Testing fire sprinklers 2014 613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST.LUCIE,FL 34986 TAMPA,FL 33619
772-878-3350•FAX: 772-878-5967 \VVVOW�AYME D� 3-630-0303•FAX:81 3-630-0312
11326 DISTRIBUTION AVENUE WEST
LAREFL AVENUE
JACKSONVILLE,FLORIDA 32256-2745
Automatic Fire Sprinklers, Inc F TTTT�IY FLORIDA 33905
904-268-3030-FAX: 904-268-0724 222 CAPITOL CT. 2A9-433- 0 39-433-3263
4370 MOTORSPORT DRIVE OCOEE, FL 34761-3033 ey �3Jl�W 1 ERRACE
CONCORD,NORTH CAROLINA 28027 407-656-3030 -407-656-8026 MPANO B FLORIDA 33064
704-782-3032-FAX: 704-795-6838 954-917-30 AX:954-917-9424
NFPA-25 Inspection, Testing and Maintenance of Wet Pipe Fire S i ler Sy terns
Information on this form covers the minimum requirements of NFPA 25-2002 for fire sprinkler systems connected to distribution systems witho plemental 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#: J00101 Report#: 1 OF 2
Owner's 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: 03/13/2014 All responses refer to the current work(inspection.testing and maintenance)performed on this date.
This work is(check one). O Monthly Qi Quarterly O 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 Qrd/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 (g)N/A
D.Has the system remained in service without modification since the last inspection? OYes ONO 2.Free of obstructions to spray patterns? OYes ONO @N/A
E. Was the system free of actuation of devices or alarms since the last OYes ONO 3.Free of foreign materials including paint? OYes ON. @NIA
inspection? O 4.Liquid in all glass bulb sprinklers? OYes ONO @N/A
O
F.Weekly logs of inspections required by NFPA#25 on file? Yes No
G.All deficiencies reported at last inspection corrected? .
ONO C.Visible pipe.
1.In good condition/no external corrosion? OYes ONO @N/q
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#25 @ an extra charge of$50.00. Oyes ONO 3.Properly aligned
K.Owner or rep.requests WAFS to release information from p y and no external loads? Oyes ONO @wA
D.Visible pipe hangers and seismic braces not damaged or loose? OYes ONO QN/A
inspections to the underwriters of my insurance company. Oyes ONO
E.Hose.hose couplings and nozzles on sprinkler system passed
03/13/2014 inspection in accordance with NFPA 1962? ONIC OYes ONO ON/A
F.Adequate heat in areas with wet piping? OYes 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
'n Owner or Owner rep.not on site. the flushing connection and one sprinkler near the end of a branch
A.Inspections
line within the last 5 years? ONIC OYes ONO @N/q
1.Daily and Weekly Items (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? @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.Valves in correct(open or closed)position? @Yes ONO ON/A B.Check valves internally inspected and all parts operate propedy,move
2.Sealed.locked or supervised&accessible? @Yes ONO ON/A freely and are in good condition? ONIC OYes ONO &/A
3.Relief port on RPZ device not discharging? B.Testing
C.For freezer systems,is the gauge near the compressor reading the Yes No
O @WA 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 @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? Yes No
closed)position? O @ �-/
Yes No /-NIA O O ON/A
O B.Post indicating valves opened until spring or torsion is felt in the rod,
B.Sprinkler wrench with spare sprinklers? @Yes ONO ON/A then closed back one-quarter turn? Oyes ONO @N/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? @Yes ONO ON/A 1.Record Static Pressure 155 psi and Residual 140 psi
D.Alarm Valves: Pressure
Gauges show normal supply water pressure,free from physical r See comments-on page 2
damage,valves in correct(open or closed)position and no leakage 2.Was flow observed? @Yes ONO ON/A
from retarding chamber or drains? OYes ONO @N/A 3.Are results comparable to previous test? @Yes ONO ON/A
2.Semiannual Test(in addition to previous items)
3.Quarterly Inspection Items(in addition to above items) A.Valve supervisory switches indicate movement? OYes ONO @N/A
A.Pressure Reducing Valve.In open position,not leaking,maintaining OYes ONO
B.Electrical waterflow,alarm devices passed tests by opening the
downstream pressure per design cntena,and in good condition with @ Not installed inspector's test connection or bypass connection with alarms actuating ,�
handwheels not broken? O Design cntena is not available and flow observed? OYes ONO &/A
B.Hydraulic nameplate(calculated systems)securely attached to riser 3.Annual Test(in addition to previous items)
and legible? OYes @No A.Main drain test.
