Q73 - Annual - Utility Building - 2023-09-25.pdf
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- Attached to
- EHRM Infrastructure Upgrades Construction - Miami - Project 546-20-120 Federal contract opportunity
- Solicitation number
- 36C77624B0027
About this file
This document is a detailed inspection report for the fire and life safety systems at the VA Medical Center - Utility Building in Miami, Florida. The report covers inspections and testing of tamper switches, water flow devices, sprinkler system main drains, and fire department water supply connections, as required by NFPA 25 and Joint Commission standards.
The key details include:
- The inspections were conducted on September 25, 2023 by Johnson Controls North America, the service provider.
- The inspection found that most of the devices passed testing, except for one tamper switch that failed due to not activating the signal on the fire alarm control panel when tested.
- The annual main drain test for the wet pipe sprinkler system was successfully completed, with no deficiencies noted.
- The quarterly inspection of the fire department connection also passed, with all components found to be in good condition.
- No changes to the occupancy, machinery, or fire protection systems were reported since the last inspection.
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Johnson Controls is committed to serving our customers with the best-in-class services and technologies. Xaap is an advanced inspection reporting application that has been used by Johnson Controls on your inspections.
Xaap is a software-as-a-service (SaaS) solution that provides a streamlined and digitized approach for performing fire and life safety inspections and managing compliance reports in a single, centralized platform.
The application allows inspectors to capture data for fire and life safety systems and devices while generating the required compliance reports directly from their phones. It also provides facility managers, building managers and key stakeholders with a centralized view of all building systems and deficiency data. Users can easily access, download and share historical inspection reports through Xaap.
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Inspection Summary
Customer Information
Name VA Medical Center (1201 NW 16th Street)
Building Information
Name VA Medical Center - Utility Building
Address 1201 N.W 16th Street, Miami, Florida 33125-1393
Contact Information
Name Veronica Allen
Role Administrative officer
E-Mail veronica.Allen3@va.gov
Phone 7867970136
Account Information
Service Provider Johnson Controls North America
Office Address 10550 Commerce Parkway, Miramar FL 33025
Office Phone 954-431-3700
Office License 80542700012002
Inspector Name Nestor De Four
Inspector License
FP122-000286
Inspection Information
Start Date 09/25/2023
Date 09/25/2023
Inspection Type Joint Commission
Work Order# 55004034
Timezone GMT-04:00
Inspection Summary
The following Tests and Inspections have been covered in this inspection
EP 2 - Tamper Switches and Water Flow Devices EP 9 - Sprinkler Systems Main Drain EP 10 - Fire Department Water Supply Connections
NFPA 25
General Inspection Notes
1. ANNUAL FIRE SPRINKLER INSPECTION
www.xaapbuildings.com
GENERAL DEFICIENCIES
DESCRIPTION IMAGES
1- (1) Missing 21/2” hose valve cap at 4”FSR East stair-2nd floor- Install —
2- Backflow #1 OS&Y valve tamper did not activate signal on FACP when tested-Troubleshoot alarm tech. —
3- Install (1)wall mounted FDC sign —
DEVICE DEFICIENCIES
TEST TO PERFORM LOCATION DESCRIPTION ADDRESS DEVICE MAKE MODEL BARCODE INSPECTOR / DATE IMAGES
EP2 Utility Bluilding, Outside
OUTSIDE
BACKFLOW N9:M1-7 Tamper Switch — — —
Nestor Roderick De Four
09/25/2023
FAILURE TYPE: Functional Failure FAILURE REASON: Did not activate signal on FACP when tested
INSPECTION RESULTS SUMMARY
CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS
TEST PERFORMED DEVICE TYPE TOTAL PASSED FAILED CANNOT INSPECT % INSPECTED TOTAL
EP2 Tamper Switch 29 28 1 0 100 29
EP2 Water Flow Switch 4 4 0 0 100 4
EP9 Main Drain - Wet Pipe Valve 1 1 0 0 100 1
EP10 Fire Dept. Connection 1 1 0 0 100 1
NFPA 25 City Connection Control Valve 2 2 0 0 100 2
NFPA 25 Wet System 1 1 0 0 100 1
TOTAL 38 37 1 0 100 38
TAMPER SWITCHES AND WATER FLOW DEVICES
CUSTOMER NAME: VA Medical Center (1201 NW 16th Street) BUILDING NAME: VA Medical Center - Utility Building BUILDING ADDRESS: 1201 N.W 16th Street, Miami, Florida 33125-1393
CONTACT NAME: Veronica Allen CONTACT E-MAIL: veronica.Allen3@va.gov CONTACT ROLE: Administrative officer
CONTACT PHONE: 7867970136
SERVICE PROVIDER: Johnson Controls North America OFFICE ADDRESS: 10550 Commerce Parkway, Miramar FL 33025
OFFICE PHONE: 954-431-3700
OFFICE LICENSE: 80542700012002
INSPECTOR: Nestor De Four
INSPECTOR LICENSE: FP122-000286
INSPECTION START DATE: 09/25/2023
INSPECTION END DATE: 09/25/2023
WORK ORDER: 55004034
TIMEZONE: GMT-04:00
INSPECTION RESULTS SUMMARY
CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS
DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT
Water Flow Switch 4 4 0 0 100 4
Tamper Switch 29 28 1 0 100 29
DEVICE DEFICIENCIES
LOCATION DESCRIPTION ADDRESS DEVICE MAKE MODEL BARCODE DATE OF TEST TYPE IMAGES
Utility Bluilding, Outside
OUTSIDE
BACKFLOW N9:M1-7 Tamper Switch — — — 09/25/2023 FUNCTIONAL
FAILURE —
FAILURE REASON: Did not activate signal on FACP when tested
RETIRED DEVICES
No retired devices in this inspection.
Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Tamper Switches and Water Flow Devices | 09/25/2023 Customer: VA Medical Center (1201 NW 16th Street) | Building: VA Medical Center - Utility Building
Elements of Performance #2
At least semi-annually, the facility tests water-flow devices and at least semi-annually the facility tests supervisory valve tamper switches. The completion date of the tests is documented.
Valve Tamper Switches and Water Flow devices
For additional guidance on performing tests, see NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2
Device Test Method
Control Valve Tamper Switch:
14.4.2.2-14.(i).(1)
Valve shall be operated and signal receipt shall be verified to be within the first two revolutions of the hand wheel or within one-fifth of the travel distance, or per the manufacture's specifications
Mechanical, Electro-sonic, or Pressure-Type Water flow Device:
14.4.2.2-14.(j)
Water shall be flowed through an inspector's test connection indicating the flow of water equal to that from a single sprinkler of the smallest orifice size in the system for wet-pipe systems, or an alarm test bypass connection for dry-pipe, pre-action, or deluge systems in accordance with NFPA 25.
A.1.1.1.2 There are times when a single inspection or test can meet the requirements of both NFPA 25 and NFPA 72 (e.g., operation of a tamper switch). This standard does not necessarily require that two separate inspections or tests be conducted on the same component, provided the inspection or test meets the requirements of both standards and the individual performing the inspection or test is qualified to perform the inspection or test required by both standards.
Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Tamper Switches and Water Flow Devices | 09/25/2023
TAMPER SWITCH
# LOCATION DESCRIPTION ADDRESS DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT
1 Utility Building , 1st Floor BY ELEVATOR LOBBY N9:M1-21 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
2 Utility Building , 1st Floor
BY FIRE ALARM
CONTROL PANEL N9:M1-2 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
3 Utility Building , 2nd Floor
BY FIRE PUMP
ROOM 20344 N9:M1-41 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
4 Utility Building , 2nd Floor
BY FIRE PUMP
ROOM 20344 N9:M1-42 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
5 Utility Building , 2nd Floor
IN BOILER ROOM
20444 ENTRANCE N9:M1-37 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
6 Utility Building , 2nd Floor
IN BOILER ROOM
20444 ENTRANCE N9:M1-38 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
7 Utility Building , 4th Floor IN ELEVATOR LOBBY 11:M1-136 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
8 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-49 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
9 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-50 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
10 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-51 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
11 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-52 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
12 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-54 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
13 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-53 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
14 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-55 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
15 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-56 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
16 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-57 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
17 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-58 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Tamper Switches and Water Flow Devices | 09/25/2023
TAMPER SWITCH
18 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-59 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
19 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-60 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
20 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-61 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
21 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-73 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
22 Utility Building , 2nd Floor
IN FIRE PUMP ROOM
20344 N9:M1-74 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
23 Utility Building , 4th Floor IN STAIR #1 N9:M1-71 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
