HomeMy WebLinkAboutSprinkler Insp. - May 2009
LID #: 3150135
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Ahern Fire Protection
13705 26th Avenue, Suite 110
1\finneapolis, MN 55441
(763) 268-0515 P . (763) 268-0516 f
www.ahernfire.com · Since 1880
Annual Sprinkler
System Inspection
Report
Work Order #:
851835
For MonthlYear:
May 2009
Invoice:
COURTWOOD VILLAGE
Street:
17092 ADELMAN ST SE
City: PRIOR LAKE
Dept.:
City: Prior Lake State: MN Zip: 55372
Phone #: (763) 286-4904
State: MN Zip: 55372-
Location: Courtwood Village Condos
Street:
Phone #:
Date:
17092 Ade]man Street SE
(763) 286-4904
Fax #: (952) 5]3-20]0
Foreman: Jesse Olmanson
Signature:
Wet
Dry
Preaction
De]uge
Stand Pipe/Hose
Contacts: Michael Lind
Invoice/Deticiency
Ron Fitch
On Site
Foam
A]arms
Detectors
Hydrants
FireDoors
FirePumps
Va]veTT
Suppression
Anti_Freeze
Water Spray
BF RP
BFDC
BF Generic
BF Lincoln
BF Omaha
Internal Sprinkler
Direct: (952) 226-] 709 Ext:
Cell/Pager:
Direct: (763) 286-4904 Ext:
Cell/Pager:
B]ake Rothnem
Invoice/Deficiency
Direct: (952) 226-1709 Ext:
Cell/Pager: (612) 328-78]5
ALARM DEVICES TESTS
]. Did waterflow or pressure switches operate satisfactorily?
2. Did tamper switches operate satisfactorily?
3. Did water motor alarm gongs or electric bells operate satisfactorily?
4. Did alarm service or central station operate satisfactorily and receive proper signals?
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IALARM SIGNALS
System # D/
Test Times /" ,r{
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5 YEAR INSPECTION
y
]. Was the 5 year Inspection performed on the following items?
A. Alarm valves
B. Check valves
C. Gauges
D. Internal Examination of Piping
Date due:
15- YEAR TESTING
I. Was the 5 year testing performed on the following items?
A. Sprinkler heads in corrosive environments or rated 325" F or higher.
B. Standard sprinklers in service for 75+ years.
y N N/A
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Date Due:
Date Due:
y N N/A
Date Due: '\.
Date Due:
Date Due:
110-YEAR TESTING
I. Was the ] 0 year testing performed on the following items?
A. Standard sprinklers in service for 50+ years.
B. Quick response sprinklers in service for 20+ years.
C. Dry pendant sprinklers.
This document PROPERTY OF AHERN FIRE PROTECTION. Copyright 2005 JF Ahern Co. REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT
rptlnspection _Annual
LID #:""3150135
ICONTROL VALVE SERVICE
I. Were the following service items performed on all control valves?
A. Fully opened and closed?
B. Valve packing checked?
C. Valve stem lubricated?
D. Is the valve properly secured and locked in it's normal operating position?
Page 2 of 3
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Y N N/A
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BACKFLOW PREVENTOR TEST
I. Did the backflow preventor(s) pass the test of back flow and forward flow capabilities?
Y N
ANTI-FREEZE TEST
Y N
I. Has the anti-freeze solution for each system below been tested by measuring specific gravity?
IHANGERS AND SEISMIC BRACING
I. Did hangers and seismic bracing appear to be in good condition, firmly attached, and free from corrosion, from a visual inspection
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performed from floor level? .,'
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Y N N/A
PIPING
I. Was the exterior of exposed sprinkler piping in good condition, not subjected to external loads. free of mechanical damage?
NOTE: Piping located in concealed spaces, such as above a drop ceiling. are not required to be inspected.
IFIRE DEPARTMENT CONNECTIONS
I. Are fire department connections visible and in good condition?
2. Are caps and plugs in place?
3. Are automatic drain valves operating properly?
4. Do hose connections operate freely?
Y N N/A
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HOSE RACKS PRESENT?
Yes
No
CONDITION:
Good
Fair
Bad
MAIN DRAIN TEST
System Number
Static Pressure
Residual Pressure
Size of drain
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l i 7"
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I. Were all main drains tested at full flow?
