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Home My WebLink AboutPre-Engineered System Inspection Report - Inspection - 10/7/2020 i IMPACT FIRE PRE=ENGINEERED SYSTEM INSPECTION REPORT IMPACT FIRE SERVICES y 00am EDT 44 GARDEN STREET, SUIT 10/07/2020 - - -- DANVERS, MA 01923 9 8.30 . 5o Annual semi-Annual Recharge Installation Renovation/Test 1:1 0 0 0 Customer J..Location System Information: o 3o 03109 2 SUP Na me:-Ed ewoodRetirement-Bistro gal e:Ar s l Address: uild'IModel: Ro2DT City, T-,zip: North Andover MA 01845 Size:Sizek6 Gal 9T x2 owner i anager Dan Forte -............. control Head Type 1 L.oeatiem 130on wall Phone: (978) Location of Gas Valve:Behind line Email: fortedan@edgewoodrc.com Yes No I Yes No 1 System interlocked with building fire alarm 13 Checkedoperation of manual release All tamper seals intact. No evidence of tampering 14 Checked operation of micro-switch All appliances properly covered w correct nozzles V :15 Checked operation of gas vaIve M E H ELE ) 4 Duct(s)&plenum properly covered w correct nozzles 16 Piping conduit securely braced � Filters in place at time of inspection 17 Nozzles cleaned Pressure gauge in acceptable range V 118Proper nozzle ca ps/covers in place Qty " leked ar -idge weight 1 System operational armed Cylinder8 within by rote t plate Due o 'lx Fan yarning sign n food 9 Inspected cylinder w o nt + 1 I -Class fire extinguisher in cooking area 10 Checked ed operation of detection line 22 Allstate Fire Equipment sticker on Automan 11#of fusible links 4 0- oo.,--other � 23 Service&certification tag on system 1 Replaced fusible links System meets l�.L, Standards ooi ing Appliances(left to right) 36" Stove w Salamander, Griddle, Gas Grill, Oven, Kettle S afetyNotice:Non-compliant systems may fail to tin uishisuppress a fire.Below are non-compliant conditions which require immediateattention.All State pment-Ate I rnpaet Fire Company assumes no responsibility for sy tem performance if these conditions are not corrected and/or verifted by areauthorized agent of All Sta-------te Fire Equipment-An Impact Fire ornpany. ................. Comments Non-Compliance: All state Fire Equipment Agent: Date: 10 0 2020 9.008im EDT .................. waylon Brown ustomer'sAuthorized Agent: Efate: 0 0 2020 09.0 am EDT If testing for Authority Having Jurisdiction: AH1 Print: Testing Date: AHJ Signature: Jurisdiction: MACR 4612 k IMPACT FIRE PRE=ENGINEERED SYSTEM INSPECTION REPORT IMPACT FIRE SERVICES 44 GARDEN STREET, SUITE 1 Date� Service: 1 202 o9:oor�l EDT DANVEFS, MA 01923 Ann r�nuai / er�ni-An r��ral echrg ir�stilation #�eno�ration Test El El El 1:1 E] 1:1 customer Location System In ormartlow 10130 11/16 2SUP Name: Edge wood Retirement-Bistro Mai :Arlin Address: Building 000 Model:R102D 40 ST Zip: North Andover MA 01845 Size:6 Gal ST x2 Owner/Manager Dan Forte Control Head Type I Location: Dean/*In cabinet Phone: 97 738-6414 Location of Gas valve:Behind Tine Em ail: for eda n@ed ewoodr . om Yes No l Yes No 1 System interlocked ed with building fire alarm 1 113 Checked operation of manual release I-E I_RV Lj I All tamper seals intact. No evidence of tampering 14 Checked operation of micro-switch Ali ar liance pro erl covered correct nozzles 1 Checked operation of gas va Ive (Z E H ELEQ E............ ply p p 4 Duct )&plenum properly covered w correct nozzles 16 Piping/ conduit securely braced FiltersE ............ 