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1301 L'ORIENT STREET <br /> ST. PAUL, MINNESOTA 55117 <br /> (651)558-3300 9 (800)-229-6263 <br /> AuronnAnc SPRINKLER 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 OIZD4 0 All rld S BUILDING OR LOCATION � <br /> _ 5L <br /> STREET INSPECTORE' <br /> CITY & STATE DATE1- <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 mode since last inspection. 014, I:v2t� /Yl <br /> pCecnbean, fires since last inspection. <br /> st prping,lgst checked fop stoppage, corrosion or foreign mat rial? <br /> e ping sgstim st chbcWd for proper pitch? <br /> equate ; eezing?r Tit l Date <br /> I tor's SAtion (All responses reference current inspection) NA =NOT APPLI."ABLE <br /> 1. General <br /> a. Is the building occupied Yes ❑No <br /> b. Are all systems in service?tl�J Yes ❑No <br /> c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?KYes ❑No <br /> d. Does all electrical heat tape appear to be satisfactory?❑Yes ❑No /"�NA <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 closedosition?A Yes ElNo <br /> b.Are all control valves in the open position locked, sealed Qr equipped with a tamper switch? &es ❑No <br /> 3. Water Supplies (See Item 16.) <br /> a.Was a water flow test of main drain made at the sprinkler riser(s)?p 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 �NA <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? Yes ElNo El NA <br /> 5. Wet Systems / <br /> a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position?/OYes ❑No ❑NA <br /> b. Have antifreeze system solutions been tested?❑Yes ❑No �NA <br /> c.Were the antifreeze test results satisfactory?❑Yes ❑No X)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?Jki Yes ❑No ❑NA Do all extertar-'bgMings appear to be protected against freezing? Yes ❑No ❑NA <br /> 6. Dry System(See Itdms 11 to 13.) / <br /> a. Are dry valve(s)in service?EI/Yes F1No F1 NA <br /> b.Are the air pressures and prin water levels in accordance with the manufacturer's instructions?❑Yes ❑No ❑NA <br /> c. Has the operation of the.air r rt n supplies been-tested?El Yes 11Noi LANA Are they in service?1:1 Yes 11 No ❑NA <br /> d.Were low points drain dt in this' ction?11 Yes 11 No ❑NA <br /> e.Did quick-opening dc4c s ope t sa'sfactorily?El Yes 11 No [INA <br /> f.Did the dry valves)ttrIpp ope y u g the trip pressure test?Ll Yes ❑No L1 NA <br /> g.Did the heating equipme in a 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-actio al operate properly during testing?❑Yes ❑No ❑NA <br /> b.Did the heat-responsive i es properly during testing?❑Yes ❑No ❑NA <br /> c. Did supervisory devices ` 'ng testing?❑Yes ❑No ❑NA <br /> 8. Alarms <br /> a. Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑No )INA <br /> b. Did electric alarm(s)test satisfactory??�3 Yes ❑No ❑NA <br /> c. Did supervisory alarm service test safisfactory? Yes ❑No ❑NA ��1 r/Zvz, <br /> 9. Sprinklers � _ <br /> a. Are all sprinklers free from corrosion,loading or obstruction to spray discharge ?jOYes ❑No <br /> b.Are sprinklers less than 50 years old?(Older sprinklers require sample testing)>5pyes ❑No <br /> c.Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)JqYes ❑No <br /> d.Is stock of spare sprinklers available?"Yes ❑No <br /> e.Does the exterior condition of sprinkler system appear to be satisfactory ?/fg Yes ❑No <br /> f.Are sprinklers of proper temperature rating for their locations�Yes ❑No <br /> 10.Explain any "No" er and comments: <br /> Signatu �� Date: <br />