Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
FM Documents
5-Year Inspection and Internal Pipe Assessment DAVIS=ULMER Form +) FIRE PROTECTION Location Code: SHMOQSK Contact: Kelli Thompson Company: Davis Ulmer Sprinkler Co Contact Address: 308 DIX AVE Address: 25 Post Rd#4 QUEENSBURY,NY 12804-3932 Albany,NY 12205 Phone: 518-449-8511 Company Phone: 518-273-7377 Email: Inspector: Brian.Young Property Evaluated: U-Haul(Storage) not required 308 DIX AVE Date of Work: 8/15/2019 QUEENSBURY,NY 12804-3932 Description: SYrinsp(4 wet) Frequency: Fifth Year Work Order: N/A Tag: 1052-0031278 Attached Files Terms and Limitations.pdf 0.2MB Deficiency Summary The are no reported deficiencies for this submission General Comments These items are outside the regular scope of the required inspection and are not the result of an engineering reviexv. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. No pressure relief valves installed on all 4 grid systems Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page I of 4 — ----*- _ Albany,NY 12205 FIRE PROTECTION Phone:51 8-273-7377 5-Year Inspection and Internal Pipe Assessment Form Tag 1052-0031278 Inspection Frequency: Fifth Year Property Being Evaluated: U-Haul(Storage) Owner: Kelli Thompson Owner's Phone Number: 518-449-8511 Property Address: 308 DIX AVE OUEENSBURY NY 12804-3932 1.General A.(To be filled out by the Owner or Owner's Representative) Has the Owners section been answered on another inspection report that will be submitted with ✓f Yes No this inspection report? 2.Five-Year Inspection Items 1.Check valve(s)internally inspected and all parts appear to operate properly,move freely,and Yes No✓;N/A are in good condition? 2.Alarm valve(s)and their associated strainers and restricted orifices passed internal inspection? Yes ._._No....✓....N/A 3.Strainers,filters,restricted orifices,and diaphragm chambers on Dry,Pre-Action,and/or Yes No-,/N/A Deluge valves passed internal inspection? 4.Have known sprinkler heads exposed to harsh conditions(ie.Corrosive atmospheres,extreme Yes No✓N/A temperatures,etc.)been tested/replaced? 5.Have gauge(s)been replaced and dated? ✓ Yes No N/A 6.Performed pressure regulating device full flow test? Yes:..... No %'N/A 7.Performed standpipe test? Yes✓No 3.Five-Year Assessment of Internal Condition of Piping The purpose of the assessment of the internal condition of piping is to provide a reasonable assurance that corrosion and obstruction issues within the fire protection system(s)are identified by opening a flushing connection at the end of one main and removing the end fitting,piece of branch line.or a sprinkler for the purpose of inspecting for the presence of foreign organic and inorganic material.It is not the intent to verify that every piece of pipe in the system is free from corrosion and obstructions. r t't"_ . O�ro Wet Zone 1 Shotgun 6" * 'Pass_1 Fail N/A �6 Pass_Fail i N/A Wet Zone 2 Shotgun 6" 4 Pass .1 Fail :N/A -Pass Fail =N/A Wet Zone 3 Shotgun 6" v"Pass Fail `N/A ✓Pass Fail _i N/A Wet Zone 4 Shotgun 6" i1 Pass—i Fail 'N/A f Pass Fail_�N/A 4.Observations These items are outside the regular scope of the required inspection and are not the result of an engineering review. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. Please see the summary section at the top of the form for the comments 5.Adjustments or Corrections Made: 6.List Changes in the Occupancy Hazard or Fire Protection Equipment,as Advised by the Owner in Section IA 7.Inspector Information: Test Verification: Inspected By Brian.Young Inspector Signature #L�r Inspector License: not required Date of Work 8/15/2019 Inspection Notes Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 paoP �f n Fire Hydrant Test Report ( DUIS=ULMER 6 FIRE PROTECTION Location Code: SHMOQSK Contact: Kelli Thompson Company: Davis Ulmer Sprinkler Co Contact Address: 308 DIX AVE Address: 25 Post Rd#4 QUEENSBURY,NY 12804-3932 Albany,NY 12205 Phone: 518-449-8511 Company Phone: 518-273-7377 Email: Inspector: James Shord Property Evaluated: U-Haul(Storage) NYS Backflow Certification#9268 308 DIX AVE Date of Work: 8/7/2019 QUEENSBURY,NY 12804-3932 Frequency: Annual Description: Fire Hydrants(#1 SE) Attached Files Terms and Limitations.pdf 0.2MB Deficiency Summary The are no reported deficiencies for this submission General Comments These items are outside the regular scope of the required inspection and are not the result of an engineering review. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. There are no general comments for this submission Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page I of 4 Davis Ulmer Sprinkler Co 25 Post Rd#4 DUIS-ULMER Albany,NY 12205 FIRE PROTECTION Phone:518-273-7377 Fire Hydrant Test Report The work covered on this form is(select one): Annual Date of Work 8/7/2019 nl Facility Location Code: U-HaulSHMOQSK Service Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 Owner: Owner's Phone: Kelli Thompson 518-449-8511 Owner's Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 Assembly Description: Fire Hydrants(41 SE) Inspection Was an inspecton performed? -4 Yes No AT " gr w eAA ,- T A.Hydrants are accessible. V Yes 'No B.Hydrant outlets are slightly more than hand-tight. V Yes No C.There are no leaks in the top of hydrant. V—Yes No D.There are no leaks in the gasket under the caps. V Yes No E.There are no cracks in the hydrant barrel. if Yes No F.Hydrant drains properly. ✓Yes No G.Operating nut is not worn and rounded comers. V Yes No H.Nozzle threads are not damaged. '—,/ Yes No I.Check hose houses to assure all equipment is in good condition. Yes 1 No N/A Comments Any deficiencies or other problems found with the fire hydrants must be explained using the comment specific for each hydrant.Additional comments can be added here. Please see the summary section at the top of the form for the comments. Inspector's Information Inspected By James Shord Inspector License: NYS Backflow Certification#9268 1 state that the information on this form is correct at the time and place of my inspection,and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments. Signature of Inspector SAAk Date 8/6/2019 Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 2 of 4 ULMER Davis Ulmer Sprinkler Co DUIS- 25 Post Rd#4 Albany,NY 12205 FIRE PROTECTION Phone: 518-273-7377 Fire Hydrant Test Report The work covered on this form is(select one): Annual Date of Work 8/7/2019 Facility Name: Property Type: Location Code: U-Haul Storage SHMOQSK Service Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 Owner: Owner's Phone: Kelli Thompson 1518-449-8511 Owner's Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 Assembly Description: Fire Hydrants(#2 NE) Inspection Was an inspecton performed? ✓'Yes' 'No A. Hydrants are accessible. ✓Yes E No B.Hydrant outlets are slightly more than hand-tight. ✓Yes!No C.There are no leaks in the top of hydrant. ✓Yes_!No D.There are no leaks in the gasket under the caps. V Yes- "No E.There are no cracks in the hydrant barrel. ✓Yes No F.Hydrant drains properly. l!Yes- i No G.Operating nut is not worn and rounded corners. iV Yes-_i No H.Nozzle threads are not damaged. iK Yes No I.Check hose houses to assure all equipment is in good condition. Yes ;No,/N/A Comments Any deficiencies or other problems found with the fire hydrants must be explained using the comment specific for each hydrant.Additional comments can be added here. Please see the summary section at the top of the form for the comments. Inspector's Information Inspected By James Shord Inspector License: NYS Backflow Certification#9268 I state that the information on this form is correct at the time and place of my inspection,and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments. Signature of Inspector qomy--J- Date 8/6/2019 Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 2 of 4 Fire Hydrant Test Report DUIS=ULMER 16FIRE PROTECTION Location Code: SHMOQSK Contact: Kelli Thompson Company: Davis Ulmer Sprinkler Co Contact Address: 308 DIX AVE Address: 25 Post Rd#4 QUEENSBURY,NY 12804-3932 Albany,NY 12205 Phone: 518-449-8511 Company Phone: 518-273-7377 Email: Inspector: James Shord Property Evaluated: U-Haul(Storage) NYS Backflow Certification#9268 308 DIX AVE Date of Work: 8/7/2019 QUEENSBURY,NY 12804-3932 Frequency: Annual Description: Fire Hydrants(#2 NE) Attached Files Terms and Limitations.pdf 0.2MB Deficiency Summary The are no reported deficiencies for this submission General Comments These items are outside the regular scope of the required inspection and are not the result of an engineering review. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. There are no general comments for this submission Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 1 of 4 DUIS �� � Davis Ulmer Sprinkler Co � 25 Post Rd#4 Albany,NY 12205 FIRE PROTECTION Phone:518-273-7377 Fire Hydrant Test Report The work covered on this form is(select one): Annual Date of Work 8/7/2019 VT!! Pro e T e: P ttY YP Storage SHMOQSK Service Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 Owner: Owner's Phone: Kelli Thompson 518-449-8511 Owner's Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 Assembly Description: Fire Hydrants(#3 NW) Inspection Was an inspecton performed? 41 Yes No A.Hydrants are accessible. ✓Yes No B.Hydrant outlets are slightly more than hand-tight. Yes No C.There are no leaks in the top of hydrant. ✓'Yes—No D.There are no leaks in the gasket under the caps. Yes-3 No E.There are no cracks in the hydrant barrel ✓'Yes No F.Hydrant drains properly. ✓Yes No G.Operating nut is not worn and rounded corners. ✓'Yes JNo H.Nozzle threads are not damaged. ✓'Yes No 1.Check hose houses to assure all equipment is in good condition. Yes 'No V N/A Comments Any deficiencies or other problems found with the fire hydrants must be explained using the comment specific for each hydrant.Additional comments can be added here. Please see the summary section at the top of the form for the comments Inspector's Information Inspected By James Shord Inspector License: NYS Backflow Certification#9268 I state that the information on this form is correct at the time and place of my inspection,and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments. Signature of Inspector Dwl, q4! Date f�"8/6/2019 Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 2 of 4 Fire Hydrant Test Report 6 DMISmULMER PROTECTION Location Code: SHMOQSK Contact: Kelli Thompson Company: Davis Ulmer Sprinkler Co Contact Address: 308 DIX AVE Address: 25 Post Rd#4 QUEENSBURY,NY 12804-3932 Albany,NY 12205 Phone: 518-449-8511 Company Phone: 518-273-7377 Email: Inspector: James Shord Property Evaluated: U-Haul(Storage) NYS Backflow Certification#9268 308 DIX AVE Date of Work: 8/7/2019 QUEENSBURY,NY 12804-3932 Frequency: Annual Description: Fire Hydrants(#3 NW) Attached Files Terms and Limitations.pdf 0.2MB Deficiency Summary The are no reported deficiencies for this submission General Comments These items are outside the regular scope of the required inspection and are not the result of an engineering review. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. There are no general comments for this submission Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 1 of 4 Wet Fire Sprinkler System Inspection Report DAVIS=ULMER 4 FIRE PROTECTION Location Code: SHMOQSK " Contact: Kelli Thompson Company: Davis Ulmer Sprinkler Co Contact Address: 308 DIX AVE Address: 25 Post Rd#4 QUEENSBURY,NY 12804-3932 Albany,NY 12205 Phone: 518-449-8511 Company Phone: 518-273-7377 Email: Inspector: James Shord Property Evaluated: U-Haul(Storage) NYS Backflow Certification#9268 308 DIX AVE Date of Work: 8/6/2019 QUEENSBURY,NY 12804-3932 Frequency: Annual Description: Wet(Four 6"Wet Sprinkler Systems) Tag: 1052-0030590 Attached Files Terms and Limitations.pdf 0.2MB Deficiency Summary Status:Open Control Valves:City Connection,No.of Valves: 1,Type:Wall PIV Easily Accessible:Yes. Signs?:Yes. Valve in proper position?:Yes. Secured?:Yes. Supervision Operational?:No.Not sending any signal back to panel when operated. Status:Open Control Valves:System,No.of Valves:4,Type:Wall PIV Easily Accessible:Yes. Signs?:Yes. Valve in proper position?:Yes. Secured?:Yes. Supervision Operational?:No.All tampers Not sending any signal back to panel when operated. Status:Open 6.d d.Did the supervisory alarms operate during testing? The five Wall post indicator valves tamper switches did not work when valve was operate. General Comments These items are outside the regular scope of the required inspection and are not the result of an engineering revieir. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. There are no general comments for this submission Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Pagel of 6 ONIS-ULMER Davis Ulmer Sprinkler Co 25 Post Rd#4 Albany,NY 12205 i► FIRE PROTECTION Phone:518-273-7377 Wet Fire Sprinkler System Inspection Report Tag 1052-0030590 Inspection Frequency: Annual Property Being Evaluated: U-Haul(Storaee) Owner: Kelli Thompson Owner's Phone Number: 518-449-8511 Property Address: 308 DIX AVE.OUEENSBURY,NY 12804-3932 1.General A.(To be filled out by the Owner or Owner's Representative) Has the Owners section been answered on another inspection report that will be submitted with Yes No this inspection report? B.(To be answered by the inspector) a.Is System in service upon arrival? VI Yes -No b.Was the alarm panel free of alarm and trouble signals upon arrival?(If no,please explain in - comments) Yes L No'.'N/A c.Does there appear to be proper clearance between the top of all storage and the sprinkler ✓Yes No :_`N/A deflector? d.Does it appear that visible exterior openings are protected against the entrance of cold air? If Yes No N/A 2.Control Valves a.Do Control Valves appear to be free of damage/leaks? ✓_I Yes!- No b.Are all control valves sealed,secured,or supervised in the open position? ✓Yes No ft Control Valves TTo"4ofvalves Typ as'� gns? i e�nEtro gr �Ne�curei3?�y Supervision , 1!]le? # Sltion? 3sOperational? J ' City Connection 1 Wall PIV ✓J Yes_)No Yes�No ✓ es b Yes No _I Yes''✓No L N/A i Y L No L N/A J N/A Yes L No L Yes J No J Yes No Backflow 1 OS&Y Yes No _'N/A ✓Yes C No N/A D N/A 7 Yes::=f No G7 Yes 7 No 1 Yes if No System 4 Wall PIV A Yes_)No `:N/A %Yes L No [YesN/A =1 N/A 3.Water Supplies a.Water Supply Source l✓City D Private J Pressure Fire Pump&Tank C Pressure Fire Pump&City 10 Pressure Fire Pump&Pond b.Include main drain test table? _✓i Yes No Mam Dramr Te�tE a Static o , xahc est a e)Caoca't}ton Time to � ' Siu � essu a ressur_ v ressur ��� � Restore .4 c Zone 1 2" 65 52 65 In sprinkler riser room. 3.0 seconds Zone 2 2" 65 53 65 In sprinkler riser room. 3.0 seconds Zone 3 2" 65 52 65 =In sprinkler riser room. 3.0 seconds Zone 4 2" 65 153 165 1 In sprinkler riser room. 3.0 seconds 4.Tanks,Pumps,Fire Dept.Connections a.Appears that the F.D.C.is in satisfactory condition,couplings free,caps or plugs in place and .!Yes No N/A check valves tight? b.Are fire department connections visible,accessible,and identification sign(s)in place? _f Yes;-.-.No J N/A c.Do fire pumps,gravity,surface and pressure tanks appear to be in good external condition and Yes No'✓N/A properly maintained? Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 2 of 6 DAVIS-ULMER Davis Ulmer Sprinkler Co 25 Post Rd#4 Albany,NY 12205 a FIRE PROTECTION Phone:518-273-7377 5.Wet Systems .System# Make, ;" Mosel:.: Size(niches] ... �,ocahonlDescription; Zone 1 Straight Cut w/flow switch 6 In sprinkler riser room. Zone 2 Straight Cut w/flow switch 6 In sprinkler riser room. Zone 3 Straight Cut w/flow switch 6 In sprinkler riser room. Zone 4 Straight Cut w/flow switch 6 In sprinkler riser room. a. Do Valve and Trim appear to be free of damage/leaks and in good condition? ✓Yes No N/A d. Is the Hydraulic Name Plate,if required,securely attached and legible? ✓Yes No N/A e.Are all known and accessible cold weather valves in the appropriate open or closed position? ✓Yes 'No N/A f.Are there anti-freeze system(s)at this location? _Yes No'36 N/A 6.Alarms a. Did the water motor gong operate during testing? Yes No,-."N/A b.Did the electric alarms operate during testing? ✓'Yes__'No`__N/A c.Did alarms activate within appropriate time? ✓_.'Yes No N/A Zone 1 Under 60 seconds. Zone 2 Under 60 seconds. Zone 3 Under 60 seconds. Zone4 Under 60 seconds. d.Did the supervisory alarms operate during testing? Yes No N/A e. Was the alarm panel clear of alarm and trouble signals upon departure?