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Permit Mech Fire System Mod 1 Ocean 2012 „r ✓ . z ;`SA CITY OF ATLANTIC BEACH r) MOOD 3 ATLANTIC 800 BEACH SE IN F L L E R 3223A INSPECTION PHONE LINE 247 -5814 .s y Application Number . . . . . 12- 00000122 Date 3/26/12 Property Address 1 OCEAN BLVD Application type description MECHANICAL FIRE PERMIT Property Zoning COM GENERAL DISTRICT Application valuation . . . 4200 Application desc MODIFICATIONS TO FIRE SPRINKLER AS REQUIRED Owner Contractor ASHFORD ATLANTIC BEACH LLP WAYNE AUTOMATIC FIRE SPRINKLER C/O EASLEY MCCALEB & ASSOC HAZARD FIRE PROTECTION ENG 431 E HORATIO AVE SUITE 120 222 CAPITOL COURT MAITLAND FL 32751 OCOEE FL 34761 (904) 268 -3030 Permit FIRE SUPPRESSION SYSTEM Additional desc . ADDING 5 HEADS RELOCTING 7 Permit Fee . . . 85.00 Plan Check Fee . . .00 Issue Date . . . 2/06/12 Valuation . . . . 0 Expiration Date . 2/06/12 Special Notes and Comments ADDING 12 HEADS TO EXISTING FIRE SPRINKLER SYSTEM AS REQUIRED - MODIFICATION TO EXISTING SYSTEM *2007 FLORIDA BUILDING CODE W/2009 REVISIONS FLORIDA FIRE PREVENTION CODE NATIONAL ELECTRIC CODE Other Fees STATE MECH DCA SURCHARGE 2.00 STATE MECH DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 85.00 85.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 89.00 89.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ,st � City of Atlantic Beach APPLICATION NUMBER . ., Building Department (To be assigned by the Building Department.) 800 Seminole Road .. �: Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -5845 p _D o• ` E -mail: building-dept©coab.us Date routed: — 7 City web - site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM p Address: / _ 6(fa X/vd Property Address• D parnt review required Yes No Buildin Applicant: ZU6ty/V } 7) fanning & Zoning Tree Administrator Project: �j j •/ rj t Public Works � � Public Utilities Public Safety Fire Services WOW: � , .: y z-' �. � "�. v . a-• ..__r � �.°�,c_iw,w. .��, � .- ti ,t �a.. _. :W Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APP (CATION STATUS Reviewing Department First Review: id Approved. ❑Denied. • e one. Comments: BUILDING P • ► • - • ZONING Reviewed by: Date: TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07/27/10 MECHANICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: (1) (IYJ c DCEA,.I / AT LP t4T I C IDEA C Y - / • 312 L o 33 PERMIT # 1 15 PROJECT VALUE $ ri.,� y;1 1 t,LI u L NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION M A R 0 9 2012 Air Conditioning: Unit Quantity Tons Per Unit Heat: Unit Quantity BTU's Per Unit Seer Rain ig 40 Duct Systems: Total CFM = REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI # Air Conditioning: Unit Quantity Tons Per Unit REQUIRED Heat: Unit Quantity BTU's Per Unit Seer Rating Duct Systems: Total CFM REQUIRED FIRE PREVENTION Fire Sprinkler System Quantity 09 (Requires 3 sets of plans) Fire Standpipe Quantity (Requires 3 sets of plans) Underground Fire Main Value (Requires 3 sets of plans) Fire Hose Cabinets Quantity (Requires 3 sets of plans) Commercial Hoods Quantity (Requires 3 sets of plans) Fire Suppression Systems Quantity (Requires 3 sets of plans) FIRE PLACES MISCELLANEOUS: Prefabricated