HomeMy WebLinkAboutReport of Inspection
l,:)Vl L Vlle!U .::JUL"'e1
"...t....Ga
UTOMATIC SPRINKLER co.
Setting The Standard...
St. Paul, Minnesota 55117
(651) 558-3300 . (800) 229-6263
Fax: (651) 558-3310
SHEET 1 of 2 - Use separate sheet for each building inspected
MINNESOTA LICENSE NO. COOS
AGREEMENT AND REPORT OF INSPECTION
#INSPECTION ., I <,;: ""
.... ...,J .~,....1
REPORT TO
STREET
CITY & STATE
~:~)~ f~, l~, t"l c. ,{ 1." .:,',:r__ l.i4 )!
I b 2. ,yo Du [.j1, t" Y\,,/
"Y. .~ LJ..t'-. Y); ,i') ~5 ~
S.I
> -.,...
.;;, ~I C
BUILDING OR LOCATION
INSPECTOR
DATE
.5i\;,~\ \;..
yV'\ ~.?\ \...
2':"; {)<'1
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: II
B. Describe fire protection modifications made since last inspection:
/1
I
C. Describe any fires since last inspection:
11):/,)(
D. When was the system piping last checked for stoppage, corrosion or foreign material?
E. When was the dry-piping system last checked for proper pitch?
F. Are dry valves adequately protected from freezing? '''I,
Signature Title Date
Inspector's Section (All responses reference current inspection) NjA = NOT APPLICABLE
1 General
a. Is the building occupied? )t'Yes 0 No
b. Are all systems in service? ..r1es 0 No
c. Does there appear to be a minimum of 18 in. (457 mm) clearance between the top of the storage and the sprinkler deflectors? 5J.Xes iJ No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? 0 Yes 0 No .~j A
2 Control Valves (See Item 15)
a. Do sprinkler system conh'ol valves appear to be in the appropriate open or closed position? ,;1Yes 0 No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch? )2'Yes 0 No
3 Water Supplies (See Item 16) --
a. Was a water flow test of main drain made at the sprinkler riser(s)? JiYes 0 No
4 Tanks, Pumps, Fire Deparhnent Connections
a. Are fire pumps, gravity tanks. reservoirs and pressure tanks in good condition and properly maintained? 0 Yes 0 No Gf'1\J1 A
b. Are fire department connections in satisfactory condition. couplings free, caps in place, and check valves tight? ;/'Yes 0 No [] NI A
Are they accessible and visible? ..i'fYes 0 No 0 NI A
5 Wet Systems
a. Are cold weather valves (0.5. & Y.) in the appropriate open or closed position? 0 Yes 0 No ,;TNI A
b. Have antifreeze system solutions been tested? 0 Yes 0 No )dfNj A
Co Were the antifreeze test results satisfactory? 0 Yes 0 No ...pNI 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?.;li Yes 0 No 0 Nj A Do all exterior openings appeal' to be protected against freezing? "r;/'res [] No 0 NI A
6 ~y System (See Items 11 to 13)
a. "A(e dry valves (s) in service? 0 Yes 0 No 0 NI A
b. Ar~ e air pressures and priming water levels in accordance with the manufacture's instructions? 0 Yes 0 No 0 Nj A
c. Has the ration of the ail' or nitrogen supplies been tested? 0 Yes 0 No 0 NI A Are they in service? [] Yes 0 No 0 NI A
d. Were all kno w points drained during this inspection? 0 Yes 0 No 0 Nj A
e. Did quick-openin ices operate satisfactorily? 0 Yes 0 No 0 NI A
f. Did the dry valve(s) tn operly during the trip pressure test? i:] Yes 0 No 0 NI A
g. Did the heating equipment e dry-pipe valve room(s) operate at time of inspection? 0 Yes 0 No 0 Nj A
7 ~pecial Systems (St't' Item 14),
a.""Did e deluge or pre-action valves ~erate properly during testing? 0 Yes 0 No 0 N j A
b. Did the he onsive devices operate properly during testing? 0 Yes 0 No 0 NI A
c. Did supervisory dev erate during testing? 0 Yes 0 No 0 Nj A
8 Alarms
a. Did water motor(s) and gong(s) test satisfactorily? 0 Yes 0 No J;tN1 A
b. Did electric alarm(s) test satisfactory? ,tYes 0 No 0 Nj A
c. Did supervisory alarm service test satisfactory? .;;rYes 0 No 0 Nj A
9 Sprinklers
a. Do visible sprinklers appear to be free from corrosion. loading or obstruction to spray discharge? ,.P'~es 0 No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) ?,Yes 0 No
c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing) ,Yes 0 No 0 NI A
d. Is stock of spare sprinklers available? f1'Yes 0 No
e. Does the exterior condition of sprinkler system appear to be satisfactory? 0 Yes 0 No
f. Do visible sprinklers appear to be of proper temperature rating for their locations? )?'Yes 0 No
10 Explain any "No" answers and comments:
Signature:
, " ~i J)
\1\.'-"/ \. J
Date:
"..,t. .-.Gi
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. 1...1 S ~-~; ::::
MAKE
.~"'MQ.l) EL
~........
