date unifour - amazon s3...09/19/2016 08:00am edt, 09/20/2016 08:00am edt 9/19/16 9 langtree...

ALARM INFORMATION (AI)

BFP INFORMATION (BI)

EXTERIOR INSPECTION (EI)

DRY PIPE SYSTEM INSPECTION (DI)

Yes No N/A

13. Antifreeze tested & OK? (Record below)

14. Relief valves on gridded systems OK?

15. FDC & caps OK?

16. FDC swivels non-binding rotation?

17. FDC gaskets/signs in place?

18. FDC equipped with ball drip?

19. Sprinkler system main drain test

completed & OK? (Record pg 2)

1. Was the WMG or elec bell tested & OK?

2. Central Station flow alarm tested & OK?

3. Central Station tamper tested & OK?

4. Alarm devises free from physical damage

& all electrical connections secure?

5. Alarm trim valves OK & set properly?

6. No leakage from retard chambers or

alarm drains?

7. Inspectors test connection(s) OK?

1. Isolation valves open?

2. Backflow devices passed test?

3. Make

4. Model

5. Size

1. Exterior hydrants flushed?

2. Non draining hydrants pump out?

3. City pit checked?

4. City pit pumped out?

1. Dry pipe valves in service & in good

condition - internally & externally?

2. Pressure & priming water OK?

3. Air supply in good working order?

4. Were low points drained during fall &

winter inspections?

5. Are accelerators in good condition?

6. All dry valves been trip tested & OK?

(Record below)

7. Dry pipe valves in heated area?

8. Pipe pitched OK & no interior ice?

# of Systems

# Dry

# of BFPs Fire

Inspector

License #

Company

Address

Phone Contact

# Antifreeze

Dom

U N I F O U R

F I R E & S A F E T Y

NFPA 25 InspectionDate

of 2

Annual Quarterly

Antifreeze System(s) Location

OK to what temperature

Number of Heads

PO Box 9489Hickory, NC 28603

Customer Acknowledgment:

Hickory, NC 828.328.6363

Greensboro, NC 336.373.3973

Raleigh, NC 919.834.9644

Charlotte, NC 704.372.3473

Charleston, SC 843.278.1018

Columbia, SC 803.929.2100

Greenville, SC 864.458.7070

Atlanta, GA 770.978.7998

Location Make/Year Mfg. Model / SIN # / QR or SR TypeColor

B=Bronze / W=White / C=Chrome

Esc Plate Style Size ‘K’-Factor Thread ½” ¾” 1” Temp

GENERAL INFORMATION (GI)

VALVE INFORMATION (VI)

SPRINKLER & PIPING INFORMATION (SI)

Yes No N/A

1. Is the building occupied as in past?

2. Is the building fully sprinklered?

3. Systems in service without modification

since the last inspection?

4. Spare head box with heads and wrench

securely mounted?

5. Stock/storage a minimum of 18” below

sprinkler head & ceiling tiles in place?

6. Gauges condition good?

Last calibration date: / /

7. Wet system areas adequately heated?

8. Does building have freezers/coolers?

1. Are all main control valves open?

2. Main control valves in good condition

and identified?

3. Are control valves secure? (Record pg 2)

4. Are all control valves accessible & free

from external leaks?

5. Are all control valve provided with the

proper operators?

6. All control valves operated through full

range & returned to normal position?

7. Valves lubricated, as needed?

1. Are all sprinklers unobstructed?

2. Sprinklers free of corrosion, tape, paint,

& physical damage?

3. Heads in freezer/coolers appear free of

ice, corrosion?

4. Are all sprinklers less than 50 years old?

5. Are escutcheon plates ok?

6. Sprinklers of proper temperature rating?

7. Riser in good condition & unobstructed?

8. Hydraulic nameplate OK?

9. System ID securely attached & legible?

10. Pipe in good condition, free of damage

& obstructions, and not leaking?

11. All hangers OK?

12. Seismic bracing OK?

09/19/2016 08:00am EDT, 09/20/2016 08:00am EDT

✔

Langtree Apartments 24150 Landings Drive 9 Na

Mooresville NC 28117 6 4Adam Lee Sims, Alex Lee Sims 2

980-406-6470 Rick Johnson 31631

✔

✔ ✔

✔ ✔

✔✔

✔

✔✔

✔

✔

2013 ✔✔

✔

✔ ✔

✔

✔

✔

✔✔

✔

✔

✔

✔

375

✔

✔

✔

✔

✔

✔

Wilkins

✔

✔

✔

✔

✔

✔

✔

✔

6"

✔ ✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

Low ceiling Tyco 2012 Ty6237 QR Chrome Sem rec SSP 17/32 11.2 3/4" 155°

Low ceiling Rascal 2012 RA1414 QR Sem rec Ssp 1/2 5.6 1/2" 155°

Open ceiling attic Rasco 2013 RA7326 QR NA Ssp 17/32 11.2 3/4"

