CommFPSystems Forms 001

8/9/2019 CommFPSystems Forms 001

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2005 National Fire Protection Association

BUILDING PERMIT

Anytown, MA

The undersigned hereby applies to the Inspectional Services Commissioner for permit to erect the following buildingor structure:

Certified street and number

Within fire zone Ward

Name of owner Address

Name of architect or engineer Address

Classification of building or structure: Pre-code Post-code

Type of construction

Dimensions of building or structure: Front Right side

Left side Rear

Main stairs Back stairs Fire escapes

Concrete balconies Other

Foundation material Floor material

Wall material Wall thickness

Roof construction Soil

Party walls Party wall thickness

Number of employees in building Proposed occupancy

Cubic volume $ per cubic foot Estimated cost

General description of the proposed work and its location:

Date

The facts set forth above in this application and accompanying plans are a true statement made under penalty of perjury.

Telephone

Address

Address Address

License number Class License expiration date

Number of persons accommodated

Designed live load

Occupancy

Floors Any others1 2 3 4

(Signature of owner or authorized agent)

(Signature of licensed builder) (Name of contractor)

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(p. 1 of 3) 2005 National Fire Protection Association

FIRE SUPPRESSION SYSTEM PERMIT APPLICATION

Anytown, MA, Fire Department, Fire Prevention Division

The undersigned hereby applies for the alteration, installation, and maintenance of the following fire extinguishingsystem:

Fire pump Water main, hydrant

Standpipe(s)

Sprinkler system

Fire department connection(s)

Special extinguishing system

Other

BUILDING INFORMATION

Building address

Owner's representative or management company

Address

Telephone Pager Cell phone

Contact person

Number of stories above grade Occupancy type

CONTRACTOR INFORMATION

Contact person (project manager, job foreman)

Name of company

Address

Company telephone Pager Cell phone

License number Type

General contractor's name

Address

Telephone Pager Cell phone

Office Use Only

Approved

Denied(state reason)

Name Title Date

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JOB INFORMATION

Is this a new sprinkler system installation? Yes No N/A

Is this an alteration to an existing system? Yes No N/A

Is this maintenance of an existing system? Yes No N/A

Is this installation of new sprinkler equipment? Yes No N/A

Will existing sprinkler system be physically removed

Yes

No

N/A from area under construction?

Describe scope of work (use additional sheet if necessary):

IMPAIRMENT INFORMATION

Will (Check one.)

Building sprinkler system be shut off?

Building sprinkler system be drained?

Construction area be zoned out?

Will (Check one.)

Fire alarm be shut off?

Sprinkler alarm be disabled by zone?

Sprinkler alarm be disabled by building?

Will any means of egress or other fire protection feature be affected by this work or by any other work being performed byyou or any other contractor? (Consult with building management before answering this question.) Yes No N/A

Floor location Approximate total floor area

Approximate area impaired

How long will system be shut off?

(If any portion of the system will be shut off longer than 4 hours in a 24-hour period or if the entire system is shutdown/drained for any length of time, an Extended Impairment Plan must be submitted with this application prior toapproval. Please ask for sample.)

Who (impairment coordinator) is responsible for shutting off and turning on the sprinkler system?

Name

Company

Telephone

Who is responsible for disabling and enabling the alarm system?

Name

Company

Telephone

ALTERATION AND IMPAIRMENT OF WATER-BASED FIRE SUPPRESSION SYSTEMS

Property address

Contractor

Telephone Job location

Job description



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FIRE SAFETY REQUIREMENTS

1. In the event of an emergency: Dial 911

2. In the event of any fire alarm activation or fire, work shall be stopped, open lines capped, and system turned back on.

3. All responsible personnel shall be instructed as to location of sprinkler control valve that controls impaired area underconstruction, alteration, or maintenance. Personnel shall understand how to turn valve on.

4. Security personnel shall be notified of system shutdown.

5. A "Red Tag Permit" system shall be in place prior to start of work. (For information on Tag Permit systems, see NFPA 25,Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems, 2002 edition, Chapter 14.)

6. A log shall be kept of all Red Tags and their locations.

7. Tags are required at fire command center and control valve for area affected.

8. All required means of egress shall be maintained at all times.

9. Work shall be performed without interruption so that fire protection systems are not shut down any longer than necessary.

10. All tenants affected by the impairment shall be notified as to location and time(s) of the impairment.

11. At least one responsible person must remain at the impaired location at all times while system is impaired.

12. The Fire Department (Fire Alarm Division) shall be notified when the fire alarm and sprinkler systems are shut downand restored. To report an emergency: Dial 911

13. A log book shall be kept containing location, time of placement, time of removal, and personnel responsible for flange

blanks if they are used.14. A system acceptance or periodic test shall be performed in accordance with applicable NFPA standards. The results shall

be given to the building owner or property manager and kept on site.

NFPA 13,Standard for the Installation of Sprinkler Systems

NFPA 14,Standard for the Installation of Standpipe and Hose Systems

NFPA 20,Standard for the Installation of Stationary Pumps for Fire Protection

NFPA 25,Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems

15. The sprinkler system shall be returned to full service at the end of each working day.

16. The fire alarm system shall be returned to full service at the end of each working day.

17. Work shall be planned and all materials shall be at the job site and ready for use.

18. Fire extinguishers shall be placed in unprotected area(s). As a minimum, for light (low) hazard occupancies, one 2-Aextinguisher is required per 3,000 ft2. (See NFPA 10, Standard for Portable Fire Extinguishers.)

19. No cutting or welding operations shall be allowed in unprotected area(s) while sprinkler system is shut off.20. No smoking shall be allowed in unprotected areas while sprinkler system is shut off.

21. No work shall begin until all fire safety requirements and/or the extended impairment plan has been implemented.

These fire safety requirements are in addition to and not in lieu of the requirements of NFPA 1, Uniform Fire Code.

Applicant signature

Print name

Impairment Coordinator signature

Print name Date

Official Use Only

Approved by

Issued by

Date issued Date of expiration

Permit number



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BASIS OF DESIGN

Project Name

Contract Number

BUILDING

Intended use

Construction type(s)

Building height Total area (ft2)

Number of floors above grade Number of floors below grade

Area per floor (ft2)

DESCRIPTION OF OCCUPANCIES OR HAZARDS WITHIN BUILDING

DESIGN CODES (Indicate editions.)

SITE ACCESS FOR EMERGENCIES (Include changes during construction stages.)

RESOURCES FOR FIRE FIGHTING (List when available during construction stages.)

SPECIAL CONSIDERATIONS



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EQUIPMENT SCOPE AND RESPONSIBLE PARTIES

Required(Y/N)Equipment

AreaProtected

New, Addition,or Modifcation

Design Plan Review

Fire alarm

Water-based sprinkler systems

Standpipe and hose systems

Water spray fixed systems

Foam water systems

Water mist systems

Wet chemical systems

Dry chemical systems

Inert gas systems

Low expansion foam systems

Private fire service mains

Private hydrants

Water tanks

Stationary pumps for fireprotection

Smoke-control systems

Emergency power systems

Other

Other

(List responsible party and specifiregulations applicable for each sta


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PROJECT INFORMATION SHEETSPRINKLER

Task Date Comments

Completed

Yes

Floor orArea

StartDate

InitialDwg

Final/Sig.

