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Home My WebLink AboutSprinkler Inspection -August 2008 LID #:3150149 ,~ ~_.'.1 ~ Ahern Fire Protection 13705 26th Avenue, Suite 110 .Minneapolis, l\fN 55441 (763) 268-0515 P . (763) 268-0516 f www.ahemfire.com. Since 1880 , Invoice: HOLIDAY CORPORATION I Street: 4567 AMERICAN BLVD City: BLOOMINGTON Dept: I Phone #: !(952) 830-8700 State: MN Zip: 55437- Location: I ,Holiday Store #391 14460 Fountain Hills Drive (952) 403-0377 Fax #: Street: City: Prior Lake Phone #: ,Date: -- -t I Signature: J. Wet Dry Preaction ,Deluge Stand Pipe/Hose Contacts: ISteve Reckinger Invoice/Deficiency Foam Alarms Detectors I Hy~rants FireDoors FirePumps , -_.__.~~~---~.~".~- ValveTT I Internal. Sprinkler Direct: (952) 830-8700 Ext Cell/Pager: Annual Sprinkler System Inspection Report State: MN Zip: Foreman: Andy Zarbok Suppression Anti_Freeze Water Spray IBF RP 'BFDC Page 1 of 3 Work Order #: 851302 For Month/Year: August 2008 Ext IALARM DEVICES TESTS I. Did waterflow or pressure switches operate satisfactorily? 2. Did tamper switches operate satisfactorily? 3. Did water motor alarm gongs or electric bells operate satisfactorily? 4. Did alarm service or central station operate satisfactorily and receive proper signals? ,BF Generic BF Lincoln iBF Omaha Direct: Cell/Pager: Y N N/A 1\ \. ~ IALARM SIGNALS System # Test Times Is YEAR INSPECTION I. Was the 5 year Inspection perfimned on the following items? A. Alarm valves B. Check valves C. Gauges D. Internal Examination of Piping Date due: IS-YEAR TESTING I. Was the 5 year testing performed on the following items? A Sprinkler heads in corrosive environments or rated 325' F or higher. B. Standard sprinklers in service for 75+ years. lID-YEAR TESTING 1. Was the 10 year testing performed on the following items? A Standard sprinklers in service for 50+ years. B. Quick response sprinklers in service for 20+ years. C. Dry pendant sprinklers. This document PROPERTY OF AHERN FIRE PROTECTION, Copyright 2005 IF Ahem Co. REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT Y N N/A \ rptInspection _Annual i.JD-4ho3150149 ICONTROL VALVE SERVICE I. Were the following service items perfonned on all control valves? A. Fully opened and closed? B. Valve packing checked? C. Valve stem lubricated? D. Is the valve properly secured and locked in it's nonnal operating position? IBACKFLOW PREVENTOR TEST 1. Did the backflow preventor(s) pass the test of back flow and forward flow capabilities? Page 2 of 3 Y N N/ A '\ , '\. " '\! Y N N/A '\ IANTI-FREEZE TEST I. Has the anti-freeze solution for each system below been tested by measuring specific gravity? Y N N/A \, IHANGERS AND SEISMIC BRACING I. Did hangers and seismic bracing appear to be in good condition, finnly attached, and free from corrosion, from a visual inspection perfonned from floor level? Y N N/A IHOSE RACKS PRESENT? IMAIN DRAIN TEST System Number ..,f C .~ ,Static Pressure ; I "'r Residual PressureT(l-';; Size of drain 114 Yes No CONDITION: Good Fair Bad !\ Y N N/A " Y N N/A " \ \ Y N N/A I I IPIPING I. Was the exterior of exposed sprinkler piping in good condition, not subjected to extemalloads, free of mechanical damage? NOTE: Piping located in concealed spaces, such as above a drop ceiling, are not required to be inspected. IFIRE DEPARTMENT CONNECTIONS I. Are fire department connections visible and in good condition? 2. Are caps and plugs in place? 3. Are automatic drain valves operating properly? 4. Do hose connections operate freely? II .,.,. ',', ""f.... I ."Vi,;, 'rrs- InJ m_ ti,/ 1. Were all main drains tested at full flow? lfno, explain: 2. Were test results similar to the last test? Ifno, explain: 3. Was there any discharge of obstructive material, heavy discoloration of water, or plugging ofthe inspector's test connection? IGENERAL INFORM A TlON I. Are all the sprinkler systems in service? 2. Is the building completely sprinklered? 3. Are all sprinklers in good condition? 4. Are all sprinklers free of obstruction? 5. Are spare sprinklers and wrenches available? 6. In spray coating area, are sprinklers free from accumulation? 