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� �� . _ / � 1301 L'ORIENT STREET � V, �1 N G ST. PAUL, MINNESOTA 55117 � (651)558-3300 • (800)-229-6263 ' AUTOMATIC SPRINKLER CO. FAX: (651) 558-3310 SHEET 1 OF 2-Use seQarate sheet for each building inspection REPORT OF INSPECTION MINNESOTA LI('ENSE NO. C00005 WISCONSIN LICENSE NO. 265989 REPORT TO `' a:'. ��`" ��'��' ''✓�� a- BUILDING OR LOCATION �''? ' � STREET � ;��k��x �:p INSPECTOR ;��~.�� ,-F' "S' _ .��. CITY & STATE Il �►�'�-t'-P� j;��`�.1 }`i �'� �'- DATE E — � � ';;,' Owner's Section (To be answered by Owner or Occupant) A. Explain any occupancy bazard changes since the previous inspection: � �` B. Describe fire protection modifications made since last inspection. 'F C. Describe any fires since last inspection. �ON�_ f D. When was the system piping last checked for stoppage, conosion or foreign material? E. When was the dry-piping system l,�st checked for proper pitch? ,_ �, F. Are dry valves ad ely proteCted from freezing? �; Signature -" " �'=�-� Title y` 'r` � Date , �' Inspector's Section (All responses reference current inspection) NA =NOT APPLICABLE 1. General a. Is the building occupied?'�Yes ❑No b. Are all systems in service?�Yes ❑ No � �'' � c. Is there a minimum of 18 in. (457 mm)clearance between the top of th storage and the sprinkler deflectors?�Yes ❑No �'' d. Does all electrical heat tape appear to be satisfactory?❑Yes ;=No �NA =` e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?Ll Yes ❑No. �NA � 2. Control Valves (See Item I5.) �� a. Are all sprinkler system contro] valves and all other valves in the appropriate open or closed osition?C�es ❑No * b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?�Yes ❑No .� � 3. Water Supplies (See Item 16.) � a. Was a water flow test of main drain made at the sprinkler riser(s)`�l Yes ��No 4. Tanks;Pumps, Fire Department Connections a. Are fire pumps,gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?f7 Yes ❑No f�„�GA � b. Are fire department connections in atisfactory condition, couplings free,caps in place, and check valves tight?.�Yes ❑No ❑NA Are they accessible and visible?I�Yes !1 No ❑NA 5. Wet Systems a. Are cold weather valves(O.S. &Y.) in the appropriate open or�d9sed position?C�Yes C No L]NA � _��`� �� n r b. Have antifreeze system solutions been tested?- Yes LJ No L�NA c. Were the antifreeze test results satisfactory?��Yes ❑No C�IA � - d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including b�ind attics and perimeter areas where accessible?�Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?�c't'es ❑No ❑NA �°�' 6. Dry System (See Ltems 11 to 13.) %�� a. Are dry valve(s) in service?C7 Yes ❑ No �NA b. Are the air pressures and priming water levels in accordance with the manufacturer's instruc[ions?C� Yes ❑No �NA � c. Has the operation of the air or nitrogen supplies been tested?L7 Yes �-:No L�NA Are they in service?L7 Yes C7 No [�NA �'`` d. Were low points drained during this inspection?'= Yes �i No �VA �' r � e. Did quick-opening devices operate satisfactorily?�Yes �]No �NA � p, f. Did the dry valve(s)trip properly during the trip pressure test?C-!Yes I�No �A == r��`,� � � g. Did the heating equipment in the dry-pipe value room(s) operate at time of inspection ?'� Yes `��No ]�NA `a�'�� '�� ; ��`�"� 7. Special Systems (See/tem 14.) � "'�`s � a. Did the delu e or re-action valves o erate ro erl durin testin �CJ Yes ❑No � � ��-��`: g P P P P Y � g• `�NA �- �, r �. � b. Did the heat-responsive devices operate properly during testing?�❑�}'es ❑No �,�'NA `.� �� � �� � c. Did supervisory devices operate during testing?I !Yes ❑No I_i�NA � ,s.; �� ' �' �` �� . �w 3'" a 8. Alarms � , � -� �;, � k, �. �' �� a. Did water motor(s)�and gong(s)test sarisfactorily?❑Yes ❑No NA� �' _ ' �� ` � �" b, Did electric alarm(s)test satisfactory?�Yes ❑No ❑NA � ;>..�,k� �.�,?_ ,;°� �- �� 's�� � _� ��_ _ ..-a:�^�.��__" � � ,�, �,; c. Did supervisory alarm service test satisfactory? 5�,'Yes ❑No ❑NA � � �� ''"�`"� � �� 9. Sprinklers 3 � ,�`°'"�'+ , ; a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?L�Yes �!No �°' � b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)�1'es C No a �; � c. Are quick response�and residential sprinklers less than 20 years old?{Older sprinklers require sample�testing)��`�es �� i No ,� �"� d. Is stock of spare sprinklers available?I�Yes ❑ No �� e. Does the exterior condition of sprinkler system appear to be satisfactory ?'�Yes ❑ No f. Are sprinklers of proper temperature rating for their locations?i�Yes I No 10. Explain any "No" answer and comments: � �� �� ` :�� � . ° }-- ?.,. Signature: ' ' Date: ' � :