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� !�� tyco Fire & Simp/exG�inne// � <br /> Securit �������°i�;� INSPE T `6QN�RACT <br /> 'INSPECTION REPORT Y Np. � /,�;i� <br /> No. REPORT OF INSPECTION SEP 1 5 �004 BUREAu Fi�E ____ _ ,;, <br /> ;CON�ERRED WITH NO. __ ' <br /> •. <br /> �. � 'r . F.z C��I�Y C7r C)}�t�Aln SET 1 OF 2 `� <br /> r � <br /> � .�-e. <br /> �' `v��� �-���� j ` ' S "` BUILDING OR LOCAT}ON INSPECTED ---}% ��'L' '•_ <br /> REPORT TO i ` '� � r <br /> STREET i � ' '` -� t INSPECTOR �' ` �' t��--� <br /> ;CITY& STATE '•� +�� "� � r1 `. �' J ZIP GRINNELL OFFICE 'ti� - PHONE NO. =�� � � �- `"'`' '� <br /> 'ATT. DATE � � I �-- Y <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 /> � <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 piping in all dry systems been checked for proper pitch within the past five years? v <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 /> �' <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 deflector7 ` <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 /> Vaivesl of Type Accessible Signs Open If yes,how? �Sealed?j Operational <br /> Locked? <br /> Valves Yes No Yes No Yes No Yes No Supvd.?) Yes No <br /> CITY CONNECTION � j ',/ v �-'" �:;=% � �/`- ✓ <br /> TANK <br /> PUMP <br /> SECTIONAL .,r::.. _i `. '✓` ✓ l/ (i. � L� .'�i i. <br /> SYSTEM <br /> ALARM LINE <br /> � <br /> 3.WATER SUPPLIES ( (�� �j u k� •-- Pressure Fire Pump&Tank <br /> a. Water supply source? Ciry �`t-' '`�� � r t `U�`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 /> c:_. i) <br /> 4.TANKS,PUMPS,FIRE DEPT.CONNECTIONS Yes N.A.$ No* <br /> Ia. 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? v� <br /> d. Are fire dept.connections visible and accessible? � <br /> : 5.WET SYSTEMS � � ,� / <br /> a. No.of systems Make&Model �-� �� � � '�� `'� t �"`�� �� =-� <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? v <br /> d. Have all the antifreeze systems been tested? v <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 /> �l�r SG4550�-R1-1 INSURANCE BUREAII COPY 'EXP�ain(No�A�sWe�s o�Back of Sheet 2 - <br />