HomeMy WebLinkAboutFire Sprinkler Report 10/17/2008
Fire Sprinkler System Inspection Report
~ G I L B E R T Gilbert Mechanical Contractors, Inc.
4451 West 76th Street
Edina, MN 55435 (952) 835-3810
Inspected By: Dean Kaminski Inspection Date: 10/17/2008 Inspection #:2617
Property Name: North Lake Office Center #2
Property Address: 14180 Commerce Avenue NE
Prior Lake, MN 55372
Bill To:
Enqelsman Limited Partnershio
Bill To Address: C/o Kraus-Anderson Realty Co.
4210 WOld Shakopee Road
Contact & Phone #: Contact: Bloominqton, MN 55437
Was owner representative contacted prior to inspection? 0 Ves 0 No
Representative's Name:
Rep present during inspection? OVes 0No *
Were all rooms available for inspection? 0Ves ONo
Are as-built drawings available? OVes 0No
Date Contacted:
Rep's Name:
Last inspection report available? 0Ves 0 No
Zone map available? OVes 0 No
* If no, see notes on following page
[l]
GENERAL SYSTEM INFORMATION
1
# of Systems
1
# of Wet
# of Dry
# of Preaction
# of Other
Location of Valve Assembly:
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SPRINKLER SYSTEM INSPECTION
System components have been inspected as follows: (circle all that apply)
Gauges (Dry, Preaction, Deluge) OVes ONo 0N/A o Other (see notes)
Waterflow Devices 0Ves ONo ON/A o Other (see notes)
Valve Supervisory Devices 0Ves ONo ON/A o Other (see notes)
Supervisory Signal Devices (Except Valve) OVes ONo 0N/A o Other (see notes)
Supervisory Switches OVes ONo 0N/A o Other (see notes)
Gauges (Wet System) 0Ves ONo ON/A o Other (see notes)
Hydraulic Nameplate 0Ves ONo ON/A o Other (see notes)
Buildings 0Ves ONo ON/A o Other (see notes)
Hanger/Seismic Bracing OVes 0No ON/A o Other (see notes)
Pipe & Fittings OVes 0No ON/A o Other (see notes)
Sprinklers 0Ves ONo ON/A o Other (see notes)
Spare Sprinklers 0Ves ONo ON/A o Other (see notes)
Fire Department Connection 0Ves ONo ON/A o Other (see notes)
Page 1 of 8
[Z]
SPRINKLER SYSTEM INSPECTION
Valves (All Types) 0Ves ONo ON/A o Other (see notes)
Control Valves 0Ves ONo ON/A o Other (see notes)
Alarm Valves OVes ONo 0N/A o Other (see notes)
Check Valves OVes ONo 0N/A o Other (see notes)
Pre-Action/Deluge OVes ONo 0N/A o Other (see notes)
Dry Pipe Valves OVes ONo 0N/A o Other (see notes)
Pressure Reducing & Relief OVes ONo 0N/A o Other (see notes)
Backflow Prevention Assemblies OVes ONo 0N/A o Other (see notes)
Sprinkler System Inspection Notes:
[l]
OBSTRUCTION INVESTIGATION
NFPA 25 (2002)
"An investigation of piping and branch line conditions shall be conducted every 5 years by opening a flushing
connection at the end of one main and by removing a sprinkler toward the end of one branch line for the
purpose of investigating for the presence of foreign organic and inorganic material."
(Stated in NFPA 25,2002 Chapter 13.2.1)
Has the owner been informed of the obstruction investigation requirement?
Date last obstruction investigation was performed:
Is an obstruction investigation required with this inspection?
*If Ves, owner's authorization: Not authorized
OVes
0No
o Ves * 0 No
(Owner/Rep name)
OVes 0No
Has an obstruction investigation been performed?
