100 W 1st St 2015 wayne fire 613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST.LUCIE,FL 34986 TAMPA,FL 33619
772-878-3350•FAX:772-878-5967 WAYNE 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: ALMOST HOME ISC# J00131 Date: 2014-12-30
Owner's Address: 100 WEST 1 ST STREET ATLANTIC BEACH,FL.32233
Property Being Evaluated: ALMOST HOME
Property Address: 100 WEST 1 ST STREET ATLANTIC BEACH,FL.32233
Monitoring Entity
Panel Manufacturer: DIGITAL MONITORING PRODUCTS Model No. XR500
Name: ESI
Circuit Styles: B Y Amt 10(IDC)3(NAC)
Telephone: 904-388-3975
Last Date System Had Service Performed: 2013-12-06
Account Ref.No. 384DM
Last Date Software or Configuration was Revised: NA
Service
Weekly AHJ DIRECTOR OF PUBLIC SAFETY
Monthly AHJ phone# 904-247-5864
Quarterly
Semi-Annually -Digital
(1
(i-Annually -R.F.
(� Other(Specify) -Other Specify
Inspected by(print) J.SCHULLDate: 2014-12-30 Time: 0900
Signature of Alarm Agent: (Agent Meets Requirements Per Florida Statute 489.518)
Name of Owner or represssenntaatti�ve GLORIA SMITH
Signature �[V"H ix Date: 2014-12-30
Owner or Owner rep.not on site.
I would like to have a copy of NFPAN72 @ 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: 1100
Notifications are made Yes No Who Time
Monitoring Entity r r ESI 1119
Building Occupants r r RESIDENTS 1119
Building Management r r GLORIA 1119
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( ) I— I— F_ F
Horns A( ) B( ) r r r r
Speakers A( ) B( ) r r r F
Chimes A( ) B( ) r r r F
Strobes A( ) B( ) (— r r F
Other:(Specify) A( ) B(5 ) r f R
HORN/STROBES No.of Alarm indicating circuits: 2 Are Circuits supervised? (*—Yes ('No
613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST. LUCIE,FL 34986 TAMPA,FL 33619
772-878-3350•FAX:772-878-5967 VI/AYNE 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
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: ALMOST HOMEISC#: ort#:J00131 Rep1 OF 1
Owner's Address: 100 WEST 1 ST STREET ATLANTIC BEACH, FL.32233 Owner's Phone Number: 904-249-3233
Property Being Evaluated: ALMOST HOME
Property Address: 100 WEST 1ST STREET ATLANTIC BEACH, FL.32233
Date of Work: 2014-12-30 All responses refer to the current work(inspection,testing and maintenance)performed on this date.
This work is(check one): O Monthly O Quarterly 0 Annual O Third Year O Fifth Year
Part I-Owner's Section
A.Is the building occupied? 10 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? @Yes ONO ON/A
since the last inspection? 4OYes ONO B.Visible sprinklers.
C.Are all fire protection systems in service? 4OYes ONO 1.Free of corrosion and physical damage? @Yes 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? @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? @Yes ONO ON/A
inspection?
F.Weekly logs of inspections required by NFPA#25 on file? OYes *No 4.Liquid in all glass bulb sprinklers? @Yes ONO ON/A
G.All deficiencies reported at last inspection corrected? Oyes •No C.Visible pipe:
1.In good condition/no external corrosion? iONo (:)N/AH.I know the location and understand the operation of all control valves. Yes ONO
2.No mechanical damage and no leaks? @Yes ONO O N/A
K I would like to have a copy of NFPWA @ t extra charge n55rm Oyes 401 3.Properly aligned and no external loads? @Yes ONO ON/A
K.Owner or rep.requests WAFS to release information from
inspections to the underwriters of my insura a company. OYes ONO D.Visible pipe hangers and seismic braces not damaged or loose? @Yes ONO i
E.Hose,hose couplings and nozzles on sprinkler system passed
inspection in accordance with NFPA 1962? ONIC OYes ONO @N/A
GLORIA SMITH46-� 0. 2014-12-30 F.Adequate heat in areas with wet piping?
Owner or representative(print name) Signature Date G.Has an internal inspection of the pipe been performed by removing @Yes ONO ON/A
Part II-Inspector's Section Owner or Owner re not site.
