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SUMMIT FIRE PROTECTION
7301 APOLLO COURT' LINOLAKES, MN 55014' (651) 251.1880
3026 40TH AVE. NW. ROCHESTER. 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 - se separate sheet for each building inspection
REPORT OF INSPECTION
MINNESO A LICENSE NO. C0075 JOB NUMBER Gt/t'/ ~
N NAME PALL! AI/c-OL.U'7 ;t)G/J/CAt. (;e-,(/7'&R. BUlLDINGILOCATION 5A/11('?"
INSPECTOR D {)oeUfrl-r;.A,,~/J
DATE :5 -3'/-0,":;-
INSPECTI
STREET
CITY & ST TE ~ JOR. L..A t't57 /11M
Owner's See ion (to be answered by Owner or Occupant)
A. Expl in any occupancy hazard changes since the previous inspection:
B. Desc 'be fire protection modifications made since last inspection:
C. Desc ibe any fires since last inspection:
D. Whe was the system piping last checked for stoppage, canisian of foreign material?
E. Whe was the dry-piping system last checked for proper pitch?
F. Are ry valves adequately protected from freezing?
Sign lure Title
Date
Inspector's eetion (All responses reference current inspection)
1. General
3. Is the uilding occupied? ~es D No
b. Are all systems in service? ~es D No
c. Is ther a minimum of 18 in. (457 mm) clearance between the top of the storage and the sprinkler deflectors? C8:(es D No
d. Does I electrical heat tape appear to be satisfactory? DYes D No [RNA
e. Does t e hand hose or standpipe on the sprinkler system(s) appear to be satisfactory? DYes D No ~A
2. Control alves (See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position? ts:Yes D No
b. Are all control valves in the open position locked. sealed or equipped with a tamper switch? l)(:ies D No
3. Tanks, P mps, Fire Department Connections
a. When as fire pump last tested for performance? A/Ii
b. Are fir pumps, gravity tanks. reservoirs and pressure tanks in good condition and properly maintained? DYes D No ~A
c. Are fir department connections in satisfactory condition, couplings free, caps in place, and check valves tight? ~es D No DNA
Are they ccessibJe and visible? ~es D No DNA
4. Wet Syst illS
a. Are co d weather valves (0.5. & Y) in the appropriate open or closed position? DYes D No ~NA
b. Have ntifreeze system soluti,o.ll}4 been tested? DYes D No ~NA
e. What t mp is antifreeze? 4v1
d. In are s protected ~ .wet system(s), does the building appear to he properly heated in all areas, including blind attics and perimeter areas
where ac essible? ~es D No DNA
5. Dry Syst m (See Items I J to J )
a. Arc d valve(s) in service' DYes NA
b. Arc th air pressures and r" ing ter Ie . in accordance with the manufacturer's instructions? DYes D No DNA
c. Has th operation of the ir r nit gen ies been tested? DYes D No DNA Are they in service? DYes D No DNA
d. Were I w points drain ding is i Yes D No D NA How many?
e. Did q ick-opening d ice: ope le s sf orily? DYes 0 No DNA
f. Did th dry valve(s rip pr y d ng th trip pressure test? DYes D No DNA
g. Did th heating e ipment. the y-pipe alue room(s) operate at time of inspection? [JYes D No DNA
