HomeMy WebLinkAboutReport of Inspection 2/21/2011 SV1 YO7'KHVC'
V��� �� St. Paul, Miiu�esota 55130
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Setting The Standard... �ax: (651) 558-3310
AGREEMENT AND REPORT OF INSPECTION
SHEET! of 2 Usc separatc shect for cach buifdinl; inspeded #INSPECTION � �. .
MINNESOTA LICENSE NO. C0
REPORT TO BUILDING OR LOCATION ;� i
STREET � � � INSPECTOR ��;_� ;�' �� ? � � { �
GTY & STATE ( i' � � DATE r; �� �, � � (�� ' � ? { �� 1 I
Customcr hires Viking Automatic Sprinklcr Company to conduct an inspcction of thc fire suppressio�� systcm at thc above location or building, and
prepare a written report of that inspection for an agreed upun fee. As part of this agreement, customer agrees to the tenns and conditions on rear of
form and will complete the O�vner's Section of this document. Viking Automalic Sprinkler Companl' ��'ill not be held Iiable for incormct or unknown
ans�vers provided in the Owncr's Section.
Owner's Section (To be answered by Owner, Occupant or Customer)
A. Explain any occupancy hazard chanhes since the previous inspection: �' ;�� i�.'
B. Describe fire protection moditicaiions made since last inspeition: �). �,� �
G DescriUe any fires since last inspection:
D. When was the system piping last checked for stoppage, mrrosion or forei�,ni material? ,� i,_:
E. When was the dry-piping system last checked for proper pitch? ; i ;�%
F. Are diy valves adequately protected from Ereezing? r
G. Does the system contain any low point drains? c Yes � No If y�es, p�ease state how many and d1e general location of each:
Custoiner's Signature `t .�' "j � " � � � � � � ��r � Title Date
Inspector's Section (All responses reference current inspection) N/A = NOT APPLICABLE
1 Gcncral
a. Is the Uuilding occupied? � Yes c No
b. nre all systeins in service? ryYes � No
c. Does there appear to Ue a minimum of 18 in. (-�57 mm) dearance behveen the top of the storage and the sprinkler deflectors? ❑ Yes u No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? ❑ Yes ❑ No o N/ A
2 Control Valves (S Itern 15)
a. Do sprinkler system control valves appear to be in the appropriate open or closed position? u Yes u No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch? ❑ Yes ❑ No
3 Water Supplies (Sce Item 16)
a. Was a watcr Flow test of main drain madc at thc sprinklcr riscr(s)? c Ycs u No
4 Tanks, Pumps, Fire Deparhnent Connections
a. Do fire pumps, gravity tanlcs, reservoirs and pressure tanks appear in good condition and properly maintained? ❑ Yes n No n N/ /�
b. Are fire department connections in satisfactory condition, couplings free, �aps in place, and check valves tight? �'Yes u No u N/A
Are they accessible and visiUle? ❑ Yes ❑ No ❑ N/A
5 Wet Systems
a. Arc cold wcathcr valves (O.S. & Y.) in thc ippropriatc opai or closcd position? u Ycs � No u N/A
b. 11ave antifreeze system solutions Ueen tested? ❑ Yes o No ❑ N/A
c Were the antifreeze test results satisfactory? n Yes n No n N//1
d. In areas protected by wet system(s), docs the building appear to be properly healed in all areas, including blind attics and perimeter areas
where accessiUle? oYes ❑ No � N/A Do all exterior openings appear to be protected against freezing? ❑ Yes ❑ No ❑ N/A
6 Dry System (Sce It��rzs 11 to ]3)
a. Are dry valves (s) in scrvice? u Yes u No u N/A
b. Are the air pressures and priming water levels in accordance with the roanufacture's instructions? c Yes � No ❑ N�A
c. Has lhe uperation of the air or iutro�en supplies been tested? n Yes n No n N/A �Are they in service? r Yes r No n N/n
d. Wcrc all known lo�v poia)ts drained during this inspcction? u Ycs � No u N/A
e. Did quick-opening devices bperate satisfactoril}'? � Y�s � No ❑ N/A
E Did the dry valve(s) appear to h't�proper]y durin}; the h'ip presstn'e test? r Yes � No n N�A
,;. Did thc hcating cyuipment in thc dry-p�e valvc room(s) appcar to oper�tc at timc of inspcction? � Ycs u No u N/A