P� on the flushing connection and one sprinkler near the end of a branch
A.Inspections line within the last 5 years? @NIC OYes ONO ON/A
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 property,move
2.Sealed,locked or supervised&accessible? @Yes ONO ON/A freely and are in good condition? ONIC OYes ONO V'/A
3.Relief port on RPZ device not discharging? OYes ON. O B.Testing
•N/A The followng tests are to be performed p y
C.For freezer systems,is the gauge near the compressor reading the 0 pe ormed at the noted intervals.Report an failures on Part III of this form.
same as the gauge near the dry-pipe valve? OYes ONO @N/A
1.Quarterly Tests
oA.Mechanical water flow alarm devices passed tests by opening the
2.Monthly Inspection Items r addition inspectors test connection or bypass connection with alarms actuating
A.Control valves with locks or electrical supervision
above items)pervision in correct(open or and flow observed? /�1r,�
OYes ONO C/'/A
closed)position? Yes •O No
O ON/A 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 tum) 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? OYes @No 1 1.Record Static Pressure psi and Residual 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? OYes ONO @N/A
from retarding chamber or drains? OYes ONO @N/A 3.Are results comparable to previous test? OYes ONO
•
2.Semiannual Test(in addition to previous items) ON/A
o
3.Quarterly Inspection Items(iaddition to above items) A.Valve supervisory switches indicate movement? Yes No //'�11rr,,I�
A.Pressure Reducing Valve.In open position,not leaking,maintaining Oyes ONO B.Electrical waterflow alar devices passed tests by opening the O O ON/A
downstream pressure per design criteria,and in good condition with @Not installed inspectors test connection or bypass connection with alarms actuating
handwheels not broken? O Design cntena is not available and flow observed? @Yes ONO ON/A
B.Hydraulic nameplate(calculated systems)securely attached to user 3.Annual Test(in addition to previous items)
and legible? @Yes ONO A.Main drain test.
C.Fire Department Connection: 1.Record Static Pressure 60 psi and Residual 35 psi
Visible,accessible,couplings and swivels not damaged and rotate I— See comments-on page 2 Pressure
smoothly,plugs or caps in place and undamaged,gaskets in place and 2.Was flow observed? @Yes ONO ON/A
in 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? @Yes ONO ON/A
valve in place and operating properly? OYes ONO ON/A B.Are all sprinklers date 1920 or later? O Unable to determine.@Yes ONO
(ff plugs or caps are not in place,inspect interior for obstructions.) C.Fast response sprinklers 20 or more years old replaced or successfully
D.Alar devices 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 DYes QNo
E.Standard response sprinklers 75 or more years old replaced or
successfully sample tested within last 5 years? @NIC Oyes QNo
F.Dry-type sprinkler replaced or successfully sample tested
within last 10 years? ONIC OYes QNo @N/A MAIN CTRL VALVE TAMPER SEAL#0834427
G.Specific gravity of antifreeze correct? OYes QNo @N/A
H.All control valves operated through full range and returned to normal
position? @Yes QNo Qty/A
I.Backflow devices passed backflow test? ONIC @Yes QNo QN/A
J.Backflow devices passed full flow test?@Provisions not provided. ONIC Q Yes QNo QN/A DISCREPANCIES:
K.Pressure reducing valves passed partial
flow test? OProvisions not provided. ONIC OYes QNo QQ N/A
4.Test to be done every third year: (1)SYSTEM IMPAIRED NO POWER TO PANEL TO TEST DEVICES
Hose(more than 5 years old)connected to the system has been service tested in accordance with
NFPA 1962.Water discharged and water low alarms operated? ONIC DYes QNo @N/A TAG#06794
5.Test to be done every 5th year
A.Sprinklers rated aboveHigh temperature tested? ONIC OYes QNo @N/A
B.Gauges checked by calibrated gauge or replaced? OYes QNo
C.Pressure reducing valves passed full flow test? ONIC Oyes QNo @N/A
C.Maintenance
1.Regular Maintenance Items
A.If sprinklers have been replaced,were they proper replacements? OYes QNo/
B.Used hose was cleaned.drained and deed before being placed back in annot be determined.
service?Hose exposed to hazardous materials was disposed of or
decontaminated in an approved manner? DYes QNo @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 QNo
D.If any of the following were discovered,was an obstruction investigation @Cannot be determined.
conducted? ONIC Oyes QNo @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 inspectors 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 DYes QNo @N/A
2.Annual Maintenance Items(in addition to previous items)
A.Operating stem of all OSBY valves lubricated completely closed,and
reopened? @Yes QNo QN/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 QNo @N/A
3.Regular Maintenance Items
A.Alarm panel dear? @Yes QNo QN/A
B.System left in service? @Yes QNo ()N/A
C.Is system impaired?(Impairment program put into place per NFPA-25 and
Wayne Automatic Fire Sprinklers protocols) QYes QNo 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 alar system design.
Date: 2014-12-30
Signature of Inspector:
Print Name: J.SCHULL
License or Certification Number(if applicable): FPI14-000092
Color of tag placed on system:
FX—Red
rG reen