Fire System Testing 2389 Mayport Road Best Western 2012 613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST.LUCIE,FL 34986 TAMPA,FL 33619
772.878-3350-FAX:772-878-5967 \V/%V�W�AYME
81 3-630-0303-FAX:81 3-630-0312
11326 DISTRIBUTION AVENUE WEST 4683 LAREDO AVENUE
JACKSONVILLE,FLORIDA 32256-2745 Au#ometic Fire Sprinklers, Inc, FORT MYERS,FLORIDA 33905
904-268-3030-FAX:904-268-0724 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: BEST WESTERN ISC#: J00261 Report#: 1 OF 1
Owner's Address: 2389 MAYPORT ROAD ATLANTIC BEACH,FL.32233 Owner's Phone Number: 904-435-3500
Property Being Evaluated: BEST WESTERN
Property Address: 2389 MAYPORT ROAD ATLANTIC BEACH,FL.32233
Date of Work: 28 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 Q Third Year 0 Fifth Year
Part I-Owner's Section
A.Is the building occupied? !�I *Yes 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? OYes ONO ON/A
since the last inspection? OYes ONO B.Visible sprinklers:
C.Are all fire protection systems in service? OYes ONO 1.Free of corrosion and physical damage? OYes ONO ON/A
D.Has the system remained in service without modification since the last inspection}? .Yes ONO 2.Free of obstructions to spray patterns? O-Yes ONO ON/A
E. Was the system free of actuation of devices or alarms since the last .yes ONO 3.Free of foreign materials including paint? OYes ONO ON/A
inspection?
F.Weekly logs of inspections required by NFPA#26 on file? ', OYes ONO 4 Liquid in all glass bulb sprinklers? O- Yes ONO (:)N/A
G.All deficiencies reported at last inspection corrected? OYes ONO C.Visible pipe:
1.In good condition/no external corrosion? O. Yes ONO ON/A
H.I know the location and understand the operation of all control valves. Oyes ONO 2.No mechanical damage and no leaks? OYes ONO O N/A
J.I would like to have a copy of NFPA#26 @ an extra charge of$50.00. OYes ONO 3.Properly aligned and no external loads? . Yes NoN/A
K.Owner or rep.requests WAFS to release information from D.Visible pipe hangers and seismic braces not damaged or loose? OYes ONO
g.N/A
inspections to the underwrite of my insura a company,. Oyes ONO
E.Hose,hose couplings and nozzles on sprinkler system passed
C.J.VLICKY 28 DECEMB i inspection in accordance with NFPA 19629 ONIC OYes ONO l
F.Adequate heat in areas with wet piping? OYes ONO ON/q
Owner or representative(print name) Signature Date G.Has an internal inspection of the pipe been performed by removing
Part II-Inspector's Section
Owner or Owner rep.not On site. the flushingconnection
last and one sprinkler near the end of a branch
A.Inspections (If the 5 y@
line within the
last ars? ONIC Oyes ONO ON/A
(
1.Daily and Weekly Itemswas No",conduct an internal inspection.)
A.Control valves supervised with seals in correct(open or closed) ',. 6.Fifth Year Inspection Items(in addition to above Items)
position? Ill ONO ON/A A.Alarm valves and their associate strainers,filters and restriction
B.Backflow Preventers: orifices passed internal inspection? ONIC OYes ONO E)N/A
1.Valves in correct(open or closed)position? O- �I es ONO ON/A B.Check valves internally inspected and all parts operate properly,move
2.Sealed,locked or supervised&accessible? O-Yes ONO ON/A freely and are in good condition? ONIC Oyes ONO ill
3.Relief port on RPZ device not discharging? Yes No N/A B.Testing
OO
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? Oyes ONO O.N/A
1.Quarterly Tests
A.Mechanical water flow alarm devices passed tests by opening the
2.Monthly Inspection Items(In addition to above items) inspector's test connection or bypass connection with alarms actuating
A.Control valves with locks or electrical supervision in correct(open or and flow observed? OYes ONO (E)NIA
closed)position? O- Yes ONO ON/A B.Post indicating valves opened until spring or torsion is felt in the rod,
B.Sprinkler wrench with spare sprinklers? ll ONO ON/A then closed back one-quarter turn? OYes ONO ill
C.Gauges on wet-pipe system in good condition and showing normal i C.Main drain test for system downstream of backflow or pressure reducing valve:
water supply pressure? Ores .ONO ON/A 1.Record Static Pressure psi and Residual psi
