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HomeMy WebLinkAboutAutomatic Sprinkler System - FIR Inspections - 10/28/2011 � I�j ©�o�a 2�{ - oo - KNIGHT F , • 0 J CO . 9702 Lathrop Industrial Drive SW Olympia, WA 98512 l�//q— (360) 786-8606 FME OCCUPANCY NUMBER FAX 360-786-8722 U 8'/ •i/ DATE LICENSE NO.#KNIGHFP044LK "ON GUARD 01 r Gjv C 24 HOURS A DAY" TECHNICIANS AUTOMATIC SPRINKLER SYSTEM CERTIFICATION INSPECTION FACILITY el C-6 Contact Phone_ d. z5g5-- 6 7 6,7 Address 14) System#_j_ Size Type: Wet Preaction/ System# Size Type: Wet /Preaction/ System# Size Y Type: Wet/ ry reaction/ System# Size ' "Type: e Dry/Preaction l us A. GENERAL INFORMATION 1. Occupancy: Assembly Mercantile Office Storage High Rise(7 stories or more) Use or Storage of Hazardous Materials Stock Piled Over 12' High the _��A�f 2 $d l i g- 2. Describe fire protection modifications since last inspection r1 Re A4&P Ga N'nent l- 1-14:2_R CE dk c f y 3. Describe any fires since last inspection N 6/V 4 4. Date sprinkler system installed(approximate if unknown) Q({r Ui,,,,-j_ A,PPRdX 5. Previous type of occupancy at that time(if known) , ,"„, 6. When was the system piping last checked for stoppage, corrosion or foreign material &fAl1�11 B. INSPECTOR'S SECTION (All responses reference current inspection) YES NO N/A 1. GENERAL a. Is the system hydraulically designed b. If hydraulically designed, are risers properly marked per NFPA 13 c. If not hydraulically designed indicate the piping schedule: Light Ordinary Extra Special d. Are all areas of building provided with sprinkler protection per NFPA 13 1W vlju,,c e. Height of building kat rI r feet) f. Is the building occupied g. In areas protected by wet system, does building appear to be properly heated in all areas, including blind attics and perimeter areas where accessible ) h. Do all exterior openings appear to be protected against freezing i. Does the exterior condition of the sprinkler system appear to be satisfactory 2. CONTROL VALVES a. Are all control valves in the appropriate position and locked, sealed or equipped with a tamper switch X 3. FIRE DEPARTMENT CONNECTIONS a. Are fire department connections in good condition and properly maintained k b. Are fire department connection couplings free, caps in place, check valves / tight, and ball drips functional X c. Date fire department connection was last backflushed V NKNvwd 0ATemplatmkServlce Templat"\Senice Dcpt.MastenWertificate of Inspection AFSS.doc FACILITY: L c o 4. ANTIFREEZE/WARM WEATHER SYSTEMS YES NO N/A a. Are all cold weather valves in appropriate open or closed position b. Have antifreeze solutions been tested _ c. Were the antifreeze test results satisfactory 5. ALARMS a. Did water motor gong/electric bell test satisfactorily b. Did electric alarm test satisfactorily >( c. Is system monitored By whom 10tysfj�-- ''Rf S£cuRiry Phone Acct# P(- - U 6 9 S d. Is the monitoring center receiving signals satisfactorily X e. Water flow alarm ',x — Test Satisfactorily K f. Valve tamper monitoring Test Satisfactorily ?