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Home My WebLink AboutReport of Inspection "V". ..e. .. Cia UTOMATIC SPRINKLER CO. Setting The Standard... UUl Lunent :>tre€r St. Paul, Minnesota 55117 (651) 558-3300 . (800) 229-6263 Fax: (651) 558-3310 AGREEMENT AND REPORT OF INSPECTION #INSPECTION 2../ S \.,,"," .-' SHEET 1 of 2, Use separate sheet for each building inspected MINNESOTA LICENSE NO. COOS <: Sell, BUILDING OR LOCATION INSPECTOR DATE ::'-.1'\ In c' l/i/: I.:t C.. 7 - S--U1 REPORT TO STREET CITY & STATE ,::,J., 6"~, / i,1f,,!', Ih 4(Y.) lli.< \ A L" -Ef j LY L,~k.l: ~ llLn l"'l~-........ tri' 1.'''--''',>,. (i"v' S C Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or building, and prepare a written report of that inspection for an agreed upon fee. As part of this agreement, owner agrees to terms and conditions on rear of form and will complete the Owner's Section of this document Owner's Section (To be answered by Owner or Occupant) A. Explain any occupancy hazard changes since the previous inspection: j..). .(<j L B. Describe fire protection modifications made since last inspection: t~) '"J .....: .;.... C Describe any fires since last inspection: /,.1..., 1/ '. D. When was the system piping last checked for stoppage, corrosion or foreign material? E. When was the dry-piping system last checked for propel' pitch? F. Are dry valves adequately protected from freezing? L/ i.., 1 L'''~ t .I'" f.. Signature Title Date - Inspector's Section (All responses reference current inspection) N/A = NOT APPLICABLE 1 General a. Is the building occupied? JlfYes 0 No b. Are all systems in service? tfYes 0 No c. Does there appeal' to be a minimum of 18 in, (457 nun) clearance between the top of the storage and the sprinkler deflectors? ;7'Yes [J No d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? 0 Yes 0 No li'N/ A 2 Control Valves (See Item 15) a. Do sprinkler system control valves appeal' to be in the appropriate open or closed position? rAes 0 No b, Are control valves in the open position locked, sealed or equipped with a~? GI''fes 0 No 3 Water Supplies (See Item 16) a. Was a water flow test of main drain made at the sprinkler riser(s)? yfes 0 No 4 Tanks, Pumps, Fire Department Connections a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? 0 Yes 0 No pINj A b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight? ~es [J No 0 N/ A Are tl1ey accessible and visible? 9"fes 0 No 0 N/ A 5 WeL Systems a. Are cold weatl1er valves (05. & Y.) in the appropriate open or closed position? 0 Yes 0 No cYN/ A b. Have antifreeze system solutions been tested? $Yes 0 No 0 Nj A c. Were the antifreeze test results satisfactory? 0 Yes !;f'No 0 N/ A .~' '- \. d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including blind attics and perimeter areas where accessible? ;'Yes 0 No 0 Nj A Do all exterior openings appear to be protected against freezing? .;<!'Yes 0 No 0 Nj A 6., Dry System (See Items 11 to 13) 'a:~dry valves (s) in service? 0 Yes 0 No 0 Nj A b. Are t ressures and priming water levels in accordance with the manufacture's instructions? 0 Yes 0 No 0 N/ A c. Has the opera . of the air or nitrogen supplies been tested? o Yes oNo oN/A Are they in service? oYes oNo oN/A d. Were all know low . ts drained during this inspection? 0 Yes 0 No 0 Nj A e. Did quick-opening devic erate satisfactorily? 0 Yes 0 No 0 Nj A f. Did tl1e dry valve(s) trip prope ~ing the trip pressure test? 0 Yes 0 No 0 N/ A g. Did the heating equipment in the dry~ valve room(s) operate at time of inspection? 0 Yes 0 No 0 N/ A 7 ~S 'stems (See Item 14) a, Did e e or pre-action valves operate properly during testing? 