6. Special ystems (See Item 14.
a. Did th deluge or pre-action v
b. Did th heat-responsive devi
c. Did su ervisory devices 0 ra
d. Did fl w for kitchen hoo sys
7. Alarms
a. D~d w ter.motor(s) and gon~(s) test satisfactorily? DYes D No }l.NA
b. Old el ctnc alarm(s) test satIsfactory? ~es [J No DNA
c. Did su ervisory alarm service test satisfuetory'? 5ltes D No DNA
d. Did ta per swithces test salisfactory'? ~es 0 No DNA
8. Sprinkle s
a. Are al ~prinklers free from corrosion. loading o~ obstructio~ to spray disc~arge? _ iCIY. es _D No
b. Are sp mklers less than 50 years old? (Older spnnklers reqUire sample testmg) ~es 0 No
c. Are 4 ick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing) ~es D No
d. Is stoe of spare sprinklers available? ~es D No
e. Does t.e exterior condition of sprinkler syst~m aPrear tobe satisfactory? ~es D No
r. Are sp mklers of proper temperature r g tor their locatIOns? ~es D No
g. Are~Y s 1 I eads on a recall r ,.t'? DYes ~()
Signalur : Date 3-3 J ~{)S
,
~__ ._._.<_.",_.__._._...__, "'.__.",.'....,~_...,^','~__.,.~_.<~.._ ~._.,_,~'".....,.7.."..~..,_..,
NA =NOT APPLICABLE
roperly during testing? DYes DNa DNA
riy during testing? DYes D No 0 NA
c ing.' DYes D No D NA
lo gas or electric? DYes D No DNA
, . SUMMIT FIRE PROTECTION
7301 APOLLO COURT' LINO LAKES, MN 55014' (651) 251.1880
,;J026 40TH AVE. NW. ROCHESTER, 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 2 OF - Use separate sheet for eachsystem inspection
LAKE
..w
9
10.
11.
Date dry- ipe valve trip tested (control valve partially open) (See Trip Test Table which foi/ows)
Date dry- ipe valve trip te~ted (control valve ri" open) . /.1 J (See Trip Test Table which follows)
Date quic -opening device tested ---;r7 (Se~ Tdl TestT;lte which loi/ows)
DRY VALVE II TQ(P TESV#AIl E QOD
MAKE /.&00 L I SoRIAL NO. ,r. MAKE I MODEL SERIAL NO
71 1.LL1 I
~:~
o Y PIPE
OP RATING
EST
Time to Tri;7
Thru Test Pip,;
MIN. S
/
tar I prt~ Trip Point Time Water Reached Alarm Operated
Pr ssure irPressure Test Outlet Properly
SI SI PSI MIN. SEC. YES NO
/ /I .... -L. . '1'- . I> ... .
Without
0':0.0.
With
0.0.0
DE UGE &
PR ACTION
V LVES
/" (Se~Jtf~~s~ which loi/ows)
1/ TRIP T "ST TA ~E
Operation 0 PNEUMATICI ELECTRIc! 0 H'rUlAULlC
Piping Supervised 0 YES 1/ NO -TT Detecti~dla supe ised
Does valve operate Irom the man# trip andil>r remote !tintrol stat
Is ~here an aGcessible facility in)lch circuit #Jr testinq/' /^ Meth d of testing-circuits
DYES 1/ 0 N 1 II \.
/}c Do"'" each circuitMerate
ODEL s'~erVlslon lossRrm
/ YES II NO
77 C; T
T
DYES
DYES
DNa
DNa
'.
12. Date deluge or preaction valve tested
MAKE
l~~:r t~a~:I~:~~:~ase
"ES I NO
I
Maximum time to
oneratereiease
YES I
I
,
NO
13. See Cont 01 Valve Maintenance Table.
Control Valve l\laintenance Table
Contro Valves
City ConnEtctiQ(l C9Mt!.ol
Valve
Tank Control V tves
Pump Control alves
Sectional Contr I Valves
System Control Valves
Other Control Vives
Number Type
/ klfl V
I
Open
Secured
Closed
Explain
Abnormal
Signs Condition
yt:"5 A/tJ/$
'7'~
yes
/1)0
7
7rJZ'j' Ye-s-. Ye~' -Jl#)
A /A/~.
Kitchen Control Valve
16. Water Fl w Test at Sprinkler Riser -~~v )
Water Suppl Source: Tank Pump
./ "- Date "Test Pipe Size of Static Residual Differential
Location Test Pipe Pressure (Flow)
Pressure
Last Water FI w Test 2f1 74- r::J? Co
This Water FI w Test 'Z::"?/-:rg -YJ<;i;Z ~If 72 ,-'.. c;;,7 .<>
14. Explain thy "No" answers and comments: A/t'J/I/G
'."
"
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Date:
}-3/-05