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0013 HAWTHORNE BOULEVARD - Street Files Pre-Engineered Restaurant Fire Suppression Systems Report SERVICE COMPANY 1. All appliances properly covered w/correct nozzles 2. Duct and plenum covered with/correct nozzles 3. Check positioning of all nozzles 1� NORTH SHORE FIRE o 4. System installed in accordance w/MFG UL listing APPLIANCE COMPANY 5. Hood/duct penetrations sealed w/weld or UL device 98 MAIN ST. P.O. BOX 263 6. Check if seals intact, evidence or tampering ✓r WENHAM, MA 01984 7. If system has been discharged, report same 8. Pressure gauge in proper range (if gauged) 'f 9. Check cartridge weight(if applicable) CUSTOMER 10.Hydrostatic test date p� � Name P�Yt I`./0', S �� 1S �f(,�� 11.6 year maintenance date 12.Inspect cylinder and mount L� �j ��/ �� �� 13.Operate system from terminal link ✓ Address /! �/r 14.Test for proper operation from remote City r/ep", ' e y�Oq 15.Check operation of micro switch 1+� 16.Check operation of gas valve Telephone G� [7 Z v (7/✓ Store No. 17.Clean nozzles 18.Proper nozzle covers in place - / Owner or Manager 19.Check fuse links and clean f� 20.Replaced fuse links 21.Check travel of cable nuts/S-hooks !0� DATE OF ERVI _/ TIME i AM PM -. l� � ,�� 22.Piping&conduit securely bracketed 1/ ANNUAL SEMI- L RECHARGE INSTALLATION RENOVATION 23. Proper separation between fryers and flame 17 24. Proper clearance-flame to filters LOCATION Or�STEM LAIRS 1 / 25.Exhaust fan in operating order /( 7 C� 17w 26.All filters replaced OANUFACTURER M E N MURtt�� WET DRY CHEMICAL 27.Fuel Shut-Off In Ofl.poS111011 V 70 28. Manual&remote set/seals in place !� CYLINDER SI ASJE? CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE 29.Replace System covers FUSE LINKS 3607 FUSE LINKS-450-F FUSE LINKS 500°F OTHER 30.System operational&seals in place 31.Slave system operational - FUEL SHUT-OFF ELECTRIC GAS / SIZE 32.Clean cylinder&mount i 33. Fan warning sign on hood I� SERIAL NUMBER LAST HY9WjE LAST RECHARGE DATE 34.Personnel Instructed In manual operation Of System // ``�� 35.Proper hand portable extinguishers k�_ MANUFACTURER'S MANUAL REFERENCE 36.Portable eXfII1gUISherS properly SefVlCed Y 37. Service & Certification tag on system PAGE NUMBER DRAWING NUMBER: NOTE DISCREPANCIES OR DEFICIENCIES BELOW COOKING APPLIANCE LOCATIONS:LEFT TO RIGHT 1 ZY Cl/'n COMMENTS / 4 /_ l On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17,17A, references to Fire Suppression Systems contained in NFPA 96, and the manufacturer's manual, and was operated according to theOp procedures with results indicated above. SER ICE T CHNICIAN PERMIT NO. I DATE' ITIME JAM IPM I CUS'TOMER'S AUTHCTRIZED AGE-. The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. WHITE-CUSTOMER COPY YELLOW-DISTRIBUTOR PINK-AUTHORITY HAVING JURISDICTION P/N SER100 02006 Heiser Logistics 07 k A A Y Ur 3ALL' IVI ree oue " FIRE DEPARTMENT - FIRE PREVENTION BUREAU Rec d b 49 Lafayette St., Ck.# ,SZ Cash. Salem,M888achUsetts 01970 1 FIXED FIRE EXTINGUISHING SYSTEM �l pow ao of 4W W oI ' APPLICATION FOR APPROVAL OF PLANS: Name of Systems To: HEAD OF FIRE DEPARTMENT system Size ar Number: CL 2040 Extinguishing Agents I� r In accordance with the provisions of the Massachusetts State Building Code and the Salem Fire Code, , appiicatIon Is hereby made for" approval of -0,1a6s for the install-' atlon of Fire Protection devices. LOCATION: 1� WZV 101'2,ffe LvT� BUSINESS NAME g jtt D �' 2-3 Te 1 INSTALLER:���� � f%2€ . DDi�.e.yC€ LICENSE INSTALLERS AOORESS fg IL1�1/j� STD Z,ry �4 TEL. #, jR &,g Plans are approved solely for identification o type and location of devices. Installation sub ect to final Inspection and filing of Certificate of Completion. ** INSTALLER MUST PROVIDE A COPY OF HISAER CERTIFICATE. Date approved: O l(J�D�D l ts�oaonw.d Qppuemul Date of azpir on `7T- . lAddrw�l _ Phone l.A 1 Y Ur :BALL' 11r1 ree uue FiRE DEPARTMENT - FIRE PREVENTION BUREAU Rectd b ae Lafayette St., Ck.# S Cash Salem,Massachusetts 01970 FIXED FIRE EXTINGUISHING SYSTEM + • l APPLICATION FOR APPROVAL OF PLANS : Name of Systems eyeo C1lo- To: HEAD OF FIRE DEPARTMENT . System Size Or Number: Pel d Extinguishing Agents In accordance with the provisions of the Massachusetts State Building Code and the Salem Fire Code, application Is hereby made for approval 'of`�plans for �thelns`tall atlon of Fire Protection devices. LOCATION: BUSINESS NAME Te 1 j 97�--7 INSTALLER:�(���r � 2€ � ,�,— LICENSE - Zq INSTALLERS ADDRESS f 2_'gdA,W 5T� TEL. #97R 9X',6-/6� Plans are approved solely for Identification o type and location of devices. Installation subject to final inspection and filing of Certificate of Completion. ** INSTALLER MUST PROVIDE A COPY OF HISMER CERTIFICATE. Date approved: U /lJ�0�D/ (ekoealar*d wpuemk) Date of •xpUatl ,9/ry �lT lAddrwl. Phone #471k- !