Fireplace Qty Automobile Lifts Gas Piping Outlets Boilers BTU's Elevators /Escalators ALL OTHER GAS PIPING Heat Exchanger Quantity of Outlets Pumps # Vented Wall Furnaces Refrigerator Condenser BTU's # Water Heaters Solar Collection Systems Tanks (gallons) Wells OTHER: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local 1 De regulation • struction or the performance of construction. Property Owners Name A F t , kb 7 A ia.5 SApN 1 2E L LC o ► g s l c _ °cow on N ber ONO 20 7 4o Z Mechanical Company \NIhY) AI,ITory\kTic R 9.-E. PR lti (z�eizs Office Phone 2 30 55, Fax Z S V12_4 Co. Address: I t 3ZC Di 6 a T 16 ki NI E W W. City SAci - & i U LL State FL • Zip 32.2_56 License Holder (Print): S 4A )W ' k A ' State Certification/Registration # 6 /00012cz'(, Notarized Signature of License Ho . A % ' Sworn and subscribed before e this `1 da of flia,VC h 2012 8TBPHANIE PARROTT ..�. > � ,'1 „i '1' PUBLIC �„ `, STATE OF FLORIDA + Comm# EE014521 FILE COPY . ” ' ' E . e . Expires 10/25/2014 \i/T wW 7 m I I w f AY I 1 I E Automatic Fire Sprinklers, Inc. LE 4 oo� . ,.. Hydraulic Calculations Wayne Automatic Fire Sprinklers, Inc. 11326 Distribution Avenue West Jacksonville, FI. 32256 -2745 904 - 268 -3030 Job Name : One Ocean Canopy Sheet Number : FP1 Location : 1 Ocean Blvd., Atlantic Beach, Florida 32233 Design Area : 1 Contract : 3251 Data File : One Ocean Canopy.wxl Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 Wayne Automatic Page 1 One Ocean Canopy Date 3/8/12 HYDRAULIC CALCULATIONS for Project name: One Ocean Canopy Location: 1 Ocean Blvd., Atlantic Beach, Florida 32233 Drawing no: FP1 Date: 3/8/12 Design Remote area number: 1 Remote area location: Outside Canopy Occupancy classification: Light Hazard Density: .1 - Gpm /SqFt Area of application: Entire - SqFt Coverage per sprinkler: 102 - SqFt Type of sprinklers calculated: Tyco TY -B 5.6K NPT Brass SSP No. of sprinklers calculated: 9 In -rack demand: - GPM Hose streams: 100 - GPM Total water required (including hose streams): 247.409 - GPM @ 52.0217 - Psi Type of system: Anti - Freeze Volume of dry or preaction system: - Gal Water supply information Date: 12 -13 -2011 Location: Annual Fire Pump Test Source: Wayne Automatic Fire Sprinklers Name of contractor: WAYNE AUTOMATIC FIRE SPRINKLERS, INC Address: 11326 Distribution Ave W / Jacksonville, FL 32256 Phone number: 904 - 268 -3030 Name of designer: David L. Blake, CET Authority having jurisdiction: City of Atlantic Beach Notes: (Include peaking information for gridded systems here.) Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 Flow Diagram Wayne Automatic Page 2 One Ocean Canopy Date 3/8/12 14.8 44.6 75.6 109.1 147.4 1 2 <- 3 <- 4 <- 5 <- 6 < - 7 <- 8 <- 9 <- 10 <- EPD 29.7 59.9 91.9 127.6 247.4 Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 o.- N O(0 � ,-. N O O .- 0 0 Ni Ott) Co CO M co (0 0 c s 0 l W O) N as m o N..- .- ov 03 03 ao I v '0 (0, o M 1` 1` r' NN (028 O 0) N 10 O N t0 to (C) NCO LO 10 CO CO a0 ,- ,- tl• V M 0 M 0 (0I oT VI CO 1 D 2 1 .0 0)- NNN E as t -a- . .- N NN C co • ow .-.