HomeMy WebLinkAboutAnnual Fire Sprinkler System Inspection - Inspection - 1/30/2020 2 7-�-t
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Annual
Fire Sprinkler System Inspection
CINTAS FIRE PROTECI"ION
710 NARRAGANSETT PARK DR
PAWTUCKET, RI 02861
USA
02861
qVI
READY FOR THE WORKDAY T hi
Inspection date: 2020-01-30 Inspector: EDWARD BICKFORD 0UF4064
Inspection Location `
NA KOHL'S 535 0OF4041372
350 WINTHROP AVE
NORTH ANDOVER, MA 018454289
Phone: Fax:
Customer
NA KOHL'S 535 0pF4441372
350 WINTHROP AVE
NORTH ANpOVER, MA 018454289
Phone: 9786868737 fax:
Inspection performed in accordance with
NFPA 25 Standard for the Inspection, Testing, and Maintenance
of Water-Based Fire Protection Systems, 2014 edition.
SPRINKLER Page 1 of 6
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Notification Friar to 'besting
Person at alarm-receiving facility notified before testing 4.1, DISPATCH
Time alarm-receiving facility notified 09:24
Person at Fire Department notified before testing ,1.4 DISPATCH
Time FD notified before testing 09:2
AHJ notified before testing 4,1. YES
Time H notified 09:2
Notifications After Fasting
Person at alarm-receiving facility notified after testing 4.1. YE
Time alarm-receiving facility notified after testing 11:92
Person at Fire Department notified after testing ,1..4 YE
Time FD notified after testing 11:92
AM notified after testing 4.1.4 YES
Time AHJ notified after testing 11;02
Date system restored to normal operation. 202 -D1- o
Time system restored to normal operation. 11: 2
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Items Total Systems
Wet System
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Wet System Inspection
Sprinkle- heads appear free of corrosion, foreign material, paint or damage, no signs of leafage and Pass
heads/deflectors installed in proper orientation .2.1..1.)
Escutcheons and coverplates in place, if applicable. (5.2.1.1.6) Pass
Minimum clearance maintained below all sprinklers ,2.1,2 Pass
replacement sprinkler heads per number installed in the head box comply: 6 per 1-300: 12 per 301 to N/A
1,Do , 24 per I 1 . ■1,
Sprinkler head wrench for each type head provided in head box .4.1. Pass
List of sprinklers installed on the property posted on head box. (5.4.1.5.6) Pass
System piping and fittings free of mechanical damage, leaks, corrosion, misalignment, or other loads or Fail
pipe hung from system .2,2
Pipe hangers and seismic braces secure and undamaged .2.3 Fail
Sprinklers in building that are at least 50 years old, has sprinkler sample been tested .3.1.1.1 N/A
Fast response sprinklers over 20 gears old, has sprinkler sample been tested .3.1.1.1.3 N/A
Dry sprinklers in service for 10 gears, has sprinkler sample been tested . .1,1,1.0 N/A
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Alarm Valve
System 1 Stock r
Water pressure gauges operating properly 13.4.1.1 Pass
Exterior of valve free of physical damage, valves in normal position 13. .1.1 Pass
System control valve is accessible and free of leaks, has appropriate wrench and properly secured Pass
(13.4.1.1)
Retard chamber and alarm drains free from leakage (1 .4.1.1) Pass
Hydraulic nameplate, if applicable, securely attached and is legible .2. Pass
Information sign securely attached and legible, 4.1t9. ) Bass
Pressure (psi) shown on System side pressure gauge, 140
SPRINKLERPage 2 of
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Alarm Valve
System I Stock r
Pressure (psi) shown on Supply water pressure gauge, 13. . 10
Residual Pressure with valve open 13. . 130
Static Pressure after valve closed 1 , .5 140
Main Drain Test Pressure less than 10% reduction in flow from original acceptance test or previous test Pass
results 13, , .