/6fe-/Z" CITY O_F. SALEM -.FEE PAID § - g� r FiRE DEPARTMENT - FIRE PREVENTION BUREAU 9 Salem, Massachuse=01970 c Date PERMIT TO INSTALL: _ Fixed Fire Extinguisher System Name of System: System Size or Number s AC/ 2s�� Extinguishing Agents V19 7- usiineae 5WI4,i5tt BOYS r� Iru5 CZ4 Installers NAme I�G yIy 5ft02I F//2S- J wl—�W!✓ & �g ' Permit Is hereby granted based on approved plans , to Install the system designated above.. All plans are approved solely for Identification of type and location of fire protectlon devices . All plans are subl'ect to approval of any Other authority havIno j urIsdiction and issuance of a permit _by said' authorlt . Upon completion, the ** Installer shall renuesr a rest and file a Certificate of Comnletion or Insneetion. LOCATION: � /AQ/T".—,yr '&" 5A&cam MA (Mve Lwaium b7 rirn.q and no.. ar dwanbo V •uot rands at to pravl llad"uI adUMIloa of 10001=4 Blpnatu 011kdal pr m"pond') This permit will expire O' (TM FERM T MUST BE CON'MCUOUSLY POSTED UPON Form. .#81D ( 2/84 ) ti Salem Boys&Girls Club 13 Hawthorne Boulevard Salem,Ma. 01970 978- 744-0915 F_ _1 4 burner range 36" Griddle FIRE SUPPRESSION SYSTEM SPECIFICATIONS Installed on: 10/5/01 Manufacturer: PyroChem Inc. Type: Wet-chemical Size: 2.40 gallon Model: PCL-240 Fuel Shutoff: GasAlarm Connect:Microswitch Actuation: Automatic &remote pull Detection: Fusible link DRAWINGS &INSTALLATION BY North Shore Fire Appliance Co. 98 Main Street Box 263 Wenham, MA 01984 MA-CR 106 Tel. (978)468-1600 MA-CC 069 Fax(978) 468-1618 D.O.T. Cert. A-886 This System will be installed in accordance with NFPA 17A, and the manufacturer's recommendations. PyroChem automatic, wet-chemical extinguishing systems are U.L Listed,U.L.C.Listed, and F.M.Approved.' This system complies with the U.L.300 enhanced fire protection coverage. NSFA: Salem Boys and Girls Club.wps mange noon aysterns neporl senvlca COMPANY 1.All appliances properly covered Wcorrect nozzles L� 2. Duct and,plenum covered w/correct nozzles 3 Check positioning of all nozzles _� 4.Syftm installed in 0000rdanoe wlMFG UL listing _� Nord Shore Are Apphanm Inc, 5. Hooftuct penetrations sealed w/weld or UL device 98 Main St 6, Check if seals intact, evidence of tampering �- Wenham,MA 01984 7. If system has been discharged, report same , & pressure gauge in proper range(if gauged) 9. Check cartridge weight•(if applicable) _-- 111 Hydrostatic test date f ou=mapf 11, 6 year maintenence date �--. 12. Inspect cylinder and mount Name i 7i��%� it 13.Operate system from terminal link c� ,�, f, 14.Test for proper operation from remote Address ,�<��Y 15. Check operation of micro switch --- aty .;2 G-Ak 16.Check operation of gas valve 17.Clean nozzles v Telephone __ _ Store No. 11 Proper nozzle covers in place L 19. Check fuse links and clean ---t-- Owner or Manager 20. Replaced fuse links [.r- OF s—w— . P. TIME A.MM. 21,Check travel of cable nutd$-hooks 22.Wiping &conduit securely bracketed 23, Proper separation between fryers and flame ate-- ANNUAL 4�W14UAL REcwwae INSTALUmow aefvo>a�no>,I 1 24. Proper clearance-flame to filters LOWON of VO M CYUNoVRs 2& Exhaust fan in operating order A v'VI /Z 26.All fitters replacedZ— ` �Fag1r 27. Fuel shut-off in on position MANURAMRER MODBL NUMBER WET Lbw 0Mr-AI ?.F1 Manual$ remote setlseals in lace r✓ i K �r`l p 29. Replace systems covers cYLINnER s¢e MASTEI GYL+Ho�R sas suu+e OYUNDER 8¢Q 30.System operational &seals in piece -a- FUSE LINKS 3005P. ;:USE UNITS Nw+1 FUSE LINKS S". OTHER . Slave System operational r°' 32. Clean cylinder& moun't �--- eveL SWUM E=Mc 33. Fan warning sign on hood �— ,,� 4 „ 34. Personnel instructed in manual operation of system r! SERIAL NUMM LW HYDRO TEST oasE LAST RECHARGE D,E 35. Proper hand portable extinguishers Lam' c 37. Se & Certification tot e extinguishers ply serviced MANUPAQTURER'S MANUAL REFE�iENOE on system PACE NUMBER: DRAWINfl NUR --- NOTE DISCRBPANCISS OR DEFICIENCIES BELOW COOYJNG APPLIANCE LOGATIoNS: LEFT 70 4RIGHHT .J Y COMMENTS: On this date, the above system was tested and inspecw'in accordance with procedures of the presently adopted editions of NFPA 17,17A,96 and the manufacturer's manual and ww operated according to these Oroqpdyres with r indicated above. X ,''�iA e ll/ Sfi E TECHNICIAN PEnm T NO. DATE: T9ME AM P1 3J-51nMFHS THORIZED AGENT The above service technician certifies that the system was personally inspmed and found conditions to be as Indicated on this report. WN(M•CUSTOMER COPY Ye-L(M-DISTRIBUTOR PINK-AUTHORITY HWNQ JORISOCnON TO/TO 39dd 3NId360HSHidON 8T9T8968L6 99:60 90071/bT/90 I I City of Salem, .Massachusetts en Fire Department Cf as J ..R 48 Lafayette Street Robert`W.Turner Salem, Massachusetts 01 9 70-3 695 fire Prevention Chief TeL 9M8-744-1235 Bureau 978-744-6990 FaX 978-745-4646 978-745-7777 PAID CHECK# NO FEE SALEM FIRE PREVENTION ANNUAL SUMMER CAMP INSPECTION ` IN'ACCORDANCE