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HomeMy WebLinkAboutFIR Inspections - 12/12/2001 INSPECTION AND TESTING FORM LU DATE: TIME: SERVICE ORGANIZATION PROPERTY NAME(USER) NAME ._4�E' Y t, L...L ---- NAME: C..G't'K i 1 Ct t ADDRESS: 2?16 0,e� ADDRESS: REPRESENTATIVE: ' OWNERCONTACT: LICENSE NO.: - 7c r ;' TELEPHONE: TELEPHONE: `d _ "r> 6 ��i MONITORING ENTITY APPROVING AGENCY r� CONTACT; cif M .ff C. . CONTACT: '0'1A-,D0 U - '_! TELEPHONE: rF TELEPHONE: 3(aQ- MONITORING ACCOUNT REF.NO.: TYPE TRANSMISSION SERVICE [ ]-McCulloh [ ] -Weekly [ ]-Multiplex [ ] -Monthly Digital [ ]-Quarterly [ ]-Reverse Priority [ ]-Semi-Annually [ ]-RF -Annually [ ]-Other(Specify [ ] -Other(Specify) PANEL MANUFACTURER:RG6�6r,e MODEL NO.: CIRCUIT STYLES: fir. NO.OF CIRCUITS: SOFTWARE REV.: LAST DATE SYSTEM HAD ANY SERVICE PERFORMED: LAST DATE THAT ANY SOFTWARE OR CONFIGURATION WAS REVISED: Al ALARM INITATING DEVICES AND CIRCUIT INFORMATION QTY OF CIRCUIT STYLE ']... MANUAL STATIONS -----' ION DETECTORS °.: PHOTO DETECTORS —. DUCT DETECTORS HEAT DETECTORS WATERFLOW SWITCHES SUPERVISORY SWITCHES - OTHER: (SPECIFY) ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION QTY OF CIRCUIT STYLE BELLS HORNS --' CHIMES S' STROBES - - SPEAKERS OTHER: (SPECIFY) NO. OF ALARM NOTIFICATION APPLIANCE CIRCUITS: 4 ARE CIRCUITS SUPERVISED? YES [ ] NO SUPERVISORY SIGNAL INITIATING DEVICES AND CIRCUIT INFORMATIOl'G` "v 2 QTY OF CIRCUIT STYLE BUILDING TEMP SITE WATER TEMP SITE WATER LEVEL FIRE PUMP POWER FIRE PUMP RUNNING FIRE PUMP AUTO POSITION FIRE PUMP OR PUMP CONTROLLER TROUBLE GENERATOR IN AUTO POSITION GENERATOR OR CONTROLLER TROUBLE SWITCH TRANSFER GENERATOR TNGINE RUNNING OTHER: (SPECIFY) SIGNALING LINE CIRCUITS Quantity and style(See NFPA 72,Table 3-6)of signaling line circuits connected to system: Quantity Style(s) . SYSTEM POWER SUPPLIES a. Primary(Main): Nominal Voltage I S j r,} Amps V1 34 Overcurrent Protection: Type `> ey N{ar ,Amps Location(Panel Number):/ai j�ve` Disconnecting Means Location: K`' Secondary(Star-oby): ?r J-�t KStorage Battery: Amp-Hr Rating fdd l Calculated capacity to operate system,in hours: 24 - W Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY [ ] Dry Cell [ ] Nickel Cadmium [ ] Sealed Lead-Acid [ ] Lead-Acid [ ] Other(Specify) C. Emergency or standby system used as a backup to primary power supply,instead of using a secondary power supply: ribed in NFPA 70,Article 700 Emergency system desc Legally required standby described in NFPA 70,Article 701 Optional standby system described in NFPA 70,Article 702,which also meets the performance requirements of Article 700 or 701. 0600 `." 3 PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE: YES NO WHO TIME MONITORING ENTITY BUILDING OCCUPANTS BUILDING MANAGEMENT OTHER(SPECIFY) [ ) [ J AHJ(NOTIFIED)OF ANY IMPAIRMENTS SYSTEM TESTS AND INSPECTIONS TYPE VISUAL FUNCTIONAL COMMENTS CONTROL PANEL [ ] [ ) INTERFACE EQUIPMENT [ ] [ J LAMPS/LEDS C ] L J FUSES [ ) [ J PRIMARY POWER SUPPLY TROUBLE SIGNALS DISCONNECT SWITCHES { ] [ J GROUND FAULT MONITORING [ ] [ ] SECONDARY POWER TYPE VISUAL FUNCTIONAL COMMENTS BATTERY CONDITION ] LOAD VOLTAGE DISCHARGE TEST [ J CHARGER TEST [ ) SPECIFIC GRAVITY [ J TRANSIENT SUPPRESSORS [ ] REMOTE ANNUNCIATORS NOTIFICATION APPLIANCES AUDIBLE VISIBLE SPEAKERS [ ) [ J VOICE CLARITY [ J INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS DEVICE VISUAL FUNCTIONAL FACTORY MEAS. LOC.