CommFPSystems Forms 001

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BUILDING PERMIT
Anytown, MA
The undersigned hereby applies to the Inspectional Services Commissioner for permit to erect the following building
or 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:
Main stairs
Front
Right side
Left side
Rear
Back stairs
Fire escapes
Concrete balconies
Other
Foundation material
Floor material
Wall material
Wall thickness
Roof construction
Soil
Party walls
Party wall thickness
Floors
Any others
Occupancy
Number of persons accommodated
Designed live load
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
(Signature of owner or authorized agent)
Address
(Signature of licensed builder)
(Name of contractor)
Address
License number
2005 National Fire Protection Association
Address
Class
License expiration date
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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 extinguishing
system:
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
(p. 1 of 3)
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JOB INFORMATION
Is this a new sprinkler system installation?
Is this an alteration to an existing system?
Is this maintenance of an existing system?
Is this installation of new sprinkler equipment?
Will existing sprinkler system be physically removed
from area under construction?
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
N/A
N/A
N/A
N/A
N/A
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 by
you 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 shut
down/drained for any length of time, an Extended Impairment Plan must be submitted with this application prior to
approval. 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
(p. 2 of 3)
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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 under
construction, 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 down
and 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-A
extinguisher 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
(p. 3 of 3)
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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
(p. 1 of 2)
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EQUIPMENT SCOPE AND RESPONSIBLE PARTIES

Design
Equipment
Required
(Y/N)
Area
Protected
New, Addition,
or Modifcation
Plan Review
Installation
Acceptance
(List responsible party and specific codes, standards, laws, and

regulations applicable for each stage from design to acceptance.)
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 fire
protection
Smoke-control systems
Emergency power systems
Other
Other
(p. 2 of 2)
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PROJECT INFORMATION SHEETSPRINKLER
Date:
Contract Number:
Designer:
Allowed Hours:
Estimated Design:
Hours Used:
Sales Rep:
Contract Completion Date:
Const. PM:
Job Name:
Heads Hrs/Head
P.M.
Const. Type:
Estimated:
Actual:
Hours to Go:
Variance:
New
Remodel
Address:
City/State:
Completed
No
Yes
Task
Design & PM review of documents
Pre-design meeting w/ sales rep.
Product brochure
Pre-install foreman meeting
O&M manuals
SPECIAL MATERIAL LEAD ORDERS

Date
Comments
Quan.
Description
Req. No.
Date req.
X
X
X
X
X
% Matl in 2 weeks:
Floor or
Area
Start
Date
Head Count
Est.
Act.
Initial Final Submit Apvd Submit Apvd

% Save Dwg /Sig. (CITY) (CITY) (AHJ) (AHJ)
Field
Check
Stock
List
Order Sched. S.O./Req. Fman

Number Tests
Placed MOJ
Test
Cert.
Hyd.
Tag
0%
Job %
Ordered
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
Notes/Comments:
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PROJECT SCHEDULE
Project Name
Contract Number
Date
Building System
D = Design
A = Approval
F = Fabrication
I = Installation
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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 PROTECTION MECHANICAL

Project manager
On-site foreman
FIRE PROTECTION ELECTRICAL

Project manager
On-site foreman
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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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TRAINING PLAN
Project Name
Contract Number
Equipment/system
Training objective
Date
Time
Training location
TRAINING SIGN-IN SHEET

Name (Print)
Department
Telephone
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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
Street Address
Unit Number
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 for
occupancy.
Building Inspector
Inspection Director
Date
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FIRE ALARM SYSTEM

RECORD OF COMPLETION
Name of protected property
Address
Representative of protected property (name/phone)
Authority having jurisdiction
Address/telephone number
Organization 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
System Software
(a) Operating system (executive) software revision level(s)
(b) Site-specific software revision date
(c) Revision completed by
(Name)
Representative name/phone
Expiration date
(Firm)
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:
Alarm
Supervisory
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 telephone
numbers of the organization receiving alarm
Indicate how alarm is retransmitted
NFPA 72, Chapter 8 Central Station
Prime contractor
Central station location
(p. 1 of 4)
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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
10
11
(circle all that apply)
NFPA 70, National Electrical Code , Article 760