WITH THE REQUIREMENTS OE MASSACHUSETTS GENERAL LAWS, . CHAPTER 148, SECTION 4, THE BOY'S & GIRL' S" CLUB.OF GREATER SALEM LOCATED AT 13 HAWTHORNE BLVD. WAS INSPFiCTED ON 5/27/03 BY: FIRE INSPECTOR KATHLEEN DESCHENE REPORT ON INSPECTION: APPROVED: YES DISAPPROVED: DATE: 5/27/03 SIGNATURE INSPECTOR TITLE CC: BOARD OF HEALTH BUILDING DEPT. PLACE OF INSPECTION FILE FORM #35. FPB 6/2001 `°� ci y o afem, Massachusetts 1 Fire Department 48 Lafayette Street o6ert`YV Turner Salem,Massachusetts 01970-3635 Ft Prevention Chief TeL 978-744-1235 Bureau 978-744-6990 Fax 978-745-4646 978-745-7777 PAID CHECK# NO FEE SALEM FIRE PREVENTION ANNUAL SUMMER CAMP INSPECTION IN ACCORDANCE WITH THE REQUIREMENTS OF14ASSACHUSETTS GENERAL LAWS, CHAPTER 148, SECTION 4, THE BOY'S & GIRL'_S=CLUB.OF",GREATER` SALEM , LOCATED AT 13 HAWTHORNE BLVD. WAS INSPI�CTED ON 6/14/2002 BY: FIRE INSPECTOR FRANK PRECZEWSKI REPORT ON INSPECTION: APPROVED: YES DISAPPROVED: DATE: SIGNATUR TITLE CC: BOARD OF HEALTH BUILDING•DEPT. PLACE OF INSPECTION FILE FORM #35 FPB 6/2001 " .3 City of Safem, ,Vassachusetts (Fire Department . 48 Laffayette Street (DavidW Cody Tire 1Trevention Bureau Chief SaCem, �t�lassachusetts 01970-3695 29 TortAvenue 978-744-6990 2ef978-744-1235 7ef978-745-7777 dcody@safem.com (Faa,,978-745-4646 ''ar,978-745-9402 VIOLATION NOTICE y Salem Boys Girls Club Thursday May 17, 2007 013 Hawthorne Boulevard Salem, MA 01970 An inspection of your facility on Friday March 30, 2007 revealed the violations listed below. - - - -- -- ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on at / / If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violation Code Article Division Page Count 1.06.1 Fire Code Violations 1.06 1 0 0 Improper slide type lock on exit door in Technology Room. Emergency lights & exit signs 2nd floor hall out of service. Exit sign 3rd floor hall out of service. All situations to be remedied forthwith. Fire Code Violations. Whenever the marshal, the head of the fire department or any person to whom the marshal or head of the fire department has delegated is his authority in writing, finds in any building or upon any premises a violation of 527 CMR or any condition likely to cause .fire or any obstacle to easy ingress or egress from such building, they shall, in writing, order the same to remedied. Notice of the violation shall be served in accordance with the provisions of M.G.L. c. 148, § 5, including, but not limited to the following: (a) Dangerous conditions which are liable to cause or contribute to the 05/17/2007 11: 15 Page 1 .�o to s r SALEM FIRE DEPARTMENT INSPECTION AND VIOLATION REPORT DATE: Q 7 STATION: ADDRESS: NAME: 13c s -i- G,rl,l C L�lv Ct 5�1� PHONE: 7 -7 y 4-0k) 'BLDG. CLASS: �;.I cf� ALARM CO: w w ww+'e I c OFFICER: LT 1. ,,Pv I F/F: �v S ✓ G�/�12 ) F/F: ;. N.c.Q MULTIPLE BUSINESSES, RETAIL SPACES, OFFICES, ETC. OCCUPANCY PHONE# OCCUPANCY PHONE # EXTERIOR PASS FAIL N/A HEATING SYSTEMS PASS FAIL N/A EXITS CPAS9 FAIL N/A ELECTRICAL -PAS FAIL N/A FIRE ALARM SYSTEM PASS FAIL N/A FIRE EXTINGUISHERS 'PASS FAIL N/A SPRINKLERS IPASS FAIL N/A STANDPIPES IPASS FAIL EMERGENCY LIGHTS PASS FAIL N/A KITCHENS PAS FAIL N/A wo r c . b e STORAGE PAS FAIL N/A PERMITS YES NO N/A OTHER VIOLATIONS AND COMMENTS 1 o IN/ C l ON P✓v'C. Z2 ) 00- G rst lev& - l ry ow r% we rY. REGULAR INSP. QUARTERLY INSP. SCHOOL INSP. 1I # 6.(&evv.6./�2/003)/ C. Ltji ckj WHITE COPY: FIRE PREVENTION PINK COPY: OWNER o Salem �Vl assachusetis city Fire Department 48 Laffayette Street David W Cody Fire Prevention Bureau Chief SaCem, �lassatFiusetts 01970-3695 29 fort-Avenue 978-744-6990 7e[978-744-1235 7e(978-745-7777 dcody@safem.com Fax 978-745-4646 TFa;C978-745-9402 VIOLATION NOTICE x Flynn, Timothy G Inspector Occupant/Owner 05/17/2007 11:15 Page 3 a �.�CfhIN3,jq cit o Salem Wassachuse t ts y V-r Fire Department Cody 481;affayette Street (DavidW.. Fire ltevention Bureau Chief Salem, Wassachusetts 01970-3695 29 FortAvenue 978-744-6990 Te1978-744-1235 7ef978-745-7777 dcody@sa(m.com Far, 978-745-4646 fax978-745-9402 VIOLATION NOTICE Salem Boys & Girls Club Thursday May 17, 2007 013 Hawthorne Boulevard Salem, MA 01970 spread of fire' or explosion in or on said premises, building or structure or -- endanger the occupants thereof; -- --- -- - - -- - (b) Conditions which interfere with the efficiency and use of any fire protection equipment; (c) obstructions to or on fire escapes, stairs, passageways, doors or windows, liable to interfere with the egress of occupants or the operation of the fire department in case of fire; (d) Accumulations of dust or waste material in air conditioning or ventilating systems or grease in kitchen or other exhaust ducts; (e) Accumulations of grease on kitchen cooking equipment, or oil, grease or dirt upon, under or around any mechanical equipment; (f) Accumulations of