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lr w <br /> r 1301 L'ORIENT STREET <br /> <!F1 <br /> ST. PAUL, MINNESOTA 55117 <br /> (651)558-3300 • (800)-229-6263 <br /> nC SPRINKLER CO. FAX: (651) 558-3310 <br /> SHEET 1 OF 2-Use separate sheet for each building inspection REPORT OF INSPECTION <br /> i <br /> MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989 <br /> REPORT TO ill47E SO BUILDING OR LOCATIONS F <br /> STREET / 01 INSPECTOR,/ <br /> CITY & STATE b�C l)Al DATE /'� <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. i <br /> C. Describe any fires since last inspection. <br /> 0 <br /> N C <br /> When was the system piping last checked for stoppage, corrosion or foreign material? <br /> When was the dry-piping system last checked for,proper pitch? <br /> F. Are dry valves adequately protected from freezing? s <br /> SignaturdtAC) Y'� Title Date <br /> Ins_pect6 s Section(All responses reference current inspection) NA =NOT APPLICABLE <br /> General <br /> a. Is the building occupied��Yes ❑No <br /> b. Are all systems in service?fixes ❑No <br /> c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors? Yes ❑No <br /> d. Does all electrical heat tape appear to be satisfactory?❑Yes ❑No SNA <br /> e. Does the hand hose on the sprinkler system(s)appear to be satisfactory?❑Yes ❑No. ,9NA <br /> 2. Control Valves (See Item 15.) <br /> a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?p Yes ❑No r <br /> b. Are all control valves in the open position locked, sealed or equipped with a tamper switch? Yes ❑No <br /> 3. Water Supplies(See Item 16.) <br /> a. Was a water flow test of main drain made at the sprinkler riser(s)?PYes ❑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 ;ONA <br /> b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight?,kYes ❑No ❑NA <br /> Are they accessible and visible?pYes ❑No ❑NA <br /> 5. Wet Systems <br /> a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position? Yes ❑No ❑NA <br /> b. Have antifreeze system solutions been tested?❑Yes ❑No V9NA <br /> c.Were the antifreeze test results satisfactory?❑Yes ❑No NA <br /> d. In areas protected by wet system(s),does the buildine annear o be properly heated in all areas,including blind attics and perimeter areas <br /> where accessible?PYes ❑No ❑NA Do all exterior openings appear to be protected against freezing? es []No ❑NA <br /> 6. Dry System (See Items 11 to 13.) <br /> a. Are dry valve(s)in service?❑Y s ❑No ❑NA <br /> b. Are the air pressures and rimi ate levels in accordance with the manufwturer's instructions?❑Yes ❑No ❑NA <br /> c. Has the operation of the or i og h!supplies been tested?El Yes ❑Nv -�]NA Are they in service?❑Yes ❑No ❑NA <br /> d. Were low points drained ' g is n ' n?❑Yes ❑No ❑NA ` <br /> e.Did quick-opening devic ra 1 factorily?❑Yes ❑No ❑NA <br /> f. Did the dry valve(s)trip <br /> to rl ri' 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-act n v$S operate properly during testing?1-1Yes El No L1 NA <br /> b. Did the heat-responsive c s e properly during testing?❑Yes El No El NA <br /> c. Did supervisory devices r t ring testing? Yes ElNo El NA <br /> 8. Alarms <br /> a. Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑No�NA <br /> b. Did electric alarm(s)test satisfactory? YemgWk io ❑NA <br /> c. Did supervisory alarm service test sa isfactory;A Yes* �6No ❑NA <br /> 9. Sprinklers <br /> a. Are all sprinklers free from corrosion,loading or obstruction to spray discharge ?ZYes` ❑No <br /> b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)Yes ❑No <br /> c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing Yes ❑No <br /> d. Is stock of spare sprinklers available? Yes ❑No <br /> e. Does the exterior condition of sprinkler system appear to be satisfactory ?$OYes ❑No <br /> f. Are sprinklers of proper temperature rating for their locations9pyes'\❑No <br /> 10.Explain any "No"an r and comments: �l f�1�E >�.� , /1���C.t)f 7,6 NES ?�W_fc// <br /> Signa Date: <br />