FIRE PROTECTION TESTING, INC. FIRE SPRINKLER ...
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ 249-251 West Main Street 06405 Branford CT Address ____________________________________________________________ Lakeview CenterBuildings #1-4 Report For __________________________________________________ 06/06/2016 Date of Inspection ___________________________ Inspector Name______________________________
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. Part I – Owner or On Site Representative Section A. Is the building occupied? B. Has the occupancy classification & hazard of contents remained the same since previous inspection? C. Are all fire protection systems in service since previous inspection? D. Has the system remained in service without modification since previous inspection? E. Was the system free of actuations of devices or alarms since previous inspection? Part II Inspector’s Section A. Inspections 1. Inspection Items A. Preaction & Deluge Valves 1. Free from physical damage? 2. Trim valves in appropriate (open/closed) position & no leakage from valve seat? 3. Electrical components appear in service? B. Dry-Pipe Valves 1. Free from physical damage? 2. Trim valves in appropriate (open/closed) position? 3. No leakage from immediate chamber? C. Relief port on reduced pressure backflow prevention assemblies free of continuous discharge? 2. Inspection items which can be performed if the items are electrically supervised or secured with locks A. Gauges on dry, preaction & deluge systems in good condition & showing normal air & water pressure?
Page 1 of 5
Yes
No
N/A ✔ ✔ ✔ ✔ ✔
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT Yes B. Control Valves 1. In normal (open/closed) position? 2. Sealed, locked, or supervised? 3. Accessible? C. Isolation valves on backflow prevention assemblies in open position? D. Proper number & type of spare sprinklers? E. Sprinkler wrench with spare sprinklers? F. Gauges on wet-pipe system in good condition & showing normal water supply pressure? G. Sprinkler system alarm devices appear free from physical damage & all electrical connections secure? H. Alarm Valves 1. Gauges indicating normal supply water pressure? 2. Free from physical damage? 3. Valves in appropriate (open/closed) position? 4. No leakage from retarding chamber of alarm drains? I. Fire Department Connections 1. Visible & Accessible? 2. Couplings & swivels not damaged and rotate smoothly? 3. Plugs or caps in place & undamaged? 4. Gaskets in place & in good condition? 5. Identification sign(s) in place? 6. Check valve is not leaking? 7. Automatic drain valve in place & operating properly? (Note: If plugs or caps are not in place, inspect the interior for obstructions & verify that the valve clapper is operational over its full range.) J. Sample of visible sprinklers 1. Free of corrosion? 2. Free of obstructions to spray patterns? 3. Free of foreign materials including paint? 4. Free of physical damage? K. Sample of visible pipe 1. In good condition? 2. Free of mechanical damage & not leaking? 3. No external corrosion? 4. Free from physical damage? L. Sample of visible pipe hangers & seismic bracing not damaged or loose?
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No
N/A
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT 1. Fifth Year Inspection Items A. Interior of dry-pipe, preaction and deluge valves passed internal inspection? B. Alarm valves and their associated strainers, filters, and restriction orifices passed internal inspection? C. Check valves internally inspected & all parts operate property, move freely, & are in good condition? D. Strainers, filters, restricted orifices, & diaphragm chambers on dry-pipe, preaction, and deluge valves passed internal inspection? E. Date of Last Obstruction / Internal Pipe Inspection Date___________________________ F. Date of Last Pressure Reducing Valve Test N/A Date___________________________ G. Date of Last Standpipe Flow Test N/A Date___________________________ H. Date of Last Hydrostatic Test of Dry Standpipe N/A Date___________________________ B. Testing The following tests are to be performed at the noted intervals. 1. Tests Performed A. Sprinkler system main drain test 75 65 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________ Page 3 of 5
Yes
No
N/A ✔ ✔ ✔
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested N/A Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/6/16 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
2
OSY
Yes
Yes
No
No
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 4 of 5
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
7/1/15
Riser
2"
75
65
This Waterflow Test
6/6/16
Riser
2"
75
65
2 Total Number Of Systems At This Location ___________ 1+2 This Is System Number ____ ✔ ✔ Wet ____ Dry ____ PreAction ____ Other___________________
Fire Panel Manufacturer & Model _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________
(2). Need new faceplate gasket on the dry valve. (VIKING. E2) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 5 of 5
No ✔
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ CT 249-251 West Main Street Branford 06405 Address ____________________________________________________________ Lakeview Center- Buildings #2 Report For __________________________________________________ 06/06/2016 Date of Inspection ___________________________ Inspector Name______________________________
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. A. Testing The following tests are to be performed at the noted intervals. Tests Performed A. Sprinkler system main drain test 75 65 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________
Page 1 of 3
Yes
No
N/A
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested N/A Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/6/16 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test UNKNOWN Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
2
OSY
Yes
Yes
No
Yes
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 2 of 3
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump
Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
7/1/15
Riser
2"
75
65
This Waterflow Test
6/6/16
Riser
2"
75
65
2 Total Number Of Systems At This Location ___________ 1+2 This Is System Number ____ ✔ Dry ____ ✔ PreAction ____ Other___________________ Wet ____