rubbish, waste, paper, boxes, shavings, or other combustible materials, or excessive storage of any combustible material; (g) Hazardous conditions arising from defective or improperly used or installed electrical wiring, equipment or appliances; (h) Hazardous conditions arising from defective or improperly installed equipment for handling or using combustible, explosive or otherwise hazardous materials; (i) Dangerous or unlawful amounts of combustible, explosive or otherwise hazardous materials; (j ) All equipment, materials, processes or operations which are in violation of the provisions and intent of 527 CMR. (k) The use of any machine, devise or chemical to create fog, foam or a haze-like visual effect which could become an obstacle to ingress or egress from any place of assembly. 05/17/2007 11:15 Page 2 SALEM FIRE DEPARTMENT Inspec. ate: J Insp.Number INSPECTION AND VIOLATION REPO Reinsp.Date: • Occupancy Name S P 4vtk Occupancy Type 'tvria Address Trjor Bldg. #'s Yes❑ No D 1 Floor/Section Phone Inspector Name Com n # Notifications D Health ❑Bldg. ❑Electrical ❑Police 1. Exterior 6. Heating Systems ❑ N/A fire escapes/decks ❑ Pass D Fail D Warn ❑ N/A combustibles ❑Pass ❑ Fail ❑Warn D N/A proper storage D Pass D Fail ❑Warn ❑ N/A within 5 feet proper access ❑Pass ❑Fail ❑Warn ❑ N/A defective chimney ❑ Pass ❑ Fail ❑Warn D N/A KNOX BOX ❑ Pass ❑ Fail ❑Warn ❑ N/A defective system ❑ Pass ❑ Fail ❑Warn ❑ N/A 2. Exit other ❑ Pass ❑ Fail ❑Warn ❑ N/A open property D Pass trail D Warn D N/A 7. Electrical exit blocked ss D Fail D Warn ❑N/A defective wiring I I Pass D Fail ❑Warn ❑ N/A exit signs working Pass ❑ Fail ❑Warn ❑ N/A panels accessible Pass ❑ Fail ❑Warn ❑ N/A adequate lighting Pass ❑ ail ❑Warn ❑ N/A extension cords: door(s)locked D Pass AFail ❑Warn ❑ N/A proper use Pass ❑ Fail ❑Warn ❑ N/A signs needed .Pass D ail ❑Warn ❑ N/A cover plate missing Pass D Fail ❑Warn ❑ N/A in need of repair ❑ Pass Fail ❑Warn ❑ N/A proper fusing Pass ❑ Fail D Warn ❑ N/A emergency lights ❑ Pass ❑ Fail D Warn X N/A other Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass D Fail ❑Warn ❑ N/A 8. Fire xtinguishers ❑ N/A 3. Fire Alarm System,/ ❑ N/A signs needed ss ❑ Fail ❑Warn ❑ N/A operative ❑ Pass ❑ Fail [.(Warn ❑ N/A properly mounted Vioass ❑ Fail D Warn ❑ N/A properly labeled If Pass ❑Fail ❑Warn ❑ N/A proper type s ❑ Fail ❑Warn ❑ N/A accessible If Pass ❑ Fail ❑Warn ❑ N/A obstructed Pass ❑ Fail D Warn ❑ N/A • trouble indication ❑ Pass Wail ❑Warn ❑ N/A need recharging Pass ❑ Fail ❑Warn ❑ N/A defective devices ❑ Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass Fail ❑Warn ❑ N/A missing devices ❑ Pass ❑ Fail D Warn ❑ N/A other ❑ Pass ❑ Fail D Warn ❑ N/A 9. Sprinkler&Standpipe System 4. Kitchens N/A valves labled ❑ Pass D Fail ❑War N/A 10 Ib.ABC extinguisher O Pass ❑ Fail ❑Warn ❑ N/A valves accessible ❑ Pass ❑ Fail ❑Warn ❑ N/A at hazard pressure reading ❑ Pass ❑ Fail ❑Warn ❑ N/A ext.system operat. Pass ❑ Fail ❑Warn 0 N/A FDC clear/capped ❑Pass D Fail ❑Warn ❑N/A roof collect.clean Pass ❑ Fail ❑Warn ❑ N/A Valves open ❑ Pass ❑ Fail ❑Warn ❑ N/A system inspected Pass ❑ Fail ❑Warn D N/A valves secured ❑ Pass ❑ Fail ❑Warn D N/A hood/duct clean Pass ❑ Fail ❑Warn ❑ N/A spare head avail. ❑Pass ❑ Fail O Warn D N/A other Pass ❑Fail ❑Warn ❑ N/A heads obstructed ❑ Pass ❑ Fail ❑Warn ❑ N/A S. Storage other ❑ Pass ❑ Fail ❑Warn ❑ N/A proper labeling ❑ Pass ❑ ail ❑Warn D N/A proper storage ❑ Pass Fail ❑Warn D N/A PTN Form *84-Completed Yes❑ No❑ legal storage O Pass Fail ❑Warn ❑ N/A other ❑ Pass ❑ Fail ❑Warn ❑ N/A Form #58- Filed Yes❑ No❑ 10. Violptions Foun W �lXM0 S J-D C) Forrp*16-(Rev.11/93) Copies: White-Fire Preeen ioin Yellow,-Inspecting Company Pi k-Building Owner/Manager De i V ��S=r 1c t�U1 It "S � 1� G . �-' I !M C� , SALEM FIREDEPARTMENT� nspec. ate: 49, Insp.Number }INSPECTIOICAND VIOLATION REPORT Reinsp.Date: S i. ... �k Occupancy Name a s' Occupancy Type�LW Address Bldg. WS Floor/Section Phone Ttn�cv Yes❑ No❑ ; Inspector Name "` Com ny# ,.Notifications 0 Health 0 Bldg. ❑Electrical D Police. 1 1. Exterior �* 6. 'Heating Systems El "NIA fire escapes/decks 0 Pass ❑ Fail 0 Warn ❑N/A combustibles ❑Pass ❑ Fail ❑Warn D N/A proper storage ❑ Pass 0.Fail ❑Warn O N/A ' within 5 feet, proper access ❑ Pass ❑ Fail ❑Warn ❑ N/A `'defective chimney D Pas c D Fail ❑Warn ❑ N/A KNOX BOX D Pass . D Fail. ❑Warn. 0 N/A defective system ❑ Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass D Fail 0 Warn D N/A 2.Pen Exit /' o property ❑ ss YFail ❑Warn D N/A 7. Electrical P PenY exit`blocked .913ass D Fail ❑Warn 0 N/A defective wiring I I Pass ❑ Fail ❑Warn ❑ N/A exit signs.working Pass`` &Fail ❑Warn ❑ N/A panels accessible Pass ❑Fail ❑Warn ❑ N/A ado uate lighting Pass ❑ ail ❑Warn ❑rN/A q g 9 extension cords: door(s)locked ❑ Pass XFail ❑:Warn:• D N/A proper use I I Pass ❑ Fail ❑Warn ❑ N/A signs needed '913ass ❑ ,ail . ❑Warn ❑ N/A cover plate missing I I Pass ,❑ Fail ❑Warn ❑ N/A in need of repair 0 Pass • Fail 0 Warn ❑ N/A proper fusing Pass D Fail ❑Warn ❑ N%A emergency lights ❑ Pass ❑Fail ❑Warn" XN/A' other � Pass D Fail ❑Warn D N/A other. ❑ Pass 0 Fail 0 Warn. ❑ N/A 8. Fire xtinguishets O .