If no. explain:
2. Were test results similar to the last test?
Ifno. explain:
3. Was there any discharge of obstructive material, heavy discoloration of water. or plugging of the inspector's test connection?
GENERAL INFORMATION
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Y N N/A I
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I. Are all the spiinkler systems in service?
2. Is the building completely sprinklered?
3. Are all sprinklers in good condition?
4. Are all sprinklers free of obstruction?
5. Are spare sprinklers and wrenches available?
6. In spray coating area. are sprinklers free from accumulation?
7. Is hydraulic nameplate and information sign securely in place and legible?
8. Is emergency service contact information readily available?
9. Are alarm devices provided and in good condition?
10. Are all standard sprinklers dated 1920 or later?
IOWNER QUESTIONS
I. Any changes in sprinkler system since last inspection?
2. Any fires since last inspection?
This document PROPERTY OF AHERN FIRE PROTECTION Copyright 2005 JF. Ahern Co REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT
rptlnspection _ Annual
Do if '3150135
A. Number of sprinkler heads that operated.
B. How long was system out of service?
C. Area where fire occured.
3. Are all areas of the building properly heated to prevent freezing where wet pipe systems exist?
4. Do you have an outside alarm service?
If yes. name and phone number.
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Owner/Representative's Signature:
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Date
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New Deficiencies found during this inspection? I Yes' No
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Customer receive copy of New Deficiency Report? Yes\No
A previous inspection for your facility revealed the following deficiency in your Fire Protection System:
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Quote:
Quantity:
Def Date: 5/21/2008
Def#: 3150596
System #
( Ii Painted head on 2nd floor elevator lobby, also missing white plate
IF THIS DEFICIENCY HAS BEEN REPAIRED. PLEASE FILL IN DATE OF REPAIR: FOREMAN'S INITIALS:
AHERN FIRE PROTECTION will perform this repair per your verbal or written approval. Should you elect to proceed with this work, please call or sign and
fax or mail a copy of this page. We will call to set up an appointment. Thank you.
ACCEPTED BY:
DATE:
A previous inspection for your facility revealed the following deficiency in your Fire Protection System:
Def Date: 5/21/2008
Def#: 3150597
System #
Quote:
Quantity:
Tape and paper covering line piping and heads right outside elevator lobby in garage level <. rt . c
IF THIS DEFICIENCY HAS BEEN REPAIRED. PLEASE FILL IN DATE OF REPAIR: FOREMAN'S INITIALS -..,.- r'
AHERN FIRE PROTECTION will perform this repair per your verbal or written approval. Should you elect to proceed with this work. please call of sign and
fax or mail a copy of this page. We will call to set up an appointment. Thank you.
ACCEPTED BY:
DATE:
A previous inspection for your facility revealed the following deficiency in your Fire Protection System:
Def Date: 5/21/2008
Def#: 3150598
System #
Quote:
Quantity:
No inspectors port to test water flow for standpipe feed. Had to test manually this year. Could not simulate waterflow.
IF THIS DEFICIENCY HAS BEEN REPAIRED. PLEASE FILL IN DATE OF REPAIR: FOREMAN'S INITIALS:
AHERN FIRE PROTECTION will perform this repair per your verbal or written approval. Should you elect to proceed with this work. please call or sign and
fax or mail a copy of this page. We will call to set up an appointment. Thank you.
ACCEPTED BY: DATE:
A previous inspection for your facility revealed the following deficiency in your Fire Protection System:
Def Date: 5/21/2008
Def # 31505~?__
System # r- _----___ Quote:
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Quantity:
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Need to add I head in each stairwell on garage level to cover under stairs. On same level standpipe hose connections point
clirectiYmto a wall making It dJthculfro-ll~ok liji~e-turned and adjusted so fire department can attach
IF THIS DEFICIENCY HAS BEEN REPAIRED. PLEASE FILL IN DATE OF REPAIR: FOREMAN'S INITIALS:
AHERN FIRE PROTECTION will perform this repair per your verbal or written approval. Should you elect to proceed with this work. please call or sign and
fax or mail a copy of this page. We will call to set up an appointment. Thank you.
ACCEPTED BY:
DATE:
INOTES
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SERVICES PERFORMED:
Alarm Test
Drain Test
Flow Test
Walk Through f Annual Inspection
REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT
Other
This document PROPERTY OF AHERN FIRE PROTECTION. Copyright 2005 JF Ahern Co
rptlnspection _Annual