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SUMMIT FIRE PROTECTION 575 MINNEHAHAAVE.W•ST.PAUL,MN 55103•(651)251-1880 3026 40TH AVE.IVW•ROCHESTER,MN 55901 •(507)280-0622 '418 GR�AT OAK DR.,WAITE PARK,MN 56387•(320)257-6390 760 LIBERTY WAY,NORTH LIBERTY,IA 52317•(319)665-4330 4208 ENTERPRISE CIRCLE•DULUTH,MN 55811 •(218)740-4412 SHEET 1 OF 2-Use sepazate sheet for each building inspection REP�RT�F''I1�SPECTI�lv MINNESOTA LICENSE NO. C0075 JOB NUMBER �' INSPECTION NAME BUILDING/LOCATION STREET INSPECTOR CITY&STATE DATE Owner's Section(to be answered by Owner or Occupant) A. Explain any occupancy hazard changes since the previous inspection: B. Describe fire protection modifications made since last inspection: C. Describe any fires since last inspection: D. When was the system piping]ast checked for stoppage,corrosion of foreign inaterial? E. When was the dry-piping system last checked for proper pitch? E Are dry valves adequately protected from freezing? Signature Title � Date Inspector's Section(All responses reference current inspection) NA=NOT APPLICABLE 1. General a.Is the building occupied?DYes ❑No b.Are all systems in service? DYes❑No c.Is there a minimum of 18 in.(457 mm)clearance between the top of the storage and the sprinkler deflectors? OYes ❑No d.Does all electrical heat tape appear to be satisfactory? ❑Yes ❑No 0�NA e.Does the hand hose or standpipe on the sprinkler system(s)appear to be satisfactory? ❑Yes ❑No O NA 2. Control Valves(See Item I5.) � a.Are all sprinkler system control valves and all other valves in the appropriate open or closed position? ❑Yes ❑No �' b.Are all control valves in the open position locked,sealed or equipped with a tamper switch? OYes 0 No 3. Tanks,Pumps,Fire Department Connections a.When was fire pump last tested for performance? b.Are fire pumps,gravity tanks,reservoirs and pressure tanks in good condition and properly maintained? ❑Yes❑No ❑NA c.Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight? DYes ❑No ❑NA Are they accessible and visible? OYes 0 No ❑ NA 4. Wet Systems � a.Are cold weather valves(O.S.&Y.)in the appropriate open or closed position? ❑Yes ❑No O'�NA b.Have antifreeze system solutions been tested? ❑Yes ❑No ❑NA � c.What temp is antifreeze? � d In areas protected by wet system(s),does the building appear to be properly heated in all areas,including blind attics and perimeter areas where accessible?❑Yes ❑No O�NA 5. Dry System(See Items l] to 13) ,� a.Are dry valve(s)in service? ❑Yes ❑No ❑NA b.Are the air pressures and priming water levels in accordance with the manufacturer's instructions? ❑Yes ❑No 0 NA � c.Has the operation of the air or nitrogen supplies been tested? OYes❑No ❑NA Are they in servicc? ❑Yes❑No ❑NA � d.Were low points drained during this inspection?OYes ❑No❑NA How many? e.Did quick-opening devices operate satisfactorily? ❑Yes ❑No C}NA f.Did the dry valve(s)trip properly during the trip pressure test? DYes ❑No❑NA g.Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? DYes ❑No ❑NA 6. Special Systems(See ltem 14.) � a.Did the deluge or pre-action valves operate properly during testing? ❑Yes ❑No ❑NA � b.Did the heat-responsive devices operate properly during testing? ❑Yes ❑No❑NA c.Did supervisory devices operate during tes[ing? ❑Yes❑No ❑NA d.Did flow for kitchen hood system shut off gas or electric? ❑Yes 0 No ❑NA 7. Alarms a.Did water motor(s)and gong(s)test satisfactorily? ❑Yes 0 No ❑NA b.Did electric alarm(s)test sarisfactorily? DYes❑No ❑NA c.Did supervisory alarm service test satisfactorily? ❑Yes ❑No ❑NA d.Did tamper switches test satisfactorily? ❑Yes ❑No 0 NA �� 8. Sprinklers a.Are all sprinklers free from corrosion,loading or obstruction to spray discharge? OYes ❑No b.Are sprinklers less than 50 years old?(Older sprinklers require sample testing) ❑Yes ❑No c.Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing) ❑Yes ❑No � d.Is stock of spare sprinklers available? DYes ❑No e.Does the exterior condition of sprinkler system appear to be satisfactory? OYes❑No f.Are sprinklers of proper temperature rating for their locations? ❑Yes ❑No g.Are any sprinkler heads{on a recall list?❑Yes ❑No Signature: . Date: �