HomeMy WebLinkAboutFire Sprinkler Inspection February 2013 AGREEMENT & REPORT OF INSPECTION 301 York Avenue
St. Paul, MN 55130
CI K 1 NO Vi king Automatic Sprinkler Co.
Minnesota License No
A UTOMATIC SPRINKLER CO. 651 -558 -3300 —1- 800 - 229 -6263
C005
FAX: 651 -558 -3310
Date 2 -18 -13 Monthly ❑
Work Order Number 241276 Quarterly ❑
Inspector DOUG PEDERSON Semi- Annual ❑
Annual El 1
Five Year ❑
Site Information Customer Information
Building Name ST. MICHAEL CHURCH Name CHURCH OF ST. MICHAEL
Address 16400 DULUTH AVE SE Address 16311 DULUTH AVE SE
PRIOR LAKE
Site Contact JUDY MENDEN Customer Contact JUDY MENDEN
Telephone 952- 447 -2491 Telephone 952- 447 -2491
I 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 Automatic 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 E 952- 447 -241 JUDY MENDEN
MONITORING ENTITY E 952- 894 -1700 TRANS 130100
2 MONITORING ENTITY ❑
AHJ ❑
NOTES:
OWNER'S SECTION (To be answered by Owner, Occupant or Customer)
1. Is the building occupied? ® Yes ❑ No
2. Are all systems in service? ® Yes ❑ No
3. Was the system(s) free of actuation of devices or alarms since the last inspection? ® Yes ❑ No
4. Explain any occupancy hazard changes since the previous inspection: NA
5. Describe any fire protection modifications made since the last inspection: NA
6. Describe any fires since the last inspection: NA
7. When was the system last checked for stoppage, corrosion, or foreign material? NA
8. When was the dry- piping system last checked for proper pitch? NA
9. Are Dry valves adequately protected from freezing? NA
10. Does the system contain Yes ❑ If yes, how many? General Location(s):
any low points? No ❑
Invoice Type: ❑ Electronic ® Paper
Email Address for Invoice:
Name: JUDY MENEN Title: MGR Date: 2 -18 -13
3/ I B/ l U 1 3
x ' � - - - - - • , . -- --�/
Owner's Signature = „ . , v .. m
REV 11 -11 -11
Report of Inspection
C ' K ' N G Job Number: S MI
AUTOMATIC SPRINKLER CO. Job Name: ST MCHAEL CHURCH
System Description: 1 WET 1 HOOD 1 LOOP
301 York Avenue Inspector: DOUG PEDERSON
St. Paul, MN 55130 Date: 2 -18 -3
651 -558 -3300
1. General Yes No Na
a. Is the building occupied? ® ❑ ❑
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 hand hose on the sprinkler system(s) appear to be satisfactory? ❑ ❑
2. Control Valves (see item 14)
a. Do sprinkler system control valves appear to be in the appropriate open or closed position? Z ❑ ❑
b. Are control valves in the open position locked, sealed or equipped with a tamper switch? ® ❑ ❑
3. Water Supplies (see item 15)
a. Was a waterflow test of the main drain made at the sprinkler riser(s)? 1 ® ❑ ❑
4. Tanks, Pumps, Fire Department Connections
a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly 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 Systems
a. Are cold weather valves (OS &Y) in the appropriate open or closed position? ❑ ❑ ❑
b. Have anti -freeze solutions been tested? ❑ ❑ ❑
c. Antifreeze test result: +32 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. Dry System (see items 10 thru 12)
a. Are dry valve(s) in service? ❑ ❑ El
b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions? ❑ ❑ El
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? ❑ ❑ El
e. Did quick opening devices operate satisfactorily? ❑ ❑ El
f. Did the dry valve(s) trip properly during the trip pressure test? ❑ ❑ El
g. Did the heating equipment in the dry pipe valve room(s) operate at the time of the inspection? ❑ ❑ El
7. Special Systems (see item 13)
a. Did the deluge or pre- action valves operate properly during testing? ❑ ❑ ❑
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 gong(s) test satisfactory? ❑ ❑ ❑
b. Did electric alarm(s) test satisfactory? ® ❑ ❑
9. Sprinklers
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? ® ❑ ❑
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 old? (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? ® ❑ ❑
Insp. Form 11 -8 -12
-.ft., Report of Inspection
VI i N G Job Number: 241276
AUTOMATIC SPRINKLER CO. Job Name: ST MICHAEL CHURCH
System Description 1 WET 1 HOOD 1 LOOP
Inspector: DOUG PEDERSON
Date: 2 -18 -13
10. Date dry pipe valve tested (control valve partially open) NA (see trip test table which follows)
11. Date dry pipe valve tested (control valve fully open) NA (see trip test table which follows)
12. Date quick opening device tested NA (see trip test table which follows)
DRY VALVE TRIP TEST TABLE Q.O.D.
