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�r�� 1301 L'Orient Street St.Paul,Minnesota 55117 v � N� (651)558-3300 • (800)229-6263 AUTC�MATIC SPRINKLER CO. Fax: (651)558-3310 S,�#ting T.'he Standard... � . AGREEMENT ANll KEPORT OF INSl'ECTION SE[EF.T 1 0:2-Use sepa�ate sheet for each building inspected #INSPECTION �'��✓ MINNESO'TA LICE SE NO.C005 RF,PORT TO N K !fl G.�'�v►� '�.(IILDING OR LOCATION STREET / ' v;� `Z / �;V� INSPECTOR �� ,� CITY&STATE fA (? {1� DATE _ Z - Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above locaHon or buildu�g,and prepare a written report of that inspection for an agreed upon fee. As part of this agreement,owner agrees to terms and conditions on rear of form and will complete the Owner's Section of this document. Owner's Section(To be answered by Owner or Occupant)�t A. Explain any occupancy hazard chan�es since the previons inspection: �v�`' ^ B. Describe fire protection modifications made since last inspection: " a�. . 4 C Describe any fires since last inspection: D. When was the system piping last checked for stoppa�e,conosion or fareign�e�al? � E. When was t]ze��ry-piping system last checked for proper pit�t,�.?� F. Are dry v es dequately protected from freezing? � Sigilatur � � i�� TiHe Date Inspector's ion(All responses reference current inspection) N/A=NOT APPLICABLE 1 General a. Is the buildin�occupied?� Y ❑No b. Are all systems in service? es ❑No � �� c. Does there appear to be a minimum of 18 in.(457 mm)clearance beiween the top of the s orage and the sprinkler deflectors? `dYes u I�Io d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? ❑Yes ❑No %A 2 Control Valves(See/feni 15) , �/ a. Do sprinkler system control valves appear to be in the appropriate open or closed position?, �-�Y,J"� o No b. Are control valves in the open posi6on locked,sealed or equipped with a tamper switch? �1`"es o No 3 Water Supplies(See Item 16) a. Was a water flow test of main drain made at the sprinkler riser(s)? es ❑No 4 Tanks,Pumps,Fire Department Connections a. Are fire pumps,gravity tanks,reservoirs and pressure tanks in�ood condition and properly maintained? o Yes ❑N - �/A b. Are fire department connecHons u1 sfactory condition,couplings free,caps in place,and check valves tight? �o No ❑N/A Are they accessible and visible? es. ❑No ❑N/A 5 Wet Systems a. Are cold weather valves(O.S.&Y.)in the appropriate open ar do d position? ❑Yes ❑No �I'1Q%A b. Have antifreeze system solutions been tested? ❑Yes ❑No �A c. Were the antifreeze test r ults satisfactory? ❑Yes o No �i�d/A d. In areas protected by t system(s),does the building appear to be properly heated in all areas,includin�blind at'cs and perimeter areas where accessible? es o No ❑N/A Do all exterior openings appear to be protected against freezing? es ❑No a N/A 6 Dry System(See 1 tems ll to 13) a. Are dry valves(s)in service? ❑Yes ❑No ❑N/A b. Are the air pressures and primin�water levels in accardance with the manufachxre's instructions? ❑Yes ❑No ❑N/A �� c. Has the operation of the air or nitrogen supplies been tested? ❑Yes o No o N/A Are they in service? ❑Yes ❑No ❑N/A d. Were all know low points drained during this inspection? o Yes o No i i N/A e. Did yuick-openin�devices operate satisfactorily? ❑Yes u No o N/A f. Did the dry valve(s)trip properly during the trip pressure test? ❑Yes u No ❑[�I/A �. Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? ❑Yes ❑No ❑N/A \� Special Systems(See Itent 14) a. Did the deluge or pre-action valves operate properly duriny,testin�? ❑Yes ❑No ❑N/A b. Did the heat-responsive devices operate properly duriny,tc�sting? ❑Yes ❑No ❑N/A c. Did supervisory devices operate during tesrin�? n Yes ❑No n N/A S Alarms � � a. Did water motar(s)and gon�(s)iest saHsf�etorily? ❑Yes o No l�'N/A b. Did electric alarm(s)test satisfactory? �es ❑No �b N/A c. Did supervisory alarm service test saHsfactory7 ��s ❑No o N/A 9 Sprinklers �'� a. Do visibie sprinklers appear to be free from corrosion,loading or obstruction to�pra�vdischar�e? �i'�es o No b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) tf�es u No / c Are quick responsc and residential sp}in151ers less than 20 years old? (Older sprinklers require sample testing) �e'Yes ❑No ❑N/A d. Is stock of spare sprinklers available? �r'1'es ❑No j' e. Does the exterior condition of sprinkler system appear to be satisfactory? �'Yes ❑,Nj�� £ Do visible sprinklers appear to be of proper temperature rating for their locations? ta�Yes ❑No 10 Explain any"No"answers and comments: Signature: �,/� �� Date: 'i ��- '� (Ruv.2/8/lHol