HomeMy WebLinkAboutAnnual Sprinkler System Inspection Report - 3/11 LID #: 3150625 � „ Page 1 of 3
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Ahern Fire Protection 'I AnnUal S Y'IIl�EI'
13705 26rh Avenue, Suite 110 � Wark Order #:
iVlinneapolis, MN 55441 System Inspection g 53880
(763) 268-0515 p•(763) 268-0516 f For Month/Year:
���� ww�v.ahernfire.com • Since 1880 I Rep�rt March 2011
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Invoice: iSOUTH OF THE RIVER CONDO INVESTORS IPhone #: ,(952) 898-5760
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IStreet: i 12280 NICOLLET AVE #103 City: BURNSVILLE State: MN Zip: 55337-1998
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i Location: Courtwood Village Dept.: �
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�Street: 17092 Adelman Street SE City: Prior Lake State: MN Zip: 55372
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Phone #: (952) 898-5760 Faac #: �(952) 4(b5-7101 ,��J _. . �� Foreman: Chris Moe
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Date: '.� �"� , F � Signature. •} �„-�-� _, �� � «�`'t
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Wet 1 Foam ' FireDoors S uppr �sse on I RP
�- - -� r --- - . . _
Dry 1 Alazms �FirePumps Anti Freeze i IBF DC
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Preaction Detectors �Va1veTT 1 Wa Spray BF Ge neric _
Deluge Hydrants !BF Lincoln
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,Stand Pipe/Hose ; Internal Sprinkler iBF Omah '
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Contacts: Joe Lehrer Direct: (952) 898-5760 Ext:
Invoice/Deficiency Cell/Pager:
ALARM DEVICES TESTS Y N N/A
1. Did watertlow or pressure switches operate satisfactorily? �', ''�
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2. Did tamper switches operate satisfactorily? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ '�
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3. Did water motor alazm gongs or electric bells operate satisfactorily? �
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4. Did alarm service or central station operate satisfactorily and receive proper signals?
ALARM SIGNALS
System # t�..- ' �_
Test Times ^ �.. .....,,.. _ '
5 YEAR INSPECTION Y N N/A
1. Was the 5 yeaz Inspection performed on the following items? --_-_---__---------_--_---------------_ -----------_ ------------ �� '�
A. Alarm valves
B. Check valves
C . Gauges _. _
D.InternalExaminadonofPiping Datedue: ----------------------------------------------[ ,�' '_
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5-YEAR TESTING Y N N/A
1. Was the 5 year testing performed on the following items? _ --- --- -- -[� _
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A. Sprinkler heads in corrosive environments or rated 325 ° F or higher. Date Due: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ �.
B. Standazd s rinklers in serv�ce for 75+ ears. Date Due: . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ', � - -
p � Y ---- J I-I --
10-YEAR TESTING Y N N/A
1. W A as Stand d prinkles mse►vicefor O+ye�ingitems? -------- -- -. DateDue: ----------- ----------------------------------- I I J'
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B. Quick response sprmklers in serv�ce for 20+ years. Date Due: u, :
C. Drypendantsprinklers. DateDue: ------------------ ---------------------' �
. This document PROPERTY OF AHERN FIItE PROTECTION. Copyrtght 2005 7.F. Ahem Co. REPRODUCTTONS IN ANY FORM VIOLATES COPYRIGHT. rptlnspection_Mnual
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LID #: 3150625 �., „ Page 2 of 3
CONTROL VALVE SERVICE Y N N/A
1. Were the following service items performed on all control valves? �
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A. Fully opened and closed? ,�{' '
B. Valve packing checked? �
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C. Valve stem lubricated? _'�' ��
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D. Is the valve properly secured and locked in it's normal operating position?
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BACKFLOW PREVENTOR TEST Y N N/A
l. Did the backflow preventor(s) pass the test of backflow and forward flow capabilities? ' ', ?'�
ANTI-FREEZE TEST Y N N/A
1. Has the anti-freeze solution for each system below been tested by measuring specific gravity? I` �('
HANGERS AND SEISMIC BRACING Y N N/A
1. Did hangers and seismic bracing appear to be in good condition, firmly attached, and free from corrosion, from a visual inspection
performed from floor level? i' ' '
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PIPING Y N N/A
1. Was the exterior of exposed sprinkler piping in good condition, not subjected to externalloads, free of inechanical damage? i � '
� '. - ' . �,.aae..aot �¢qt�iredtab�.in�pecterL . _
FIRE DEPARTMENT CONNECTIONS Y N N/A
1. Are fire department connections visible and in good condition? _.._.__ '� J u
2. Are caps and plugs in place? '
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3. Are automatic drain valves operating properly? .