< g. Dry system low/high-low air pressure sensor _ Test Satisfactorily 7< 6. SPRINKLERS a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge Tij-rwCr ONLy - N v15 lN: b. Are sprinklers less than 50 years old _ c. Is a complete stock of spare sprinklers and required wrenches available d. Are sprinkler temperature ratings proper for their location Ti-5Tli4 ONL'y-No vrruhl W5P e. Are sprinkler deflectors proper distances from structure and/or storage « 7. DRY SYSTEMS a. Is the dry valve in service b. Are air pressure and priming water in accordance with mfg.'s instructions X c. Has the operation of the air supply been tested and is it in service Automatic X Manual d. Were low points drained during inspection K e. Did quick opening devices operate satisfactorily x f. Did dry valve trip properly during this testing X g. Did heating equipment in valve room operate at the time of inspection h. Date piping last checked for proper pitch I1 i. Internal exam of piping conducted in U. (Required every 10 years) j. Date dry pipe valve trip tested, control valve open a 01 l (Required every 3 years) k. Date quick opening device tested �-o // (Required every year) w DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. 41 Ewe F-3o y ! 6 'I-Yco cL - l al DRY PIPE-A Z RfL,.4$ 1 -7-7 9E RtiCch$ -7 OPERATIN TESTDAT 3 (ZEi.'kY,1,l� 1 -7 3E f1'�+G« -I WATER INITIAL TIME TO TRIP TRIP POINT TPA OF WATER 3 YEAR ALARM ALARM Q.O.D. L PRESSURE AIR PRESS. THRU TEST PIPE AIR PRESS. TO TEST OUTLET TRIP FULL TRIP LOCAL REMOTE O.K. PSI PSI MIN!'. SEC. /P,SI MIN. SEC. #YSTE�VI 13 S �� `� '7 S �7 z YEs �/E S yE s *,ff s #YSTE1 !a�' U 6 -y 13 y 3 -9 2 N yf 5 yf 5 YJ 5 SYS M # 13 t:/y 4 l 5' L10 5; 7 `//E5 y£5 'A SYSTEM FACILITY: ELL o 8. MAIN DRAIN WATER FLOW TESTS MADE AT SPRINKLER RISERS Sys. Test Pipe Size Static Pressure Before Residual (Flow) Static Pressure # Location Test Pipe (Above Clapper) Pressure After 1 iser 2' 1 1/4"/3/4"/ Q I dL '311;;-- lsea, ' 1 1/4"/3/4"/ 3 isGr/ r / 1 1/4"/3/4"/_ 130 � Riser/ "/ 1 1/4"/3/4"/ Nn 9. EXPLAIN APPLICABLE "NO" ANSWERS AND COMMENTS 10. ADJUSTMENTS OR CORRECTIONS MADE DURING THIS INSPECTION �2 As[e-a r ���i Pl A2� QU� rNy l S >5 {� �/N 5 r�Z /�/�r„1 G!.�t-('P k U, 81 rz. PA42--1-5 V—c r (J A.) 5 ys. # 1 (3�k F- , ni s Til_.i_5.e IA)wA lr d N s ys ## / 11. ALTHOUGH THESE COMMENTS ARE NOT THE RESULT OF AN ENGINEERING REVIEW, THE FOLLOWING DESIRABLE IMPROVEMENTS ARE RECOMMENDED �I NQ V 1 s 14A-L InrfP w 4-s h orf-& H-0,;f�VL.RC d +R F C-cY� ` o �ypN�- 'in1 FLI.LL iN5P CT2Jnl )QN 5PA- L 1AJ<r A r - ys 1/7 /0 C! � cyREC f�7ll I A/ -5 A&$ A-5 System# is: System# .Z is: ❑ operational ❑ operational 9 operational with defects & operational with defects ❑ not operational ❑ not operational System# 3 is: System # '7 is: ❑ operational jii, operational f'operational with defects ❑ operational with defects ❑ not operational ❑ not operational This is to certify that this automatic sprinkler system has been inspected and tested in accordance with the standard adopted by the Washington State Fire Marshal and NFPA Standards 13 and 25. Name Title Date (Signature of Contractor) Employee Certification# oP4 7� -/T- U/U ZD 7 Name Title Date (Signature of Owner's Representative) KNIGHT FIRE PROTECTION,INC. TRANSMITTAL 9702 LATHROP INDUSTRIAL DRIVE SW OLYMPIA, WA 98512-9188 360-786-8606 FAX 360-786-8722 1C� _DD 000 ` u CONTRACTOR'S LICENSE NO.