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2321 Mayport Rd, Dollar Tree FPI21-000025 Fire Sprinkler • :�pF INgNC!.. ,......., •• r Uniform Summary ITM Report ,o,, :IL': - ' . : ,, ITM Service Company: Contact Telephone#: Fortitude Fire Protection 904-733-9008 Inspector's Name: Inspector's Permitee#: 1 \Jason Kestner FPI21 -000025 Inspected Property Name: i inspection Start Date: Inspection Finish Date: Dollar Tree #5993 11/4/2021 11/4/2021 I Inspected Property Address: City: State. ZIP. Dollar Tree #5993 Atlantic Beach FL 32233 System(s) Inpected: Inspection Status: 1 Wet ' Yellow Ta g Ii_aeTi" _ Brief Description of Noncritical Deficiencies: None Brief Description of Critical Deficiencies: None Brief Description of Impairments: None Additional Comments: None rwimmirrir FORTITUDE FIRE PROTECTION 2430 University Blvd W. * Jacksonville, FL 32217 * 904-733-9008 www.fortitudefire.com NFPA-25 Inspection, Testing and Maintenance of Wet Pipe Fire Sprinkler Systems Information on this form covers the minimum requirements of NFPA 25 for fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. Separate forms are available to inspect, test and maintain fire pumps, water tanks and other fire protection systems. More frequent inspection. testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. Owner: Owner Phone Number: Job#: Owner's Address: Property Being Evaluated: Dollar Tree#5993 Property Address: 2321 Mayport Rd Atlantic Beach FL 32233 Date of Work: 11/4/2021 All responses refer to the current work(inspection,testing and maintenance)performed on this date. This work is(check one) Monthly uarterly Annual Third Year Fifth Year Part I-Owners Section II 4.Annual Inspection Beers(in addition to above items) w A.Is the building occupied? Ones ONO A Proper number and type of spare sprinklers? CYes ONO OWA B.Has the occupancy classification and hazard of contents remained the same since 8.Visible sprinklers: �, the last inspection? ®Yes ONo 1.Free of corrosion and physical damage? On" ONO f�lu,A C.Are all fire protection systems in service? ®Yes ONO 2.Free of obstructions to spray patterns? §Yes �� A © 3.Free of foreigne matt erials including paint?D.Has the system remained in service without modification since the last Inspection? es Non /.Liquid in at glass bulb sprinklers? Yes ONo eq E.Was the system free of actuation of devices or alarms since the last inspection? .-lyes ONo C.Visible pipe. O F.Weekly logs of inspections re Wired by NFPA#25 on file? �/vyes ONo V►.� 1 In good condition/no external corrosion? Yes [-SLA 2.No mechanical damage and no leaks? OYes ()No OM G.All deficiencies reported at last inspection corrected? 1 ()Yes ONo 3 Properly aligned and no external loads? H.By signing I know the location and understand the t.nf pii control valves. �w�' C. Hall Hyl/' 11/4/2021 D.Visible pipe hangers and seismic braces not damaged or lose? Oyes a No OVA E.Hose,hose couplings and nozzles on sprinkler system passed V V Owner or representalve(print name) Signature Date ❑Owner or Owner rep. Inspection in accordance with NFPA 1962? ()Yes o OVA not onsite F.Adequate heat in areas with wet piping? Oyes ONo OVA Part II-Inspector's Section G.Has an internal inspection of the pipe been performed by removing VV A Inspections the flushing connection and one sprinkler near the end of a branch Vis, 1.Daily and Weekly Items line within the last 5 years? Ones ONo OVA A Control valves supervised with seal in correct(open or closed) (If the answer was"No",conduct an internal inspection.) V position? /� 5.Fifth Year Inspection Hems(in addition to above items) 5 Year Inspection Due: 9/2025 ®Yes ONo 01/A B.Backflow Preventers. v A.Alarm valves and their associate strainers,filters and restriction '' 1.Valves in correct(open or closed)position? ®Yes ONo OVA orifices passed internal Inspection? ONIC ()Yes (mowhvo OVA 2.Sealed.locked or supervised&accessible? ()Yes ( ■ lwA B.Check valves internaty inspected and at parts operate properly.move V 3.Relief porton RPZ device not discharging? Ones Cr''a OVA freely and are in good condition? ONIC OYes ONo �q C.For freezer systems,is the gauge near the compressor reading the V <;J_ B. lolowr � The following tests are to be performed at the noted intervals.Report any failures on Part III of the form, same as the gauge near the dry-pipe valve? ©Yes OJo OVA V 1.Quarterly Tests 2.Monthly Inspection Items(in addition to above items) A Mechanical water flow alarm devices passed tests by opening the A.Control valves with locks or electrical supervision in correct(open or inspectors test connection or bypass connection with alarms actuating closed)position? Oyes ONo OVA and flow observed? Oven ONO 0" B.Sprinkler wrench with spare sprinklers? ®Yes ONo OVA 8.Post indicating valves opened until spring or torsion is tett in the rod, C.Gauges on wet-pipe system in good condition and showing normal then closed back one-quarter turn? °Yes ONO OWA water supply pressure? ()Yes ONo OVA C.Main drain test for system downstream of backflow or pressure reducing valve. V D.Alarm Valves: 1.Record Static Pressure 43 psi and Residual 35 psi Pressure Gauges show normal supply water pressure,free from physical ❑ See comments-on page 2 damage.valves in correct(open or closed)position and no leakage `^t,�� III111... 