HomeMy WebLinkAboutReport of Inspection 2/21/2011 V� K 1 N G St Paul, N4ii�nesota 55 L30
AUTOMATIC SPRINKLER CO. , (65] � ��8 •(800� 229
Setting The Standard... rax: (657) 558-3370
AGREtiMENT AND REPORT OF INSPECTION
SHEFT 1 of 2- Use separate shcet for eich building inspcded #INSPECTION �
MINNESOTA LICENSE NO. C005
REPORT TO �� y -�� � �_ ' BUILDING OR LOCATION � . �� �� ;.
STREET � �� , : INSPECTOR � �i i� j'�i"�T`r�^ � f�7 �
CITY & STAT� � DATE � z` r' r �� � j� I l
Customer hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or building, and
}�repare a written report of that inspection for an agrced upon fee. As part of this agreement, customcr agrees to the terms and conditions on rear of
form and will completc thc O�vncr's Scction of this doaimcnt. Vilcing Automatic Sprinklcr Company will not bc hcld liablc for incorrcd or unknown
answcrs provided in the Owncr's Section.
Owner's Section (To be answered by Owner, Occupant or Customer)
A. Explau� u�y occupancy hazard changes since the previous inspection t
B. Describe fire protection modifications made since last inspection:
G Describe any fires since last inspection:
D. When was the system piping last checked for stoppage, corrosion or forei},�i materi�l?
E. When was the dry-pip���g system last checked for proper pitd�?
F. Are dry valves adeyuately protected from freezing?
G. Does the s}'stem cont�in any low point dr�ins? ❑ Yes ❑ No If yes, please state how meny and the general location of e�ch:
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Customer's Signature j,- '�r� `- '° Title Date
Inspector's Section (All responses reference cuirent inspection) N/A = NOT APPLICABLE
1 Gencral
a. Is the Uuilding occupied? sYes ❑ No
b. Are all systems in service? n Yes n No
c. Docs thcrc appcar to bc a �niilimum of 18 in. (-�57 irun) dcarancc bct�vccn thc top oF thc storagc and thc sprinklcr dcflectors? u Ycs ❑ No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? ❑ Yes ❑ No e N/ A
2 Contro] Valves (Se� Itcm 15)
a. Do sprinkler system conh•ol vaives appear to be in the appropriate open or closed position? u Yes u No
b. Are control vah�es in the open position locked, sealed or equipped with a tamper switch? � Yes ❑ No
3 Water Supplies (Sre Ilurn 16)
a. Was a watcr flow test of main drain madc at thc sprinkler riscr(s)? �� Yes � No
4 Tanks, Pumps, Eire Department Conneitions
a. Do fire pumps, gravity tanks, reservoirs and pressure tanks appear in good condition and properly maintained? n Yes n No � N/ �\
b. Arc fire deparhnent connections in satisfactory condition, couplings free, caps in place, and check valves tight? u Yes u No u N/ A
Are they accessible and visible? ❑ Yes ❑ No ❑ N/A
5 Wet Systems
a. Are cold weather valves (O.S. & Y.) in the appropriate open or closed position? c Yes � No u N/A
b. F�ave antifreeze sVStem solutions been tested? ❑ Yes ❑ No ❑ N/A
c Were the antifreeze test results satisfactory? ❑ Yes n No n N/ A
d. In areas protected bV �vet systein(s), does the building appear to be properly heated in all areas, including blind attics and perimeter areas
where accessiUle? oYes ❑ No a N/A Do all exterior openings appear to be p�rotected against freezin;? ❑ Yes a No c N/A
6 Dry System (See Iteu�s 71 to 13)
a. Am dry val�es (s) in service? u Yes u No u N/A
b. Are tlieair pressw'es and priming water levels in accordance with the manufacture's insh�uctions? � Yes � No ❑ N/A
c Has the operation of the air or nitrogen supplies been tested? n Yes n Nu n N�A Are the}' ��� ser��ice? r Yes r No n N�A
d. Were all known low.�?oints drained during this inspection? ❑ Yes � No u N/ A
e. Did quick-opening devites,uperate satisfactorily? c Yes ❑ No ❑ N/A
f. Did the dry valve(s) appear to,h'ip properly during the trip pressure test? r Yes � No n N//1
�. Did thc hcating cquipincnt in thc dry-pipc valvc room(s) appcar to operatc at timc of inspection? � Ycs u No u N/A
7 Special Systems (S�•� IMni 1�)
a. Did�tTie deauge or pre-action valves operate properly dw'in}; testing? n Yes ��Io n N�A
b. Did the hcat-i'�spQnsivc dc� iccs operatc properly d�n�ing tcsting? u Ycs � No u N/A
c. Did supervisory devices operate during testing? ❑ Yes ❑ No ❑ N/A
8 /�larms
a. Did watcr motor(s) and gong(s) test satisfactorily? u Yes u No u N/A
b. Did electric alartn(s) test satisfactory? ciYes ❑ No � N/A
c Did supervisory alarm service test satisfactory? ryYes ❑ No n N/iA
9 Sprinklcrs
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? O Yes o No
U. Do visiUle sprinklers appear to be less than 50 years old? (Older sprinklers reyuire sample testing) �.Yes n No
c Do yuick response and residential sprinklcrs appear Icss than 20 ycars old? (Older sprinklers require sainplc testing) u�Ycs u No � i�]/f'.