7. Is hydraulic nameplate and inf;Jnnation sign securely in place and legible? 8. Is emergency service contact infonnation readily available? 9. Are alann devices provided and in good condition? 10. Are all standard sprinklers dated 1920 or later? , " "'. Y N N/A I '\ ",' "- ,; \J " \ \ ~ IOWNER QUESTIONS I. Any changes in sprinkler system since last inspection? 2. Any fires since last inspection" Y N N/A \ ). ~'. i\ This document PROPERTV OF AHERN FIRE PROTECTION. Copyright 2005 J F Ahern Co. REPRODUCTIONS IN A.,'\IY FORM VIOLATES COPYRIGHT rptInspection _Annual <LID.#:-3150149 Page 3 of 3 A. Number of sprinkler heads that operated. B. How long was system out of service? C. Area where fire occured. 3. Are all areas of the building properly heate~ol!e}~nUTeeZing where wet pipe systems exist? 4. Do you have an outside alarm service? --.) ....) ..1. lfyes, name and phone number. "p--!o ._0- \ ~ Note to Owner - Our inspectiions will only report conditions as they exist at time of inspection and do not guarantee the operation of the System due to factors beyond our control. (i.e., potentially closed valves or depleted municipal water supply.) Per NFPA-25, this inspection is based on the assumption that the system has been installed in accordance with all applicable codes and standards. Owner/Representative's Signature: ---'-'~,- Date j"CJ /""" New Deficiencies found during this inspection? "Yes) No '--.....-"- ~ Customer receive copy of New Deficiency Report? \. Xe~)No INOTES ~ rOd' f'O: ,,~ {{f!:P /.:-, ~C[ 1;:1;: ,',/,r -<or fA;j ( 0 f\ fie-:' ";}A \ : ).+ ~r( LJ1' /J ~ ,_ /71 "'~.! J tt - /'t ~e.JJ t to Oc' -+r~~-' ,-,If' , ()A((<'/L r i,'\ C6/;./j..../flJA i'\et'(. (){',,{,- ;/ lJf/ _ 1", -.; '/" / ' / Ii) J. ( < L/ll>l~ -< l"'-- i V/'.,' - -76-;' -J~~{/ - .J:t)~ r .; Yr'...: .:..: Pill ( i)I+Y A~ (, (j~ -- / (. r j/l0t'"1 (r'/1 SERVICES PERFORMED: Alarm Test Drain Test Flow Test Walk Through ~ Annual Inspection Other /J /? "l' f,l &I./L. w..~!/ -;:". ) ," r::: Ii ,; .l/:.e1/ (:"r '7 t10!Cc- ~?~_tI.. ", J ~."..,-/.- ,'. f)t.j/1. {' C~)/l /1 UeL- / (' ( .^- ii e. O~/\' ( h /! I') [". C/ ------~--.,.~._--_. - '''~....... "'.'- -~ , I ,~---~ This document PROPERTY OF AHERN FIRE PROTECTION. Copy tight 2005lF. Ahem Co REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT rptInspection _Annual ~ Location: Holiday Store #39] Street: I Phone #: ; Date: 4460 Fountain Hills Drive (952) 403-0377 S stem #: /) System Type: Dry Valve Serial #: Manufacturer Name: L...S C Valve Model: Valve Size: Controlling Sprinklers Location: Controlling Sprinklers Number: Date of Last System Pressure Test: (Must be done every 3rd Year) Date of Last Full-Flow Trip Test: (Must be done every 3rd Year) Date Last Operated: Pressure Before Test - Air Pressure Before Test - Water Size and Location of Test Valve: Ahern Fire Protection .:-l ..._~' p ~'1- 13705 26th Avenue, Suite 110 1'vfinneapolis, MN 55441, (763) 268-0515 p. (763) 268-0516 f www.ahemfire.com · Since 1880 I Fax #: Central 3 fxf 3 attic approx 7- J { or tfO I -1 r- r oJ lIASi'> ; ,,,-, lbs. lbs_ Was gate valve below dry valve open wide at test? (if not, how many turns?) r- Ibs. rf'. \.) lbs. m~.('-- sec. ~,.-- sec. ,....) Poor Poor Poor Poor No N/A No N/A No N/A No N/A No N/A Yes (J/A Valve Tripped At - Air pressure Valve Tripped At - Water Pressure Valve Tripped At - Time If system flooded, list time water reached test opening. PERFORMANCE Interior of Body Movingi'arts Rubber Facing Seats Reset? Did alarms operate at trip test? Have low point drains been emptied? # Water control valve left open and sealed? Are the valves accessible? Device Manufacturer Name: Device Type and Model: Air pressure in upper chamber r Ibs. Quick opening device tripped at sec. lbs. Quick opening device left in service, and control open and sealed? Yes No N/A Dry /Pre action/ Deluge Pipe Valve Trip Test Dept.: City: Prior Lake State: MN Zip: Date: 8/1/2008 I Work Order #: 851302 LID #: 3150149 Foreman: lAndy Zarbok Belt Conditions? Reset? Yes No N/A Page I of I This document PROPERTY OF AHERN FIRE PROTECTION. Copyright 2008 JF. Ahem Co REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT rptValveTripTest