Report 2180 PH B101 FM200 Fire System PM 3-9-22.pdf

(ATTACH ADDITIONAL SHEETS IF NECESSARY)

YES NO

YES NO

YES NO

MATERIALS USED

MAINTENACE & INSPECTION REPORT

(ONE FOR EACH PIECE OF EQUIPMENT)

WILL MATERIALS NEED TO BE ORDERED? HOW LONG IS THE LEED TIME?

EXPLAIN BELOW

HAVE NOT BEEN MET

(BELOW) FOR ADMINISTRATION USE ONLY

DATE IT WILL BE RECEIVED :

PROPER PPE BEING WORN

YES

CONTRACTOR: TECHNICIANS NAME:

LOCATION WEATHERBUILDING NAME or #

CONTRACTOR/SIGNATURE CCI/ SIGNATURE SITE INSPECTOR/SIGNATURE

CONTRACT # ELIN # REPORT NO.

HAVE BEEN MET

DATE:

General Direct Condition Rating

TYPE OF EQUIPMENT MAKE MODEL

WORK DESCRIPTION & PROBLEMS FOUNDS

TIME TO COMPLETE TASK

IS INSPECTION CHECK LIST ATTACHED?

SAFETY REQUIREMENTS

WAS WORK COMPLETED?

IF NO EXPLAIN BELOW

General Direct Condition Rating Notes ( Explain Conditions found for the Rating given above)

N40085-17-D-7201

NO

HOUSE KEEPING COMPLETE

YES

NO

MAXIMO # Work Order #

Barry Prescott #135

200000047937Inspection Ref:

Conducted by:

Report of Inspection/Test

Property Owner/Agent

526 Western Ave.

Augusta, ME 04430

CCI Group, LLCUS Navy - Prospect Harbor -

Bldg 101

Light House Point Road

Prospect Harbor, ME

Annual Special Hazard

Derek McCaslin

(207)620-7172 x111 Print Date: 3/30/2022

03/09/2022

Signatures

Inspector - Printed Date CompletedInspector - Signature

Barry Prescott 3/9/22

I state that the information on this form is correct at the time and place of my inspection, and all equipment tested at this time was left in operational condition upon completion of this inspection except as noted.

Equipment Summary

Site

Description

Inspected Unable to

Inspect Serviced

Repaired Failed

%Qty%Qty%Qty%QtyQty

Special Hazard Agent Cylinder

FM 200 3 3 0 0100.0% 0.0% 0.0% 0 0.0%

Special Hazard Battery

Sealed Lead Acid 1 1 0 0100.0% 0.0% 0.0% 0 0.0%

System and Panel Information

Type Amount of Agent Hazard FM200 92# Control Room

Panel Manufacturer Model Serial No. Location

Ansul Autopulse Iq318 Panel PP2 circuit #23

Overcurrent Protection Type Overcurrent Size (Amps) Primary Supply Disconnect Location / Panel # / Breaker

#Breaker Panel PP2 circuit #2320

Battery Test

Location Type Manufacturer

Model

R e p la ce m e n t

D a te

Q u a n tit iy

C o n d iti o n

L e a ks o r

C o rr o si o n

C o n n e ct io n s

V o lta g e N o

L a d

M e a su re d

C a p a ci ty A

-H r

R a te d C a p a ci ty

A -H r O k?

V o lta g e W ith h a rg e r

V o lta g e N

L a d

M e a su re d a p a ci ty A

-H r

FM200 System #1 3/20/2019 Ok OkOk OkUltra power 12-552 Sealed Lead Acid 50 13.18 5113.1826.5

Cylinder(s)

SizeLocation / Description Manufacturer Model

Inspection - Service

B ra ck e t

G a u g e

Ta g g e d

C o lla r

S a fe ty C a p

H o se

C o n d iti o n

H yd ro T e st

F ill e d

L iq u id

L e ve l

G a u g e P re s

Cylinder Fill

Weight

A g e n t

Ta re

To ta l

Ok Ok Ok206FM200 Cylinder #1 Pyrochem P/N 570006 OkOk360 Ok OkOk Ok204.4122.4 82 NA

Ok Ok Ok92#FM200 Cylinder #2 Pyrochem P/N 570006 OkOk360 Ok OkOk Ok410.95204.95 206 38

Ok Ok Ok92#FM200 Cylinder #3 Pyrochem P/N 570006 OkOk360 Ok OkOk Ok215.8108.8 107 NA

Ok - Passes Inspection S - Serviced on site X - Requires Service NA - Not Applicable

Print Date: 3/30/2022 Copyright 2002-2020 Life Safety Inspector, OnSite Software

Report of Inspection/Test

US Navy - Prospect Harbor - Bldg 101Property:

Owner: CCI Group, LLC 200000047937Inspection Ref:

Annual Special Hazard

03/09/2022

Device Summary

Device Qty Manufacturer Model Quantity

Failed

% of Total

Tested

Quantity

Tested

Initiating Devices

Pull Station 4 Autopulse AP-NBG-12LR 4 0100%

Smoke PE 16 Notifier addressable 16 0100%

Abort Switch 4 4 0100%

Indicating Devices

Horn/Strobe 3 3 0100%

Strobe 3 3 0100%

Print Date: 3/30/2022

Owner: CCI Group, LLC 200000047937Inspection Ref:

Annual Special Hazard

03/09/2022

System Function Summary & Test

Function Description Test Result

Alarm Panel Supervisory Functions

Panel AC Power Loss Loss of AC power to the alarm panel is detected by the alarm system. Pass

Panel Sec Power Loss Loss of Secondary power to the alarm panel is detected by the alarm system. Pass

Open Alarm Circuits Electrical opens in initiating and indicating circuits are detected. Pass

Short Alarm Circuits Electrical shorts in initiating and indicating circuits are detected. Pass

Panel to Panel Circuits Integrity of single or multiple circuits providing interface between two or more control panels verified.