2.Was flow observed? o OVA from retarding chamber or drains? Oyes V OVA ()Yes 3.Quarterly Inspection hems(in addition to above Hems) V 3.Are results comparable to previous test? ()Yes OW /,_ A 2.Semiannual Test(in addition to previous items) v A.Pressure Reducing Valve.In open position,not leaking.maintaining A.Valve supervisory svAtches indicate movement? OYes ON' 0" downstream pressure per design criteria,and in good condition with B.Electrical water flow alarm devices passed tests by opening the V hand wheels not broken? ()Yes ONo OVA inspectors test connection or bypass connection with alarms actuating ��.�� B.Hydraulic nameplate(calculated systems)securely attached to riser and flow observed? Yes OJo ■0)1VA and legible? OYes ONo 0 1/A 3.Annual Test(n addition to previous Hems) vV C.Fire Department Connection: Vv v/- A.Main drain test 1 Record Static Pressure psi and Residual psi Visible,accessible,couplings and swivels not damaged and rotate Pressure smoothly,plugs or caps in place and undamaged.gaskets in place and ❑ See comments-on page 2 in good condition,identification sign(s)in place,check valve is not ()Yes ONO ()WA 2 Was flow observed? leaking,clapper is in place and operating properly and automatic drain valve in place and operating properly? Oyes ONo OvA 3 Are results comparable to previous lest? OYes OJo OWA (If plugs or caps are not In place,inspect interior for obshuc5ons) V B.Are all sprinklers date 1920 or later? CYes �Mym OWA D.Alarm devices free from physical damage? ®Yes ()No /1,i A C.Fast response sprinklers 20 or more years old replaced or successfully v w OVA sample tested within last 10 years? Ones No @4/A Wet Pipe Report page2 D.Standard response sprinklers 50 or more years old replaced or (Yes Ohio eyA Partin-Comments(any"No"answers,test failures orother problemsfound with the sphnklersystem v must be explained here.Also,note here any products noticed on the system that have been the successfully sample tested within last 10 years? subject of a recall or a replacement program. E.Standard response sprinklers 75 or more years old replaced or /���� successfullysample tested within last 5 years? ©Yes ONo ®-4/A F.Dry-type sprinkler replaced or successfully sample tested within last ��:/J 10 years? (Yes V 0- G.Specific gevity of antifreeze correct? OYes ONo dA H.AI control valves operated through full range and returned to normal position? OYee ONo &A I.Backflow devices passed backflow test? Oyes Ohio JuA J.Backflow devices passed full lbw test? OYes ON° 0" K.Pressure reducing valves passed partial flow test? °Yes 0No VSA 4.Test to be done every third year: �;/ Hose(more than 5 years old)connected to the system has been service tested in accordance oath NEPA 1962.Water discharged and water flow alarne operated? ONIC OYes Cp. OVA 5.Test to be done every 5th year /� __ A Sprinklers rated above high temperature tested? OYes ( )No A B.Gauges checked by calibrated gauge or replaced? (Yes va 'io (/)N utA C.Pressure reducing valves passed full flow test? ONIC OYes ONO C>llA C.Maintenance 1.Regular Maintenance items A.I1 sprinklers have been replaced,were they proper replacements? OYes ONo 0A v B.Used hose was cleaned,drained and died before being placed back in service? a sues ONo Ow. C.Hose exposed to hazardous materiels was disposed of or ^'' decontaminated in an approved manner? Ores ` irw OVA D.Systems normally filed with fresh water were drained and retied twice if raw v water got into the system? (Yes ONo ®WA E.Item of the blowing were dscovered,was an obstruction investigation conducted? (Yes ONO O WA Explain reason(s)and obshucam investigation finding in Part 111 1.Defective intake screen on pump with suction horn open sources. 2.Obstructive material discharged during water flow tests. 3.Foreign materials found in dry-pipe valves,check valves or pumps. 4.Foreign material in water raring drain test or plugging of inspector's test connection. 5.Plugging of pipe or sprinklers found during activation or alteration. 6.Failure to flush yard piping or surroundng pubic rreirhs blowing new installation or repairs. 7.Record of broken mains in the vicinity. 8.Abnormally frequent false-tripping of dry-pipe valves. Part IV - Recommendations: Not a part of the NFPA-25 inspection, the following items may need to 9.System is returned to service after an extendedperiod out of service be reviewed by a fire pmfecson engineer. (greater than one year). 10.There is reason to beieve the system contains sodum situate or its derivatives or highly Valve seal #0006794 0006792 corrosive Mares in copper pipe systems. F.If condtions were found that required flushing,was flushing of system conducted? °Y ° ' 0" 2.Annual Maintenance Items(in addition to previous items) A.Operating stern of al OS&Y valves lubricated completely closed,and re-opened? OYes ONo OVA B.Sprinklers end spray noes protecting commercial cooking equipment vv and ventilating systema replaced except for bulb-type which show no sighs of grease buildup? 8Yes ONo OWA C.Does there appear to be recaled fire sprinklers installed at this site? Yes 0 No €NIA 3.Regular Maintenance Items A Alarm panel clear? ®Yes (No ONA B.System left in service? ®Yes ONo ONA C.Is system impaired?(Impairment program put into place per NFPA-25 and Fortitude Fire Protection protocols) °Yes ®No Part V-Inspectors Information I state that the information on this form is correct at the time and place of try inspection and that all equipment tested at this time was left in operational condition upon completion of the inspection except as noted in Part III above. Date: 11/4/2021 Printed Name of Inspector: Jason Kestner eP Signature of Inspector: ) License or Certification Number(if applicable): FP 121-0000255 Color of tag placed on system: 'Red Green I (fellow