Submit(CITY)

Apvd(CITY)

Submit(AHJ)

Apvd(AHJ)

FieldCheck

StockList

OrderPlaced

Sched.MOJ

S.O./NumEst. Act. % Save

Head Count

No

Contract Nu

Contract Completion

Job N

Designer: Sales Rep:

Const. PM:

Notes/Comments:

Allowed Hours:

Estimated Design:

Hours Used:

Hours to Go:

Variance:

Design & PM review of documents

Pre-design meeting w/ sales rep.

Product brochure

Pre-install foreman meeting

O&M manuals

X

X

X

X

X

P.M.

Estimated:

Actual:

Const. Type:

Address:

City/State:

Heads Hrs/Head

DescrQuan.

SPECIAL MATERIAL L

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Project Name Contract Number

PROJECT SCHEDULE

Building System

D= Design A= Approval F= Fabrication I= Installation


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PREINSTALLATION CHECKLIST

Project Name

Contract Number

Material/Equipment:

No shipping damage

Shipping damage (Describe.)

Order is shipped complete.

Material/equipment complies with approved submittal.

Installation instructions are included.

Material/equipment is properly stored and protected.

Noncompliance or other problems revealed during inspection:

Signed:

Name Title

Date Company

COMMISSIONING TEAM(The following is a list of organizations/individuals involved in the commissioning process for this project.)

Owner representative

Registered design professional

CONSTRUCTION MANAGER

Project manager

Superintendent

Commissioning manager

Coordination drawing manager

FIRE PROTECTIONMECHANICAL

Project manager

On-site foreman



FIRE PROTECTIONELECTRICAL

Project manager

On-site foreman





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WATER-BASED FIRE PROTECTION SYSTEMS FINAL CHECKLIST

Project Name

Contract Number

Date and time of Acceptance Tests

AHJ notified of testing time (Print name.)

Owners rep notified of testing time (Print name.)

Others notified of testing times (Print name(s).)

Complete and sign:

Contractors Material and Test Certificate for Aboveground Piping Yes No N/A

Contractors Material and Test Certificate for Underground Piping Yes No N/A

Design information matches design on plans and as-built drawings.

Adequate heat is supplied in all riser rooms to maintain 40.

Deviations from standard acceptance testing and/or problems were corrected during acceptance testing (list):

Interface between system activation and building automatic systems is successful. List systems:

Numbered test blanks, if used, were removed and each is accounted for.

NFPA 25 was reviewed with owners rep. and copy given to:

Training class was scheduled.

Date Time Location

First-year inspection, testing, and maintenance timeline was given to:

SPRINKLER SYSTEM PUNCH LIST

Hydraulic design information is posted at riser.

Riser information indicates area of building protected by each riser.

Multiple risers are numbered and numbering is consistent with inspection forms.

Signs are located on all control valves, auxiliary drains, and inspectors test connections.

All low-point drains are clearly indicated and accessible.

Information at riser includes number and location of all sectional valves and auxiliary/low-point drains.

Spare heads are located in cabinet at riser; sprinkler wrench is included. Sprinkler guards are where needed.

Pipe identification is provided where required.

Escutcheons are provided where needed and are secured properly.

All wall and/or floor penetrations by pipe are properly packed.

A set of as-built drawings was given to owners rep.



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TRAINING PLAN

Project Name

Contract Number

Equipment/systemTraining objective

Date Time

Training location

TRAINING SIGN-IN SHEET

Name(Print) Department Telephone



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CERTIFICATE OF OCCUPANCY

Building Permit Number Date

The undersigned hereby applies for a permit of occupancy in accordance with 780 CMR 120, sixth edition:

1. Location of building

2. Applicant

3. Owner

Address

4. Occupant

5. Use group Occupancy

6. Construction type Occupant load

7. Special stipulations or conditions

Plumbing/gas Fire

Electrical Water and sewer

Health Public works

I hereby certify that the work specified by the above named building permit has been completed and is ready foroccupancy.

Building Inspector

Inspection Director

Date

Unit NumberStreet Address



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FIRE ALARM SYSTEMRECORD OF COMPLETION

(Name) (Firm)

Name of protected property

Address

Representative of protected property (name/phone)

Authority having jurisdictionAddress/telephone number

Organization name/phone Representative name/phone

Installer

Supplier

Service organization

Location of record (as-built) drawings

Location of operation and maintenance manuals

Location of test reports

A contract for test and inspection in accordance with NFPA standard(s)

Contract number(s) Effective date Expiration date

System Software(a) Operating system (executive) software revision level(s)

(b) Site-specific software revision date

(c) Revision completed by

1. TYPE(S) OF SYSTEM OR SERVICE

NFPA 72, National Fire Alarm Code,Chapter 6 Local

If alarm is transmitted to location(s) off premises, list where received

NFPA 72,Chapter 8 Remote Station

Telephone numbers of the organization receiving alarm:

AlarmSupervisory

Trouble

If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone

numbers of the organization receiving alarm

Indicate how alarm is retransmitted

NFPA 72,Chapter 8 Proprietary

Telephone numbers of the organization receiving alarm:

Alarm

Supervisory

Trouble

If alarms are retransmitted to public fire service communications centers or others, indicate location and telephonenumbers of the organization receiving alarm

Indicate how alarm is retransmitted

NFPA 72,Chapter 8 Central Station

Prime contractor

Central station location



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Means of transmission of signals from the protected premises to the central station

McCulloh Multiplex One-way radio

Digital alarm communicator Two-way radio Others

Means of transmission of alarms to the public fire service communications center

(a)

(b)

System location

NFPA 72,Chapter 9 Auxillary

Type of connection: Local energy Shunt Parallel telephone

Location of telephone number for receipt of signals

2. RECORD OF SYSTEM INSTALLATION

(Fill out after installation is complete and wiring is checked for opens, shorts, ground faults, and improper branching

but prior to conducting operational acceptance tests.)

This system has been installed in accordance with the NFPA standards as shown below and was inspected by

on , includes the devices shown

in items 5 and 6, and has been in service since .

NFPA 72,Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply)

NFPA 70,National Electrical Code, Article 760

Manufacturers instructions

Other (specify)

Signed Date

Organization

3. RECORD OF SYSTEM OPERATIONDocumentation in accordance withNFPA 72, Inspection Testing Form, Figure 10.6.2.3, is attached .