Pass

Ground Faults Detected Ground faults in alarm circuits are detected Pass

Alarm Functions - Chemical Suppression

Discharge disabled for test? System electric actuator and control head disconnected so that system will not discharge during testing?

Pass

1st Alarm First alarm (warning) occurs upon activation of a single initiating device. Pass

2nd Alarm Second alarm occurs upon activation of a second initiating device/zone/or matrix of devices. Pass

Time Delay Delay between 2nd alarm and agent discharge measured. Pass

Timer Function Timer completes cycle even if wiring to the first alarm initiating circuit is interupted Pass

Cross Zone Detection One sensor or detector on each zone is operated with correct sequence of operation with first device and then with operation of the second device verified.

Pass

Verified, sequential or counting circuit

Sensors at a minimum of four locations in circuit are operated with correct sequence for both the first and second sensors verified.

Pass

Matix-type circuit All sensors in the system are operated with development of the correct matrix with each sensor operated verified.

Pass

Discharge Alarm Audible alarm upon agent discharge. Pass

Abort Switch Abort switch operates properly and the correct sequence and operation is verified. Pass

Selonoid Release Circuit Selonoid actuated and operation verified. Pass

Squibb Release Circuit AGI flashbulb or other test light approved by the manufacturer is used and operation verified. NA

Agent discharge Actual discharge of chemical fire suppression agent. Pass

System returned to service System is returned to service with all electric actuators and control heads reconnected. Pass

Auxiliary Functions

Remote Annunciator Remote annunciator shows properly Pass

HVAC Shutdown HVAC shutdown upon an alarm condition. Pass

Computer Power Shutdown Computer power is shutdown upon an appropriate alarm condition NA

Elevator Recall Elevators are recalled upon an alarm condition. NA

Chemical Suppression Documentation

Yes Modification made to systems fully reviewed and documented?

YesAll prior inspection reports, logs and test data are available for review?

Yes Is the occupancy and hazard the same reported on the last inspection?

YesReports of system actuation fully reviewed and documented?

Yes Have all deficiencies reported at last inspection been corrected?

Print Date: 3/30/2022

Owner: CCI Group, LLC 200000047937Inspection Ref:

Annual Special Hazard

03/09/2022

Chemical Suppression Inspection

Yes All ceiling and floor panels are in place.YesThe size of the hazard area is unchanged. All room dimesions, ceiling elevations and openings are unchanged from the original design.

Yes Doors are not blocked open.YesWarning signs are proper and visible.

Yes Agent control heads or nozzles are clean, secure, properly oriented and sealed (where needed).

YesManual pull station(s) and abort switch(es) are easily accessible with all covers in place.

Yes Cylinder(s) are clean, free from dents, corrosion, abrasions or weld damage.

YesPipe is secure, properly supported, undamaged with no signs of corrosion.

NA Equipment shutdown functions are adequate with all necessary equipment included.

YesSelector valves are exercised and properly reset.

Yes Explosive release devices (if any) in good condition and within any replacement date?

NADampers (if any) close completely.

Panel Inspection

Yes Panel and surrounding equipment, conduit and wiring well secured and in good condition

YesSystem was in operation upon arrival?

Yes Primary power supply operates properly under full load

YesAre all lamps and displays operating correctly?

Yes Have all fuses been checked for rating and supervision

YesTransient suppressors visually inspected?

Yes Are operating instructions posted or available at the panel?

YesAre drawings and wiring diagrams available at the panel?

Yes Are zones labeled and identified?

Central Station Test

Alarm, Trouble and Supervisory indication tested and verified with the central station?

NAType Transmission

NA Operator spoke to

Inspector's Recommendations

None The inspector recommends the following system changes/improvements, however, these suggestions are not the result of an engineering survey.

Note: All cylinders activated with any single pull station or any 2 smoke detectors

Alarm Device List

P h ys ic a l

C o n d iti o n

F u n ct io n a l

Te st

Manufacturer ModelLocation/DescriptionZone/ AddressDevice Type

HVAC Shutdown Notifier 1M016 OkOkSupport equipment room

Alarm Device

Detail Summary

Number of Items:

S

X 0

Number of Items Requiring Service

Repaired, Replaced and Tested Ok

NI Number of Items NOT InspectedOk - Item passed 0 0

Print Date: 3/30/2022

Owner: CCI Group, LLC 200000047937Inspection Ref:

Annual Special Hazard

03/09/2022

Deficiency / Recommendations Summary

These items were deficient and do not meet the requirements of the applicable code at the time of the inspection. Items marked

Recommendation are not required by the applicable code but are opportunities to improve the Life Safety of the property.

Inspector's Recommendations FM200 System #1 Recommendations FM200 System #1

None The inspector recommends the following system changes/improvements, however, these suggestions are not the result of an engineering survey.

Note: All cylinders activated with any single pull station or any 2 smoke detectors

Print Date: 3/30/2022