100 W. 1st St fire sprinkler inspection results c t
613 N.W.MERCANTILE PLACE 3226 CHERRY PALM DRIVE
PORT ST.LUCIE,FL 34986 TAMPA,FL 33619
772-878-3350•FAX:772-878-5967 \VVV 011111�/AYNE 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 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 the current adopted NFPA 25 code 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 HOME SITE#: CALL#:
Owner's Address: 100 WEST IST 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: Jan 8,2020 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? O. Yes 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? O.Yes 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? (2)Yes 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? (E)Yes ONO ONIA
inspection? 4.Liquid in all glass bulb sprinklers? QYes ONO ON/A
F.Weekly logs of inspections required by NFPA#25 on fie? OYes ONO
G.All deficiencies reported at last inspection corrected? OYes ONO C.Visible pipe:
1.In good condition/no external corrosion? (2)Yes ONO ON/A
H.I know the location and understand the operation of all control valves. OYes ONO
J.I would like to have a copy of NFPA#25 @ an extra charge of$50.00 Oyes O No 3.2.No mechanical damage and no leaks?Properly aligned and no external loads? (E)Yes ONO O NIA
K.Owner or rep.requests WAFS to release information from (E)Yes ONO ON/A
inspections to the underwriters of my insurance company. OYes ONO
D.Visible pipe hangers and seismic braces not damaged or loose? QYes ONO ON/A
E.Hose,hose couplings and nozzles on sprinkler system passed
GLORIA SMITH Jan 8,2020 inspection in accordance with NFPA 1962? ONIC OYes ONO a1/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 r
Owner or Owner rep not on site. the Flushing connection and one sprinkler near the antl of a branch
A.Inspections ?ears
1.Daily and Weekly Items line within the last 5 y ONIC OYes ONo .ay/A
(If the answer was"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? O. Yes ONO ON/A A.Alarm valves and their associate strainers,filters and restriction
B.Backflow Preventers: orifices passed Internal inspection? ONIC OYes QNo (:)N/A
1.Valves in correct(open or closed)position? QYes ONO ON/A B.Check valves internally inspected and all parts operate properly,move
2.Sealed,locked or supervised&accessible? (E)Yes ONO ON/A freely and are in good condition? ONIC QYes ONO (3rNtA
3.Relief port on RPZ device not discharging? Oyes ON. 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? Oyes ONO (DN/A/A 1.Quarterly Tests
oA.M"i Iamral water flo•,v alarm devices passed tests by open:::g tits
2.Monthly Inspection Items r addition above Items) inspector's test connection or bypass connection with alarms actuating
A.Control valves with locks or electrical supervision in cored(open or
and flow observed? OYes ONO (E)N/A
closed)position? OYes ONO ON/A B.Post indicating valves opened until spring or torsion is felt in the rod �
6.Sprinkler wrench with spare sprinklers? O'Yes ONO ON/A then closed back one-quarter turn? Oyes ONO ll',�
/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? O.Yes ONO ON/A 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 ON/A
from retarding chamber or drains? OYes ONO O.N/A 3.Are results comparable to previous test? OYes ONO ON/A
3.Quarterly Inspection Items tin addition to above items) 2.Semiannual Test(in addition to previous items)
A.Valve supervisory switches indicate movement? Yes No ON
/A
Pressure Reducing Valve:In open position,not leaking,maintaining Oyes ONO B.Electrical water-flow alarm devices passed tests by opening the O O ON/A
downstream pressure per design criteria,and in good condition with O' Not installed inspector's test connection or bypass connection with alarms actuating
hand-wheels not broken? O Design cntena is not available and flow observed? QYes ONO ON/A
B.Hydraulic nameplate(calculated systems)securely attached to riser 3.Annual Test(in addition to previous items)
and legible? QYes ONo A_Main drain test.
C.Fire Department Connection: 1.Record Static Pressure 50 psi and Residual 25 psi
Pressure
smooth)
Visible,accessible.couplings and swivels not damaged and rotate
f See comments-on page 2
y,plugs or caps in place and undamaged,gaskets in place and 2 Was flow observed? QYes ONO ON/A
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? QYes ONO ON/A
valve in place and operating property? (E)Yes ONO Op//A B.Are all sprinklers date 1920 or later? O Unable to determine.QYes 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 ()N/A sample tested within last 10 years? O' NIC OYes ONO
1 1
CALL#:
Part 111 -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? ONIC 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#77159
F.Dry-type sprinkler replaced or successfully sample tested
within last 10 years? ONIC Oyes ONO Ohl/A
G.Specific gravity of antifreeze correct? OYes ONO aN/A
H.All control valves operated through full range and returned to normal SYSTEM DUE FOR 5 YEAR
position? .OYes ONO ON/A
1 GAUGE OUT OF DATE
I.Backflow devices passed backflow test? ONIC OYes ONO ON/A
J.Backflow devices passed full flow test?OProvisions not provided. ONIC O Yes ONO &I/q
K.Pressure reducing valves passed partial
flow test? OProvisions not provided. ONIC O Yes ONO .Ohl/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 OYes ONO ON/A
5.Test to be done every 5th year
A.Sprinklers rated aboveHigh temperature tested? ONIC OYes ONO a/A
B.Gauges checked by calibrated gauge or replaced? OYes E)No
C Pressure reducing valves passed full flow test? ONIC OYes ONO aJ/A
C.Maintenance
1.Regular Maintenance Items
A.If sprinklers have been replaced,were they proper replacements? OYes O No
B.Used hose was leaned,drained and dried before being placed pack in OCannot be determined.
service?Hose exposed to hazardous materials was disposed of or
decontaminated in an approved manner? OYes ONO ON/A
C.Systems normally filled with fresh water were drained and QCannot 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 0cannot be determined.
conducted? ONIC OYes ONO (E)N/A
Explain reason(s)and obstruction investigation finding in Part 111
I.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 Oyes ONO V'/A
2.Annual Maintenance Items(in addition to previous items)
A.Operating stem of all OSBY valves lubricated completely closed,and
reopened? OYes 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 (E)N/A
3.Regular Maintenance Items
A.Alarm panel dear? OYes ONO ()N/A
B.System left in service? (2)Yes ONO ON/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: Jan 8,2020
Signature of Inspector: '
Print Name: K LAVERY
License or Certification Number(if applicable): FP115-000206
Color of tag placed On system: Which systems are Red Tagged:
F Q F_
Red Yellow Green