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<br /> ��J` �� ,-._ -�` VIKING AUTOMATIC SPRINKLER �`
<br /> ,, COMPANY ,�C' .
<br /> �:,'��"i� �400 ROSE PLACE • ST, PAUL, MINNESOTA 55113 • (612) 636-4680 • 1-800-229-6263 • FAX: (612) 636-4685 <:�
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<br /> SHEET 1 OF 2-Use separate sheet for each bwld�ng mspectwn
<br /> lns��ctiun_ReFn��t Nu. _ _ _ REPORT OF INSPECTION �nsprcti�in Contract No. _ _ ���
<br /> '"' � Conferred With � Rureau File No. _ _ _-__- _ - ---- :`°
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<br /> � RF.I'ORT TC) - '-� g-�` K._ /`� ��: _ BUII.DW(� OR L(�(A�ION _ '� - - -
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<br /> STRF.F,T _.�' 1_�' �.� -'.i ,� r �it.F � �"_ INSI'EiCTOR _ C _� t,
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<br /> -' C'ITY & STATE /t�ii � � - � ,,< ; /Jv . -- [)ATF: _�' �`-�--,�- �
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<br /> Owner's Section (To be answered by Owner or Occupant►
<br /> ', i A. I?xplain any c�rciipancy hai.ard chan�;es sinc��thE• previuus insperti��n. _ _ _ ,i
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<br /> B. f)escribe fire prc�terhon mudif�cationti madc tiincr latit inspect�un. _�___j�_,_n/;/ —�RONO
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<br /> C. I�escribe any f�rt s�incr�latit �ntipei ticin. _ a_ 'J ____
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<br /> D. Wh�n was thc tiyst��m pipinK last rhecked F'f ippa},e�, c�irr�isiun ur f��r��i�n material� .---__ � 1J►� �,+ �p� �,
<br />�.,x E. When was the dry-pipin�;sytitem last ch<�cked hir�r�ip��r�i,rh? _ _ ����� lV �1� � .,_,�
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<br /> =' F. Are clry valye5 adt�yuately Fx�itected frc>m fine�in�;? � _ -r�^ n � _ _
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<br /> ,,.�`-'��`� Titic t�-��r`� t'`� 'V Date _ �.
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<br /> _ Inspector's Section (All res nses referen f current inspection) NA NOT APPLICABLE 'i
<br /> 1. General �- :�
<br /> a. Is the building uccupi�•d7�Ycs [] Nu ' �� '
<br /> b. Are all systems in service?�Yes �] No � ' �
<br /> r. Is there a minimum��f IS in. (457 mm)clearance betwern the tup uf the storage and the sprinkler deflect��rs?�Yes ❑ No "
<br /> d. Dc�es all electrical heat tape appear to be satisfactory?❑ Yes ❑ No �!�[A ,�
<br /> e. Does the hand hose on the sprinkler system(s) appear t�i be satisfactoryZ ❑ Yes ❑ No �NA - ��
<br /> ��'� 2. Control Valves (See It�m l5.) r�� �
<br />����.. a. Are all spnnkler system control valves and all other valves in the appropriate open or closed position?,�Yes ❑ No ;Y�� �
<br /> b. Are all control valves in the open position locked, sealed cx equipped with a tamper switch?,�Yes ❑ No ��- ^�`"��`:
<br />��„ 3. Water Supplies (See Item I6.) ���,•,��
<br /> a. Was a water flow test of main drain made at the sprinkler riser(s)?�es ❑ Nc� � "'``` �
<br /> 4. Tanks, Pumps, Fire Department Connections -
<br /> _ a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?Q Yes ❑ No �NA ��_
<br /> b. Are fire department connectio�s in satisfactory condition,couplings free,caps in Place,and check valves tight?�Yes ❑No �lA _, �'�
<br /> Are they accessible and visible?'�Yes ❑ No ❑ NA - �.�'
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<br /> � i 5. Wet Systems �'t�
<br /> a. Are cold weather valves (O.S. & Y.).in the appropriate open or closed position?�Yes ❑ No ❑ NA =�
<br /> b. Have antifreeze system solutions been tested7 ❑ Yes ❑ Nc�NA �
<br /> �'�� _� c Were the antifreeze test results satisfactory? �Yes ❑ No NA 4�
<br /> - � d. In areas protected by wet system(s),does the building a�ear to be properly heated in all areas, including blind attics and perimeter areas
<br /> � where accessible? Yes No NA Do all exterior o nin 5 a tar to be rotected a ainst freezin ��Yes No NA �-��-"s�'
<br /> :a's�; ,�CL. ❑ ❑ F'f K PP' P S g ❑ ❑ � .�
<br /> � 6. Dry Systems (See ltems 1] to 13.) �?
<br />�,.,�',� a. Are dry valve(s) in sr�rvice? ❑ Yes ❑ No �NA �;
<br /> �.: b. Are the air pressures and primin�water levels in accurdance with the manufaiturer's instructions? [� Yes ❑ No NA �
<br /> c Has the operatiun of th��air or nitrogen wpplies been tested?[]Yes ❑N<� �,�lA Are they in servire? �Yes, ❑No�NA �"�
<br /> - d. Werc low points drained during this inspection? []Yes ❑ 1�{0 [�fVA ��
<br /> e. Did quick-opening devices operate satisfactorily?❑ Yes ❑ No �.NA �3
<br /> � f. Did the dry valve(s) trip properly during thc trip pressure test? 0 Yes [� Nc� ,�],NA �'�
<br /> � Did the heatin e ui ment in the d � valve room s u �rate at the time ��f ins���tion? Yes [Vo �NA �'
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<br /> _ 7. Special Systems (See Item 14.) - " ,
<br /> a. Did the deluge or pre-action valves operate properly durin� testing? ❑Yes ❑ NQ_ �NA "`
<br /> b. Did the heat-responsive devices operate properly during testing?❑ Yes ❑ No �NA "�`�
<br /> c Did the supervisory devices operat2 during testing?❑Yes ❑ No [p�.�IA .� _
<br /> 8. Alarms
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<br /> _ a. Did water motor(s) and gong(s) test satisfactorily?0 Yes ❑ No �..1�U1 - �: � a�
<br /> b. Did electric alarm(s) test satisfactorily?�Yes ❑ No ❑ NA � � � � � � �,����: �
<br /> ;,` c Did supervisory alarm service test satisfactorily?� Yes ❑ No y�IVA � �;
<br /> 9. Sprinklers ��'� � �;
<br /> a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge? ❑ Yes ❑ No �
<br /> b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) ❑Yes ❑ No �,;;�
<br /> _ c. Are quick i•esponse and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)❑Yes ❑ No '� 7:;
<br /> - d. Is stock of spare sprinklers available? ❑ Yes ❑No �
<br /> e. Does the exterior condition of sprinkler system appear to be satisfactory? ❑Yes ❑No �
<br /> f. Are sprinklers of proper temperature ratin s for their locations? ❑Yes ❑No� �
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<br /> 10. Ex lain an ` "answers and comments: �-��_ � 671 c�� �` f�'� � ✓ °'
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<br /> Signature: �� _ Date: / �
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