24 Utility Building , 1st Floor IN STAIR #2 N9:M1-5 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
25 Utility Building , 2nd Floor IN STAIR #2 N9:M1-34 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
26 Utility Building , 3rd Floor IN STAIR #2 N9:M1-64 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
27 Utility Bluilding, Outside OUTSIDE BACKFLOW N9:M1-7 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Failed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
Reason for failure: (Functional Failure) Did not activate signal on FACP when tested
28 Utility Bluilding, Outside OUTSIDE BACKFLOW N9:M1-8 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
29 Utility Bluilding, Outside OUTSIDE PIV N9:M1-6 Tamper Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is tamper switch free of damage with its electrical connections secure? Yes
WATER FLOW SWITCH
# LOCATION DESCRIPTION ADDRESS DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT
1 Utility Building , 4th Floor IN STAIR #1 N9:M1-72 Water Flow Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes
What was the number of seconds that the water flow signal was delayed 35sec
Open test connection/bypass. Did water flow activate the alarm? Yes
2 Utility Building , 1st Floor IN STAIR #2 N9:M1-4 Water Flow Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes
What was the number of seconds that the water flow signal was delayed 30sec
Open test connection/bypass. Did water flow activate the alarm? Yes
Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Tamper Switches and Water Flow Devices | 09/25/2023
WATER FLOW SWITCH
3 Utility Building , 2nd Floor IN STAIR #2 N9:M1-33 Water Flow Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes
What was the number of seconds that the water flow signal was delayed 35sec
Open test connection/bypass. Did water flow activate the alarm? Yes
4 Utility Building , 3rd Floor IN STAIR #2 N9:M1-63 Water Flow Switch — Nestor Roderick De
Four 09/25/2023 Passed
Quarterly Visual Inspection Only - Is flow switch free of damage with its electrical connections secure? Yes
What was the number of seconds that the water flow signal was delayed 36sec
Open test connection/bypass. Did water flow activate the alarm? Yes
Inspector Signature
Inspector Name Nestor De Four Date 09/25/2023
Signature of the
Electric Supervisor
Printed name of the Electric
Supervisor Valdes Juan F Date 09/25/2023
Element of Performance - EP-2 NFPA 72-2010: Table 14.4.5 and NFPA 25-2011: Table 5.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 2 EP -2
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Tamper Switches and Water Flow Devices | 09/25/2023
SPRINKLER SYSTEMS MAIN DRAIN
BUILDING NAME: VA Medical Center - Utility Building BUILDING ADDRESS: 1201 N.W 16th Street, Miami, Florida 33125-1393
CONTACT NAME: Veronica Allen CONTACT E-MAIL: veronica.Allen3@va.gov CONTACT ROLE: Administrative officer
CONTACT PHONE: 7867970136
SERVICE PROVIDER: Johnson Controls North America OFFICE ADDRESS: 10550 Commerce Parkway, Miramar FL 33025
OFFICE PHONE: 954-431-3700
OFFICE LICENSE: 80542700012002
INSPECTOR: Nestor De Four
INSPECTOR LICENSE: FP122-000286
INSPECTION START DATE: 09/25/2023
INSPECTION END DATE: 09/25/2023
WORK ORDER: 55004034
TIMEZONE: GMT-04:00
INSPECTION RESULTS SUMMARY
CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS
DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT
Main Drain - Wet Pipe Valve 1 1 0 0 100 1
DEVICE DEFICIENCIES
No device deficiencies in this inspection.
RETIRED DEVICES
No retired devices in this inspection.
Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1
Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Sprinkler Systems Main Drain | 09/25/2023
Elements of Performance #9
Every 12 months the facility tests the main drains at the system low point or at all system risers. A main drain test shall be conducted annually at each system riser and any time the valve is closed at each system riser or feed main after the control valve has been closed to determine whether there has been a change in the condition of the water supply piping and control valves. The completion date of the tests is documented.
Main Drain
For additional guidance on performing the annual / quarterly tests, see NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1
Device Test Method
Main Drain 1. Record the pressure indicated by the supply water gauge.
2. Close the alarm control valve on alarm valves.
3. Fully open the main drain valve.
4. After the flow has stabilized, record the residual (flowing) pressure indicated by the water supply gauge.
5. Close the main drain valve slowly.
6. Record the time taken for the supply water pressure to return to the original static (non-flowing) pressure.
7. Open the alarm control valve.
** 13.2.5.1 In systems where the sole water supply is through a backflow preventer and/or pressure reducing valves, the main drain test of at least one system downstream of the device shall be conducted on a quarterly basis.
Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1
Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Sprinkler Systems Main Drain | 09/25/2023
MAIN DRAIN - WET PIPE VALVE
# LOCATION DESCRIPTION DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT
1 Utility Building , 1st Floor
Main Drain - Wet Pipe Valve 1
Main Drain - Wet Pipe Valve — Nestor Roderick De
Four 09/25/2023 Passed
Test Pipe Located? North Stair
Size of Test Pipe? 1”
Previous Main Drain Test Date 06/20/2023
Previous Main Drain Static Pressure 165
Previous Main Drain Residual Pressure 90
Static Supply Pressure? 165
Residual Pressure? 90
Time to return to Normal System Pressure? 3sec
Static Pressure after completion of test? 165
Main Drain-PSI Comparable Yes
Main drain opened & free of obstruction discoloration? Yes
Inspector Signature
Inspector Name Nestor De Four Date 09/25/2023
Signature of the
Electric Supervisor
Printed name of the Electric
Supervisor Valdes Juan F Date 09/25/2023
Element of Performance - EP-9 NFPA 25-2011: 13.2.5; 13.3.3.4; Table 13.1.1.2; Table 13.8.1
Joint Commission Standard EC.02.03.05 Element of Performance 9 EP -9
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Sprinkler Systems Main Drain | 09/25/2023
FIRE DEPARTMENT WATER SUPPLY CONNECTIONS
BUILDING NAME: VA Medical Center - Utility Building BUILDING ADDRESS: 1201 N.W 16th Street, Miami, Florida 33125-1393
CONTACT NAME: Veronica Allen CONTACT E-MAIL: veronica.Allen3@va.gov CONTACT ROLE: Administrative officer
CONTACT PHONE: 7867970136
SERVICE PROVIDER: Johnson Controls North America OFFICE ADDRESS: 10550 Commerce Parkway, Miramar FL 33025
OFFICE PHONE: 954-431-3700
OFFICE LICENSE: 80542700012002
INSPECTOR: Nestor De Four
INSPECTOR LICENSE: FP122-000286
INSPECTION START DATE: 09/25/2023
INSPECTION END DATE: 09/25/2023
WORK ORDER: 55004034
TIMEZONE: GMT-04:00
INSPECTION RESULTS SUMMARY
CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS
DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT
Fire Dept. Connection 1 1 0 0 100 1
DEVICE DEFICIENCIES
No device deficiencies in this inspection.
RETIRED DEVICES
No retired devices in this inspection.
Element of Performance - EP-10 NFPA 25-2011: 13.7; Table 13.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 10 EP -1
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Fire Department Water Supply Connections | 09/25/2023
Elements of Performance #10
Every quarter the facility inspects all fire department water supply connections. The completion date of the tests is documented.
Fire Department Connections
For additional guidance on performing the tests, see NFPA 25-2011: 13.7; Table 13.1.1.2