All operational features and functions of this system were tested by date

and found to be operating properly in accordance with the requirements of:

NFPA 72,Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply)

NFPA 70,National Electrical Code, Article 760

Manufacturers instructions

Other (specify)

Signed Date

Organization

4. SIGNALING LINE CIRCUITS

Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):

Quantity Style Class



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5. ALARM-INITIATING DEVICES AND CIRCUITS

Quantity and class of initiating device circuits (see NFPA 72, Table 6.5)


MANUAL

(a) Manual stations Noncoded Transmitters Coded Addressable

(b) Combination manual fire alarm and guards tour coded stations

AUTOMATIC

Coverage: Complete Partial

Selective Nonrequired

(a) Smoke detectors Ion Photo Addressable

(b) Duct detectors Ion Photo Addressable

(c) Heat detectors FT RR FT/RR RC Addressable

(d) Sprinkler waterflow indicators: Transmitters Noncoded Coded Addressable

(e) The alarm verification feature is disabled or enabled , changed from seconds to seconds.

(f) Other (list)

6. SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUITS (use blanks to indicate quantity of devices)

GUARDS TOUR

(a) Coded stations

(b) Noncoded stations

(c) Compulsory guards tour system comprised of transmitter stations and intermediate stations

Note: Combination devices are recorded under 5(b), Manual, and 6(a), Guards Tour.

SPRINKLER SYSTEM

Check if provided

(a) Valve supervisory switches

(b) Building temperature points

(c) Site water temperature points(d) Site water supply level points

Electric fire pump

(e) Fire pump power

(f) Fire pump running

(g) Phase reversal

Engine-driven fire pump

(h) Selector in auto position

(i) Engine or control panel trouble

(j) Fire pump running

ENGINE-DRIVEN GENERATOR

(a) Selector in auto position(b) Control panel trouble

(c) Transfer switches

(d) Engine running

Other supervisory function(s) (specify)



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7. ANNUNCIATOR(S)

Number Type Location

8. ALARM NOTIFICATION APPLIANCES AND CIRCUITS

NFPA 72, Chapter 6 Emergency Voice/Alarm Service

Quantity of voice/alarm channels Single MultipleQuantity of speakers installed Quantity of speaker zones

Quantity of telephones or telephone jacks included in system

Quantity and the class of notification appliance circuits connected to system (see NFPA 72, Table 6.7):


Types and quantities of notification appliances installed

(a) Bells With Visible

(b) Speakers With Visible

(c) Horns With Visible

(d) Chimes With Visible

(e) Other: With Visible

(f) Visible appliances without audible

9. SYSTEM POWER SUPPLIES

(a) Fire Alarm Control Panel Nominal voltage Current rating

Overcurrent protection Type Current rating

Location

(b) Secondary (standby)

Storage battery Amp-hour rating

Calculated capacity to drive system, in hours

Engine-driven generator dedicated to fire alarm system

Location of fuel storage

(c) Emergency system used as backup to primary power supply

Emergency system described in NFPA 70, Article 700

10. COMMENTS

Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s)

System deviations from the referenced NFPA standard(s)

(signed) for installation contractor/supplier (title) (date)

(signed) for alarm service company (title) (date)

(signed) for central station (title) (date)

Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction)

(signed) representative of the authority having jurisdiction (title) (date)



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Date

Time

SERVICE ORGANIZATION PROPERTY NAME (USER)

Name Name

Address Address

Representative Owner contact

License No. Telephone

Telephone

MONITORING ENTITY APPROVING AGENCY

Contact Contact

Telephone Telephone

Monitoring Account Ref. No.

TYPE TRANSMISSION SERVICE

McCulloh Weekly

Multiplex Monthly

Digital Quarterly

Reverse Priority Semiannually

RF Annually

Other (specify) Other (specify)

Control unit manufacturer Model No.

Circuit styles

Number of circuitsSoftware revised

Last date system had any service performed

Last date that any software or configuration was revised

ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION

Quantity Circuit Style

Manual fire alarm boxes

Ion detectors

Photo detectors

Duct detectorsHeat detectors

Waterflow switches

Supervisory switches

Other (specify)

Alarm verification feature is disabled enabled .

FIRE ALARM SYSTEMS INSPECTION AND TESTING FORM



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ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION


Bells

Horns

Chimes

Strobes

SpeakersOther (specify)

Number of alarm notification appliance circuits

Are circuits monitored for integrity? Yes No

SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUIT INFORMATION


Building temperature

Site water temperature

Site water level

Fire pump power

Fire pump running

Fire pump auto positionFire pump or pump controller trouble

Fire pump running

Generator in auto position

Generator or controller trouble

Switch transfer

Generator engine running

Other

SIGNALING LINE CIRCUITS

Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):

Quantity Style(s)

SYSTEM POWER SUPPLIES(a) Primary (main): Nominal voltage Amps

Overcurrent protection: Type Amps

Location (of primary supply panelboard)

Disconnecting means location

(b) Secondary (standby):

Storage battery: Amp-hr. rating

Calculated capacity to operate system, in hours: 24 60

Engine-driven generator dedicated to fire alarm system:

Location of fuel storage

TYPE BATTERY

Dry cell

Nickel-cadmium

Sealed lead-acid

Lead-acid

Other (specify)

(c) Emergency or standby system used as a backup to primary power supply, instead of using a secondary power supply:

Emergency system described in NFPA 70, Article 700

Legally required standby described in NFPA 70, Article 701

Optional standby system described in NFPA 70, Article 702, which also meets the performance requirements of Article 700 or 701.



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PRIOR TO ANY TESTING

NOTIFICATIONS ARE MADE Yes No Who Time

Monitoring entity

Building occupants

Building management

Other (specify)

AHJ notified of any impairments

SYSTEM TESTS AND INSPECTIONS

TYPE Visual Functional Comments

Control unit

Interface equipment

Lamps/LEDS

Fuses

Primary power supply

Trouble signals

Disconnect switches

Ground-fault monitoring

SECONDARY POWER

Type Visual Functional Comments

Battery condition

Load voltage

Discharge test

Charger test

Specific gravity

Transient Suppressors

Remote Annunciators

Notification Applicances

Audible

Visible

Speakers

Voice clarity

INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS

Device Visual Functional Factory MeasuredLoc. & S/N Type Check Test Setting Setting Pass Fail

Comments



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EMERGENCY COMMUNICATIONS EQUIPMENT Visual Functional Comments

Phone set

Phone jacks

Off-hook indicator

Amplifier(s)

Tone generator(s)

Call-in signal System performance

Device SimulatedVisual Operation Operation

INTERFACE EQUIPMENT

(Specify)

(Specify)

(Specify)

SPECIAL HAZARD SYSTEMS

(Specify)

(Specify)

(Specify)

Special procedures

Comments

SUPERVISING STATION MONITORING Yes No Time Comments

Alarm signal

Alarm restoration

Trouble signal

Supervisory signal

Supervisory restoration

NOTIFICATIONS THAT TESTING IS COMPLETE Yes No Who Time

Building management

Monitoring agency

Building occupants

Other (specify)

The following did not operate correctly

System restored to normal operation: Date Time

THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS.

