HomeMy WebLinkAboutSprinkler Inspection Report
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1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651) 558.3300 . (800)-229-6263
FAX: (651) 558.3310
s. iEET 1 OF 2 - Use separate sheet fOf each building inspection
AGREEMENT & REPORT OF INSPECTION ""t...... D . ,...,
INSPECTION # oJ '-' DO '""
MINNESOTA LICENSE NO. COO5
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REPORT TO
BUILDING OR LOCATION <:.-.. "",,c
INSPECTOR p.~I:.b~_'oJ
DATE--.b-?q-OC. .
STREET
CITY & STATE
Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or
building, and prepare a wriuen report of that inspection for an agreed upon fee. As part of this agreement, owner agrees to terms
and conditions on rear of form and will complete (he Owner's Section of this document.
Owner's Section (To be answered by Owner or Occupant)
A. Explain any occupancy hazard changes since the previous inspection: n \.-r-1...0
B. Describe fire protection modifications made since last inspection.
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C. Describe any fires since last inspection.
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D. When was the system piping last checked for stoppage, corrosion o.I...fuxeign material? '-:, _ ~ "L....l f _.J 1 L.f' q ':=>
E. When was the dry-piping system last checked for proper pitch? I _ _..... L. 1\--'1 I c....',.-._t'-
F. Are dry valves adequalely,,'protected from freezing? t_j _..... -
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Inspector's Section (All responses reference current inspection)
I. General
a. Is the building occupied'~es I No
b. Are all systems in service?~ es I No
c. Does there appear to be a minimum of 18 in. (457 mm) clearance between the top of the storage and the sprinkler def1ectors?~es
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? I I Yes I No. ~A
2. Control Valves (Set' Item 15.)
a. Do sprinkler system control valves appear to be in the appropriate open or closed position~es I No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch~es UNo
3. Water Supplies (See Item 16.)
a. Was a water flow test of main drain made at the sprinkler riser(s)'~es i' No
4. Tanks, Pumps, Fire Department Connections
a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? I Yes 1 No .J.o'NA
b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight?/yes I No I NA
Are they accessible and visible?/'{es ! No I NA
5. Wet Systems
a. Are cold weather valves (0.5. & Y.) in the appropriate open or closed position? I Yes i No ~A
b. Have antifreeze system solutions been tested?, I Yes '--1 No ~A
c. Were the antifreeze test results satisfactory?; Yes I No ,P(NA
d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, ind",ding blind attics and perimeter areas
where accessible? I' Yes I I No KNA Do all exterior openings appear to be protected against freezing~es I I No ,- I NA
6. Dry System (See Item... 11 to 13.)
a. Arc dry valve(s) in service?YYcs I No I NA .
b. Are the air pressures and priming water levels in uccordance with the manufacturer's instruction~ es, I No
c. Has the operation of the air or nitrogen supplies been tested?~ es 1__ No ;., NA Are they in service?~ es
d. Were all known low points drained during this inspection?,/Yes I i No I NA
e. Did quick-opening devices operate satisfactorily? I Yes I No ~A
f. Did the dry valve(s) trip properly during the trip pressure test?y-'Yes U No I I NA
g. Did the heating equipment in the dry-pipe valve room(s) operate at time of inspection ~Yes I i No I I NA
7. Special Systems (See Item /4.)
a. Did the deluge or pre-action valves operute properly during testing?, I Yes [ No ~A
b. Did the heut-responsive devices operate properly during testing?!"] Yes :-l No ~A
c. Did supervisory devices operate during testing? I_~ Yes I' No ~A
8. Alarms
a. Did water motor(s) and gong(s) test satisfactorily? I Yes ~--I No ~A
b. Did electric alarm(s) test satisfactory'0Yes r No I NA
c. Did supervisory alarm service test satisfactory? Il Yes I' No ~A
9. Sprinklers
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge VYes L_l No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testin~Yes 'I No _
c. Are quick response and residential spri_nklers le~s than 20 years old? (Older sprinklers require sample testin~ Yes
d. Is stock of spare sprinklers available?/"'Yes I No
e. Does the exterior condition of sprinkler system appear to he satisfactory VYes t__ No
f. Do visible sprinklers appear to be of prope,r:..!emperature rating for their locations? ~es I No
10. Explain any "No" answer and comments: ,<~,..-'", H '7';' V \./<.. 4-i-.ru ~L)r-_
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I~~\;~ Date 1o-2Gj -05
NA =NOT APPLICABLE
No
INA
I No
INA
I No ! NIA
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Signature:
~UT~~S~~
130l L'ORIENT STREET
ST. PAUL, MINNESOTA 55!]7
(651) 558-3300. (800)-229-6263
FAX: (651) 558-3310
Sl-U::ZT 2 OF 2 - Use separate sheet for each system inspection
System No.
systems
or Description if multiple
I-/' J 19
11. Date dry-pipe valve trip tested (control valve partially open) _L.,- 7C,-o c.. (See Trip Test Table which follows)
12. Date dry-pipe valve tri.p tested (control valve fully open) (See Trip Test Table which follows)
13. Date quick-opening device tested (See Trip Test Table which follows)
DRY VALVE TRIP TEST TABLE 0.0.0.
I MAKE MODEL I SERIAL NO. I MAKE
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Inspection Report
No. 5/Ll \30 e,
DRY PIPE
OPERATING
TEST
MODEL
SERIAL NO.
Time to Trip
Thru Test Pipe
MIN. SEC.
Water Air Trip Point Time Water Reached Alarm Operated
Pressure Pressure Air Pressure TeslOutlet Properly
PSI PSI PSI MIN SEC. YES NO
b -, -=?'7 1'7 ....-- /' .,,-/
IWithOU.'
0.0.0
I With
0.0.0.
/'
./
14. Date deluge or preaction valve tested
DELUGE &
PREACTION
;..J ~ VALVES
(See Trip Test Table which follows)
TRIP TEST TABLE
Operation 0 PNEUMATIC 0 ELECTRIC 0 HYDRAULIC
Piping Supervised 0 YES 0 NO I Detecting media supervised
Does valve operate from the manual trip and/or remote control stations
Is there an accessible facility in each circuit for testing Method ot testing-circuits
o YES ONO
o YES
o YES
o NO
o NO
MAKE
Does each circuit operate
2.!:!.Q.ervision loss alarm
YES I NO
NO
Does each circuit
ooeratE' valve release
YES I NO
MODEL
Maximum time to
ooeraterelease
YES
15. See Control Valve Maintenance Table.
Control Valves
City Control Valves
Bvoass Valves
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves
Other Control Valves
Kitchen Control Valves
16. Water Flow Test at Sprinkler Riser
Water Supply Source:
Last Water Flow Test
This Water Flow Test
Control Valve Maintenance Table
Number
Type
Explain
Abnormal
Condition
Open
Secured
Closed
Signs
'- ,-," n~d 'I
1 ~/'>z. R.j:::.
-
-
-
---
Date
C 'City 'J
Test Pipe
Location
Static
Pressure
Pump
Residual
(Flow)
Pressure
Tank
Size of
Test Pipe
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[(,(1
LI'-1
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cr
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17. Explain any "No" answers and comments:
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18. Adjustments or corrections made during this inspection-
19. Although these comments are not the result of an engineering review, the following desirable improvements are recommended:
.
Signature:
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Date:
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