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HomeMy WebLinkAboutFire Alarm System - FIR Inspections - 4/5/2012 a Maso n t M �o County Fire Marshal Ov Inspection Contract No. Mason County Bldg. III SQ�1 c File No. �26 W. Cedar MP' PO Box 186 Shelton WA 98584 FIRE ALARM SYSTEM REPORT OF INSPECTION Date: Name of Facility: ,,,,, Qua-, Occupied as: .6 5n Address: i 3!Z3 shed t�ti „u ►2,1 County: M&f,�h Zip: q ygg y Telephone: 3i o _ N. A - 36a5 Building Designation (if more than one building) Inspection by: u.e.v_ Title: Tech.Teck Date of Inspection: A,,ug* j000 1 . Type of Test: Monthly [ ] Quarterly [ ] Semi-Annual [ ] Annual [X] 2. Type of system: Noncoded [X] Common coded [ ] Selective coded [ ] Dual Coded [ ] (as pertaining to Chapter 212-14 WAC) 3. Local Fire Department: 5k,jf,n -�rs �e� ��.� v\A 4. Fire Department Official Contacted: 5. Test Received at Alarm Center: D"Yes [ ] No 6. Master Box Reset [,,);.,J AM PM 7. All Tests Satisfactory D' Yes [ ] No 8. Comments, explanation of unsatisfactory results, action taken, etc. %tip,w. k-54 ak os ' << Original Form to be returned to Fire Marshal e e EQUIPMENT TESTED # of Units Test Satifactory Type of Equipment Tested Date Yes No N/A Type and Manufacturer 9. Control Panel 1 lg 'e co L)'5ia o 10. Manual Station 51el 11 . Heat Detectors 11 12. Smoke Detectors >( 13. Audible Alarm Devices y AX 1 1 14. Visual Alarm Devices 15. Code Transmitters X 16. Automatic Door Releases x 17. Trouble Indicators Vhg 18. Master Alarm Box 19. Batteries e 20. Charger 1 t Imo 21 . Generator X 22. Ventilation Control N M 0-1 co Ve,, 23. Fire Dept Interconnection X 24. Central Station Interconnection I 5/f6 I too 25. Ext Sprinkler Elec Alarm Bell 26. Sprinkler Water Flow Switch 27. Sprinkler Gate Valve Super Switch 28. Annunciators IQ it o ob ::1 29. Automatic Time Delay of General Alarm Minutes. None Installed [ ]. 30. Test of alarm system on emergency power, satisfactory [4Yes [ ] No 31 . This is to certify that this fire alarm system has been properly inspected for reliability covering the items listed in this report and is consistent with NF ire alarm M 'nt nance Standards. A. Signature of Owner or Representative B. Signature of Fire Alarm Firm Repesentative C. Name of Firm: PIONEER FIRE & SECURI :�� D. Mailing Address: PO Box 597, E. Olympia, WA 98540-0597 Phone No. 360-491-8141 E. Electrical Contractors License #: PIONEFS088LR Original Form to be returned to Fire Marshal Mason County Fire Marshal Equipment Tested Mason County Bldg. III Inspection Contract No. J26 W. Cedar File No. P.O. Box 186 Shelton, WA 98584 FIRE ALARM SYSTEM REPORT OF INSPECTION Name of Facility: Extreme Auto PF0301 Date: Occupied as: Auto Shop Address: 1383 E. Shelton S rin s Road County: Mason - i Zip: 98584 Telephone: 360-432-3625 Building Designation (if more than one building) Inspection By: rn,�/.�� L �,��,��� Title: Tech Date of Inspection: 1. Type of Test: Monthly ( Quarterly (O Semi-Annual O Annual (X) ` 2. Type of System: Noncoded ( ) Common Coded ( ) Selective Coded( ) Dual Coded ( ) (As pertaining to Chapter 212-14 WAC) 3. Local Fire Department: 4. Fire Department Official Contacted: 5. Test Received At Alarm Center: X Yes ( ) No 6. Master Box Reset AM 7. All Test Satisfactory Yes No PM ( ) 8. Comments, explanation of unsatisfactory results, action taken etc. Original Form to be returned to Fire Marshal Equipment Tested SATISFACTORY TYPE OF EQUIPMENT #OF TEST YES NO N/A TYPE&MANAFACTURE UNITS DATE 9. CONTROL PANEL 1 F Ademco Vista 100 10.MANUAL STATION 2 yc,1/0 SK-PSDA 11. HEAT DETECTORS 11 '�� Edwards 12.SMOKE DETECTORS X 13.AUDIBLE DEVICES 4 Q,� Q Gentex 14.VISUAL DEVICES 4 pal! Gentex 15.CODE TRANSMITTERS X 16.AUTOMATIC DOOR RELEASES X 17.TROUBLE INDICATORS ] 0 Ademco Vista 18.MASTER ALARM BOX X 19.BATTERIES 2 Extreme Plus D 20.CHARGER 1 Ademco Vista 100 21.GENERATOR _ X 22.VENTILATION CONTROL 1 14MCH2 Control Header MRENERT INTERCONNECTION X L STATION INTERCONNECTION 1 �� Ademco Vista 100 INKLER ELEC ALARM BELLX ER WATER FLOW SWITCHX ER GATE VALVE SUPER SWITCH X CIATORS Ademco Vista 100 1 `r� 29. Automatic time of General Alarm Minutes. None Installed ( ). 