D.Alarm Valves: 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 ', 2.Was flow observed? OYes ONO (E)N/A
from retarding chamber or drains? Oyes ONO &/A 3.Are results comparable to previous test? OYes ONO O.N/A
3.Quart"Inspection Items(in addition to above items) 2.Semiannual Test(in addition to previous Items)
A.Pressure Reducing Valve:In open position,not leaking,maintaining Oyes ONO A.Valve supervisory switches indicate movement? OYes ONO ON/A. O B.Electrical waterflow alarm devices passed tests by opening the
downstream pressure per design criteria,and in good condition with O. Not installed inspector's test connection or bypass connection with alarms actuating
handwheels not broken? Oil Design criteria is not available and flow observed? OYes ONO ON/A
B.Hydraulic nameplate(calculated systems)securely attached to riser 3.Annual Test(in addition to previous items)
and legible? O-kes ONO A.Main drain test:
C.Fire Department Connection: 1.Record Static Pressure 40 psi and Residual 30 psi
Visible,accessible,couplings and swivels not damaged and rotate Pressure
(! See comments-on page 2
smoothly,plugs or caps in place and undamaged,gaskets in place and 2.Was flow observed? OYes ONO ON/A
in good condition,identification sign(s)in place,check valve is not Yes No /A
leaking,clapper is in place and operating property and automatic drain 3.Are results comparable to previous test? O- O Old
valve in place and operating properly? OYes ONO ON/A B.Are all sprinklers date 1920 or later? O Unable to determine.Oyes l
(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 devices free from physical damage? OIYes ONO ON/A sample tested within last 10 years? ONIC Oyes ONO
Repolt#: 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? Q. NIC OYes ONo
E.Standard response sprinklers 75 or more years old replaced or
successfully sample tested within last 5 years? (DNIIC Oyes ONo MAIN CTRL VALVE TAMPER SEAL#0703306
F.Dry-type sprinkler replaced or successfully sample tested
within last 10 years? ONIC OYes ONo Oi N/A FIRE BACKFLOW OS&Y TAMPER SEAL#'s 0703503 0703308
G.Specific gravity of antifreeze correct? OYes ONo ( N/A
H.All control valves operated through full range and returned to normal
position? O.Yos ONo ON/A
I.Backflow devices passed backflow test? ONIC OYes ONo ON/A
J.Backflow devices passed full flow test?(DProvisions not provided. ONIC O Yes ONo ()NIA
K.Pressure reducing valves passed partial
flow test? OProvisions not provided. ONIC O Yos ONo )N/A
4.Test to be done every third year:
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? ONICOY®s ONo .dl/A DISCREPANCIES:
6.Test to be done every 6th year
A.Sprinklers rated aboveHigh temperature tested? ONIC Oyes ONo O.N/A (1)FIRE BYPASS FAILED INSPECTION;SEE REPORT.
B.Gauges checked by calibrated gauge or replaced? Oyes ONo (2)GAUGE OUT OF DATE
C.Pressure reducing valves passed full flow test? ONIC OYbs ONo O.N/A
C.Maintenance (3)PAINTED HEAD IN RM 124 CLOSET/119 MAIN RM&CLOSET
1.Regular Maintenance Items
A.If sprinklers have been replaced,were they proper replacements? Oyes ONo HEAD IN LAUNDRY OVER TABLE
B.Used hose was cleaned,drained and dried before being placed back in Ocannot be determined.
service?Hose exposed to hazardous materials was disposed of or (4)BENT DEFLECTOR ON SPRINKLER HEAD IN 209 MAIN RM
decontaminated in an approved manner? Oyes ONo O.N/A
(5)PACKING LEAKING ON FIRE BACKFLOW
C.Systems normally filled with fresh water were drained and OCannot be determined.
refilled twice if raw water got into the system? 01,YIes O No NOTE:
r
D.If any of the following were discovered,was an obstruction investigation �Cpnnot be determined.
conducted? ONIC OYes ONo Q.N/A (1)NO ACCES TO FOLLOWING ROOM DUE TO CUSTOMER
Explain reason(s)and obstruction investigation finding in Part 111
1.Defective intake screen on pump with suction from open sources. OCCUPANCY:204
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 during 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 surrounding public mains following new installation or repairs.
7.Record of broken mains in the vicinity.