� C • O _ a? M o N- ' (D � c U Q C O E > .O Ce CO V co > N • 1 ,- 0 O 3 O N c U a> L0 0 N .O- +-• (� O Q E CNI N N (0 W ,- ,- O > d N N w u_ 0 o odd' 76 .2 c 2 " to 0 O lL N 0 (.itrmorn0o n •t � U (�np to s 0)4_ o o) � I -o 7 O B (A `a a V 2 NM 'a) 0 CO `* a X C N a-- O N -1-• _ 1. 10 LI- N (6 7 � t E 3 N •- N N (0 O (0 10 4) 0 (A E � 0 # .0 n. a) o. 0") w f0 3 )a 0 E I! 0 my -p L O o d c o c O o ..s 0 o N 0 ) co to -0 0 c E � N w 0) U ` c N U a) CO O a 0)N N o • O N LL O t () CL.Lnd " . C E o E CO CO (0 (� C — -p 4) 0 C 'D no,- - N u C a N *co d > a) N N as > U) - Y 70 f6 .. N e- E > o >r a , 0 c ° c E >..o (0 U 0 � o� s EW > a rn- o No r) a) a � co . E 2 C (6 U n oo =`mg`63c c m ° c To m 0 c 3 00 3 z N CD rnmaj — o C 0 c 3 c c Li_ E cu • C _ C a) T (n Q N rn 0 Si u _00 0 0) E = c (n U_a c o � c • c 0 > (A a _c D m li . > X � E � m > , o ma) • Y E rn3 (n hi N aN U G >mc c N c O)(7)02 0- - 0 - � c^� L >O u_< coW(LOU) D bJEd Z W o co (0 O Pressure / How Summary - S I ANUAFZU Wayne Automatic Page 4 One Ocean Canopy Date 3/8/12 Node Elevation K -Fact Pt Pn Flow Density Area Press No. Actual Actual Req. 1 20.0 5.6 7.0 na 14.82 0.1 102 7.0 2 20.0 5.6 7.03 na 14.85 0.1 102 7.0 3 20.0 5.6 7.15 na 14.98 0.1 102 7.0 4 20.0 5.6 7.41 na 15.24 0.1 102 7.0 5 20.0 5.6 7.84 na 15.68 0.1 102 7.0 6 20.0 5.6 8.51 na 16.34 0.1 102 7.0 7 20.0 5.6 9.48 na 17.24 0.1 102 7.0 8 20.0 5.6 10.8 na 18.41 0.1 102 7.0 9 20.0 5.6 12.57 na 19.86 0.1 102 7.0 10 7.0 49.7 na 100.0 EPD 2.0 52.02 na The maximum velocity is 14.09 and it occurs in the pipe between nodes 9 and 10 Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 I-mal (;alculations - Hazen - Williams Wayne Automatic Page 5 One Ocean Canopy Date 3/8/12 Hyd. Qa Dia. Fitting Pipe Pt Pt Ref. "C" or Ftng's Pe Pv * * * * *** Notes * * * * ** Point Qt Pf /Ft Eqv. Ln. Total Pf Pn 1 14.82 2.067 0.0 12.000 7.000 K Factor = 5.60 to 120.0 0.0 0.0 0.0 2 _ 14.82 0.0028 0.0 12.000 0.033 Vel = 1.42 2 14.85 2.067 0.0 12.000 7.033 K Factor = 5.60 to 120.0 0.0 0.0 0.0 3 29.67 0.0099 0.0 12.000 0.119 Vel = 2.84 _ 3 14.97 2.067 0.0 12.000 7.152 K Factor = 5.60 to 120.0 0.0 0.0 0.0 4 44.64 0.0212 0.0 12.000 0.254 Vel = 4.27 4 15.24 2.067 0.0 12.000 7.406 K Factor = 5.60 to 120.0 0.0 0.0 0.0 5 59.88 0.0363 0.0 12.000 0.436 Vel = 5.73 5 15.69 2.067 0.0 12.000 7.842 K Factor = 5.60 to 120.0 0.0 0.0 0.0 _6 75.57 0.0560 _ 0.0 12.000 0.672 Vel = 7.23 6 16.34 2.067 0.0 12.000 8.514 K Factor = 5.60 to 120.0 0.0 0.0 0.0 7 _ 91.91 0.0803 0.0 12.000 0.964 Vel = 8.79 7 17.24 2.067 0.0 12.000 9.478 K Factor = 5.60 to 120.0 0.0 0.0 0.0 8 109.15 0.1105 0.0 12.000 1.326 Vel = 10.44 8 18.40 2.067 0.0 12.000 10.804 K Factor = 5.60 to 120.0 0.0 0.0 0.0 9 127.55 0.1474 0.0 12.000 1.769 Vel = 12.20 9 19.86 2.067 8E 40.0 64.710 12.573 K Factor = 5.60 to 120.0 3T 30.0 83.250 8.630 * Fixed Toss = 3 10 147.41 0.1926 1S 11.0 147.960 28.501 Vel = 14.09 1B 2.25 1 Fsp 0.0 10 100.00 6.357 1 E 17.603 10.500 49.704 Qa = 100 to 120.0 1G 3.772 61.610 2.166 EPD 247.41 0.0021 1S 40.235 72.110 0.152 Vel = 2.50 0.0 247.41 52.022 K Factor = 34.30 Computer Programs by Hydratec Inc. Route 111 Windham N.H. USA 03087 N 0 WO CO .76 mvN ern r , O 1A -- C N -- N N RS N .. .. .. .. .... a. 0 e "a a C O CLLa C0 C o w U) CO U) , 1 4 1 4 0 C NN MM al 000X E a) 0 n co O M O O Q O f/) ca D e- Z E CO O) V• co t v itiOO C '-ML - e-e- r 3 o o O LL e- 0 X 0 ee ea o 2 U e e2 aaLL e o -- o o =22 �x L ca to : (a co' >, UWWa2 _ O 0.0.0.0.0 = EEEEE Z m ia a'' o_ a. 5 co ca m.. O 0 0T -NNMM 0, LL O Qaaaa E a. = o a O c O 0. E 0 0 N a O O co O O co a) m U >. 