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<br />�� ; VIKING AUTOMATIC SPRINKLER COMPANY �� 1��a �`�`�;
<br />� �� 2400 ROSE PLACE • ST. PAUL, MINNESOTA 55113 • (612) 636 4680 • 1-800-229-6263 w11+�1X:�612) 636-4685 ����
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<br /> � SHEET 1 OF 2-Use se arate sheet for each buildin ms ection �� ��r`
<br />� '�d. P 9� P � v�i �,�i'1V� '+- "��
<br />� RF,PORT OF INSPECTION ���
<br /> MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. SC0000115 �
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<br /> REPORT TO BUILDING OR LOCATION � �
<br /> STREET INSPECTOR � ��
<br /> x ' CITY & STATE DATE � `` �
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<br /> Owner's Section (To be answered by Owner or Occupant) ��.�.
<br /> '�F` ' A. Explain any occupancy hazard changes since the previous inspection: ��
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<br />� B. Describe fire protection modifications made since last inspection. � TM
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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, carrosion 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?�
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<br /> � Signature � - _ Title � Date �
<br /> Inspector's Section (All responses reference current inspection) NA =NOT APPLICABLE " t=
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<br />�r; 1. General �x,,,,:.'��
<br />' a. Is the building occupied?� Yes �:No ,.� ,, > �
<br />� b. Are all systems in service?�Yes ❑ No r � <� +
<br /> c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?�Yes ❑No ; � �
<br /> d. Does all electrical heat tape appear to be satisfactory?L_.Yes ❑No �-�NA �� � �
<br /> e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?—Yes —No. ���NA -
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<br />"' 2. Control Valves (See Item I5.) �-
<br /> _ a. Are all sprinkler system control valves and all other valves in the appropriate open or closed posiCion?�-1'es ❑No -_ �. �
<br /> b. Are all co�trol va►ves in the open position locked, sealed or equipped with a tamper switch?�Yes �No '"`
<br /> 3. Water Supplies (See ltem 16.) "' � �
<br /> � a. Was a water flow test of main drain made at the sprinkler riser(s)?yL_yes �No � �
<br />��� 4. Tanks, Pumps, Fire Department Connections �� "
<br /> a. Are fire pumps, gravity ta�ks, reservoirs and pressure tanks in good condition and properly maintained?�Yes ❑No C�IA � ;
<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 (OS. &Y.)in the appropriate open or closed position?ec Yes �No ❑ NA �'��
<br /> � b. Have antifreeze system solutions been tested?�' Yes —No �--AIA
<br /> c. Were the antifreeze test results satisfactory?_ Yes -�No e��-NA � �
<br /> d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including blind atUcs and perimeter areas � �
<br /> where accessible?'�-Yes ❑No ���NA Do all exterior openings appear to be protected against freezing?�Yes C No ❑NA �
<br /> 6. Dry System(See Items 11 to 13.) , � �
<br />_z � a. Are dry valve(s) in service?�Yes —No ���4 NA ,:, ���'
<br /> b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions?u Yes ❑No C��IA �.'��,__
<br /> c. Has the operation of the air or nitrogen supplies been tested?�—Yes _No I�NA Are they in service?❑Yes ❑No �A �` ` "
<br /> d. Were low points drained during this inspection?-Yes —No �NA
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<br /> e. Did quick-opening devices operate satisfactorily?❑Yes `No !�.NA
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<br /> f. Did the dry valve(s) trip properly during the trip pressure test?f_ Yes _No �NA �
<br /> g. Did the heating equipment in the dry-pipe value room(s) operate at time of inspection ?C Yes C7 No ,�NA -_ �, ,��,.
<br /> 7. Special Systems (See Item 14.) � � -'�
<br />- � a. Did the deluge or pre-actio❑ valves operate properly during testing?❑Yes No �ax-I�IA , -�' �. .,� � ;� �- "`'
<br />' '� b. Did the heat-responsive devices operate properly during testing? Yes �No �AIA - - - � �'�
<br /> c. Did supervisory devices operate during testing?_ Yes _. No �1A � ��
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<br /> 8. Alarms ,��,,: ��
<br /> a. Did water motor(s) and gong(s) test satisfactorily?C Yes -No �_NA _ _
<br /> b. Did electric alarm(s) test satisfactory?��Yes '-'No �� NA � � � �
<br />. �� c. Did supervisory alarm service test satisfactory? _ Yes _ No �.NA
<br /> 9. Sprinklers , w
<br /> a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?�I'es -No
<br /> b. Are sprinklers less than 50 years old? (Older sprinklers require sample tesUng) _�'�� Yes ��7 No �
<br /> a Are quick response and residential sprinklers]ess than 20 years old:' (Older sprinklers require sample testing)+��Yes l.-No _ .�
<br /> ,,," d. Is stock of spare sprinklers available?�I Yes '�:_ No
<br /> e. Does the exterior condition of sprinkler system appear to be satisfacCory '?�-Yes -No
<br /> f. Are sprinklers of proper temperature rating for their locations'?-�Yes �_. No
<br /> 10.Explain any "No" answer and comments:
<br /> Signature: -� ;` - Date:
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