5 in place at time of inspection r 17 Nozzles cleaned Pressure gauge in acceptable range I:LV 118 proper nozzle caps/covers in place Qty / Checked cartridge weight 119 System operational&armed 8 Cylinder within hydrotest dame Due 20 9120 Fan yarning sign on hood 9 Inspected cylinder mount v 1 -Class fire extinguisher in oohing area 10 Checked operation of detection line Allstate Fire Equipment sticker on Auto rnan 11#of fusible link {450� 500�...._�ther � Service c certification tag on System 1 Replaced fusible links system meets U1.300 Standards Cooking Appliances(left to right) o" stove, griddle: grill, fryer FFIreEquipment Notice: Ion-compliant systems may fall to extinguish/suppress a fire.Below are non-compliant conditions wl�'ro�n require immediate attention.All state �-An Impact Fire Company assumes no responsibility for syste€n performance if these conditions are not corrected and/or v rified by an ed agent of All State Fire Equipment-An Impact Fire Company, Comments/Nora-Compliance: i i f All State dire Equipment Ant. Date: 10 07 2 20 :00am EDP' Wayion Brown x Date: 10 7 2020 o :oo rrr EDT u�#: tomerF s Authorized Agent. If testing for Authority Having Jurisdiction: I. Vesting Date: AHJ Print: AHJ Signature: Jurisdiction: MAC 1 WORK ACKNOWLEDGEMENT IMPACT FIRE f Your Tech n Man: From Impact Fire Services,LL .n Waylon Brown 44 Garden 3t,Unit 1 On site 10 7 2020 at 9:0 a m Danvers,MA 01923 (978)30 -1 0 Job No. 19737248 Jab For Edgewood Retirement-Bistro Type Inspection Building 4000 PO No. North Andover,MA 1845 Completed Services 0) Suppression Inspection- 360Degree Fusible Lind -Qty-4Lin1 s Blow Down 02DT 1.02DT 02DT Parts,labor and items used QTY Inspection KITCHEN FIRE SUPPRESSION SYSTEM INSPECTION Inspection KITCHEN ESSI -ADDL CYLINDER 2 Part FUSIBLE LINK 1 Labor SU PPf ESSiON SEMI-AN NUAL PIPE BLOWDOWN (PER CYLI N DER) Part RUBBERNOZZLE CAP REPLACED ED O Part METAL NOZZLE CAP REPLACED Part FOIL NOZZLE SEAL REPLACED Pam RE PLACE SUP PRESS IOi SMALL CO2A TI ATi0I ON CARTRIDGE O Labor SUPPRESSION ESSION SYSTEM NOZZLE CLEANING(PER NOZZLE) 1 Fee KS SERVICE CALL Inspection FX SERVICE CALL Inspection FX ANNUAL MAINT FIVE E T O Part FXTAMPER INDICATING DEVICE O Service FCC DISCHARGE ASSURANCE PLAN Other SWAP OUT DRY CHEM SLB Other SWAP OUT DIY HEM OO Other (;WAP 01 IT K CAI l PAN AC F T n WORK ACKNOWLEDGEMENT IMPACT FIRE Your Techniciam From impact Fire Services,LL . x Waylon Brown 44 Garden St,Unit 1 n site 10 0 at 9:5 2a rn Danvers,MA 01923 978)34-156 Job No. 19737241 Job For Fd ewood Retirement- Type inspection Meadows Po No. Building 900 North Andover, 01845 Completed Services Inspect System Parts,labor and items used CITY Inspection KITCHEN FIRE SUPPRESSION SYSTEM iNSPECTI N I I nspe tion KITCHEN FSS -A DL CYLINDER 1 Part FUSIBLE LINK Labor SUPPRESSION SEMI-ANNUAL PIPE BL DOWN(PER CYLINDER) 2 Part RUBBER NOZZLE CAP REPLACED 10 Part METAL NOZZLE CAP REPLACED Part FOIL NOZZLE SEAL REPLACED Part RP LAC ESUP PRESS II SMALL C2ACTIVATIN CARTRIDGE o Labor SUPPRESSION SYSTEM NOZZLE CLEANING(PER NOZZLE) 10 Fee KSSERVICE CALL Convents o Comment Disclaimers and Warranties 1.LlMIT'ATION of COMPANYS LIABILITY.To THE FULLEST EXTENT PEt MIITTED BY APPLICABLE LAW,IF COMPANY