Name of inspector Date Time

Signature

Name of owner or representative

Date Time

Signature



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FIRE ALARM SYSTEMS PLAN REVIEW CHECKLIST

Project Name

Contract Number Date

Name of owner

Name of occupant

Location, including street address

Device legend

Floor plan drawings are drawn to an indicated scale and include the following information:

Floor or area identification

Point of compass

Graphic scale

All walls and doors

All partitions extending to within 18 in. (0.5 m) of ceiling

Room descriptions

Fire alarm device/component locations

Location(s) of fire alarm primary power connection(s)

Locations of monitor/control interfaces to other systems

Riser locations

Fire alarm system riser diagrams include the following information:

General arrangement of system, in building cross section

Number of risers

Type and number of circuits in each riser

Type and number of fire alarm system components /devices on each circuit, on each floor or level

Control panel wiring diagrams are provided for all control equipment, power supplies, battery chargers,and annunciators and include the following information:

Identification of control equipment depicted

Locations

All field wiring terminals and terminal identifications

All circuits connected to field wiring terminals and circuit identifications

All indicators and manual controls, including full text of all labels

All field connections to supervising station signaling equipment, releasing equipment, and fire safetycontrol interfaces

Typical wiring diagrams are provided for all initiating devices, notification appliances, remote alarm

light emitting diodes (LEDs), remote test stations, and end-of-line and power supervisory devices.

Reviewed by Date



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AUTOMATIC SPRINKLER SYSTEMS PLAN REVIEW CHECKLIST

Project Name

Contract Number Date

Name of owner

Name of occupant

Location, including street address

Point of compass

PLANS

Working plans are drawn to an indicated scale, on sheets of uniform size, with a plan of each floor, andshow those items from the following list that pertain to the design of the system:

Full-height cross section or schematic diagram, including structural member information (if required forclarity), ceiling construction, and method of protection for nonmetallic piping

Location of partitions

Location of fire walls

Occupancy class of each area or room Location and size of concealed spaces, closets, attics, and bathrooms

Any small enclosures in which no sprinklers are to be installed

Size of city main in street and whether it is dead end or circulating

If dead end, direction and distance to nearest circulating main

City main test results and system elevation relative to test hydrant

Other sources of water supply, with pressure or elevation

Make, type, model, and nominal K-factor of sprinklers, including sprinkler identification number

Temperature rating and location of high-temperature sprinklers

Total area protected by each system on each floor

Number of sprinklers on each riser, per floor

Total number of sprinklers on each dry pipe, preaction, combined dry pipepreaction, or deluge system Approximate capacity in gallons of each dry pipe system

Pipe type and schedule of wall thickness

Nominal pipe size and cutting lengths of pipe (or center-to-center dimensions)

Where typical branch lines prevail, necessary information is shown to complete plan review:

Location and size of riser nipples

Type of fittings and joints

Location of all welds and bends

Verification of all sections to be shop welded and type of fittings or formations to be used

Type and locations of hangers, sleeves, braces, and methods of securing sprinklers, where applicable

All control valves, check valves, drain pipes, and test connections Make, type, model, and size of alarm or dry pipe valve

Make, type, model, and size of preaction or deluge valve

Type and location of alarm bells

Size and location of standpipe risers, hose outlets, hand hose, monitor nozzles, and related equipment

Private fire service main sizes, lengths, locations, weights, materials, and point of connection to city main

Types and locations of valves, valve indicators, regulators, meters, and valve pits



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Depth that top of pipe is laid below grade

Piping provisions for flushing

Where equipment is to be installed as an addition to an existing system, enough of existing system indicated onplans to make all conditions clear

For hydraulically designed systems, information on the hydraulic data nameplate

Graphic representation of scale used on all plans

Name and address of contractor

Hydraulic reference points shown on plan that correspond with comparable reference pints on hydrauliccalculation sheets

Minimum rate of water application (density), design area of water application, in-rack sprinkler demand, andthe water required for hose streams both inside and outside

Total quantity of water and the pressure required noted at a common reference point for each system

Relative elevations of sprinklers, junction points, and supply or reference points

If room design method is used, all unprotected wall openings throughout the floor protected

Calculation of loads for sizing and details of sway bracing

The setting for pressure-reducing valves

Information about backflow preventers (manufacturer, size, type)

Information about antifreeze solution used (type and amount) Size and location of hydrants, showing size and number of outlets and whether outlets are to be equipped with

independent gate valves

Whether hose houses and equipment are to be provided and by whom

Indication of static and residual hydrants used in flow tests

Size, location, and piping arrangement of fire department connections

Working plan submittal includes manufacturers installation instructions for any specially listed equipment,including descriptions, applications, and limitations for any sprinklers, devices, piping, or fittings.

WATER SUPPLY CAPACITY

The following information on water supply capacity is included:

Location and elevation of static and residual test gauge with relation to riser reference point Flow location

Static pressure, psi (bar)

Residual pressure, psi (bar)

Flow, gpm (L/min)

Date and time of test

Other sources of water supply, with pressure or elevation

HYDRAULIC CALCULATION REVIEW

The summary sheet contains the following information where applicable:

Date

Location Name of owner

Name of occupant

Building number or other identification

Description of hazard

Name and address of contractor or designer

Name of approving agency



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SYSTEM DESIGN REQUIREMENTS

System design requirements as follows are included:

Design area of water application, ft2 (m2)

Minimum rate of water application (density), gpm/ft2(mm/min)

Area per sprinkler, ft2 (m2)

Total water requirements as calculated, including allowance for inside hose, outside hydrants, and watercurtain and exposure sprinklers

Allowance for in-rack sprinklers, gpm (L/min)

Limitations (dimension, flow, and pressure) on extended coverage or other listed special sprinklers

DETAILED WORKSHEETS

Detailed worksheets or computer printout sheets contain the following information:

Sheet number

Sprinkler description and discharge constant,K

Hydraulic reference points

Flow, gpm (L/min)

Pipe size

Pipe lengths, center-to-center of fittings

Equivalent pipe lengths for fittings and devices

Friction loss of pipe, psi/ft (bar/m)

Total friction loss between reference points

In-rack sprinkler demand balanced to ceiling demand

Elevation head between reference points, psi (bar)

Required pressure at each reference point, psi (bar)

Velocity pressure and normal pressure if included in calculations

Notes to indicate starting points or reference to other sheets or to clarify data shown

Diagram to accompany gridded system calculations to indicate flow quantities and directions for lines with

sprinklers operating in the remote area CombinedK-factor calculations for sprinklers on drops, armovers, or sprigs where calculations do not begin

at the sprinkler

GRAPH SHEET

Graphic representation of complete hydraulic calculation is plotted on semiexponential graph paper(Q1.85) and includes the following:

Water supply curve

Sprinkler system demand

Hose demand (where applicable)

In-rack sprinkler demand (where applicable)

Reviewed by Date



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2000, 2005 National Fire Protection Association

AUTOMATIC SPRINKLER SYSTEMS GENERAL INFORMATION

GENERAL

System designation

Building

Location of sprinkler valve

Type of sprinkler system Wet Dry Deluge Preaction

Make and model of sprinkler valve

Is building fully sprinklered? Yes No

Is entire sprinkler system in service? Yes No

Has sprinkler system been modified since last inspection? Yes No

VALVESHow are valves supervised? Seated Locked Tamper switch

Are valves identified with signs? Yes No

WATER SUPPLY

When was last water supply test made?