8.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 is 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.
E.If conditions were found that required flushing,was flushing of system ',
conducted? ONIC OYes ONo O.N/A
2.Annual Maintenance Items(in addition to previous Items)
A.Operating stem of all OS&Y valves lubricated completely closed,and
reopened? O.Yes ONo ON/A
B.Sprinklers and spray nozzles protecting commercial cooking equipment
and ventilating systems replaced except for bulb-type which show no
signs of grease buildup? Oyes ONo O.N/A
3.Regular Maintenance items
A.Alarm panel clear? O.Yes ONo ON/A
B.System left in service? O.Yes ONo ()N/A
C.Is system impaired?(Impairment program put into place per NFPA-25 and
Wayne Automatic Fire Sprinklers protocols) yes No
O � Part IV-Inspector's Information
I state that the information on this form 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: 28 DECEM R 2 1
Signature of Inspector:
Print Name: MICHAEL TAUVELL
License or Certification Number(if applicable): 11081600012008
Color of tag placed on system:
Red
r'Green
,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 \"V"'Wnm
YNE 81 3-630-0303•FAX:81 3-630-0312
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
222 CAPITOL CT.
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
Fire Alarm System Inspection and Testing Report
This testing was performed in accordance with applicable N.F.P.A.standards.
Owner. BEST WESTERN ISC# J00261 Date: 28 DECEMBER 2(
Owner's Address: 2389 MAYPORT ROAD ATLANTIC BEACH,FL.32233
Property Being Evaluated: BEST WESTERN
Property Address: 2389 MAYPORT ROAD ATLANTIC BEACH,FL.32233
Monitoring Entity
PanelManufacturer: NOTIFIER Model No. AFP 100
Name: NA
Circuit Styles: 4.0 B Y Amt 1(SLC)2(NAC)
Telephone: NA
Last gate System Had Service Performed: AUGUST 2012/LSDI
Account Ref.No. NA
Last[ate Software or Configuration was Revised: R1.0 B4
Service
Weekly AHJ DIRECTOR OF PUBLIC SAFETY
Monthly AHJ phone# 904-247-5864
Quarterly
C-Semi-Annually ' Digital
(i;-Annually ' R.F.
('-Other(Specify) Other Specify LOCAL ONLY
Inspected by(print) MICHAEL TAE Date: 28 DECEMBER 2012 Time: 09:00:00
Signature of Alarm Agent: (Agent Meets Requirements Per Florida Statute 489.518)
Name of Owner or representativ C.J. Y
Signature Date: 28 DECEMBER 2012
I would like to have a co of NFPA#72 Owner or Owner rep.not on site.
copy (81 an extra charge of$50.00. OYes O No
Owner or rep.requests WAFS to release information from
inspections to the underwriters of my insurance company. OYes ONo
System restored to normal operation:Time:
Notifications are made Yes No Who Time
Monitoring Entity r r OPR:MARIANNA 0915
Building Occupants r r
Building Management r'! C.J.VLICKY 0900
F
Other(Specify) r I-
1.
I. ALARM NOTIFICATION APPLIANCES TEST AND INSPECTION
Device - Circuit Style/Quantity Operational Test Approved Location Pass - Fail
Bells Quantity( 1 ) Size(6" ) Type(1$OVAC ) r r' r I—i
Horns A( ) B( ) r' r r,
Speakers A( ) B( ) r' F_ (-