-'N/A .3. Fire Alarm-System . O .N/A =ems'i ns needed ss ❑ Fail D Warn ❑ N A ❑ D Fit Wa'ruz'vaj N A operative Pass, a t :.,, / property mounted ss ❑ Fail ❑Warn ❑ N/A properly labeled Pass ❑ Fail ClVVam ❑ N/A proper type_ ss D Fail ❑Warn : ❑ N/A 6,h accessible Pass ❑ Fail O Warn D N/A obstructed ss ❑ Fail ❑Warn ❑ N/A • trouble indication ❑ Pass V. ❑Warn ❑ N/A need recharging „ Pass. ❑ Fail ❑Warn ❑ N/A defective devices D Pass ❑Fail ❑Warn D N/A other D Pass, Fail ❑Warn 0 N/A missing devices ❑ Pass D Fail ❑Warn 0 N/A other D Pass D Fail ❑Warn ❑ N/A 9. Sprinkler&.Stari'dpipe System x N/A w 4:'Kitchens -,,..; valves labled D Pass ❑ Fail OWar N/A 10 lb.ABC extinguisher D Pass ❑ Fail ❑Warn _❑ N/A valves accessible 0 Pass D Fail Warn ❑ N/A at,hazard F ' pressure reading ❑ Pass 0 Fail ❑,Warn D N/A ext..,system operat ❑ Pass ❑ Fail ❑Warn 0 N/A Mt clear/capped ❑ Pass 0 Fail ❑Warn. 0 NI/A roof collect.clean Pass ❑ Fail El Wain ❑ N/A Valves open ❑'Pass ❑ Fail ❑Warn ❑ N/A system inspected Pass ❑ Fail ❑Warn 0,N%a""''valves secured ❑ Pass ❑ Fail ❑Warn ❑ N/A hood/duct clean d Pass ❑ Fail ❑Warn ❑ N/A spare head avail. ❑ Pass ❑ Fail ❑Warn 0 N/A other 11 Pass ❑Fail ❑Warn ❑ N/A heads obstructed ❑ Pass'', ❑ Fail D Warn ❑ N/A 5. Storage other 0 Pass O'Fail ❑Warn ).D N/A`- proper,labeling ❑ Pass . D ail ❑Warn ❑ N/A proper storage: ❑ Pass Fail ❑Warn D N/A J PTN Form*84-Completed Yes❑ No❑ . legal storage` ❑ Pass Fail ❑Warn O N/A.' other ❑ Pass D Fail --D,Warn` ❑ N/A Form *58- Filed Yes❑ No❑ 10. Violations Fount vi s f in a)(L Wtl �e t* 4Vk&+- AkLt 0z big #t 16-(Rev.11/93) Copies: White-Fire ProvoqI Yellow-Inspecting ompany Pink-Building Owner/Manager U+f\*(P-- 4v �'�s-r �UrCY t Y�ty-s- `�_► i 11 �� ��d(�/A(1 �Q Fire Alarm and Life Safety System Inspection Certificate For BOYS_AND GIRLS CLUB OF SALEM 13 HAWTHORNE BLVD SALEM, MA 01970 Tested to NFPA 72 Standards This Inspection was performed in accordance with applicable NFPA Standards. The subsequent pages of this report provide performance measurements, listed ranges of acceptable results, and complete documentation of the inspection. Whenever discrepancies exist between acceptable performance standards and actual test results, notes and/or recommended solutions have been proposed or provided for immediate review and approval. Inspection Date Jun 28, 2008 Building:BOYS AND GIRLS CLUB OF SALEM Company:Hayden Systems,Inc. Contact:RAY A Contact:Chris Whitmarsh Title:MANAGER Title: Owner Executive Summary Generated by:BuildingReports.com Building Information Building: BOYS AND GIRLS CLUB OF SALEM Contact: RAY A Address: 13 HAWTHORNE BLVD Phone: 978-744-0915 Address: Fax: City/State/Zip: SALEM, MA 01970 Mobile: Country: United States of America Email: Inspection Performed By Company: Hayden Systems, Inc. Inspector: Chris Whitmarsh Address: PO Box 713 Phone: (978) 744-0022 Address: Fax: (978) 432-1007 City/State/Zip: Rowley, MA 01969 Mobile: (978) 265-5836 Country: United States of America Email: haydensystems@comcast.net System Control Unit Manufacturer: ESL Inspection Date: 06/27/2008 IDC Style: A Model Number: 1500 Install Date: 06/27/2008 SLC Style: Software Version: Version Date: 06/27/2008 NAC Style: Z Location: Basement office Current Protection: Breaker Monitoring Type: McCulloh Mfg: Gamewell Model #: masterbox 195 Test Time/Date: 6/27/08 2:08:29 PM Restore Time: Inspection Summary . Total Items Serviced Passed Failed'Other Category Q % Q % Q % Q % Initiating 78 88% 78 100% 71 91% 7 9% Control 5 6% 5 100% 5 100% 0 0% Indicating 6 7% 1 6 100% 3 50% 1 3 50% Totals 89 100% 89 100% 79 89% 10 11% Certification Building: BOYS AND GIRLS CLUB OF SALEM Company: Hayden Systems, Inc. Contact: RAY A Inspector: Chris Whitmarsh Signed: Signed: Hayden Systems,Inc. 1 06/28/2008 Discrepancy Report Generated by:BuildingReports.com Building: BOYS AND GIRLS CLUB OF SALEM Control Panel: 1 -,ESL 1500 -The Discrepancy Report consolidates each discrepancy listed within the various Testing sections of your Inspection. Discrepancies are listed by Category, and grouped by device type. The description of the problem is provided and where appropriate, code references are listed for your convenience.Any item that was inspected that is listed on the Consumer Product Safe Commission's website and is subject to a recall by the manufacturer is included. Device Type Manufacturer ModelNumber Date Qt Items listed or Recall by Manufacturer No recalled items found during this inspection. $ ScanlD 0 Location Q Problem Address � Reference Indicating Horn/Strobe 07743183 1 st all fail 07743186 auditorium 1 fails 07743185 