(If no,please explain ✓Yes No N/A in comments) 7.Systems,Sprinklers,and Piping(Inspected at the ground level) a.Do all gauges appear to be in good condition and read within normal range? Yes No N/A b.Are all of the gauges dated within 5 years or compared to a calibrated gauge? ✓Yes_No N/A c.Do sprinkler heads generally appear to be free of damage,corrosion,paint,loading and visible ✓Yes No N/A obstruction,and appear to be installed in the correct orientation? d.Do escutcheons and cover plates for recessed,flush,and concealed sprinklers generally ✓Yes-No N/A appear to be installed? e.Are extra sprinklers heads available on the premises in a head cabinet,along with the Yes' No N/A appropriate head wrench? f.Is a list of the installed sprinkler heads kept in the spare head cabinet? ✓Yes No N/A Make/Model of Heads: g.Does the exterior condition of fire sprinkler system appear to be satisfactory? vV Yes_ No N/A h.Have all dry heads known to be more than 10 years old been replaced or a sample tested? Yes No'6 N/A i.Have all QR heads known to be more than 20 years old been replaced or a sample tested? ✓:Yes No j.Have all SR heads known to be more than 50 years old been replaced or a sample tested? ✓Yes_No_N/A k.Do all known high-temp and sprinklers subject to harsh conditions appear to be less than 5 years old? _Yes L No✓N/A I.Does the hand hose valve(s)on the sprinkler system appear to be in satisfactory condition? ;Yes No'v/N/A m. Do all visible pipe supports/hangers and seismic bracing appear to be in good condition? Z Yes No N/A 8.Observations These items are outside the regular scope of the required inspection and are not the result of an engineering revie►v. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. Please see the summary section at the top of the form for the comments. 9.Adjustments or Corrections Made: I put a list of fire sprinkler heads on the fire sprinkler head boxes per NFPA 25.1 changed out eight water pressure gauges that were out dated and in need of replacement. 10.List Changes in the Occupancy Hazard or Fire Protection Equipment,as Advised by the Owner in Section IA 11.Inspector Information: Test Verification: Inspected By James Shord Inspector Signature oawf^ Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 3 of 6 Davis Ulmer Sprinkler Co 25 Post Rd#4 OUIS-ULMER Albany,NY 12205 FIRE PROTECTION Phone:518-273-7377 Inspector License: NYS Backflow Certification#9268 Date of Work 8/6/2019 Inspection Notes Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 4 of 6 ULMER Davis Ulmer Sprinkler Co DUIS- 25 Post Rd#4 Albany,NY 12205 FIRE PROTECTION Phone:518-273-7377 BACKFLOW ASSEMBLY TEST FORM CUSTOMER NAME ACCOUNT NUMBER WATER METER NUMBER U-haul (Old K-Mart) 024246.00 1 94193156 SERVICE ADDRESS TYPE OF INSTALLATION DATE OF TEST TIME TESTED 308 DIX AVE, QUEENSBURY, NY, 12804-3932 ❑CONTAINMENT ®ISOLATION 8/6/2019 1:55pm HEIGHT OF ASSEMBLY MANUFACTURER MODEL SIZE ASSEMBLY NO. ABOVE SURFACE 40 IN. WATTS 909 1 1/2" 273362 SUPPLY PRESSURE DISCHARGE PRESSURE SIZE OF SERVICE LINE AIR GAP "Y"STRAINER BLOW-OFF AT ASSEMBLY AT ASSEMBLY (RP DISCHARGE) INSTALLED ❑YES ®NO 60 PSI 50 PSI 1 1/2" IN. ®YES ❑ NO I ®YES ❑ NO SIZE IN. TYPE OF ASSEMBLY TYPE OF FREEZE PROTECTION ®RPZA ❑DCVA ❑FIRE CHECK ❑ ❑ PVB [_1 AVB ❑AIR GAP OUTDOOR ENCLOSURE CK INSIDE BUILDING ❑ NONE REDUCED PRESSURE ZONE ASSEMBLY(RPZA) DOUBLE CHECK VALVE ASSEMBLY(DCVA) PASSED PASSED 1ST CHECK VA 7•9 psi" (5 or more) 2 1ST CHECK VA psi' (1 or more) ❑ (HOLDING IN DIRECTION OF FLOW) (HOLDING IN DIRECTION OF FLOW) RELIEF VALVE 2•3 psi' (2 or more) ® 2ND CHECK VA (HOLDING BACK PRESSURE) ❑ (OPENED AT) DIFFERENCE 5•6 psi' (3 or more) ® NO.2 SHUTOFF VALVE (LEAK TIGHT) ❑ (1 ST CHECK VALVE) 2ND CHECK VA (HOLDING BACK PRESSURE) 14 2ND CHECK VA psi' (1 or more) ❑ (HOLDING IN DIRECTION OF FLOW) NO.2 SHUTOFF VALVE (LEAK TIGHT) ® DESCRIBE TYPE OF BUSINESS 2ND CHECK VA 3.1 psi' (1 or more) ® Storage (HOLDING IN DIRECTION OF FLOW) (-POUNDS PER SQUARE INCH) LOCATION OF ASSEMBLY ON PROPERTY FAILURE REQUIRES REPAIR AND RE-TESTING In sprinkler riser room. BY METER A Separate Test Form is Required for Both Main and Detector Assemblies TYPE OF APPLICATION DID ASSEMBLY PASS OR FAIL ® PASSED ❑ FAILED CK DOMESTIC ❑LAWN IRRIGATION ❑ FIRE SYSTEM NAME OF INSTALLATION COMPANY(FOR NEW ASSY.) TELEPHONE ❑ NEW INSTALLATION DATE INSTALLED ❑ REPLACEMENT REMARKS: I HEREBY CERTIFY THAT THE ABOVE TEST IS TRUE,ACCURATE AND REFLECTS THE PROPER OPERATION OF THE ASSEMBLY: LICENSE# COMPANY ASSEMBLY TESTING TECHNICIAN TESTERS TELEPHONE Mow Certificatil Davis Ulmer Sprinkler Co am hor 518-273-7377 CUSTOMERS REPRESENTATIVE CUSTOMERS TELEPHONE TEST GAUGE CALIBRATION (PRINTED) SERIAL# DATE Kelli Thompson 518-449-8511 748144 7/26/2019 LMER Davis Ulmer Sprinkler Co BUIS-U 25 Post Rd#4 Albany,NY 12205 PROTECTIONFIRE Phone: 518-273-7377 BACKFLOW ASSEMBLY TEST FORM CUSTOMER NAME ACCOUNT NUMBER WATER METER NUMBER U-haul (Old K-Mart) 024246.00 94193156 SERVICE ADDRESS TYPE OF INSTALLATION DATE OF TEST TIME TESTED 308 DIX AVE, QUEENSBURY, NY, 12804-3932 ❑CONTAINMENT X ISOLATION 8/6/2019 1:55pm HEIGHT OF ASSEMBLY MANUFACTURER MODEL SIZE ASSEMBLY NO. ABOVE SURFACE 40 IN. WATTS 909 1 1/2" 273362 SUPPLY PRESSURE DISCHARGE PRESSURE SIZE OF SERVICE LINE AIR GAP "Y"STRAINER BLOW OFF AT ASSEMBLY AT ASSEMBLY (RP DISCHARGE) INSTALLED ❑YES X NO 60 PSI 50 PSI 1 1/2" IN. X YES ❑NO I X YES ❑ NO SIZE IN. TYPE OF ASSEMBLY TYPE OF FREEZE PROTECTION X RPZA ❑DCVA ❑ FIRE CHECK ❑ ❑ PVB [:1 AVB ❑AIR GAP OUTDOOR ENCLOSURE X INSIDE BUILDING [:1 NONE REDUCED PRESSURE ZONE ASSEMBLY(RPZA) DOUBLE CHECK VALVE ASSEMBLY(DCVA) PASSED PASSED 1 ST CHECK VA 7.9 psi* (5 or more) X 1 ST CHECK VA psi* (1 or more) ❑ (HOLDING IN DIRECTION OF FLOW) (HOLDING IN DIRECTION OF FLOW) RELIEF VALVE 2•3 psi* (2 or more) ® 2ND CHECK VA (HOLDING BACK PRESSURE) ❑ (OPENED AT) DIFFERENCE 5•6 psi" (3 or more) ® NO.2 SHUTOFF VALVE (LEAK TIGHT) ❑ (1 ST CHECK VALVE) 2ND CHECK VA (HOLDING BACK PRESSURE) 2ND CHECK VA psi* (1 or more) ❑ (HOLDING IN DIRECTION OF FLOW) NO.2 SHUTOFF VALVE (LEAK TIGHT) ® DESCRIBE TYPE OF BUSINESS 2ND CHECK VA 3.1 psi* (1 or more) ® Storage (HOLDING IN DIRECTION OF FLOW) (*POUNDS PER SQUARE INCH) LOCATION OF ASSEMBLY ON PROPERTY FAILURE REQUIRES REPAIR AND RE-TESTING In sprinkler riser room. X BY METER A Separate Test Form is Required for Both Main and Detector Assemblies TYPE OF APPLICATION DID ASSEMBLY PASS OR FAIL ® PASSED ❑ FAILED ®DOMESTIC ❑ LAWN IRRIGATION ❑FIRE SYSTEM TALLED NAME OF INSTALLATION COMPANY(FOR NEW ASSY.) TELEPHONE ❑NEW INSTALLATION DATE INS ❑REPLACEMENT REMARKS: I HEREBY CERTIFY THAT THE ABOVE TEST IS TRUE,ACCURATE AND REFLECTS THE PROPER OPERATION OF THE ASSEMBLY: LICENSE# COMPANY ASSEMBLY TESTING TECHNICIAN TESTERS TELEPHONE am hor Mow Certificab Davis Ulmer Sprinkler Co 518-273-7377 CUSTOMERS REPRESENTATIVE CUSTOMERS TELEPHONE TEST GAUGE CALIBRATION (PRINTED) SERIAL# DATE Kelli Thompson 518-449-8511 748144 7/26/2019 ULMER Davis Ulmer Sprinkler Co BUIS- 25 Post Rd#4 Albany,NY 12205 FIRE PROTECTION Phone: 518-273-7377 BACKFLOW ASSEMBLY TEST FORM CUSTOMER NAME ACCOUNT NUMBER WATER METER NUMBER U-haul (Old K-Mart) 0000000.000 94194187 SERVICE ADDRESS TYPE OF INSTALLATION DATE OF TEST TIME TESTED 308 DIX AVE, QUEENSBURY, NY, 12804-3932 ❑CONTAINMENT I&ISOLATION 8/6/2019 2:30pm HEIGHT OF ASSEMBLY MANUFACTURER MODEL SIZE ASSEMBLY NO. ABOVE SURFACE 20 IN. WATTS 909 2" 272830 SUPPLY PRESSURE DISCHARGE PRESSURE SIZE OF SERVICE LINE AIR GAP "Y"STRAINER BLOW-OFF AT ASSEMBLY AT ASSEMBLY (RP DISCHARGE) INSTALLED ❑YES ®NO 60 PSI 50 PSI 2" IN. ®YES ❑NO ®YES ❑ NO SIZE IN. TYPE OF ASSEMBLY TYPE OF FREEZE PROTECTION ®RPZA ❑DCVA ❑ FIRE CHECK ❑ PVB El AVB ❑AIR GAP ❑OUTDOOR ENCLOSURE I$INSIDE BUILDING El NONE REDUCED PRESSURE ZONE ASSEMBLY(RPZA) DOUBLE CHECK VALVE ASSEMBLY(DCVA) PASSED PASSED 1ST CHECK VA 8.2 psi* (5 or more) X 1ST CHECK VA psi* (1 or more) ❑ (HOLDING IN DIRECTION OF FLOW) (HOLDING IN DIRECTION OF FLOW) RELIEF VALVE 2•3 psi* (2 or more) ® 2ND CHECK VA (HOLDING BACK PRESSURE) ❑ (OPENED AT) DIFFERENCE 5.9 psi* (3 or more) ® NO.2 SHUTOFF VALVE (LEAK TIGHT) ❑ (1ST CHECK VALVE) 2ND CHECK VA (HOLDING BACK PRESSURE) 2ND CHECK VA psi* (1 or more) ❑ (HOLDING IN DIRECTION OF FLOW) NO.2 SHUTOFF VALVE (LEAK TIGHT) ® DESCRIBE TYPE OF BUSINESS 2ND CHECK VA 2•8 psi* (1 or more) ® Storage (HOLDING IN DIRECTION OF FLOW) (*POUNDS PER SQUARE INCH) LOCATION OF ASSEMBLY ON