One Ocean Fire System Test Reports 2013 613 N.W.MERCANTILE PLACE -_—� ------....__.VE
PORT ST.LUCIE,FL 34986
772-878-3350•FAX:772-878-5967 Im- l is-S►4 - 30-0312
11326 DISTRIBUTION AVENUE WEST \VAV/WAYNE P V A�, 44— JE
JACKSONVILLE,FLORIDA 32256-2745 Automatic Fire Sprinklers, Inc. I L 33905
904-268-3030-FAX:904-268-0724 3-3263
222 CAPITOL CT.
4370 MOTORSPORT DRIVE OCOEE, FL 34761-3033 ACE
CONCORD,NORTH CAROLINA 28027 DA 33064
704-782-3032-FAX:704-795-6838 407-656-3030-407-656-8026 )17-9424
Fire Alarm System Inspection and Testing Report
This testing was performed in accordance with applicable N.F.P.A.standards.
Owner: ONE OCEAN ISC# J00101 Date: 18 DECEMBER 1:
Owner's Address: ONE OCEAN BOULEVARD ATLANTIC BEACH,FL.32233
Property Being Evaluated: ONE OCEAN
Property Address: ONE OCEAN BOULEVARD ATLANTIC BEACH,FL.32233
Monitoring Entity Panel Manufacturer: Model No.
INTELLIKNIGHT 5820XL
Name: COPS
Circuit Styles: 4.0 B Y Amt 2(SLC)4(NAC)
Telephone: 1-800-934-2527
Last Date System Had Service Performed: DECEMBER 2011 /WAFS
Account Ref.No. 656-0572
Last Date Software or Configuration was Revised: V9.09 AUGUST 2007
Service
(`-Weekly AHJ DIRECTOR OF PUBLIC SAFETY
-Monthly AHJ phone#
904-247-5864
(` Quarterly
Semi-Annually r+ -Digital
(-Annually (` -R.F.
Other(Specify) ` -Other Specify
Inspected by(print) MICHAEL TAE Date: 18 DECEMBER 12 Time: 0900
Signature of Alarm Agent: (Agent Meets Requirements Per Florida Statute 489.518)
Name of Owner or representative
Signature Date: 18DECEMBERI2ownerorOwnerrep.notonsite.
I would like to have a copy of NFPA#72 @ an extra charge of$50.00. OYes ONo
Owner or rep.requests WAFS to release information from
inspections to the underwriters of my insurance company. OYes ONo
System restored to normal operation:Time: 1500
Notifications are made Yes No Who Time
Monitoring Entity r' r' OPERATOR 746 0900
Building Occupants F F
Building Management r' r JUAN 0900
Other(Specify) r r
I. ALARM NOTIFICATION APPLIANCES TEST AND INSPECTION
Device - Circuit Style/Quantity - Operational Test Approved Location Pass - Fail
Bells Quantity( ) Size( ) Type( ) r', rj r r;
Horns A( ) B(193 ) r, r r', r''
Speakers A( ) B( ) r, r r—
Chimes A( ) B( ) ri, F' r r
Strobes A( ) B(10 ) r r' r F'
Other:(Specify) A( ) B(84 ) FF r' r' F
SPEAKER/STROBE No.of Alarm indicating circuits: 4 Are Circuits supervised? (e—Yes (-No
Page 2
II.INITIATING AND SUPERVISORY DEVICE TEST AND INSPECTION
Device - Circuit Style/Quantity - Operational Test - Simulated Test Pass - Fail
Manual Stations A( ) B(38 ) r, r, r F
Ion Detectors A( ) B( ) F r__ r
Photo Detectors A( ) B(67 ) r r, R r
Duct Detectors A( ) B(5 ) r rFX_ r
Heat Detectors A( ) B(7 ) r FI r r
Waterflow Detectors A( ) B(10 ) r r' r F
Supervisory Switches A( ) B(18 ) r, F r F
Pressure Switches A( ) B( ) F F r r
Low Air A( ) B( ) r' r r'' r'
Other(Specify): A( ) B(4 ) FX_ ", FX_
MONITOR MODS
III. SUPERVISORY SIGNAL INITIATING DEVICES&CIRCUIT INFORMATION
Site Water Temp. C.Yes [`No (ii N/A
Site Water Level (`Yes ( No re j N/A
Fire Pump Power (i;Yes r`No (`N/A
Fire Pump Running (%Yes No ( N/A
Fire Pump Auto Position (i`;Yes (`No N/A