Adequate drainage available 13. . Pass
Valve Status Test-Valves open when returned to service, (13.3.1.2.1) Pass
Internal inspection -all components operate properly and move freely, valve cleared and in good condition l 1
{13.4. .1
Internally inspect valve strainers, filters, and restriction orifices; free from obstructions, operating properly, I
and in good condition 13.4.1.
Gauges on valve, when compared to calibrated gauge, error is loss than 3co full scale or gauge has been I
recalibrated or replaced .5.3L
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Alarm Valve
System 2 Stock Rm
Water pressure gauges operating properly 13. .1.1) Pass
Exterior of valve free of physical damage, valves in normal position 1 . .1.1 Pass
System control valve is accessible and free of leas, has appropriate wrench and properly secured Pass
13, .1.1
Retard charnber and alarm drains free from leakage 13,4.1.1 Pass
Hydraulic nameplate, if applicable, securely attached and is legible 5, . ) Pass
Information sign securely attached and legible. (4.1.9.2) Pass
Pressure (psi) shown on System side pressure gauge. 140
Pressure (psi) shown or Supply Water pressure gauge. 13L . 140
Residual al Pressure with valve open 1 . .5 130
Static Pressure after valve closed 1 . . 140
Maim Drain Test Pressure less than 10% reduction in flow from original acceptance test or previous test Pass
results 13, . . )
Adequate drainage available 13. . Pass
Valve Status Test•- Valves open when returned to service. 1 .3.1. .1 Pass
Internal inspection -all components operate properly and move freely, valve cleared and in good condition I
114. .1
Internally inspect valve strainers, filters, and restriction orifices; free from obstructions, operating properly,
and in good condition 1 . t1.
Gauges on valve, when compared to calibrated gauge, error- is less than 3% full scale or gauge has been I
recalibrated or replaced .3,
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Area/Location Operates properly
SYSTEM I COMPACTOR Pass
Y TEf TOO Pass
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Check Valve
FD
Internal inspection and test valve for correct operation, valve roves freely and is it in good condition 1
13. . .1
SPRINKLER Page 3 of
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Check Valve
System side bck flour
Externally inspect -Are gauges working property, valve free of damage and in normal open or closed Pass
position, retarding chamber or alarm drain without leaks 13.4.1.1)
Internal inspection and test valve for correct operation, valve moves freely and is it in good condition N I
{13.4. .1
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Type Area/Location Area/Location [yodel Size Signs Condition Position Secured Exercised Seal
Control Valve- Butterfly 6 Pass Pass Pass Pass Pass NA
locked/tamper
Control Valve - :City bck flow ' S and Y 11 Pass Pass Pass Pass Pass NA
locked tamper
Control Valve - SYSTEM 2 Butterfly F't Pass Pass Pass Pass Pass NA
locked tamper
Control Vaive - SYSTE I Butterfly 611
Pass Pass Pass Pass Pass NA
locked/tamper
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"n
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Type Area/Location Visual Insp Functional Test
Tamper Switch Pass Pass
Tamper-Switch Pass Pass
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Type Area/Location Visual.Insp Functional Test
Water Motor Alarm Pass Pass
Iaterflow Alarm - Pressure pass Pass 36-12
Switch/Vane
Electric Bell Pass Pass
Water Pressure Alarm Switch SYSTEM 2 Pass Pass 36.12
1 aterflow Alarm - Pressure YST 1 Pass Pass .1