Obstruction Investigation Notes:
Page 2 of 8
D
Fire Sprinkler System Inspection Report
STANDPIPE & HOSE SYSTEM INSPECTION
System components have been inspected as follows: (circle all that apply)
Control Valves aVes aNa ON/A o Other (see notes)
Pressure Regulating Devices OVes ONo ON/A o Other (see notes)
Piping OVes ONo ON/A o Other (see notes)
Hose Connections OVes ONo ON/A o Other (see notes)
Cabinet OVes ONo ON/A o Other (see notes)
Hose OVes ONo ON/A o Other (see notes)
Hose Storage Device OVes ONo ON/A o Other (see notes)
Hose Nozzle OVes ONo ON/A o Other (see notes)
Standpipe and Hose System Inspection Notes:
D
PRIVATE FIRE SERVICE MAIN INSPECTION
System Components have been Inspected as Follows:
(circle all that apply)
Hose Houses
Hose Hydrants (Dry Barrel & Wall)
Monitor Nozzles
Hydrants (Wet Barrel)
Mainline Strainers
Piping (Exposed)
Piping (Underground)
OVes
OVes
OVes
OVes
OVes
OVes
OVes
o Other (see notes)
o Other (see notes)
o Other (see notes)
o Other (see notes)
o Other (see notes)
o Other (see notes)
o Other (see notes)
ONo
ONo
ONo
ONo
ONo
ONo
ONo
ON/A
ON/A
ON/A
ON/A
ON/A
ON/A
ON/A
Private Fire Service Main Inspection Notes:
D
FIRE PUMP INSPECTION & TESTING (see Fire Pump Inspection form on separate page)
Page 3 of 8
D
WATER STORAGE TANK INSPECTION
Fire Sprinkler System Inspection Report
System components have been inspected as follows: (circle all that apply)
Condition of Water in Tank OVes ONo ON/A o Other (see notes)
Water Temperature 0
Heating System OVes ONo ON/A o Other (see notes)
Control Values OVes ONo ON/A o Other (see notes)
Water Level OVes ONo ON/A o Other (see notes)
Air Pressure PSI
Tank Exterior OVes ONo ON/A o Other (see notes)
Support Structure OVes ONo ON/A o Other (see notes)
Catwalks and Ladders OVes ONo ON/A o Other (see notes)
Surrounding Area OVes ONo ON/A o Other (see notes)
Hoops & Grillage OVes ONo ON/A o Other (see notes)
Painted/Coated Surfaces OVes ONo ON/A o Other (see notes)
Expansion Joints OVes ONo ON/A o Other (see notes)
Interior OVes ONo ON/A o Other (see notes)
Check Valves OVes ONo ON/A o Other (see notes)
Water Storage Tank Inspection Notes:
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D
WATER SPRAY FIXED SYSTEM INSPECTION
Fire Sprinkler System Inspection Report
System components have been inspected as follows: (circle all that apply)
Backflow Preventer OVes ONo ON/A o Other (see notes)
Check Valves OVes ONo ON/A o Other (see notes)
Control Valves OVes ONo ON/A o Other (see notes)
Deluge Valves OVes ONo ON/A o Other (see notes)
Detection Systems OVes ONo ON/A o Other (see notes)
Detector Check Valves OVes ONo ON/A o Other (see notes)
Drainage OVes ONo ON/A o Other (see notes)
Electric Motor OVes ONo ON/A o Other (see notes)
Engine Drive OVes ONo ON/A o Other (see notes)
Fire Pump OVes ONo ON/A o Other (see notes)
Fittings OVes ONo ON/A o Other (see notes)
Fittings (Rubber-Gasketed) OVes ONo ON/A o Other (see notes)
Gravity Tanks OVes ONo ON/A o Other (see notes)
Hangers OVes ONo ON/A o Other (see notes)
Heat (Deluge Valve House OVes ONo ON/A o Other (see notes)
Nozzles OVes ONo ON/A o Other (see notes)
Pipe OVes ONo ON/A o Other (see notes)
Pressure Tank OVes ONo ON/A o Other (see notes)
Steam Driver OVes ONo ON/A o Other (see notes)
Strainers OVes ONo ON/A o Other (see notes)
Suction Tanks OVes ONo ON/A o Other (see notes)
Supports OVes ONo ON/A o Other (see notes)