Fire Plump or Pump Control Trouble r,Yes C No r N/A
Gene�ator In Auto Position (`Yes (`No (STN/A
Generator or Controller Trouble (`Yes r_No C N/A
Switch Transfer ;Yes (7=No (4 N/A
Generator Engine Running (`Yes (7 No (%':N/A
Lock Box (`;Yes (No (ii N/A
A.SIGNALING LINE CIRCUITS
Quantity and style(See NFPA 72,Table 3-6)of signaling line circuits connected to system
Quantity 2 Style(s): 4.0
IV.SYSTEM POWER SUPPLIES
A.Primary(Main): Normal Voltage 120VAC Amps 3
Overcurrent Protection:Type: CKT BRK Amps 20
Location(Panel#): FIRST FLR FACP/TELCO RM/PANEL ITLRO
Disconnecting Means Location: CKT 1
B.Secondary(Standby): 24VDC(INSTALLED OCTOBER 2011)
Storage Battery:Amp-Hr.Rating 18Ah
Calculated capacity to operate system,in hours: r', 24 60
NA Engine driven generator dedicated to fire alarm system:
C.Location of Fuel Storage: NA
D.TYKE BATTERY SECONDARY POWER
r Dry Cell Type Visual Functional
r; Nickel Cadmium
Battery Condition r' r'
r Saled Lead-Acid Load Voltage NOTE FX_
r
0,:,
her(Specify): Discharge Test Min. r
Specific Gravity r;
E.Emergency or standby system used as a back-up to primary power supply,instead of using a secondary
power supply. NA Emergency system described in N.F.P.A.,.Article 700.
Page 3
V.SYSTEM TESTS t£INSPECTIONS
A.Type Visual Functional D.Notification Appliances - Visual - Functional
Control Panel r r' Audible r'
Interface Equipment Rr' Visual r, r,
rx-
L.E.D.s/Lamps r r Speakers r' r
Fuses/MicroBreakers r' r Voice Clarity r r
Primary Power Supply r r'
Trouble Signals r r
Disconnect Switches r'; r
Ground Fault Monitoring r'' r' E.ON/OFF Premises Monitoring
B.Emergency Communication Equipment Yes No N/A
Alarm Signal
Type Visual Functional N/A r" r r:
Phone Set
Alarm Restoral �.
r r
Phone Jacks r rX; - Trouble Signal (' r
Off Hook Indicatorsr- r r Trouble Restoral r
r-
Amplifier(s) r r r- Supervisory Signal r; C (`
Tone Generator(s) r', r Supervisory Restoral C r ('•,
Call In Signal r r, �--, Remote Anuciator r
System Performance r' r'
C.Interface Equipment DEVICE SIMULATED
(SPECIFY) VISUAL OPERATION OPERATION
DIALER Fx- r r'
r
Special Hazard System(Specify) r '
HOOD SUPP r, r r
r � r
r r r
VI.COMMENTS:
(1)SILENT KNIGHT 5495 NAC BOOSTERS ARE SHOWING BATTERY TROUBLES.
(2)T O ANNUNCIATOR PANELS;ONE IN FRONT LOBBY THE OTHER IN THE SPA
VII.DEFICIENCIES: These items are the owner's responsibility to be repaired and will be quoted separate from inspection cost.
(1)THE BATTERIES FOR THE EVAX SYSTEM FAILED UNDER LOAD TEST
(2)THE BATTERIES FOR THE SILENT KNIGHT NAC BOOSTERS FAILED UNDER LOAD TEST
613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST.LUCIE,FL 34986 �
TAMPA,FL 33619
772-878-3350-FAX:772-878-5967 81 3-630-0303-FAX:81 3-630-0312
WAYNE
11326 DISTRIBUTION AVENUE WEST 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 ISC#: J00101 Report#: 1 OF 1
Owner's Address: ONE OCEAN BOULEVARD ATLANTIC BEACH,FL.32233 Owner's Phone Number:
Property Being Evaluated. ONE OCEAN 904-249-7402
Property Address: ONE OCEAN BOULEVARD ATLANTIC BEACH,FL.32233
Date of Work: 17 DECEMBER 2012 All responses refer to the current work(inspection,testing and maintenance)performed on this date.