Device Test Method
Fire Department Connections
1. The fire department connections are visible and accessible.
2. Couplings or swivels are not damaged and rotate smoothly.
3. Plugs or caps are in place and undamaged.
4. Gaskets are in place and in good condition.
5. Identification signs are in place.
6. The check valve is not leaking.
7. The automatic drain valve is in place and operating properly.
8. The fire department connection clapper(s) is in place and operating properly.
Element of Performance - EP-10 NFPA 25-2011: 13.7; Table 13.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 10 EP -1
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Fire Department Water Supply Connections | 09/25/2023
FIRE DEPT. CONNECTION
1 Floor 01 By Test Header Fire Dept. Connection — Nestor Roderick De Four 09/25/2023 Passed
FDC Quarterly Questions
Is FDC Visible / Accessible? Yes
Are Couplings / Swivels / Plugs / Caps in place? Yes
Identification Signs In Place? Yes
Check Valve Not Leaking / Gaskets In Good Condition / Ball Drip and Clapper in Place and Operating Properly Yes
FDC Hydrostatic Test Date 06/14/2022
FDC Check Valves Internal Inspection Date 11/22/2022
Notes:
• FDC- outside north Images: DEVICE NOTES IMAGES APPENDIX 1.1
Inspector Signature
Inspector Name Nestor De Four Date 09/25/2023
Signature of the
Electric Supervisor
Printed name of the Electric
Supervisor Valdes Juan F Date 09/25/2023
Element of Performance - EP-10 NFPA 25-2011: 13.7; Table 13.1.1.2
Joint Commission Standard EC.02.03.05 Element of Performance 10 EP -1
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | Fire Department Water Supply Connections | 09/25/2023
NFPA 25
BUILDING NAME: VA Medical Center - Utility Building BUILDING ADDRESS: 1201 N.W 16th Street, Miami, Florida 33125-1393
CONTACT NAME: Veronica Allen CONTACT E-MAIL: veronica.Allen3@va.gov CONTACT ROLE: Administrative officer
CONTACT PHONE: 7867970136
SERVICE PROVIDER: Johnson Controls North America OFFICE ADDRESS: 10550 Commerce Parkway, Miramar FL 33025
OFFICE PHONE: 954-431-3700
OFFICE LICENSE: 80542700012002
INSPECTOR: Nestor De Four
INSPECTOR LICENSE: FP122-000286
INSPECTION START DATE: 09/25/2023
INSPECTION END DATE: 09/25/2023
WORK ORDER: 55004034
TIMEZONE: GMT-04:00
INSPECTION RESULTS SUMMARY
CURRENT INSPECTION RESULTS PREVIOUS INSPECTION RESULTS
DEVICE TYPE INVENTORY COUNT PASSED FAILED CANNOT INSPECT % INSPECTED INVENTORY COUNT
City Connection Control Valve 2 2 0 0 100 2
Wet System 1 1 0 0 100 1
DEVICE DEFICIENCIES
No device deficiencies in this inspection.
RETIRED DEVICES
No retired devices in this inspection.
NFPA 25, Edition 2011
N
FP
A
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | NFPA 25 | 09/25/2023
CITY CONNECTION CONTROL VALVE
1 Backflow City Connection Valve
1 ; OS&Y
City Connection Control Valve — Nestor Roderick De
Four 09/25/2023 Passed
Is This A Main System, Sub System, Or Auxiliary Control Valve? Main
What Size Is This Control Valve? 8”
Easily Accessible? Yes
Signs? Yes
Valve in the Appropriate Open or Closed Position? Yes
Sealed, Locked, and/or Supervised Locked, Supervised
Free from External Leaks Yes
Control Valve - Annual Questions
Control Valve Fully Exercised? Yes
2 Backflow City Connection Valve
2 ; OS&Y
City Connection Control Valve — Nestor Roderick De
Four 09/25/2023 Passed
Is This A Main System, Sub System, Or Auxiliary Control Valve? Main
What Size Is This Control Valve? 8”
Easily Accessible? Yes
Signs? Yes
Valve in the Appropriate Open or Closed Position? Yes
Sealed, Locked, and/or Supervised Supervised, Locked
Free from External Leaks Yes
Control Valve - Annual Questions
Control Valve Fully Exercised? Yes
WET SYSTEM
# LOCATION DESCRIPTION DEVICE TYPE BARCODE INSPECTOR DATE OF TEST RESULT
1 Stair#1&2, Utility Bldg
Wet System (4)-21/ 2”floor Systems &
(2)4”FSR
Wet System — Nestor Roderick De
Four 09/25/2023 Passed
Wet Systems - Weekly - Monthly Questions
Make and Model (4)21/2”floor Systems
What Size Is This Wet Pipe Valve 2.5
Hydraulic Name Plate Present No
Gauges Reading Normal PSI Yes
Date of Check Valves Internal Inspection 11/22/2022
Date the internal pipe inspection was performed? 11/22/2022
Date of Gauges Replacement 11/22/2022
Wet Systems Quarterly - Semi Annual - Annual - Questions
Did check valves, water flow alarm devices, and retards test satisfactorily? Yes
Inspector's Test Valve Opened & Free Of Obstruction / Discoloration? Yes
NFPA 25, Edition 2011
N
FP
A
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | NFPA 25 | 09/25/2023
NFPA 25
NFPA 25 Questions
1. Has there been any changes in the occupancy classification, machinery or operations since the last inspection? No
2. Has there been any changes or repairs to the fire protection systems since the last inspection? No
3. Have you had an internal pipe inspection performed in the last 5 years? Yes
4. Date the internal pipe inspection was performed? 11/22/2022
5. Date Backflow Devices Were Tested 12/16/2022
6. Number Of Water Gauges? (12) -2022
7. Are all Tanks, Fire Pumps, and Fire Department Connections Inspected and Tested Per NFPA 25? Yes
8. Date That The Private Fire Main Been Flow Tested? 11/22/2022
9. All Systems Restored To Normal? Yes
Control Valves
1. Are all sprinkler system main control valves and all other valves in the appropriate open or closed position? Yes
2. Are all control valves sealed, locked, or supervised, in the appropriate open or closed position? Yes
Water Supplies
1. What type of water supply does this sprinkler system use? Pressure Fire Pump and City
Alarms
1. Did the electric alarms operate during testing? Yes
2. Did the supervisory alarms operate during testing? Yes
Sprinklers and Piping
1. Were All Sprinklers Made After 1920 Yes
2. Do sprinklers generally appear to be free of corrosion, paint, or loading visible obstructions? Yes
3. Is the buildings sprinklers inventory list located within the sprinkler spare head cabinet? Yes
4. Are appropriate number of extra sprinklers and sprinkler wrenches available on the premises? Yes
5. Does there appear to be proper clearance between the top of all storage and the sprinkler deflector? Yes
6. Does the exposed exterior condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers and strainers appear to be satisfactory 1st floor piping in area of service elevator disconnected.