#KNIGHFP044LK "ON GUARD 24 HOURS A DAY" TO: Mason County Community Development DATE: January 16, 2012 JOB NO. P.O. Box 186 ATTENTION: Craig Haugen Shelton, WA 98584 REFERENCE: Automatic Sprinkler Certification Semi-Annual Suppression System Test COPIES DATE NO. DESCRIPTION 1 10/28 1 Welco - Skookum Lumber THESE ARE TRANSMITTED FOR YOUR USE. REMARKS: -- COPY TO FILES SIGNED CCxtlLrt�i IF ENCLOSURES ARE NOT AS DESCRIBED,PLEASE NOTIFY US AT ONCE. � _ ccoo � �E FIRE DEPARTMENT Iq `{ CONFIDENCE TESTING AUTOMATIC SPRINKLER SYSTEMS Address 76,0 At Occupied as '5k6014_U yr Cluld Building Owner/Cu<771'� T'' L d9ohone 34c) -(Os-1 Address r city SKEZ.-fa� Zip Code Date of inspection _ ~r Z e of inspection: Annual '� Other Tester's Name PLEASE PRINT) t SFD Certification No DRY SYSTEM' Z��� � � DcGLC7� 1. 'trip test Idry u ip) conducted: . . . . . . . . . . . . . . . . . . Yes ElNo ❑ System tripped in -" , seconds. 2. All flow switches, supervisory switches No ❑ N/A Eland alarm bells tested: . . . . . . . . . . . . . . . . . . . . . . . . . . Yes ❑ Static Pressure: 3. Alarm bell operates: . . . . • • • • • • • • • • • • - • • • • • • • • • Yes ❑ No El N/A ❑ 4. Flow tests conducted: • . . . . . . . . . . . . Yes 1-1 No0' Flow pressure: psi =PAP � . . . Yes No ❑ 2-inchdrain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Systems inspected and lubricated: . • • • • • • • • • • • • • • • - Yes ❑ No El �44> ❑ No ❑ n ,X�_ CO 6. Air compressor refills system in 30 minutes: • •.• • • • . • F.; LLJ _ in7. System drained and restored to normal operation: . . . . . Yes ❑ No ❑ 0 N a Y > o LU 0 ,_.....4 ^n L J c� 8. Were the heat actuation cievi%e7s +��� .. pre-action and deluge systems? Ccu?;5r•;��r� 'L (es ❑ No ❑ LLJ U cl WET SYSTEM: Yes ❑ . No 1. Flow test conducted: . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ -- `r Stat' pressure: Psi F)oi pressure: _____--PSI Yes ❑ No ❑ Other ❑ 2-inch drain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Flow switches, supervisory switches ❑ No ❑ N/A ❑ and alarm bells tested: . . . . . .• • • • • • • • • - . . . . . . Yes � . Yes ❑ No ❑ N/A ❑ 3. Alarm bell operates: . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Systems insp ed and lubricated: . . . . . . . . . . . . . . . es ❑ No ❑ regulating valves tested: . . . Yes ❑ 'No ❑ 5. Press re re • • • ' crr_` ltu r n h Ia 1 ( RE: Automatic Sprinkler Systems (continuedl: Qsneral: 1. Central Station monitoring? . . • . Yes No ❑ Name of Company R' lZt 2. Location of sprinklers: Basement Hallways 100% Other 5 W Vazs'T K ot�P Ga►,��T om` 3. Pumper connections and clapper valves unobstructed: . Yes ❑�No ❑ 4. Sprinkler heads less than 50 years old: . . . . . . . . . . . . . Yes L" No ❑ 5. Sprinkler coverage is acceptable: . . . . . . . . . . . . . .available: . . Yes No ❑ 6. Spare sprinkler heads are available: . . . . . . . . . . . . . . . . Yes E!f No ❑ 7. Systems left in service: . . . . . . . . . . . . . . . . . . . . . . . . . . ervice: . . . . . . . . . . . . . . . . . . . . . . . . . . Yes EY No ❑ 8. Valves are sealed or supervised: . . . . . . . . . . . . . . . . . . Yes Q-' No ❑ 9. Signs are provided on valves: . . . . . . . . . . . . . . . . . . . . Yes ErNo ❑ 10. City static water pressure '_ psi. Problems found: ���%�► Corrections made: Sb Cate corrected BY r SIGNATURE OF TESTS 1 AGENCY ' ��h� i� i�L �� PHONE ANIME FIRE DEPARTMENT CONFIDENCE TESTING AUTOMATIC SPRINKLER SYSTEMS Address `7 � Occupied as �l�E�'Y�f�(- � �'l'�'t'��� Building Owner lL ram-' Phone •�'oC��Co Sl --/S(�(� Cry SF�Cs,T Zip Code GI�524 Address Date of inspectior Type of inspection: Annual Other l Tester's Name ('LEASE PRINT) VLS� SFD Certification No DRY SY'-MM: 1. yrip test (dry• trip) con uried: . . . . . . . . . . . . . . . . . . Yes [3, No ❑ System tripped in 41 seconds. 