This work is(check one): O Monthly O Quarterly Q Annual QThird Year O Fifth Year
Part I-Owner's Section
A.Is the building occupied? OYes ONO
B.Has the occupancy classification and hazard of contents remained the same
since the last inspection? Oyes ONO 10.Circulation relief valve flowing water while pump chums? O Yes O No ON/A
C.Are all fire p tection systems in service? OYes ONO 11.Pressure relief valves operating with proper pressure downstream
D.Has the system remained in service without modification since the last inspection? OYes ONO while pump is operational? OYes O No @N/A
E. Was the system free of actuation of devices or alarms since the last OYes ONO 12.Alarm panel clear? OYes @No ON/A
inspection? _
F.Weekly logs f inspections required by NFPA#25 on file? OYes ONO 13.System left in service? O Yes No ON/A
B.Tests
G.All defidenc as reported at last inspection corrected? OYes ONO
1.Weekly Test Items
H.I know the I"tion and understand the operation of all control valves. Oyes ONO A.Electric Motor-Driven Pumps
J.I would like t have a copy of NFPA#25 Q an extra charge of$5o.00. OYes ONO 1.Pump started automatically
K.Owner o�rep.requests WAFS to release information from O Yes ONO ON/A
inspections to the underwriters of my insurance company. OYes ONO Record starting pressure: 110 psi.
Note to owner.Periodic tests of transfer switches and emergency generators are to be performed in 2.Pump ran for at least 10 minutes? @ Yes O No ON/A
accordance with NFPA 110 b qualified electrical contractor. Record suction 40 and discharge 145
Y a 4 pressure while running.
3.Pump packing gland showing slight discharge? @Yes ONO ON/A
Adjust if necessary.
REP NOT AVAILABLE 17 DECEMBE 4.Free from unusual noises or vibrations? @Yes 0N ON/A
Owner or representative(print name) Signature Date 5.Packing boxes,bearings and pump casing free from overheating? @ Yes ONO ON/A
Part II-Ins',pectoes Section 6.Record time for motor to accelerate to full speed: 3SEC
A.Inspections-All to be performed weekly. 7.For reduced voltage or reduced current starting,record time controller
1.Pump houseyroom proper temperature(at least 70 degrees F for diesels without on first step. NA
engine heaters or 40 degrees F for others?) @ Yes ONO ON/A 8.For automatic stop controllers, record time pump runs after starting: NA
2.Ventilating lowers free to operate? Oyes ONO @N/A
3.Suction,discharge and bypass valves open? @Yes No ON/A 9.All times and pressures in Part A acceptable? @ Yes O No ON/A
B.Diesel Engine-Driven Pumps
4.Piping appears to be free from leaks? @ Yes ONO ON/A 1.Pump started automatically? OYes ONO @N/A
5.Suction and System pressure gauges normal? OYes 0 No ON/A Record starting pressure:
6.Suction reservoir,if provided,full? O Yes ONO @N/AO
2.Pump run for at least 30 minutes? Yes No •O
N/A
7.Electric Motor Driven Pumps Record suction and discharge ressure while runnin
a.Controller indicating power on,transfer switch indicating normal P g'
3.Pump packing gland showing slight discharge? OYes ONO @N/A
situation a isolation switch closed? @Yes ONO ON/A
b.Reverse pt ase alarm indicator off or normal phase rotation indicator Adjust if necessary.