Chimes A( ) B( ) rl, I! I—' r
Strobes A( ) B(6 ) r' r' r r'
Other:(Specify) A( ) B(12 ) [7 r': r' r—
HORN/STROBES No.of Alarm indicating circuits: 2 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(4 ) 17 r, r
Ion Detectors A( ) B( ) F �- rr
Photo Detectors A( ) B(8 ) 1X_ - r, F
Duct Detectors A( ) B( ) F F, r r
Heat Detectors A( ) B(3 ) FX_ FX_, F'
Waterflow Detectors A( ) B(1 ) r r, r, r
Supervisory Switches A( ) B(1 ) r, r r F,
Pressure Switches A( ) B( ) F, f—; r rr—
Low Air A( ) B( ) �; r F
Other(Specify): A( ) B(3 ) CX' F r'I r
RELAY MODS
III. SUPERVISORY SIGNAL INITIATING DEVICES&CIRCUIT INFORMATION
Site Water Temp. C,Yes (`>No t i N/A
Site Water Level (,Yes r No r N/A
Fire Pump Power (`Yes No ( ;N/A
Fire Pump Running ("Yes C'� o (i N/A
Fire Pump Auto Position (`Yes (�J�to (i N/A
Fire Pump or Pump Control Trouble Yes (`No N/A
Generator In Auto Position ( ;Yes (7No (%N/A
Generator or Controller Trouble (`Yes No r-N/A
Switch Transfer (7;Yes (' No re N/A
Generator Engine Running (`:Yes (7 No (i:N/A
Lock Box (7Yes (`No (e-N/A
A.SIGNALING LINE CIRCUITS
Quantity and style(See NFPA 72,Table 3-6)of signaling line circuits connected to system
Quantity 1 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#): NEXT TO FACP/PANEL HB
Disconnecting Means Location: CKT 30
B.Secondary(Standby): 24VDC(INSTALLED DECEMBER 2009)
Storage Battery:Amp-Hr.Rating 8Ah
Calculated capacity to operate system,in hours,: fX— 24 r' 60
NA Engine driven generator dedicated to fire alarm system:
C.Location of Fuel Storage: NA
D.TYPE BATTERY SECONDARY POWER
r Dry Cell Type Visual Functional
Nickel Cadmium Battery Condition 17
P'! Sealed Lead-Acid Load Voltage r'
r Other(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&INSPECTIONS
A.Type Visual Functional D.Notification Appliances - Visual - Functional
Control Panel r, r, Audible r r',
Interface Equipment r Fx– Visual r Fx
L.E.D.s/Lamps rr Speakers r r
Fuses/MicroBreakers r r Voice Clarity r' r
Primary Power Supply r' [x—
Trouble Signals r' r''.
Disconnect Switches r: r'
Ground Fault Monitoring r' r', j E.ON/OFF Premises Monitoring
Yes No N/A
B.Emergency Communication Equipment Alarm Signal (` C
Type Visual Functional N/A
Alarm Restoral �, (`_ (`
Phone Set r r
Trouble Signal (`:,
Phone Jacks r r r
Off Hook Indicators r r Trouble Restoral {� (`; (`.
Amplifier(s) F r r Supervisory Signal C (`: (`
Tone Generator(s) r, Supervisory Restoral
Call In Signal r", r r, Remote Anuciator
System Performance r' r r'
C.Interface Equipment DEVICE SIMULATED
(SPECIFY) VISUAL OPERATION OPERATION
ELEV RECALL rl r F-
F
r r r.
r r r.
Special Hazard System(Specify)
F- F-
17, r r
F7 r r
VI.COMMENTS:
(1)BATT LOAD LEFT. 12.88VDC 6.OAh RIGHT.12.88VgC 6.2Ah
(2)PANEL WILL NOT SILENCE TROUBLES;BRIELYACKNOWLEDGES BEFORE AUDIBLE TROUBLE CHIME REACITIVATES
(3)DID NOT GAIN ACCESS TO ELEVATOR SHAFT OR"PIT TO TEST DETECTION
VII.DEFICIENCIES: These items are the owner's responsibility to be repaired and will be quoted separate from inspection cost.