30. Test of alarm system on emergency power, satisfactory,{ ) Yes ( ) No 31. This is to certify that this fire alarm system has bee properly inspected for reliability covering the items listed in this report and is consistent with NFP alarm Mai t ance Standards. 7A. Signature of Owner or Representative; z .�/41 B. Signature of Fire Alarm Firm Representati C. Name of Firm: PIONEER FIRE & SEC RITY D. Mailing Address: P O Box 597E Olympia WA 98540-0597 Phone No. 360-491-8141 E. Electrical Contractors License#: PIONEFS088LR Original form to be returned to the fire Marshal � SPECIALIZING IN FIRE B, 7 20 P.O.BOX 2846 PROTECTION SALES ! OLYMPIA,WA 98507-2846 AND SERVICE f (360)352-1725 R -2 1-800-556-4ACE(4223) DATE �"r G FIRE AND SAFETY INC. L < X T �- _ - R L / J .T ci a.; .a{Jr� i , /�'c , _- V T I T CI CUSTOMER P.O. CUSTOMER PHONE TERMS 1.5%PER MONTH ON PAST DUE ACCOUNTS REPRESENTATIVE MINIMUM$2.50 PER MONTH NNUAL SERVICE ❑SERVICE CALL MONTH SERVICE C1 NEW EQUIPMENT NUMBER DESCRIPTION PRICE AMOUNT Kt-:)C X 76 c ��.) .�,�_ �-c.,>, � � "%} �J i ,rV, / - - - — y I , WE RESERVE THE RIGHT TO REPOSSESS EQUIPMENT ON DEFAULT OF PAYMENT G TAX r , REMARKS: J , zGaCS RECEIVEDX:�r CUSTOMERS INVOICE PLEASE PAY ON INVOICE HOOD&DUCT SUPPRESSION SYSTEMS SERVICE REPORT DATE: TYPE OF SERVICE NAME OF ESTABLISHMENT 12 k T=•f r t " r1 " ACE FIRE A SAFETY ADDRESS: j L I L rA C E o.. �r P.O.Box 2846 MAKE OF SYSTEM SIZE f C Olympia,Wa. 98507 352-1725 1-800-5564ACE (4223) EQUIPMENT COVERED FOR PROTECTION: CHECK DETECTION•NO OF LINKS LINKSCHANGED CHECK TYPE OF AUTOMATIC SHUT-OFF: Gas O Elea O Part O None O CHECK: NOZZLES 0 PIPING 0 SUPPORTS M CHECK CYLINDER YES O NO Cl DATE OF LAST HYROTEST CHECK MANUAL REMOTE,IF USED YES O NOD NONE O THIS SYSTEM HAS BEEN TRIPPED TESTED YES O NO❑ VIA: RMP CH GENERAL CONDITION OF SYSTEM: GOOD 0 FAIR❑ UNSERVICEABLE O HAZARDS AND RECOMMENDATION (ADDITIONAL WORK REQUIRED IS NOT PART OF SERVICE): COMMENTS: lam' SERVICED BY: ACCEPTED BY: TITLE Copy Distribution: WB=: Ace Piro&Sarety YELLOW: Ace Office Copy PINK: Insurance Company GOLD- Establishment Pre-Engineered:Restaurant Fire Suppression Systems Report SERVICE COMPANY DATE OF SERVICE TIME A.M. P.M. g'; CDC x ER ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION IX LOCATION OF SYST M CYLINDERS UL 300 { IRE SECURITY INC. PO BOX 597 T2` � . x- �cov--i YES �'NO J EAST OLYMP IA WA 9 8 5 4 0 MANUFACTURER MODEL NUMBER WET 7 DRY CHEMICAL 360-491 -8141 Tl' C I Pc 1>1-� CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE Z� Z - Z1 --61016Z ir/� 11" CUSTOMER FUSE LINKS 360'F. FUSE LINKS 450'F FUSE LINKS 500°F. OTHER J Name �fCe ✓teey+o /S�'ci`-J - /65 v� 77 II FUEL SHUT-OFF ELECTRIC GAS SIZE Address /3 S4 �'�o _5��r old L ✓� Y WL SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE City Sti C /f0`^ State ZI P?R3 Z oG>9 Telephone Store No. MANUFACTURER'S MANUAL REFERENCE - '�3Z - 36 ZS PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager J •'I COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT 1. 44 applianeea properly covered w/correct nozzles 20. Replaced fuse links \ 2. Duct and plenum covered w/correct nozzles �� 21. Check travel of cable nuts/S-hooks y 3. Check positioning of all nozzles. y 22. Piping&conduit securely bracketed 4. System installed in accordance w/MFG UL listing y 23. Proper separation between fryers&flame IVA 5. Hood/duct penetrations sealed w/weld or UL device Y 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 N� 8. Pressure gauge in proper range(If gauged) 27. Fuel shut-off in on position 9. Check cartridge weight(If applicable) /V 28. Manual&remote set/seals in place 10. Hydrostatic test date y 29. Replace systems covers 11. 