IS FOUND LIABLE FOR ANY LOSS OR DAMAGE DUE TO BREACH OF CONTRACT OR WARRANTY,ANY DEGREE OF NEGLIGENCE OF COMPANY,STRICT PRODUCT LIABILITY,SUBROGATION,INDEMNIFICATION OR NTRIBUTIO ,OR ANY OTHER THEORYOF LIABILITY(EXCEPT FOR INTENTIONAL M ISCONDU T)AR IS]N FROM OR RELATIN G TO THIS QUOTE,PROPOSAL OR AGREEMENT,THE DESIGN,,INSTALLATION,INSPECTION,TESTIN ,MONITORING,REPAIR,SERVICE,OPERATION OR NON-OPERATION I OF THE SYSTEM OR EQUIPMENT, IN ANY RESPECT AT ALL,THE MAXIMUM LIABILITY OF THE COMPANY WILL BE LIMITED To A SUM NEVER TO EXCEED FIVE THOUSAND DOLLARS( 50 .0 ),AND THIS LIABILITY SHALL BE EXCLUSIVE.THE COMPANY IS DEFINED IN THESE GENERAL TERMS AND CONDITI ONSTO INC LUDE THE COMPAN S EMPLOYEES,AGENTS ANL SUBCONTRACTORS,THIS LIMITATION OF LIABILITY SPECIFICALLY COVERS LIABILITY FOR,AMN OTHER THINGS,LOST PROFITS;BUSINESS INTERRUPTION;LOSS OF PROPERTY,DAMAGE D PROPERTY OR LOSS OF USE OF PROPERTY;PERSONAL INJURIES AN D DEATH;GLOSS-CLAIMS AND CLAIMS FOR IN DEM IITY AN CONTRIBUTION;N;AND THE CLAIMS OF THIRD PARTIES.ALSO COVERED BY THIS LIMITATION ARE,AMONG OTHERS,THE FOLLOWING TYPES OF DAMAGES-DIRECT, INDIRECT,SPECIAL,INCIDENTAL,CONSEQUENTIALANDPUNITIVE. IM PA CT FIRE aPREmENGINEERED SYSTEM INSPECTION REPORT IMPACT FIRE SERVICES 44 GARDEN STREET SUITE 1 Date of Service: 10/07/2020 09,30am EDT DAM E S, MA 01923 978.304.1506 Annual ei-Annual Recharge instaliatlon Renovation Test Customer/Location System I nformation.10 13 0 1 2 SUP Nme:—E ewRetirement-Meadows MakeAnsul Address: Building 900Model:R1 02 City,ST,Zip: North Andover MA 01845 di e: owner/Manager Control Head Typo / Location: 13 wall Phone: Location of Gays Valve'Behind line Email: Yes No I Yes No /A System interlocked with building fire alarm 113 Checked operation of manual release 2 All tamper seals intact. No evidence of tampering 114 Checked operation of micro-switch h PIE All appliances properly covered w/correct nozzles115Checked operation of gas valve ( l ECH FL } D t(s)&plenum properly covered w/correct nozzles 16 Piping/conduit securely braced *MMMM Filters in place at time of inspection V t I L 17 Nozzles cleaned Pressure gauge in acceptable range 18 Proper nozzle caps/covers in place Qty 1 7 Checked artrdge weight System operational armed Cylinder within hydrotest date Due 2022x 20 Fan warning sign on hood Inspected cylinder&mount 21 K-Class fire extinguisher in cooking area + o Checked operation of detection line 22 Allstate Fire Equipment sticker on Autornan + 11#of fusible links 50 450- 500a other�� 23 Service&certification tag on system 2 Replaced fusible lint 24 Systernmeets U.L.300 Standards Cooing Appliances(left to right) Ovens, Char Grill, 24" Stove, Griddle, Fryer, Steamers Safety Notice:Ikon-compliant systems may fail to extinguish/suppress a fire.Below are non-compliant conditions which require immediate attention.All State r ire Equiprnent-Are Impact Fire ompany assumes no responsibility for system performance if the a conditions are not corrected and/or verified b an uthorized agent of All State Fire Equipment-An Impact Fire Company, Comments Non-compliance: All State Fire Equipment Agent: Date: / /2 2 9:3 am EDT 1ayion Brown Customer's Authorized Agent: Date: _1 2 2 9-3 am EDT If testing for Authority Having Jurisdiction: A l Print; Testing Date: M Signature: Jurisdiction: 11ACR 4612