(1)FIRE ALARM HAS DIALER INSTALLED TO MONITOR SYSTEM BUT,DIALER IS POWERED DOWN AT THIS TIME
&PHONE LINES HAVE NOT BEEN HOOKED UP.FOUND DIAL TONE FROM PHONE JACK 1 BUT UNABLE TO SUCCESSFULLY
DIAL OUT.WHILE TRYING TO DIAL OUT REPEATEDLY REACHED THE BEST WESTERN BUT NO OTHER CONNECTIONS
WERE MADE.DID NOT FIND DIAL TONE ON PHONE,JACK LABELLED 2. UNITED MONITORING HAS THE ACCOUNT AS
BEING"INACTIVE"DUE TO ACCOUNT NOT PROPERLY FINISHED BEING SET UP.THE LAST SIGNALS RECEIVED
WERE FROM OCTOBER 24TH.CUSTOMER REPORTS THAT TECHNICIAN POWERED DOWN DIALER,REMOVED CKTS,ETC.&
SAID THAT THEY HAD A PHONE LINE ISSUE.CUSTOMER DID REPORT DIALER REPEATEDLY GOING INTO TROUBLE AS WELL
AS THEIR FAX LINE HAVING TROUBLE
613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST.LUCIE,FL 34986 / TAMPA,FL 33619
772-878-3350•FAX:772-878-5967rr 81 3-630-0303•FAX:81 3-630-0312
11326 DISTRIBUTION AVENUE WEST AYN� 4683 LAREDO AVENUE
JACKSONVILLE,FLORIDA 32256-2745 Automatic Fire Sprinklers Inc., FORT MYERS,FLORIDA 33905
904-268-3030-FAX:904-268-0724
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 2$-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: BEST WESTERN ISC#: J00261 Report#:
1 OF 1
Owner's Address: 2389 MAYPORT ROAD ATLANTIC BEACH,FL.32233 Owner's Phone Number: 904-435-3500
Property Being Evaluated: BEST WESTERN
Property Address: 2389 MAYPORT ROAD ATLANTIC BEACH, FL.32233
Date of Work: 28 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 @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? OYes ONO ON/A
since the last inspection? *Yes ONO B.Visible sprinklers:
C.Are all fire protection systems in service? *Yes ONO 1.Free of corrosion and physical damage? OYes ONO ON/A
D.Has the system remained in service without modification since the last inspection? *Yes ONO 2.Free of obstructions to spray patterns? OYes ONO ON/A
E. Was the system free of actuation of devices or alarms since the last .yes ONO 3.Free of foreign materials including paint? OYes (j)No ON/A
inspection?
F.Weekly logs of inspections required by NFPA#26 on file? OYes .No 4.Liquid in all glass bulb sprinklers? OYes ONO ON/A
G.All deficiencies reported at last inspection corrected? eYes ONO C.Visible pipe:
H I know the location1.In good condition/no external corrosion? O• Yes ONO (:)N/A
and understand the operation of all control valves. Yes ONO 2 No mechanical damage and no leaks? • Yes No
J.I would like to have a copy of NFPA#26 @ an extra charge of$50.00. OYes ONO O O O N/A
3.Properly aligned and no external loads?
K.Owner or rep.requests WAFS to release information from (. Yes ONO ON/A
Inspections to the underwrite of my insura a company, OYes ®No D.Visible pipe hangers and seismic braces not damaged or loose? VXYes ONO O.N/A
E.Hose,hose couplings and nozzles on sprinkler system passed
C.J.VLICKY 28 DECEMB r�i inspection in accordance with NFPA 1962? ONIC OYes ONO •Op//A
F.Adequate heat in areas with wet piping? (j)Yes O No �,1/A
Owner or representative(print name) Signature Date G.Has an internal inspection of the pipe been performed by removing V
Part II-Inspector's Section r',Owner or Owner rep,not on site. the flushing connection and one sprinkler near the end of a branch
A.Inspections
1.Dally and Weekly Items
line within the last 5 years? ONIC OYes ONO ON/A
(If the answer was"No",conduct an internal inspection.)
A.Control valves supervised with seals in correct(open or closed) 5.Fifth Year Inspection Items(in addition to above items)
position? O•Yes ONO ON/A A.Alarm valves and their associate strainers,filters and restriction
B.Backflow Preventers: orifices passed internal inspection? ONIC Oyes ONO (E)N/A
1.Valves in correct(open or closed)position? OYes ONO ON/A B.Check valves internally inspected and all parts operate properly,move
2.Sealed,locked or supervised&accessible? OYes ONO ON/A freely and are in good condition? ONIC Oyes ONO ON/A
3.Relief port on RPZ device not discharging? Oyes ONo ON/A B.Testing
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? Owes ONO ON/A
1.Quarterly Tests
A.Mechanical water flow alarm devices passed tests by opening the
2.Monthly inspection kerns tin addition above Items) inspector's test connection or bypass connection with alarms actuating
A.Control valves with locks or electrical supervision in correct(open or and flow observed? �
OYes ONO V,�'/A
closed)position? OYes ONO ON/A B.Post indicating valves opened until spring or torsion is felt in the rod,
B.Sprinkler wrench with spare sprinklers? O• Yes ONO (:)N/A/A
V" then closed back one-quarter turn? OYes ONO (DN/A
C.Gauges on wet-pipe system in good condition and showing normal C.Main drain test for system downstream of backflow or pressure reducing valve:
water supply pressure? Oyes •ONo ON/A 1.Record Static Pressure psi and Residual
D.Alarm Valves: Pressure psi
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 2.Was flow observed? Oyes ONO (2)NIA
from retarding chamber or drains? Oyes ONO ON/A 3.Are results comparable to previous test? OYes ONO (E)N/A
3.Quarterly Inspection Items(in addition to above items) 2.Semiannual Test(in addition to previous items)
A.Valve supervisory switches indicate movement?
