HomeMy WebLinkAboutSprinkler Inspection - 7/19/12 AGREEMENT & REPORT OF INSPECTION 301 York Avenue
VI I�CI NG Viking Automatic Sprinkler Co. St. Paul MN 55130
�uro�wicsrw�uEaco. 651-558-3300 —1-800-229-6263 Minnesota License No.
C005
FAX: 651-558-3310
Date 07-19-2012 Monthly ❑
Work Order Number 237457 Quarterly ❑
Ins ector PAUL HENRY Semi-Annual ❑
Annual �
Five Year ❑
Site Information Customer Information
Buildin Name NOREX Name NOREX
Address 5505 COTTONWOOD LN Address 5505 COTTONWOOD LN
R 72 PRIOR LAKE MN 55372
Site Contact KITTY MAYNARD Customer Contact KITTY MAYNARD
Tele hone 952-447-8898 Tele hone 952-447-8898
Customer hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or building and to prepare a written
report of that inspection for the agreed upon fee. As a part of this agreement, customer agrees to Terms And Conditions found on Report of Inspection and will
complete the Owner's Section of this document. Viking AutomaUc Sprinkler Company will not be held liable for incorrect or unknown answers provided in the
Owner's Section.
PRIOR TO TESTING
NOTIFICATIONS YES PHONE NUMBER CONTACT NOTES
BUILDING MANAGEMENT ❑
MONITORING ENTTTY �
2 MONTTORING ENTITY
AHJ ❑
NOTES:
OWNER'S SECTION To be answered by Owner, Occu t or Customer
1. Is the buildin occu ied? � Yes ❑ No
2. Are all s stems in service? Yes No
3. Was the s stem s free of actuation of devices or alarms since the last ins ection? � Yes No
4. Ex lain an occu anc hazard chan es since the revious ins ection: NONE
5. Describe any fire protection modifications made since the last inspection: NONE
6. Describe any fires since the last inspection: NONE
7. When was the system last checked for stoppage, corrosion, or foreign material? TIME TESTED 07-20-2011
8. When was the dry-piping system last checked for proper pitch? NO PROBLEMS
9. Are Dry valves adequately protected from freezing? YES
10. Does the system contain Yes If yes, how many? General Location(s): AT INSPECTORS TEST VALVE
an low oints? No ❑ 1
Invoice Type: ❑ Electronic ❑ Paper
Email Address for Invoice:
Name: KITTY MAYNARD Title: EMPLOYEE Date: 07-19-2012
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Report of Inspection
�, �� Job Number: 237457
�wra,wicsawN�aw. Job Name: NOREX
S stem Descri tion: 1-WET, 1-DRY
Ins ector: PAUL HENRY
Date: 07-19-2012
1. General Yes No Na
a. Is the buildin occu ied? � ❑
b. Are all systems in service?
c. Does there appear to be a minimum of 18 inches (457 mm) clearance between the top of storage and the �
sprinkler deflectors?
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory?
2. Control Valves see item 15
a. Do sprinkler system control valves appear to be in the appropriate open or closed osition?
b. Are control valves in the open position locked, sealed or equipped with a tamper switch?
3. Water Su lies see item 16
a. Was a waterflow test of the main drain made at the s rinkler riser s)?
4. Tanks Pum s, Fire De artment Connections
a. Are fire um s, ravit tanks, reservoirs and ressure tanks in ood condition and ro erl maintained? ❑ ❑ �
b. Are fire department connections in satisfactory condition, couplings free, caps in place and check valves �
tight?
c. Are they accessible and visible? �
5. Wet S stems
a. Are cold weather valves OS&Y in the a ro riate o en or closed osition?
b. Have anti-freeze solutions been tested? ❑
c. Antifreeze test result: Type of solution: ❑ Glycerin Propylene Glycol
d. In areas protected by the wet system(s), does the building appear to be properly heated in all areas, �
including blind attics and perimeter areas where accessible?
e. Do all exterior openings appear to be protected against freezing?
6. D S stem see items 10 thru 12
a. Are d valve s in service? �
b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions?
c. Has the operation of the air or nitrogen supplies been tested? ❑
Are they in service?
d. Were all known low points drained during this inspection? ❑
e. Did quick opening devices operate satisfactorily?
f. Did the dry valve(s) trip properly during the trip pressure test? �
g. Did the heating equipment in the dry pipe valve room(s) operate at the time of the inspection? �
7. S ecial S stems see item 13
a. Did the delu e or re-action valves o erate ro erl durin testin 7
b. Did the heat responsive devices operate properly during testing? �
c. Did the supervisory devices operate properly during testing?