0 V O N O L2 LL 0 r 0. E 0 ^ 0 0 a 0 , e� 0 _ w......... N CO Q V 0 0 0 0 0 0 a) °) 0 LC) 't M N 0 0 0 0 0 0 0 0 0 0 463 � , •— e-- •c- c- N- 0) CO V-- CO L() V' M N CD O LL 2 W CO CO 0 0: W - PORT ST. LUCIE, FL 34986 rr�� __ _.._.,.,. . ,,,,,, 772 -878 -3350 • FAX: 772 - 878 -5967 TAMPA, FL 33619 81 3- 630 -0303 • FAX: 81 3 - 630 -0312 11326 DISTRIBUTION AVENUE WEST I 4683 LAREDO AVENUE JACKSONVILLE, FLORIDA 32256 -2745 Automatic Fire Sprinklers, Inc. FORT MYERS, FLORIDA 33905 904- 268 -3030 - FAX: 904 - 268 -0724 239 -433 -3030 - FAX: 239 -433 -3263 4370 MOTORSPORT DRIVE 222 CAPITOL CT. OCOEE, FL 34761 -3033 3121 NW 16TH TERRACE CONCORD, NORTH CAROLINA 28027 POMPANO BEACH, FLORIDA 33064 704- 782 -3032 - FAX: 704 - 795 -6838 407 - 656 -3030 - 407 - 656 - 8026 954- 917 -3030 - FAX: 954 -917 -9424 NFPA -25 Inspection, Testing and Maintenance of Fire Pumps Information on this form covers the minimum requirements of NFPA 25 -2002 for centrifugal pumps. Separate forms are available to inspect, test and maintain the rest of the fire protection system of which the fire pump is a part. More frequent inspection, testing and maintenance may be necessary depending on the conditions of the occupancy and the water supply. Owner: One Ocean Resort & Spa ISC #: J00101 Report#: Owner's Address: 1 Ocean Blvd. Atlantic Beach 32233 Owner's Phone Number: Property Being Evaluated: One Ocean Resort & Spa Property Address: 1 Ocean Blvd. Atlantic Beach 32233 Date of Work: Dec 13, 2011 All responses refer to the current work (inspection, testing and maintenance) performed on this date. This work is (check one): 0 Monthly 0 Quarterly ® Annual °Third Year 0 Fifth Year Part I - Owner's Section A. Is the building occupied? ()Yes QNo B. Has the occupancy classification and hazard of contents remained the same 10. Circulation relief valve flowing water while pump chums? since the last inspection? ()Yes Q No ()Yes No ON/A C. Are all fire protection systems in service? ()Yes Q No 11. Pressure relief valves operating with proper pressure downstream D. Has the system remained in service without modification since the last inspection? °Yes ° No while pump is operational? Q Yes No ON /A E. Was the system free of actuation of devices or alarms since the last ()Yes Q No 12. Alarm panel clear? O Yes Q No ON /A inspection? 13. System left In service? Q No Yes Q • F. Weekly logs of inspections required by NFPA#25 on file? OYes ONo ON/A B. Tests G. All deficiencies reported at last inspection corrected? ()Yes QNo 1. Weekly Test Items H. I know the location and understand the operation of all control valves. °Yes 0 No A. Electric Motor -Driven Pumps J. I would like to have a copy of NFPA#25 @ an extra charge of $50.00. ()Yes 0 No 1. Pump started automatically 0 Yes QNo ON /A K. Owner or rep. requests WAFS to release information from Record starting Inspections to the underwriters of my insurance company. °Yes QNo pressure: 110 pa Note to owner. Periodic tests of transfer switches and emergency generators are to be performed in 2. Pump ran for at least 10 minutes? O Yes Q No ON/A accordance with NFPA 110 by a qualified electrical contractor. Record suction 42 and discharge 145 pressure while running. 