gym all fail Initiating Heat Detector 07743279- �Basement @vending 07743282 Basement @ panel ___a painted NFPA 72 10.3.1 Pull Station 07743216 Basement gym Damaged/Worn NFPA 72 10.2.1.2 07743272 _ 1 st lunch rm.exit _ Damaged/Worn NFPA 72 10.2.1.2 Smoke Detector 07743246 2nd hall @ womens Failed Operation NFPA 72 10.2.1.2 07743247 2nd hall @ 24 Failed Operation NFPA 72 10.2.1.2 07743249 2nd @ stairs missing Hayden Systems,Inc. 2 06/28/2008 Proposed Solutions Report Generated by:BuildingReports.com Building: BOYS AND GIRLS CLUB OF Control Panel: 1 - ESL 1500 j SALEM The Proposed Solution Report provides a solution for each discrepancy listed on the Discrepancy Report. Provide a check mark where indicated to approve repairs listed within the report.Items listed as TIM are available for repair on a Time and Materials basis. $ ScanlD 0 Location 4 Solution Model # Cost Fix Indicatin Horn/Strobe 07743183 1 st Reschedule T/M 07743186 auditorium Replace T/M 0 07743185 gym Replace T/M 11 Initiating Heat Detector 07743279 Basement @ vending Relocate T/M 07743282 Basement @ panel_ Replace T/M Pull Station 07743216 Basement gym Replace T/M ❑ 07743272 1 st lunch rm.exit _ Replace i__ _T T/M _ Smoke Detector 07743246 2nd hall @ womens Replace T/M ❑ 07743247 2nd hall @ 24 Replace T/M 07743249 2nd @ stairs Install T/M ❑ Hayden Systems,Inc. 3 06/28/2008 Inspection & Testing Generated by:BuildingReports.com -- --- ----- ---- ---- j Building: BOYS AND GIRLS CLUB OF SALEM Control Panel. 1 - ESL 1500 - - - - - - _ The Inspection& Testing section lists all of the items inspected in your building. Items are grouped by Passed or FailedlOther.Items are listed by Category. Each item includes the services performed, and the time&date at which testing occurred. Device Tye Location Service Time Date Passed Control Annunciator 1 st front door Tested 2:22:01 PM 06/27/2008 Battery panel left Tested 2:11:29 PM 06/27/2008 Battery panel right Tested 2:12:36 PM 06/27/2008 Communicator outside Tested 2:08:29 PM 06/27/2008 Control Panel Basement office Tested 2:09:56 PM 06/27/2008 Indicating _ Horn/Strobe Basement Tested 2:16:12 PM 06/27/2008 Horn/Strobe 2nd Tested 2:16:54 PM 06/27/2008 Horn/Strobe - - 2nd u Tested_ 2:17:05 PM 06/27/2008 Initiating _ Heat Detector Basement game rm. Tested 1:58:56 PM 06/27/2008 Heat Detector Basement arts rm. Tested 1:59:15 PM 06/27/2008 Heat Detector Basement @ panel storage rm. Tested 2:00:18 PM 06/27/2008 Heat Detector Basement activity rm. Tested 2:00:38 PM 06/27/2008 Heat Detector Basement activity rm. Tested 2:01:07 PM 06/27/2008 Heat Detector Basement computer rm. Tested 2:01:20 PM 06/27/2008 Heat Detector Basement gym Visually Checked 2:02:55 PM 06/27/2008 Heat Detector Basement gym Visually Checked 2:03:06 PM 06/27/2008 Heat Detector Basement gym office Tested 2:03:18 PM 06/27/2008 Heat Detector Basement weight rm. Tested 2:03:38 PM 06/27/2008 Heat Detector Basement girls locker Tested 2:04:11 PM 06/27/2008 Heat Detector Basement boys locker Tested 2:05:04 PM 06/27/2008 Heat Detector Basement boiler rm. Visually Checked 2:33:22 PM 06/27/2008 Heat Detector 1 st rm 12 Tested 1:52:29 PM 06/27/2008 Heat Detector 1 st rm 13 Tested 1:52:44 PM 06/27/2008 Heat Detector 1 st parish office Tested 1:53:32 PM 06/27/2008 Heat Detector 1 st parish office inner Tested 1:53:53 PM 06/27/2008 Heat Detector 1 st parish office inner Tested 1:54:07 PM 06/27/2008 Heat Detector 1 st ladies rm Tested 1:54:13 PM 06/27/2008 Heat Detector 1 st main office Tested 1:54:35 PM 06/27/2008 Heat Detector 1 st main office Tested 1:54:53 PM 06/27/2008 Heat Detector 1 st kitchen Tested 1:54:59 PM 06/27/2008 Heat Detector 1 st lunch room Tested 1:55:14 PM 06/27/2008 Heat Detector 1 st kitchen storage Tested 1:55:58 PM 06/27/2008 Heat Detector 1 st auditorium 4 heats Visually Checked 1:57:18 PM 06/27/2008 Heat Detector 1 st auditorium stotage Tested 1:57:28 PM 06/27/2008 Hayden Systems,Inc. 4 06/28/2008 Device TO - Location Service Time Date Heat Detector 2nd rm 32 Tested 1:49:32 PM 06/27/2008 Heat Detector 2nd tech. rm Tested 1:49:51 PM 06/27/2008 Heat Detector 2nd womens rm Tested 1:50:16 PM 06/27/2008 Heat Detector 2nd rm 33 Tested 1:50:42 PM 06/27/2008 Heat Detector 2nd break rm Tested 1:50:56 PM 06/27/2008 Heat Detector 2nd rm 24 Tested 1:51:16 PM 06/27/2008 Heat Detector 2nd mens rm Tested 1:51:33 PM 06/27/2008 Heat Detector 2nd rm 15 Tested 1:51:52 PM 06/27/2008 Heat Detector 2nd rm 26 Tested 1:52:09 PM 06/27/2008 Heat Detector 3rd golf room Tested 1:47:41 PM 06/27/2008 Heat Detector 3rd room 34 Tested 1:48:1 5 PM 06/27/2008 Heat Detector 3rd storage rm Tested 1:48:32 PM 06/27/2008 Heat Detector 3rd class rm Tested 1:48:55 PM 06/27/2008 Heat Detector 3rd rm 22 Tested 1:49:11 PM 06/27/2008 Pull Station Basement @ reception Tested 2:18:07 PM 06/27/2008 Pull Station Basement @ rear exit Tested 