--,
Water
Pressure
(See Trip Test Table which follows)
(See Trip Test Table which follows)
(See Trip Test Table which follows)
Q.O.D.
MODEL
11
12
13
Dafech:y.-.pipe valve trip tested (control valve partially open)
Date dry.pipe-v.aJ.ye trip tested (control valve fully open)
Date quick-openin~~~ tested
''''........._~"~
DRY VALVE ._~-_.
(See Trip Test Table w/lich follows)
TRIP TEST TABLE
jOperation D PNEUMA TIC D ELECTRIC D HYDRAULIC
I Piping Supervised D YES D NO IDetecting Media Supervised D YES
IOoes valve operate from the manual trip and/or remote control stations D YES
lIs there an accessible facility in each circuit for testing D YES D NO IMethod of Testing Circuits
Does each circuit operate Does each circuit
supervision loss alann operate valve release
YES NO YES NO
DRY PIPE
OPERATING
TEST
Without
Q.O.O
With
Q.O.D
TRIP TEST TABLE
SERIAL NO. MAKE
SERIAL NO.
'.......-........,""'"'-Air
P--.
ressure ....~_...
PSI
Time Water Reached
Test Outlet
Alarm Operated
Properly
Trip Point
Air Pressure
Time to Trip
Thru Test Pipe
MIN. SEe.
~~I MIN. I
~--.... J
-~-". -,
SEe.
YES
NO
PSI
14
Date deluge or preaction valve tested
DELUGE &
PREACTION
V ALVES
-J NO
D NO
MAKE
MODEL
;-.1aXlnlUl11 tinle to
operate release
YES I
NO
15 See Control Valve Maintenance Table
Control Valves
City Control Valves
Bypass Valves
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves
Other Control Valves
Kitchen Control Valves
COl'TTROL VALVE MAINTENANCE TABLE
Number
t.3
Type Open
~~ J l-1~'~\t
Secured
{ h-
Signs
Explain
Abnormal
Condition
Closed
.-.,>
\:'\, "
i.
I
Co
,.;, -f
~!<"-$>d-
,~
16 Water Flow Test at Sprinkler Riser,
Water Supply Sourcek~ '\ .lv', i" ,,< c.v \
Last Water Flow Test
This Water Flow Test
City P.., .L,- L, ii"'.
c.t
Pump
Residual
(Flow)
Pressure
Tank
Date
Test Pipe
Location
Size of
Test Pipe
:to
..-~:: '~
Static
Pressure
{. .~~ {,7 ~;3
i:
-~
,
,
17 Explain any "No" answers and comments:
..I"
. '- ::J " L)'-'..
18 Adjustments or corrections made during this inspection:
19 Although these comments are not the result of an engineering review, the following desirable improvements are recommended:
U.\.{U.,....~ ('i
V~ . (j, -'.'-'
/ )
//
I .,/
t.........~
Signature:
(T\cv, 2/8/06)
Date:
~~ ~. t:;') c...,
-"/ ;
L "
Report of Inspection
Additional Comments
..~~
\ <..-'"..-' t..,,~_<) ~ "'~\ ~
f
f
,,;.)-(\ (
1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651) 558-3300 . (800)-229-6263
FAX: (651) 558-3310