HomeMy WebLinkAboutSprinkler Inspection 12/7/2006
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AUTOMATIC SPRINKLER CO.
Setting The Standard...
St. Paul, Minnesota 55117
(651) 558-3300 . (800) 229-6263
Fax: (651) 558-3310
AGREEMENT AND REPORT OF INSPECTION
#INSPECTION
2D;2. 52.3
REPORT TO
STREET
CITY & STATE
&: K
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 chan~es since the previous inspection: Vll.:>)-t e.
Ave.
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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 pipin~ last checked for stoppa~e, corrosion or foreign material?
E. When was thelJ.t:y~pipu\.~ sysbfl'n last checked for proper pitch? ,V L~
F. Are dry valves adequ~ly p tected from freezin~?
Sio-n"ture ;/ /" / Title c:n f t
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Inspector's Section'(All responses reference current inspection)
1 General
a. Is the buildin~ occupied?~Yes LI No
b. Are all systems in service? 'J".. Yes 0 No
c. Does there appear to be a minimum of 18 in. (457 mm) clearance between the top of the stora~e and the sprinkler deflectors? ~ Yes II No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? LJ Yes 0 No 'f<.,.N/ A
2 Control Valves (See Item 15)
a. Do sprinkler system control valves appear to be in the appropriate open or closed position?~Yes 0 No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch? 'j...Yes LJ No
3 Water Supplies (See Item 16)
a. Was a water flow test of main drain made at the sprinkler riser(s)?~.Yes 0 No
4 Tanks, Pumps, Fire Department Connections '
a. Are fire pumps, ~ravity tanks, reservoirs and pressure tanks in good condition and properly maintained? 0 Yes. 0 No ')(N/ A
b. Are fire department connections irJ satisfactory condition, couplings free, caps in place, and check valves ti~t~ Yes uNo [l N/ A
Are they accessible and visible~es 0 No 0 N/ A
5 Wet Systems
a. Are cold weather valves (0.5. & Y.) in the appropriate open or closed position? n Yes Ll No ~/ A
b. Have antifreeze system solutions been tested? 0 Yes 0 No 'r$.N/ A
c. Were the antifreeze test results satisfactory? [J Yes 0 No ~N/ A
d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including blind attics and perimeter areas
where accessible?1:- Yes D No D N/ A Do all exterior openings appear to be protected against freezing?]lYes uNo D N/ A
6 Dry System (See Items 11 to 13)
a. Are dry valves (s) in service? DYes oNo ~N/A
b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? n Yes [I No ~ N/ A
c. Has the operation of the air or nitrogen supplies been tested? eYes D No,*"N/ A Are they in service? DYes D No ~/ A
d. Were all know low points drained during this inspection? DYes D No ~/ A
e. Did quick-openin~ devices operate satisfactorily? [J Yes D No ~ N/ A I
f. Did the dry valve(s) trip properly during the trip pressure test? [] Yes LJ No )4 N/ A
~. Did the heating equipment in the dry-pipe valve room(s) operate at time of inspection? DYes D No ~ N/ A
7 Special Systems (See Item 14)
a. Did the deluge or pre-action valves operate properly during testing? II Yes [I No )<:tN/ A
b. Did the heat-responsive devices operate properly during testing? DYes D No i-N/ A
c. Did supervisory devices operate during testing? DYes D No ~/ A
8 Alarms
a. Did water motor(s) and gong(s) test satisfactorily? DYes D No I!(N/ A
b. Did electric alarm(s) test satisfactory? 'A Yes D No D N/ A
c. Did supervisory alarm service test satisfactory? DYes D No )( N / A
9 Sprinklers
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to 5'ray discharge? 'r;I:Y. es D No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) ~ Yes 0 No
c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing) [] Yes D No 'ji..N/ A
d. Is stock of spare sprinklers available? )(Yes [] No
e. Does the exterior condition of sprinkler system appear to be satisfactory?)(1 Yes c No
f. Do visible sprinklers appear to be of proper temperature ratin~ for their locations? >6Yes [] No
10 Explain any "No" answers and comments: ( -
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N/A = NOT APPLICABLE
Date
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(Rev. 2/8/(6)
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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
SHEET 2 of 2 - Use separate sheet for each system inspected
System No. or Description if multiple
systems 4,1 t-L.AoT
Inspection Report
No. 2..0 z. 5,z 3
(See Trip Test Table which follows)
(See Trip Test Table which follows)
(See Trip Test Table which follows)
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
DRY PIPE
OPERATING
TEST
;JIA
DRY VALVE TRIP TEST TABLE O.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 Pressure 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 follows)
TRIP TEST TABLE
/
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Operation D PNEUMATIC D ELECIRIC D HYDRAULIC
Piping Supervised DYES D NO IDetecting Media Supervi.ed DYES D NO
Does valve operate from the manual trip and/ or remote control stations DYES D NO
Is there an accessible facility in each circuit for testing DYES D 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 YES I NU YES 1 NO
I I I
DELUGE &
PREACTION
V ALVES
15 See Control Valve Maintenance Table
CONTROL VALVE MAINTENANCE TABLE
Explain
Abnormal
Control Valves Number Tvve Open Secured Closed Signs Condition
City Control Valves
Bypass Valves
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves 1_4" C6# '1' - -- -
Other Control Valves
Kitchen Control Valves
16 Water Flow Test at Sprinkler Riser
Water Su I Source:
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Test Pipe
Location
Tank
Date
Size of
Test Pi e
Static
Pressure
Pum
Residual
(Flow)
Pressure
Last Water Flow Test
This Water Flow Test
q
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17 Explain any "No" answers and comments:
18
19
ese co~ments are not
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an engineering review,
e improvements are recommen e
Signature:
Date:
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(Rev. 2/8/06)
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