Manufacturers instructions
Other (specify)
Signed
Date
Organization
3. RECORD OF SYSTEM OPERATION

Documentation in accordance with NFPA 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
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
(p. 2 of 4)
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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
(b) Combination manual fire alarm and guards tour coded stations
AUTOMATIC
Coverage: Complete
Selective
Coded
Addressable
Partial
Nonrequired
(a) Smoke detectors

Ion
Photo
Addressable
(b) Duct detectors
Ion
Photo
Addressable
(c) Heat detectors
FT
RR
FT/RR
RC
(d) Sprinkler waterflow indicators: Transmitters
Noncoded
Coded
(e) The alarm verification feature is disabled
or enabled
, changed from
(f) Other (list)
Addressable
Addressable
seconds to
seconds.
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)
(p. 3 of 4)
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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
Quantity of speakers installed
Quantity of speaker zones
Quantity of telephones or telephone jacks included in system
Multiple
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)
(b)
(c)
(d)
(e)
(f)
Bells
With Visible
Speakers
With Visible
Horns
With Visible
Chimes
With Visible
Other:
With Visible
Visible appliances without audible
9. SYSTEM POWER SUPPLIES

(a) Fire Alarm Control Panel
Overcurrent protection
Nominal voltage
Type
Location
Current rating
Current rating
(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)
(p. 4 of 4)
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FIRE ALARM SYSTEMS INSPECTION AND TESTING FORM

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
McCulloh
Multiplex
Digital
Reverse Priority
RF
Other (specify)
SERVICE
Weekly
Monthly
Quarterly
Semiannually
Annually
Other (specify)
Control unit manufacturer
Model No.
Circuit styles
Number of circuits
Software 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 detectors
Heat detectors
Waterflow switches
Supervisory switches
Other (specify)
Alarm verification feature is disabled
enabled
(p. 1 of 4)
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ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION

Quantity
Circuit Style
Bells
Horns
Chimes
Strobes
Speakers
Other (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 position
Fire 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
Overcurrent protection: Type
Location (of primary supply panelboard)
Disconnecting means location
(b) Secondary (standby):
Amps
Amps
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.
(p. 2 of 4)
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PRIOR TO ANY TESTING
Yes
NOTIFICATIONS ARE MADE

Monitoring entity
Building occupants
Building management
Other (specify)
AHJ notified of any impairments
No
Who
Time
SYSTEM TESTS AND INSPECTIONS

TYPE
Control unit
Interface equipment
Lamps/LEDS
Fuses
Primary power supply
Trouble signals
Disconnect switches
Ground-fault monitoring
Visual
Functional
Comments
Visual
Functional
Comments
SECONDARY POWER
Type
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

Loc. & S/N
Device
Type
Visual
Check
Functional
Test
Factory
Setting
Measured
Setting
Pass
Fail
Comments
(p. 3 of 4)
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EMERGENCY COMMUNICATIONS EQUIPMENT

Phone set
Phone jacks
Off-hook indicator
Amplifier(s)
Tone generator(s)
Call-in signal
System performance
INTERFACE EQUIPMENT
(Specify)
(Specify)
(Specify)
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Visual
Functional
Comments
Visual
Device
Operation
Simulated
Operation
SPECIAL HAZARD SYSTEMS

(Specify)
(Specify)
(Specify)
Special procedures
Comments
SUPERVISING STATION MONITORING

Alarm signal
Alarm restoration
Trouble signal
Supervisory signal
Supervisory restoration
Yes
No
Time
Comments
NOTIFICATIONS THAT TESTING IS COMPLETE

Building management
Monitoring agency
Building occupants
Other (specify)
Yes
No
Who
Time
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
(p. 4 of 4)
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FIRE ALARM SYSTEMS PLAN REVIEW CHECKLIST