0 Yes 0 No 0 N/ A b. Did tl1e heat-respon vices operate properly during testing? 0 Yes 0 No 0 N / A c. Did supervisory devices opera~ testing? 0 Yes 0 No [J N/ A 8 Alarms a. Did water motor(s) and gong(s) test satisfactorily? 0 Yes 0 No ~/ A b. Did electric alarm(s) test satisfactory? ~es 0 No 0 N/ A c. Did supervisory alarm service test satisfactory? Ji'\'es 0 No 0 Nj A 9 Sprinklers a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? 0 Yes Q'No b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) j7Yes 0 No c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing) .fl"Yes uNo 0 Nj A d. Is stock of spare sprinklers available? ;it'Yes 0 No e, Does the exterior condition of sprinkler system appear to be satisfactory? ,,{YeS' 0 No f. Do visible sprinklers appear to be of proper temperature rating for their locations? ,lfYes 0 No 10 Explain any "No" answers and comments: 5 L" y\ . II "\ \ (. I j {(, i~\ (-, L -\ Signature: \.~, " ,r~l )':: lv\.....-\:,. , /,.-... (..Ii Date: C"'l , "'. .-t. .. c:::P AUTOMATIC SPRINKLER CO. Setting The Standard... 1301 L'Orient Street St. Paul, Minnesota 55117 (651) 558-3300 . (800) 229-6263 Fax: (651) 558-3310 SHEET 2 of 2 - Use separate sheet for each system inspected System No. or Description if multiple systems Inspection Report No. Z/.s SS' :;... 11 12 13 (See Trip Test Table which follows) (See Trip Test Table Wllich follows) (See Trip Test Table which follows) MODEL TRIP TEST TABLE SERIAL NO. MAKE Q.O.D. MODEL SERIAL NO. DRY PIPE OPERATING TEST Water Air Trip Point Air Pressure Time Water Reached PSI MIN. SEe. YES Alarm Operated Properl )' NO Test Outlet Without Q.O.D With Q.O.D 14 Date deluge or preaction valve tested ~ ............-- DELUGE & PREACTlON VALVES "'TO~ 0 PNEUMATIC 0 ELECTRIC -.......... IPiping Supe~~ 0 YES 0 NO I Detecting Media Supervised 0 'YES Does valve operate from the-~~ and/ or remote control stations 0 YES Is there an accessible facility in each circuit~ 0 YES 0 NO IMethod of Testing Circuits '-------' I Does each circuit operate Does each circuit .tvlAKE MODEL -~~ion loss alarm operate valve release YES-rO_ YES NO CJ NO 'j NO 1Ylaximum hn1e to oper8te release YES NO 15 See Control Valve Maintenance Table COI\TROL VALVE MAINTENANCE TABLE Control Valves City Control Valves Bypass Valves Tank Control Valves Pump Control Valves Sectional Control Valves Svstem Control Valves Other Control Valves Kitchen Control Valves Or..l) ''[', 16 Water Flow Test at Sprinkler Riser f Water Supply Sourccl:-.,li fIll. u, ,'\ ;~ \3& City P,. Number Type Open Secured Closed Signs Explain Abnormal Condition f \::. F,,; ':'<::. .r-l..........- ~' Date Test Pipe Location Size of Test Pipe Ilt( I~'<-, Static Pressure ",,' Pump "" Residual (Flow) Pressure )/- ..I,"..{' Tank (j) Last Water Flow Test 7 l! 0:"', V, ._,-" This Water Flow Test ..,. ':': 'Od"J fl, .... 17 Explain any "NoH answers and comments: t..':.l;t ,....,11;;. f~t~. -t>/ 18 Adjustments or corrections made during this inspection: 19 Although these comments are not the result of an engineering review, the following desirable improvem.ents are recommended: Signature: \\k..~{J) (-j i ./" i.,-.J C__ /.-.... C,/I Date: "I {... cy.:/ (Rev 2/8/(6) t._ i \ \' l " v\ ~ t....."f 7- ._. ), r {~~, 1- cA_ \<- AUTOMATIC SPRINKLER CO. Report of Inspection Additional Comments I - t ".., ''l~ :: ( / j t , j.. C.,_,,;?, J-t l-f .-" ,. '''1 l 1(,-- i' "L I .J ( ;, i '- ;.? ,1. i I j ;"'"JJ'-' \; ..;- 1.- , , (,to i,'- c~ , t,-t. " \ (:,... 130l L'ORIENT STREET ST. PAUL, MINNESOTA 55117 (651) 558-3300 . (800)-229-6263 FAX: (651) 558-3310 I i