Fire Panel Manufacturer & Model SIMPLEX 4001 _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________ (2). Need a new faceplate gasket on the dry valve. (VIKING. E2) _____________________________________________________________________________________ (3). Should have a check valve installed for the 1-1/2"drain cup tied into the 2" main drain to allow a proper drain _____________________________________________________________________________________ test without overflowing. _____________________________________________________________________________________ (4). Must have proper support installed under the elbow for the dry valve. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 3 of 3
No ✔
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ CT 249-251 West Main Street Branford 06405 Address ____________________________________________________________ Lakeview Center- Building #3 Report For __________________________________________________ 06/06/2016 Date of Inspection ___________________________ Inspector Name______________________________
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. A. Testing The following tests are to be performed at the noted intervals. Tests Performed A. Sprinkler system main drain test 75 65 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________
Page 1 of 3
Yes
No
N/A
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested N/A Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/616 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
1
OSY
Yes
Yes
No
Yes
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 2 of 3
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump
Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
7/1/15
Riser
2"
75
60
This Waterflow Test
6/6/16
Riser
2"
75
65
1 Total Number Of Systems At This Location ___________ 1 This Is System Number ____ ✔ PreAction ____ Other___________________ Wet ____ Dry ____
Fire Panel Manufacturer & Model _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 3 of 3
No ✔
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ CT 249-251 West Main Street Branford 06405 Address ____________________________________________________________ Lakeview Center- Buildings #4 Report For __________________________________________________ 06/06/2016 Date of Inspection ___________________________ Inspector Name______________________________
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. A. Testing The following tests are to be performed at the noted intervals. Tests Performed A. Sprinkler system main drain test 70 60 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________
Page 1 of 3
Yes
No
N/A
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/6/16 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test 4/14 Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
1
OSY
Yes
Yes
No
Yes
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 2 of 3
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump
Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
5/26/15
Riser
2"
70
60
This Waterflow Test
6/6/16
Riser
2"
70
60
1 Total Number Of Systems At This Location ___________ This Is System Number ____ ✔ PreAction ____ Other___________________ Wet ____ Dry ____
Fire Panel Manufacturer & Model _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________ (2). The OS+Y tamper switch did not report to the panel. _____________________________________________________________________________________ (3). The drain cup on the 2" main drain has no check valve. So, the drain can not be opened all the way for a drain test. _____________________________________________________________________________________ (4). Need new faceplate gasket on the dry valve.(VIKING. E2) _____________________________________________________________________________________ _____________________________________________________________________________________ Back in service Badge#251 _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 3 of 3
No ✔
FIRE PROTECTION TESTING, INC. DRY PIPE VALVE TEST REPORT 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ 249-251 West Main Street Branford CT 06405 Address ____________________________________________________________ Lakeview Center- Buildings #1-4 Report For __________________________________________________ 06/06/2016 Date of Trip Test ___________________________ Pat O'Toole Inspector Name______________________________
NOTE: Before any dry pipe valve is trip tested, the water supply line to it should be thoroughly flushed. The two inch drain below the valve should be opened wide, and water at full pressure should be discharged long enough to clear the pipe of any accumulation or scale or foreign material. If there is A hydrant on the supply line, this hydrant should be flushed before the two inch drain is opened. The drip valve on the dry pipe valve should be checked before tripping the dry pipe valve, to see that it is in operating condition.
Dry Pipe Valves Valve Serial No. Manufacturer Valve Model Valve Size Controlling Sprinklers Date Of Last Partial Trip Tested Date Of Full Trip Air Pressure Before Test Water Pressure Before Test Size of Test Valve Location of Test Valve Was Gate Valve Below Dry Valve Open Wide at Test? (If not, how many turns?) Air Pressure Valve Tripped At Water Pressure Valve Tripped At Time It Took Valve to Trip If System Flooded, List Time Water Reached Test Opening Performance
System No. ( 1 )
System No. ( 2 )
System No. ( 3 )
System No. ( 4 )
2467
3132
VIKING
VIKING
VIKING
VIKING
E2
E2
E2
E2
Inch
4
Inch
4
Inch
6
Inch
6
ATTIC
ATTIC
BUILDING
BUILDING
6/6/16
6/6/16
6/6/16
6/6/16
7/1/15
UNKNOWN
Lbs. Lbs.
43 75
75
1/2"
7/1/15
Lbs. Lbs.
35
75
1/2"
4/14
Lbs. Lbs.
37
Lbs. Lbs.
37
70
1/2"
1/2"
DAY CARE
5
5
Lbs. Lbs. Min. N/A Sec.
12
16
75
N/A
Lbs. Lbs. Min. N/A Sec.
5 28
75
N/A
Lbs. Lbs. Min. N/A Sec.
5
N/A
Lbs. Lbs. Min. N/A Sec. 10
75
70
N/A
N/A
N/A
N/A
N/A
OK
OK
OK
OK
Page 1 of 2
FIRE PROTECTION TESTING, INC. DRY PIPE VALVE TEST REPORT Dry Pipe Valves Interior of Body Moving Parts Valve Condition Rubber Facing Seats Reset Did Alarms Operate at Trip Test? Auxillary Low Points Drained? Water Control Valve Left Open & Sealed? Alarm Control Valve Left Open & Sealed?