on? @ Yes ONO ON/A 4.Free from unusual noises or vibrations? OYes ONO
c.Oil level in
vertical motor sight normal? OYes No @N/A 5.Packing boxes,bearings and pump casing free from overheating? O Yes ONO @N/A
6.Record time for engine to crank:
8.Diesel Engin driven Pumps
a.Fuel tank at least two thirds full? OYes ONO @N/A 7.Record time for engine to reach running speed:
b.Controller elector switch in auto position? O Yes ONO @N/A 8.Engine oil pressure gauge,speed indicator,water and oil temperature
c.Battery vol ge and charger readings normal? O Yes ONO @N/A indicators all reading normal? OYes ONO @N/A
d.Battery ind tors on or failure indicators off? OYes ONO @N/A 9.Cooling water flowing from heat exchanger'? OYes ONO (E)NIA
e.All alarm indicators off? OYes ONO @N/A 10.All times and pressures in Part B acceptable? OYes ONO @N/A
C.steam Turbine-Driven Pumps
f.Record eng ne running time meter reading: 1.Record pump starting pressure suction
Is this apprc priately higher than previous reading? OYes ONO @N/A and discharge
g.Oil level in right angel ear drive normal? pressures while running.
9 9 9 OYes ONO @N/A
h.Crankcase oil level normal? O Yes ONO @N/A 2.Pump packing gland showing slight discharge? O Yes ONO @N/A
Adjust if necessary.
I.Cooling water level normal? OYes ONO @N/A 3.Free from unusual noises or vibrations? O Yes ONO @N/A
I.Electrolyte level in batteries normal? O Yes ONO @N/A
4,Packing boxes,bearings and pump casing free from overheating? O Yes ONO @N/A
k.Battery to finals free from corrosion? OYes ONO @N/A 5.Record steam pressure gauge reading:
I.Water-jacke heater operating? O Yes ONO @N/A 6.Record time for turbine to reach running spe�-
9.Steam preSSL ire gauge for steam driven pump reading normal? O Yes ONO @N/A 7,All times andressures in Part C acceptable?P p 0 Yes ONO @NIA
' Pump Test Results Report#: 1 OF 1
No Flow Rated Flow Peak Flow 4.Semiannual Maintenance Items:
Suction
Pressure 45 25 NOTE A.Manual starting means on electrical systems operated
and boxes,panels and cabinets cleaned? OYes ONO (@J/A
Discharge 145 75 NOTE B.Antifreeze tested in coolant system? OYes ONO ON/A O NIC
Pressure C.Flexible exhaust section acceptable? OYes ONO @N/A
Flow N/A 750 1125 D.Alarms operated on electrical portions of diesel engine systems? Oyes ONO @N/A
5.Annual Maintenance Items: V,
Electric Voltage N/A N/A A.Added grease to pump bearings? Yes N /A
and Current N/A O ONO •
B.Shaft end play acceptable? OYes ON. /y.&
yq
Pump
C.Transmission coupling,right angle gear drive and mechanical V
Speed moving parts lubricated? OYes ONO @N/A
D.Circuit breakers passed trip test? OYes ONO ON/A O NIC
2.Annual Tests
E.Emergency manual starting means operated without power? OYes No @N/A
F.Electrical connections secure?
/A
Q Oves ON. v,
@N
Annual pump test was run using the following method:(check one) G.Pressure switch settings calibrated? Oyes ONO Method A.Discharge of flow through hose streams. @NIAH.Motor bearings greased? Ove. ONO aJ/A
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? OYes ONO @N/A 0 NIC
❑ Method C.Discharge through by-pass flow meter directly returned to J.Antifreeze changed in coolant system? Oyes ONo V'tq 0 NIC
pump suction.Flow readings taken by flow meter. K.Heater exchanger cleaned out? OYes ONO ON/A 0 NIC
combustion air acceptable?Note:At least Once every three years method A or B must be used. L.Duct work and louvers( ) P table?
OYes ONo •Od/A
A.Are the values in the above table acceptable? O Yes O No ON/A M.Exhaust system free of back pressure? OYes ONO SNIAN.Exhaust system hangers and supports acceptable? ves ONO
• /A
B.No-flow(chum)test run for 30 min? 9 Yes ONo ON/A 0.Control and power wiring tight? Oves ONo
•
C.Circulation relief valve and pressure relief valve operated propertyOtl/A
during all flow tests? Q Yes ONo ON/A Part III-Comments(any"No"answers,test failures or other problems found with the sprinkler
D.No alarm indicators or other visible abnormalities observed during system must be explained here.Also,note here any products noticed on the system that have been
no flow test? O 0 No ONIA the subject of a recall or a replacement program.)All items that need repaired or replaced are the owners
• Yes responsibility and are not included in the price or inspection.