Are reservoirs, tanks, or pressure tanks in good condition? Yes No

PUMPS

What type of fire pump does system have? Diesel Electric Gasoline None

When was pump last inspected?

Is pump in good condition?

Yes

No

FIRE DEPARTMENT CONNECTIONS

Location

Are identification signs provided? Yes No

WET SYSTEMS

Is building adequately heated? Yes No

Is system hydraulically calculated? Yes No

If yes, is hydraulic information sign provided at valve? Yes No

DRY SYSTEMS

Is dry pipe valve in heated room? Yes No

Does heated room have low-temperature alarm? Yes No

Notes

Project Name

Date Inspector

System



26/57


OWNERS INFORMATION CERTIFICATE

Name/address of property to be protected with sprinkler protection

Owner

Existing or planned construction is: Fire resistive or noncombustible

Wood frame or ordinary (masonry walls with wood beams)

Unknown

Is the system installation intended for one of the following special occupancies:

Aircraft hangar Yes No Airport terminal Yes No

Fixed guideway transit system Yes No Aircraft engine test facility Yes No

Race track stable Yes No Power plant Yes No

Marine terminal, pier, or wharf Yes No Water-cooling tower Yes No

If the answer to any of the above is yes, the appropriate NFPA standard should be referenced for sprinkler density/area criteria.

Indicate whether any of the following special materials are intended to be present:

Flammable or combustible liquids Yes No Compressed or liquefied gas cylinders Yes NoAerosol products Yes No Liquid or solid oxidizers Yes No

Nitrate film Yes No Organic peroxide formulations Yes No

Pyroxylin plastic Yes No Idle pallets Yes No

If the answer to any of the above is yes, describe type, location, arrangement, and intended maximum quantities.

Indicate whether the protection is intended for one of the following specialized occupancies or areas:

Spray area or mixing room Yes No

Solvent extraction Yes No

Laboratory using chemicals Yes No

Oxygenfuel gas system for welding Yes No

or cuttingAcetylene cylinder charging Yes No

Production or use of compressed or Yes Noliquefied gases

If the answer to any of the above is yes, describe type, location, arrangement, and intended maximum quantities.

Will there be any storage of products over 12 ft (3.6 m) in height? Yes No

If the answer is yes, describe product, intended storage arrangement, and height.

Will there be any storage of plastic, rubber, or similar products over 5 ft (1.5 m) high except as described above? Yes No

If the answer is yes, describe product, intended storage arrangement, and height.

I certify that I have knowledge of the intended use of the property and that the above information is correct.

Signature of owners representative or agent Date

Name of owners representative or agent completing certificate (print)

Relationship and firm of agent (print)

Commercial cooking operation Yes No

Class A hyperbaric chamber Yes No

Cleanroom Yes No

Incinerator or waste-handling system Yes No

Linen-handling system Yes NoIndustrial furnace Yes No

Water-cooling tower Yes No



27/57

(p. 1 of 3)

CONTRACTORS MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING

1 Measured from time inspectors test connection is opened2 NFPA 13 only requires the 60-second limitation in specific sections

PROCEDURE

Upon completion of work, inspection and tests shall be made by the contractors representative and witnessed by an owners representative.All defects shall be corrected and system left in service before contractors personnel finally leave the job.

A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor.It is understood the owners representatives signature in no way prejudices any claim against contractor for faulty material, poor workmanship,

or failure to comply with approving authoritys requirements or local ordinances.

Property address

Date

Accepted by approving authorities (names)

Address

Installation conforms to accepted plans.

Equipment used is approved.If no, explain deviations.

Has person in charge of fire equipment been instructed as

to location of control valves and care and maintenanceof this new equipment? If no, explain

Have copies of the following been left on the premises?

1. System components instructions

2. Care and maintenance instructions

3. NFPA 25

Location ofSystem

Supplies buildings

Make Model

Year ofManufacture

OrificeSize Quantity

Temperaturerating

Sprinklers

Pipe andFittings

AlarmValve or

FlowIndicator

Maximum Time to OperateThrough Test Connection

Make ModelType Minutes Seconds

Dry PipeOperating

Test

Q. O. D.

Make Serial no. Make Model Serial no.

Time to Trip

Through TestConnection1,2

WaterPressure

AirPressure

Trip PointAir Pressure

Time Water

ReachedTest Outlet1,2

AlarmOperated Properly

Minutes Seconds psi psi psi Minutes Seconds Yes No

WithoutQ.O.D.

WithQ.O.D.

If no, explain

Type of pipe

Type of fittings

Alarm Device

Model

Dry Valve

Property name

Instructions

Plans

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No




28/57

(p. 2 of 3)

Deluge andPreaction

Valves

OperationPneumatic Electric Hydraulics

Piping supervised Yes No Detecting media supervised Yes No

Does valve operate from the manual trip, remote, or bothcontrol stations?

RemoteManual Both

Is there an accessible facility in each circuitfor testing?

If no, explain.

Yes No

Make Model

Does each circuit operatesupervision loss alarm?

Does each circuit operatevalve release?

Maximum time tooperate release

Yes No Yes No Minutes Seconds

Test

Description

Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar)above static pressure in excess of 150 psi (10.2 bar) for 2 hours. Differential dry-pipe valve clappers shall be leftopen during the test to prevent damage. All aboveground piping leakage shall be stopped.

Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1 x psi (0.1 bar)in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shallnot exceed 1 x psi (0.1 bar) in 24 hours.

Tests

All piping hydrostatically tested atDry piping pneumatically testedEquipment operates properly

psi ( bar) for hours If no, state reason.

Do you certify as the sprinkler contractor that additives and corrosive chemicals, sodium silicate or derivativesof sodium silicate, brine, or other corrosive chemicals were not used for testing systems or stopping leaks?

Draintest

Reading of gauge located near watersupply test connection

Yes No

psi ( bar)

Residual pressure with valve in test

connection open wide

Underground mains and lead-in connections to system risers flushed before connection made tosprinkler piping

Verified by copy of the Contractors Material and TestCertificate for Underground PipingFlushed by installer of underground sprinkler piping

Yes No

Yes No

Other Explain

Blank TestingGaskets

Number used Locations Number removed

Welding

Do you certify as the sprinkler contractor that welding procedures complywith the requirements of at least AWS B2.1?

Do you certify that the welding was performed by welders qualified incompliance with the requirements of at least AWS B2.1?

