HomeMy WebLinkAboutReport of Inspection 12/21/2009
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_____ AII1DMATIC SPlUNI<l.ER CO.
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Fax: (651) 558-3310
SHEET 1 of 2 - Use separate sheet for each building inspected
MINNEdOTA LICEN~~P. ~005 ~ -1/ _ .un
REPORT TO jL{.,(;i/'v1.i..A.,./ 'f'"' /.M} v~ BUILDING OR LOCATION -; !""",
STREET -~ ('A- :.6, s. Ii INSPECTOR v:<LA.,r ') ()"J- j 1
CITY & STATE M .I,.r? !.1 j{~ ii/V"'\.. 72. DATE -- /"1. 2..... - O/~
Customer hires Vikit.~ Automatic'Sprinkler Com;any 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, customer agrees to terms and conditions on rear of form
and will complete the Owner's Section of this document. Viking Automatic Sprinkler Company will not be held liable for incorrect or own
answers provided in the Owner's Section.
Owner's Section (To be answered by Owner, Occupant or Customer)
A. Explain any occupancy hazard changes since the previous inspection:
AGREEMENT AND REPORT OF INSPECTION
#INSPECTION
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B. Describe fire protection modifications made since last inspection:
C: Describe any fires since last inspection:
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?
G. Does the system contain any low oint drains? 0 Yes 0 No If yes, please state how many and the general location of each:
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Inspector's Section (All responses referense curyent inspection)
1 General ./ ' --~
a. Is the building occupied? res 0 No
b. Are all systems in service? ~ 0 No ./
c. Does there appear to be a minimum of 18 in. (457 mm) clearance between the top of the stora~d the sprinkler deflectors? ~es 0 No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? 0 Yes 0 No 9>f7 A
2 Control Valves (See Item 15) ./"'"
a. Do sprinkler system control valves appear to be in the appropriate open or closed position? ~~ 0 No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch? ~s 0 No
3 Water Supplies (See Item 16) .' ./
a. Was a water flow test of main drain made at the sprinkler riser(s)? ~ 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 r!f1'If'(X
b. Are fire department connectio~ in.~actory condition, couplings free, caps in place, and check valves tight? ~s 0 No 0 N/ A
Are they accessible and visible~es 0 No 0 N/ A
5 Wet Systems . .
a. Are cold weather valves (O.S. & Y.) in the appropriate open or clo~ position? 0 Yes 0 No ~
b. Have antifreeze system solutions been tested? 0 Yes 0 No <'l""Kf/ A
c. Were the antifreeze test results satisfactory? 0 Yes 0 No fJ'N1 A
d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including blind '!!tics and perimeter areas
where accessible? ~ 0 No 0 N/ A Do all exterior openings appear to be protected against freezing? ~s 0 No 0 N/ A
6 Dry System (See Items 11 to 13)
a. Are dry valves (s) in service? 0 Yes 0 No 0 N/ A
b. Are the air pressures and priminmW ter levels in accordance wi the manufacture's instructions? 0 Yes 0 No 0 N/ A
c. Has the operation of the air or n' 0 supylies been test . 0 Yes 0 No 0 N/ A Are they in service? 0 Yes 0 No 0 N/ A
d. Were all know low pOints~' ~d 4 . this ins . n? 0 Yes 0 No 0 N/ A
e. Did quick-opening devices b evat Isfactor'. 0 Yes 0 No 0 N/ A
f. Did the dry valve(s) trip p fly u e trip pressure test? 0 Yes 0 No 0 N/ A
g. Did the heating equipmen in e ipe valve room(s) operate at time of inspection? 0 Yes 0 No 0 N/ A
7 Special Systems (See Item 14)
a. Did the deluge or pre-ac' valves operate properly during testing? 0 Yes 0 No 0 N/ A
b. Did the heat-respo ' devices operate properly during testing? 0 Yes 0 No 0 N/ A
c. Did superviso evices operate during testing? 0 Yes 0 No 0 N/ A
8 Alarms
a. Did'water motor(s) and gong(s) test satisfjllltorily? 0 Yes 0 No ~ A
b. Did electric alarm(s) test satisfactory? ~es 0 No? N/ A
c. Did supervisory alarm service test satisfactory? lYfes 0 No 0 N/ A
9 Sprinklers ._
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge?~s 0 No /!) t?, Jd , LJXJ-l
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing)res 0 No I "1
c. Are quick response and residential spr~s less than 20 years old? (Older sprinklers require sample testing) ;;Y'/es ~o 0 N/ A
d. Is stock of spare sprinklers available? Ji"""es 0 No ~
e. Does the exterior condition of'sprinkler system appear to be satisfactory~ Yes 0 No c
f. Do visible sprinklers appear to be of proper temperature ratingfor their locations~ 0 No
10 Explain any "No~' ~~ers and comments: . ,
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Date
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N/A = NOT APPLICABLE
Si~ture:
{Rev. 9/02/09)
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SHEET 2 of 2- Use separate sheet for each system inspe~d ~
Inspecti9!l R~~N) r::l./' I S i/;.fw ,L 1j,(/y'1;L/'V2.)
No.1 L-J uu.. 1. <M, T
11 Date dry-pipe valve trip tested (control valve partially open)
12 Date dry-pipe valve trip tested (control valve fully open)
13 Date quick-opening device tested
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(651) 558-3300 . (800) 229-6263
Fax: (651) 558-3310
(See Trip Test Table which follows)
(See Trip Test Table which follows)
(See Trip Test Table which follows)
'"
DRY VALVE ! \ . TRIP TEST TABLE O.O.D.
MAKE MODEL j S~IAL NO. MApr" MODEL SERIAL NO.
1'\ V \ /'
Time to Trip wa~ I I Air /' Trip Point Time Water Reached Alarm Operated
Thru Test Pipe Press \ 1\\ Pressure / Air Pressure Test Outlet Properly
MIN. SEe. 1'$] \ \ PSV PS] MIN. SEe. YES NO
Without ; \J /
Q.O.D ,
With /
Q.O.D
e or preaction valve tested / (See Trip Test Table which follows)
/ TRIP TEST TABLE
Operation o PNEUMATlC/ o ELECTRIC o HYDRAULIC
Piping Supervised o J'ES o NO Detecting Media Supervised DYES o NO
Does valve operate from the gt.lnual trip and/ or remote control stations DYES o NO
Is there an accessible facilil;(in each circuit for testing DYES o NO IMethod of Testing Circuits
~'-''''' / Does each circuit operate Does each circuit Maximum time to
MAKE MODEL supervision loss alarm operate valve release operate release
YES I NO YES NO YES NO
I
DRY PIPE
OPERATING
"'TEST
14 Date delug
DELUGE &
PREACTION
VAL YES
15 See Control Valve Maintenance Table
CONTROL VALVE MAINTENANCE TABLE
Explain
/Apnormal
.. ondition
Control Valves
Control Valves
B ass Valves
Tank Control Valves
um Control Valves
SQGSSPlll.l Control Valves
S stem Control Valves
Other Control Valves
Kitchen Control Valves
16 Water Flow Test at Sprinkler Riser
Water Su I Source:
Ci
Tank
Pum
Residual
(Flow)
-.,P essure
Test Pipe
Location
Size of
Test Pi e
Static
Last Water Flow Test
This Water Flow Test
17 Explain any "No" answers and comments:
18 Adjustments or corrections made during this inspection:
19 Althoughthese comments are not the result of an engineering review, the following desirable improvements are recommended:
Signature:
Date:
(Rev. 2/26/(9)