Switch/Vane
3'.'� .^. r ur 'fir' ..:............�.,.. ". ,.....�
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Backflow Prevention s emb Device
Are isolation valves in open position 13.6.1,1 Pass
Forward flower test at minimum flow rate of system demand 13. . .1 1
Backflow performance test conducted satisfactorily at completion of forward flow test N I
Internally inspection verifies all components operate correctly, move freely and are in good condition N/I
(0.6.1.4)
Internal Pipe Condi ion Assessment
Internal pipe condition assessment. 1 . .1 N/I
Date of last 5 year internal inspection. NEEDS TO BE DONE
Internal Pipe Condition Assessment
Internal pipe condition assessment. 1 * .1 N I
Date of last 5 year internal inspection. NEEDS TO BE DONE
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! I
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Fire Department Connection
STOCK ROOM
FDC risible and accessible, without damage and signs in place 13.7.1 Pass
Couplings and swivels free of damage and rotate smoothly 13.7.1 Pass
Caps, plugs and gaskets in place and free fronn damage 1 .7,1 Pass
Check valve clapper free from leaks and automatic drain valve in place and operating property 13.7.1 Pass
Interior of the connection free of obstructions. 13,7,1 II
Internal inspection of chock valve - components operate properly, cleaned/repaired as needed 13. . .1 N I
Hydrostatic test results of piping from FDC to check valve acceptable. 13.7. 1
......."......� ..?'. .... .. w....a.. a ....✓ �m .". ...,yt ... �......".. i k.r.,. :!^c�::�:;:'�.;'{:...:i�.:n,.::•:.n::.:.::: ..�.�.",•::..:r..x.v;:: n•fy:N' .�
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.♦.. .. ik! N..: � .. :n ..v.. ... .. � .:s...'::.:s:yv.-..may..[.�:k.,r....n}�. �::ix
_. .....: ... x w, a.: r. v � 2•..... yw .:... v .. .k...... - i�:� .',r.♦ .'Sw.'x.�'�':..:�.�:`.�:>i:,,y':,.}..<�.�vn'r:.".'x::..�:...k:[:':�':y..::.;...':..v:':::�'v M1 .i:f%�;i��:�{..:''s.�;:':::,`:',�
w i .. .. ',",�' .. n ,< ...� u F".fx �n � ...Y'•. y.,.�.;.:...:'..._....,J,'L.:::::...........',k-� f............�.X^..y... �w* {/:1�: 1 .5../:f. ..}..
yr"....�...........?x..h..�.a'i..W.s..ar,4r,�'.oav�,e....rn.,.s,.J.fr...,..>��.v.,.�w�..�+•�.r.��."`A3b1:...cc�k ti.�/3...�u7 o?r...r.....�rrrS?M.,:+.'v,er��.«,ta:e_...,.eY.�v w._...,�^�`.�r. ..... .. ,
*PAR response indicated 'Pass After Repair". Technician rates a deficiency of a device, and repairs the deficiency during inspection.
System Inspection
System piping and fittings free of mechanical damage, leaks, corrosion, misalignment, or other loads or pipe hung from
system .2;
Technician Response: pipe/Fittings - Leaking
ing
Wet System Inspection
Pipe hangers and seismic braces secure and undamaged : .
Technician Response: Hangers/Seismic Braces - Missing
_. .r...,... ��>+^ .. :�5�,,... � r 'C. .w ,.M M.�.. ....,..��_ � .. ';%. r� ,y �:r-!:M ':�7:'„'r-nr ,✓"'r..rn.,...n.::w:::rd%'n:s�r',:::)'�':�:`;:`:::Efy'>''';:z%:":.;:+i�..S�n;'>. ....... ...... .....
........ .. ....
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i�../-f.n.y.t.{�i.t»+: ,r} rv. f Sf.' y ,f�✓ ..w tA.i���.*::'f"' '�Y>}3 N,::y ...kl. ,-f. }} �:�„Mt+* Y.l`':�+�wry,l,..�,. ,Y'="-"'..
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„"Jy. 9 �'C{ �> .' � � .+ '�'�'.."w '7�%' �;...� n G �;rM,� s!�r"•,�;..••—„%w �✓„..N{•},'�y" a5 �.�t, y .�
. y'Y'�,,,5 "�..,� . „r'w ��.� .ex„:•"may '"
r
V
C? :. ,�: ..r :."x�.��� „s-�.'„�? �. .�Y .��. ,. .. .,.h , oi'a»..���rrf � ky��.'.w.�r � '�JS'/ �,k•*y;,'J..^��!l!.'. '„y�, r+wn*::k•�:,k;.�Y�c:�7!�.