3. Pump packing gland showing slight discharge? 0 Yes Q No ON /A Adjust if necessary. Dec 13, 2011 4. Free from unusual noises or vibrations? O Yes Q No ON /A Owner or representative (print name) Signature Date 5. Packing boxes, bearings and pump casing free from overheating? O Yes Q No ON /A Part II - Inspector's Section 6. Record time for motor to accelerate to full speed: 2 sec 7. For reduced voltage or reduced current starting, record time controller A. Inspections •All to be performed weekly. 1. Pump house /room proper temperature (at least 70 degrees F for diesels without on first step. N/A engine heaters or 40 degrees F for others ?) O. Yes Q No ON /A 8. For automatic stop controllers, record time pump runs after starting: 10 mins 2. Ventilating louvers free to operate ?Q Yes Q No ON /A 9. All times and pressures in Part A acceptable? ° • Yes 3. Suction, discharge and bypass valves open? ()Yes Q No ON /A Q No ON/A B. Diesel Engine- Driven Pumps 4. Piping appears to be free from leaks? Q. Yes Q No ON /A 1. Pump started automatically? ()Yes Q No ON/A 5. Suction and system pressure gauges normal? O Yes Q No ON /A Record starting pressure: 6. Suction reservoir, if provided, full? 0 Yes Q No ON /A 2. Pump run for at least 30 minutes? ()Yes Q No ON /A 7. Electric Motor Driven Pumps Record suction and discharge pressure while running. a. Controller indicating power on, transfer switch indicating normal situation and isolation switch closed? ()Yes Q No ON/A 3. Pump packing gland showing slight discharge? 0 Yes Q No ON /A b. Reverse phase alarm indicator off or normal phase rotation indicator Adjust if necessary. 4. Free from unusual noises or vibrations? on? O Yes Q No ON/A 0 Yes 0 No 5. Packing boxes, bearings and pump casing free from overheating? O Yes Q No ON /A c. Oil level in vertical motor sight normal? ° Yes 0 No ON /A 6. Record time for engine to crank: 8. Diesel Engine driven Pumps a. Fuel tank at least two thirds full? 0 Yes Q No ON/A 7. Record time for engine to reach running speed: b. Controller selector switch in auto position? ()Yes Q No ON/A 8. Engine oil pressure gauge, speed indicator, water and oil temperature c. Battery voltage and charger readings normal? 0 Yes 0 No ON /A indicators all reading normal? 0 Yes Q No ON /A d. Battery indicators on or failure indicators off? 0 Yes 0 No ON/A 9. Cooling water flowing from heat exchanger? ()Yes Q No ON /A e. All alarm indicators off? 0 Yes 0 No ON /A 10. All times and pressures in Part B acceptable? ()Yes Q No ON /A C. St Turbine - Driven Pumps f. Record engine running time meter reading: 1. Record pump starting pressure , suction Is this appropriately higher than previous reading? 0 Yes Q No ON /A and discharge g. Oil level in right angel gear drive normal? Q es 0 No ON/A pressures while running. h. Crankcase oil level normal? 0 Yes 0 No ON/A 2. Pump packing gland showing slight discharge? O Yes Q No ON/A Adjust if necessary. i. Cooling water level normal? ()Yes Q No ON /A 3. Free from unusual noises or vibrations? 