Yes
Inspector Signature
Inspector Name Nestor De Four Date 09/25/2023
Signature of the
Electric Supervisor
Printed name of the Electric
Supervisor Valdes Juan F Date 09/25/2023
NFPA 25, Edition 2011
N
FP
A
3a919b32-e4a8-48ce-80e8-d59e6b81ae43 | NFPA 25 | 09/25/2023
Terms And Conditions
1. Limitation of Liability; Limitations Of Remedy. It is understood and agreed by the Customer that Company is not an insurer and that insurance coverage, if any, shall be obtained by the Customer and that amounts payable to Company hereunder are based upon the value of the services and the scope of liability set forth in this agreement and are unrelated to the value of the Customer's property and the property of others located on the premises. Customer agrees to look exclusively to the Customer's insurer to recover for injuries or damage in the event of any loss or injury and that Customer releases and waives all right of recovery against Company arising by way of subrogation. Company makes no guaranty or Warranty, including any implied warranty of merchantability or fitness for a particular purpose that equipment or services supplied by Company will detect or avert occurrences or the consequences there from that the equipment or service was designed to detect or avert.<br />It is impractical and extremely difficult to fix the actual damages, if any, which may proximately result from failure on the part of Company to perform any of its obligations under this agreement. Accordingly, Customer agrees that, Company shall be exempt from liability for any loss, damage or injury arising directly or indirectly from occurrences, or the consequences therefrom, which the equipment or service was designed to detect or avert. Should Company be found liable for any loss, damage or injury arising from a failure of the equipment or service in any respect, Company's liability shall be limited to an amount equal to the agreement price (as increased by the price for any additional work) or where the time and material payment term is selected, Customer's time and material payments to Company. Where this agreement covers multiple sites, liability shall be limited to the amount of the payments allocable to the site where the incident occurred. Such sum shall be complete and exclusive. If Customer desires Company to assume greater liability, the parties shall amend this agreement by attaching a rider setting forth the amount of additional liability and the additional amount payable by the Customer for the assumption by Company of such greater liability, provided however that such rider shall in no way be interpreted to hold Company as an insurer. IN NO EVENT SHALL COMPANY BE LIABLE FOR ANY DAMAGE, LOSS, INJURY, OR ANY OTHER CLAIM ARISING FROM ANY SERVICING, ALTERATIONS, MODIFICATIONS, CHANGES, OR MOVEMENTS OF THE COVERED SYSTEM(S) OR ANY OF ITS COMPONENT PARTS BY THE CUSTOMER OR ANY THIRD PARTY. COMPANY SHALL NOT BE LIABLE FOR INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY KIND, INCLUDING BUT NOT LIMITED TO DAMAGES ARISING FROM THE USE, LOSS OF THE USE, PERFORMANCE, OR FAILURE OF THE COVERED SYSTEM(S) TO PERFORM. The limitations of liability set forth in this agreement shall inure to the benefit of all parents, subsidiaries and affiliates of Company, whether direct or indirect, Company's employees, agents, officers and directors.