E.Suction screens cleaned after flow? OYes ONo ON/A 0 NIC
F.Low SuctionThrottling Device Test VALVE TAMPER SEAL#
1.Low sucti n pressure simulated> 8Yes ONo 8N/A 0 NIC
Free from bnornalitiesinthrottling action? Yes ONo •N/A 0NIC PUMP INLET 0703792
2.Free from bnormalities in return to full flow? OYes ONo @N/A 0 NIC
G.Automatic transfer Switch Test BYPASS INLET 0703798
1.Power failure simulated during peak flow? OYes ONo ON/A0NIC PUMP OUTLET 0703796
Connection made to alternate power source? OYes ONo ON/A 0 NIC
2.After termination of simulated power failure,did motor reconnect BYPASS OUTLET 0703795
to the normal power source? OYes ONo ON/A 0 NIC
H.All alarm conditions simulated? OYes 0 N @N/A TEST HEADER 0703797
All alarms operated? OYes ONo O•N/A
C.Maintenance JOCKEY INLET 0703794
A maintenance schedule must be established in accordance with the manufacturer's instructions.In the JOCKEY OUTLET 0703799
absence of such a schedule,the following must be used:
1.Weekly Maintenance Items for Diesel Engine Systems:
A.Fuel tank level,tank float,switch and solenoid valve
operationacceptable? O Yes ONo O•N/A
B.Diesel fuel system free of water? O Yes ONo @N/A
C.Flexible hoses and connectors in fuel and coolant systems
acceptable? OYes ONo @N/A
D.Oil level and tube oil heater acceptable? O Yes ONo @N/A
E.Coolant level acceptable? O Yes ONo 0 N/A
F.Water pump for coolant system operating? OYes ONo @ N/A
G.Jacket water heater for coolant system acceptable? OYes ONo @N/A
H.Exhaust system free of leakage? OYes ONo ON/A NOTE:
I.Drain condensate trap on exhaust system operational? OYes
J.Electrolyt�level inbatteries acceptable? OYes ONo No O•N/A 1) DUE TO LOW SUCTION LEVEL UNABLE TO
necti
K.Conns to electric system acceptable? OYes ONo @N/A
2.Monthly Maintenance Items: TEST AT 150%
A.Isolation switch and circuit breaker exercised? OYes ONo @N/A
B.Battery�se clean,dry and free of corrosion and battery's specific
gravity orlstate of charge passed test? O Yes ONo ON/A
C.Charger and charge rate passed visual inspection and battery charge Part IV-Inspector's Information
being equalized? Yes No •N/A
O O O I state that the information on this form is correct at e a place d
D.Circuit br akers appear clean? O Yes ONo @N/A that all equipment tested at this time was left in eretion I diti upon letion of th
3.Quarterly Maintenance Item: inspection except as noted in Part III above.
A.Cleanedtrainer,filter or dirt leg in diesel fuel system? O Yes O No O•N/A 0 NIC
B.Cleaned tr ,replaced crank case breather in lubrications stem? Date: 17 DECEMBER 20'
NIC
C.Cleaned sy O Yes O No @N/A O tar strainer in coolant system? O Yes O No O•N/A 0 NIC
D.Insulation acceptable and fire hazards eliminated from exhaust Signature of Inspector:
system? Yes No •N/A
O Print Name: MICHAEL TAUVELL
E.Battery terminals clean and tight?
OYes ONo Oi N/A
F.Electrical system free of wire chafing? OYes 0 No ON/A License or Certification Number(if applicable): 11081600012008
Color of tag placed on system:
ORed
@Green
613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST.LUCIE,FL 34986 ����� TAMPA,FL 33619
772-878-3350-FAX:772-878-5967
WAYNEE 81 3-630-0303•FAX:81 3-630-0312
11326 DISTRIBUTION AVENUE WEST 4683 LAREDO AVENUE
JACKSONVILLE,FLORIDA 32256-2745 Automatic Fire Sprinklers, Inc.