System No. ( 1 )
System No. ( 2 )
System No. ( 3 )
System No. ( 4 )
OK
OK
OK
OK
OK
OK
OK
OK
POOR
POOR
OK
Poor
oK
OK
OK
OK
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Quick Opening Devices Device Serial No. Manufacturer Type Model No. Air Pressure in Upper Chamber Quick Opening Device Tripped At Performance Quick Opening Device Left in Service, Control Open, & Sealed?
System No. ( 1 )
System No. ( 2 )
System No. ( 3 )
System No. ( 4 )
N/A
N/A
N/A
RELIABLE
ACCELLERATOR B-1
Sec.
Lbs. Lbs.
Sec.
Lbs. Lbs.
37 N/A
Sec.
28
Lbs. Lbs.
Sec.
OK
Yes a
Adjustments or corrections made during this inspection Performed partial trip of four dry systems. ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Fire Panel Manufacturer & Model ___________________________________________________________________________________________ Comments ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________
Page 2 of 2
Lbs. Lbs.
TERMS AND CONDITIONS When performing service or inspection, Fire Protection is solely responsible for the work for which it is retained by the customer. Fire Protection is not responsible for any conditions that may exist beyond the scope of the retention by the customer. However, if the customer wishes a complete engineering evaluation or survey to ensure complete system integrity we offer this service on a time and material basis. 1. The Fire Protection Team, Fire Protection Testing, Inc. Fire Protection Alarms, and Fire Protection Extinguishers, hereinafter collectively “FPT,” warrants that the workmanship hereunder shall be free from defects for thirty (30) days from date of installation. If any replacement part or equipment proves defective, FPT will extend to Customer the benefits of any warranty FPT has received from the Manufacturer. 2. All work under this Agreement will be performed during FPT’s normal working hours. Work necessary on overtime will be billed at prevailing rates, or clearly stated within the scope of work. 3. Customer will promptly pay invoices, and FPT shall be afforded all rights of a contractor provided in Public Act No. 99-153. In addition, should any payment become thirty (30) days delinquent, FPT may stop all work without notice and/or cancel this Agreement in its sole discretion. 4. Customer shall be responsible for all taxes applicable to the services rendered and material provided. 5. Any alteration to, or deviation from, any Agreement involving extra material or labor will become an extra charge (fixed price to be negotiated or on time-and-material basis at FPT's rates then in effect) over the sum stated in the Agreement. 6. FPT does not accept responsibility for problems or conditions that are the result of the improper water pressure or causes beyond FPT's control. 7. If any emergency call is made at Customer's request and inspection indicates a condition that is not covered under this Agreement, FPT may charge Customer at the rate then in effect for such services rendered. Work performed outside of normal working hours will be billed at prevailing rates. 8. Customer shall permit only FPT's personnel or agents to perform the work included in this Agreement. 9. Customer acknowledges that this is a commercial transaction and expressly waives its right to notice and hearing under CT General Statutes Section 52-578a et seq. relative to prejudgment remedies. 10. FPT shall not be liable for failure to render services or any delay, loss, damage or detention due to causes beyond its control, including but not limited to, strikes unavailability of equipment or materials, delays by carriers, work stoppages, fires, lockouts, civil or military authority, insurrection or riot, action of the elements, forces of nature, acts of “God”, or any cause beyond FPT's control. 11. Any inspection or testing set forth in this Agreement is conditioned upon the systems covered being in operating condition, free from hidden or latent defects. If repairs are deemed necessary, FPT may submit a quote for approval, at the customer’s request. 12. Inspection or testing as set forth in this Agreement applies to the maintainable portion of the system. 13. The owner further agrees that under no circumstances shall FPT be responsible or liable to the owner for any claims, losses, damages, or expenses incurred by the owner as a result of any matter occurring prior to the date of the first inspection and testing or work performed by FPT on behalf of the owner pursuant to this Agreement. 14. To the fullest extent permitted by law, Customer shall indemnify and hold harmless FPT, its agents and employees from and against all claims, damages, losses and expenses, including but not limited to attorney's fees, arising out of or resulting from the performance of services or work hereunder, provided that such claim, damage, loss or expense is caused in whole or in part by any active or passive act or omission of Customer, anyone directly or indirectly employed by Customer, or anyone for whose acts Customer may be liable. 15. The owner agrees that under no circumstances, whether arising in contract, tort (including negligence) equity or otherwise, will it hold FPT responsible for loss of use, loss of profit, increasing operating or maintenance expenses, claims of customer’s tenants or clients, or any special, indirect, or consequential damages of any kind, including, but not limited to, damages arising from the use, loss of use, performance, or failure of the system(s) to, or the work performed as a result of this contract. 16. FPT and the Customer agree that it is impractical and extremely difficult to fix actual damages which may arise due to the faulty operation of the System or failure of any Fire Protection device or failure to perform, damage to the Customer’s Systems or negligent performance of services; if, notwithstanding the above provisions, should there arise any liability on the part of FPT, such liability shall be limited to an amount equal to the price of services performed pursuant to this Agreement. Where this Agreement covers multiple sites, liability shall be limited to the
