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Fire Sprinkler System Inspection Report
'~ G I L B E 1 T Gilbert Mechanical Contractors, Inc.
, 4451 West 76th Street
\-.." Edina, MN 55435 (952) 835-3810
Inspected By:
Dean Kaminski
I nspection Date: 1/6/08
Inspection #:2754
Property Name: Friendshio Church
Property Address: 17741 Fairlawn Avenue
Prior Lake, MN 55372
Contact & Phone #:Todd 952-447-0545
Bill To:
Friendshio Church
Bill To Address: 17741 Fairlawn Avenue
Prior Lake, MN 55372
Contact:
Was owner representative contacted prior to inspection?
Representative's Name:
Rep present during inspection? 0Ves ONo *
Were all rooms available for inspection? 0 Ves 0 No
Are as-built drawings available? OVes 0No
OVes 0 No
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 Fire pump - no date of install
Basement mechanical room
Location of Valve Assembly:
[l]
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 OVes ONo 0N/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 OVes 0No ON/A o Other (see notes)
Buildings OVes 0No 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
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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:
Basement system only - all sprinkler heads on system have been recalled.
[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 ofinvestigating for the presence offoreign organic and inorganic material."
(Stated in NFP A 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
0ves
ONo
0Ves" 0 No
Has an obstruction investigation been performed?
(Owner/Rep name)
OVes 0No
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 OVes ONo 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:
[Z]
FIRE PUMP INSPECTION & TESTING (see Fire Pump Inspection form on separate page)
Page 3 of 8
[{]
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 0No ON/A o Other (see notes)
Water Temperature
Heating System OVes ONo ON/A o Other (see notes)
Control Values @Ves ONo ON/A o Other (see notes)
Water Level 0Ves ONo ON/A o Other (see notes)
Air Pressure NA PSI
Tank Exterior OVes ONo 0N/A o Other (see notes)
Support Structure OVes ONo 0N/A o Other (see notes)
Catwalks and Ladders OVes ONo 0N/A o Other (see notes)
Surrounding Area 0Ves ONo ON/A o Other (see notes)
Hoops & Grillage OVes ONo 0N/A o Other (see notes)
Painted/Coated Surfaces OVes ONo 0N/A o Other (see notes)
Expansion Joints OVes ONo 0N/A o Other (see notes)
Interior OVes ONo 0N/A o Other (see notes)
Check Valves 0Ves ONo ON/A o Other (see notes)
'Water Storage Tank Inspection Notes:
Outside underqround water tank
Page 4 of 8
D
WATER SPRAY FIXED SYSTEM INSPECTION
Fire Sprinkler System Inspection Report
System components have been inspected as follows: (circle all that apply)
Backflaw Preventer OVes ONo ON/A o Other (see notes)
Check Valves OVes ONa ON/A o Other (see notes)
Control Valves OVes ONo ON/A o Other (see notes)
Deluge Valves OVes ONa ON/A o Other (see notes)
Detection Systems OVes ONo ON/A o Other (see notes)
Detector Check Valves OVes ONa ON/A o Other (see notes)
Drainage OVes ONa ON/A o Other (see notes)
Electric Motor OVes ONa ON/A o Other (see notes)
Engine Drive OVes ONa 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 ONa ON/A o Other (see notes)
Gravity Tanks OVes ONa ON/A o Other (see notes)
Hangers OVes ONo ON/A o Other (see notes)
Heat (Deluge Valve House OVes ONa ON/A o Other (see notes)
Nozzles OVes ONa 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 ONa ON/A o Other (see notes)
Strainers OVes ONa ON/A o Other (see notes)
Suction Tanks OVes ONa ON/A o Other (see notes)
Supports OVes ONa ON/A o Other (see notes)
Water Supply Piping OVes ONa ON/A o Other (see notes)
U HSWSS-Detectors OVes ONa ON/A o Other (see notes)
UHSWSS-Contrallers OVes ONa ON/A o Other (see notes)
UHSWSS-Valves OVes ONo ON/A o Other (see notes)
Water Spray Fixed System Inspection Notes:
Page 5 of 8
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) o Yes ONo ON/A o Other (see notes)
Discharge Device Location (Spray Nozzle) o Yes ONo ON/A o Other (see notes)