Project Name
Contract Number
Name of owner
Name of occupant
Location, including street address
Device legend
Date
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 safety
control 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
Name of owner
Name of occupant
Location, including street address

Point of compass
Date
PLANS
Working plans are drawn to an indicated scale, on sheets of uniform size, with a plan of each floor, and
show 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 for
clarity), 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
(p. 1 of 3)
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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 on
plans 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 hydraulic
calculation sheets
Minimum rate of water application (density), design area of water application, in-rack sprinkler demand, and
the 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
(p. 2 of 3)
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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 water
curtain 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
Combined K-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
(p. 3 of 3)
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AUTOMATIC SPRINKLER SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
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
VALVES
How are valves supervised? Seated Locked
Are valves identified with signs? Yes No
Tamper switch
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
When was pump last inspected?
Is pump in good condition? Yes No
Electric
Gasoline
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
DRY SYSTEMS
Is dry pipe valve in heated room? Yes No
Does heated room have low-temperature alarm? Yes
Notes
2000, 2005 National Fire Protection Association
No
No
None
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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
Fixed guideway transit system
Race track stable
Marine terminal, pier, or wharf
Yes
Yes
Yes
Yes
No
No
No
No
Airport terminal
Aircraft engine test facility
Power plant
Water-cooling tower
Yes
Yes
Yes
Yes
No
No
No
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
Aerosol products
Yes
No
Liquid or solid oxidizers
Nitrate film
Yes
No
Organic peroxide formulations
Pyroxylin plastic
Yes
No
Idle pallets
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
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
Solvent extraction
Laboratory using chemicals
Oxygenfuel gas system for welding
or cutting
Acetylene cylinder charging
Production or use of compressed or
liquefied gases
Yes
Yes
Yes
Yes
No
No
No
No
Yes
Yes
No
No
Commercial cooking operation

Class A hyperbaric chamber
Cleanroom
Incinerator or waste-handling system
Linen-handling system
Industrial furnace
Water-cooling tower
Yes
Yes
Yes
Yes
Yes
Yes
Yes
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
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
Name of owners representative or agent completing certificate (print)
Relationship and firm of agent (print)
Date
No
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CONTRACTORS MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING

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.
Date
Property name
Property address
Accepted by approving authorities (names)
Address
Plans
Instructions
Location of
System
Installation conforms to accepted plans.
Yes
No
Equipment used is approved.

If no, explain deviations.
Yes
No
Has person in charge of fire equipment been instructed as

to location of control valves and care and maintenance
of this new equipment? If no, explain
Yes
No
Yes
Yes
Yes
No
No
No
Have copies of the following been left on the premises?

1. System components instructions
2. Care and maintenance instructions
3. NFPA 25
Supplies buildings
Year of
Manufacture
Model
Make
Orifice
Size
Temperature
rating
Quantity
Sprinklers
Pipe and
Fittings
Type of pipe
Type of fittings
Alarm
Valve or
Flow
Indicator
Maximum Time to Operate

Through Test Connection
Alarm Device
Type
Make
Model
Minutes
Q. O. D.
Dry Valve
Make
Dry Pipe
Operating
Test
Model
Seconds
Make
Serial no.
Time to Trip
Through Test
Connection1,2
Water
Pressure
Air
Pressure
Trip Point
Air Pressure
Minutes Seconds
psi
psi
psi
Model
Time Water
Reached
Test Outlet1,2
Minutes
Seconds
Serial no.
Alarm
Operated Properly
Yes
No
Without
Q.O.D.
With
Q.O.D.
If no, explain
1 Measured from time inspectors test connection is opened