904-268-3030-FAX:904-268-0724 FORT MYERS,FLORIDA 33905
222 CAPITOL CT. 239-433-3030-FAX:239-433-3263
4370 MOTORSPORT DRIVE OCOEE, FL 34761-3033 3121 NW 16TH TERRACE
CONCORD,NORTH CAROLINA 28027 407-656-3030-407-656-8026 POMPANO BEACH,FLORIDA 33064
704-782-3032-FAX:704-795-6838
954-917-3030-FAX:954-917-9424
NFPA-25 Inspection, Testing and Maintenance of Wet Pipe Fire Sprinkler Systems
Information on this form covers the minimum requirements of NFPA 25-2002 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: ONE OCEAN ISC#: J00101p
Re ort#: 1 OF 1
Owners Address: ONE OCEAN BOULEVARD ATLANTIC BEACH,FL.32233 Owner's Phone Number:
904-249-7402
Property Being Evaluated: ONE OCEAN
Property Address: ONE OCEAN BOULEVARD ATLANTIC BEACH,FL.32233
Date of Work: 19 AUGUST 2012 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 O Third Year O Fifth Year
Part I-Owner's Section
A.Is the building occupied? Oyes ONO 4.Annual Inspection Items(in addition to above items)
B.Has the occupancy classification and hazard of contents remained the same A.Proper number and type of spare sprinklers? @Yes ONO ON/A
since the last inspection? OYes ONO B.Visible sprinklers:
C.Are all fire rotection systems in service? OYes ONO 1.Free of corrosion and physical damage? @Yes ONO ON/A
D.Has the 91 stem remained in service without modification since the last inspection? OYes ONO 2.Free of obstructions to spray patterns? @Yes ONO ON/A
E. Was the system free of actuation of devices or alarms since the last Oyes O No 3.Free of foreign materials including paint? OYes ONo ON/A
inspection?
F.Weekly to s of inspections required by NFPAA25 on file? OYes ONO 4.Liquid in all glass bulb sprinklers? @Yes ONO ON/A
G.All deficiencies reported at last inspection corrected? OYes ONO C.Visible pipe:
H.I know the Vocation and understand the operation of all control valves. OYes ONO 1.In good condition/no external corrosion? @Yes ONO ON/A
J.I would liketo have a copy of NFPA#25 2.No mechanical damage and no leaks? s Yes No
py @ an extra charge of$50.00. OYes ONO 3.Properly aligned and no external loads? O O ON/A
K.Owner or rep.requests WAFS to release information from OYes ONo ON/A
inspections to the underwriters of my insurance company. OYes ONO D.Visible pipe hangers and seismic braces not damaged or loose? @Yes ONO ON/A
E.Hose,hose couplings and nozzles on sprinkler system passed
19 AUGUST Z inspection in accordance with NFPA 19629 ONIC OYes ONO @N/A
F.Adequate heat in areas with wet piping? @Yes ONO ON/A
Owner or representative(print name) Signature Date G.Has an internal inspection of the pipe been performed by removing
Part II-Inspector's Section
A.Inspections P Owner or Owner re not on site.
the flushing connection and one sprinkler near the end of a branch
1.Dally and Weekly Items line within the last 5 years? @NIC Oyes ONO ON/A
A.Control li valves supervised with seals in correct(open or closed) (If the answer was"No",conduct an internal inspection.)
5.Fifth Year Inspection Items(in addition to above Items)
position6 @Yes ONO ON/A A.Alarm valves and their associate strainers,filters and restriction
B.Backflow Preventers: orifices passed internal inspection? ONIC OYes ONO @N/A
1.Valvt►s in correct(open or closed)position? @Yes ONO ON/A B.Check valves internally inspected and all parts operate properly,move
2.Sealed,locked or supervised&accessible? O @ O ON/A Yes No Nt,�/A freely and are in good condition?