Discharge Device Position (Sprinkler) o Yes ONo o N/A o Other (see notes)
Discharge Device Position (Spray Nozzle) o Yes ONo ON/A o Other (see notes)
Foam Concentrate Strainer o Yes ONo ON/A o Other (see notes)
Drainage in System Area o Yes ONo ON/A o Other (see notes)
Proportioning System(s) - All o Yes ONo o N/A o Other (see notes)
Pipe Corrosion o Yes ONo ON/A o Other (see notes)
Pipe Damage o Yes ONo ON/A o Other (see notes)
Fitting Corrosion o Yes ONo ON/A o Other (see notes)
Fitting Damage o Yes ONo o N/A o Other (see notes)
Hangers/Supports o Yes ONo ON/A o Other (see notes)
Waterflow Devices o Yes ONo ON/A o Other (see notes)
Water Supply Tanks o Yes ONo ON/A o Other (see notes)
Fire Pump(s) o Yes ONo ON/A o Other (see notes)
Water Supply Piping o Yes ONo ON/A o Other (see notes)
Control Valves o Yes ONo ON/A o Other (see notes)
Deluge/Preaction Valve(s) o Yes ONo o N/A o Other (see notes)
Detection System o Yes 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 YES
o NO (circle one)
Notes:
Page 6 of 8
[ZJ
SEMI-ANNUAL TESTS
Waterflow Devices
Vane Type # 1
Notes:
Valves Supervisory Devices
# Present
Notes:
All valves chained
Supervisory Signal Devices
# Present
Notes:
[ZJ
Pressure Switch Type # _
Do All Waterflow Devices Operate Properly: 0 YES
ONO
Do All Supervisory Devices Operate Properly: 0 YES
Type: _
ONO
(circle one)
(circle one)
ANNUAL TESTS
Main Drain Test
Static: 70
Antifreeze Solution
Specific Gravity at 600 F:
Notes:
PSI
Residual: 50 pump kicks in PSI
Freezing Point:
Adjustment Needed:
OF
OYES 0 NO
(circle one)
Page 7 of 8
[l]
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: 4
# Recalibrated: -
# Tested: -
# Replaced: 3
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:
[{]
Control valves left opened and system placed back in service?
o Yes
o No
Page 8 of 8
Fire Pump Test Data
Tested By:
Dean Kaminski
Gilbert Mechanical Contractors, Inc.
4451 West 76th Street
Edina, MN 55435 (952) 835-3810
Tested Date: 1/6/2009 Inspection #: 2754
Bill To: Friendship Church
Bill To Address: 17741 Fairlawn Avenue
Prior Lake, MN 55372
~ejGILBERT
Property Name: Friendship Church
Property Address: 17741 Fairlawn Avenue
Prior Lake, MN 55372
Contact & Phone #: Todd 952-447-0545
Contact & Phone#
Was owner representative contacted prior to test? aVes 0 No
Representative's Name:
Date Contacted:
Rep present during test? 0 Ves a No.
· If no, see notes on following page
Rep's Name: Todd
FIRE PUMP INFORMATION
Manufacturer
Model Number
Serial Number
Pump
Motor
EnQine
Controller
Patterson
Marathon
Metron
M30A-20-230B
EL9310571-01
PUMP
Manufacturer: Patterson Approved: FM
Shaft: V
Horizontal
Vertical. - Vertical
Rated GPM: 300
Rated Max PSI: 78
Rated PSI: 65
Rated RPM: 3525
Rated PSI: at 1.5 50
Suction From: Tank
Tank Size:
Tank Height underground
VERTICAL PUMP (if applies)
Vertical Distance Discharge Gauge to Water Level:
Right Angle Gear Drive:
Static 70
ft.
Pumping 75
ft.
Manufacturer
Patterson
Model
93FP0193TL3
o Smooth
a Rough
Type
JOCKEY PUMP INFORMATION
Manufacturer
Model Number
Serial Number
Jockey Pump Panel
Jockey Pump
Metron
Baldoor
M15B-1-230
AK931 0571-02
Page 1 of 3
DRIVER
Manufacturer: Marathon
Electric Motor:
Rated Volt:
Operating Volt:
Engine Type:
230/460
230
RPM: 3550
Horse Power: 60
Diesel
Gas
Gasoline
Steam Turbine
CONTROLLER
Start PSI
Stop PSI
Manual
./ Manual
Auto
Auto
Water Flow
./ Pressure Drop
Control Valves Number Type Open Secured Signs Condition
City Conection Control Valves 1 OS&Y 0YON (e)yON ,;)YON Chained onlv
Test & Control Valves 1 OS&Y OY(e)N 0YON :)Y(e)N Chained only
Pump Control Valves 0Y(;')N nynN jynN
Sectional Control Valves 1 BFV 0:!:..ON Q.Y..0N :)Y€)N
System Control Valves 1 BFV 0.Y...ON 0!:.ON .Jr.0N Chained only
* Circle Yes or No
PERFORMANCE
Suction Discharge Boost
Pressure Pressure PSI TDH GPM VOLTS AMPS 1 AMPS 2 AMPS 3 RPM
Churn
38
74
36
3530
100%
150%
Fire Pump
Jockey Pump
ON 50
ON 57
PSI
PSI
OFF -
OFF 74
PSI
PSI
Notes:
Churn test on Iv because of with the cold weather. the owner did not want ice oroblems.
Puma controller has timer in it but it did not work.
Page 2 of 3