HomeMy WebLinkAboutFire Inspection 2004
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AUTOMATIC SPRINKLER CO.
Setting The Standard...
1301 L'Orient Street
St. Paul, Minnesota 55117
(651) 558-3300 . (800) 229-6263
Fax: (651) 558-3310
AGREEMENT AND REPORT OF INSPECflON
#INSPECTION
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SHEET 1 of 2 " Use separate sheet for each building inspected
MINNESOTA LICENSE NO. COOS
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BUILDING OR LOCATION
II <~ .(.Iv!::: INSPECTOR
,
IA/'N DATE
REPORT TO
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 written 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 the 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: =.JI""
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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 or foreign material?
E. When was the dry-piping syst~m last checked for proper pij91?\ '\fJJA
F. Are dry valves adequatelyprotectecJ/from freezing? \fII'
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Signature 'Y'T::- '/ ,.-------litle
Inspector's Section (All responses reference current inspection)
1 General /
a. Is the building occupied? \li9S uNo
b. Are all systems in service? Mes 0 No /.
c. Does there appear to be a minimum of 18 in. (457 mm) clearance between the top of the stora~'and the sprinkler deflectors? ~Yes' II No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? 0 Yes 0 No '~j A
2 Control Valves (See Item 15) , /
a. Do sprinkler system control valves appear to be in the appropriate open or closed position? \.O'es 0 No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch? 'a.,Ves uNo
3 Water Supplies (See Item 16) .
a. Was a water flow test of main drain made at the sprinkler riser(s)? ~~s 0 No
4 Tanks, Pumps, Fire Department Connections ../
a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? n Yes 0)>(0 b.Kfj A
b. Are fire department connections in s;1tisfactory condition, couplings free, caps in place, and check valves tight? b/fes 0 No [] Nj A
Are they accessible and visible? b-Yes 0 No 0 Nj A,
5 Wet Systems / .
a. Are cold weather valves (0.5. & Y.) in the appropriate open or closed position? LI Yes 0 No bilj A
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b. Have antifreeze system solutions been tested? 0 Yes 0 No b:Nj A
c. Were the antifreeze test results satisfactory? 0 Yes 0 No \;..Nj A
d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including blind ;ittics and perimeter areas
where accessible? ~es 0 No 0 Nj A Do all exterior openings appear to be protected against freezing? bJ.fes 0 No 0 Nj A
6 Dry System (See Items 11 to 13)
a. Are dry valves (s) in service? 0 Yes 0 No 0 Nj A
r b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? 0 Yes II No 0 Nj A
~\ c. Has the operation of the air or nitrogen supplies been tested? 0 Yes [J No 0 Nj A Are they in service? 0 Yes [] No 0 Nj A
\~ d. Were all know low points drained during this inspection? 0 Yes 0 No 0 Nj A
, e. Did quick-opening devices operate satisfactorily? 0 Yes [] No 0 Nj A
f. Did the dry valve(s) trip properly during the trip pressure test? [J Yes 0 No LI Nj A
g. Did the heating equipment in the dry-pipe valve room(s) operate at time of inspection? 0 Yes 0 No 0 Nj A
7 Special Systems (See Item 14)
\r~\' Did the deluge or pre-action valves operate properly during testing? 0 Yes 0 No r I Nj A
'1\ b. Did the heat-responsive devices operate properly during testing? 0 Yes 0 No 0 Nj A
c. Did supervisory devices operate during testing? 0 Yes 0 No [J Nj A
8 Alarms " '
a. Did water motor(s) and gong(s) test satisfadorily? 0 \I;?S 0 No L..t<ij A
b. Did electric alarm(s) test satisfactory? /;y{es 0 J;Jo /6 Nj A
c. Did supervisory alarm service test satisfactory? Ues 0 No 0 Nj A
9 Sprinklers .'
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spr~discharge?
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) \-fYes 0 No
c. Are quick response and residential sp~myers less than 20 years old? (Older sprinklers require sample testing)
d. Is stock of spare sprinklers available? 't(Yes 0 No /
e. Does the exterior condition of sprinkler system appear to be satisfactory? ~es 0 No /
f. Do visible sprinklers appear to be of proper temperature rating for their locations? b)(~s LI No
10 Explain any "No" answers and comments:
Date
NjA = NOT APPLICABLE
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6-'1es 0 No
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6-Yes
o No 0 Nj A
Signature:
(Rev. 2/8/"")
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AUTOMATIC SPRINKLER CO.
Setting The Standard...
1301 L'Orient Street
SI. Paul, Minnesota 55117
(651) 558-3300 . (800) 229-6263
Fax: (651) 558-3310
SHEET 2 of 2 - Use separate sheet for each system inspected
System No. or Description if multiple
systems
Inspection Report
No. 7til1f1 I
11 Date dry-pipe valve trip tested (control valve partially open)
12 Date dry-pipe valve trip tested (control valve fully open)
13 Date quick-opening device tested
(See Trip Test Table which follows)
(See Trip Test Table which follows)
(See Trip Test Table which follows)
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DRY PIPE
OPERATING
TEST
DHY VALVE TRIP TEST TABLE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
Time to Trip Water Air Trip Point Time Water Reached Alarm Operated
Thru Test Pipe Pressure Press ure Air Pressure Test Outlet Properly
MIN. SEe. PSI PSI PSI MIN. SEe. YES NO
Without
Q.o.D
With
Q.o.D
14 Date deluge or preaction valve tested
(See Trip Test Table which follaws)
TRIP TEST TABLE
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DELUGE &
PREACTION
VALVES
Operation D PNEUMATIC D ELECI1UC D HYDRAUUC
Piping Supervised DYES D NO I Detecting Media Supervised DYES D NO
Does valve operate from the manual trip andj or remote control stations DYES D NO
Is there an accessible facility in each circuit for testing DYES o NO IMethod of Testing Circuits
Does each circuit operate Does each circuit Maximum time to
MAKE MODEL supervision loss alarm operate valve release operate release
YES I NU YE~ I NU YE~ I NU
I I I
15 See Control Valve Maintenance Table
CONTROL VALVE MAINTENANCE TABLE
Explain
Abnormal
Control Valves Number Type Open Secured Closed Signs Condition
City Control Valves '1 L N I t.h~ " "- L/ , L__"
-
Bypass Valves I
Tank Control Valves
Pump Control Valves
Sectional Control Valves , v , .'
System Control Valves \ f '-i 'rt/ V L/' L/
Other Control Valves ~
Kitchen Control Valves
16 Water Flow Test at Sprinkler Riser
Water Su I, Source:
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Tank
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Size of
Test i e
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Static
Pressure
(
C.
Pum
Residual
(Flow)
Pressure
Last Water Flow Test
This Water Flow Test
Test Pipe
Location
17 Explain any "No" answers and comments:
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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(Rev. 2/8/06)