3.Relief port on RPZ device not discharging? Oyes ONo @N/A B.Testing ONIC OYes ONO @N/q
C.For freezer systems,is the gauge near the compressor reading the The following tests are to be performed at the noted intervals.Report any failures on Part III of this form.
same as the gauge near the dry-pipe valve? O ONO No @N/A 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 inspector's test connection or bypass connection with alarms actuating
and flow observed?
closed) sition? Yes No ��1r,,�I/q OYes ONO SN/A
O O ON/A B.Post indicating valves opened until spring or torsion is felt in the rod,
B.Spnnkl wrench with spare sprinklers? @ Yes No (:)NIA O O V' then closed back one-quarter tum? OYes ONO W/q
C.Gauges n wet-pipe system in good condition and showing normal C.Main drain test for system downstream of backflow or pressure reducing valve:
water SL pply pressure? Yes No 1.Record Static Pressure
@ O ON/A psi and Residual
D.Alarm Valves: Pressure psi
Gauges i how nornal supply water pressure,free from physical [ See comments-on page 2
damage,valves in correct(open or closed)position and no leakage 2.Was flow observed? OYes ONO SN/A
from ret ding chamber or drains? Oyes ONO @N/A 3.Are results comparable to previous test? Oyes ONO SN/A
3.Quarterly Inspection Items(in addition to above Items) 2.Semiannual Test(In addition to previous Items)
@ Yes No
A.Pressurt!Reducing Valve:In open position,not leaking,maintaining OYes ONO A.Valve supervisory switches indicate movement? O B.Electrical waterflow alarm devices passed tests by opening the O ON/A
downstream pressure per design criteria,and in good condition with @ Not installed inspector's test connection or bypass connection with alarms actuating
handwhgeis not broken? O Design criteria is not available and flow observed? @Yes ONO ON/A
B.Hydrauli nameplate(calculated systems)securely attached to riser 3.Annual Test(in addition to previous Items)
an( legi:,a? OYes ONo A.Main drain test:
C.Fire Department Connection: 1.Record Static Pressure 155 psi and Residual 140 psi
Visible,accessible,couplings and swivels not damaged and rotate Pressure
smoothly,,plugs or caps in place and undamaged,gaskets in place and r See comments-on page 2
2.Was flow observed? @Yes ONO ON/Ain good condition,identification sign(s)in place,check valve is not
leaking,clapper is in place and operating property and automatic drain 3.Are results comparable to previous test? @Ves ONO ON/A
valve in place and operating properly? @Yes ONO ON/A B.Are all sprinklers date 1920 or later? O Unable to determine.OQ Yes ONO
(If plugs or caps are not in place,inspect interior for obstructions.) C.Fast response sprinklers 20 or more years old replaced or successfully
D.Alarm d vices free from physical damage? @Yes ONO ON/A sample tested within last 10 years? @NIC OYes ONO
• Report#: 1 OF 1
Part III-Comments (any"No"answers, test failures or other problems found with the sprinkler
Wet Pipe Report page 2 system must be explained here. All items that need repaired or replaced are the owners
D.Standard response sprinklers 50 or more years old replaced or responsibility and are not included in the price of inspection,
successfully sample tested within last 10 years? @ NIC OYes ONo
E.Standard response sprinklers 75 or more years old replaced or
successfully sample tested within last 5 years? @NIC OYes ONo
F.Dry-type sprinkler replaced or successfully sample tested RISER TAMPER SEAL#
within last 10 years? ONIC Oyes ONo @N/A 8TH FLR 0703804
G.Specific gravity of antifreeze correct? @Yes ONo ON/A
H.All control valves operated through full range and returned to normal 7TH FLR 0703806
position? @Yes ONo ON/A
I.Backfiow devices passed backflow test? ONIC OYes @No ()NIA 6TH FLR 0703801
J.Backflow devices passed full flow test?OProvisions not provided. ONIC @ Yes ONo ON/A 5TH FLR 0703803
K.Pressure reducing valves passed partial
flow test? OProvisionsnot provided. ONIC OYes ONo @N/A
4.Test to be done every third year: 4TH FLR 0703805
Hose(more than 5 years old)connected to the system has been service tested in accordance with
NFPA 1962.Water discharged and water flow alarms operated? ONIC OYes ONo @N/A 3RD FLR 0703807
5.Test to be done every lith year
A.Sprinklers rated aboveHigh temperature tested? ONIC OYes ONo @N/A 2ND FLR 0703802
B.Gauges checked by calibrated gauge or replaced? OYes ONo 1 ST FLR 0548684
C.Pressure reducing valves passed full flow test? ONIC OYes ONo @N/q
C.Maintenance STANDPIPE B STAIRWELL TAMPER SEAL#0703808
1.Regular Maintenance hems
A.If sprinklers have been replaced,were they proper replacements? OYes O No STAIR A STANDPIPE OS&Y TAMPER SEAL#0703808
B.Used hose was cleaned,drained and dried before being placed back in @Cannot be determined.