PROPERTY FAILURE REQUIRES REPAIR AND RE-TESTING In sprinkler riser room. BY METER A Separate Test Form is Required for Both Main and Detector Assemblies p TYPE OF APPLICATION DID ASSEMBLY PASS OR FAIL ® PASSED ❑ FAILED ®DOMESTIC ❑LAWN IRRIGATION ❑ FIRE SYSTEM NAME OF INSTALLATION COMPANY(FOR NEW ASSY.) TTELEPHONE ❑ NEW INSTALLATION DATE INSTALLED ❑ REPLACEMENT REMARKS: I HEREBY CERTIFY THAT THE ABOVE TEST IS TRUE,ACCURATE AND REFLECTS THE PROPER OPERATION OF THE ASSEMBLY: LICENSE# COMPANY ASSEMBLY TESTING TECHNICIAN TESTERS TELEPHONE ;flow Certificatil Davis Ulmer Sprinkler Co Jame ho 518-273-7377 CUSTOMERS REPRESENTATIVE CUSTOMERS TELEPHONE TEST GAUGE CALIBRATION (PRINTED) SERIAL# DATE Kelli Thompson 518-449-8511 748144 7/26/2019 Fire Alarm Supplementary Form DAVIS=ULMER 6 FIRE PROTECTION Location Code: SHMOQSK Contact: Kelli Thompson Company: Davis Ulmer Sprinkler Co Contact Address: 308 DIX AVE Address: 25 Post Rd#4 QUEENSBURY,NY 12804-3932 Albany,NY 12205 Phone: 518-449-8511 Company Phone: 518-273-7377 Email: Inspector: Matt Cramer Property Evaluated: U-Haul(Storage) Date of Work: 8/5/2019 308 DIX AVE QUEENSBURY,NY 12804-3932 Description: Fire Alarm Supplement(Fire Alarm Devices) Deficiency Summary The are no reported deficiencies for this submission General Comments These items are outside the regular scope of the required inspection and are not the result of an engineering review. This information is not intended to be all-inclusive but rather a list of items discovered as a by-product of the required inspection. All descriptors are going to have to be changed once U-Haul is done with construction to match the new layout. Davis Ulmer Sprinkler Co,25 Post Rd#4,Albany,NY, 12205 Phone:518-273-7377 Page 1 of 5 DAVIS ����� Davis Ulmer Sprinkler Co • 25 Post Rd#4 Albany,NY 12205 FIRE PR O T T I O N Phone:518-273-7377 i Fire Alarm Supplementary Form The work covered on this form is(select one): Annual Date of Work 8/5/2019 Facility Name: Property Type: Location Code: U-Haul Storage SHMOQSK Service Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 Owner: Owner's Phone: Kelli Thompson 1518-449-8511 Owner's Address: 308 DIX AVE,QUEENSBURY,NY, 12804-3932 ^ IL ma a ".. ... AS-Abort Station BATT-Batteries CoD-Carbon Monoxide Detector CM-Control Module DA-Damper DD-Duct Detector DH-Door Holder EL-Emergency/Exit Light I FACP-Fire Alarm Control Panel HD-Heat Detector HORN-Horns/Horn-Strobes LA-Low Air MM-Monitor Module(Ansul,temp,CO,etc) MR-Manual Release Other PR-Phase Reversal PS-Pull Station PWS-Power Supply SC Signal/Sounder Control SD-Smoke Detector SD-Ion-Ion Smoke Detector SD-Photo-Photo Smoke Detector SPKR-Speakers Strobe-Strobes iTS-Tamper Switch WF-Waterflow a *HD 1 1 0 1 0 OPS 19 19 0 19 0 0SD 1 1 0 1 0 Zone: Heat Detectors 3 ,k *HD 01 Ceiling 8/7/2019 [Inss Zone: Pull Stations •'ell slat io� ' air Cap ° a PS log 12nd floor mezzanine 8/6/2019 1 Pass ©2014 FormLink Systems,Inc., Fire Alarm Supplement vI A Page 2 of 5 Davis Ulmer Sprinkler Co 25 Post Rd#4 � '� -ULMER Albany,NY 12205 FIRE PROTECTION Phone: 518-273-7377 ............ Z" a t -L&T A46 0 1�A T, T 0 PS 10 2nd floor mezzanine 8/6/2019 Pass O PS 07 By door 60 8/6/2019 Pass O PS 009 By door 63 8/6/2019 Pass O PS 01 By door 64 8/6/2019 Pass O PS 03 By door 65 8/6/2019 Pass •PS 05 By Door 58 8/6/2019 Pass •PS 06 By Exit Door 66 8/6/2019 11a."s •PS 08 By NW exit door 8/6/2019 Pass •PS 12 Dix Ave entrance(Auto) 8/6/2019 Pass 0 PS 13 Dix Ave furniture store exit 8/6/2019 Pass CPS 11 Entrance to Auto side 8/6/2019 Pass •PS Oil In between Auto bay doors 8/6/2019 Pass •PS 04 Inside Switch ear Room .8/6/2019 Pass M PS 006 NE store entrance 8/6/2019 Pass 0 PS 100 Next to FACP 8/6/2019 Pass M PS 02 Outside FACP 8/6/2019 Pass 0 PS 008 SE corner Exit 8/6/2019 Pass I C PS 007 SE store entrance 18/6/2019 Pass Zone: Smoke Detectors L 1109MMMIN f4ff6WM,, �Q,' W It OSD O1 Ceilinp- 1 18/7/2019 Pass Comments Any deficiencies or other problems found with the devices must be explained using the comment specific for each device.Additional comments can be added here. Please see the summary section at the tc,12 of the form for the comments. Inspector's