2. All flow switches, supervisory swftches El'No El N/A Eland alarm bells tested: . . . . . . . . . . . . . . . . . . . . . . . . . . Yes Static Pressure: t LLpsi . 3. Alarm bell operates: . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes ❑� No El N/A El . 4. Flow tests conducted: . . . . . . . . . . . . . . . . . . . . . . . . . . Yes 0 No ❑ Flow pressure: =psi �2-inch drain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes 0"No ❑ 5. Systems inspected and lubricated: . . . . . . . • - . . . . . . . . Yes Cj'No ❑ 6. Air compressor refills system in 30 minutes: . • . . . • . . . . Yes ❑ No ❑ 7. System drained and restored to normal operation: . . . . . Yes ❑ No ❑ a. Were the neat ac uat;or. dav'C:s tee9d on pre-action and deluge systems? . . . . . . . . . . . . . . . . . . . Yes ❑ No ❑ WET SYSTEM: No ❑ 1. Flow test conducted: . . . . . . . . . . . . . . . . . . . . . . . . . . . Yeses❑ Static pressure: - Psi Flow pressure: Ps' ❑ No ❑ Other ❑ 2-inch drain? . . . . . . . . . . Yes 2. Flow switches, supervisory swd ❑ No [I N/A ❑ and alarm bells tested: . . ..... . . . . . . . . . . . . . . . . . . . . . Yes 3. Alarm bell operates: . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes ❑ No /A ❑ inspected and lubricated: . . . . Yes No ❑ 4. Systems • • • " " " " " 5. Pressure regulating valves tested: . . • • • • • . • • • • Yes ❑ No ❑ cam' /1himh1A) f REO Automatic Sprinkler Systems (continued): (aweral: 1. Central Station monitoring? . . . . . . . . . . . . . Yes No Name of CompanyL %!a? /� 71- 2. Location of sprinklers: Basement Hallways 100% Other 3. Pumper connections and clapper valves unobstructed: . Yes L7 No ❑ 4. Sprinkler heads less than 50 years old: . . . . . . . . . . . . . Yes LJ No ❑ 5. Sprinkler coverage is acceptable: . . . . . . . . . . . . . . . . . . Yes MN. El6. Spare sprinkler heads are available: . . . . . . . . . . . . . . . . Yes e No ❑ 7. Systems left in service: . . . . . . . . . . . . . . . . . . . . . . . . . . ervice: . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No ❑ S. Valves are sealed or supervised: . . . . . . . . . . . . . . . . . . Yes No El9. Signs are provided on valves: . . . . . . . . . . . . . . . . . . . . Yes No ❑ 10. City static water pressure G'S psi. Problems found: Corrections made: Date corrected BY SIGNATURE OF TESTER AGENCY �/� � PHONE II �. DRY- AUTOMATIC SPRINKLERS Certification Given RED El YELLOW ❑�� WHITE COI�IDENCE TEST REPAIRS Location of System: Sor_i.,,g_t�,_ fzm'A - �'e.,cc: i2ut—r- Design Density 0.00 exam le .495/2000 s . ft : Occupancy Address: -7o3 W { w w i0g CIQ Occupancy Name: Building Owner: �JC-Le_o j 5VeOV—„i- phone Number: Responsible Person: I_4,ez, Lwyq Phone Number: Buildiing Owner ."-.4dress: Dateof Inspection: is -3t -vc-, Inspection Type: Annual _- "Quarterly ❑ Acceptance 0 Testers Name SFD Certification Number: SCP- r cA� ��1-vt( 3 Please Print : -- - Central station monitoring? Yes 1�1 No C Monitoring company name: hL- � Cx -tQi - Control panel manufacturer: Model Number: ;,���- Problems Found: (if additional room is needed, please add a separate sheet) Corrections Made: Date Corrected: Corrected By: (If additional room is needed, please add a separate sheet) Z AfA T4 ncckt- mac,.