HomeMy WebLinkAboutSprinkler System Inspection, 3/21/14 - Church �\ AGREEMENT & REPORT OF INSPECTION 301 York Avenue
Viking Automatic Sprinkler Co. St. Pau1,1v1N 55130
V ��� N� Minnesota License No.
NROMA7ICSPItINKLERCQ 651-558-3300 —1-800-229-6263
C005
FAX: 651-558-3310
Date 3-21-2014 Monthly ❑
Work Order Number 248665 Quarterly ❑
Ins ector BOB M Semi-Annual ❑
Annual �
Five Year ❑
Site Information Customer Information
Building Name ST.MICHAEL CHURCH Name CHiJRCH OF ST. MICHAEL
Address 16400 DULUTH AVE SE PRIOR Address 16311 DiJLUTH AVE SE
LAKE NIN PRIOR LAKE MN
Site Contact LANE FARNQUIST Customer Contact JCTDY MENDEN
Tele hone 952-807-2466 Tele hone 952-447-2491
Customer hues Viking Automatic Sprinkler Company to conduct an inspechon of the fire suppress�on system at the above locahon or buildmg and to prepare a written
report of that mspection 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 Vikmg Automatic Sprmkler Company �vill not be held Lable for inconect or unknown answers prov�ded in the
O�vner's Section
PRIOR TO TESTING
NOTIFICATIONS YES PHONE NUMBER CONTACT NOTES
BUILDING MANAGEMENT ❑
MONITORING ENTITY �
2 MONITORING ENTITY ❑
AHJ ❑
NOTES
OWNER'S SECTION (To be answered by Owner, Occupant 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 flre 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? LJNKNOWN
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):
an low oints? No ❑
Invoice Type: ❑ Electronic � Paper
Email Address for Invoice:
Name: LANE FARNQUIST Title: MANT. Date: 3-21-2014
3„�„0 �.
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Owner's Si nature = � . a . a m��
REV 11-11-11
Report of Inspection
Job Number: 248665
V 1!�1 N G Job Name: ST.NIICHAEL CHURCH
AIIfOMA71C5PRINKLERCQ System Description: 1-3" WET 1-2" HOOD 1-
301 York Avenue 1 "LOOP
St Pau1, N1N 5513o Ins ector: BOB M
651 Date: 3-21-2014
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 hand hose on the sprinkler system(s) appear to be satisfactory? ❑ ❑ �
2. Control Valves see item 14
a. Do s rinkler s stem control valves a ear to be in the a ro riate o en 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 15
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 appro riate open or closed position? ❑ ❑ �
b. Have anti-freeze solutions been tested? � ❑ ❑
c. Antifreeze test result: +30 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? ❑ ❑ �
£ 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 ? ❑ ❑ �
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 ar 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 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
Report of Inspection
V� �� N Job Number: 248665
,uiro�.wwncswuN�aco. Job Name: ST.MICHAEL CHCTRCH
System Description 1-4"WET 1-HOOD 1-
LOOP
Ins ector: BOB M
Date: 3-21-2014
10. Date d 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.D.
MAKE MODEL SERIAL MAKE MODEL SERIAL NO.
NO.
