HomeMy WebLinkAboutSprinkler Report 12/4/08
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: 12/04/2008 Inspection #: 2743
Bill To: Air-Pur Systems
Bill To Address: 16873 Fish Point Road SE
Prior Lake, MN 55372
Property Name: Air-Pur Systems
Property Address: 1 Ei873 Fish Point Road SE
Prior Lake, MN 55372
Contact & Phone #:
Contact:
Was owner representative contacted prior to inspection?
Representative's Name:
Rep present during inspection? OVes 0No *
Were all rooms available for inspection? 0 Ves a No
Are as-built drawings available? OVes 0No
o Yes 0 No
Date Contacted:
Rep's Name:
Last inspection report available? 0Ves a No
Zone map available? aVes 0 No
* If no, see notes on following page
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GENERAL SYSTEM INFORMATION
1
# of Systems
1
# of Wet
# of Dry
# of Preacltion
# of Other No date of install
Location of Valve Assl3mbly:
Warehouse
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SPRINKLER SYSTEM INSPECTION
System components have been inspected as follows: (circle all that apply)
Gauges (Dry, Preaction, Deluge) OVes ONa 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 Delvices (Except Valve) o Yes 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 ONa ON/A o Other (see notes)
Hanger/Seismic Bracing 0Ves ONa ON/A o Other (see notes)
Pipe & Fittings 0Ves ONo ON/A a Other (see notes)
Sprinklers 0Ves ONo ON/A o Other (see notes)
Spare Sprinklers o Yes ONo ON/A o Other (see notes)
Fire Department Connection 0Ves ONo ON/A a Other (see notes)
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SPRINKLER SYSTEM INSPECTION
Valves (All Types) o Yes 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 o Yes ONo 0N/A o Other (see notes)
Dry Pipe Valves o Yes ONo 0N/A o Other (see notes)
Pressure Reducing & Relief o Yes ONo 0N/A o Other (see notes)
Backflow Prevention Assemblies 0Ves ONo ON/A o Other (see notes)
Sprinkler System Inspection Notes:
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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 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 Yes, owner's authorization:
Has an obstruction investigation been performed?
OVes
0No
o Yes * 0 No
(Owner/Rep name)
OVes ONo
Obstruction Investigation Notes:
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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 a Other (see notes)
Standpipe and Hose System Inspection Notes:
D
PRIVATE FIRE SE~VICE MAIN INSPECTION
System Components 11ave been Inspected as Follows: (circle all that apply)
Hose Houses OVes ONo ON/A o Other (see notes)
Hose Hydrants (Dry Barrel & Wall) aVes ONo ON/A o Other (see notes)
Monitor Nozzles OVes ONo ON/A o Other (see notes)
Hydrants (Wet Barrel) OVes ONo ON/A o Other (see notes)
Mainline Strainers OVes ONo ON/A o Other (see notes)
Piping (Exposed) OVes ONo ON/A o Other (see notes)
Piping (Underground) OVes ONo ON/A o Other (see notes)
Private Fire Service Main Inspection Notes:
D
FIRE PUMP INSPECTION & TESTING (see Fire Pump Inspection form on separate page)
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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
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 o Yes 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 o Yes ONo ON/A o Other (see notes)
Painted/Coated Surfaces OVes ONo ON/A o Other (see notes)
Expansion Joints o Yes ONo ON/A o Other (see notes)
Interior OVes ONo ON/A o Other (see notes)
Check Valves o Yes 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 o Yes 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 o Yes ONo ON/A o Other (see notes)
Detection Systems OVes ONo ON/A o Other (see notes)
Detector Check Valves o Yes ONo ON/A o Other (see notes)
Drainage o Yes 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 o Yes ONa ON/A o Other (see notes)
Fittings (Rubber-Gasketed) OVes ONo ON/A o Other (see notes)
Gravity Tanks o Yes 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 o Yes 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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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 o N/A o Other (see notes)
Discharge Device Position (Sprinkler) o Yes ONo ON/A o Other (see notes)
Discharge Device Position (Spray Nozzle) o Yes ONo o N/A o Other (see notes)
Foam Concentrate Strainer o Yes ONo ON/,tI. o Other (see notes)
Drainage in System Area o Yes ONo o N/A o Other (see notes)
Proportioning System(s) - All o Yes ONo o N/A o Other (see notes)
Pipe Corrosion o Yes ONo o N/A o Other (see notes)
Pipe Damage o Yes ONo ON/A o Other (see notes)
Fitting Corrosion o Yes ONo o N/A o Other (see notes)
Fitting Damage o Yes ONo o N/A o Other (see notes)
Hangers/Supports o Yes ONo a N/A o Other (see notes)
Waterflow Devices o Yes ONo ON/A o Other (see notes)
Water Supply Tanks aYes ONo o N/A a Other (see notes)
Fire Pump(s) o Yes ONo a N/A o Other (see notes)
Water Supply Piping o Yes aNo a N/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: a YES
a NO (circle one)
Notes:
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SEMI-ANNUAL TESTS
Waterflow Devices
Vane Type # 1
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 YES
a NO (circle one)
# Present
Notes:
Supervisory Signal Devices
# l:Jresent
Type:
Notes:
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ANNUAL TESTS
Main Drain Test
Static: ~ PSI
Antifreeze Solution
PSI
Residual: 78
Specific Gravity Bit 600 F:
OF
Freezing Point:
Adjustment Needed:
aYES a NO
(circle one)
Notes:
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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: See Sprinkler Test Report
o Replace Sprinklers: See Sprinkler Test Report
Date Last Tested:
D
SPRINKLER TESTING (20 YEARS OR OLDER)
Fast Response Sprinklers
Date of Initial Installation:
o Sprinklers Operate Properly: See Sprinkler Test Report
o Replace Sprinklers: See Sprinkler Test Report
Date of Last Test:
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
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