6 year maintenance date 30. System operational&seals in place 12. Inspect cylinder and mount �� 31. Slave system operational �h . ---`v-, ----Y-_....,._ -32. Clean cylinder&mount y 14. Test for proper operation from remote 33. Fan warning sign on hood evA 15. Check operation of micro switch .L 34. Personnel instructed in manual operation of system 16. Check operation of gas valve IVA 35. Proper hand portable extinguishers 17. Clean nozzles 36. Portable extinguishers properly serviced V 18. Proper nozzle covers in place 37. Service&Certification tag on system 19. Check fuse links and clean tJ NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this pre-engineered fire suppression system was inspected and operationally tested;in accorda ce with the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results i 'd' ated above. XE: SE VICE TECHNI PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AU HORI ED AGENT The lSove servict;"technician certifies that the system was personally inspected and found conditions to be as indicated on this report. AUTHORITY HAVING JURISDICTION Pre-Engineered FIWIl Tire Suppression Systems Report SERVICE COMPANY DATE OF SERVICE�j TIMEQ A.M. P.M. \\ ANNUAL SEMI-ANNUAL I RECHARGE INSTALLATION RENOVATION PIONEER '� LOCATION OF SYSTEM CYLINDERS UL 300 FIRE & SECURITY INC. Je a-� Pt„+ /�o-f ❑YES ]KNO P O B O X 5 9 7 MANUFACTURER MODEL NUMBER WET DRY CHEMICAL EAST OLYMPIA WA 98540 �� 360-491 -8141 ace CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE If 2nl Z.-221^ 9 p 10Z �, `2 1� 1- 43 /? i-10 FUSE LINKS 360'F. FUSE LINKS 450'F. FUSE LINKS 500-F OTHER CUSTOMER o Name rx4 r F.,i^e A -L�p &J�/ .�- Z-I Z FUEL SHUT-OFF ELECTRIC GAS SIZE Address SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE City 1 � �'� State _ ZIP�� -`f 7 cog, 3� L1 3�- 3v Z MANUFACTURER'S MANUAL REFERENCE Telephone Store No. PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager � ' "M LEFT TO RIGHT 1. y4lnees properly covered w/correct nozzles 20. Replaced fuse links Z__ 2. Duct and plenum covered w/correct nozzles -y- 21. Check travel of cable nuts/S-hooks -_ 3. Check positioning of all nozzles. Y 22. Piping&conduit securely bracketed y 4. System installed in accordance w/MFG UL listing V 23. Proper separation between fryers&flame 14,14 5. Hood/duct penetrations sealed w/weld or UL device 24. Proper clearance-flame to filters HA 6. Check if seals intact, evidence of tampering `/ 25. Exhaust fan in operating order y _ 7. If system has been discharged, report same Aj 266. All filters in place 8. Pressure gauge in proper range(If gauged) �- 27. Fuel shut-off in on position y 9. Check cartridge weight(If applicable) /VA 28. Manual&remote set/seals in place y 10. Hydrostatic test date 1/ 29. Replace systems covers -� 11. 6 year maintenance date y 30. System operational&seals in place 12. Inspect cylinder and mount y 31. Slave system operational V 13. Operate system from terminal link y 32. Clean cylinder&mount y 14. Test for proper operation from remote 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 17. Clean nozzles y 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place 37. Service&Certification tag on system 19. Check fuse links and clean /✓ NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: On this date, this pre-engineered fire suppression system was inspected and operationally tested in accordance with the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with theresults indicat d above. X SERVICE TECHNICIAN/ PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AUTHORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. AUTHORITY HAVING JURISDICTION Pre-Engineered -Rl 0-4n# Fire Suppression Systems Report SERVICE COMPANY DATE OF SERVICE TIME A.M. I P.M. \ ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION PIONEER LOCATION OF SY TEM CYLINDERS UL 300 F IRE P SECURITY INC. ��p��'�� /�r� �Y�l []YES �No P O B 0 X 5 9 7 MANUFACTURER MODEL NUMBER WET DRY CHEMICAL EASIOLYMPIAWA 98540 P1)ro ��,c�"1 PGA 360-491 -8141 CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE ---' 101Oz 1 -) L_ 's FUSE LINKS 360°F FUSE LINKS 450°F FUSE LINKS 500'F. OTHER / CUSTTOMERn Name F x'r e'M e A l D [Sock/ l - l FUEL SHUT-OFF ELECTRIC GAS SIZE Address 13 e3 r S�Q1+0 s����c,�5 � \/(f 5 SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE City s� e fc� State ZIP L!22L/ fOf 200cl �7bn` _ �� MANUFACTURER'S MANUAL REFERENCE Telephone '7 Store No. PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager ���`1 _.._-_----__.