✔

✔

155°

NA

WhiteBronze

of 2

Date

Annual

Quarterly

Monthly

Company

Riser tag in place

Inspector’s Signature Customer Acknowledgement Print Name & Title

All systems in service Alarm system reset

U N I F O U R


NFPA 25 Inspection


Hickory, NC 828.328.6363Greensboro, NC 336.373.3973Raleigh, NC 919.834.9644Charlotte, NC 704.372.3473

Charleston, SC 843.278.1018Columbia, SC 803.929.2100Greenville, SC 864.458.7070Atlanta, GA 770.978.7998

Control Valves

Main Drain & Alarm Test

Check Valve and Piping

ControlValves

System

Sectional

City Pit/BFP

Tank/Pump

No. ofValves

Type

EasilyAccessible

Signs Valve OpenIf yes, how?

Secured?Circle those applicable

Sealed Locked Supvd

ValveSupervisionOperational

Yes Yes Yes Yes YesNo No No No No

1

System No.

System Size

Static Pressure (psi)


Residual Pressure (psi)

Local Alarm OK (Y / N)

Central Alarm Sent (Y / N)

Make

Model

Year

2 3 4 5 6 7 8 9

Comments And Inspection Deficiencies

Install Dateor Last Inspect. LocationType What Type of Access # of Valves

Other

09/19/2016 08:00am EDT, 09/20/2016 08:00am EDT

Langtree Apartments

✔

33 Bfv ✔ ✔ ✔ ✔

✔ ✔ ✔ ✔

✔ ✔ ✔ ✔

✔

13 Bfv

6 Os&y

✔

✔ ✔

2013 Fdc @ Risers Good grooved bldg 119 is inaccesible 6

2013 Alarm @ Risers Good grooved 20

✔

✔

Clubhouse143 main161 main130 2nd 130 2nd 130 mai 130 main130 roostreality120 2nd2"

100

8595Y

YShotgun

-

-

6"

110

8595Y

YShotgun

-

-

6"

110

8595Y

YShotgun

-

-

2"

100

7080Y

YAnvilD-1

2013

2"

105

7080Y

YAnvilD-1

2013

6"

105

7080Y

YShotgun

-

-

4"

105

8090Y

YReliable

G

2012

4"

105

7090Y

YReliable

G

2012

2"

100

7080Y

YAnvilD-1

2013

■ ■ ■

Rick Johnson

of 2

Date

Annual

Quarterly

Monthly

Company

Riser tag in place



U N I F O U R


NFPA 25 Inspection




Control Valves



ControlValves

System

Sectional

City Pit/BFP

Tank/Pump

No. ofValves

Type

EasilyAccessible



Sealed Locked Supvd



1

System No.

System Size






Make

Model

Year

2 3 4 5 6 7 8 9



Other

09/19/2016 08:00am EDT, 09/20/2016 08:00am EDT

Langtree Apartments

✔

Bldg 138 @ apt # 303 missing deflector will need access to room to change dry head sidewall (rasco RA1664 white standard escutcheon 1"155° 10" long measurement)

120 2nd 120 sunup120 pizza119 2nd 119 2nd 119 kilted119 slate 138 2nd 138 2nd2"

100

7080Y

YAnvilD-1

2013

6"

100

7080Y

YReliable

G

2012

4"

100

7080Y

YReliable

G

2012

2"

90

7080Y

YAnvilD-1

2013

2"

85

7080Y

YAnvilD-1

2013

6"

85

7090Y

YReliable

G

2012

4"

85

7090Y

YReliable

G

2012

2"

105

7580Y

YAnvilD-1

2013

2"

100

7080Y

YAnvilD-1

2013

■ ■ ■

Rick Johnson

Women's RR

of 2

Date

Annual

Quarterly

Monthly

Company

Riser tag in place



U N I F O U R


NFPA 25 Inspection




Control Valves



ControlValves

System

Sectional

City Pit/BFP

Tank/Pump

No. ofValves

Type

EasilyAccessible



Sealed Locked Supvd



1

System No.

System Size






Make

Model

Year

2 3 4 5 6 7 8 9



Other

09/19/2016 08:00am EDT, 09/20/2016 08:00am EDT

Langtree Apartments

✔

138 buc 138 buc 161 1st 161 1st 143 1st 143 1st6"

90

7580Y

YReliable

G

2012

4"

90

7580Y

YReliable

G

2012

2"

115

8590Y

YAnvilD-1

2013

2"

115

8090Y

YAnvilD-1

2013

2"

115

8090Y

YAnvilD-1

2013

2"

120

8090Y

YAnvilD-1

2013

■ ■ ■

Rick Johnson

Dry Pipe Valves System No. _______ System No. _______ System No. _______Area ProtectedValve Serial NumberMakeModelSizeDate of last full tripType of Trip Test Performed Today ______Partial ______Full ______Partial ______Full ______Partial ______Full

Pressure Before TestAir ______ psi ______ psi ______ psiWater ______ psi ______ psi ______ psi

Size and location of Inspector test valve

Was gate valve below dry valve open wide at test?(If not, how many turns?)

