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<br /> � `' ��F 1301 L'ORIENT STREET �"`�` �` `� '
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<br /> � 1 �1 N G " ST. PAUL,MINNESOTA 55117 -' ,�- ��
<br /> , -��� '- (651)558-3300 • 800-229-6263 �- ��
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<br /> " AuronMnc S�N�R CO. FAX: (651)558-3310) "�� :°' � �
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<br /> SHEET 1 OF 2-Use separate sheet for each building inspection �pORT OF INSPECI'ION
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<br /> ��t � MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989 �
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<br /> �}�'�{� REPORT TO �� C/��5 Sc,�.�%��,� UN�:.�r BUILDING OR LOCATTONC;2 �'/J Y 1 {�S�
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<br />` ��y` � STREET 3� 3 ? S ff o�e c �1�.J�= D,� , � i.i, '
<br /> INSPECTOR � 'i��T �.��!�I; i
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<br />� �' CITY & STATE J"1,': ,�'�, f- h. � , a, ; ,, DATE /_. i , y-,'�
<br /> 3�a Owner's Section(To be answered by Owner or Occupant) �
<br /> � A. Explain any occupancy hazard changes since the previous inspection: ?�'
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<br />�' B. Describe fire protection modifications made since last inspection. �
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<br /> C. Describe any fires since last inspection. -
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<br /> �' �' � D. When was the system piping last checked for stoppage, corrosion or foreign material? '�_
<br /> � �; �- E. When was the dry-piping system last checked for proper pitch? �
<br />����>. ; F. Are dry valves adequately protected from freezing? ��
<br />� Signature Title Date �
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<br /> Inspector's Section (All responses reference current inspection) NA =NOT APPLICABLE
<br />� 1. General ��
<br />�.�,� ;7�,. a. Is the building occupied?�Yes ❑No � .
<br />� � �F+` b. Are all systems m serv�ce?�Yes ❑No ` ��;�
<br />�� c. Is there a minimum of 18 in. (457 mm)cleazance between the top of the storage and the sprinkler deflectors?j3�i''Yes ❑No a��
<br /> d. Does all electrical heat tape appear to be satisfactory?❑Yes ❑No �jNA ��'�
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<br /> a " � e. Does the hand hose on the sprinkler system(s)appear to be satisfactory?O Yes ❑No. [�NA � f r
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<br /> �, 2. Control Valves(See Item IS.) a�,'
<br />�° � a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?,�Yes ❑No
<br />� ��`� b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?�Yes ❑No �r;
<br /> 3. Water Supplies(See Item 16.) '" `f � �`
<br /> a. Was a water flow test of main drain made at the sprinkler riser(s)?'�Yes ❑No ` p ,_
<br /> 4. Tanks, Pumps,Fire Department Connections �
<br /> " a. Are fire pumps, gravity tanks,reservoirs and pressure tanks in good condition and properly maintained?❑Yes ❑No �NA �'
<br /> �;� b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight?�Yes ❑No ❑NA ���
<br /> Are they accessible and visible?�Yes ❑No ❑NA �� ;�
<br /> � 5. Wet Systems ��
<br /> a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position?❑Yes ❑No L�NA
<br /> b. Have antifreeze system solutions been tested?❑Yes ❑No �NA
<br />� � c. Were the antifreeze test results satisfactory?❑Yes ❑No '�NA �
<br /> d. In areas protected by wet system(s),does the building appear to be properly heated in all azeas,including blind attics and perimeter areas �
<br />� where accessible?❑Yes �No ❑NA Do all exterior openings appeaz to be protected against freezing?❑Yes �No ';�NA
<br />�= 6. Dry System(See Items I1 to 13.) �
<br /> �: a. Are dry valve(s)in service?❑Yes ❑No �`NA �� � �
<br /> r� b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions?❑Yes ❑No F�'NA � �
<br />��= c. Has the operation of the air or nitrogen supplies been tested7�J Yes ❑No Bl NA Are they in service?❑Yes ❑No C�NA
<br />� d. Were low points drained during this inspection?❑Yes ❑No �NA -.=���,��
<br />�."� e.Did quick-opening devices operate satisfactorily7 O Yes ❑No J�NA ���
<br />� f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes ❑No ,�NA " �
<br /> g. Did the heating equipment in the dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No `J,�( NA '�-' �"`�:�
<br /> S� � 7. Special Systems (See Item 14.) - �''`*�`
<br />� '* � a. Did the deluge or pre-action valves operate properly during testing?❑Yes ❑No .�NA ;.w. �' ' � � �
<br /> b. Did the heat-responsive devices operate properly during testing?❑Yes ❑No S(NA �� .� �
<br />� c. Did su erviso devices o erate durin testin �f_�Yes ❑No �NA �" ` '�
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<br /> 8. Alazms - 5. ¢ �:� .�.'
<br />� ; a. Did water motor(s) and gong(s)test satisfactorily?❑Yes ❑No �'NA " �� �, ; ,
<br /> b. Did electric alarm(s)test satisfactory?�Yes �No ❑NA ;'�'�'`�r � � ` �
<br /> ���� c. Did supervisory alarm service test satisfa tory?T�Yes ❑No �NA x,._ ;: .�* .�,�
<br />� - 9. S rinklers
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<br />„�j � a. Are all sprinklers free from corrosion, loading or obstruction to spray dischazge ?[�Yes ❑No a" :. � �.�
<br />�� a��- b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)�Yes ❑No �.;�
<br />��'���'� c. A r e q u i c k r e s p o n s e a n d r e s i d e n t i a l s p ri n k l e r s l e s s t h a n 2 0 y e a r s o l d?(O l d e r s p ri n k l e r s r e q u i r e s a m p l e t e s ti n g�l Y e s ❑N o �
<br />� d. Is stock of spare sprinklers available 7�f Yes �No
<br />��.�- ' e. Does t he ex terior con di tion o f sprin k fer sys tem appear to be sa tis fac tory ?�3 Yes ❑No
<br /> = f. Are sprinklers of proper temperature rating for their locations?,�Yes ❑No �',
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<br />�� � 10.Explain any "No"answera�d comments:
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<br /> Signature: /�� .ti--� �' - ---r�-�--�c--'' Date: -
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