¢ $r¢-Ki This certifies that this fire and life safety system has been properly inspected for reliability to cover the Items listed in this report and is consistent with Seattle Fire Department Fire Code standards, discrepancies are noted and have been reported to the building Owner/Manager for corrective action. Signature of Tester: Phone # Zo(,- -�c�0� Testing Agency: S l t1N.v 'u- Mailing Address: 99. Trip test (dry trip) conducted? Yes No 10( Sysierr, tripped in ;"? 1,V seconds. 101 Flow test conducted? Yes e- No ❑ 10.' Static pressure: jZ240psi Flow pressure.- P / Psi 103 2-inch drain? Other ❑ Yes L;�- No ❑ 10- Flow switches, supervisory switches and alarm bells tested? N/A ❑ Yes 2 No ❑ 105 Alarm bell operates? N/A ❑ Yes No ❑ 10( Air compressor refills system in 30 minutes or less? P�� x " . r M.. Yes ❑ No ❑ 107 Heat actuation devices tested on pre-action and deluge systems? N/A u% Yes ❑ No ❑ 10F Valves inspected and lubricated? p Yes No ❑ 109 Valves are sealed or supervised? Yes ❑- No ❑ 11( Signs are provided on valves? M W- Yes No ❑ 111 Pumper connections and clapper valves unobstructed? Yes - No ❑ 11.' Sri . .. p nkler heads less than 50 years old? § � � - <r ,� :� Yes ®- No ❑ 113 Sprinkler coverage is acceptable? may' 11, Spare sprinkler heads are available? � �� �� max . Yes - No ❑ � .. Yes f No 115 System drained and restored [I to normal . Yes � No on UNNELL FIRE PROTECTION SYSTEMS COMPANY INS"' CTION REPORT INSPECTION CONTRACT 'No. .. ....:-... ._.......... NO. ......................... CONFERRED WITH REPORT OF INSPECTION BUREAU FILE ................ iNO. .....................I.......... ........................... .............._... ._......_.......... SET 1 OF 2 REPORT TO ' " NZ. IeN INSPECTED�IrC STREET EPESF�6TOX S CITY&STATE ZIP GRINNELL OFFICE A. PHONE NO. ATT. 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 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? Date last checked (checking is recommended at least every 5 years) \ e. Has the piping in all systems been checked for obstructive materials? 1 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 termperatures 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 deflector? 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 openings protected against the entrance of cold air? 2. CONTROL VALVES 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 Control f Type e Accessible (Sealed?) Valves YP A Signs Open If yes,how? (Locked?) Operational Valves Yes No Yes No Yes No Yes I No (Supvd.?) Yes No CITY CONNECTION TANK PUMP SECTIONAL SYSTEM ALARM LINE 3. WATER SUPPLIES Pressure Fire Pump&Tank a. Water supply source? City 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 Pie Before Pressure After 4. TANKS,PUMPS,FIRE DEPT.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 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? d. Are fire dept.connections visible and accessible? S. WET SYSTEMS �\ a. No.of systems Make&Model l� — 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? d. Have all the antifreeze systems been tested? e. Date antifreeze systems were tested f. The antifreeze tests indicate protection to: system 1 3_ 4 S temperature g. Did alarm valves,waterflow alarm indicators and retards test satisfactorily? A VICO INTERNATIONAL LTD. COMPANY 'Not Applicable G45�0-� Explain(No)Answers on Back of Sheet 2 ORIGINAL IMP— GPJNNELL FIRE PROTECTION SYSTEMS COMPANY O`NDED�� INSPECTION CONTRACT NO. 