&S/N TYPE CHECK TEST SETTING SETTING PASS FAIL COMMENTS: `ems VISUAL FUNCTIONAL COM4 _L) 4 EMERGENCY COMMUNICATIONS EQUIPMENT HNE SETS [ ] [ ] PHONE JACKS [ ] [ ] OFF-HOOK INDICATOR [ ] [ ] AMPLIFIER(S) [ ] [ ] TONE GENERATOR(S) [ ] [ ] CALL IN SIGNAL [ ] [ ] SYSTEM PERFORMANCE [ ] [ ] DEVICE SIMULATED VISUAL OPERATION OPERATION INTERFACE EQUIPMENT (SPECIFY) [ ] [ ] [ ] (SPECIFY) [ ] [ ] [ ] (SPECIFY) [ l [ l [ l SPECIAL HAZARD SYSTEMS (SPECIFY) [ ] [ l [ l (SPECIFY) [ l [ ] [ ] (SPECIFY) [ l [ ] [ ] SPECIAL PROCEDURES: COMMENTS: ON/OFF PREMISES MONITORING: YES NO TIME COMMENTS ALARM SIGNAL ALARM RESTORAL TROUBLE SIGNAL [ ] [ ] a TROUBLE RESTORAL [ ] [ ] ' wf SITPERVISORY SIGNAL [ ] [ ] SUPERVISORY RESTORAL [ ] [ ] NOTIFICATIONS THAT TESTING: IS COMPLETE YES NO WHO TIME BUILDING MANAGEMENT MONITORING AGENCY BUILDING OCCUPANTS...,,-- OTHER(SPECIFY) [ l [ ] THE FOLLOWING DID NOT OPERATE CORRECTLY: SYSTEM RESTORED TO NORMAL OPERATION: DATE TIME •+� THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS. NAME C�ISPECTOR: AW ,h 6t" lKr' DATE: t TIME: ' SIGNATURE: b NAME OF OW R,rfJR REPRESENTATIVE: DATE: ! TIME: . SIGNATU E: Reprinted with permission from NFPA 72,National Fire Alarm Code,Copyright©1999,National Fire Protection Association,Quincy,MA 02269. This reprinted material is not the complete and official position of the National Fire Protection Association,on the referenced subject which is represented only by the standard in its entirety. Distributed by: AFAA—P.O.Box 951807—Lake Mary,FL 32795-1807 (407)322=6288—(407)322-7488 fax—www.afaa.org 12 L-OLJ 5 2 -- (oOW O REORDER PART NO.IF 100 Pre-Engineered Restaurant Fire Suppression Systems Report SERVICE COMPANY DATE OF SERVICE TIME A.M. P.M. ANNUAL SEMI-ANNUAL RECHARGE I INSTALLATION RENOVATION AmeriSafe LOCATION OF SYSTEM CYLINDERS UL300 Q YES ❑NO 3006 29th Ave. SW MANUFACTURER MODELNUMBER WET DRY CHEMICAL Tumwater, WA 98512 360-943-5634 CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE FUSE LINKS 360°F. FUSE LINKS 450'F. FUSE LINKS 500°F. OTHER CUSTOMER Name 11.,E �t f: FUEL SHUT-OFF ELECTRIC GAS SIZE Address t-�.,� � C" �C t � C U E �i� °� �f��-� I _F.. f SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE 41 City statel ZIP MANUFACTURER'S MANUAL REFERENCE Telephone Store No PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager COOKING APPLIANCE LOCATIONS:LEFT TO RIGHT 1. All appliances properly covered w/correct nozzles 20. Replaced fuse links 2. Duct and plenum covered w/correct nozzles v 21. Check travel of cable nuts/S-hooks 3. Check positioning of all nozzles. _� 22. Piping&conduit securely bracketed 4. System installed in accordance w/MFG UL listing "d 23. Proper separation between fryers&flame 5. Hood/duct penetrations sealed w/weld or UL device _ 24. Proper clearance-flame to filters 6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order 7. If system has been discharged,report same 26. All filters in place 8. Pressure gauge in proper range(If gauged) 27. Fuel shut-off in on position 9. Check cartridge weight(If applicable) 28. Manual &remote set/seals in place 10. Hydrostatic test date ti 29. Replace systems covers 11. 6 year maintenance date V 30. System operational&seals in place 12. Inspect cylinder and mount ' 31. Slave system operational 13. Operate system from terminal link * 32. Clean cylinder&mount 14. Test for proper operation from remote L 33. Fan warning sign on hood 15. Check operation of micro switch 34. Personnel instructed in manual operation of system 16. Check operation of gas valve 35. Proper hand portable extinguishers v 17. Clean nozzles d 36. Portable extinguishers properly serviced V 18. Proper nozzle covers in place y 37. Service&Certification tag on system 19. Check fuse links and clean v NOTE DISCREPANCIES OR DEFICIENCIES BELOW COMMENTS: i On this date, this pre-engineered fire suppression system was inspected and operationally tested in accordance with tile fire suppression system requirements of NFPA 17 or 17 A, 96 and the manufacturer's manual with the results indicated above. X � SERVICE TE( I iPERMIT NO. DATE: TIME: AM PM CUSTOMER'S AUTHORIZED AGENT