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/Y 7.2 ','h ;-74,71,11::‘:^:40K"Y - R`�` 3 '- :T # JLC` + <br /> `` �' L'� 1301 L'ORIENT STREET <br /> v'' ST.PAUL,MINNESOTA 55117 - <br /> V I I'I N G - ` <br /> ��� �� � �`•�' (651)558-3300•(800)-229-6263 ��- <br /> AUTOMATIC SPRINKLER CO • _ ,. } °_," c FAX: (651)558-3310 <br /> SHEET 1 OF 2-Use separate sheet tor each buildinginspection '"�`"`} ` "�e4M''� "' 5 r'�' <br /> P P REPORT OF INSPECTION .�. <br /> MINNESOTA LICENSE NO.C00005 WISCONSIN LICENSE NO.265989 If <br /> REPORT TO QR()/43.-- ---- • J: v • BUILDING OR LOCATION,c <br /> STREET '7 9`� 42Z-:-.1 C 7/AL -RA( R-0, INSPECTOR` fi - <br /> • CITY & STATE )'~FUND i Ry <br /> N, DATE i E)%14461' D/ <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 /> I <br /> C. Describe any fires since last inspection. <br /> f, <br /> . When was the system piping last checked for stoppage, corrosion or foreign material? <br /> E. When was the dry-piping system last checked for proper pitch? <br /> F. Are dry valves adequately protected from freezing? <br /> ` Signature Title Date <br /> Insp tor's Section(All responses reference current inspection) NA =NOT APPLICABLE :, <br /> 1. General - <br /> a. Is the building occupied?1�J Yes ❑No : <br /> , :_ { R ._Y" -, ; - <br /> b. Are all systems in service?A9 Yes ❑No <br /> c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?D Yes ❑No - r ; <br /> Ac,- <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 satisfactoryes ❑No. CMN < , Rmf , <br /> 2. Control Valves(See Item 15.) ", ' .,. .`? . . ,f. n4;,,- 77 ` r ,41- ',7'• <br /> a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?i Yes ❑No -'?,*4-',.,,i. <br /> � x�?�- <br /> b. Are all control valves in the open position locked,-se31�d_or equipped with a tamper switch?p Yes •No »s Sa .:I •w <br /> 3. Water Supplies(See Item 16) ';; ' „ <br /> a. Was a water flow test of main drain made at the sprinkler riser(s)?rYYes ❑No —,,..„-,4,•"-„: E"-,;;;Aa:,,, -:,'-',2,-;;*--44, . `,1,.- <br /> '1&:-',r---,. , <br /> 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 <br /> b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight? 3 Yes ❑No ❑NA <br /> Are they accessible and visible?P'Yes ❑No ❑NA <br /> 5. Wet Systems WY <br /> a. Are cold weather valves (O.S. &Y.)in the appropriate open or closed position?L 1 I es ❑No ❑NA <br /> b. Have antifreeze system solutions been tested?❑Yes ❑No ®NA <br /> c. Were the antifreeze test results satisfactory?IDQ <br /> Yes ❑No , "NA <br /> d. In areas protected by wet system(s), does the building,_.;pea:to be properly heated in all areas, including blind attics and perimeter areas <br /> where accessible?$ Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?p Yes ❑No ❑NA <br /> 6. Dry System(See Items 11 to 13.) <br /> a. Are dry valve(s)in service?❑Y's Li No ❑NA <br /> b. Are the air pressures and riming dater levels in accordance with the manufacturer's instructions?❑Yes ❑No CI NA <br /> c. Has the operation of the a or nitro, ei1 siipplies been tested?El Yes ❑No ❑NA Are they in service?❑Yes ❑No ❑NA <br /> �_, A: d. Were low points drained uring'thi§ inspp ction?❑Yes ❑No CI NA <br /> e. Did quick-opening device operate'saFf4ctorily?CI DI No ❑NA <br /> f. Did the dry valve(s)trip properly durWhe 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-action V lve4 operate properly during testing?❑Yes ❑No ❑NA <br /> b. Did the heat-responsive devi o rate properly during testing?❑Yes ❑No ❑NA <br /> Ac. <br /> Did supervisory devices opera d rii g testing?❑Yes ❑No ❑NA fu <br /> 8. Alarms i W. ,, ` • <br /> t :',. a. Did water motor(s)and on /s test satisfactorily?❑Yes ❑No 1�$INA ,e ,,',,a,`," .. `. <br /> b. Did electric alarm(s)test satisfactory`]Yes ❑No ❑NA ,. ."---D <br /> ` <br /> c. Did supervisory alarm service test satisfactory?(D Yes ❑No ❑NA . ✓Q. ~• �*g ',..,,,•,,,,,,,,„,..r.,,,x + <br /> 9. Sprinklers t t, <br /> a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?Pres ❑No ,' r"'",- r ' rte' "Ar- <br /> b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)$Yes ❑No � `2 <br /> c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing) Yes ❑No a <br /> d. Is stock of spare sprinklers available?` Yes ❑No <br /> e. Does the exterior condition of sprinkler system appear to be satisfactory ? 'Yes ❑No <br /> f. Are sprinklers of proper temperature rating for their locations?517i'es ❑No <br /> 10.Explain any"No"answer and comments: <br /> Signature: /'su 7t /.,j .�'`��' ` 2 Date: f i ✓���/�� <br />