__- �11 w�LOCATIONS: LEFT TO RIGHT �it 1✓� T /' t �! ✓�'� 1. All appti�properly covered w/correct nozzles 20. Replaced fuse links 2. Duct and plenum covered w/correct nozzles IVA 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 23. Proper separation between fryers&flame 1✓� 5. Hood/duct penetrations sealed w/weld or UL device y 24. Proper clearance-flame to filters 41A 6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order y 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 29. Replace systems covers 11. 6 year maintenance date �� 30. System operational&seals in place y 12. Inspect cylinder and mount 31. Slave system operational 14"A 13. Operate system from terminal link 32. Clean cylinder&mount 14. Test for proper operation from remote �- 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 NA 35. Proper hand portable extinguishers 1- 17. Clean nozzles 1/ 36. Portable extinguishers properly serviced y 18. Proper nozzle covers in place _77- 37. Service&Certification tag on system V 19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: � e ;j On this date, this pre-engineered fire suppression system was inspected and operationally testOin accorda a with the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results in a d above. x z_ _ 'Y ERVICE TE9,W4TC1 PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AUTHORIZED AGENT The above sepke technician certifies that the system was personally inspected and found co aitions to be as indicated on this report. AUTHORITY HAVING JURISDICTION / Pre-Engineered-R° _ j� ft Fire Suppression Systems Report SERVICE COMPANY DATE OF SERVICE TIME A.M. I P.M. 12 oo x PIONEERANNUAL SEVNNUAL RECHARGE INSTALLATION RENOVATION r t R E x SECURITY I N C. LOCATION O11F SYSTEM CYLINDERS UL 300 Po B 0 X 597 SIcJe 0_t doart� ❑YES VNO F A S 1 OLYMPIA WA 98540 MANUFACTURER MODEL NUMBER WET DRY CHEMICAL 360-691 -8141 (- (' F-t-Z CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE �Z -2O t-9 FUSE LINKS 360'F. FUSE LINKS 450'F. FUSE LINKS 500-F. OTHER CUSTOMER Name ,CV 4 (� �'+�+It. A 13a �`f FUEL SHUT-OFF ELECTRIC GAS SIZE Address /353 RIB f `7 X SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE City 6� } State 4�L_ ZIP� SY Zpp ��©� / •�2^ �/ MANUFACTURER'S MANUAL REFERENCE Telephone S C7 Store No. PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager J-� COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT 4 SPA �� T wort C', A Y 1. All appliaRees properly covered w/correct nozzles V 20. Replaced fuse links 2. Duct and plenum covered w/correct nozzles Y 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 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 _Y 7. If system has been discharged, report same 20. All filters in place y 8. Pressure gauge in proper range(If gauged) 27. Fuel shut-off in on position y 9. Check cartridge weight(If applicable) A/A 28. Manual&remote set/seals in place 10. Hydrostatic test date y 29. Replace systems covers 11. 6 year maintenance date 30. System operational&seals in place 12. Inspect cylinder and mount Y 31. Slave system operational V 13�-CperaW System frorA ter-urinal!in4 - y Clean cylinder&mount 14. Test for proper operation from remote 7 33. Fan warning sign on hood 15. Check operation of micro switch y 34. Personnel instructed in manual operation of system 16. Check operation of gas valve /A_ 35. Proper hand portable extinguishers 17. Clean nozzles �_ 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place y 37. Service&Certification tag on system 19. Check fuse links and clean / �� NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: �� j� L3c�O� C �y �• LUe ,�( y ( a 1✓t�. On this date, this pre-engineered fire suppression system was inspected and operationally tested-in accordant? with the fire suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual wth'the results ind•i*ed above. X ERVICE TE C1AN PERMIT NO. DATE: TIME: AM PM TOMER'S AUTHORIZED AGENT The above seFViCs technician certifies that the system was personally inspected and found cofiditions to be as indicated on this report. AUTHORITY HAVING JUFWSDICTION