amount of the Agreement price allocable to the site where the incident occurred. Such sum shall be complete and exclusive and shall be paid and received as liquidated damages and not as a penalty. If the Customer desires FPT to assume greater liability, the parties shall amend this agreement by attaching a rider setting forth the amount of additional liability and the additional amount payable by the Customer for the assumption by FPT of such greater liability, provided however that such rider shall in no way be interpreted to hold FPT as an insurer. In no event shall FPT be liable for any damage, loss, injury or any other claim arising from and servicing, alterations, modifications, changes, or movements of the system(s) or any of its component parts by customer or any third party. 17. The Customer does hereby, for itself and all others claiming for it under this Agreement, release and discharge FPT from and against all hazards covered by all of the Customer's insurance, it being expressly agreed and understood that no insurance company or insurer will have any right of subrogation against FPT. 18. It is agreed that no suit or cause of action or other proceeding shall be brought against either party more than one (1) year after the accrual of the cause of action or one (1) year after the claim arises, whichever is shorter, whether known or unknown when the claim arises or whether based on tort, contract, or any other legal theory. The laws of the State of Connecticut shall govern the validity, enforceability, and interpretation of this Agreement. 19. The Customer may not assign this Agreement without FPT’s prior written consent. FPT’s may assign this Agreement to an affiliate without obtaining the Customer's consent. 20. If any provision of this Agreement is held by any court or other competent authority to be void or unenforceable in whole or in part, this Agreement will continue to be valid as to the other provisions and the remainder of the affected provision. 21. FPT shall be entitled to recover from the Customer all reasonable legal fees incurred in connection with Fire Protection enforcing the terms and conditions of this Agreement. 22. It is understood and agreed by the Customer that FPT is not an insurer and that insurance covering personal injury and property damage on the Customer's premises shall be obtained by the Customer; that the Customer agrees to look exclusively to the Customer's insurer to recover for injuries or damage in the event of any loss or injury; that the amounts payable to the FPT hereunder are based upon the value of the services and the scope of liability set forth herein; that FPT is not guaranteeing that no loss will occur; and Customer agrees that FPT is not responsible for any losses which may occur. 23. Except as expressly set forth herein, FPT disclaims all warranties, expressed or implied, including but not limited to any implied warranties of merchantability or fitness for a particular purpose with respect to the services performed or the products, systems or equipment supported hereunder. 24. It is understood that this proposal sets forth our entire agreement. 25. This proposal will become a contract between us if accepted by you and thereafter approved in writing by our duly authorized representative. 26. FPT assumes that the Customer’s transfer or sale of Site includes all existing records and rights to previous inspection reports on service tickets. PAYMENT TERMS Pursuant to Public Act N. 99-153, all bills are payable within 30 days from receipt thereof, and failure to pay in accordance with the terms of Public Act No. 99-153 may subject you to interest payments, legal fees and costs set forth therein. Notwithstanding anything to the contrary, if it is necessary to start legal proceedings to collect any unpaid fees or costs you agree to pay all costs of collection, including, without limitation, reasonable attorneys fees. THIS WORK ORDER IS SUBJECT TO A FINANCE CHARGE OF 1.5% PER MONTH, ANNUAL PERCENTAGE RATE OF 18% WHICH IS ALLOWED BY LAW. CUSTOMER AGREES TO PAY ALL COSTS AND REASONABLE ATTORNEY’S FEE IF THIS WORK ORDER IS PLACED IN THE HANDS OF AN ATTORNEY FOR COLLECTION.
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. Part I – Owner or On Site Representative Section A. Is the building occupied? B. Has the occupancy classification & hazard of contents remained the same since previous inspection? C. Are all fire protection systems in service since previous inspection? D. Has the system remained in service without modification since previous inspection? E. Was the system free of actuations of devices or alarms since previous inspection? Part II Inspector’s Section A. Inspections 1. Inspection Items A. Preaction & Deluge Valves 1. Free from physical damage? 2. Trim valves in appropriate (open/closed) position & no leakage from valve seat? 3. Electrical components appear in service? B. Dry-Pipe Valves 1. Free from physical damage? 2. Trim valves in appropriate (open/closed) position? 3. No leakage from immediate chamber? C. Relief port on reduced pressure backflow prevention assemblies free of continuous discharge? 2. Inspection items which can be performed if the items are electrically supervised or secured with locks A. Gauges on dry, preaction & deluge systems in good condition & showing normal air & water pressure?
Page 1 of 5
Yes
No
N/A ✔ ✔ ✔ ✔ ✔
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT Yes B. Control Valves 1. In normal (open/closed) position? 2. Sealed, locked, or supervised? 3. Accessible? C. Isolation valves on backflow prevention assemblies in open position? D. Proper number & type of spare sprinklers? E. Sprinkler wrench with spare sprinklers? F. Gauges on wet-pipe system in good condition & showing normal water supply pressure? G. Sprinkler system alarm devices appear free from physical damage & all electrical connections secure? H. Alarm Valves 1. Gauges indicating normal supply water pressure? 2. Free from physical damage? 3. Valves in appropriate (open/closed) position? 4. No leakage from retarding chamber of alarm drains? I. Fire Department Connections 1. Visible & Accessible? 2. Couplings & swivels not damaged and rotate smoothly? 3. Plugs or caps in place & undamaged? 4. Gaskets in place & in good condition? 5. Identification sign(s) in place? 6. Check valve is not leaking? 7. Automatic drain valve in place & operating properly? (Note: If plugs or caps are not in place, inspect the interior for obstructions & verify that the valve clapper is operational over its full range.) J. Sample of visible sprinklers 1. Free of corrosion? 2. Free of obstructions to spray patterns? 3. Free of foreign materials including paint? 4. Free of physical damage? K. Sample of visible pipe 1. In good condition? 2. Free of mechanical damage & not leaking? 3. No external corrosion? 4. Free from physical damage? L. Sample of visible pipe hangers & seismic bracing not damaged or loose?
