HomeMy WebLinkAbout528 Evergreen Way - Life Safety System T DO NOT REMOVE BY ORDER OF THE STATE FIRE MARSHAL
Pre-Enc veered-system Inspection Report
' ALLSTATE UIPMENT Date of Service: 2�1 /� Time: `� AM PM
r
New Engla er in Fire Protection Annual/-Semi-Annual/Recharg New System Renovation(circle one)
i 15 Robert Jackson Way Office(860)793-6900
Plainville,CT 06062 Fax(860)793-6906 VALID FOR 6 MONTHS FROM DATE OF SERVICE
www.allstatefireinc.com
F. Customer/Location System Information
Name: Z. Make:
Address: , .>/ �`-ri.riCC /Z Model: Ao
City, ST Zip: Size: `X- '� �
Phone: Control Head: 40 - o-y
Owner/Manager: Location of system: Z , a ,r
Yes No N/A Yes No NlA
1 Hazard unchanged since last inspection 13 Manual release proper and operable.
2 System interlocked with building fire alarm. 14 Microswitches installed QTY -Tied-in QTY
3 All appliances properly covered w/correct nozzles. 15 Gas valve connected to system{M �ELEC.)
4 Duct(s)&plenum properly covered w/correct nozzles. le— 16 Piping/conduit securely bracketed.
5 Hood/duct penetrations properly sealed. 41 17 Piping obstruction test performed
6 Grease accumulation: excessive heavy normal 18 Proper nozzle caps/covers in place. QTY.
7 Pressure gauge within acceptable range. 19 Exhaust fan in operating condition.
8 Cartridge weight within acceptable range. WT. ..... 20 System operational&armed.
9 Cylinder within hydrotest date. Due: 21 Fan warning sign on hood.
10 Cylinder properly mounted. 122 K-Class fire extinguisher in cooking area.
11 Detection line proper and operable. 23 Personnel instructed on manual operation of system.
12 Replaced fusible links. 24 Filters compliant with NFPA96
13600 450' `! 500° other( °) 25 Syste`m�meets U.L.300 standards.
Hazard Protected Hood, Ducts,Appliances): C.0
Safety Notice:Non-compliant systems may fail to extinguish/supress a fire.Below are non compliant conditions which require immediate attention.All State Fire
Equipment assumes no responsibility for system performance if these conditions are not corrected and/or verified by an authorized agent of All State Fire
Equipment.
❑See Attached Proposal to Correct Deficiencies
Comments/Non-Compliance: - d F A,
All State Fire Equipment Agenw Date: �2 2
Customer's Authorized Agent: Date:
n1 CT LIC.#F30042 MA-CR.1097 � �
® Customer Acknowledgement and UL-300 Safety Alert on reverse —Rev.07-24-13
NFPA This report may be forwarded to the local authority having jurisdiction.