2:18:28 PM 06/27/2008 Pull Station Basement gym rear exit Tested 2:18:51 PM 06/27/2008 Pull Station 1 st auditorium Tested 2:20:39 PM 06/27/2008 Pull Station 1 st auditorium Tested 2:21:03 PM 06/27/2008 Pull Station 1 st auditorium rear exit Tested 2:21:11 PM 06/27/2008 Pull Station 1 st front door Tested 2:22:21 PM 06/27/2008 Pull Station 1 st @ stairs Tested 2:22:31 PM 06/27/2008 Pull Station 1 st @ stairs Tested 2:22:54 PM 06/27/2008 Pull Station 2nd @ stairs Tested 2:23:38 PM 06/27/2008 Pull Station 2nd @ stairs Tested 2:23:51 PM 06/27/2008 Pull Station 3rd @ stairs Tested 2:24:02 PM 06/27/2008 Pull Station 3rd @ stairs Tested 224:17 PM 06/27/2008 Smoke Detector Basement hall Tested/Cleaned 2:32:04 PM 06/27/2008 Smoke Detector Basement hall Tested/Cleaned 2:32:16 PM 06/27/2008 Smoke Detector Basement hall Tested/Cleaned 2:32:23 PM 06/27/2008 Smoke Detector 1 st 0 stairs Tested/Cleaned 2:27:37 PM 06/27/2008 Smoke Detector 1 st @ stairs Tested/Cleaned 2:27:53 PM 06/27/2008 Smoke Detector 1 st front Tested/Cleaned 2:28:05 PM 06/27/2008 Smoke Detector 1 st hall Tested/Cleaned 2:31:20 PM 06/27/2008 Smoke Detector 1 st hall Tested/Cleaned 2:31:27 PM 06/27/2008 Smoke Detector 1 st hall Tested/Cleaned 2:31:33 PM 06/27/2008 Smoke Detector 2nd @ stairs Tested/Cleaned 2:26:54 PM 06/27/2008 Smoke Detector 2nd hall Tested/Cleaned 2:29:29 PM 06/27/2008 Smoke Detector 2nd hall @ 24 Tested/Cleaned 2:30:38 PM 06/27/2008 Smoke Detector 3rd @ stairs Tested/Cleaned 2:26:21 PM 06/27/2008 Smoke Detector 3rd @ stairs Tested/Cleaned 2:26:30 PM 06/27/2008 Smoke Detector 3rd hall Tested/Cleaned 2:28:35 PM 06/27/2008 Smoke Detector 3rd hall Tested/Cleaned 2:29:02 PM 06/27/2008 Smoke Detector 3rd hall Tested/Cleaned 2:29:07 PM 06/27/2008 Smoke Detector 3rd hall Tested/Cleaned 2:29:13 PM 06/27/2008 Failed/Other Indicating_ Horn/Strobe 1 st Tested 2:16:46 PM 06/27/2008 Horn/Strobe auditorium Tested 2:15:22 PM 06/27/2008 Horn/Strobe gym Tested 10:09:19 AM 06/28/2008 Hayden Systems,Inc. 5 06/28/2008 Device T e Location Service Time Date Initiating Heat Detector _ Basement @ vending Tested 10:08:16 AM 06/28/2008 Heat Detector Basement @ panel Tested 10:08:30 AM 06/28/2008 Pull Station Basement gym Tested 10:08:58 AM 06/28/2008 Pull Station 1 st lunch rm.exit Tested 10:08:50 AM 06/28/2008 Smoke Detector 2nd @ stairs Tested 2:27:27 PM 06/27/2008 Smoke Detector 2nd hall @ 24 Tested 2:30:31 PM 06/27/2008 Smoke Detector 2nd hall @ womens Tested 10:09:06 AM 06/28/2008 I Hayden Systems,Inc. 6 06/28/2008 Battery & Power Supply Testing Generated by:BuildingReports.com Building: BOYS AND GIRLS CLUB OF Control Panel: 1 - ESL 1500 SALEM The Control&Power Testing section details the readings and measurements of batteries and power supplies used to provide power to the fire alarm and life safety systems.Items are grouped by Passed or Failed/Other. Pre Post Type Location Comment Amps volts Test Test Passed Battery panel left Passed 4.80 12.9 panel right Passed 4.95 12.8 I Y Hayden Systems,Inc. 7 06/28/2008 Y Inventory & Warranty Report Generated by:BuildingReports.com Building: BOYS AND GIRLS CLUB OF Control Panel: 1 - ESL 1500 SALEM The Inventory& Warranty Report lists each of the devices and items that are included in your Inspection Report.A complete inventory count by device type and category is provided. Items installed within the last 90 days, within the last year, and devices installed for two years or more are grouped together for easy reference. Device or Item Cate o %of Inventory Quantity Heat Detector Initiating 47% 42 Communicator Control 1% 1 Control Panel Control 1% 1 Battery Control 2% 2 Horn/Strobe Indicating 7% 6 Pull Station Initiating 17% 15 Annunciator Control 1% 1 Smoke Detector Initiating 24% 21 T e Qt Model # Description Install Date New (under 90 days) Annunciator 1 LED List 06/27/2008 Smoke Detector 21 Photoelectric 06/27/2008 Chem_etron Heat Detector 42 _ Rate-of-Rise - 06/27/2008 ESL ^Control Panel 1 1500� — 06/27/2008 FCI Pull Station 15 Dual Action 06/27/2008 G_ame_well Communicator 1 masterbox 195 McCulloh 06/27/2008 Wheelock Horn/Strobe 6 06/27/2008 zeus Battery— 2 7am� -� 06/27/2008 Hayden Systems,Inc. 8 06/28/2008 Pre-Engineered Restaurant Fire Suppression Systems Report SERVICE COMPANY DATE OF SERVICE TIME A.M. P.M. ( dot A011 1-0136 1--,- ANNUAL SEMI-ANNUAL I RECHARGE INSTALLATION RENOVATION \ plop GAB fa chore Fire �$PPHR�P-0 LOC/y ION OFF SYSTEM CYLINDERS .