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4. Do hose connections operate freely? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^' ' '
HOSE RACI{S PRESENT? O Yes �� No �CONDITION: O Good O Fair ��J Bad � Y N N/A
MAIN DRAIN T T
System Number ' _ '
Static Pressure ' _.-_..- _ '
Residual Pressure � ' '
Size of drain / �
1. Were all main dra ns tested at full flow? �� '_—', ;
If no, explain:
2. Were test results similaz to the last test? ---------- - -- -°- ---------- - ---- - ----- - ---- I _ i ��
If no, explain: �
3. Was there any dischazge of obstructive material, heavy discoloration of water, or plugging of the inspector's test connection? _____;�, , !,�
GENERAL INFORMATION ' ' Y N1A
,� 1. Are all the sprinkler systems m service� ___ '�' __
- -- - - - - - - � --'-- -.�;--.,� �..,...�..,,.:.;...P �. ,��,p - _..._.., .,�. _,._.....,.,,,, �-.:a...,�.0 3i
� .w ,...�. _ __ .,.... ., . .: .. _ _ � � � � _«.--�- �
2. Is the building completely sprinklered? ' �� __
3. Are all sprinklers in good condition?
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4. Are all sprinklers free of obstruction? '_ ';
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5. Are spare sprinklers and wrenches available? ❑,_
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6. In spray coating area, are sprinklers free from accumulation? �_�
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7. Ishydraulicnameplateandinformationsignsecurelyinplaceandlegible? _________________________________________-----------_---__--_--- �! ', , ',
8. Is emergency service contact information readily available? ---- - '� J
9. Are alarm devices provided and in good condition? '� u
10. Are all standazd sprinklers dated 1920 or later? �' '
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OWNER QUESTIONS Y N N/A
1. Any changes in sprinkler system since last inspection? _ '`- ',
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2. Any fires since last inspection? i� ''-
This document PROPERTY OF AHERN PROTECT[ON. Copyright 2005 J.F. Ahem Co. REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT. � �� rptInspection_Mnual �
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LID #: 3150625 ,. .: �, Page 3 of 3
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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 alann service?
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If yes, name and phone number. `
Note to Owner - Our inspections will only report conditions as they exist at time of inspection and do not guarantee the operation of the
System due to factors beyond our control. (i.e., potentially closed valves or depleted municipal water supply.) Per NFPA-25, this inspection is
based on the assumption that the system has been installed in accordance with all applicable codes and standards.
Owner/Representative's Signature: Date
New De�ciencies found during this insp ection? Ye� No ,? Customer receive co of New D e�ciency Rep ort? Ye No ,
NOTES
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SERVICES PERFORMED: ��� Test � Drain Test � Flow Test U Walk Through U Annual Inspection �J Other �
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�� � This document PROPERTY OF AHERN FIILE PROTECTION. Copyright 2005 J.F. Ahem.Co. REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGH'C. rptInspection_Mmial � .
.. . � ,;. , . . . .� „ �.�
-.... Ahern Fire Protection F ����.eaCt10I1�
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13705 26th Avenue, Stute 11�0 � Date: 3/1/2011 �
Minneapolis, l�� 55441 Delu e Pi e �
(763) 268 p•(763) 268 f g p � Wark Order #: g53880
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�,��� vwvw.aherntire.com • Since 1880 Valve Trip Test LID #: 3150625
Location: �ourtwood Village Dept.:
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- (952) 898-5760 Fas #: (952) 4b5-7101 Zip: 55372_ _
i Phone #: I _ ' Prior Lake State. �I Foreman: �hris Moe
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Street 17092 Adelman Street SE �` Ci - - — -
; Date: <" _ � Signature: � �„ -: ' ,�.; � ,.-�
S stem #•
System Type: • k
Valve Serial #:
Manufacturer Name: � � � t ,
Valve Model: r._ F ' �
Valve Size: /
Controlling Sprinklers Location: +x,.
.. . . z t �.-.-
....� . . . . _.. .. , .. �: ��.: .+�,,.w....a,,: 4. -+�wi ...c.�.... ., ., .. .__ ._...:�i
ontrollin S rmklers Number: �w . . . ._ _.....,� ,�....._,,., ..„,.._.....
g p � H aPProx.. ;
Date of Last System Pressure Test: '
(Must be done every 3rd Yeaz) � I
Date of Last Full-Flow Trip Test: r; '
(Must be done every 3rd Yeaz) {
Date Last Operated: , r
Pressure Before Test - Air - ]bs.
Pressure Before Test - Water ]bs.