A.Pressure ReducingValve:In open position,not leaking,maintaining Yes No (E)Yes No /A
P P 9. 9 O O B.Electrical waterflow alarm devices passed tests by opening the O O ON
/A
pressure per design criteria,and in good condition with O Not installed inspector's test connection or bypass connection with alarms actuating
handwheels not broken? O Design criteria is not available and flow observed? •OYes ONO ON/A
B.Hydraulic nameplate(calculated systems)securely attached to riser 3.Annual Test(in addition to previous items)
and legible? G)Yes ONO A.Main drain test
C.Fire Department Connection: 1.Record Static Pressure 40 psi and Residual 30 psi
Pressure
Visible,accessible,couplings and swivels not damaged and rotate (� See comments-on page 2
smoothly,plugs or caps in place and undamaged,gaskets in place and 2.Was flow observed? O'Yes ONO ON/q
in good condition,identification sign(s)in place,check valve is not
leaking,clapper is in place and operating properly and automatic drain 3.Are results comparable to previous test? OYes ONO ON/A
valve in place and operating property? OYes ONO ON/A B.Are all sprinklers date 1920 or later? O unable to determine.Oyes 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 devices free from physical damage? Oyes ONO ON/A sample tested within last 10 years? O' NIC Oyes ONO
Report#: 1 OF 1
Part III-Comments(any No"answers, test failures or other problems Pound 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 ofinspection.
successfully sample tested within last 10 years? (2)NIC OYes ONo
E.Standard response sprinklers 75 or more years old replaced or
successfully sample tested within last 5 years? (' NIC OYes ONo MAIN CTRL VALVE TAMPER SEAL#0703306
F.Dry-type sprinkler replaced or successfully sample tested
within last 10 years? ONIC Oyes ONo Q.N/A FIRE BACKFLOW OS&Y TAMPER SEAL#'s 0703503 0703308
G.Specific gravity of antifreeze correct? OYes ONo C)/A
H.All control valves operated through full range and returned to normal
position? O. Yes ONo ON/A
I.Backflow devices passed backflow test? ONIC OYes ONo ON/A
J Backflow devices passed full flow test?QProvisions not provided. ONIC O Yes ONo ON/A
K.Pressure reducing valves passed partial
flow test? OProvisions not provided. ONIC QYes ONo ON/A
4.Test to be done every third year:
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 (Yes ONo ON/A DISCREPANCIES:
b.Test to be done every 5th year
A.Sprinklers rated aboveHigh temperature tested? ONIC Oyes ONo (2)NIA (1)FIRE BYPASS FAILED INSPECTION;SEE REPORT.
B.Gauges checked by calibrated gauge or replaced? OYes ONo (2)GAUGE OUT OF DATE
C.Pressure reducing valves passed full flow test? ONIC Oyes ONo ON/A
C.Maintenance (3)PAINTED HEAD IN RM 124 CLOSET/119 MAIN RM&CLOSET
1.Regular Maintenance Items
A.If sprinklers have been replaced,were they proper replacements? /(Yes 0N HEAD IN LAUNDRY OVER TABLE
B.Used hose was cleaned,drained and dried before being placed back in Ocannot be determined.
service?Hose exposed to hazardous materials was disposed of or (4)BENT DEFLECTOR ON SPRINKLER HEAD IN 209 MAIN RM
decontaminated in an approved manneR Oyes ONo ( N/A (5)PACKING LEAKING ON FIRE BACKFLOW
C.Systems normally filled with fresh water were drained and (Cannot be determined.
refilled twice if raw water got into the system? �O�Y es ONo NOTE:
D.If any of the following were discovered,was an obstruction investigation Ocannot be determined.
conducted? (NIC (Yes ONo (j)N/A (1)NO ACCES TO FOLLOWING ROOM DUE TO CUSTOMER
Explain reason(s)and obstruction investigation finding in Part 111
1.Defective intake screen on pump with suction from open sources. OCCUPANCY:204
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 during 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 surrounding public mains following new installation or repairs.
7.Record of broken mains in the vicinity.