C.Fire Department Connection. 1.Record Static Pressure psi and Residual psi
Pressure
Visible,accessible,couplings and swivels not damaged and rotate r"', See comments-on page 2
smoothly plugs or caps in place and undamaged,gaskets in place and 2.Was flow observed? OYes ONO @N/A
in good condition,identification signs)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 @N/A
valve in place and operating properly? @Yes ONO ON/A B.Are all sprinklers date 1920 or later? O Unable to determine.Oi Yes ONO
(If plugs or caps are not to place,inspect interior for obstructions.) C.Fast response sprinklers 20 or more years old replaced or successfully
D.Alarm devices free from physical damage? @Yes ONO ON/A sample tested within last 10 years? @NIC Oyes ONO
Report#: 1 OF 2
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
responsibility and are not included in the price of inspection.
D.Standard response sprinklers 50 or more years old replaced or
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 5years? @NICOYes ONO RISER TAMPER SEAL#
F.Dry-type sprinkler replaced or successfully sample tested
within last 10 years? ONIC Oyes ONO @N/A 8TH FLR 0760930
G.Specific gravity of antifreeze correct? OYes ONO @N/A
H.All control valves operated through full range and returned to normal 7TH FLR 0760929
position? OYes ONO @N/A
I.Backflow devices passed backflow test? ONIC Oyes ONO @N/q 6TH FLR 0760928
J.Backflow,devices passed full flow test?OProvisions not provided. ONIC OYes ONO @N/A 5TH FLR 0760927
K.Pressure reducing valves passed partial
flow test? OProvisions not provided. ONIC O Yes ONO @N/A 4TH FLR 0760926
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 OYes ONO @N/A 3RD FLR 0760925
5.Test to be done every 5th year
A.Sprinklers rated aboveHigh temperature tested? ONIC OYes ONO @N/q 2ND FLR 0760924
B.Gauges checked by calibrated gauge or replaced? OYes ONO 1 ST FLR 0760923
C.Pressure reducing valves passed full flow test? ONIC OYes ONO @N/A
C.Maintenance LL FLR 0760922 0760921
1.Regular Maintenance items
A.If sprinklers have been replaced,were they proper replacements? OYes ONO STANDPIPE B STAIRWELL TAMPER SEAL#0760859 @C
B.Used hose was cleaned,drained and dried before being placed back in annot be determined.
STAIR A STANDPIPE OS8rY TAMPER SEAL#0703808
service?Hose exposed to hazardous materials was disposed of or
decontaminated in an approved manner? OYes ONo @WA BACKFLOW CTRL VALVE TAMMPER SEAL#'S 0760945 0760942
C.Systems normally filled with fresh water were drained and OCannot be determined.
refilled twice if raw water got into the system? OYes ONo 2"ANTI FREEZE RISER#0760937
D.If any of the following were discovered,was an obstruction investigation @Cannot be determined.
conducted? ONIC OYes ONO @N/A 1.5"ANTI FREEZE RISER#0760940
Explain reason(s)and obstruction investigation finding in Part III
1.Defective intake screen on pump with suction from open sources. 9TH FLR CTRL VALVE#0760946
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. SEE ANNUAL REPORT FOR DEFICIENCIES.
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 Auxes in copper pipe systems.
E.If conditions were found that required flushing,was flushing of system
conducted? ONIC OYes ONO @N/A
2.Annual Maintenance Items(in addition to previous Items)
A.Operating stem of all OSBY valves lubricated completely closed,and
reopened? OYes ONo @N/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 @NIA
3.Regular Maintenance Items
A.Alarm panel clean @Yes ONO ON/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) 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 III above.