2 NFPA 13 only requires the 60-second limitation in specific sections
(p. 1 of 3)
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Operation
Pneumatic
Piping supervised
Deluge and
Preaction
Valves
Electric
Yes
Yes
Manual
Does each circuit operate

supervision loss alarm?
Model
Make and
model
Location
and floor
Setting
No
Remote
Both
If no, explain.
Is there an accessible facility in each circuit

for testing?
Yes
No
Yes
Test
Description
Detecting media supervised
No
Does valve operate from the manual trip, remote, or both

control stations?
Make
Pressure
Reducing
Valve Test
Hydraulics
No
Yes
Minutes
No
Seconds
Residual pressure
(flowing)
Static pressure
Inlet (psi)
Maximum time to
operate release
Does each circuit operate

valve release?
Outlet (psi)
Inlet (psi)
Flow rate
Outlet (psi)
Flow (gpm)
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 left
open 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 1Z\x psi (0.1 bar)
in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall
not exceed 1Z\x psi (0.1 bar) in 24 hours.
All piping hydrostatically tested at
Dry piping pneumatically tested
Equipment operates properly
psi (
hours
bar) for
Yes
Yes
If no, state reason.
No
No
Do you certify as the sprinkler contractor that additives and corrosive chemicals, sodium silicate or derivatives
of sodium silicate, brine, or other corrosive chemicals were not used for testing systems or stopping leaks?
Yes
Tests
Drain
test
No
Reading of gauge located near water

supply test connection
psi (
Residual pressure with valve in test

connection open wide
psi (
bar)
Underground mains and lead-in connections to system risers flushed before connection made to
sprinkler piping
Verified by copy of the Contractors Material and Test
Other
Yes
No
Certificate for Underground Piping
Flushed by installer of underground sprinkler piping
Yes
No
If powder-driven fasteners are used in concrete,
has representative sample testing been
satisfactorily completed?
Blank Testing
Gaskets
Number used
Welding piping
Yes
Locations
Yes
No
bar)
Explain
If no, explain
Number removed
No
If yes . . .
Welding
Cutouts
(Discs)
Do you certify as the sprinkler contractor that welding procedures comply

with the requirements of at least AWS B2.1?
Yes
No
Do you certify that the welding was performed by welders qualified in

compliance with the requirements of at least AWS B2.1?
Yes
No
Do you certify that the welding was carried out in compliance with a
documented quality control procedure to ensure that all discs are retrieved,
that openings in piping are smooth, that slag and other welding residue
are removed, and that the internal diameters of piping are not penetrated?
Yes
No
Do you certify that you have a control feature to ensure that

all cutouts (discs) are retrieved?
Yes
No
(p. 2 of 3)
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Hydraulic Data
Nameplate
Remarks
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If no, explain.
Nameplate provided
Yes
No
Date left in service with all control valves open
Name of sprinkler contractor

Tests witnessed by
Signatures
For property owner (signed)
Title
Date
For sprinkler contractor (signed)
Title
Date
Additional explanations and notes
(p. 3 of 3)
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STANDPIPE AND HOSE SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
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 hose
should 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
Are valves identified with signs? Yes No
Tamper switch
WATER SUPPLY
Yes
No
PUMPS
What type of fire pump does system have? Diesel
Is pump in good condition? Yes No
When was pump last tested?

Location
Yes
Notes
No
Electric
Gasoline
None
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CONTRACTORS MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING

Standpipe System NFPA 14
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 name
Date
Property address
Accepted by approving authorities (names)
Address
Plans
Type of
System
Water Supply
Data Used for
Design and As
Shown on Plans
Water Supply
Source Capacity,
Gallons
If Public
Waterworks
System:
Have Copies
of the Following
Been Left on
the Premises?
Supplies
Building(s)
Valve
Supervision
Pipe and
Fittings
Backflow
Preventor
Installation conforms to accepted plans?
Yes
No
Equipment used is approved or listed?