2. Limited Warranty. COMPANY WARRANTS THAT ITS WORKMANSHIP AND MATERIAL FURNISHED UNDER THIS AGREEMENT WILL BE FREE FROM DEFECTS FOR A PERIOD OF NINETY
(90) DAYS FROM THE DATE OF FURNISHING. Where Company provides product or equipment of others, Company will warrant the product or equipment only to the extent warranted by such third party. EXCEPT AS EXPRESSLY SET FORTH HEREIN, COMPANY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE SERVICES PERFORMED OR THE PRODUCTS, SYSTEMS OR EQUIPMENT, IF ANY, SUPPORTED HEREUNDER. COMPANY MAKES NO WARRANTY OR REPRESENTATION, AND UNDERTAKES NO OBLIGATION TO ENSURE BY THE SERVICES PERFORMED UNDER THIS AGREEMENT, THAT COMPANY'S PRODUCTS OR THE SYSTEMS OR EQUIPMENT OF THE CUSTOMER WILL CORRECTLY HANDLE THE PROCESSING OF CALENDAR DATES BEFORE OR
AFTER DECEMBER 31, 1999.
3. Indemnity. Customer agrees to indemnify, hold harmless and defend Company against any and all losses, damages, costs, including expert fees and costs, and expenses including reasonable defense costs, arising from any and all third party claims for personal injury, death, property damage or economic loss, including specifically any damages resulting from the exposure of workers to Hazardous Conditions whether or not Customer pre-notifies Company of the existence of said hazardous conditions, arising in any way from any act or omission of Customer or Company relating in any way to this agreement, including but not limited to the Services under this agreement, whether such claims are based upon contract, warranty, tort (including but not limited to active or passive negligence), strict liability or otherwise. Company reserves the right to select counsel to represent it in any such action.
4. Hazardous Materials. Customer represents that, except to the extent that Company has been given written notice of the following hazards prior to the execution of this agreement, to the best of Customer's knowledge there is no:
a. "permit confined space," as defined by OSHA, or space in which work must be performed that, because of its construction, location, contents or work activity therein, accumulation of a hazardous gas, vapour, dust or fume or the creation of a risk of infectious disease
b. need for air monitoring, respiratory protection, or other medical risk
c. asbestos, asbestos-containing material, formaldehyde or other potentially toxic or otherwise hazardous material contained in or on the surface of the floors, walls, ceilings, insulation or other structural components of the area of any building
d. All of the above are hereinafter referred to as "Hazardous Conditions". Company shall have the right to rely on the representations listed above. If hazardous conditions are encountered by Company during the course of Company's work, the discovery of such conditions shall constitute an event beyond Company's control and Company shall have no obligation to further perform in the area where the hazardous conditions exist until the area has been made safe by Customer as certified in writing by an independent testing agency, and Customer shall pay disruption expenses and re-mobilization expenses as determined by Company. This agreement does not provide for the cost of capture, containment or disposal of any hazardous waste materials, or hazardous materials, encountered in any of the Covered System(s) and/or during performance of the Services. Said materials shall at all times remain the responsibility and property of Customer. Company shall not be responsible for the testing, removal or disposal of such hazardous materials.
5. Equipment Disconnections. This represents Company's notice to you that the system(s)/device(s) listed on the face of this agreement as temporarily or permanently disconnected are no longer in service and, thus, cannot detect, perform and/or report
6. General. Unless otherwise specified, work shall be performed during company's regular business hours,, exclusive of Saturdays, Sundays and Company holidays. All work is subject to review and rebilling in accordance with the terms and conditions of Customer's agreement/contract with Company, if one is in effect. Company shall not be responsible for failure to render services due to causes beyond its control, including but not limited to material shortages, work stoppages, fires, civil disobedience or unrest, severe weather, fire or any other cause beyond the control of Company. Customer is aware that the Limitation of Liability and other provisions set forth in any existing agreement/contract, if one is in effect, or set forth above, apply to services performed and materials supplied. The terms of this agreement shall govern notwithstanding any inconsistent or additional terms and conditions in any purchase order or other document submitted by Customer.
Joint Commission Report | Date: 09/25/2023 Page 4 of 5
DEVICE NOTE IMAGE APPENDICES
EP10
LOCATION DESCRIPTION DEVICE BARCODE IMAGES
Floor 01 By Test Header Fire Dept. Connection — DEVICE NOTES IMAGES APPENDIX 1.1 Notes:
• FDC- outside north
Joint Commission Report | Date: 09/25/2023 Page 5 of 5
File details come from the government source that posted it. Updated .