�/ / UL 300 l �1�W-jain St ® gP�O BOX 2C3 4i.j o * +d�t w( ❑YES ❑NO ej,jl' a MA 01981 MANUFACTURER MODEL NUMBER WET DRY CHEMICAL 978 468 1618 FaX CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE A.q 6. CUSTOMER FUSE LINKS 360'F. FUSE LINKS 450'F. FUSE LINKS 500'F OTHER ]] Name s ,/� FUEL SHUT-OFF ELECTRIC GAS SIZE Address 13 >'dGw ! ,O&Wt Tdl )ad I./ �+ t SERIAL NUMBER ]-LAST HYDRO TEST DATE LAST RECHARGE DATE City State A ZIP 01970 qq9 MANUFACTURER'S MANUAL REFERENCE ,. Telephone �7Q✓`- Y ©���� Store No. PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager A -S COOKIN(G�APPLIANCE_LOCATIONS: LEFT TO RIGHT `LLB 1. All appliances properly covered w/correct nozzles 20. Replaced fuse links A10 2. Duct and plenum covered w/correct nozzles - _�/ 21. Check travel of cable nuts/S-hooks 3. Check positioning of all nozzles. V., 22. Piping&conduit securely bracketed a� 4. System installed in accordance w/MFG UL listing ✓ 23. Proper separation between fryers&flame 5. Hood/duct penetrations sealed w/weld or UL device __Z( 24. Proper clearance-flame to filters y 6. Check if seals intact,evidence of tampering t/ 25. Exhaust fan in operating order uae 7. If system has been discharged, report same 26: All filters in place 8. Pressure gauge in proper range(If gauged) 27: Fuel shut-off in on position 9. Check cartridge weight(If applicable) rt'�"" 28. Manual&remote set/seals in place v 10. Hydrostatic test date ci'�al 29. Replace systems covers or 11. 6 year maintenance date 30. System operational&seals in place y 12. Inspect cylinder and mount ✓ 31. Slave system operational 13. Operate system from terminal link - ✓ 32. Clean cylinder&mount 14. Test for proper operation from remote 33. Fan warning sign on hood 15. Check operation of micro switch +j C 34. Personnel instructed in manual operation of system ✓ 16. Check operation of gas valve 35. Proper hand portable extinguishers 17. Clean nozzles 36. Portable extinguishers properly serviced 18. Proper nozzle covers in place 37. Service&Certification tag on system 19. Check fuse links and cleaner NOTE DISCREPANICES OR DEFICIENCIES BELOW COMMENTS: r, t U U {�a k- c14_rs c' `4Ft��vff'+liyt 0j p "w-, 1094 s o 14 e t P 2 f S e c-T' qPcA in:a re.9 o cc 7- On this date, this pre-engineered fire suppression system was inspected and operationally tested in accordance with the fire s�ppre�Sion system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above. r SERVICE TECHNICIAN PERMIT NO. DAT TIME: AM PM CUSTOMER'S AUTHORIZED AGENT The.above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. AUTHORITY HAVING JURISDICTION y ineered Restaurant Fire Suppression Systems Report s' ICE COMPANY DATE OF SERVICE TIM A.M. P.M. C- /�t 0., ANNUAL SEMI-ANNUAL RECHARGET INSTALLATION RENOVATION North Shore Fire Appliance LOCATION OF SYSTEM CYLINDERS UL300 98 Main St - PO Box 263 &21Es NO Wenham MA 01984 MANUFACTURER MODEL NUMBER WET DRY CHEMICAL 978 468 1600 rjor_ tOWI Pt CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE ;•y 5q/ FUSE LINKS 360'F. FUSE LINKS 450°F. FUSE LINKS 500'F OTHER t CUSTOMER �^ Name � t-e tn, �d S i- �'����.� ��� II FUEL SHUT-OFF ELECTRIC GAS SIZE Address /3 ( SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE City �s State d g ZIP 01270 MANUFACTURER'S MANUAL REFERENCE Telephone cl70 4/- Qt IS- Store No. PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT A� 1. All appliances.properly covered w/correct nozzles 20. Replaced fuse links... 2. Duct and plenum covered w/correct nozzles L/ 21 Check travel of cable nuts/S-hooks 3. Check positioning of all nozzles. >/ 22. Piping&conduit securely bracketed 4. System installed in accordance w/MFG UL listing 23..Proper separation between fryers&flame f 1� 5. Hood/duct penetrations sealed w/weld or'UL device ✓ 24. Proper clearance-flame to filters y 6. Check if seals intact,evidence of tampering ✓ 25. Exhaust fan in operating order t/ 7. If system has been discharged, report same '-" 26. All filters.in place +G 8. Pressure gauge in proper range(If gauged) ✓ 27. Fuel shut-off in on position r/ 9. Check cartridge weight(If applicable) 0-1 28. Manual&remote set/seals in place 10. Hydrostatic.test date ofL 29. Replace systems covers ✓ 11. 6 year maintenance date Al A. 30. System operational&seals in place 12. Inspect cylinder and-mount ✓ 31. Slave system operational A/A .13. Operate system from terminal link ✓ 32. Clean cylinder&mount 14. Test for proper operation from remote 33. Fan warning sign on hood ✓- 15. Check operation of micro switch 1/ 34. Personnel instructed in manual operation of system 16. Check operation of gas valve 35. Proper hand portable extinguishers 17. Clean nozzles « 36..Portable extinguishers properly serviced 18. Proper nozzle covers in-place . _ 37: Service&•Certification tag on system 19. Check fuse links and.clean NOTE.DISC REPANICES OR DEFICIENCIES BELOW COMMENTS: On-this date, this pre-engineered-.fire suppression system was inspected and operationally teste, in accordance with the fire suppression system requirements of.NFPA17 or 17A, 96 and the manufacturer's manual with results indicated above. 6 z 16I.Lifi2d 1: 3 s v SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM STO THORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. AU AVING JURISDICTION