The scope of work preformed does not include a review of fire sprinkler or fire alarm system design.
Date: 03/13/2014
Signature of Inspector:
Print Name: MICHA ELL ZD
License or Certification Number(if applicable): 11081600012008
Color of tag placed on system:
rx Red
FGreen
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
11326 DISTRIBUTION AVENUE WEST \"NAWAYMIE 4683 LAREDO AVENUE
JACKSONVILLE, FLORIDA 32256-2745 Automatic Fire 'Sprinklers, In v �F YERS,FLORIDA 33905
904-268-3030-FAX:904-268-0724
222 CAPITOL CT. /j�� 2 --- FAX: 239-433-3263
4370 MOTORSPORT DRIVE OCOEE, FL 34761-3033 eY �26' 312 TERRACE
CONCORD,NORTH CAROLINA 28027 407-656-3030 -407-656-8026 \ POM#/�NO B FLORIDA 33064
704-782-3032-FAX:704-795-6838
954-947-3 AX:954-917-9424
NFPA-25 Inspection, Testing and Maintenance of Wet Pipe Fire Sprinkler tems
Information on this form covers the minimum requirements of NFPA 25-2002 for fire sprinkler systems connected to distribution systerrLswithout pplemental tanks or fire pumps.
Separate forms are available to inspect, test and maintain fire pumps,water tanks and other fire protection systems. More frequent in io ,testing and maintenance may be
necessary depending on the conditions of the occupancy and the water supply.
Owner BEST WESTERN MAYPORT INN &SUITES 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 MAYPORT INN&SUITES
Property Address: 2389 MAYPORT ROAD ATLANTIC BEACH, FL.32233
Date of Work: 03/04/2014 All responses refer to the current work(inspection,testing and maintenance)performed on this date.
This work is(check one): O Monthly Q Quarterly O 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 @IJ/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? OYes 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 OYes ONO 3.Free of foreign materials including paint? Oyes ONO ON/A
inspection? 4.Liquid in all glass bulb sprinklers? OYes ONO @WA
F.Weekly logs of inspections required by NFPA#25 on file? OYes ONO
C.Visible pipe:
G.All deficiencies reported at last inspection corrected? OYes ONO 1.In good condition/no external corrosion? OYes ONO @N/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.1 would like to have a copy of NFPA#25 @ an extra charge of$50.00. OYes ONO 3.Properly aligned and no external loads? OYes ONO (j)N/A
K.Owner or rep.requests WAFS to release information from
D.Visible pipe hangers and seismic braces not damaged or loose? OYes ONO QN/A
inspections to the underwriters of my insurance company. Oyes ONO
E.Hose,hose couplings and nozzles on sprinkler system passed
03/04/2014 inspection in accordance with NFPA 1962? ONIC OYes ONO (R)N/A
F.Adequate heat in areas with wet piping? OYes ONO @N/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 IX_Owner or Owner rep.not on site. the flushing connection and one sprinkler near the end of a branch
A.Inspections p line within the last 5 years? ONIC OYes ONO @NIA
1.Daily and Weekly Items
(If the answer was"No",conduct an internal inspection.)
A.Control valves supervised with seals in correct(open or closed) S.Fifth Year Inspection Items(in addition to above items)
position? @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.Valves 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? @Yes ONO Oa/A freely and are in good condition? ONIC Oyes ONO @N/A
3.Relief port on RPZ device not discharging? Yes ON. ONIA 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.
1.Quarterly Tests
same as the gauge near the dry-pipe valve? OYes ONO &/A
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 @N/A
closed)position? @Yes ONO ON/A B.Post indicating valves opened until spring or torsion is felt in the rod,
B.Sprinkler wrench with spare sprinklers? (E)Yes ONO ON/A then closed back one-quarter tum? Oyes ON. @.IIA
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? @Yes ONO ON/A 1.Record Static Pressure 40 psi and Residual 30 psi
Pressure
D.Alarm Valves.