Page 2 of 5
No
N/A
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT 1. Fifth Year Inspection Items A. Interior of dry-pipe, preaction and deluge valves passed internal inspection? B. Alarm valves and their associated strainers, filters, and restriction orifices passed internal inspection? C. Check valves internally inspected & all parts operate property, move freely, & are in good condition? D. Strainers, filters, restricted orifices, & diaphragm chambers on dry-pipe, preaction, and deluge valves passed internal inspection? E. Date of Last Obstruction / Internal Pipe Inspection Date___________________________ F. Date of Last Pressure Reducing Valve Test N/A Date___________________________ G. Date of Last Standpipe Flow Test N/A Date___________________________ H. Date of Last Hydrostatic Test of Dry Standpipe N/A Date___________________________ B. Testing The following tests are to be performed at the noted intervals. 1. Tests Performed A. Sprinkler system main drain test 75 65 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________ Page 3 of 5
Yes
No
N/A ✔ ✔ ✔
✔
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested N/A Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/6/16 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
2
OSY
Yes
Yes
No
No
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 4 of 5
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
7/1/15
Riser
2"
75
65
This Waterflow Test
6/6/16
Riser
2"
75
65
2 Total Number Of Systems At This Location ___________ 1+2 This Is System Number ____ ✔ ✔ Wet ____ Dry ____ PreAction ____ Other___________________
Fire Panel Manufacturer & Model _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________
(2). Need new faceplate gasket on the dry valve. (VIKING. E2) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 5 of 5
No ✔
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ CT 249-251 West Main Street Branford 06405 Address ____________________________________________________________ Lakeview Center- Buildings #2 Report For __________________________________________________ 06/06/2016 Date of Inspection ___________________________ Inspector Name______________________________
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. A. Testing The following tests are to be performed at the noted intervals. Tests Performed A. Sprinkler system main drain test 75 65 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________
Page 1 of 3
Yes
No
N/A
✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested N/A Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/6/16 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test UNKNOWN Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
2
OSY
Yes
Yes
No
Yes
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 2 of 3
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump
Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
7/1/15
Riser
2"
75
65
This Waterflow Test
6/6/16
Riser
2"
75
65
2 Total Number Of Systems At This Location ___________ 1+2 This Is System Number ____ ✔ Dry ____ ✔ PreAction ____ Other___________________ Wet ____
Fire Panel Manufacturer & Model SIMPLEX 4001 _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________ (2). Need a new faceplate gasket on the dry valve. (VIKING. E2) _____________________________________________________________________________________ (3). Should have a check valve installed for the 1-1/2"drain cup tied into the 2" main drain to allow a proper drain _____________________________________________________________________________________ test without overflowing. _____________________________________________________________________________________ (4). Must have proper support installed under the elbow for the dry valve. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 3 of 3
No ✔
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ CT 249-251 West Main Street Branford 06405 Address ____________________________________________________________ Lakeview Center- Building #3 Report For __________________________________________________ 06/06/2016 Date of Inspection ___________________________ Inspector Name______________________________
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. A. Testing The following tests are to be performed at the noted intervals. Tests Performed A. Sprinkler system main drain test 75 65 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________
Page 1 of 3
Yes
No
N/A
✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔
✔ ✔ ✔ ✔ ✔ ✔
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested N/A Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/616 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
1
OSY
Yes
Yes
No
Yes
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 2 of 3
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump
Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
7/1/15
Riser
2"
75
60
This Waterflow Test
6/6/16
Riser
2"
75
65
1 Total Number Of Systems At This Location ___________ 1 This Is System Number ____ ✔ PreAction ____ Other___________________ Wet ____ Dry ____
Fire Panel Manufacturer & Model _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 3 of 3
No ✔
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ CT 249-251 West Main Street Branford 06405 Address ____________________________________________________________ Lakeview Center- Buildings #4 Report For __________________________________________________ 06/06/2016 Date of Inspection ___________________________ Inspector Name______________________________
