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<br /> :� VIKING AUTOMATIC SPRINKLER COMPANY
<br />�.._;. 2400 ROSE PLACE • ST, PAUL, MINNESOTA 55113 • (612) 636-4680 • 1-800-229-6263 • FAX; (612) 636-4685
<br /> SHEET 1 OF 2- Use separate sheet for each building msprction
<br /> Ins�ctiun ReFwrt N��. REPORT OF INSPECTION ►nsperticin Contract No. ____ __-_—
<br /> ' " ' Conferred With _ _ _ Bureau Filr No. _ _- __ _ -_--- - - ".
<br />, Rf?I'ORTTO _ _:. _ _ BUII.I�ING OR I_(�CATION _ `,
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<br /> , ST'REF.T - r _ _ - _ _ INSPECTOR = ---'- -- - - - -- _
<br />.ti,'. CITY & S"I'ATE i � ," �_' _ _ DAT'E ' �-,�----___.---- a
<br /> Owners Section (To be answered by Owner or Occupant)
<br /> � w A. F.xplain any occupancy hazard chan�;cs sinc��th�• pr�viuus mtip��rti��n. _ _ __ __. _- !-__--___- -- - ___ ___-_-__-- ��,�.--�e
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<br /> B. l�escribe fire prc�tectiun mudifications made since last inspecticin. _ _ __ ________ ��p��___
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<br /> ' C. Descnbe any f�res smce last insperhon. ____---- ------ --- -- -- — �
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<br /> D. When was the svstem piping last rhecked f�ir st��ppa�;e, corr��si�m �>r foreign material? _ �
<br />, • > E. When was the dry-piping syst��m last check��d fe�r pre�per pi;ch? __ _ __ , ;;
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<br />, F. Are dry valves adeyuately F�mtected from frcezing7 _.__ = `
<br /> . Signature - --- - - _ _ _ Titl�• _ _ Date----- '
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<br /> Inspector's Section (All responses reference current inspection) NA = NOT APPI.ICABLF,
<br /> 1. General
<br /> a. Is the building occupied?� Yes ❑ Nu �
<br /> b. Are all systems in service? [�Yrs �] N<� ��
<br /> c. Is there a minimum��f 1R in. (457 mm)��Iearance brtwe��n the tup uf the storage and the sprinkler deflrctors7(�,Yes ❑ No � � �
<br /> � d. Does all electrical heat tape appear to be satisfactory? ❑Yes ❑ No [s]�.�ilA
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<br /> e. Does the hand hosr un the sprinkler system(s) appcar to be satisfactory? ❑ Yes ❑ Nu [�dy,.A '•��a
<br /> 2. Control Valves (See Item 1.5.) Ai-
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<br /> a. Are all spnnkler system cuntrol valves and all other valves in the appropriate open or closed position? �--Y�s ❑ No `
<br /> b. Are all control valves in the open position lockrd, sealed cx equipped with a tamper switch?�„�es ❑ No �
<br /> 3. Water Supplies (See Item 16.)
<br /> a. Was a water flow test of main drain made at the sprinkler riser(s)? [�-�is ❑ N�
<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 []�IYA :
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<br /> b. Are fire department connectio�s in satisf�ctory condition,co�plings free, caps in place,and check valves tEght?�es ❑No ❑17A _
<br /> Are they accessible and visible?[�-�a=s ❑ No ❑ NA
<br /> 5. Wet Systems �
<br /> a. Are cold weather valves (C).S. & Y.).in the appropriate upen or closed position? [�Yes ❑ Nc� ❑ NA
<br /> b. Have antifreeze system solutions been tested? [J Yes ❑ No �,.L�IA :
<br />�'� c Were the antifreere test results satisfactory? [� Yes ❑ No �o��iiA
<br /> d. In areas rotected b wet s Stem s, dcxs the buildin a ar to be ru erl -heated in all areas, includin blind attics and erimeter areas
<br /> P Y Y- O K Pf'e P P 7 K P
<br /> where accessible? [�-Xes ❑No ❑NA [k�all extenor openings appear to be protected against freezing? .[c�Yes ❑No ❑NA
<br /> 6. Dry Systems (See (tems ]1 to 73.)
<br /> a. Are dry valve(s) in service? ❑Yes ❑ No [�NA
<br /> - b. Are the air pressures and priminK water Ievels in acc��rdance with the manufacturer's instructions? ❑ Yes ❑ No [�j�lA
<br /> c. Has the operatiun of the air or nitrogen supplies been tested?❑Yes ❑N�� [�TtA Are they in service? ❑Yes, ❑No (�,�IA
<br /> d. Were low points drained during this inspection? �Yes ❑ I�lo [,�NA ��'Y
<br /> e. Did quick-opening devices operate satisfactorily?❑ Yes ❑ No �_NA ���;-��
<br /> f. Did the dry valve(s) trip properly durin� the trip pressure test? 0 Yes ❑ No [�.NA �
<br /> g. Did the heating equipment in the dry-pipe valve room(s) operate at the time <�f inspectic�n? � Yes ❑ No [�VA
<br /> 7. Special Systems (See Item 14.) ,�
<br /> , a. Did the deluge or pre-action valves operate properly during testing? ❑ Yes ❑ Nc�, [�.NA � �?
<br /> b. Did the heat-responsive devices operate properly during testing? ❑Yes ❑ No (�.NA ��
<br /> c Did the supervisory devices operate durinR testing? ❑ Yes ❑ No [a�NA �t 4'�
<br />� : 8. Alarms
<br />�5 a. Did water motor(s) and gong(s) test satisfactorily? ❑ Yes ❑ No [.}�lA , � � �'�,�
<br />�` b. Did electric alarm(s) test satisfactorily?[�Yes �No ❑ NA ' �� �xa� �+�:
<br /> 1 _ c Did supervisory alarm service test satisfactorily?�Yes ❑ No [�NA �;,;
<br />� 9. Sprinklers 4"�
<br />`�, a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge? C�.Yes [7 No � "
<br /> b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) [-,Yes �] No
<br />�,�- � c Are yuick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)��Yes ❑ No �.•
<br />� d. Is stock of spare sprinklers available? ❑Yes C�No �
<br />'� -- e. Does the exterior condition of sprinkler system appear to be satisfactory? �`Yes ❑No �
<br />, ' f. Are sprinklers of proper temperature ratings for thc ir locations? [�es ❑ No r ,,, �
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<br /> _"' 10. F.xptai�any"No"answers and comments: i - �� . __ - ___ __�.' p`-�L��
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<br /> Signalure: ..���___���..�.� --- ------- Date: �c� /L , ��
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