Do you certify that the welding was carried out in compliance with adocumented quality control procedure to ensure that all discs are retrieved,that openings in piping are smooth, that slag and other welding residueare removed, and that the internal diameters of piping are not penetrated?

Welding piping Yes No

If yes . . .

Yes No

Yes No

Yes No

Cutouts(Discs)

Do you certify that you have a control feature to ensure thatall cutouts (discs) are retrieved?

Yes No

PressureReducingValve Test

Make andmodel Setting

Locationand floor Static pressure

Residual pressure(flowing) Flow rate

Inlet (psi) Outlet (psi) Inlet (psi) Outlet (psi)

If powder-driven fasteners are used in concrete,

has representative sample testing beensatisfactorily completed?

If no, explainYes No

Flow (gpm)

psi ( bar)

Yes No

Yes No




29/57

(p. 3 of 3)

Nameplate providedHydraulic Data

Nameplate Yes No

If no, explain.

RemarksDate left in service with all control valves open

Signatures

Name of sprinkler contractor

Tests witnessed by

For property owner (signed) Title Date

For sprinkler contractor (signed) Title Date

Additional explanations and notes




30/57


STANDPIPE AND HOSE SYSTEMS GENERAL INFORMATION

GENERAL

System designation

Building

Location of control valve

Type of system Class I Class II Class III

Length of hose provided None 50 ft (15 m) 75 ft (23 m) 100 ft (30 m)

Type of hose Rubber lined Unlined

(If unlined hose is presently installed, it may remain in use. However, when it requires replacement, only lined hoseshould be used in accordance with NFPA 14,Standard for the Installation of Standpipe and Hose Systems.)

Are shutoff nozzles provided? Yes No

(If no, nozzles should be replaced with shutoff type in accordance with NFPA 14.)

Are pressure-regulating devices provided? Yes No

Type of regulating devices

VALVES

How are valves supervised? Sealed Locked Tamper switch


WATER SUPPLY



PUMPS


Is pump in good condition? Yes No

When was pump last tested?


Location


Notes

Project Name

Date Inspector

System



31/57

(p. 1 of 3)

PROCEDURE

Upon completion of work, inspection and tests shall be made by the contractors representative and witnessed by an owners representative.All defects shall be corrected and system left in service before contractors personnel finally leave the job.

A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and

contractor. It is understood the owners representatives signature in no way prejudices any claim against contractor for faulty material, poorworkmanship, or failure to comply with approving authoritys requirements or local ordinances.

Property name

Property address

Date

Plans

Accepted by approving authorities (names)

Address

Installation conforms to accepted plans?

Equipment used is approved or listed?If no, explain deviations.

Yes No

Yes No

Automatic-dry

Automatic-wet

Semitautomatic-dry

Manual-dry

Manual-wet

Combination standpipe/sprinkler

Other (if yes, explain)

Yes

Type ofSystem Yes

Yes

Yes

Water SupplyData Used forDesign and As

Shown on Plans

If PublicWaterworks

System:

Type of pipe

Type of fittings

Standpipe System NFPA 14

Yes

Yes

Yes

Fire pump date

Manufacturer Model

Type:

Rated, gpm

Electric Diesel Other (explain)

Rated, psi Shutoff, psi

Water SupplySource Capacity,

Gallons

Public waterworks system Storage tank Gravity tank Open reservoir

Other (explain)

Static, psi Residual, psi Flow in, gpm

Have Copiesof the Following

Been Left onthe Premises?

System components instructions Care and maintenance of system NFPA 25

Copy of accepted plans Hydraulic data/calculations

SuppliesBuilding(s)

Main waterflow shutoff location

Number of standpipe risers

Do all standpipe risers have base of r iser shutoff valves? Yes No

ValveSupervision

Locked open Sealed and tagged Tamperproof switch Other

If other, explain.

Pipe andFittings

Double check assembly

Reduced-pressure deviceSize Make and model

BackflowPreventor

CONTRACTORS MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING




32/57

(p. 2 of 3)

CONTROL VALVE DEVICE

Type Size Make Model

Time to trip through remote hose valve

Time water reached remote hose valve outlet

Alarm operated properly?

Min Sec Water pressure Air pressure

Min Sec Trip point air pressure psi

Min Sec

Yes No If no, explain.

Time water reached remote hose valve outlet

Hydraulic activation

Electric activation

Pneumatic activation

Make and model of activation device

Each activation device tested? Yes No If no, explain.

Yes

Yes

Yes

Each activation device operated properly? Yes No If no, explain.

Yes No If no, explain.

PRESSURE-REGULATING DEVICE

Location & Floor Model Inlet Outlet Inlet Outlet gpm

Nonflowing (psi) Flowing (psi)

All hose valves on system operated properly?




33/57


34/57


WATER SPRAY FIXED SYSTEMS GENERAL INFORMATION

GENERAL

System designation

Building


Has system been modified since last inspection? Yes No

What is hazard protected?

VALVES



WATER SUPPLY



PUMPS




FIRE DEPARTMENT CONNECTIONSLocation


OPERATING INSTRUCTIONS

Are operating instructions posted? Yes No

Notes

Project Name

Date Inspector

System



35/57


WATER MIST SYSTEMS GENERAL INFORMATION

GENERAL

System designation

Building

Location of main control valve



VALVES


Are valves identified with signs?

Yes

No

WATER SUPPLY

Is water supply filtered? Yes No

Are storage tanks, if used, in good condition? Yes No

PUMPS



DETECTION SYSTEM(if any)

When was detection system last inspected?



Notes

Project Name

Date Inspector

System



36/57


FOAMWATER SPRINKLER SYSTEMS GENERAL INFORMATION

GENERAL

System designation

Building


Make and model of valve



VALVES



WATER SUPPLY



PUMPS





Location




Notes

Project Name

Date Inspector

System



37/57


FOAM SYSTEMS GENERAL INFORMATION

GENERAL

System designation

Building


Make and model of valve


What hazard is protected?

VALVES



WATER SUPPLY



PUMPS





Location




Notes

Project Name

Date Inspector

System



38/57


39/57


HYDRANT FLOW TEST REPORT

Location Date

Test made by Time

Representative of

Witness

Purpose of test

Consumption rate during test

If pumps affected test, indicate pumps operating

Flow hydrants: A1 A2 A3 A4

Size nozzle

Pitot reading

Discharge coefficient Total gpm

gpm

Static B psi Residual B psi

Projected results: @20 psi residual gpm or @ psi residual gpm

Remarks

Location map: Show line sizes and distance to next cross-connected line. Show valves and hydrant branch size. Indicatenorth. Show flowing hydrants and label as A1, A2, A3, A4. Show location of static and residual and label as B.

Indicate B: Hydrant Sprinkler Other (identify)



40/57


SAMPLE HYDRAULIC DATA GRAPH SHEET

Notes

Project Name

Date Inspector

System

100(378.5)

200(757)

300(1136)

400(1514)

500(1893)

600(2271)

700(2650)

800(3028)

900(3407)

1000(3785)

Q1.85 Flow, gpm (L/m) (Multiply this scale by _______ .)