MAKE MODEL SERIAL MAKE MODEL SERIAL NO.
NO.
NA
Time to trip through test Water Air Pressure Trip Point Air Time Water Reached Alarm Operated
DRY PIPE pipe Pressure Pressure Test Outlet Pro rly
OPERATING Minutes Seconds PSI PSI PSI Minutes Seconds Yes No
TEST Without ❑ ❑
Q.O.D. _
With Q.O.D. ❑ ❑
I 13. Date deluge or preaction valve tested 1 NA 1 (see trip test table which follows)
TRIP TEST TABLE
Operation 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 testing
ACTION MAKE MODEL Does each circuit operate Does each circuit operate valve Maximum time to operate release
TEST supervision loss alarm release
Yes No Yes No Yes No
❑ ❑ ❑ ❑ ❑ ❑
14. See Control Valve Maintenance Table
Control Valves Number Type Open Secured Closed Signs Explain Abnormal Condition
City Valves Select Valve Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑
Bypass Valves Select Valve Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑
Tank Valves Select Valve Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑
Pump Valves Select Valve Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑
Sectional Valves 2 BFV Y E N Y® NO Y❑ N® Y E N GOOD
System Valves 1 BFV Y E N Y E N Y❑ NE YE N GOOD
Other Valves Select Valve Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑
Kitchen Valves Select Valve Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑ Y ❑ N ❑
15. Water Flow Test at Sprinkler Riser Source:City ® Tank ❑ Pump ❑
Date Test Pipe Location Size of Test Pipe Static Pressure Residual (Flow) Pressure
Last Flow Test 3 -30 -12 RISER 2 IN 88 72
This Flow Test 2 -18 -13 RISER 2 IN 84 76
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)
1/18 /1011
X V
g i q n e tl b y: s tl m I n
Inspector's Signature
Insp. Form 11 -8 -12
TERMS AND CONDITIONS
The Report of Inspection, together with 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 are 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 WILL IN ALL CASES (A)
PROVIDE THE LEVEL OF PROTECTION FOR WHICH IT WAS ORIGINALLY INTENDED, (B) IS FREE OF ALL DEFECTS AND DEFICIENCIES, (C)
AND IS IN COMPLIANCE WITH ALL APPLICABLE CODES. Customer agrees that it has not retained Company to make these assessments unless otherwise
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 HARMLESS COMPANY
AND ITS AFFILIATES, AGENTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS, DAMAGES, LOSSES, INJURIES OR
LIABILITIES, OF ANY KIND, RESULTING FROM OR IN ANY MANNER RELATED TO OR CONNECTED WITH THE WORK PERFORMED
BY THE COMPANY UNDER THIS AGREEMENT (WHETHER ARISING DURING OR FOLLOWING THE PERFORMANCE OF THE WORK),
AND ALL ACTIVITIES RELATED THERETO, OR OCCURRING OR RESULTING FROM THE USE BY THE COMPANY OR ITS AGENTS OR
EMPLOYEES OF MATERIALS, EQUIPMENT, INSTRUMENTALITIES OR OTHER PROPERTY, WHETHER THE SAME BE OWNED BY THE
CUSTOMER, THE COMPANY OR THIRD 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 EVIDENCE 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 LIABILITY OF COMPANY, IT'S OFFICERS, DIRECTORS, 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 ACTS OR
OMISSIONS, SHALL BE LIMITED TO THE LESSER OF 55,000 OR THE AMOUNT OF THE CONTRACT/PRICE OF WORK
PERFORMED BY THE COMPANY. THIS LIMITATION OF LIABILITY 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 THEM.
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 party 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 rate of 3% per annum on all past due sums, together with all costs of collection, including attomey'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. The law of the state where the work is performed will govern. This Agreement supersedes all prior agreements. This Agreement may be
modified only by a written instrument signed by both parties.
T &C 3 -3 -11