HomeMy WebLinkAboutFire Sprinkler Inspection 2/8/2006
AUTOMATIC SPRINKLER CO.
1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651) 558-3300 . (800)-229-6263
FAX: (651) 558-3310
.1t.NO
SHEET 1 OF 2 . Use separate sheet for each building inspection
AGREEMENT & REPORT OF INSPECTION 5'
INSPECTION # i Y <. I ::5 3-
MINNESOTA LICENSE NO. C005
REPORT TO S-t, VV\ \ c \v:, ~ \ ?cu I <"'1.
STREET 110 ~ \ \ D '--' \ v\--\. ; A.,....
CITY & STATE VI \. r LA \( t;:
C~F l"-.e..
S,e.
BUILDING OR LOCATION S. ~~
INSPECTOR ~,-,) "
d-.-B - O~
.
\49 V'> / '--'\
itVl ....,
DATE
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: n<,,::) l/\ ..p
B. Describe fire protection modifications made since last inspection.
V'\C(A--P
"" ~"v' -f'
C. Describe any fires since last inspection.
D. When was the system piping last checked for stoppage, corrosion or foreign m~terial?
E. When was the dry-piping system last checked for proper pitch? /V J A-.
F. Are dry valve. s a quatel)7lrotected from freezing? " ) \.....1-
Signature / ._ '" 7' f~- _r~ Title
Date d -8' -06
Inspector's Section (All responses reference current inspection)
1. General
a. Is the building occupied~es [] No
b. Are all systems in service?;;-rYes n No
c. Does there appear to be a minimum of 18 in. (457 mm) clearance between the top of the storage and the sprinkler det1ectors:LJ.J--Ves II No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? [] Yes I] No. j.,J-NA
2. Control Valves (See Item 15.)
a. Do sprinkler system control valves appear to be in the appropriate open or closed position? 2'Yes I J No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch?y.....es No
3. Water Supplies (See Item /6.)
a. Was a water t10w test of main drain made at the sprinkler riser(s)?j.J--'(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? LJ Yes I No ~A
b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight~Yes No I I NA
Are they accessible and visible?yYes UNo n NA
5. Wet Systems
a. Are cold weather valves (O.S. & Y.) in the appropriate open or closed position? [] Yes I I No )A-NA
b. Have antifreeze system solutions been tested? DYes L.I No r.mA
c. Were the antifreeze test results satisfactory? !] Yes U No ~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? I'}-'f'es [1 No [J NA Do all exterior openings appear to be protected against freezing? j.j-Yes I I No NA
6. Dry System (See Items // to /3.)
a. Are dry valve(s) in service? U Yes [J No ~A
b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions? 1.1 Yes I! No .H-'NA
c. Has the operation of the air or nitrogen supplies been tested? I ] Yes. U No ~A Are they in service? I I Yes : No y-NA
d. Were all known low points drained during this inspection? 1"1 Yes !.] No l5NA
e. Did quick-opening devices operate satisfactorily? [] Yes [] No .B'NA
f. Did the dry valve(s) trip properly during the trip pressure test? [] Yes [] No y;rNA
g. Did the heating equipment in the dry-pipe valve room(s) operate at time of inspection? n Yes
7. Special Systems (See Item 14.)
a. Did the deluge or pre-action valves operate properly during testing? DYes U No !~A
b. Did the heat-responsive devices operate properly during testing? [J Yes D No ~A
c. Did supervisory devices operate during testing? [] Yes n No ~A
8. Alarms ~
a. Did water motor(s) and gong(s) test satisfactorily? U Yes D No J.6 NA
b. Did electric alarm(s) test satisfactory?z(Yes n No [J NA
c. Did supervisory alarm service test satisfactory?~es [] No 1 I NA
9. Sprinklers
.a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? A es L.I No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing)~es n No
c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing)~s I I No [] N/A
d. Is stock of spare sprinklers available? 9"f es [J No ../
e. Does the exterior condition of sprinkler system appear to be satisfactory ?.('J Yes D No
f. Do visible sprinklers appear to be of proper temperature rating for their locations~es LJ No
10. Explain any "No" answer and comments: <)C "yl e '. ,> k \ I '. C:-:--' y c '- 1-t\. f '..C ~.... .,
NA =NOT APPLICABLE
No yrNA
r........ . -. _ \
t-'c{ , f"~ c) .-
j '.::. c. c'\ \ '\
<::. '""' IC \ I <:.
),,",.. ..>
~ ~lL
J.> '-7
I .-' v
p\-'~o'"\\
.1
""'"'-"i..'
,.... ..~. ( '-' u
Signature:
Date:
.~
- R - 0 l:J
,.~
AUTOMATIC SPRINKLER CO.
1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651) 558-3300. (800)-229-6263
FAX: (651) 558-3310
..t.NC5
SHEET 2. OF 2 - Use separate sheet for each system inspection
System No. or Description if multiple
systems
/ - 2 ' I t.v€' +-
Inspection Report
No. 51 '-l 93"3>
11. Date dry-pipe valve trip tested (control valve partially open) (See Trip Test Table which follows)
12. Date dry-pipe valve trip 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.
f~
MAKE MODEL SERIAL NO. I MAKE I MODEL SERIAL NO.
I I
DRY PIPE Time to Trip Water Air Trip Point Time Water Reached Alarm Operated
OPERATING Thru Test Pipe Pressure Pressure Air Pressure Test Outlet Properly
TEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
Without
0.0.0.
With
0.0.0.
deluge or preaction valve tested (See Trip Test Table which follows)
TRIP TEST TABLE
Operation D PNEUMATIC D ELECTRIC D HYDRAULIC
Piping Supervised DYES D NO I Detecting media supervised DYES D NO
DELUGE & Does valve operate from the manual trip and/or remote control stations DYES D NO
PREACTION Is there an accessible facility in each circuit for testing Method of testing-circuits
VALVES DYES D NO
Does each circuit operate Does each circuit Maximum time to
MAKE MODEL sUDervision loss alarm one rate valve release one rate release
YES I NO YES I NO YES I NO
I I T
ontrol Valve Maintenance Table.
Control Valve Mamtenance Table
(V~
14. Date
15. See C
Explain
Abnormal
Control Valves Number Ty~ Open Secured Closed Signs Condition
City Control Valves I "Plv - _. -
Bvpass Valves
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves 1~2~ IS.\=- - - -
Other Control Valves
Kitchen Control Valves
16. Water Flow Test at Sprinkler Riser
Water Su ly Source:
Date
Tank
Size of
Test Pipe
Static
Pressure
Pump
Residual
(Flow)
Pressure
Last Water Flow Test
This Water Flow Test
-B-Dlc
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:
f\
I ') S
/ .- /~~
!
Date:
~ _ c"; _ C'; i
,6 r, .' '0