0 Yes 0 No ON/A ). Electrolyte level in batteries normal? °Yes Q No ON /A 4. Packing boxes, bearings and casing n9 g e pump casin free from overheating? Q Yes Q No ON/A k. Battery terminals free from corrosion? °Yes Q No ON /A 5. Record steam pressure gauge reading: I. Water- jacket heater operating? Q Yes Q No ON /A 6. Record time for turbine to reach running speed: 9. Steam pressure gauge for steam driven pump reading normal? 0 Yes 0 No ON/A 7. All times and pressures in Part C acceptable? 0 Yes 0 No ON /A r Pump Test Results No Flow Rated Flow Peak Flow 4. Semiannual Maintenance Items: Suction 42 35 30 A. Manual starting means on electrical systems operated Pressure and boxes, panels and cabinets cleaned? QYes QNo ON /A Discharge 145 130 115 B. Antifreeze tested in coolant system? OYes QNo ON /A Q NIC Pressure C. Flexible exhaust section acceptable? QYes QNo ON /A D. Alarms operated on electrical portions of diesel engine systems? Qves QNo Q nt /A Flow N/A 750 1125 5. Annual Maintenance Items: Electric Voltage A. Added grease to pump bearings? QYes QNo OV /A and Current N/A N/A N/A B. Shaft end play acceptable? QYes QNo ()V!A Pump C. Transmission coupling, right angle gear drive and mechanical Speed moving parts lubricated? QYes QNo ON /A D. Circuit breakers passed trip test? QYes QNo ON /A Q NIC E. Emergency manual starting means operated without power? Qves QNo .Q,/ /A Annual Tests F. Electrical connections secure? QYes QNo • Q./ /A Annual pump test was run using the following method: (check one) G. Pressure switch settings calibrated? ves No ❑ Method A. Discharge of flow through hose streams. H. Motor bearings greased? Q O ON /A QYes QNo OVlq Flow readings taken at each hose stream. I. Fuel tank free of water and foreign material, tank vents and ® Method B. Discharge through by -pass flow meter to drain or suction overflow pipes free of obstructions, fuel piping acceptable, reservoir. Flow readings taken by flow meter. and oil and filters changed in diesel systems? QYes QNo ON /A Q NIC ❑ Method C. Discharge through by -pass flow meter directly returned to J. Antifreeze changed in coolant system? Qves QNo ON /A Q NIC pump suction. Flow readings taken by flow meter. K. Heater exchanger cleaned out? QYes QNo ON /A Q NIC L. Duct work and louvers (combustion air) acceptable? QYes QNo .Q,/ /A Note: At least once every three years method A or B must be used. M. Exhaust system free of back pressure? Qves QNo ON /A A. Are the values in the above table acceptable? ()Yes Q No QN /A N. Exhaust system hangers and supports acceptable? Yes ONo • !A B. No (chum) test run for 30 min? () Yes Q No ON /A O. Control and power wiring tight? Qves QNo O" • /A C. Circulation relief valve and pressure relief valve operated properly during at flow tests? ()Yes 0 No QN /A Part 111 - Comments (any "No " answers, test failures or other problems found with the sprinkle D. No alarm indicators or other visible abnormalities observed during system must be explained hem. Also, note here any products noticed on the system that have been no flow test? Q Q QN /A the subject of a recall or a replacement program.) All items that need repaired or replaced ere the owners • Yes No responsibility and am not included in the price of inspection. E. Suction screens cleaned after flow? ()Yes Q No ON /A Q NIC F. Low Suction Throttling Device Test 1. Low suction pressure simulated? 