'INSF?NOMREPORT REPORT OF INSPECTION BUREAU FILE . ........... No. NO. .. . _ ... ........ SET 2OF2 6 DRY SYSTEMS �— (� ��'� y, `k— Yes N.A.# No' a. No.of systems Make&Model �a ll� (- l Date last trip tested a 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 all 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 heated? 7. SPECIAL SYSTEMS \ a. No.of systems Make&Model N Type b. Were valves tested as required? c. Did all heat responsive systems operate satisfactorily? d. Did the supervisory features operate during testing? Heat Responsive Devices: Type Type of test Valve No. 1...... 2...... 3...... 4...... 5...... ...... Valve No. 1...... 2...... 3...... 4...... 5......6...... Valve No. 1...... 2...... 3...... 4...... 5...... ...... 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...... Auxiliary equipment: No. Type Location Test results 8. 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 condition? 10. EXPLANATION OF"NIY'ANSWERS(For Sections 18 thru 9): 11 . I 11. THE INSPECTOR SUGGESTS THE FOLLOWING NECESSARY IMPROVEMENTS.HOWEVER,THESE SUGGESTIONS ARE NOT THE RESULT OF AN ENGINEERING SURVEY: f 12. ADJUSTMENTS OR CORRECTIONS ADJUSTMENTS OR CORRECTIONS MADE: �T 13. LIST CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPMENT,AS ADVISED BY THE OWNER IN SECTION 1A: 14. INSPECTION AND SUGGESTED IMPROVEMENTS WERE DISCUSSED WITH THE UNDERSIGNED OWNER OR OWNER'S REPRESENTATIVE? Signature of owner or owner's representative Date DUPLICATE TO: STREET CITY&STATE ZIP ATT. FNot Applicable 64"0-2 A tgCO INTERNATIONAL LTD. COMPANY 'Explain(No)Answers on Back of sheet ORIGINAL G4274RI DRY PIPE VALVE TRIP TEST REPORT MANELL FIRE PROTECTION SYSTEMS COMPANY LA FOR •� n `AV71) INSPECTION NO. STREET_L� UJV CITY PUCJSTATE CONTRACT NO. G GATE OF TRIP TEST--[C) - N �U INSPECTOR C - Y= DAY WORK NO. NOTE: BEFORE ANY DRY PIPE VALVE IS TRIP TESTED, THE WATER SUPPLY LINE TO IT SHOULD BE THOROUGHLY FLUSHED. 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 ANY ACCUMULATION OF SCALE OR FOREIGN MATERIAL. IF THERE IS A HYDRANT ON THE SUPPLY LINE, THIS HYDRANT SHOULD BE FLUSHED BEFORE THE TWO INCH DRAIN IS OPENED. THE DRIP VALVE ON THE DRY PIPE VALVE SHOULD BE CHECKED BEFORE TRIPPING THE DRY PIPE VALVE, TO SEE THAT IT IS IN OPERATING CONDITION. DRY PIPE VALVES SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) SYSTEM NO. ( ) VALVE SERIAL NUMBER MANUFACTURER (NAME) VALVE MODEL VALVE SIZE INCH INCH INCH INCH (LOCATION) C`\ CONTROLLING SPRINKLERS (NUMBER) / (A P PR O X) (APPROX) (APPROX) (APPROX) DATE LAST TRIP TESTED? DATE LAST OPERATED? AIR Les Lei LOS LOS PRESSURE BEFORE TEST WATER Les Les Les Les SIZE AND LOCATION OF TEST VALVE -7, WAS GATE VALVE BELOW DRY VALVE OPEN WIDE AT TEST? (IF NOT MOW MANY TURNS?) AIR PRESSURE Les Les Les Les VALVE TRIPPED AT WATER PRESSURE '� Les Les Les Les TIME MIN SEC MIN SEC MIN SEC MIN SEC IF SYSTEM FLOODED, LIST TIME WATER REACHED TEST OPENING —MIN SEC MIN SEC MIN SEC MIN SEC 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) TYPE AND MODEL AIR PRESSURE IN UPPER CHAMBER Les Les LOS Le! QUICK OPENING DEVICE TRIPPED AT SEC Les SEC Les SEC Les SEC Les PERFORMANCE QUICK OPENING DEVICE LEFT IN SERVICE AND CONTROL OPEN AND SEALED? LIST ANY UNSATISFACTORY CONDITIONS: REMARKS: Le In, _ , ORIGINAL