Information on this form covers the minimum requirements of NFPA 25-2011 for the fire sprinkler systems connected to distribution systems without supplemental tanks or fire pumps. All responses refer to the current inspection performed on the above date stated. A. Testing The following tests are to be performed at the noted intervals. Tests Performed A. Sprinkler system main drain test 70 60 1. Record Static Pressure ____PSI & Residual Pressure ____PSI Was flow observed? 2. Did water motor gong activate on water flow? 3. Are results comparable to previous tests? B. Waterflow alarm devices passed tests? 1. Inspectors test connection opened? (wet-pipe when not in freezing weather) 2. Bypass connection opened? (wet-pipe systems in freezing weather, dry-pipe, preaction, or deluge) 3. Alarms actuated? 4. Was waterflow observed? C. Tamper switches tested? D. Valves fully exercised & lubricated 6/6/16 Date________________ E. Priming water level passed test in dry-pipe & preaction systems? F. Low air pressure signal in dry-pipe & preaction systems? F. Quick opening devices passed test? G. Are all sprinklers in service dated 1920 or later? H. Fast response sprinklers in service for less than 20 years? (If “no” test sample now and every 10 years) I. Extra High, Very Extra High, & Ultra High Temperature sprinklers tested? Date________________
Page 1 of 3
Yes
No
N/A
✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔
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FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Yes
No
N/A ✔
I. Dry barrel sprinkler in service less than 10 years? Date________________ J. Standard sprinklers in service less than 50 years? (If “no” test sample now and every 10 years) K. Specific gravity of antifreeze correct? L. Fire pump full waterflow date last tested Date________________ M. Preaction & deluge valves full waterflow trip test (Except deluge valves where water can’t be discharged) 1. Water discharge from all nozzles unimpeded? 2. Pressure reading at hydraulically most remote nozzle ____PSI 3. Residual pressure reading at valve ____PSI Was waterflow observed? 4. Are the above readings comparable to design? 5. Manual activation devices passed test? 6. Automatic air pressure maintenance devices passed test? N. Automatic air maintenance devices on dry-pipe & preaction systems passed test? O. All sprinkler pressure regulating control valves passed full waterflow test? P. Dry-pipe full waterflow trip test to be done every third year 1. Date of Last Dry-pipe valve partial waterflow trip test 6/6/16 Date_______________________ 2. Date of Last Dry-pipe valve full waterflow trip test 4/14 Date_______________________ Q. Date of Last Backflow devices tested? B.O. Date_______________________ 1. Backflow full waterflow test? 2. Backflow devices passed main drain test? R. Gauges checked against calibrated gauge or replaced? 10/12 Date Last Replaced_______________________
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Part III – Table Control Valve Maintenance Table Control Valves
No.
Type
Open
Secured
Closed
Signs
1
OSY
Yes
Yes
No
Yes
City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves System Control Valves
Page 2 of 3
Explain Abnormal Conditions
FIRE PROTECTION TESTING, INC. FIRE SPRINKLER INSPECTION REPORT FOR ADDITIONAL SYSTEMS Control Valves
No.
Type
Open
Secured
Closed
Signs
Explain Abnormal Conditions
Other Control Valves Test Header Bypass Waterflow Test at Sprinkler Riser Y N/A N/A Water Supply Source ____City ____Tank ____Pump
Date
Test Pipe Location
Size of Test Pipe
Static Pressure
Residual (Flow) Pressure
Last Waterflow Test
5/26/15
Riser
2"
70
60
This Waterflow Test
6/6/16
Riser
2"
70
60
1 Total Number Of Systems At This Location ___________ This Is System Number ____ ✔ PreAction ____ Other___________________ Wet ____ Dry ____
Fire Panel Manufacturer & Model _____________________________________________________________________________________ Comments, adjustments and/or corrections made during this inspection (1). Performed partial trip of dry system. _____________________________________________________________________________________ (2). The OS+Y tamper switch did not report to the panel. _____________________________________________________________________________________ (3). The drain cup on the 2" main drain has no check valve. So, the drain can not be opened all the way for a drain test. _____________________________________________________________________________________ (4). Need new faceplate gasket on the dry valve.(VIKING. E2) _____________________________________________________________________________________ _____________________________________________________________________________________ Back in service Badge#251 _____________________________________________________________________________________ _____________________________________________________________________________________
Authorized Signature ____________________________Inspector Name_________________________ F10907 6/6/16 Date __________________________________________License No._____________________________ Yes Is a separate form being used for multiple valves?
Page 3 of 3
No ✔
FIRE PROTECTION TESTING, INC. DRY PIPE VALVE TEST REPORT 1701 Highland Ave, Cheshire, CT 06410 203-250-1115 (Phone) Ct. License F1-10011 [email protected] 10956050 ServiceTrade Job No _________________________ 249-251 West Main Street Branford CT 06405 Address ____________________________________________________________ Lakeview Center- Buildings #1-4 Report For __________________________________________________ 06/06/2016 Date of Trip Test ___________________________ Pat O'Toole Inspector Name______________________________
NOTE: Before any dry pipe valve is trip tested, the water supply line to it should be thoroughly flushed. The two inch drain below the valve should be opened wide, and water at full pressure should be discharged long enough to clear the pipe of any accumulation or scale or foreign material. If there is A hydrant on the supply line, this hydrant should be flushed before the two inch drain is opened. The drip valve on the dry pipe valve should be checked before tripping the dry pipe valve, to see that it is in operating condition.