7 Special Sqstems (See lie�n l�)
a. Did the deluge or pre-action valves operate properly during testim�? r Yes n No n N/n
b. Did the hcat-responsive dc�ices opciatc properly during tcsting7 � Ycs �� No u N�A
c. Did supervisory devices operate dw'ing testing? � Yes ❑ No ❑ N/A
8 iVanns
a. Did watcr motor(s) and gong(s) test satisfactorily? o Ycs � No u N/A
b. Did electric �larm(s) test satisfactory? ❑ Yes ❑ No � N/A
e Did supervisory alarm service test satisfactory? n Yes n No n N/n
9 S}
a. Do visible sprinklers appear to be free brom corrosion, loading or obstruction to spray disch irge? o Yes o No
b. Do visiUle sprinklers appear to be less than 50 years old? (Older sprinklers reyuire sample testing) rfYes n No
c. Do yuick response and residential sprinkiers appear Iess than 20 years old? (Older sprinklers require sample tesHng) �i Yes u No ��1�A
d. Is stock of spare sprinklers available? c-Yes � No
e. Does the exterior condition of sprinkler system appear to be satisfactory? n Yes n No
f. Do visiblc sprinkicrs appcar to be of piroper tcmper�tin�c rating for thcir locations?, C Ycs � No
10 Explain any "No" answers and comments:
a � � 1 � t � , �
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inspector's Signature: � �: ��' -�� < '� �,� �� � } � ' .i{__( i � � �� Date: � :, t�`:fJtJ� i ,� �(�" ,� �i � � �
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I�is��e�li. I I'I'_-I-10 .
v , �, N G 301 York Ave
AUTOMATIC SPRINKLER CO.
St. Paul, Minnesota 55130
Setting The Standard... (651) 558-3300 •(800) 229-6263
Fax: (651) 558-3310
SHEET 2 of 2- Usc separate sheet for each system inspected Systein No. or Description if multiple
systems /f_ :: �
[iispection Report
No. .'
ll Date dry-pipe valve trip tested (control valve partially open) (Se� Trip Test Toble �nhicli follozt�s)
12 Date dry-pipe valve h�ip tested (control valve fully open) (See Trip Test TnHle �ohich follozns)
13 Date quick-opening device tested (Sc�e Trip Test Tn le tuliicli follo�vs)
DrzY v.al.Vl: TRIP TEST TABLE Q.O.D.
h1AKE I�TODEL SERIAL NO. NIAKE titODEL SERiAL NO.
DRY PIPE I'ime to "frip Water Air "1'rip Point 'I'ime Water Rcached Alarm Operated
OPERATiNG Tlu u Test Pipe Pressure Nressme �ir Pressure Test Outlet Properly
TEST N11N. SEC. PSI PSl PSI ��i1N. SEC. YES NO
�Vithout �-
Q.O.D
1Nith
Q.O.D
14 Date deluge or pre�ction valve tested (See Trip Test Tnhle which follozns)
TRIP TEST TABLE
Operation � PNEUhiATIC = ELECTRIC = HYDRAULIC
Piping Superviscd YES NO Dctecting Media Supervised YES ; NO
DELUGE & Does valve operate h�om the manual triy and/or remote conhol sGitions c YES o NO
PREACTION Is there an accessible facility in each circuit for testing - YES - NO Method of Testing Circui[s
VALVES Does each iircuit operate Does each circuit hfaximum time to
MAKE MODEL supervision loss alarnt operate valve release operate release
YES NO YES NO YES NO
15 See Conh Valve Maintenance TaUle
CONTROL VALVE MAINTENANCE TABLE
Explain
Abnormal
Control Valves Number Type Open Secured Closed Signs Condition
Cit Control Valves
B pass Valves
Tank Conh�ol Valves
Pnm Control Valves
Scctional Control Valves
S stem Control Valves � rf ' � j - � ; ) F � �
Other Control Valves
Kitchen Conh Valves ` ' „t, �<
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 � -� '� - t; ..�1
17 Explain any "No° answers and comments:
18 A justments or corrections made uring t�is inspection: r_ ,,;.) � l,��,,- _
r , y : � y, � � �. y,.
19 A t Zoug 1 t 1e cominents are not t 1e result o an engineering review, p ease see t 1e attac ec Non-Inspection Re ate� De iciencies
forin for additional itetns found durn�g the course of the inspection (only attached if applicaUle).
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Inspector'sSignahu�e: ��-� �� C;� �_���; � ��� � � �:! Date: (c��Ll.i',� �_.;,_:.�� `� �
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[nspection Porm P3 2-1-10 � �'
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