HomeMy WebLinkAboutBuilding Permit 8/15/2005
SUMMIT FIRE PROTECTION
7301 APOLLO COURT. LINO LAKES, MN 55014. (651) 251-1880
3026 40TH AVE.NW. R{)CHESTER, MN 55901. (507) 280-0622
418 GREAT OAK DR., WAITE PARK, MN 56387 . (320) 257-6390
760 LIBERTY WAY, NORTH LIBERTY, IA 52317. (319) 665-4330
SHEET 1 OF 2 - Use separate sheet for each building inspection
REPORT OF INSPECTION
MINNESOTA LICENSE NO. C0075
JOB NUMBER
"" .,>iI' <''''
INSPECTION NAME
STREET ! i~~)
CITY & STATE
t:::""ll''',''-). .,r::- I -' ,..
10 ~ r..,t- Ji t-". ;'"~
,
...
'. ../'..
'.~ ; .~
B UILDING/LOCATION
INSPECTOR'
DATE '.f.:"
I
."._0"""'.
f")
-
"
" -'
v."jl , ) ,
.. "
:: ,,/ ~~
,-
;/ ,.
Owner's Section (to be answered by Owner or Occupant) ,
A. Explain any occupancy hazard changes since the previous inspecti~:
. I
(
I
B. Describe fire protection modifications made since last inspecti~n: I
\
~
\ (
;,J
/-
.t_
....,)'~..".
C. Describe any fires since last inspection:
,
I
I
\. l
..,,'"
D.
E.
..F.
When was the system piping last checked for stoppage, corrisihn of foreign material?
When was the dry-piping systemlast checked for proper pitch?
Are dry valves adequately p~otected from freezing?
Signature
(",''''''''
'. '-" I
""~'~.S~tioil (All responses reference current inspection)
a. Is the building occupied? EJ)'es D No
b. Are all systems in service? [2fYes D No
c. Is there a minimum of 18 in. (457 mm) clearance between the top of the storage and the sprinkler deflectors? Ja'Yes D No
d. Does all electrical heat tape appear to be satisfactory? DYes D No .B1:NA
e. Does the hand hose or standpipe on the sprinkler system(s) appear to be satisfactory') DYes D No .0 NA
2. Control Valves (See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position') DYes D No
b. Arc all control valves in the open position locked, sealed or equipped with aJf.l[T1p~U.~ili:t1]___OYes D No
3. Tanks, Pumps, Fire Department Connections ' "
a. When was fire pump last tested for performancc') ...
b. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained') DYes
c. Are fire department connections i\l.l~atisfactory condition, couplings free, caps in place, and check valves tight')
Are they accessible and visible') [j-Yes D No DNA
4. Wet Systems
a. Are cold weather valves (OS & Y) in the appropriate open or closed position? DYes D No J(LNA
b. Have antifreeze system solutions been tested? DYes D No ~ !
c. What temp is antifreeze') .----.'.
d. In areas protected by wet system(s), does the buildingil.PJ2Sar to be properly heated in all areas. including blind attics and pcrimeter arcas
where accesSihle'). ~ '..<:)s D No D NA --,--
5. Dry System (See Ittlfns II 10 13)
a. Arc dry valve(s) 'in service? DYes D]\<o D NA
b. Arc the air pressures and priming water levels in accordance with the manufacturer's instructions'? DYes D No D NA
c Has the operatIOn of the atr or ~J1.ro$en ,~upphes been tested') DYes D No D NA Are they 111 servICe) DYes D No DNA
d. Were low p01l1ts draIned dunn, th~s 1I1spectlOn) DYes D No D NA How many')
e. DId qUlck-open1l1g deVICes o~:ate satlsfactonly) DYes D No D NA
f. Did the dry valve(s) tnp'prqgerly dur1l1giTie trip pressure test? DYes D No DNA
g. DId the heat1l1g equIpment l'n the <;Jry-pipe value room\s) operate at time of 1I1spectlOn) DYes D No DNA
6. Special Systems (See Item 14.) ,
a. Did the deluge or pre-action valves;operal>e properly during testing') DYes D No D NA
b. Did the heat-responsive devices,'i;,perate properly during testing) DYes D No D NA
c. Did supervisory devices opera~t djJring.~ting') DYes ::J No DNA
d. Did flow for kitchen hood syf/.eri shll,t ofif gas or electric') DYes D No D NA
7. Alarms '
a. Did water motor(s) and gong(s) test satisfactorily') DYes D No ~NA
b. Did electric alarm(s) test satisfactory? Z]Yes D No DNA
c. Did supervisory alarm service test satisfactory'? ~Yes D No D NA '77.,1
d. Did tamper swithces test satisfactory') ~Yes D No D NA
8. Sprinklers
a. Are all sprinklers free from corrosion, loading or ohstruction to spray discharge') .DYes D No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) ,r]Ycs 0 No .