YesNo ____ # turns

Valve Tripped AtAir Pressure ______ psi ______ psi ______ psiTime _____ min _____ sec _____ min _____ sec _____ min _____ sec

If full trip test, list the water delivery time _____ min _____ sec _____ min _____ sec _____ min _____ sec

Yes No N/A Yes No N/A Yes No N/A

Valve ConditionAcceptable

ExternallyInteriorMoving PartsRubber FacingSeatsValve Reset

Did alarms operate at trip testAll low points/drum drips drainedWater control valve left open and sealedAlarm control valve left open and sealedPressure and Priming water okayAir supply in good working orderDry pipe valves in heated area

Quick Opening Devices (Accelerators) System No. _______ System No. _______ System No. _______ManufacturerType and ModelAir Pressure in upper chamber ______ psi ______ psi ______ psiQuick opening device tripped at ______ sec ______ psi ______ sec ______ psi ______ sec ______ psi


Quick opening device left in service and control open

Comments or Deficiencies:

Company: ____________________________________________________________ Address: ____________________________________________________________

____________________________________________________________Phone: __________________________ Contact: __________________________

Date: ________________

Annual Quarterly

Full Flow Date: _____________

# Dry: _________

Inspector: ___________________________ License #: ___________________________

NFPA DRY SYSTEM INSPECTIONHickory, NC 828.328.6363 Charleston, SC 843.278.1018Greensboro, NC 336.373.3973 Columbia, SC 803.929.2100Raleigh, NC 919.834.9644 Greenville, SC 864.458.7070Charlotte, NC 704.372.3473 Atlanta, GA 770.978.7998

PO Box 9489 Hickory, NC 28603

Yes YesNo ____ # turns No ____ # turns

09/19/2016 08:00am EDT, 09/20/2016 08:00am EDT

✔

9/19/16

9Langtree Apartments150 Landings Drive

NC 28117 Adam Sims

980-406-6470 Rick Johnson 31631

Clubhouse attic Bldg 143 parking garage Bldg 143 attic

Victaulic Victaulic VictaulicS/768 S/768 S/768

4" 4" 4"2013 2013 2013

X X X

16 21 19

100 95 95

1" storage room opposite side of deck 1" Opposite stairwellNo itv installed✔ ✔ ✔

4 10 14

12 8 32

NA NA 1 4 1 6

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

Victaulic Victaulic

Na S746 S746

21 19

10 14

✔ ✔ ✔





YesNo ____ # turns











Company: ____________________________________________________________ Address: ____________________________________________________________

____________________________________________________________Phone: __________________________ Contact: __________________________

Date: ________________

Annual Quarterly


# Dry: _________





09/19/2016 08:00am EDT, 09/20/2016 08:00am EDT

✔

9Langtree Apartment

150 Landings DriveNC 28117 Adam Sims

980-406-6470 Rick Johnson 31631

Bldg 161 parking garage Bldg 161 attic Bldg 120

Victaulic Victaulic Victaulic fire lockS/768 S/768 S/768

4" 4" 4"2013 2013 2013

X X X

14 15 23

95 95 70

1" opposite stairwell 1" opposite stairwell1" electrical room opposite side of deck

✔ ✔ ✔

10 10 1

6 34 2 12

32 1 27 3 32

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

Victaulic Victaulic NA

S746 S746

14 10

10 34

✔ ✔ ✔

Dry valve in bldg 120 valve did not trip within 90 seconds recommend installing Victaulic s/746 accelerator onvalve and retest





YesNo ____ # turns











Company: ____________________________________________________________ Address: ____________________________________________________________

____________________________________________________________Phone: __________________________ Contact: __________________________

Date: ________________

Annual Quarterly


# Dry: _________





09/19/2016 08:00am EDT, 09/20/2016 08:00am EDT

✔

9/19/16

9Langtree Apartments150 Landings Drive

NC 28117 Adam Sims

980-406-6470 Rick Johnson 31631

Bldg 138 attic Bldg 130 attic Bldg 119 attic

Victaulic Victaulic VictaulicS/768 S/768 S/768

4" 4" 4"2013 2013 2013

X X X

14 14 16

85 90 85

1" opposite stairwell 1" opposite stairwell1" opposite stairwell✔ ✔ ✔

5 2 3

58 1 10 1 28

1 25 1 42 2 08

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

NA NA NA

✔ ✔

date unifour - amazon s3...09/19/2016 08:00am edt, 09/20/2016 08:00am edt 9/19/16 9 langtree...

Documents