10(69)

20(138)

30(207)

40(276)

50(345)

60(414)

70(483)

80(552)

90(621)

100(689)

110(758)

120(827)

Pressure,psi(kPa

)

0



41/57


CARBON DIOXIDE EXTINGUISHING SYSTEMS GENERAL INFORMATION

CO2system manufacturer

Detector manufacturer

Control panel manufacturer

Date system installed

Room or area designation

Volume protected Above ceiling Below raised floor Between floor and ceiling

System concentration 50% 65% 75% Other % for minutes

Weight of CO2agent with cylinder lb (kg)

Weight of cylinder (tare weight) lb (kg)

Weight of CO2agent lb (kg)

Normal pressure (super pressure) psi (bar)

Detection system Ionization-type smoke detectors

Photoelectric-type smoke detectors

Rate-of-rise heat detectors

Fixed-temperature heat detectors

Rate-compensation heat detectors

OtherType of detection for CO2 Single zonesystem operation

Two zones (cross-zoned)

Two detectors on any zone

Other

Notes

Project Name

Date Inspector

System

Reset All Pages Reset Form PageReset Form Page


42/57


DRY CHEMICAL EXTINGUISHING SYSTEMS GENERAL INFORMATION

System designation

System manufacturer


Service contractor

Type of extinguishing agent Potassium bicarbonate Ammonium phosphate Sodium bicarbonate

Other

Dry chemical cylinder

Normal pressure psi (bar)

Manufacturers minimum pressure psi (bar)

Normal weight lb (kg)

Manufacturers minimum weight lb (kg)

Equipment protected Deep-fat fryer(s) Upright broiler(s) Grill(s)

Griddle(s) Charbroiler(s) Range top(s)

Other

Expellant gas cartridge provided? Yes No

If yes, normal weight (if carbon dioxide) lb (kg)

normal pressure (if nitrogen) psi (bar)

Connected to fire alarm system? Yes No

Automatic shutdown of cooking equipment? Yes No

If yes, Gas Electric

Notes

Project Name

Date Inspector

System

Reset Form PageReset Form PageReset All Pages


43/57

Project Name

Date Inspector

System


DRY CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE INSPECTION

Y= Satisfactory N= Unsatisfactory (explain) N/A= Not applicable

Note: Pressures and weights are satisfactory if equal to or greater than minimums in Form 9B

Dry chemical cylinder pressure psi (bar)

Expellant gas cartridge:

Pressure of nitrogen, psi (bar)

Weight of carbon dioxide, lb (kg)

Check dry chemical agent for lumping or caking incartridge-operated-type systems.

Check to ensure that hazard is as defined on approved plans.

Check detectors and fusible links for damage or obstruction.

Check expellant gas containers for proper installation.

Check agent containers for proper installation.

Check manual releases for proper installation.

Check piping for proper installation and changes.

Check hand-hose assemblies for proper installation.

Check discharge nozzles for proper installation.

Check local signal devices for proper installation.

Check auxiliary equipment for proper installation.

Check that fusible link is installed.

Notes

Acceptance? If N, Explanation



44/57


DRY CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE TESTS

Date of acceptance test

Manual release Satisfactory Unsatisfactory

Fusible link Satisfactory Unsatisfactory

Connection to fire alarm system? Yes No

Results Satisfactory Unsatisfactory

Connection to shut off power to cooking equipment? Yes No


Fusible link replaced? Yes No

Connection to shut down supply air to exhaust hood?


Grease exhaust fan Continues to run Stops

Connection to shut off electric power to receptacles under hood?


Hydrostatic test performed on:

Pressure cylinders Yes No Hoses and fittings Yes No

Dry chemical chambers Yes No Check valves Yes No

Auxiliary pressure containers Yes No Directional valves Yes No

Valve assemblies Yes No Manifolds Yes No

Notes

Project Name

Date Inspector

System



45/57


WET CHEMICAL EXTINGUISHING SYSTEMS GENERAL INFORMATION

System designation

System manufacturer


Service contractor

Type of extinguishing agent Potassium carbonate Potassium acetate

Combination potassium carbonate/potassium acetate

Wet chemical cylinder

Normal pressure psi (bar)

Manufacturers minimum pressure psi (bar)

Normal weight lb (kg)

Manufacturers minimum weight lb (kg)

Equipment protected Deep-fat fryer(s) Upright broiler(s) Grill(s)

Griddle(s) Charbroiler(s) Range top(s)

Other

Expellant gas cartridge provided? Yes No

If yes, normal weight (if carbon dioxide) lb (kg)

normal pressure (if nitrogen) psi (bar)

Connected to fire alarm system? Yes No

Automatic shutdown of cooking equipment? Yes No

If yes, Gas Electric

Notes

Project Name

Date Inspector

System



46/57

Project Name

Date Inspector

System


WET CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE INSPECTION


Note: Pressures and weights are satisfactory if equal to or greater than minimums in Form 9E

Wet chemical cylinder pressure, psi (bar)(if stored-pressure type)

Expellant gas cartridge (if expellant gas type):

Pressure of nitrogen, psi (bar)

Weight of carbon dioxide, lb (kg)

Components are undamaged:

Detectors or fusible links

Expellant gas cylinder(s)

Wet chemical containers

Releasing devices

Piping

Nozzles

Alarms

Auxiliary equipment

Damaged components replaced or hydrostatically tested

System piping tested for obstructions

System piping not obstructed

Fusible link installed

Notes




47/57


WET CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE TESTS

Date of acceptance test

Manual release Satisfactory Unsatisfactory

Fusible link Satisfactory Unsatisfactory

Connection to fire alarm system? Yes No


Connection to shut off power to cooking equipment? Yes No


Connection to shut down supply air to exhaust hood? Results Satisfactory Unsatisfactory

Grease exhaust fan Continues to run Stops

Connection to shut off electric power to receptacles under hood?


Hydrostatic test performed; system left in service Yes No

Notes

Project Name

Date Inspector

System



48/57


CLEAN AGENT EXTINGUISHING SYSTEMS GENERAL INFORMATION

Clean agent system manufacturer

Detector manufacturer

Control panel manufacturer


Room or area designation

Type of extinguishing agent

Volume protected Above ceiling Below raised floor Between floor and ceiling

System concentration 50% 65% 75% Other

Weight of clean agent with cylinder lb (kg)

Weight of cylinder (tare weight) lb (kg)

Weight of clean agent lb (kg)

Normal pressure (super pressure) psi (bar)

Detection system Ionization-type smoke detectors

Photoelectric-type smoke detectors

Rate-of-rise heat detectors

Fixed-temperature heat detectors

Rate-compensation heat detectors

Other

Type of detection for clean Single zonesystem operation

Two zones (cross-zoned)

Two detectors on any zone

Other

Notes

Project Name

Date Inspector

System



49/57

Project Name

Date Inspector

System


CLEAN AGENT EXTINGUISHING SYSTEMS ACCEPTANCE INSPECTION AND TEST


Clean agent containers free from physical damage

Container pressure psi (bar)

(Pressure loss greater than 5% requires container refillor replacement.)

