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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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
2005 National Fire Protection Association
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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
2005 National Fire Protection Association
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2005 National Fire Protection Association
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
Commissioning manager
Coordination drawing manager
FIRE PROTECTIONELECTRICAL
Project manager
On-site foreman
Commissioning manager
Coordination drawing manager
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2005 National Fire Protection Association
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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2005 National Fire Protection Association
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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2005 National Fire Protection Association
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)
Quantity Style Class
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):
Quantity Style Class
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
Quantity Circuit Style
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
Quantity Circuit Style
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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2005 National Fire Protection Association
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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(p. 3 of 3) 2005 National Fire Protection Association
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
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2002 National Fire Protection Association
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
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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
2002 National Fire Protection Association
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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
2002 National Fire Protection Association
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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
2002 National Fire Protection Association
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2000, 2005 National Fire Protection Association
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
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
Is pump in good condition? Yes No
When was pump last tested?
FIRE DEPARTMENT CONNECTIONS
Location
Are identification signs provided? Yes No
Notes
Project Name
Date Inspector
System
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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
2003 National Fire Protection Association
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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?
2003 National Fire Protection Association
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2000, 2005 National Fire Protection Association
WATER SPRAY FIXED SYSTEMS GENERAL INFORMATION
GENERAL
System designation
Building
Location of control valve
Has system been modified since last inspection? Yes No
What is hazard protected?
VALVES
How are valves supervised? Sealed 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 CONNECTIONSLocation
Are identification signs provided? Yes No
OPERATING INSTRUCTIONS
Are operating instructions posted? Yes No
Notes
Project Name
Date Inspector
System
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2000, 2005 National Fire Protection Association
WATER MIST SYSTEMS GENERAL INFORMATION
GENERAL
System designation
Building
Location of main control valve
Has system been modified since last inspection? Yes No
What is hazard protected?
VALVES
How are valves supervised? Sealed Locked Tamper switch
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
When was pump last inspected?
Is pump in good condition? Yes No
DETECTION SYSTEM(if any)
When was detection system last inspected?
OPERATING INSTRUCTIONS
Are operating instructions posted? Yes No
Notes
Project Name
Date Inspector
System
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2000, 2005 National Fire Protection Association
FOAMWATER SPRINKLER SYSTEMS GENERAL INFORMATION
GENERAL
System designation
Building
Location of control valve
Make and model of valve
Has system been modified since last inspection? Yes No
What is hazard protected?
VALVES
How are valves supervised? Sealed 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
OPERATING INSTRUCTIONS
Are operating instructions posted? Yes No
Notes
Project Name
Date Inspector
System
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2000, 2005 National Fire Protection Association
FOAM SYSTEMS GENERAL INFORMATION
GENERAL
System designation
Building
Location of control valve
Make and model of valve
Has system been modified since last inspection? Yes No
What hazard is protected?
VALVES
How are valves supervised? Sealed 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
OPERATING INSTRUCTIONS
Are operating instructions posted? Yes No
Notes
Project Name
Date Inspector
System
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2002 National Fire Protection Association
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)
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2002 National Fire Protection Association
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
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2000, 2005 National Fire Protection Association
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
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2000, 2005 National Fire Protection Association
DRY CHEMICAL EXTINGUISHING SYSTEMS GENERAL INFORMATION
System designation
System manufacturer
Date system installed
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
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
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
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2000, 2005 National Fire Protection Association
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
Results Satisfactory Unsatisfactory
Fusible link replaced? 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?
Results Satisfactory Unsatisfactory
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
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2000, 2005 National Fire Protection Association
WET CHEMICAL EXTINGUISHING SYSTEMS GENERAL INFORMATION
System designation
System manufacturer
Date system installed
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
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
WET 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 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
Acceptance? If N, Explanation
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2000, 2005 National Fire Protection Association
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
Results Satisfactory Unsatisfactory
Connection to shut off power to cooking equipment? Yes No
Results Satisfactory Unsatisfactory
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?
Results Satisfactory Unsatisfactory
Hydrostatic test performed; system left in service Yes No
Notes
Project Name
Date Inspector
System
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2000, 2005 National Fire Protection Association
CLEAN AGENT EXTINGUISHING SYSTEMS GENERAL INFORMATION
Clean agent system manufacturer
Detector manufacturer
Control panel manufacturer
Date system installed
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
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
CLEAN AGENT EXTINGUISHING SYSTEMS ACCEPTANCE INSPECTION AND TEST
Y= Satisfactory N= Unsatisfactory (explain) N/A= Not applicable
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
Acceptance? If N, Explanation
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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
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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
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
SMOKE-CONTROL SYSTEMS ACCEPTANCE TEST
Y= Satisfactory N= Unsatisfactory (explain) N/A= Not applicable
Fans (list each)
Dampers (list each)
Doors and Closers
Other Equipment
EquipmentOperatesProperly?Equipment
Notes(Number and record additional notes on reverse)
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
SMOKE-CONTROL SYSTEMS PERFORMANCE TEST
Y= Satisfactory N= Unsatisfactory (explain) N/A= Not applicable
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
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
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.
RecordInformation Notes
Pressure
Difference NotesDoor
Verify proper operation of each zoned smoke-control system in response to each required means of actuation. List each.
RecordInformation Notes
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
EMERGENCY GENERATOR ACCEPTANCE INSPECTION
Y= Satisfactory N= Unsatisfactory (explain) N/A= Not applicable
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.
Acceptance? If N, Explanation
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Project Name
Date Inspector
System
2000, 2005 National Fire Protection Association
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
Acceptance? If N, Explanation
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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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