HomeMy WebLinkAboutReport of Inspection
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AUTOMAnc SPRINKLER CO.
Setting The Standard...
St. Paul, Minnesota 55117
(651) 558-3300 . (800) 229-6263
Fax: (651) 558-3310
SHEET 1 012 - Use separale sheet for each building inspecled
MINNESOTA LICENSE NO. COOS
AGREEMENT AND REPORT OF INSPECTION
#INSPECTION
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REPORT TO
STREET
CITY & STATE
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BUILDING OR LOCATION
INSPECTOR
DATE
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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:
B. Describe fire protection modifications made since last inspection:
C Describe any fires since last inspection:
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D. When was the system piping last checked for stoppage, corrosion or foreign materia!?
E. When was the dry-piping system last checked for proper pitch? '.-
1'. Are dry valves adequately protected from freezing?
Signature
Title
Date
Inspector's Section (All responses reference current inspection) N/A = NOT APPLICABLE
1 General
a_ Is the building occupied? l{Yes 0 No
h Are all systems in service? dYes 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? Ifill Yes No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? 0 Yes 0 No ...rN/ A
2 Control Valves (See Item 15)
a. Do sprinkler system control valves appear to be in the appropriate open or closed position? .dYes 0 No
h Are control valves in the open position locked, sealed or equipped with a tamper switch? Od"Yes 0 No
3 Water Supplies (See Item 16) ~-'---'~-
a. Was a water flow test of main drain made at the sprinkler riser(s)? ;t(Yes 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 p''N/ A
b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight? )iff'Yes 0 No u Nj A
Are they accessible and visible? .)'l'Yes 0 No 0 N/ A
5 Wet Systems
a. Are cold weather valves (0.5. & Y.) in the appropriate open or closed position? 0 Yes 0 No ~N/ A
b. Have antifreeze system solutions been tested? 0 Yes 0 No'l'f'N/ A
c. Were the antifreeze test results satisfactory? [) Yes 0 No t"fNj 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? .J!i'Yes 0 No 0 N/ A Do all exterior openings appear to be protected against freezing? ,.,dYes [J No 0 N/ A
6 DIY System (See Items 11 to 13)
'ii'''-.4.re dry valves (s) in service? eYes 0 No 0 N/ A
b. AI:e~ir pressures and priming water levels in accordance with the manufacture's instructions? 0 Yes 0 No 0 N/ A
c. Has the ~tion of the air or nitrogen supplies been tested? 0 Yes 0 No 0 N/ A Are they in service? 0 Yes 0 No 0 N/ A
d. Were all know"'~oints drained during tllis inspection? 0 Yes 0 No 0 N/ A
e. Did quick-opening d~(;:es operate satisfactorily? 0 Yes 0 No 0 N/ A
f. Did the dry valve(s) h'ip properly during the trip pressure test? 0 Yes 0 No 0 N/ A
g. Did the heating equipment in the dry-pipe valve room(s) operate at time of inspection? 0 Yes 0 No 0 N/ A
7 '-Sp~ial Systems (See Item 14)
a. ~e deluge or pre-action valves operate properly during testing? 0 Yes 0 No 0 N/ A
b. Did th~onsive devices operate properly during testing? 0 Yes 0 No 0 N/ A
c. Did supervisory ~vices operate during testing? 0 Yes 0 No 0 N/ A
8 Alamls
a. Did water motor(s) and gong(s) test satisfactorily? 0 Yes 0 No p1<J/ A
b. Did electric alarm(s) test satisfactory? J'f"Yes 0 No 0 N/ A
c. Did supervisory alarm service test satisfactory? ,Ff'Yes 0 No 0 N/ A
9 Sprinklers
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? 0 Yes .I'f'No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) /J- Yes 0 No
c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing)_..l'iYes 0 No 0 Nj A
d. Is stock of spare sprinklers available? p Yes 0 No
e_ Does the exterior condition of sprinkler system appear to be satisfactory? (;INes 0 No
f. Do visible sprinklers appear to be of proper temperature rating for their locations? ,..I,rYes 0 No
10 Explain any "No" answers and comments:
Signature:
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Date:
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AUTOMATIC SPRINKLER CO.
Setting The Standard...
1301 L'Orient Sh'eet
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_ ?i $ S"\~I
11
12
13
Time to Trip
Thru Test Pipe
'-'-..l4,pDEL
----......
Water ---.."",,-- Air
Pressure P~!lW.r.\L
(See Trip Test Table which follows)
(See Trip Test Table which follows)
(See Trip Test Table which follows)
TRIP TEST TABLE Q_O.D.
SERIAL NO. MAKE MODEL
SERIAL NO_
Date dry-pipe valve h'ip tested (control valve partially open)
Date dIy-pipe valve trip tested (control valve fully open)
Date guick-(jp~:UJ:1g device tested
........,"-..
DRY VAt:'\o'E........_.,
MAKE
DRY PIPE
OPERATING
TEST
Trip Point
Air Pressure
Time Water Reached
Test Outlet
Alarm Operated
Properly
MIN.
SEe.
PSI
PSI
-........,
PSI
'".
......."
MIN.
SEe.
YES
NO
Without
Q.O_D
With
QDD
'...
14
Date deluge or preaction valve tested
DELUGE &
PREACTION
V ALVES
-:J NO
'J NO
MAKE
fv1aXlnlUlll tinl€ to
operate releasc'
........._____YES
YES I
NO
15 See Control Valve Maintenance Table
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CONTROL VALVE MAINTENANCE TABLE
'Y' "
Secured
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Closed
Signs
Explain
Abnormal
Condition
Control Valves
Citv Control Valves
Bypass Valves
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves
Other Control Valves
Kitchen Control Valves
16 Water Flow Tes;jat,rFrinkler Rts~r f<;\ r-.
WaterSupplySoUrCE:.h< 'f\!'u".~u-!)L City py^io/ i.v.~.k-,
Number
Type Open
L\ ,-....
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,
Tank (/>
Date
Test Pipe
Location
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Ili'~'-'"
,
Size of
Test Pipe
Sta tic
Pressure
Pump (15
Residual
(Flow)
Pressure
Last Water Flow Test
This Water Flow Test
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17 Explain any "No" answers and comments:
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:
Signature: \0"",t/
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Date:
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(Rev. 2/8/06)
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AUTOMATIC SPRINKLER CO.
1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651) 558-3300 . (800)-229-6263
FAX: (651) 558-3310
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Report of Inspection
Additional Comments
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