d. Is stock of spare sprinklers available? �'Yes � No
e. Does the exterior condition of sprinkler system appear to be satisfacrory? n Yes n No
f. Do visiblc sprinklcrs appcar to be of proper tempciature ratin� for thcir locations? � Ycs � No
10 Explain any , �No" answers and comments:
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inspedo�'s Signature: ' n� ���„ i��-r� � � '� { ' �
i„s r.,«, r� z-i-io ' ...
301 York Ave
V � K � N �7 St. Paul, Minnesota 55130
AUTOMATIC SPRINKLER CO. (651� 558 •(800) 229
Setting T'ie Standard... Fax: (651) 558-3310
SHEET 2 of 2- Use separate sheet for eadl system inspected System No. or Description if multiple
systems
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Inspection Report ' �`�
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11 Date dry-pipe velve trip tested (control valve partially open) (See Trip Test Tnhle zohic}� follo�os)
12 Date dry-pipe valve h�ip tested (control valve fully open) (Sce TriV Tesf Tnble zullich follozo�)
13 Date quick-opening device tested (See Trip Test Tn �le �uliicli follo�us)
DRY v,al.vE TRIP TEST TABLE Q.O.D.
h1AKE I�fODEL SERIAL NO. h1AKE N10DEL SERIAL NO.
DRY PIPE Cimc to "Crip Watcr Air "Prip Point 'fimc Watcr Rcached Alarm Operatcd
OPERATING rhru Test Pipe Pressure Yressure air I'ressure Test Outlet Properly
TEST ti11N. S�C. PSI PSl PSI N11N. SEC. YES NO
WiN�out
Q.O.D
W ith
Q.O.D
14 Date deluge or preaction valve tested (See Trip Test Tnb1e zuhich follozus)
TRIP TEST TABLE
Operation ❑ PNEUh1ATIC ❑ ELECTRIC � HYDRAULIC
� NO Detectin>�7ediaSu �rvised � Z'�S �� NO
Piping Supervised �% Y�S b P'
DELUGE & Does valve operate from the manual tri}� and/or remote conh'ol stations
_. YES ❑ NO
PREACTION is there an accessiUle facility in each circuit for tes[ing e YES _ NO niethod of Testing Circuits
VALVES Does eaclt circuit operate Does each circuit hfaximwn ti�7�e to
MAKE MODEL supervision loss alann operate v�lve release oyerate rele�se
YES NO YES NO YES NO
15 See Control Valve Maintenance TaUle
CONTROL VALVE MAINTENANCE TABLE
Explain
Abnormal
Control Valves Number Type Open Secured Closed Signs Condition
Cit Control Valves r'`% i��� � ��
C ..' � , y+{` '
B }�dSS V1�vCS .. . . -
T�nk Control Valves
P�nn Control Valves
Sectional Control Valvcs
S stem Control Valves �! ' � ' �� �r � "- ''j ''
Other Control Valves d° ' f
Kitchen Control V�Ivrs
16 Water Flow Test at Sprinkler Riser
Water Su 1 Source: City ��= �� � Tank Pum �•�>
Residual
Test Pipe Size of Static (Flow)
Date Location Test Pi e Pressure Pressure
,
Last Water Flow Test � ' �
This Water Flow Test `� �� ��
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17 Expl�in any "No" answers and conunents:
18 Adjustments or corrections made dwinb t tis inspection: "
19 Alt zoug 1 t Ze comments are not t�e resuit o an engineering review, p ease see t 1e attac Ze� Non-Inspection Re ate� De iciencies
form for additional items fot���j �juring the course of the inspection (only attadled if applicable).
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Inspector'sSignahire � � �� � � � �` � � ; f � �i��� ' �ti i �� Date:�(��� � �
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InspecHon Porm P2 2-1-10 .
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