12-4 Technology Drive, East Setauket, NY 11733 (631) 689-6869 (631) 689-6866 info@foosfire.com facebook System Offline Operator name Alarm Panel TYPE ID SIZE LOCATION IN SITE RISER 1 RISER 2 SIGNATURES System Online DRY RISERS Total Number of Dry Risers RISER 3 RISER 4 RISER 5 RISER 6 RISER 7 RISER 8 RISER 9 Inspector Printed Inspector - Signature Date Completed I state the information on this form is correct at the time and place of my inspection, and all the equipment tested at this time was left in operational condition upon completion of this inspection except as noted. Except as noted, the building occupancy and hazard classifications have not changed since last inspection. After this inspection, the system has been restored to normal and all panels are clear. All deficiencies and immediate actions have been explained to me and I have been informed of all necessary actions. Authorized Representative Printed Authorized Representative Signature Date Completed DRY ANNUAL INSPECTION Customer Customer W.O.# Technician Name Date of Inspection Building Name Building Street Building City/State/Zip Building ID# RISER 10 DRY VALVE INSPECTION Valves accessible and free from physical damage? No leakage from intermediate chamber? Low Air pressure signal passed test? Gauges on dry, preaction, & deluge systems in good condition? AIR PRESSURE Yes No N/A Trim Valves in appropriate position & free from leaks? Priming Water level correct? Hydraulic nameplate, if provided, securely attached? Quick opening devices passed Test? Yes No N/A FIRE DEPARTMENT CONNECTION Total Number of FDC's Visible and accessible? Plugs or Caps in place and undamaged? Caps painted as per AHJ code? Identification signs(s) in place? Ball Drip Valve in place and operating properly? Couplings & swivels not damage and rotate smoothly? Gaskets in place in good condition? Check valve is not leaking? Interior free of obstructions (if caps are not in place)? Yes No N/A Yes No N/A WATER PRESSURE Job #
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Inspector Printed Inspector - Signature Date Completed
I state the information on this form is correct at the time and place of my inspection, and all the equipment tested at this time was left in operational condition upon completion of this inspection except as noted.
Except as noted, the building occupancy and hazard classifications have not changed since last inspection. After this inspection, the system has been restored to normal and all panels are clear. All deficiencies and immediate actions have been explained to me and I have been informed of all necessary actions.
Authorized Representative Printed Authorized Representative Signature Date Completed
DRY ANNUAL INSPECTION Customer
Customer W.O.#
Technician Name
Date of Inspection
Building Name
Building Street
Building City/State/Zip
Building ID#
RISER 10
DRY VALVE INSPECTIONValves accessible and free from physical damage?
No leakage from intermediate chamber?
Low Air pressure signal passed test?
Gauges on dry, preaction, & deluge systems in good condition?
AIR PRESSURE
Yes No N/ATrim Valves in appropriate position & free from leaks?
Priming Water level correct?
Hydraulic nameplate, if provided, securely attached?
Quick opening devices passed Test?
Yes No N/A
FIRE DEPARTMENT CONNECTION
Total Number of FDC's
Visible and accessible?
Plugs or Caps in place and undamaged?
Caps painted as per AHJ code?
Identification signs(s) in place?
Ball Drip Valve in place and operating properly?
Couplings & swivels not damage and rotate smoothly?
Gaskets in place in good condition?
Check valve is not leaking?
Interior free of obstructions (if caps are not in place)?
SIGNATURESInspector Printed Inspector - Signature Date Completed
I state the information on this form is correct at the time and place of my inspection, and all the equipment tested at this time was left in operational condition upon completion of this inspection except as noted.
Authorized Representative Printed Authorized Representative Signature Date Completed
Except as noted, the building occupancy and hazard classifications have not changed since last inspection. After this inspection, the system has been restored to normal and all panels are clear. All deficiencies and immediate actions have been explained to me and I have been informed of all necessary actions.
Building Name
Building Street
Building City/State/Zip
Building ID#
FIRE DEPARTMENT CONNECTIONTotal Number of FDC's
Visible and accessible?
Plugs or Caps in place and undamaged?
Caps painted as per AHJ code?
Identification signs(s) in place?
Ball Drip Valve in place and operating properly?
Couplings and swivels not damage and rotate smoothly?
Gaskets in place in good condition?
Check valve is not leaking?
Interior free of obstructions (if caps are not in place)?
Yes No N/A
TYPE ID SIZE LOCATION PSI
RISER 1
RISER 2
RISER 3
RISER 4
RISER 5
RISER 6
RISER 7
RISER 8
RISER 9
RISER 10
WATER BASED SYSTEM INSPECTION
Are there landlord/access issues requiring visual only?
Gauges on wet pipe system in good condition and
showing normal water supply pressure?
Alarm devices accessible?
Retard chamber/alarm drains OK?
Alarm devices free from physical damage?
Is the Audible alarm device working properly?
Hydraulic nameplate, if provided, securely attached to