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<br /> � � � SUMMIT FIRE PROTECTION �$�
<br /> 575 l�innehaha Ave.W • St.Paul,MN 55103 • 651-251-1880 3026 40TH Ave.NW • Rochester,MN 55901 • 507-280-0622 t
<br /> - 418 Great Or.k Dr. • Waite Park,MN 56387 • 320-257-6390 760 Liberty Way • North Liberty,IA 52317 • 319-665-4330 `:
<br />�;`� 4208 Enterprise Circle • Duluth,MN 55811 • 218-740-4412 4353 NW Urbandale Dr. • Urbandale,IA 50322 • 515-867-2424 ��
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<br />�' SHEET 1 OF 2-Use sepazate sheet for each building inspection 3�
<br /> : REPORT OF INSPECTION Q /� �
<br />�<<; MINNESOTA LICENSE NO. C0075/IOWA LICENSE NO.FP-036 JOB NUMBER ��/y�0�-� ��
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<br /> INSPECTION NAME � 6 .G = "��:x. BUILDING/LOCATION — ILI �
<br /> STREET '`� �IC��E INSPECTOR ��''r Gk9� � ��
<br /> CITY&STATE �. /b'`�.' ����� DATE �i
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<br /> � Owner's Section(to be answered by Owner or Occupant) �
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<br />� '� A. Explain any occupancy hazard changes since the previous inspection: ���,��
<br />�' A �n�
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<br /> dRc.: J *y511.
<br /> =�t B. Describe fire protection modifications made since last inspection:� ��
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<br /> C. Describe any fires since last inspection: C� � ,��
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<br />� D. When was the system piping last checked for stoppage,corrosion of fpj�ign material? � :�
<br /> .�� E. When was the dry-piping sy�tem last checked for proper p t h? i(iJ�''� �'�„�
<br /> �, E Are dry valves adeyuate(y protected from freezing? �/��"' �
<br /> Signature `�� � Title - � �"���. �£. :` Date � �
<br />�� Inspector's Section(All responses reference current inspection) NA=NOT APPLICABLE ��..
<br />��� 1. General "` �..�
<br />��� a.Is the building occupied?;�Y ❑No �
<br />� J� b.Are all systems in service?�Yes❑No
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<br />�� c.Is there a minimum of 18 in.(457 mm)clearance between the top of the storage and the sprinkler deftectors? ld'�'es ❑No
<br /> ��= d.Does the hand hose or standpipe on the sprinkler system(s)appear to be satisfactory? ❑Yes ❑N�NA
<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 position?�es ❑No
<br />� b.Are all control valves in the open position locked,sealed or equipped with a tamper switch?�a'Yes 0 No ' �x
<br />�;,' 3. Tanks,Pumps,Fire Department Connections `
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<br />�,?; a.When was fire pump last tested for performance? �
<br />�;�: b.Are fire pumps,gravity tanks,reservoirs and pressure tanks in good condition and properly maintained? ❑Yes 0 No �NA
<br />�'� c.Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight?�es ❑No ❑NA
<br />`�'� � Are they accessible and visible? �'�1'es 0 No ❑NA
<br />�-� 4. Wet Systems r � "�
<br /> a. Have antifreeze system solutio een tested? ❑Yes ❑No�NA `� -��"�� ,�
<br /> b.What temp is antifreeze?� a � � `'�����
<br /> - a In areas protected by wet system(s),does the building appear to be properly heated in all areas? C�'es ❑No 0 NA .�" � '} f " ' R 3�.�-;
<br />',„�:� 5. Dry System(See Items 11 to 13) � �, �
<br />�� a.Are dry valve(s)in service? ❑Yes ❑No�NA „���
<br />� b.Are the air pressures and priming water 1�4e1s in accordance with the manufacturer's instructions? ❑Yes ❑No�NA �� ;� .
<br />� c.Has the operation of the air or nitrogen supplies been tested? ❑Yes 0 No fd"NA Are h y in service? ❑Yes❑No�NA ;� ����
<br /> d.Were low points drained during this inspection?OYes ❑No J�NA How many? � �` �
<br /> = e.Did quick-opening devices operate satisfactorily? ❑Yes ❑No,.�NA �*�`�'z a'�
<br /> k ' f.Did the dry valve(s)trip properly during the trip pressure test? ❑Yes ❑No�]'NA � a� -. 2�
<br />� g.Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? ❑Yes ❑No I�- 'NA '`k � �
<br /> � 6. Special Systems(See Item 14.) � �� �
<br />� :;� a.Did the deluge or pre-action valves operate properly during testing? ❑Yes ❑No.�NA �` "� ;�
<br /> b.Did the heat-responsive devices operate properly during testing? ❑Yes ❑No C�NA RECE���D II
<br /> c.Did supervisory devices operate during testing? ❑Yes 0 No�NA - '� +
<br /> d.Did flow for ldtchen hood system shut off gas or electric? ❑ es 0 No fd'NA `�� �
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<br /> 7. f��al"Il7S ' , a.. �i � ~�1 !��� �y ,�
<br />�C. ,; F`- ri� d �- � �
<br /> c:� a.Did water motor(s)and gong(s)test satisfactorily? ❑Yes ❑No Q°NA � ,, „, v� �„.
<br /> b.Did electric alarm(s)test satisfactorily? �Yes 0 No ❑NA ; -� �^ ,�_� � ;�,�'��
<br /> c.Did supervisory alarm service test satisfactorily?.�Yes ❑No ❑NA � ' � C�N OF ����� �'�
<br />���� d.Did tamper switches test satisfactorily?�'Yes ❑No❑NA � � � � �� �
<br />� ` S. Sprinklers +''*.� ��
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<br /> � a.Are all sprinklers free from corrosion,paint,loading or obstruction to spray discharge? 0'Yes ❑No t�x,�`•
<br /> b.Are sprinklers less than 50 years old?(Older sprinklers require sample testing)�Yes ❑No � ��'
<br /> � c.Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)�dYes ❑No ❑NA
<br />" d.Is stock of spare sprinklers available? �Vi"es ❑No �
<br />�g e.Does the exterior condition of spri�kler system appear to be satisfactory?,0'f'es❑ No � ��'�' ;;
<br />� f.Are sprinklers of proper temperature rating for their locations?,�'es❑No � s ; a ""�
<br />� g.Is location free of recalled heads�Yes ❑No ,.�`� : �^,- �,�a� �,• � '� ,��
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<br /> Signature: Date: � � �.s;�
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