8. Alarms
a. Did water motor s and on s test satisfacto ?
b. Did electric alarm(s) test satisfactory? � ❑
9. S rinklers
a. Do visible s rinklers a ear to be free from corrosion, loadin or obstruction to s ra dischar e? �
b. Do sprinklers appear to be less than 50 years old? (Older sprinklers require sample testing)
c. Do quick response and residential sprinklers appear to be less than 20 years old? (Older sprinklers require ❑ �
sample testing)
d. Do dry sprinklers appear to be less than 10 years o1d7 (Older sprinklers require sample testing)
e. Is stock of spare sprinklers available?
f. Does the exterior condition of sprinkler system appear to be satisfactory? ❑
g. Do visible sprinklers appear to be of proper temperature rating for their location?
REV 9/1/11
�' �' N Job Number: 237457
NITOMA7ICSPWNKLERCO. Job Name: NOREX
S stem Descri tion #1 of 2, 4" WET
Ins ector: PAUL HENRY
Date: 07-19-2012
10. Date dry i e valve tested (control valve artiall o en) see tri test table which follows
11. Date d i e valve tested control valve full o en (see tri test table which follows)
12. Date uick o enin device tested see tri test table which follows
DRY VALVE TRIP TEST TABLE Q.o.n.
MAKE MODEL SERIAL MAKE MODEL SERIAL NO.
NO.
Time to trip tivough test Water Air Pressure Trip Point Air Time Water Reached Alarm Operated
DRY PIPE i e Pressure Pressure Test Outlet Pro rl
OPERATING Minutes Seconds PSI PSI PSI Minutes Seconds Yes No
TEST �'�thout
.O.D.
With .O.D. ❑ ❑
13. Date delu e or reaction valve tested see tri test table which follows
TRIP TEST TABLE
O eration PNUEMATIC ELECTRIC HYDRAULIC
Piping supervised Yes No Detecting media supervised Yes No
Does valve operate from the manual trip / or remote control station Yes No ❑
DELUGE & Is there an accessible facility in Yes ❑ No ❑ Method of testing circuits
PRE- each circuit for testin
ACTION MAKE MODEL Does each circuit operate Does each circuit operate valve Maximum time to operate release
TEST su ervision loss alarm release
Yes No Yes No Yes No
❑ ❑ ❑
14. See Control Valve Maintenance Table
Control Valves Number T O en Secured Closed Si ns Ex lain Abnormal Condition
Ci Valves 1-PN OSY � BFV ❑ Y N Y N Y❑ N❑ Y N
B ass Valves OSY BFV Y N Y N Y❑ N❑ Y❑ N
Tank Valves OSY BFV Y N Y N Y N Y❑ N
Pum Valves OSY BFV Y N Y N Y N Y❑ N
Sectional Valves 1-6" OSY BFV ❑ Y N Y N Y❑ N❑ Y� N
S stem Valves 1-4" OSY ❑ BFV � Y� N❑ Y� N❑ Y❑ N❑ Y N❑
Other Valves 1-4" OSY ❑ BFV � Y� N❑ Y� N❑ Y N Y� N❑
Kitchen Valves OSY ❑ BFV ❑ Y❑ N❑ Y❑ N❑ Y❑ N❑ Y N❑
15. Water Flow Test at S rinkler Riser Source:Cit � Tank ❑ Pum ❑
Date Test Pi e Location Size of Test Pi e Static Pressure Residual Flow Pressure
Last Flow Test 07-20-2011 RISER 4" 2" 75 65
This Flow Test 07-19-2012 RISER 4" 2" 80 70
16. Explain any "No" answers and comments:
17. Adjustments or corrections made during this inspection:
18. Although the comments are not the result of an engineering review, please see the attached Non-Inspection Related Deficiencies
form for additional items found during the course of the inspection. (Only attached if applicable)
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Inspector's Signature
TERMS AND CONDITIONS
The Report of Inspection, together wi[h these Terms and Conditions, constitute the entire agreement ("Agreement") of the parties.
1. This Agreement is for work performed on this Inspection only. If Customer wants Viking Automatic Sprinkler Company ("Company") to make any additional
repairs, alterations or replacements as a result of the work performed, the Company will do so for additional compensation to be agreed upon in writing by the
parties.
2. The Company does not know and does not represent whether the current fire protection system on the property of Customer ("Property") was originally designed
and installed in such a way that the system will perform as originally intended or is suitable and sufficient for its intended purpose given the way in which the
Property has been or will be used. In other words, the Property has been or may be used in ways such that the configuration of partition walls, the location of and
types of materials (including the presence of hazardous materials) and other conditions of the Property's use aze such that the fire protection system is inadequate,
insufficient or unsuitable for the Property. THIS AGREEMENT IS NOT A GUARANTEE OR WARRANTY THAT THE SYSTEM WII.L IN ALL CASES (A)
PROVIDE THE LEVEL OF PROTECTION FOR WHICH Tf WAS ORIGINALLY INTENDED, (B) IS FREE OF ALL DEFECTS AND DEFICIENCIES, (C)
AND IS IN COMPLIANCE WTTH ALL APPLICABLE CODES. Customer agrees that it has not retained Company to make these assessmenu unless othenvise
specifically indicated.
