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`>;,„„,,.'.:: , ,;,::,,,,.%.,..:: x' „ :v. ti� v^. .;;..y ` ...,.1/4. �;.. ..•c- ..+..a..;,i.;,,,Y,�7."r•:4o« N. w" 'r 47*".. Yrt' '+' i,j..,:. _ :y jA„'4401420#44 1301 L'ORIENT STREET Iv, k I hi G ST.PAUL,MINNESOTA 55117 (651)558-3300•(800)-229-6263 AUTOMATIC SPRINKLER CO. FAX:(651)558-3310 SHEET 1 OF 2 Use separate sheet for each oudding inspection REPORT OF INSPECTION MINNESOTA LICENSE NO.C0000 WISCONSIN LICENSE NO.265989 REPORT TO L r..t.) 27' t wit' BUILDING OR LOCATION STREET 9 t "—, _ SrR.� INSPECTOR glire N� - DATE /C) / CITY.& STATE / / Owner's Section(To be answered by Owner or Occupant) • ' A. Explain any occupancy hazard changes since the previous inspection: N Q B. Describe fire protection modifications made since last inspectio ''"• ,..a I r•;' ;.: b.:. . -. - IC C. Describe any fires since last inspection. D. When was t system piping last ch ked for age,corrosion or foreign material? E. When wa a ry-pipi g system last Necked for proper pitch? F. Are dry e ade I protected f m freezing? Signat a Title Date Inspector's Section(All responses reference current inspection) NA =NOT APPLICABLE 1. General a. Is the building occupied?4-Yes No b. Are all systems in service?6-Yes. No c. Is there a minimum of 18 in. (457 mm)clearance between the top of the forage and the sprinkler deflectors?L-01.--Y-es ❑No d. Does aI le hheat tape appear to be satisfactory?❑Yes No A AA e. Dces the Nan se"2�fn the sprinkler systems)appear to be satisfactory? Yes No. 2. Control Valves(See Item 15.) a.Are all sprinkler system control valves and all other valves in the appropriate open or closed position?des ❑No b.Are all control valves in the open position locked, sealed or equipped with a tamper switch?des ❑No 3. Water Supplies(See Item 16.) a. Was a water flow test of main drain made at the sprinkler riser(s)?E Yes ❑No 4. Tanks,Pumps,Fire Department Connections a. Are fire pumps, gravity tanks,reservoirs and pressure tanks in good condition and properly maintained?❑Yes ❑No [NA _ b. Are fjre_departmgnt congections in,satisfactory condition, ottplings free,caps in place,and check valves tight?iX.Yes ❑No ❑NA Are they accessible and:visible?Mali---❑No w NA 4 ' „i 5. Wet Systems a. Are cold weather valves(O.S. & Y.)in the appropriate open or closed position? 'lies 0 No 0 NA b. Have antifreeze system solutions been tested?U Yes ❑No t'NA c.Were the antifreeze test results satisfactory?❑Yes U No L'-NA 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 where accessible? Yes ❑No NA Do all exterior openings appear to be protected against freezing?[PI`Yes No NA 6. Dry System(See Items 11 to 13.) "" a. Are dry valve(s) in service?❑Yes 0 No 16-NA b. Are thelntlr pressures and priming water levels in accordance with the manufac er's instructions?❑Yes ❑No LTJ NA c. Has the operation of the air or nitrogen supplies been tested?❑Yes ❑No ,_J NA Are they in service?❑Yes ❑No [ZONA d.Were low points drained during this inspection?❑Yes 0 No 14-NA e. Did quick-opening devices operate satisfactorily?❑Yes 0 N Z bIA f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes ❑No it'NA g. Did the heating equipment in the dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No 7. Special Systems(See Item 14.) a. Did the deluge or pre-action valves operate properly during testing?❑Yes ❑No "-NA b. Did the heat-responsive devices operate properly during testing?E Yes 7 NoI1a'A c. Did supervisory devices operate during testing?E Yes 0 No 011tA 8. Alarms <: a. Did water motor(s)and gong(s)test sati§factotily?0 Yes 0 No WIC'd. b. Did electric alarm(s)test satisfactory?LR"Y'es 0 No 0 NA c. Did supervisory alarm service test satisfactory?V-Yes ❑No ❑NA 9. Sprinklers a.Ale all sprinklers free from corrosion,loading or obstruction to spray discharge?14-Yes 1 No b.Are sprinklers less de `5D"years old?(bider sprinklers require sample-testing)[ e¢ E No c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing).19-Yes iE No d. Is stock of spare sprinklers available? ..Yes ❑No e. Does the exterior condition of sprinkler system appear to be satisfactory ?,6 res 0 No f. Are sprinklers of proper temperature rati f: . -ir locations?4•Y'es No 10.Explain any"No"ans . o corn 'e Signature: - • ate