service?Hose exposed to hazardous materials was disposed of or BACKFLOW CTRL VALVE TAMMPER SEAL#'S 0703750 0703749
decontaminated in an approved manner? OYes ONo @N/A DISCREPANCIES:
C.Systems normally filled with freshwater were drained and QCannot be determined.
refilled twice if raw water got into the system? OYes ONo 1)FIRE BACKFLOW FAILED ANNUAL INSPECTION
D.If any of the following were discovered,was an obstruction investigation Wannot be determined.
conducted? ONIC OYes ONo (DNIA 2)PACKING GLAND BUSTED ON STAIR B CTRL VALVE
Explain reasatr(s)and obstruction investigation finding in Part 111
1.Defective intake screen on pump with suction from open sources. 3)2.5"BRASS CAP MISSING 1 ST FLR STAIR B
2.Obstructive material discharged during water flow tests. 4)STAIR A STANDPIPE SIGN MISSING
3.Foreign rh1 atenals found in dry-pipe valves,check valves or pumps.
4.Foreign tetanal in water during drain test or plugging of inspectors test connection. 5) STANDPIPE OS&Y IN STAIR A REQUIRES REPACKING,LEAKING
5.Plugging lof pipe or sprinklers found during activation or alteration.
6.Failure to flush yard piping or surrounding public mains following new installation or repairs. 6)PAINTED HEADS FOUND IN ROOMS:222 223 225 228&302
7.Record of broken mains in the vicinity.
B.Abnormally frequent false-tripping of dry-pipe valves. Part IV-Observations: Not a part of the NFPA-25 inspection, the following items may need to
9.System i returned to service after an extended period out of service(greater than one year). be reviewed by a fire protection engineer.
10.There is reason to believe the system contains sodium silicate or its derivatives or highly
corrosive vluxes in copper pipe systems. DISCREPANCIES CONTIUNUED:
E.If conditions were found that required flushing,was flushing of system
conducted? ONIC Oyes ONo @N/A 7)HEAD IN ROOM 302 NOT PROPERLY ORIENTATED
2.Annual Maintenance Items(in addition to previous items)
A.Operating stem of all OS&V valves lubricated completely closed,and NOTE:DO TO OCCUPANCY DID NOT ACCESS THE FOLLOWING
reopened? @Yes ONo ()NIA
B.Sprinklers and spray nozzles protecting commercial cooking equipment
and ventilating systems replaced except for bulb-type which show no ROOMS:202 203 301 324 417 421 502 518 523 616 617 620 622
signs of grease buildup? Oyes ONo @N/q
624 625 626 700 702 703 719 721 800 802 803 822
3.Regular Maintenance hems
A.Alarm panel Gear? @Yes ONo ()N/A
B.System left in service? @Yes ONo ON/A
C.Is system impaired?(Impairment program put into place per NFPA-25 and
Wayne Automatic Fire Sprinklers protocols) Yes
O @NO Part IV-Inspector's Information
I state that the information on this forth is correct at the time and place of my inspection and that all
equipment tested at this time was left in operational condition upon completion of this inspection except
as noted in Part III above.
The scope of work preformed does not include a review of fire sprinkler or fire alarm system design.
Date: 19 AUGUS 201
Signature of Inspector:
Print Name: MICHAEL TAUVELL
License or Certification Number(if applicable): 11081600012008
Color of tag placed on system:
rjRed
',Green