Dry Pipe Valves Valve Serial No. Manufacturer Valve Model Valve Size Controlling Sprinklers Date Of Last Partial Trip Tested Date Of Full Trip Air Pressure Before Test Water Pressure Before Test Size of Test Valve Location of Test Valve Was Gate Valve Below Dry Valve Open Wide at Test? (If not, how many turns?) Air Pressure Valve Tripped At Water Pressure Valve Tripped At Time It Took Valve to Trip If System Flooded, List Time Water Reached Test Opening Performance
System No. ( 1 )
System No. ( 2 )
System No. ( 3 )
System No. ( 4 )
2467
3132
VIKING
VIKING
VIKING
VIKING
E2
E2
E2
E2
Inch
4
Inch
4
Inch
6
Inch
6
ATTIC
ATTIC
BUILDING
BUILDING
6/6/16
6/6/16
6/6/16
6/6/16
7/1/15
UNKNOWN
Lbs. Lbs.
43 75
75
1/2"
7/1/15
Lbs. Lbs.
35
75
1/2"
4/14
Lbs. Lbs.
37
Lbs. Lbs.
37
70
1/2"
1/2"
DAY CARE
5
5
Lbs. Lbs. Min. N/A Sec.
12
16
75
N/A
Lbs. Lbs. Min. N/A Sec.
5 28
75
N/A
Lbs. Lbs. Min. N/A Sec.
5
N/A
Lbs. Lbs. Min. N/A Sec. 10
75
70
N/A
N/A
N/A
N/A
N/A
OK
OK
OK
OK
Page 1 of 2
FIRE PROTECTION TESTING, INC. DRY PIPE VALVE TEST REPORT Dry Pipe Valves Interior of Body Moving Parts Valve Condition Rubber Facing Seats Reset Did Alarms Operate at Trip Test? Auxillary Low Points Drained? Water Control Valve Left Open & Sealed? Alarm Control Valve Left Open & Sealed?
System No. ( 1 )
System No. ( 2 )
System No. ( 3 )
System No. ( 4 )
OK
OK
OK
OK
OK
OK
OK
OK
POOR
POOR
OK
Poor
oK
OK
OK
OK
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Quick Opening Devices Device Serial No. Manufacturer Type Model No. Air Pressure in Upper Chamber Quick Opening Device Tripped At Performance Quick Opening Device Left in Service, Control Open, & Sealed?
System No. ( 1 )
System No. ( 2 )
System No. ( 3 )
System No. ( 4 )
N/A
N/A
N/A
RELIABLE
ACCELLERATOR B-1
Sec.
Lbs. Lbs.
Sec.
Lbs. Lbs.
37 N/A
Sec.
28
Lbs. Lbs.
Sec.
OK
Yes a
Adjustments or corrections made during this inspection Performed partial trip of four dry systems. ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Fire Panel Manufacturer & Model ___________________________________________________________________________________________ Comments ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________
Page 2 of 2
Lbs. Lbs.
TERMS AND CONDITIONS When performing service or inspection, Fire Protection is solely responsible for the work for which it is retained by the customer. Fire Protection is not responsible for any conditions that may exist beyond the scope of the retention by the customer. However, if the customer wishes a complete engineering evaluation or survey to ensure complete system integrity we offer this service on a time and material basis. 1. The Fire Protection Team, Fire Protection Testing, Inc. Fire Protection Alarms, and Fire Protection Extinguishers, hereinafter collectively “FPT,” warrants that the workmanship hereunder shall be free from defects for thirty (30) days from date of installation. If any replacement part or equipment proves defective, FPT will extend to Customer the benefits of any warranty FPT has received from the Manufacturer. 2. All work under this Agreement will be performed during FPT’s normal working hours. Work necessary on overtime will be billed at prevailing rates, or clearly stated within the scope of work. 3. Customer will promptly pay invoices, and FPT shall be afforded all rights of a contractor provided in Public Act No. 99-153. In addition, should any payment become thirty (30) days delinquent, FPT may stop all work without notice and/or cancel this Agreement in its sole discretion. 4. Customer shall be responsible for all taxes applicable to the services rendered and material provided. 5. Any alteration to, or deviation from, any Agreement involving extra material or labor will become an extra charge (fixed price to be negotiated or on time-and-material basis at FPT's rates then in effect) over the sum stated in the Agreement. 6. FPT does not accept responsibility for problems or conditions that are the result of the improper water pressure or causes beyond FPT's control. 7. If any emergency call is made at Customer's request and inspection indicates a condition that is not covered under this Agreement, FPT may charge Customer at the rate then in effect for such services rendered. Work performed outside of normal working hours will be billed at prevailing rates. 8. Customer shall permit only FPT's personnel or agents to perform the work included in this Agreement. 9. Customer acknowledges that this is a commercial transaction and expressly waives its right to notice and hearing under CT General Statutes Section 52-578a et seq. relative to prejudgment remedies. 10. FPT shall not be liable for failure to render services or any delay, loss, damage or detention due to causes beyond its control, including but not limited to, strikes unavailability of equipment or materials, delays by carriers, work stoppages, fires, lockouts, civil or military authority, insurrection or riot, action of the elements, forces of nature, acts of “God”, or any cause beyond FPT's control. 11. Any inspection or testing set forth in this Agreement is conditioned upon the systems covered being in operating condition, free from hidden or latent defects. If repairs are deemed necessary, FPT may submit a quote for approval, at the customer’s request. 12. Inspection or testing as set forth in this Agreement applies to the maintainable portion of the system. 13. The owner further agrees that under no circumstances shall FPT be responsible or liable to the owner for any claims, losses, damages, or expenses incurred by the owner as a result of any matter occurring prior to the date of the first inspection and testing or work performed by FPT on behalf of the owner pursuant to this Agreement. 