If no, explain deviations.
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Automatic-dry
Automatic-wet
Semitautomatic-dry
Manual-dry
Manual-wet
Combination standpipe/sprinkler
Other (if yes, explain)
Fire pump date

Manufacturer
Type:
Model
Electric
Diesel
Rated, gpm
Public waterworks system
Other (explain)
Rated, psi
Storage tank
Shutoff, psi
Gravity tank
Open reservoir
Other (explain)
Static, psi
Residual, psi
System components instructions

Copy of accepted plans
Flow in, gpm
Care and maintenance of system
NFPA 25
Hydraulic data/calculations
Main waterflow shutoff location

Number of standpipe risers
Do all standpipe risers have base of riser shutoff valves?
Locked open
Sealed and tagged
Yes
Tamperproof switch
No
Other
If other, explain.
Type of pipe
Type of fittings
Double check assembly
Reduced-pressure device
Size
Make and model
(p. 1 of 3)
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CONTROL VALVE DEVICE
Type
Size
Make
Time to trip through remote hose valve
Min
Min
Time water reached remote hose valve outlet

Yes
Alarm operated properly?
No
Yes
Electric activation
Yes
Pneumatic activation
Yes
Sec
Water pressure
Sec
Trip point air pressure
Air pressure
psi
If no, explain.
Min
Time water reached remote hose valve outlet

Hydraulic activation
Model
Sec
Make and model of activation device

Each activation device tested?
Yes
Each activation device operated properly?
No
If no, explain.
Yes
No
If no, explain.
PRESSURE-REGULATING DEVICE
Nonflowing (psi)
Location & Floor
Model
All hose valves on system operated properly?
Inlet
Yes
Outlet
No
Flowing (psi)
Inlet
Outlet
gpm
If no, explain.
(p. 2 of 3)
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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 left open during 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 1Z\x psi (0.1 bar) in 24 hours.
Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed
1Z\x psi (0.1 bar) in 24 hours.
All piping hydrostatically tested at
Dry piping pneumatically tested?
Equipment operates properly?
Tests
psi (
Yes
Yes
hr
bar) for
No
No
If no, state reason.
Do you certify as the standpipe contractor that additives and corrosive chemicals,
sodium silicate, or derivatives of sodium silicate, brine, or other corrosive chemicals
were not used for testing systems or stopping leaks?
Yes
Drain
test
Reading of gauge located near water

supply test connection
psi (
bar)
No
Residual pressure with valve in test

connection open wide
psi (
bar)
Underground mains and lead-in connections to system risers flushed before connection made to standpipe piping.
Blank Testing
Verified by copy of the U form no. 85b?
Yes
No
Flushed by installer of underground standpipe piping?
Yes
No
Number used
Welded piping
Other
Explain:
Locations
Yes
Number removed
No
If yes . . .
Welding
Cutouts
(Discs)
Hydraulic
Data
Nameplate
Do you certify as the standpipe contractor that welding procedures comply with the requirements
of at least AWS D10.9, Level AR-3?
Yes
No
Do you certify that the welding was performed by welders qualified in compliance with the
requirements of at least AWS D10.9, Level AR-3?
Yes
No
Do you certify that welding was carried out in compliance with a documented quality control
procedure to ensure that all discs are retrieved, that openings in piping are smooth, that slag and
other welding residue are removed, and that the internal diameters of piping are not penetrated?
Yes
No
Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved?
Yes
No
Nameplate provided?
Yes
No
If no, explain.
Date left in service with all control valves open:

Remarks
Name of
Sprinkler/
Standpipe
Contractor
System
Operating Test
Witnessed by
Name of contractor
Address
State license number (if applicable)
Property owner
Title
Date
Sprinkler/standpipe contractor
Title
Date
Approving authorities
Title
Date
Additional
Explanation
and Notes
(p. 3 of 3)
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WATER SPRAY FIXED SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
GENERAL
System designation
Building
Has system been modified since last inspection?
Yes
No
What is hazard protected?
VALVES
How are valves supervised?
Sealed
Are valves identified with signs?
Locked
Yes
Tamper switch
No
WATER SUPPLY
Yes
No
PUMPS
What type of fire pump does system have?
Diesel

Is pump in good condition?
Yes
No

Location
Yes
No
OPERATING INSTRUCTIONS
Are operating instructions posted?
Yes
Notes
No
Electric
Gasoline
None
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WATER MIST SYSTEMS GENERAL INFORMATION
Project Name
Date
Inspector
System
GENERAL
System designation
Building
Location of main control valve
Yes
No
VALVES
Sealed
Locked
Yes
Tamper switch
No
WATER SUPPLY
Is water supply filtered?
Yes
No
Are storage tanks, if used, in good condition?
Yes
PUMPS
Yes
No
DETECTION SYSTEM (if any)