8.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 is 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.
E.If conditions were found that required flushing,was flushing of system
conducted? ONIC QYes ONo .Old/A
2.Annual Maintenance Items(in addition to previous Items)
A.Operating stem of all OS&Y valves lubricated completely closed,and
reopened? QYes ONo ON/q
B.Sprinklers and spray nozzles protecting commercial cooking equipment
and ventilating systems replaced except for bulb-type which show no
signs of grease buildup? Oyes ONo O.N/A
3.Regular Maintenance Items
A.Alarm panel clear? O.Yes ONo ()N/A
B.System left in service? O.Yes ONo ()N/A
C.Is system impaired?(Impairment program put into place per NFPA-25 and
Wayne Automatic Fire Sprinklers protocols) Oyes ONo Part IV -Inspector's Information
',. I state that the information on this form 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 II I above.
The scope of work preformed does not include a review of fire sprinkler or fire alarm system design.
Date: 28 DECEM R 2 1
Signature of Inspector:
Print Name: MICHAEL TAUVELL
License or Certification Number(if applicable): 11081600012008
Color of tag placed on system:
I^Red
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 \"A/"W�AYME 81 3-630-0303-FAX:813-630-0312
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 222 CAPITOL CT. 239-433-3030-FAX:239-433-3263
4370 MOTORSPORT DRIVE OCOEEFL 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
Fire Alarm System Inspection and Testing Report
This testing was performed in accordance with applicable N.F.P.A.standards.
Owner: BEST WESTERN ISC# J00261 Date: 28 DECEMBER 2(
Owner's Address: 2389 MAYPORT ROAD ATLANTIC OEACH,FL.32233
Property Being Evaluated: BEST WESTERN
Property Address: 2389 MAYPORT ROAD ATLANTIC BEACH,FL.32233
Monitoring Entity
Panel Manufacturer: NOTIFIER Model No. AFP 100
Name: NA
Telephone: NA Circuit Styles: 4.0 BY Amt 1(SLC)2(NAC)
Last Date System Had Service Performed: AUGUST 2012/LSDI
Account Ref.No. NA
Last Date Software or Configuration was Revised: R1.0 B4
Service
Weekly AHJ DIRECTOR OF PUBLIC SAFETY
�-
MonthlyAHJ phone# 904-247-5864
-Quarterly
(` Semi-Annually -Digital
-Annually `' R.F.
(�-Other(Specify)
r -Other Specify LOCAL ONLY
Inspected by(print) MICHAEL TAE Date: 28 DECEMBER 2012 Time: 09:00:00
Signature of Alarm Agent: (Agent Meets Requirements Per Florida Statute 489.518)
Name of Owner or representativ C.J.'V&eKY
Signature Date: 28 DECEMBER 2012 [—,Owner or Owner rep.not on site.
I would like to have a copy of NFPA#72(d 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:
Notifications are made Yes No Who Time
Monitoring Entity r' �'; OPR:MARIANNA 0915
Building Occupants
Building Management r' r C.J.VLICKY 0900
Other(Specify) r
1. ALARM NOTIFICATION APPLIANCES TEST AND INSPECTION
Device - Circuit Style/Quantity : - Operational Test - Approved Location Pass - Fail
Bells Quantity( 1 ) Size(6" ) Type(120VAC ) rr', r r
Horns A( ) B( ) r', F r r—
Speakers A( ) B( ) F r' F r
Chimes A( ) B( ) F_ 17 F (�
Strobes A( ) B(6 ) rl r' 17 r'.
Other:(Specify) A( ) B(12 ) 17 r, r' F'
HORN/STROBES No.of Alarm indicating circuits: 2 Are Circuits supervised? ;Yes (-No
Page 2
It.INITIATING AND SUPERVISORY DEVICE TEST AND INSPECTION
Device - Circuit Style/Quantity - Operational Test Simulated Test Pass - Fail
Manual Stations A( ) B(4 ) r, r 17 F
Ion Detectors A( ) B( ) F r F r
Photo Detectors A( ) B(8 ) r r r r
Duct Detectors A( ) B( ) r F r r
Heat Detectors A( ) B(3 )
r F r
Waterflow Detectors A( ) B(1 ) r, r r,
Supervisory Switches A( ) B(1 ) r; r' r' r,
Pressure Switches A( ) B( ) �— r, r r
Low Air A( ) B , F" F.
