HomeMy WebLinkAboutSprinkler Inspection 2014 AGREEMENT & REPORT OF INSPECTION 301 York Avenue
', •N0 Viking Automatic Sprinkler Co. St.Paul,MN 55130
KsraAeuoa
651-558-3300— 1-800-229-6263 Minnesota License No.
C005
FAX: 651-558-3310
Date 6-20-2014 Monthly ❑
Work Order Number 250519 Quarterly ❑
Inspector BOB M Semi-Annual ❑
Annual
Five Year ❑
Site Information Customer Information
Building Name LITTLD•LAKERS,MONTESSORI Name SAME
Address ' 4730 DAKOTA ST PRIOR LAKE MT Address SAME
Site Contact KAREN FISHER ___ / Customer Contact SAME
Telephone -_ ._ 612-308-5982 Telephone SAME
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 ❑
MONITORING ENTITY El
2r1D 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 El 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: 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? UNKNOWN
8.When was the dry-piping system last checked for proper pitch? 6-7-2013
9.Are Dry valves adequately protected from freezing? YES
10.Does the system contain Yes El If yes,how many? General Location(s):
any low points? No El
Invoice Type: ❑Electronic®Paper
Email Address for Invoice:
Name:KAREN FISHER Title:CEO Date:6-20-2014
6/10,2011
x
Owner's Signature , ••, • •<m •
REV 11-Il-Il