:::.::ir ....
a� .. .ion ition: ssesrr
Question: Internal pipe condition assessment. 14. .1
Technician Response: NOT DUE FOIE TESTING AT TIT TIME,
Backflow 'Prevention Assembly Device
Question: Forward flow test at minimum flow rate of system demand (13.6.2.1
Technician Response:
Question: Back flow r performance test conducted satisfactorily at completion of forward flow test
Technician Response:
Question: Internally inspection verifies all components operate correctly, more freely and are in good condition
(13.6.1.4)
Technician Response: NOT DUE FOR TESTING AT THIS TIME.
'Interna
I Pipe Condition Assessment
Question: Internal pipe condition assessment. 1 . .1
Technician Response: NOT DUE FOR VESTING AT THIS TIME.
Fire Department Connection
STOCK Roots
Question: Interior of the connection free of obstructions. 13.7.1
Technician Response: NOT DUE FOR TESTING AT THIS TIME.
Question: Internal inspection of check valve - components operate properly, cleaned/repaired as needed 1 . . .1
Technician Response: NOT DUE FOIE TESTING AT TH IS TIDE.
Question: Hydrostatic test results of piping from FDC to check valve acceptable. 13.7.4
Technician Response; N OT DUE FOR TESTING AT THIS TIME.
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n. ..�:x. f.. .�...., r f, r ...w•w. �, T'.."�. ^�f wi.rSf.. ..n... ^'?:'... . ..,.
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..�yC .V"y!.Ph... ' ��' '^':v ",e�'.o' "F.S3rt..r^v� '� .:�',,.b�.v`"�"a�s "'",r_: :::!�....:�".:v_%L:..:•8'irf r v...r;%Z'::6rs?w^';:is�vnsr,::l+iti:' :;'„o:::�;':;.n2G!s....n#x�:C;.*�: %�'�"":.":C� w;�r,;,'=Y :- :��'.�e'o-�
: .Check Valve
ED
Question: Internal inspection and test valve for correct operation, valve moves freely and is it in good condition
13. r 2.1
Technician Response: N OT DUE FOR TESTING AT THIS TIME.
'Alarm Valve
System 1 Stock rr
Question: Internal inspection - all components operate properly and move freely, valve cleaned and in good condition
3. . .1
Technician Response: NOT DUE FOR TESTING AT THIS TI ME.
Question: Internally inspect valve strainers, filters, and restriction orifices; free from obstructions, operating properly,
and in good condition 3. . ..
Technician Response: NOT DUE FOR TESTING AT THIS TIME.
Question; Gauges on valve, when compared to calibrated gauge, error is less than °o full scale or gauge has been
rec librated or replaced ,3.
Technician Response: NOT DUE FOR TESTING AT THIS TIME.
AID I
System 2 Stock Rm
Question: Internal inspection - all components operate properly and move freely, valve cleaned and in good condition
1. . . .1
Technician Response: N OT DUE FOR TE STIN G AT THIS TIME.
Question: Internally inspect valve strainers, filters, and restriction orifices; free from obstructions, operating properly,
and in good condition 13, .1,2
Technician Response: NOT DUE FO i- TESTJ N G AT THIS TI ME.
Question: Gauges on valve, when compared to calibrated gauge, error is less than 3% full scale or gauge has been
recalibrat d or replaced .3,
Technician Response: N OT Dt1E FO R TESTING AT TH IS TIME.
System side b k flow
Question: Internal inspection and test valve for correct operation, valve moves freely and is it in goad condition
(13. ,2.1
Technician Response: NOT DUE FG R TESTING AT THIS TIME.
Liability Release Statement
The owner and/or designated representative acknowledges the responsibility of the operating condition of the component
parts at the time of this inspection. It is agreed that the inspection service provided by the contractor as prescribed
herein is limited to performing a visual inspection and/or routine testing, and any investigation or unscheduled testing,
modification, maintenance, repair, etc,, of the component parts is not included as part of the inspection work performed.
It is further understood that all information contained herein is provided to the best of the knowledge of the party
providing such information.
1/30120 1 i o120
Customer: JANREY Technician: EDWA D BICKFORD 0OF O 4
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