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? (E)Yes ONO ON/A
from retarding chamber or drains? OYes ONO ON/A 3.Are results comparable to previous test? @Yes ONO Ort/A
2.Semiannual Test(in addition to previous items)
3.Quarterly Inspection Items(in addition to above items) A.Valve supervisory switches indicate movement? OYes ONO @N/A
A.Pressure Reducing Valve:In open position,not leaking,maintaining OYes ONO
B.Electrical waterflow,alarm devices passed tests by opening the
downstream pressure per design criteria,and in good condition with @ 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 @NIA
B.Hydraulic nameplate(calculated systems)securely attached to riser 3.Annual Test(in addition to previous items)
Yes No A.Main drain test.
and legible?
O O 1.Record Static Pressure psi and Residual psi
C.Fire Department Connection: Pressure
Visible,accessible,couplings and swivels not damaged and rotate r See comments-on page 2
smoothly,plugs or caps in place and undamaged,gaskets in place and 2.Was flow observed? OYes ONO @N/A
in good condition,identification sign(s)in place,check valve is not 3.Are results comparable to previous test? OYes ONO &VA
leaking.clapper is in place and operating properly and automatic drain
B.Are all sprinklers date 1920 or later? O Unable to determine.@Yes OJo
valve in place and operating property? @Yes ONO O/A
(If plugs or caps are not in place,inspect interior for obstructions.) C.Fast response sprinklers 20 or more years old replaced or successfully
@NIC OYes ONO
D.Alarm devices free from physical damage? @Yes ONO ON/A sample tested within last 10 years?
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
responsibility and are not included in the price of inspection.
D.Standard response sprinklers 50 or more years old replaced or
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 MAIN CTRL VALVE TAMPER SEAL#07760945
F.Dry-type sprinkler replaced or successfully sample tested
within last 10 years? ONIC Oyes ONO @N/A FIRE BACKFLOW SEAL#'s 0760910 0760908
G.Specific gravity of antifreeze correct? OYes ONO @N/A
H.All control valves operated through full range and returned to normal
position? OYes ONO @N/A
I.Backflow devices passed backflow test? ONIC OYes ONO @WA
J.Backflow devices passed full flow test?OProvisionsnot provided. ONIC OYes ONO @N/A DEFICIENCIES FROM ANNUAL INSPECTION:
K.Pressure reducing valves passed partial
flow test? OProvisions not provided. ONIC OYes ONO @N/A (1)PAINTED HEADS;SEE HEAD SURVEY
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 OYes ON. @111A (2)RECESSED HEAD IN ROOM 207 BATHROOM
5.Test to be done every 5th year
A.Sprinklers rated aboveHigh temperature tested? ONIC OYes ONO ON/A
B.Gauges checked by calibrated gauge or replaced? OYes ONO
C.Pressure reducing valves passed full flow test? ONIC Oyes ONO @N/A
C.Maintenance
1.Regular Maintenance Items
A.If sprinklers have been replaced,were they proper replacements? Oyes ONO
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
decontaminated in an approved manner? OYes ONO @N/A
C.Systems normally filled with fresh water were drained and OCannot be determined.
refilled twice if raw water got into the system? Oyes ONO
D.If any of the following were discovered,was an obstruction investigation @Cannot be determined.
conducted? ONIC Oyes ONO @N/A
Explain reason(s)and obstruction investigation finding in Part 111
1.Defective intake screen on pump with suction from 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 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 retumed 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 (F)N/A
2.Annual Maintenance items(in addition to previous items)
A.Operating stem of all OSBY valves lubricated completely closed,and
reopened? OYes ONO Old/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 @N/A
3.Regular Maintenance items
A.Alarm panel clear? @Yes ONO ON/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) 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 III above.
The scope of work preformed does not include a review of fire sprinkler or fire alarm system design.
Date: 03/04/2014
Signature of Inspector:
Print Name: MICHA ELL
ZLI
License or Certification Number(if applicable): 11081600012008
Color of tag placed on system:
F!Red
EGreen