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�r�� 1301 L'Orient Street ('� � St.Paul,Minnesota 55117 �� (651)558-3300 • (800)229-6263 AUTOMATlC SPRINKIER C4. Fax: (651)558-3310 Settin,�; "I'he Standard... � AGREEMENT AND REPORT OF INSPEC'I'ION SHEE�L of 2-Use sepaeate sheet for each building insExcted #INSPECTION MINNESOTA LICENSE NO.C005 REPORT TO BUILDING OR LOCATION STREET INSPECTOR CITY&STATE DATE Owner hires Viking Automatic Sprvlkler Compviy to conduct an inspection of the fire suppression system at the aUove location or buildirtg,and prepare a written report of that inspecHon for an agreed upon fee. As part of this agreement,owner agrees to tern�s and conditions on rear of form and will complete the Owner's Section of 8iis�9ocument. Owner's Section(To be answered by Owner or Occupant) A. Explain any occupancy hazard changes since the previous inspection: B. Describe fire protecHon modifications made since last inspecHon: C. Describe any fires since last inspection: D. When was the system piping last checked for stoppage,corrosion or foreign material? E. When was the dry-pipinR system last checked for proper pitch? F. Are dry valves adequately protected fmm freezing? Si�ature Title Date Inspector's Section(All responses reference current inspection) N/A=NOT APPLICABLE 1 General a. Is the building occupied? n Yes �No b. Are all systems in service? a Yes :�No c. Does there appear to be a minimum of 18 in.(457 mm)clearance between the top of the storage and the sprinkler deflectors? t�Yes ❑No d. Does the valve hose on the sprinkler system(s)appear to Ue satisfactory? ❑Yes �i No n N/A 2 Control Valves(See Item 15) a. Do sprinkler system control valves appear to he in the appropriate open or closed position? .d Yes ❑No b. Are control valves in the open position locked,sealed or eyuipped with a tam,�er switch? ��_Yes ��No 3 Water Supplies(See Itern 16) a. Was a water flow test of main drain made at the sprinUer riser(s)? a Yes ❑No 4 Tanks,Pumps,Fire Departuient Connections a. Are fire pumps,�ravity tanks,reservoirs and pressure tanks in good condifion and properly maintained? n Yes ❑No ,�#N/A b. Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight?�i Yes ❑No ❑N/A Are they accessible and visible? e Yes ❑No ❑N/A 5 Wet Systems a. Are cold weather valves(O.S.&Y.)in the appropriate open ar closed position? ❑Yes ❑No "�N/A b. Have antifreeze system solutions been tested? ❑Yes u No d N/A c. Were the antifreeze test results satisfactory? ❑Yes ❑No fl N/A 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 N/A Do all exteriar openings appear to be protected against freezing? ❑Yes ❑No o N/A 6 Dry System(See Items 11 to 13) a. Are dry valves(s)in service? e Yes ❑No ❑N/A b. Are the air pressures and primin�water levels in accardance with the manufacture's instructions? ❑'Yes ❑No ❑N/A c. Has the operafion of the air ar nitrogen supplies been tested?;Q Yes ❑No ❑N/A Are they in service? �Yes ❑No ❑N/A d. Were all lmow low points drained during this inspection? a Yes ❑No ❑N/A e. Did quick-opening devices operate satisfactorily?�Yes n No n N/A f. Did the dry valve(s)trip properly during the trip pressure test? u�-Yes ❑No u N/A Q. Did the heating equipment in the dry-pipe valve room(s)operate at Hme of inspection? erYes ❑No ❑N/A 7 Special Systems(See Item 14) a. Did the deluge or pre-ac6on valves operate properly dutting testin�? i i Yes i i No n N/A b. Did the heat-responsive devices operate properly during testing? ❑Yes n No .r�N/A c. Did supervisory devices operate during testing? ❑Yes ❑No , �N/A S Alarms a. Did water motor(s)and�on�(s)test sadsfactorily? i i Yes �,No ,�4 N/A b. Did electric alarm(s)test satisfactory? b Yes ❑No ❑N/A c. Did supervisory alarm service test satisfactory?,-h Yes ❑No ❑N/A 9 Sprinklers a. Do visible sprinklers appear to be free from corrosion,loadinQ or obstruction to spray discharge? o Yes ❑No b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing);:o Yes ❑No c. Are quick response and residendal sprinklers less than 20 years old? (Older sprinklers require sample testing)„-a Yes ❑No n N/A d. Is stock of spare sprinklers available? a Yes ❑No e. Does the exterior condition of sprinkler system appear to be satisfactory?s o Yes ❑No f. Do visible sprinklers appear to be of proper temperature rating for their locations? n Yes �No 10 Explain any"No"answers and comments: Signature: Date: _� (Re�_�/a/o�)