Container weight lb (kg)

(Weight loss greater than 5% requires container refillor replacement.)

Container pressure and weight recorded on tag attachedto container

Control heads operational (Remove heads from containers.)

Conduct acceptance test of system.

Notes




50/57

(p. 1 of 2)

HIGH-RISE STAIR TOWER SMOKE-CONTROL ACCEPTANCE TEST

Building name and address

Date

STAIR TOWER AND SYSTEM DESCRIPTION, EQUIPMENT AND DESIGN FEATURESStair tower identification Location

Number of floors accessible by stair tower

Fan, equipment, and control location

Fan type HP RPM CFM

Fan equipment circuit breaker and/or disconnect location

Fan supply air-intake location

Emergency power transfer switch location

Number of system injection points Location

Number of system dampers Type Location

Number of system static sensors Location

Number of system status indicators Location

STAIR PRESSURIZATION SYSTEM OPERATION, METHOD OF ACTIVATION

Standpipe and/or sprinkler system main water flow Yes No FST* N/AStandpipe riser (wet) system water flow Yes No FST N/ASprinkler (wet) system floor and/or areas/zones water flow Yes No FST N/ASprinkler (dry pipe) system water flow Yes No FST N/ASprinkler (preaction) system detection device Yes No FST N/ASprinkler (preaction) system water flow Yes No FST N/A

Smoke (area detection) detector Yes No FST N/A

Smoke (stair tower) detector Yes No FST N/ASmoke (HVAC supply air) detector Yes No FST N/ASmoke (HVAC return air) detector Yes No FST N/ASmoke (stair pressurization supply air fan) detector Yes No FST N/AHeat detector Yes No FST N/A

Kitchen hood suppression system Yes No FST N/AFire suppression system Yes No FST N/A

Manual pull boxes Yes No FST N/AManual control Yes No FST N/A

System fan control equipment circuitry (impairment) Yes No FST N/Asupervision

*FST = Time it takes to start fan on actuation of initiation device.

Comments



51/57

(p. 2 of 2)

STAIR PRESSURIZATION, DOOR HARDWARE, AND DOOR OPERATIONPERFORMANCE RESULTS

Comments

Type of instrumentation equipment used for differential pressure evaluation

Type of instrumentation equipment used for force factor evaluation

Test conducted by

Door LatchRelease

Force

Stair

Door

Door Setin Motion

Force

Door Swingto Full Open

Force

PressureDifferencewith All

Doors Closed

PressureDifferencewith One

Door Open

PressureDifferencewith Two

Doors Open

PressureDifferencewith Three

Doors Open



52/57

Project Name

Date Inspector

System


SMOKE-CONTROL SYSTEMS ACCEPTANCE TEST


Fans (list each)

Dampers (list each)

Doors and Closers

Other Equipment

EquipmentOperatesProperly?Equipment

Notes(Number and record additional notes on reverse)



53/57

Project Name

Date Inspector

System


SMOKE-CONTROL SYSTEMS PERFORMANCE TEST


Ensure that system is in normal mode.

Measure and record:

Wind speed

Wind direction

Outside temperature

Test system normal power.

Test system emergency power.

Confirm that for each input there is a designated output.

Demonstrate complete smoke-control system sequence:

Normal mode

Automatic smoke control from first alarm

Manual override of normal and automatic modes

Return to normal

Confirm that fire alarm inputs produce correct outputs.

Establish consistent method for recording pressuredifferences.

Confirm that introduction of untempered air will notdamage equipment.

Confirm that weather conditions (freezing temperatures)will not damage equipment.

Notes

RecordInformation Notes



54/57

Project Name

Date Inspector

System


ZONED SMOKE-CONTROL SYSTEMS ACCEPTANCE TEST

Verify location of the perimeter of each smoke-control zone.

Confirm that all doors in the smoke-control zoneare closed.

Measure and record pressure difference across smoke barrier at each door or pair of doors in smoke barrier.


Pressure

Difference NotesDoor

Verify proper operation of each zoned smoke-control system in response to each required means of actuation. List each.




55/57

Project Name

Date Inspector

System


EMERGENCY GENERATOR ACCEPTANCE INSPECTION


Check fuel tank fuel supply level.

Inspect dry tank level.

Inspect and operate dry tank float switch.

Inspect and operate supply or transfer pump.

Inspect and operate solenoid valve.

Check for water in fuel system.

Check flexible hose and connectors.

Check oil level in the engine.

Check lube oil heater for operation.

Check level of cooling system for engine.

Check cooling water to heat exchanger for adequacy.

Check adequacy of fresh air through radiator.

Check water pump.

Check flexible hoses and connections.

Check water-jacket heater.

Check exhaust system for leakage.

Check the drain condensate trap.

Check electrolyte level in the batteries.

Check electrical system.

Inspect engine.

Check housekeeping in generator room and fuelsupply tanks.

Inspect generator.




56/57

Project Name

Date Inspector

System


EMERGENCY STANDBY POWER SYSTEMS ACCEPTANCE TESTS

Y= Satisfactory N= Unsatisfactory (explain)

Test each battery-powered unit so that laps operatefor 30 seconds.

Test emergency generator batteries for specificgravity or state of charge.

Operate emergency generator with no load.

Test antifreeze protection level.

Test operation of safeties and alarms.

Test tank vents and overflow piping.

Test louver motors and controls.

Test exhaust system for excessive backpressure.

Test ignition systemplugs, points, cap, rotor,secondary wire insulation.

Test injector pump and injectors.

Measure and record resistance readings of windingswith insulation tester (Megger).

Test each battery-powered unit for 90 minutes.

Test emergency generator under full load or underbank-load full load.

Notes




57/57

Project Name

Date Inspector

System

FIRE DOORS ACCEPTANCE INSPECTION

1. Check door for physical damage and to see that vision panel (if provided) is secure.

2. Check that closer works.

3. Check that latch works.

4. Check that hinges are secure.

5. Check that coordinator (if provided) works.

6. Check tin-clad or Kalamein doors for dry rot.

7. Check cables and/or chains on sliding doors to ensure that they are in good condition and operate properly.

8. Check cables, chains, rollers, fusible links, and other moving parts for paint or other contaminants that may alteroperation. Replace fusible links that have been painted.

9. Lubricate hinges on swinging doors and rollers on sliding doors.

10. Check that labeled fire doors have not been modified improperly.11. Clear surrounding area of obstructions that may interfere with door operation.

12. Check that sliding doors close freely and completely.

Notes

Y= Satisfactory N= Unsatisfactory (explain on reverse) N/A= Not applicable

Fire Door Number or Location 1 2 3 4 5 6 7 8 9 10 11 12


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