3. The Company will be permitted, at all reasonable times, to enter the Property to conduct the work as outlined in this Agreement.
4. TO THE FULLEST EXTENT PERMITTED BY LAW, CUSTOMER AGREES TO DEFEND, INDEMNIFY AND HOLD HARNII.ESS COMPANY
AND ITS AFFILIATES, AGENTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS, DAMAGES, LOSSES, INNRIES OR
LIABILITIES, OF ANY KIND, RESULTING FROM OR IN ANY MANNER RELATED TO OR CONNECTED W1TH THE WORK PERFORMED
BY THE COMPANY iJNDER THIS AGREEMENT (WHETHER ARISING DURING OR FOLLOWING THE PERFORMANCE OF THE WORK),
AND ALL ACTIVITIES RELATED THERETQ OR OCCURRING OR RESULTING FROM THE USE BY THE COMPANY OR ITS AGENTS OR
EMPLOYEES OF MATERIALS, EQUIPMENT, INSTRUMENTALTI'IES OR OTHER PROPERTY, WHETHER THE SAME BE OWNED BY THE
CUSTOMER, THE COMPANY OR THIIiD PARTIES, EXCEPT FOR AND TO THE EXTENT OF CLAIMS AND LIABILITIES ARISING SOLEY
OUT OF THE COMPANY'S NEGLIGENT ACTS OR OMISSIONS BUT SUBJECT TO THE LIMITATION IN PARAGRAPH 5. a. BELOW.
CUSTOMER SHALL INDEMNIFY COMPANY FOR COMPANY'S LEGAL FEES, COSTS AND DISBURSEMENTS PAID OR INCURRED TO
ENFORCE THE PROVISIONS OF THIS PARAGRAPH. CUSTOMER FURTHER AGREES TO OBTAIN MAINTAIN AND PAY FOR SUCH
INSURANCE COVERAGE AND ENDORSEMENTS, INCLUDING COMPLETED OPERATIONS COVERAGE, AS WILL INSURE THE
PROVISIONS OF THIS PARAGRAPH AND, UPON REQUEST, SHALL PROVIDE COMPANY WITH E VIDENCE THEREOF.
5. IF THE ABOVE INDEMNIFICATION IS UNENFORCEABLE IN THE STATE IN WHICH THE WORK IS PERFORMED, THEN THE
FOLLOWING LIMITED LIABILITY LANGUAGE APPLIES:
a. CUSTOMER AGREES THAT THE LIABILTI'Y OF COMPANY, IT'S OFFICERS, DIItECTORS, EMPLOYEES, PARENT
COMPANY, SUBSIDIARIES, AFFILIATES, CONSULTANTS, SUBCONTRACTORS AND VENDORS TO CUSTOMERS AND
OR OTHER OCCUPANTS OR VISITORS OF THE PROPERTY, ARISING OUT OF THE COMPANY'S NEGLIGENT AGTS OR
OMISSIONS, SHALL BE LIMITED TO THE LESSER OF $5,000 OR THE AMOUNT OF THE CONTRACT/PRICE OF WORK
PERFORMED BY THE COMPANY. THIS LIMITATION OF LIABILTTY SHALL APPLY TO ALL JUDGMENTS, CLAIMS,
LIABILITY, COSTS, EXPENSES, LEGAL FEES AND ALL DAMAGES OR LOSSES OF ANY NATURE, SUSTAINED BY
CUSTOMER, CONTRACTOR OR SUBCONTRACTOR, OR ANY OTHER PARTY CLAIMING BY OR THROUGH THENL
THIS LIMITATION DOES NOT APPLY TO CLAIMS OF INTENTIONAL, WILLFUL OR WANTON ACTS.
6. IT IS UNDERSTOOD AND AGREED BY THE CUSTOMER THAT THE COMPANY IS NOT AN INSURER AND THAT INSURANCE
COVERAGE SHALL BE OBTAINED BY THE CUSTOMER AND THAT THE AMOUNTS PAYABLE TO THE COMPANY HEREUNDER
ARE BASED UPON THE VALUE OF THE SERVICES TO BE RENDERED AND ARE UNRELATED TO THE VALUE OF THE
CUSTOMER'S PROPERTY AND THE PROPERTY OF OTHERS LOCATED ON THE PREMISES. CUSTOMER AGREES TO LOOK
EXCLUSIVELY TO THE CUSTOMER'S INSURANCE TO RECOVER FOR INJURY OR DAMAGE IN THE EVENT OF ANY LOSS OR
INJURY AND THE CUSTOMER RELEASES AND WAIVES ALL RIGHT OF RECOVERY AGAINST COMPANY ARISING BY WAY OF
SUBROGATION.