Other(Specify): A( ) B(3 ) r r �'
RELAY MODS
111. SUPERVISORY SIGNAL INITIATING DEVICES&CIRCUIT INFORMATION
Site Water Temp. (~Yes (`No (Z N/A
Site Water Level C Yes r^No (Z N/A
Fire Pump Power (`.Yes r No (i;N/A
Fire Pump Running (`Yes (`No (i N/A
Fire Pump Auto Position (^;Yes No Co N/A
Fire Pump or Pump Control Trouble ( Yes (`No 4 N/A
Generator In Auto Position (`Yes r No (i:N/A
Generator or Controller Trouble Yes (`No (i N/A
Switch Transfer (`;Yes ( No N/A
Generator Engine Running t' Yes No (%aN/A
Lock Box (`Yes (">No (i N/A
A.SIGNALING LINE CIRCUITS
Quantity and style(See NFPA 72,Table 3-6)of signaling line circuits connected to system
Quantity 1 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#): NEXT TO FACP/PANEL HB
Disconnecting Means Location: CKT 30
B.Secondary(Standby): 24VDC(INSTALLED DECEMBER 2009)
Storage Battery:Amp-Hr.Rating 8Ah
Calculated capacity to operate system,in hoursF r 24 (—', 60
NA Engine driven generator dedicated to fire alarm system:
C.Location of Fuel Storage: NA
D.TYPE BATTERY SECONDARY POWER
I— Dry Cell Type Visual Functional
F Nickel Cadmium Battery Condition r'' r'.
rX; Sealed Lead-Acid Load Voltage r
Other(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&INSPECTIONS
A.Type Visual Functional D.Notification Appliances - Visual Functional
Control Panel r! r Audible
Interface Equipment r r Visual F7 rx-
r r,
L.E.D.s/Lamps r r Speakers 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 rr E.ON/OFF Premises Monitoring
A
N
Yes No No /
B.Emergency Communication Equipment Alarm Signal (^, I
Type Visual Functional N/A
Phone Set r r' Alarm Restoral t:;' (`, r'
Signal Si
Phone Jacks �"", � r. Trouble g t!' � r`
Trouble Restoral
Off Hook Indicators r' r r; (^ r,,
Amplifier(s) r r' r Supervisory Signal
Tone Generator(s) Supervisory Restoral
F r r
Call In Signal r r r, Remote Anuciator re
System Performance r! r r,
C.Interface Equipment DEVICE SIMULATED
(SPECIFY) VISUAL OPERATION OPERATION
ELEV RECALL r', r' r
F r
Special Hazard System(Specify)
r r r
r F
r r r
VI.COMMENTS:
(1)BATT LOAD LEFT: 12.88VDC 6.OAh RIGHT:12.88VDC 6.2Ah
(2)PANEL WILL NOT SILENCE TROUBLES;BRIELY ACKNOWLEDGES BEFORE AUDIBLE TROUBLE CHIME REACITIVATES
(3)DID NOT GAIN ACCESS TO ELEVATOR SHAFT OR PIT TO TEST DETECTION
VII.DEFICIENCIES: These items are the owner's responsibility to be repaired and will be quoted separate from inspection cost.
(1)FIRE ALARM HAS DIALER INSTALLED TO MONITOR SYSTEM BUT, DIALER IS POWERED DOWN AT THIS TIME
&PHONE LINES HAVE NOT BEEN HOOKED UP.FOUD DIAL TONE FROM PHONE JACK 1 BUT UNABLE TO SUCCESSFULLY
DIAL OUT.WHILE TRYING TO DIAL OUT REPEATEDLY!::REACHED THE BEST WESTERN BUT NO OTHER CONNECTIONS
WERE MADE,DID NOT FIND DIAL TONE ON PHONE JACK LABELLED 2.UNITED MONITORING HAS THE ACCOUNT AS
BEING'INACTIVE"DUE TO ACCOUNT NOT PROPERLY FINISHED BEING SET UP.THE LAST SIGNALS RECEIVED
WERE FROM OCTOBER 24TH.CUSTOMER REPORTS'THAT TECHNICIAN POWERED DOWN DIALER,REMOVED CKTS,ETC.&
SAID THAT THEY HAD A PHONE LINE ISSUE.CUSTOMER DID REPORT DIALER REPEATEDLY GOING INTO TROUBLE AS WELL
AS THEIR FAX LINE HAVING TROUBLE