c. Are quick response and residential sprinklers less than 20 years old') (Older sprinklers require sample testing) ./[]Yes 0 No
d. Is stock of spare sprinklers available') Q'jYes D No .
e. Docs the exterior conditioI\ of sprinkler system appcar to he satisfactory') C'JYes [J No
f. Arc sprinklers of proper temperature rating for their locations" 12!Yes D No
g Arc any sprinklerheads on a recall list" DYes ~ J\o
Title
Date
NA =NOT APPLICABLE
D No [2J.:NA
J&:Yes D No D NA
.",":
,.....-"'~",,"'~ -t -::?
Date:
<:.
.-
Signature:
'7'
SUMMIT FIRE PROTECTION
7301 APOLLO COURT. LINO LAKES, MN 55014. (651) 251-1880
3026 40TH Av~ N..w.. Jl.OCHESTER, MN 55901 . (507) 280-0622
418 GREAT OAK DR., WAITE PARK, MN 56387. (320) 257-6390
760 l,IBERTY WAY, NORTH LIBERTY, IA 52317 . (319) 665-4330
SHEET 2 OF 2 - Use separate sheet for eachsystem inspection
.'"':,.~,., ....
,;(,. ... :c"" ",' ~
I
Type of System I
How Many?
WhatSize? ,i ,
Flow Swi~C~lOr,:":V- '.
Alarm€heck with Pressure Switch
Inspection Name and Number
~' ,;-_~'-j....,t jf;'~~ i;:,~)(;
.'
.'
~~ "
9.
10.
11.
Date dry-pipe valve trip tested (control valve partially open) . l (See Trip Test Table which follows)
Date dry-pipe valve trip tested (control valve fully open) i..,j .A- (See Trip Test Table which follows)
Date quick-opening device tested (See Trip Test Table which follows)
DRY VALVE TRIP TEST TABLE 0.00.
MAKE MODEL SE~IAL NO ..' ! MAKE I MODEL SERIAL NO,
I I
DRY PIPE Time to Trip Water Air Tnp 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 f
000 '~..,....~" ~-,,- -<,......'"
With
OOD.
,_..>,
f""" (See Trip Test Table which follows)
deluge or preaction valvc tested I
-' ~-" TRIP TEST TABLE
Operation o PNEUMATIC 0 ELECTRIC o HYDRAULIC
Piping Supervised DYES 0 NO I Detecting media supervised DYES o NO
DELUG E & Does valve operate from the manual trip and/or remote control stations DYES o NO
PREACTION Is there an accessible facility in each circuit for testing Method of testing~cl~cuits
VALVES o YE:;1 o NO
1,/ Does each Circuit operate Does each circuit Maximum time to
MAKE MODEL sunerVISlon loss alarm one rate valve release one rate release
"0.... _r'. YES I NO YES T NO YES I NO
I "~~ I I I
I
12. Date
13. See Control Valve Maintenance Table.
Control Valve Maintenance Table
Control Valves ~umber Type
C'tyv~~~nec~'~n contro~__ -/~~L~
Tank Control Valves I
Pump Contro'l Valves - _.--~__ !
Sectional Control Valves i I
System Control Valves -=r-:::~--i-:" ,"
Other Control Valves i
'-K;rell\'".,~ontrol Valve ;:::'L. -t-~
I fl, Water Flow Test at Sprinkler Riser
W'lt'r Supply Sour'"
Open
See u red
Closed
Signs
Explain
Abnormal
Condition
l,""~":?
" . ~.".
~~
;'.:,
------r--
I
=~~
i)4'~\ !
,
, i =-t :, .'~
y~
'.-........
Cit,,' \
Tmk
Pump
, C u:, ) j ,
Date --''fe'!ifPi pc Size of Static Residual Differential
Location Test Pipe Pressure (Flow)
Pressure
Last Water Flow Test i.. -' ..J,. , I.;' .~...", .,.i .' i~i' ! "
. " -- , '"
This Water Flow Test ,;.\'l j 'J)-r'" ;;7. ' .. ''''1';:::' .,/
" . .' \:-'~" ;~
.... ;
14. Explain any "No" answers and comments: /V..
; v'
....,~
.J
. .I
..,..,.....
"" ""..;-
..
)
-.)
Date:
\. ..
I /.
.' ;'
.,..,-"
Signature:
\.."\
...........