8 Yes O No ON /A Q NIC Free from abnormalities in throttling action? 8 Yes No • N/A Q NIC 2. Free from abnormalities in retum to full flow? 0 Yes Q No ON /A Q NIC G. Automatic Transfer Switch Test OS&Y-0426640 1. Power failure simulated during peak flow? QYes QNo QN /A 0 NIC Test Header - 0426650 Connection made to alternate power source? Q Yes Q No QN /A 0 NIC 2. After temrination of simulated power failure, did motor reconnect Bypass - 0426645 & 0426641 to the normal power source? Q Yes QNo QN /A 0 NIC H. All alarm conditions simulated? ()Yes 0 No QN /A Jockey Supply-0426636 All alarms operated? O Yes QNo QN /A C. Maintenance Jockey System 0426630 A maintenance schedule must be established in accordance with the manufacturer's instructions. In the System- 0426629 absence of such a schedule, the following must be used: 1. Weekly Maintenance hems for Diesel Engine Systems: A. Fuel tank level, tank float, switch and solenoid valve operation acceptable? 0 Yes Q No ON /A B. Diesel fuel system free of water? Q Yes Q No ON /A C. Flexible hoses and connectors in fuel and coolant systems acceptable? Q Yes Q No ON /A D. Oil level and tube oil heater acceptable? QYes QNo ON /A E. Coolant level acceptable? Q Yes Q No O N/A F. Water pump for coolant system operating? Q Yes Q No O N/A G. Jacket water heater for coolant system acceptable? 0 Yes QNo ON /A H. Exhaust system free of leakage? 0 Yes Q No ON /A I. Drain condensate trap on exhaust system operational? QYes QNo ON /A J. Electrolyte level in batteries acceptable? Q Yes ONO ON /A K. Connections to electric system acceptable? Q Yes Q No ON /A 2. Monthly Maintenance Items: A. Isolation switch and circuit breaker exercised? 0 Yes Q No ON /A B. Battery case clean, dry and free of corrosion and battery's specific gravity or state of charge passed test? 0 Yes Q No ON /A C. Charger and charge rate passed visual inspection and battery charge Part IV - Inspector's Information being equalized? QYes QNo ON /A D. Circuit breakers appear clean? I state that the information on this form is correct at the time and place of my inspection and 0 Yes Q No ON /A that all equipment tested at this time was left in operational condition upon completion of this 3. Quarterly Maintenance Item: inspection except as noted in Part 111 above. A. Cleaned strainer, filter or dirt leg in diesel fuel system? Q Yes 0 No ON /A Q NIC B. Cleaned or replaced crank case breather in lubrication system? Date: Dec 13, 2011 0 Yes 0 No ON /A Q NIC P-J15' C. Cleaned water strainer in coolant system? Q Yes 0 No ON /A Q NIC 1 t D. Insulation acceptable and fire hazards eliminated from exhaust Signature of Inspector: Co ✓ system? QYes QNo ON /A / E. Battery terminals clean and tight? Print Name: Larry L. White II QYes QNo ON /A F. Electrical system free of wire chafing? Q Yes Q No ®NIA License or Certification Number (if applicable): 19367800012010 Color of tag placed on system: 0 Red ()Gre