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` 1301 L'ORIENT STREET <br /> kM <br /> , ST. PAUL, MINNESOTA 55117 <br /> (651)558-3300 • (800)-229-6263 <br /> AUIOMASPRINKLER CO. FAX: (651) 558-3310 <br /> SHEET t OF 2-Use-separate sheet for each building inspection REPORT OF INSPECTION <br /> MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989 <br /> REPORT TO (� —J��� <� a-J7 Z— BUILDING OR LOCATION <br /> STREET —INSPECTOR <br /> CITY & STATE O /17*1 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. <br /> C. Describe any fires since last inspection. <br /> D. When was the system piping last hecked for stoppage, corrosion or foreign material? <br /> E. When was the dry-pipiirg sys mast checked-for proper pitch? <br /> F. Are dry van a ,ately t om ing? <br /> `• f �� '.� <br /> Signature 7. Title -��`: _-� -' ',' } / < Date <br /> Inspector's SectiAll responses reference current inspection) NA =NOT APPLICABLE <br /> 1. General <br /> a. Is the building occupief�Yes ❑No <br /> b.Are all systems in service Yes ❑No <br /> c. Is there a minimum of 19 in. (457 mm)clearance between the top of th torage and the sprinkler deflectors?�PCes ❑No <br /> d.Does all electrical heat tape appear to be satisfactory?❑Yes ❑No A <br /> e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?❑Yes ❑No. /`�,NA <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?(1-0 ❑No <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)?�AYes ❑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 XNA <br /> b. 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?Wes ❑No ❑NA (( <br /> 5. Wet Systems <br /> a. Are cold weather valves(O.S.&Y.)in the appropriate open orcl sed position?�es 11 No El NA <br /> b. Have antifreeze system solutions been tested?El Yes 11 No TNA <br /> c. Were the antifreeze test results satisfactory?❑Yes ❑No NA <br /> d. In areas protected by wet system(s),does the building appe a properly heated in all areas, including blind attics and perimeter areas <br /> where accessible?p Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing? Yes ❑No ❑NA <br /> 6. Dry System(See Items 11 to 13.) <br /> a. Are dry valve(s)in service? s ❑No ❑NA <br /> b. Are the air pressures and p�Vjn <br /> at levels in accordance with the manufacturer's instructions?❑Yes ❑No ❑NA <br /> c. Has the operation of the ' gaff upplies been,tested?❑Yes ❑No. LVNA Are they in service?❑Yes ❑No ❑NA <br /> d. Were low points drained 's ins ction?❑Yes ❑No ❑NA <br /> e. Did quick-opening device s actorily?❑Yes ❑No ❑NA <br /> f. Did the dry valve(s)trip d 'ri the trip pressure test?❑Yes ❑No ❑NA <br /> g. Did the heating equipme -pi 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-actio vtPAn <br /> r properly during testing?1-1Yes 11 No El NA <br /> b.Did the heat-responsive de aproperly during testing?L1 Yes Ll No El NA <br /> c. Did supervisory devices o 1testing?❑Yes ❑No ❑NA <br /> 8. Alarms t <br /> a. Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑No )OqA <br /> b. Did electric alarm(s)test satisfactory? Yes ❑No ❑NA <br /> c. Did supervisory alarm service test satisfactory?❑Yes ❑No 'INA <br /> 9. Sprinklers <br /> a. Are all sprinklers free from corrosion,loading or obstruction to spray discharge ? CesElNo <br /> b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing?14Nes ❑No <br /> c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing),11aes ❑No <br /> d. Is stock of spare sprinklers available es ❑No <br /> e. Does the exterior condition of sprinkler system appear to be satisfactory ?'t�Zves ❑No <br /> f. Are sprinklers of prope temperature rating for their locations es ❑No <br /> 10.Explain any "No" swer d comments: <br /> Signat Date: <br />