back of Sheet INSURANCE BUREAU COPY r' �� DRY PIPE VALVE TRIP TEST REPORT � GRINNII,L FIRE PR,OTECTION SYSTQVIS COMPANY e FOR �! `.- - . ', :-'L/` � INSPECTION NO. �'.` '�� . . ,�Y2 � � r: STREET-1��-�•-- `' ' CITY " '�'��-=-�� STATE �'��'�'` CONTRACT NO. �'„!� ' DATE OF TRIP TEST '+` %;� INSPECTOR - �� of �-•--- DAY WORK NO, t'�� NOTE: BEFORE ANY DRV PIPE VALVE IS TRIP TESTED, TME WATER SUPPLV LINE TO IT SMOULO 8E TMOROUGMI.Y FI.USHEQ. TME TYIO INCN DRAIN BELOW THE VA�VE SMOU�D BE OPEMED WIDE, AND MATER AT FUIL PRESSURE SMOULD BE DISCHARGEO LOMG ENOUGN TO '" CLEAR THE PIPE Oi ANY ACCUMULATION OF SCALE OR FOREIGH MATERIAL. IF THERE IS A NVDRANT OH TME SUPPLV LINE, THIS MVDRANT SMOULD BE FLUSMED BEFORE THE TWO INCH DRAIN IS OPENED. TNE DRIP VALVE ON THE ORV PIPE VALVE SHOULDBE CMECKED BEFORE TRIPPING TNE DRY PIPE VALVE, TO SEE THAT IT IS IN OPERATING CONDITION. ORY PIPE VALVES SYSTEM N0. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) VAIVE SERIAL NUMBER IdANUFACTURER (NAME) �:'� .- VALVE MODEL VALVE SIZE � �� INCM INCM INCM / INCN �" (LOGATION) . 7--� CONTqOLL1NG SPRINKLERS (NUMBER) (APVI�OR) (APPROIII (APPROIO (APr1�07O �� DATE LAST TRIP TESTEDI ��. Z,j - Lr DATE LAST OPERATEDI � � AIR l.sf Lss l.s! Ls1 �' PRESSURE BE�ORE TEST WATER � ��s �ss �es L�s -. '`. SIZE AND LOCATION OF TEST VALVE � �� L� ;�: WAS GATE VAIVE BELOW DRV VALVE OPEN '�� MIDE AT TEST' UF NOT MOW MANV TURN 1 AIR PRESSURE �of �BS �u Ls3 ' � VALVE TRIPPEO AT WATER PRESSURE / �es , �ss ��s �as �i TIME MIN .� Z SEC MIH S MIN fEG MIN fEC �.- a�'• — IF SVSTEM FIOODED, LIST TiMfi WATER REACHED TEST OPENING NIN /� tEC MIN 3EC MtN fEG MIN 3EG � PERFORMANCE d INTERIOR OF 80DY I ' MOVING PARTS � N VALV�E CONDITION RUBBER FACING c'�j� _ � SEATS j RESET+ � � � � OID ALARMS OPERATE AT TRIP TE5T1 ALL LOW POINT DRAINS BLOWN OUT1 r WATER CONTROL VALVE LEPT —t— � OPEN ANO SEALED� __ __ _ _� __ � ---��----- � ALARM CONTROL VAIVE LEFT .:�— -- -- - OPEN AHD SEAIED� -�— �__�- — __�_.---- OUICK OPENING DEViCES SYSTEAK'NO. ( ) i SYS?E4 N . ( ` ) , SYSTEM N0. ( ) SYSTEM N0. ( ) DEVICE SERil1l. NUMBER � — - -- -- � ---- MANUFACTURER (NAME) � TrPE ANG MODE� AIR PRESSURE IN UPPER CNAMBER �os LI�f � l.�t � �� QUICK OPEwIHG OEV�CE TRIPPED AT scc �es s[c ��s sac ��s �[C ��f . .: PERFORMANCE ' � ' ;:- QUICK OPENING DEVtCE LEFT IH SENVICE � � i - -� AMD CONTROL OPEN ANOSEALEDI '�-� LIST ANV UNSATISFACTORV CONDITIONS: �f / �:�(�G�_ _. �+../`�-�� .— REMARKS: f �� .. _ � ^- . _ •� c�` _i% . . �/�,�f �'i.�_ - L �:'�!� . f .� r � � �..�> � tNSURANCE BUREAU C�►��' «