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<br /> " "` 1301 L'ORIENT STREET
<br /> 44
<br /> ST.PAUL,MINNESOTA 551171
<br />/l',
<br /> 1 1 NG (651)558-3300.(800 -229-6263
<br /> AUTOMTIC SPRINKLER CO. FAX:(651)558-3310)
<br /> SHEET 1 OF 2-Use separate sheet for each ou,ldung inspection
<br /> REPORT OF INSPECTION
<br /> MINNESOTA LICENSE NO.C00005 WISCONSIN LICENSE NO.265989
<br /> t.
<br /> REPORT TO (---10.- O N U , i<=- BUILDING OR LOCATION J f
<br />` STREET t r 0 fi`�i(Ij l t.r S/fyr-�1 :` t /./'; INSPECTOR '
<br /> 7)1
<br /> CITY &_STATE 6�CC�j(,/(7 /" r i/ I, ,. DATE
<br /> Owner's Section(To be answered by Owner or Occupant) ` .
<br /> A. Explain any occupancy hazard changes since the previous inspection: i.#'
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<br /> , it) 4,,„--r .
<br /> ..,�.4 B. Describe fire protection modifications made since last inspection. �'-
<br /> J'e. 4,'.'4: - _ 1..\\*)
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<br /> C. Describe any fires since last inspection. Q _
<br /> D. When was t i- ste 't pipin. . t checked .r stoppage, corrosion or foreign material?
<br /> E. When w:• e ,ryf.ing ste a ch l ed for proper pitch?
<br /> F. Are dr valve •uatel pr . fro; freezing?
<br /> Signatb 't i i` .4. --- Title/1 '� ''2' / Date
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<br /> Inspector's Sect'.n(All responses reference current inspection) NA =NOT APPLICABLE
<br /> 1. General �_•
<br /> a. Is the balding occupied? Yes _No
<br /> b. Are all systems in service?likes ❑No
<br /> c. Is there a 'mum of 18 in.(457 mm)clearance between the top of the storage and the sprinkler deflectors?.l fes ❑No
<br /> d. Does ail-elec aT aat tape appear to be satisfactory?❑Yes U No [ NA
<br /> e. Does the hand hose on the sprinkler system(s)appear to be satisfactory?❑Yes —No. A
<br /> r 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?tomes ❑No
<br /> 4i. b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?`Y°Yes ❑No
<br /> 3. Water Supplies (See Item 16.)
<br />--`"'r"' a. Was a water flow test of main drain made at the sprinkler riser(s)?des O.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 t NA
<br /> tt ,s b. Are',fire department connections i satisfactory condition,couplings free,gaps in place, andtcl1eck vflves tight?des ❑No U NA
<br /> Are they accessible and visible?I"4'L{s i U.No _. NA f.= t
<br /> 5. Wet Systems
<br /> a. Are cold weather valves(O.S. & Y.) in the appropriate open or closed position? Yes ❑No ❑NA 1
<br /> .) b. Have antifreeze system solutions been tested?❑Yes ❑No i NA '
<br /> c. Were the antifreeze test results satisfactory?❑Yes ❑No -PIA •
<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?PhYes ❑No ❑NA Do all exterior openings appear to be protected against freezing?fig-Yes ❑No ❑NA
<br />' , 6. Dry System(See Items 11 to 13.)
<br /> k` a. Are dryvalve(s)inS
<br /> ,service?❑Yes ❑No NA
<br />''- b. Are thOdir des and priming water levels in accordance with the manufacturer's instructions?❑Yes ❑No fI NA
<br /> c. Has the operation of the air or nitrogen supplies been tested?❑Yes ❑No e?'tA Are they in service?❑Yes ❑No SNA
<br /> d. Were low points drained during this inspection?❑Yes ❑No *DIA .:
<br /> e. Did quick-opening devices operate satisfactorily?a Yes D.No ANA
<br /> f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes C No "NA
<br /> g- Did the heating equipment in the dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No PIN*rl
<br />,* 7. Special Systems(See Item 14.) - I� `t t "r ,,,t
<br /> t a. Did the deluge or pre-action valves operate properly during testing? Yes -. No (''NA ~r k t
<br /> b. Did the heat-responsive devices operate properly during testing?❑Yes O No SFA
<br /> c. Did supervisory devices operate during testing?U Yes ❑No 0+1A
<br /> 8. Alarms
<br /> - a. Did water motor(s)and gong(s)test satisfactorily?0 Yes ❑No li)b. Did electric alarms)test satisfactory?1�4 es ❑No ❑NA �c.Did supervisory alarm service test satisfactory? 9.-Yes ❑No ❑N ��I�«�`��L'�fOki
<br /> 9. Sprinklers �/
<br /> a.Are all sprinklers free4frpm corrosion,fading pr obstruction to spray discharge ? es ❑No
<br /> b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)testing)jilkices ❑'Nicr* - -= P,- -'
<br /> c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)des LiNo -
<br /> d. Is stock of spare sprinklers available?d'afes ❑No
<br /> e. Does the exterior condition of sprinkler system appear to be satisfactory ?1s O No
<br /> f.Are sprinklers of proper temperature rating for their locations?Vain ❑No
<br /> 10.Explain any"No" wer and
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<br /> Signature- �rr:fi =, 4i Date: _____Ze24Z.,/ -,
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