Information Inspected By Matt Cramer Inspector License: Not Specified I state that the information on this form is correct at the time and place of my inspection,and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments. Signature of Inspector Date 8/5/2019 02014 Forml-ink Systems,Inc., Fire Alarm Supplement vL4 Page 3 of 5 ONIS �� �� Davis Ulmer Sprinkler Co i 25 Post Rd#4 Albany,NY 12205 FIRE PROTECTION Phone:518-273-7377 SECTION IV-OTHER TERMS AND LIMITATIONS 1. This Agreement is for inspection services only. If Customer wants Company to make any repairs,alterations or replacements as a result of the inspection services performed pursuant to this Agreement,such work and the additional compensation to Company must be specified in a separate written agreement between Company and Customer. 2. Any additional system equipment added to the Property after the date of this Agreement or not otherwise specified in Section II of this Agreement is not included in the inspection services to be provided pursuant to this Agreement. Inclusion of any such other equipment will require execution of an amendment to this agreement and adjustment of the inspection fee. 3. The inspection services provided by Company pursuant to this Agreement are limited to an evaluation of the functionality of the equipment identified in Section II above. Company will not evaluate or express any opinion as to whether the design and/or installation of the system are suitable for the Property or the operations at the Property. 4. Company's inspection is limited to a visual inspection of external readily accessible parts of the system and will not include every component including but not limited to sprinkler heads,pipe,fittings,hangers,pull stations,smoke detectors,conduit wire or other parts of the system being inspected. Company will only inspect a representative number or sample of the sprinkler heads,pipes,hangers,valves or other devices and equipment in their current position. THEREFORE,BY CONDUCTING ITS INSPECTION UNDER THIS AGREEMENT,COMPANY DOES NOT GUARANTEE OR WARRANT THE CONDITION OR OPERATION OF EVERY PIPE,SPRINKLER HEAD OR OTHER PART OF THE FIRE PROTECTION AND/OR FIRE ALARM/SECURITY SYSTEM ON THE PROPERTY. S. AS A MATERIAL INDUCEMENT FOR COMPANY TO PROVIDE THE SERVICES SPECIFIED IN THIS AGREEMENT AT THE INSPECTION FEE QUOTED IN THIS AGREEMENT,CUSTOMER AGREES THAT COMPANY'S LIABILITY TO CUSTOMER AND ALL THIRD PARTIES WITH RESPECT TO ANY CLAIM UNDER THIS AGREEMENT,OR ARISING FROM THE SERVICES FURNISHED BY COMPANY,SHALL BE LIMITED TO THE LESSER OF$1,000.00 OR THE TOTAL CONSIDERATION ACTUALLY RECEIVED BY COMPANY UNDER THIS AGREEMENT. THE FOREGOING LIMITATION SHALL APPLY TO ALL CLAIMS REGARDLESS OF THE NATURE THEREOF,INCLUDING CLAIMS ASSERTED AS A BREACH OF CONTRACT,A BREACH OF WARRANTY, NEGLIGENCE,STRICT LIABILITY OR OTHERWISE. IN NO EVENT SHALL COMPANY BE LIABLE FOR INCIDENTAL,CONSEQUENTIAL,SPECIAL,AND INDIRECT OR PUNITIVE DAMAGES,OR DAMAGES FOR LOST PROFITS. If Customer desires Company to accept an increased limit of liability for the services provided under this Agreement,Company will provide an alternate inspection fee quote reflecting such increased limit,provided, however,that the increased limit shall be effective only upon Company's and Customer's execution of a replacement agreement confirming the same and Customer's payment of the alternate fee. 6. Company,following each inspection,will provide to Customer a written"Report of Inspection"("Report"). If required and/or with prior written authorization,Company will provide copies of the Report to the local or state authority having jurisdiction on behalf of Customer. If requested by Customer,a copy of the Report will also be forwarded to Customer's insurance company. The Report and recommendations,if any,by Company are only advisory in nature and are intended to assist Customer in reducing the possibility of loss to the Property by indicating obvious defects or impairments to the system(s)which were discovered by Company's inspection and which should receive prompt attention. C2014 FoAL,ink Systems,Inc., Fire Alarm Supplement vl.4 Page 4 of 5