Time to tnp through test Water Au Pressure Trip Pomt Air Time Water Reached Alarm Operated
DRY PIPE 1 e Pressure Pressure Test Outlet Pro erl
OPERATING Minutes Seconds PSI PSI PSI Mmutes Seconds Yes No
Without � �
TEST .o D
W�th .O D � �
13. Date delu e or reaction valve tested (see tri test table which follows)
TRIP TEST TABLE
O eration PNUEMATIC ❑ ELECTRIC ❑ HYDRALJLIC ❑
Piping supervised Yes ❑ No ❑ Detectmg media superv�sed Yes ❑ No ❑
Does valve operate from the manual trip / or remote control station Yes ❑ No ❑
DELUGE 8L Is there an accessible fac�l�ty in Yes ❑ No ❑ Method of testing circuits
PRE- each cucuit for teshn
ACTION MAKE MODEL Does each circu�t operate Does each cucuit 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 e O en Secured Closed Si ns Ex lain Abnormal Condition
Ci Valves Select Valve Y❑ N❑ Y❑ N❑ Y❑ N❑ Y❑ N❑
B ass Valves Select Valve Y❑ N❑ Y❑ N❑ Y❑ N❑ Y❑ N❑
Tank Valves Select Valve Y❑ N❑ Y❑ N❑ Y❑ N❑ Y❑ N❑
Pum Valves Select Valve Y❑ N❑ Y❑ N❑ Y❑ N❑ Y❑ N❑
Sechonal Valves Select Valve Y❑ N❑ Y❑ N❑ Y❑ N❑ Y❑ N❑
S stem Valves 1-4" BFV Y� N❑ Y� N❑ Y❑ N� Y� N❑
Other Valves Select Valve Y❑ N❑ Y❑ N❑ Y❑ N❑ Y❑ N❑
Kitchen Valves 1-2" 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 S�ze of Test Pi e Stahc Pressure Residual Flow Pressure
Last Flow Test 2-18-2013 RISER 1.25" 84 76
This Flow Test 3-21-2014 RISER 1.25" 85 75
16. Explain any "No" answers and comments:
17. Adjustments or corrections made during this inspection: ANTIFREEZE TESTED AT +30 NEEDS TO BE RECHARGED.
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)
3����zo��
x l� �i� ��D C�—�
s �u . a e r . a m i�
Inspector's Signature
Insp Form 11-8-12
TERMS AND CONDITIONS
The Report of Inspectron, together wrth these Terms and Condrt�ons, constrtute the entire agreement ("AgreemenY') of the part�es
1 This Agreement is for work performed on this Inspection only If Customer wants Vikmg Automatic Spnnkler Company (`Company") to make any additional
repairs, alterat�ons or replacements as a result of the work performed, the Company will do so for additional compensation to be agreed upon in wrrting by the
parties
2 The Company does not know and does not represent whether the current fire protection system on the property of Customer ("PropeRy") was origmally designed
and installed in such a way that the system will perform as originally mtended or is suitable and sufficient for its mtended 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 m ways such that the configuration of partihon walls, the location of and
types of matenals (mcludmg the presence of hazardous matenals) and other condd�ons of the Property's use are such that the fire protection system is tnadequate,
msuff�cient 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 retamed Company to make these assessments unless otherwise
specifically indicated.
3. The Company will be perm�tted, at all reasonable hmes, to enter the Property to conduct the work as outhned m this Agreement.
4. TO THE FULLEST EXTENT PERMITTED BY LAW, CUSTOMER AGREES TO DEFEND, INDENINIFY AND HOLD HARMLESS COMPANY
AND ITS AFFILIATES, AGENTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL CLAIMS, DAMAGES, LOSSES, INNRIES OR
LIABILITIES, OF ANY HIND, 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 LIABILTTIES ARISING SOLEY
OUT OF THE COMPANY'S NEGLIGENT ACTS OR OMISSIONS BUT SUBJECT TO THE LIb�ITATION IN PARAGRAPH 5. a. BELOW.
CUSTOMER SH.4LL 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 INDEMNIFICATIO�' 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 PROPERTti", ARISING OUT OF THE COMPANY'S NEGLIGENT ACTS 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 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 INNRY 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 effoR to prevent the discharge of water mto or onto areas of landscaping, decoratrve pavement, etc., rt is the
Customer's respons�b�lity to provide suffic�ent and readily access�ble means to accept the full flow of water that may be required by tests as determined by the
type of inspectron
8 This Agreement may not be assigned by Customer without the written consent of the Company.
9 Nerther party shall be liable to the other for indirect, mcidental, consequential or punitive damages azismg out of the wak.
10. If payment for work provided m this Agreement is not recerved by the Company wrthm 30 days from Customer's rece�pt of an �nvoice for the work, Customer
shall pay mterest at the rate of 3% per annum on all past due sums, together with all costs of collection, mcludmg attorney's fees
1 l. This Agreement constrtutes the entire agreement of the parties If any provision hereof shall be mvalid, the remaming 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 mstrument signed by both parties
T&C 3-3-11