Size and L,ocation of Test Va1ve:
Was gate valve below dry valve open w' e at test? (if not, how many tums?) <
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Valve Tripped At - Air pressure a / lbs. � �,,� ., � ��' ��
� � �
�`alve Tripped At - Water Pressure lbs. �'"
Valve Tripped At - Time F min. sec. �
r -_ ;.,.._ .
If system flooded, list time water reached test opening. � min. �:
PERFORMANCE Poor Fair �o
Inferior of Body Poor Fair �Sd` �
Moving Parts Poor Fai
Rubber Facing Poor Fair o0
Seats P or Fair dod�
�teset? ,_ _ - � �;,_ _ . : �
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Did alarms operate at trip test? es"°� No N/A
Have low point drains been emptied? # : es ' No N/A
Water control valve left open and sealed? es No N/A
Are the valves accessible? , es ? No N/A
Are the valve enclosures heated adaquately? ?�es' ;' No N/A
Interior of pipe that passes through freezers °" " -�"
free of ice blockage? Yes No i.a
uick O enin Devices
Device Serial #:
Device Manufacturer Name: , ' '
Device Type and Model: ,,� ,.' ,r'
Air pressure in upper chamber :�' % F ,,,,,.-- lbs.
t
Quick opening device tripped at ��" ' sec.`, lbs. � '
Quick opening device left in service, and control open and sealed? °
Yes No N/A
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: Oil Level? Add Oil? ° Belt Tight? ! Belt Conditions?
' Cuts In? lbs 's Cuts Out? lbs. Tested? Reset? Yes No N/A
� Page 1 of 1�� This document PROPERTY OF AHERN FIRE�PROTECTION. Copyright 2008 J.F. Ahem Co. REPRODUCTIONS IN ANY FORM VIOLATES COPYRIGHT. �rptValveTripTest �
Electronic Installations, Inc.
,S`BC1�rtt� 11545 Lakeland Dr. #102 pace
Maple Grove, MN 55369-3663 Au uSt 12 2010
Phone: (763)425-8850 Fax: (763)424-6529 .�
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Alarm System Test Report ��� �' `' j ` �"
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Name Address Gity ' Type of Inspection '
I, Keystone—Prior Lake 4 685 P Nicollet Ave Prior Lake Annual
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_ _—:— � —
Control Panel - Make & Model 'Monitoring Awt: # Work Order #
i Silent Knight 5820 _ 3R00 1270 19005 �
Yes ' No N/A Panei' Phone Line # 1 Panel Phone Line #2
Walk Test ,� ❑ ❑ 952 952
� AIC Power on dedicakec� circuit ❑ � Type of BatterylSize Test voltage Full Load Voitage
A!C Power has lock off device. ❑ ❑ - �V�L � � � � �- • �
�, Transfer from A to Sattery , ❑ ❑
❑ ❑ Battery Ah R� g 'Tested Ah' Ratin Panel Battery Date
A/C Power supervision _ - � , �'
� 1 ❑ _ e
DfC Power Supervision u
Battery �ontacts Ciean j � � Communicator Battery Tested Ah Raiing Communicator Battery Date
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� Trouble Ligh & Buzzer ❑ ❑ -
System Supervision ❑ ❑ Sensitivity Testing
Control switches working correctly. � ❑ ❑ Horn Max. Am p Draw ' �
I panei free of dust and dirt. _� ❑ � I'anel Information
AllZones are labe & Identified. ❑ ❑
All Zon on System Work �j � (� Addressable Yes ❑ No X�
All Devices work conectly. y�+ ❑ ❑ I Number of zones on Panel 8
Remote Annnnciator Work' � ❑ ❑ Number of zones used� 8
Local Indicating Devices. _ _� _ � � �Number of Signal'Circuit Boosters ''
System sends signals to: ❑ �
I Local � Central Station � Proprietary Elevator Phone Tested/Monitored Yes ❑ No
Quantity Type of Device Brand of Device How Tested Quantity Type of Device Brand of Deviee
Manual Pull Statiott Water Pressure Switch
80 Smoke Detectors , ya.+ 107 Mini Horns
1 Heat Detectors ;,7 �, �, Mini Hom-strobes
� Carbon monoxide Detectors Homs
Duct Detectors 52 Hom' - Strobes
11 Gate Valves v��C 9 Strobe Only
6 Water flow Devices O Bells
2/0 Low J 13igh Air Devices �r. t�, � E-Lights
List ail abnormal condition found that were corrected / not corrected at time of inspection.
As the inspecting agent, I ha e zoughly checked the above minimum reguirements and to 1he best of my knowiedge, all statements acc true:
Inspecting Agents Signature: �"` 1 anagement S' nature:�`_ .
_ �;"t;' C.�'�'"�-