14. To the fullest extent permitted by law, Customer shall indemnify and hold harmless FPT, its agents and employees from and against all claims, damages, losses and expenses, including but not limited to attorney's fees, arising out of or resulting from the performance of services or work hereunder, provided that such claim, damage, loss or expense is caused in whole or in part by any active or passive act or omission of Customer, anyone directly or indirectly employed by Customer, or anyone for whose acts Customer may be liable. 15. The owner agrees that under no circumstances, whether arising in contract, tort (including negligence) equity or otherwise, will it hold FPT responsible for loss of use, loss of profit, increasing operating or maintenance expenses, claims of customer’s tenants or clients, or any special, indirect, or consequential damages of any kind, including, but not limited to, damages arising from the use, loss of use, performance, or failure of the system(s) to, or the work performed as a result of this contract. 16. FPT and the Customer agree that it is impractical and extremely difficult to fix actual damages which may arise due to the faulty operation of the System or failure of any Fire Protection device or failure to perform, damage to the Customer’s Systems or negligent performance of services; if, notwithstanding the above provisions, should there arise any liability on the part of FPT, such liability shall be limited to an amount equal to the price of services performed pursuant to this Agreement. Where this Agreement covers multiple sites, liability shall be limited to the
amount of the Agreement price allocable to the site where the incident occurred. Such sum shall be complete and exclusive and shall be paid and received as liquidated damages and not as a penalty. If the Customer desires FPT to assume greater liability, the parties shall amend this agreement by attaching a rider setting forth the amount of additional liability and the additional amount payable by the Customer for the assumption by FPT of such greater liability, provided however that such rider shall in no way be interpreted to hold FPT as an insurer. In no event shall FPT be liable for any damage, loss, injury or any other claim arising from and servicing, alterations, modifications, changes, or movements of the system(s) or any of its component parts by customer or any third party. 17. The Customer does hereby, for itself and all others claiming for it under this Agreement, release and discharge FPT from and against all hazards covered by all of the Customer's insurance, it being expressly agreed and understood that no insurance company or insurer will have any right of subrogation against FPT. 18. It is agreed that no suit or cause of action or other proceeding shall be brought against either party more than one (1) year after the accrual of the cause of action or one (1) year after the claim arises, whichever is shorter, whether known or unknown when the claim arises or whether based on tort, contract, or any other legal theory. The laws of the State of Connecticut shall govern the validity, enforceability, and interpretation of this Agreement. 19. The Customer may not assign this Agreement without FPT’s prior written consent. FPT’s may assign this Agreement to an affiliate without obtaining the Customer's consent. 20. If any provision of this Agreement is held by any court or other competent authority to be void or unenforceable in whole or in part, this Agreement will continue to be valid as to the other provisions and the remainder of the affected provision. 21. FPT shall be entitled to recover from the Customer all reasonable legal fees incurred in connection with Fire Protection enforcing the terms and conditions of this Agreement. 22. It is understood and agreed by the Customer that FPT is not an insurer and that insurance covering personal injury and property damage on the Customer's premises shall be obtained by the Customer; that the Customer agrees to look exclusively to the Customer's insurer to recover for injuries or damage in the event of any loss or injury; that the amounts payable to the FPT hereunder are based upon the value of the services and the scope of liability set forth herein; that FPT is not guaranteeing that no loss will occur; and Customer agrees that FPT is not responsible for any losses which may occur. 23. Except as expressly set forth herein, FPT disclaims all warranties, expressed or implied, including but not limited to any implied warranties of merchantability or fitness for a particular purpose with respect to the services performed or the products, systems or equipment supported hereunder. 24. It is understood that this proposal sets forth our entire agreement. 25. This proposal will become a contract between us if accepted by you and thereafter approved in writing by our duly authorized representative. 26. FPT assumes that the Customer’s transfer or sale of Site includes all existing records and rights to previous inspection reports on service tickets. PAYMENT TERMS Pursuant to Public Act N. 99-153, all bills are payable within 30 days from receipt thereof, and failure to pay in accordance with the terms of Public Act No. 99-153 may subject you to interest payments, legal fees and costs set forth therein. Notwithstanding anything to the contrary, if it is necessary to start legal proceedings to collect any unpaid fees or costs you agree to pay all costs of collection, including, without limitation, reasonable attorneys fees. THIS WORK ORDER IS SUBJECT TO A FINANCE CHARGE OF 1.5% PER MONTH, ANNUAL PERCENTAGE RATE OF 18% WHICH IS ALLOWED BY LAW. CUSTOMER AGREES TO PAY ALL COSTS AND REASONABLE ATTORNEY’S FEE IF THIS WORK ORDER IS PLACED IN THE HANDS OF AN ATTORNEY FOR COLLECTION.