Water Supply Piping OVes ONo ON/A o Other (see notes)
UHSWSS-Detectors OVes ONo ON/A o Other (see notes)
UHSWSS-Controllers OVes ONo ON/A o Other (see notes)
UHSWSS-Valves OVes ONo ON/A o Other (see notes)
Water Spray Fixed System Inspection Notes:
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D
FOAM WATER SPRINKLER SYSTEM INSPECTION
Fire Sprinkler System Inspection Report
System components have been inspected as follows: (circle all that apply)
Discharge Device Location (Sprinkler) OVes ONo ON/A o Other (see notes)
Discharge Device Location (Spray Nozzle) OVes ONo ON/A o Other (see notes)
Discharge Device Position (Sprinkler) OVes ONo ON/A o Other (see notes)
Discharge Device Position (Spray Nozzle) OVes ONo ON/A o Other (see notes)
Foam Concentrate Strainer OVes ONo ON/A o Other (see notes)
Drainage in System Area OVes ONo ON/A o Other (see notes)
Proportioning System(s) - All OVes ONo ON/A o Other (see notes)
Pipe Corrosion OVes ONo ON/A o Other (see notes)
Pipe Damage OVes ONo ON/A o Other (see notes)
Fitting Corrosion OVes ONo ON/A o Other (see notes)
Fitting Damage OVes ONo ON/A o Other (see notes)
Hangers/Supports OVes ONo ON/A o Other (see notes)
Waterflow Devices OVes ONo ON/A o Other (see notes)
Water Supply Tanks OVes ONo ON/A o Other (see notes)
Fire Pump(s) OVes ONo ON/A o Other (see notes)
Water Supply Piping OVes ONo ON/A o Other (see notes)
Control Valves OVes ONo ON/A o Other (see notes)
Deluge/Preaction Valve(s) OVes ONo ON/A o Other (see notes)
Detection System OVes ONo ON/A o Other (see notes)
Foam-Water Sprinkler System Inspection Notes:
Sprinkler System Testing
D
QUARTERLY TESTS
Waterflow Devices
Water Motor Gong:
# Present
Did the Alarm Sound: 0 VES
o NO (circle one)
Notes:
Page 6 of 8
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SEMI-ANNUAL TESTS
Waterflow Devices
Vane Type # ~
Pressure Switch Type # _
Do All Waterflow Devices Operate Properly: 0 YES
o NO (circle one)
Notes:
Valves Supervisory Devices
2
Do All Supervisory Devices Operate Properly: 0 VES
o NO (circle one)
# Present
Notes:
Supervisory Signal Devices
# Present
Type:
Notes:
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ANNUAL TESTS
Main Drain Test
Static: flL PSI
Antifreeze Solution
Residual: 88
PSI
Specific Gravity at 600 F:
Freezing Point:
Adjustment Needed:
OF
OVES 0 NO
(circle one)
Notes:
Page 7 of 8
D
5 YEAR TESTS
Gauges
**Gauges shall be replaced every 5 years or tested every 5 years by comparison with calibrated gauuge. Gauges not
accurate to within 3% to the full scale shall be recalibrated or reduced.
# Present:
# Recalibrated:
# Tested:
# Replaced:
Notes:
Sprinklers (Extra High Temperature)
Date of Initial Installation:
o Sprinklers Operate Properly:
o Replace Sprinklers:
Date Last Tested:
See Sprinkler Test Report
See Sprinkler Test Report
D
SPRINKLER TESTING (20 YEARS OR OLDER)
Fast Response Sprinklers
Date of Initial Installation:
o Sprinklers Operate Properly:
o Replace Sprinklers:
Date of Last Test:
See Sprinkler Test Report
See Sprinkler Test Report
Notes:
D
SPRINKLERS 50 YEARS OLD OR OLDER
Date of Initial Installation:
o Sprinklers Operate Properly:
o Replace Sprinklers:
Date of Last Test:
See Sprinkler Test Report
See Sprinkler Test Report
Notes:
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Control valves left opened and system placed back in service?
0Ves
o No
Page 8 of 8