7. While the Company will make every reasonable effort to prevent the discharge of water into or onto areas of landscaping, decorative pavement, etc., it is the
Customer's responsibility to provide sufficient and readily accessible means to accept the full flow of water that may be required by tests as determined by the
type of inspection.
8. This Agreement may not be assigned by Customer without the written consent of the Company.
9. Neither par[y shall be liable to the other for indirect, incidental, consequential or punitive damages arising out of the work.
10. If payment for work provided in this Agreement is not received by the Company within 30 days from Customer's receipt of an invoice for the work, Customer
shall pay interest at the tate of 3% per annum on all past due sums, together with all costs of collection, including attorney's fees.
11. This Agreement constitutes the entire agreement of the parties. If any provision hereof shall be invalid, the remaining provisions shall survive and be enforceable
against the parties. 1'he law of the state where the work is performed will govem. This Ageement supersedes all prior agreements. This Agreement may be
modified only by a written instrument signed by both parties.
REV 9/1/11
�' �' N Job Number: 237457
, Job Name: NOREX
System Descri tion #2 of 2, 4" DRY
10. Date d i e valve tested control valve artiall o en 07-19-2012 see tri test table which follows
11. Date d i e valve tested control valve full o en 07-20-2011 see tri test table which follows
12. Date uick o enin device tested 07-19-2012 see tri test table which follows
DRY VALVE TRII' TEST TABLE Q.o.n.
MAKE MODEL SERIAL MAKE MODEL SERIAL NO.
NO.
RELIABLE D-2002 40206B RELIABLE B-1 7576960
Time to trip through test Water Air Pressure Trip Point Air Time Water Reached Alarm Operated
DRY PIPE � e Pressure Pressure Test Outlet Pro rl
OPERATING Minutes Seconds PSI PSI PSI Minutes Seconds Yes No
without
TEST .O.D.
With .O.D. 80 42 35
13. Date delu e or reaction valve tested see tri test table which follows
TRIP TEST TABLE
O eration PNUEMATIC ELECTRIC ❑ HYDRAULIC
Piping supervised Yes No Detecting media supervised Yes No
Does valve operate from the manual trip / or remote conirol station Yes ❑ No
DELUGE & ��ere an accessible facility in Yes No Method of testing circuits
PRE each circuit for testin
ACTION MAKE MODEL Does each circuit operate Does each circuit operate valve Maximum time to operate release
TEST su ervision loss alann release
Yes No Yes No Yes No
❑ ❑
14. See Control Valve Maintenance Table
Control Valves Number T e O en Secured Closed Si ns Ex lain Abnormel Condition
Ci Valves OSY BFV Y N Y N❑ Y❑ N❑ Y N❑
B ass Valves OSY BFV ❑ Y❑ N❑ Y❑ N❑ Y N Y❑ N
Tank Valves OSY BFV Y❑ N Y N Y❑ N❑ Y N❑
Pum Valves OSY BFV Y N Y❑ N❑ Y❑ N Y❑ N❑
Sectional Valves OSY ❑ BFV ❑ Y❑ N❑ Y❑ N❑ Y N❑ Y❑ N❑
S stem Valves 1-4" OSY � BFV ❑ Y� N❑ Y� N❑ Y N Y� N
Other Valves OSY BFV Y N Y N Y❑ N❑ Y N❑
Kitchen Valves OSY ❑ BFV ❑ Y❑ N❑ Y❑ N❑ Y N❑ Y❑ N
15. Water Flow Test at S rinkler Riser Source:Ci � Tank ❑ Pum ❑
Date Test Pi e Location Size of Test Pi e Static Pressure Residual Flow Pressure
Last Flow Test 07-20-2011 RISER 4" 2" 75 65
This Flow Test 07-19-2012 RISER 4" 2" 80 70
16. Explain any "No" answers and comments:
17. Adjustments or corrections made during this inspection: REPLACED AIR COMPRESSOR, PUT Q.O.D BACK IN SERVICE
18. Although the comments are not the result of an engineering review, please see the attached Non-Inspection Related Deficiencies
form for additional items found during the course of the inspection. (Only attached if applicable)
]I19I2012
X � 4 � �
5 I p � e d h y: a d m I n
Inspector's Signature
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