HomeMy WebLinkAboutFire Sprinkler Inspection 12/28/2006
1301 L'Orient Street
St. Paul, Minnesota 55117
(651) 558-3300 . (800) 229-6263
Fax: (651) 558-3310
AGREEMENT AND REPORT OF INSPECTION
.INSPECTION
SHEET 1 oi 2. Use separate sheet ior each building inspected
MINNESOTA LICENSE NO. COO5_
,BUILDING OR LOCA nON
, '- INSPECTOR
j !i I /V'~'-':: // ~':_ DATE ..-.-'\
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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 fonn and
will complete the Owner's Section of this document.
Owner's Section (fo be answered by Owner or Occupant)
A. Explain any occupancy hazard changes since the previous inspection:
REPORT TO -1
STREET V
CITY & STATE
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B. Describe fire protection modi~cations made sinc~ last ins tion:
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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 forei~ material?
E. When was the dry-piping system last checked for proper pitch?
re dry valve~dequately protected from freezing?
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Inspector's Se' ion (All responses reference current inspection)
1 General
a. Is the building occupied?~.? D No
b. Are all systems in service?~Yes D No
c. Does there appear to be a minimum of 18 in. (457,mm) clearance between the top of the sto~ and the sprinkler deflectorsL--~ l! No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? DYes D No~N/ A
2 Control Valves (See Item 15)
a. Do sprinkler system control valves appear to be in the appropriate open or closed position? ~s D No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch? ~s n No
3 Water Supplies (See Item 16) -
a. Was a water flow test of main drain made at the sprinkler riser(s)?,.2"'!es D No
4 Tanks, Pumps, Fire Department Connections
a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained? DYes DNa rtt:i/ A
b. Are fire department connections in,?3tisfactory condition, couplings free, caps in place, and check valves ti~t? D-~S uNo u N/ A
Are they accessible and visible?--tJ Yes D No D N/ A
5 Wet Systems
a. Are cold weather valves (0.5. & Y.) in the appropriate open or c~d position? DYes
b. Have antifreeze system solutions been tested? l! Yes 0 No,~ NJ A
c. Were the antifreeze test results satisfactory? DYes D No r;.;..N!A
d. In areas protected b);:)Net system(s), does the building appear to be properly heated in all areas, including b~cs and perimeter areas
where accessible? ..ci Yes uNo 0 Nj A Do all exterior openings appear to be protected against freezin~ Yes 0 No [] Nj A
6 Dry System (See ltenis 11 to 13) ,
a. Are dry valves (s) in service? DYes D No D N/ A
b. Are the all' pressures and priming water levels in accordance with the manufacture's instructions? DYes n No u Nj A
c. Hastheoperationoftheairornitrogensuppliesbeen~r DYes DNo DN/A Are they in service? DYes DNo DN/A
d. Were all know low points drained 4~g this ~tion? DYes D No D N/ A
e. Did quick-opening devices operaJ;ll'Sapsfactorily? DYes D No fl N/ A
f. Did the dry valve(s) trip pr<;>petly di.lr;iR~the trip pressure test? 0 Yes 0 No u Nj A
g. Did the heating equipment in the dry-pipe valve room(s) operate at time of inspection? DYes D No D Nj A
7 Special Systems (See Item 14) ,
a. Did the deluge or pre-a~J:iOn valves operate properly during testing? DYes uNo 0 Nj A
b. Did the heat-respon$v'e devices operate properly during testing? 0 Yes D No 0 N/ A
c. Did supervisory d6ices operate during testing? DYes 0 No D Nj A
8 Alarms -
a. Did water motor(s) and gong(s) test satisfactorily? DYes D NoJd"N/ A
b. Did electric alarm(s) test satisfactory? 3'~ 0 No 0 Nj A-
c. Did supervisory alarm service te.st-s1i""tisfactory? .%Yes D No [] N/ A
9 Sprinklers /
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to sp~ischarge? ,--rj'Yes D No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing~es D No //
c. Are quick response and residential sprinkl~rs less than 20 years old? (Older sprinklers require sample testing) "aYes ,..,6'No D Nj A
d. Is stock of spare sprinklers available?~s 0 No . '
e. Does the exterior condition of sprinkler system appear to be satisfactory? ~ l! No
f. Do visible sprinklers appear to be of proper temperature rating for their locations? I.J>'es D No
10 Explain any "No" answers and comments:
Date
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N/A = NOT APPLICABLE
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No ,.rN/ A
Signature:
Date:
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(Rev.2/8/rh)
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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 mul~ple
systems ! '
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Inspection-Report i
No. '
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)
DRY PIPE
OPERATING
TEST
DRY VALVE TRIP TEST TABLE 0.0.0.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
Time to Trip Water Air Trip Point Time Water Reached Alarm Operated
11rru T es t Pipe Pressure Pressure " Air Pressure -' Test Outlet Properly
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MIN. SEe. PSI PSl \ PSI .. MIN. SEe. YES NO
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(See Trip Test Table which follows)
TRIP TEST TABLE
14 Date deluge or preaction valve tested
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DELUGE &
PRE ACTION
VALVES
Operation D PNEUMATIC D ELE0RIC D HYDRAUliC
Piping Supervised DYES DpIO IDetecting Media Supervised 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 testi~' DYES D NO IMethod of Testing Circuits
/ Does each circuit operate Does each circuit Maximum time to
MAKE ~()DEL supervision loss alarm operate valve release operate release
. YES I NO YES I NU YES I NU
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15 See Control Valve Maintenance Table
Explain
Abnormal
Control Valves Number Tvve Open Secured Closed Signs Condition
City Control Valves i if / ,/ f " '"
Bypass Valves '"
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves " .'"
Other Control Valves ',' .. /
,~n Control Valves ;/> ;
CONTROL VALVE MAINTENANCE TABLE
16 Water Flow Test at Sprinkler Riser
Water Supplv Source: City Tank Pump
Residual
Test Pipe Size of Static (Flow)
Date Location TestPiue Pressure . Pressure
Last Water Flow Test .. ,
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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:
Date:
(Rev, 2/8/06)
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