When was detection system last inspected?
Yes
Notes
No
No
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FOAMWATER SPRINKLER SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
GENERAL
System designation
Building
Make and model of valve
Yes
No
VALVES
Sealed
Locked
Yes
Tamper switch
No
WATER SUPPLY
Yes
No
PUMPS
Diesel

Yes
No

Location
Yes
No
Yes
Notes
No
Electric
Gasoline
None
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FOAM SYSTEMS GENERAL INFORMATION
Project Name
Date
Inspector
System
GENERAL
System designation
Building
Make and model of valve
Yes
No
What hazard is protected?

VALVES
Sealed
Locked
Yes
Tamper switch
No
WATER SUPPLY
Yes
No
PUMPS
Diesel

Yes
No

Location
Yes
No
Yes
Notes
No
Electric
Gasoline
None
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FIRE PUMPS FLOW AND PRESSURE RECORD
Project Name
Date
Inspector
System
150
N1.85
140
130
120
110
100
Pressure (psi)
90
80
70
60
50
40
30
20
10
12 3 4 5
10
Notes
11
12
13
14
Flow (gpm)
15
16
17
18
19
20
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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
Projected results: @20 psi residual
Residual B
gpm or @
psi
psi residual
gpm
Remarks
Location map: Show line sizes and distance to next cross-connected line. Show valves and hydrant branch size. Indicate
north. 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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SAMPLE HYDRAULIC DATA GRAPH SHEET
Project Name
Date
Inspector
System
120
(827)
110
(758)
100
(689)
90
(621)
Pressure, psi (kPa)
80
(552)
70
(483)
60
(414)
50
(345)
40
(276)
30
(207)
20
(138)
10
(69)
0
400
100 200 300
(378.5) (757) (1136) (1514)
500
(1893)
Q1.85
Notes
600
(2271)
700
(2650)
800
(3028)
Flow, gpm (L/m) (Multiply this scale by _______ .)
900
(3407)
1000
(3785)
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CARBON DIOXIDE EXTINGUISHING SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
CO2 system manufacturer
Detector manufacturer
Control panel manufacturer
Date system installed
Room or area designation
Volume protected
Above ceiling
System concentration
50%
Below raised floor
65%
75%
Between floor and ceiling
Other
Weight of CO2 agent with cylinder
lb (kg)
Weight of cylinder (tare weight)
lb (kg)
Weight of CO2 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 CO2

system operation
Single zone
Two zones (cross-zoned)
Two detectors on any zone
Other
Notes
for
minutes
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DRY CHEMICAL EXTINGUISHING SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
System designation
System manufacturer
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)

Connected to fire alarm system?
Yes
psi (bar)
No
Automatic shutdown of cooking equipment?

If yes,
Gas
Electric
Notes
Yes
No
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DRY CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE INSPECTION

Project Name
Date
Inspector
System
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
Acceptance?
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 in
cartridge-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
If N, Explanation
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DRY CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE TESTS

Project Name
Date
Inspector
System
Date of acceptance test
Manual release
Fusible link
Satisfactory
Satisfactory
Connection to fire alarm system?

Results
Satisfactory
Unsatisfactory
Unsatisfactory
Yes
No
Unsatisfactory
Connection to shut off power to cooking equipment?

Results
Satisfactory
Fusible link replaced?
Yes
No
Unsatisfactory
Yes
No
Connection to shut down supply air to exhaust hood?

Results
Satisfactory
Grease exhaust fan
Unsatisfactory
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
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WET CHEMICAL EXTINGUISHING SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
System designation
System manufacturer
Service contractor
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)

Connected to fire alarm system?
Yes
psi (bar)
No
Automatic shutdown of cooking equipment?

