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1301 UORIENT STREET <br /> ST.PAUL,MINNESOTA 55117 <br /> (651)558-3300•(800)-229-6263 <br /> AIJTC�MATIC SPNNKM CO. FAX: (651)558-3310 <br /> SHEET 1 OF 2-Use separate sheet for each building inspection REPORT OF INSPECTION <br /> MINNESOTA LICENSE NO.C00005 WISCONSIN LICENSE NO.265989 <br /> REPORT TO BUILDING OR LOCATION <br /> STREET �'--, ' 0 ' - L y. --4 L- 12f,A INSPECTOR7!f <br /> CITY & STATE 2L,)^20 DATE J OLI Z611 <br /> Owner's Section(To be answered by Owner or Occupant) <br /> A. Explain any occupancy hazard changes since the previous inspection: <br /> B. Describe fire protection modifications made since last inspection. <br /> C. Describe any fires since last inspection. <br /> D. When was the system piping last checked for stoppage,corrosion or foreign material? <br /> E. When was the dry-piping system last checked for proper pitch? <br /> F. Are dry valves adequately 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?�Q Yes ❑No <br /> b. Are all systems in service?10 Yes ❑No <br /> c. Is there a minimum of 18 in. (457 mm)clearance between the top of thstorage and the sprinkler deflectors? Yes ❑No <br /> d. Does all electrical heat tape appear to be satisfactory?El Yes ❑No 9NA �. <br /> e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?ElrW <br /> Yes ❑No. IOA <br /> 2. Control Valves(See Item 15.) <br /> a. Are all sprinkler system control valves and all other valves in the appropriate open or closedsition?(PYes ❑No <br /> b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?WYes ❑No <br /> 3. Water Supplies(See Item 16.) <br /> a.Was a water flow test of main drain made at the sprinkler riser(s)?kt>Yes ❑No <br /> 4. Tanks,Pumps,Fire Department Connections <br /> a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?❑Yes ❑No 92NA <br /> b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight?Foxes ❑No ❑NA <br /> Are they accessible and visible? Yes ❑No ❑NA <br /> 5. Wet Systems <br /> a. Are cold weather valves(O.S. &Y.) in the appropriate open or closed position)O Yes ❑No ❑NA <br /> b. Have antifreeze system solutions been tested?❑Yes ❑No CLIA <br /> c. Were the antifreeze test results satisfactory?❑Yes ❑No P NA <br /> 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 <br /> where accessible?,ALi Yes [:]No ❑NA Do all exterior openings app be protected against freezing?)DYes ❑No ❑NA <br /> 6. Dry System(See Items 11 to 13.) <br /> a. Are dry valve(s) in servicg?❑Yes 13 o ❑NA <br /> b. Are the air pressures and prim g/water vels in accordance with the manufacturer's instructions?El Yes ❑No El NA <br /> c. Has the operation of the air or�nitrogen lies been tested?❑Yes ❑No ❑NA Are they in service?❑Yes ❑No ❑NA <br /> d. Were low points drained during this n ction?❑Yes ❑No ❑NA <br /> e. Did quick-opening devices operate'sa' factorily?❑Yes ❑No ❑NA <br /> f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes ❑No ❑NA <br /> g. Did the heating equipment in the dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No ❑NA <br /> 7. 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 ❑NA <br /> c. Did supervisory devices�iper to during testing?❑Yes ❑No ElNA <br /> 8. Alarms <br /> a. Did water motor(s) and gong(s)testsatisfactorily?❑Yes ❑No ,SNA <br /> b. Did electric alarm(s)test satisfactory? Yes ❑No ❑NA <br /> c. Did supervisory alarm service test satisfactory?ElYes ANo El NA <br /> 9. Sprinklers ! <br /> a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?82 Yes ❑No <br /> b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)rpYes ❑No <br /> c.Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testingm Yes ❑No <br /> d. Is stock of spare sprinklers available?MYes ❑No <br /> e.Does the exterior condition of sprinkler system appear to be satisfactory ?El-,Yes ❑No <br /> f. Are sprinklers of proper temperature rating for their locations? Yes ❑No <br /> 10.Explain any "No",answer and comments: r " 4,Ae_." X AaOh,)C� '� Si��,.1�C s �-%veyf ,�.✓/S� ��ri <br /> i <br /> Signature: '�':f��� `� ` `�`_Sr' '� ��� Date: J � v <br />