If yes,
Gas
Electric
Notes
Yes
No
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WET CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE INSPECTION

Project Name
Date
Inspector
System
Y = Satisfactory
Note: Pressures and weights are satisfactory if equal to or greater than minimums in Form 9E
Acceptance?
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
If N, Explanation
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WET CHEMICAL EXTINGUISHING SYSTEMS ACCEPTANCE TESTS

Project Name
Date
Inspector
System
Date of acceptance test
Manual release
Fusible link
Satisfactory
Satisfactory
Connection to fire alarm system?

Results
Satisfactory
Unsatisfactory
Unsatisfactory
Yes
No
Unsatisfactory
Connection to shut off power to cooking equipment?

Results
Satisfactory
Yes
No
Unsatisfactory
Connection to shut down supply air to exhaust hood?

Results
Satisfactory
Grease exhaust fan
Unsatisfactory
Continues to run
Stops
Connection to shut off electric power to receptacles under hood?

Results
Satisfactory
Unsatisfactory
Hydrostatic test performed; system left in service

Notes
Yes
No
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CLEAN AGENT EXTINGUISHING SYSTEMS GENERAL INFORMATION

Project Name
Date
Inspector
System
Clean agent system manufacturer
Detector manufacturer
Control panel manufacturer
Room or area designation
Volume protected
Above ceiling
System concentration
50%
Below raised floor
65%
75%
Between floor and ceiling
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

system operation
Single zone
Two zones (cross-zoned)
Two detectors on any zone
Other
Notes
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CLEAN AGENT EXTINGUISHING SYSTEMS ACCEPTANCE INSPECTION AND TEST

Project Name
Date
Inspector
System
Y = Satisfactory
Acceptance?
Clean agent containers free from physical damage
Container pressure
psi (bar)
(Pressure loss greater than 5% requires container refill
or replacement.)
Container weight
lb (kg)
(Weight loss greater than 5% requires container refill
or replacement.)
Container pressure and weight recorded on tag attached
to container
Control heads operational (Remove heads from containers.)
Conduct acceptance test of system.
Notes
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 FEATURES

Stair 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
Number of system dampers
Location
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
Standpipe riser (wet) system water flow
Sprinkler (wet) system floor and/or areas/zones water flow
Sprinkler (dry pipe) system water flow
Sprinkler (preaction) system detection device
Sprinkler (preaction) system water flow
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
FST*
FST
FST
FST
FST
FST
N/A
N/A
N/A
N/A
N/A
N/A
Smoke (area detection) detector

Smoke (stair tower) detector
Smoke (HVAC supply air) detector
Smoke (HVAC return air) detector
Smoke (stair pressurization supply air fan) detector
Heat detector
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
FST
FST
FST
FST
FST
FST
N/A
N/A
N/A
N/A
N/A
N/A
Kitchen hood suppression system

Fire suppression system
Yes
Yes
No
No
FST
FST
N/A
N/A
Manual pull boxes

Manual control
Yes
Yes
No
No
FST
FST
N/A
N/A
System fan control equipment circuitry (impairment)

supervision
Yes
No
FST
N/A
* FST = Time it takes to start fan on actuation of initiation device.
Comments
(p. 1 of 2)
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STAIR PRESSURIZATION, DOOR HARDWARE, AND DOOR OPERATION

PERFORMANCE RESULTS
Stair
Door
Door Latch
Release
Force
Door Set
in Motion
Force
Door Swing
to Full Open
Force
Pressure
Difference
with All
Doors Closed
Pressure
Difference
with One
Door Open
Pressure
Difference
with Two
Doors Open
Pressure
Difference
with Three
Doors Open
Comments
Type of instrumentation equipment used for differential pressure evaluation

Type of instrumentation equipment used for force factor evaluation
Test conducted by
(p. 2 of 2)
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SMOKE-CONTROL SYSTEMS ACCEPTANCE TEST

Project Name
Date
Inspector
System
Y = Satisfactory
Equipment
Fans (list each)
Dampers (list each)
Doors and Closers
Other Equipment
Equipment
Operates
Properly?

Notes
(Number and record additional notes on reverse)
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SMOKE-CONTROL SYSTEMS PERFORMANCE TEST

Project Name
Date
Inspector
System
Y = Satisfactory
Record
Information
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 pressure
differences.
Confirm that introduction of untempered air will not
damage equipment.
Confirm that weather conditions (freezing temperatures)
will not damage equipment.
Notes
Notes
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ZONED SMOKE-CONTROL SYSTEMS ACCEPTANCE TEST

Project Name
Date
Inspector
System
Record
Information
Notes
Verify location of the perimeter of each smokecontrol zone.

Confirm that all doors in the smoke-control zone
are closed.
Measure and record pressure difference across smoke barrier at each door or pair of doors in smoke barrier.
Door
Pressure
Difference
Notes
Verify proper operation of each zoned smoke-control system in response to each required means of actuation. List each.
Record
Information
Notes
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EMERGENCY GENERATOR ACCEPTANCE INSPECTION

Project Name
Date
Inspector
System
Y = Satisfactory
Acceptance?
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 fuel
supply tanks.
Inspect generator.

If N, Explanation
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EMERGENCY STANDBY POWER SYSTEMS ACCEPTANCE TESTS

Project Name
Date
Inspector
System
Y = Satisfactory
Acceptance?
Test each battery-powered unit so that laps operate

for 30 seconds.
Test emergency generator batteries for specific
gravity 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 windings
with insulation tester (Megger).
Test each battery-powered unit for 90 minutes.
Test emergency generator under full load or under
bank-load full load.
Notes
If N, Explanation
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FIRE DOORS ACCEPTANCE INSPECTION
Project Name
Date
Inspector
System
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Check door for physical damage and to see that vision panel (if provided) is secure.
Check that closer works.
Check that latch works.
Check that hinges are secure.
Check that coordinator (if provided) works.
Check tin-clad or Kalamein doors for dry rot.
Check cables and/or chains on sliding doors to ensure that they are in good condition and operate properly.
Check cables, chains, rollers, fusible links, and other moving parts for paint or other contaminants that may alter
operation. Replace fusible links that have been painted.
Lubricate hinges on swinging doors and rollers on sliding doors.
Check that labeled fire doors have not been modified improperly.
Clear surrounding area of obstructions that may interfere with door operation.
Check that sliding doors close freely and completely.
Y = Satisfactory
Fire Door Number or Location
Notes
N = Unsatisfactory (explain on reverse)
10
11
12

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Name of architect or engineer

Classification of building or structure: Pre-code

Party wall thickness

per cubic foot

General description of the proposed work and its location:

(Signature of licensed builder)

License expiration date

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FIRE SUPPRESSION SYSTEM PERMIT APPLICATION

General contractor's name

Office Use Only

2005 National Fire Protection Association

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Describe scope of work (use additional sheet if necessary):

Approximate total floor area

Approximate area impaired

ALTERATION AND IMPAIRMENT OF WATER-BASED FIRE SUPPRESSION SYSTEMS

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FIRE SAFETY REQUIREMENTS

2005 National Fire Protection Association

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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.)

2005 National Fire Protection Association

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EQUIPMENT SCOPE AND RESPONSIBLE PARTIES

(List responsible party and specific codes, standards, laws, and

2005 National Fire Protection Association

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Contract Completion Date:

SPECIAL MATERIAL LEAD ORDERS

Initial Final Submit Apvd Submit Apvd

Order Sched. S.O./Req. Fman

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Order is shipped complete.

Noncompliance or other problems revealed during inspection:

FIRE PROTECTION MECHANICAL

FIRE PROTECTION ELECTRICAL

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WATER-BASED FIRE PROTECTION SYSTEMS FINAL CHECKLIST

Owners rep notified of testing time

Others notified of testing times

Complete and sign:

Contractors Material and Test Certificate for Underground Piping

Design information matches design on plans and as-built drawings.

First-year inspection, testing, and maintenance timeline was given to:

SPRINKLER SYSTEM PUNCH LIST