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1301 L'Orient Street do St.Paul,Minnesota 55117 C‘irN (651)558-3300 • (800)2219-6263 AUTOMATIC SPRINKLER CO. Fax: (651)558-3310 Setting Tice Standard... AGREEMENT AND REPORT OF INSPECTION SHEET 1 of 2-'Use separate sheet for each building inspected = #INSPECTION d /3 J S MINNESOTA LICENSE NO.C005 REPORT TO OR won fy L L BUILDINGQOR LOCATION SA en STREET 47j q s Q Ld C1 rlAC AA 'Ga INSPECTOR "A 7- CITY CITY&STATE 0 /040 . r14 d _ DATE f fj Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or building,and prepare a written report of that inspection for an agreed upon fee. As part of this agreement,owner agrees to terms and conditions on rear of form and will complete the Owner's Section of this document. Owner's Section(To be answered by Owner or Occupant) A. Explain any occupancy hazard changes since the previous inspection: AJA,Aig B. Describe fire protection modifications made since last inspection: /JO id C. Describe arty fires since last inspection: /O OA)l D. When was the systenipiping last checked for stoppage,corrosion or foreign material? , E. When was the dry-piping system last checked for proper pitch? /0 f{. F. Are dry valves equately protected from freezing? iiJ 14- Signature Title_ Date Inspector's Section( responses reference current inspection) N/A=NOT APPLICABLE 1 General a. Is the building occupied? Yes o No b. Are all systems in service.f'i Yes a No c. Does there appear to be a minimum of 18 in.(457 mm)clearance between the top of the storage and the sprinkler deflectors? Yes o No d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? a Yes a No p.N/A 2-Control Val'vesYSee 1 05) ; , ; a. Do sprinkler system control valves appear to be in the appropriate open or closed position?$Yes a No b. Are control valves in the open position locked,sealed or equipped with a tamper switch?it.Yes o No 3 Water Supplies(See Item 16) a. Was a water flow test of main drain made at the sprinkler riser(s)?0-Yes o No 4 Tanks,Pumps,Fire Department Connections a. Are fire pumps,gravity tanks,reservoirs and pressure tanks in good condition and properly maintained? o Yes a No 10 N/A b. Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight?pf.Yes a No o N/A Are they accessible and visible?0-Yes o No o N/A 5 Wet Systems a. Are cold weather valves-(O.S.&Y.)in the appropriate open or closed position? a Yes a No N/A b. Have antifreeze system solutions been tested? a Yes o No FIN/A c. Were the antifreeze test results satisfactory? o Yes o No vot N/A d. In areas protected by wet system(s),does the building appearto be properly heated in-all areas,including blind attics and perimeter areas where accessible?O.Yes o No o N/A Do all exterior openings appear to be protected against freezing?pt.Yes o No o N/A 6 Dry System(See Items 11 to 13) a. Are dry valves(s)in service? a Yes o No bp N/A b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? o Yes a No ;fa N/A c. Has the operation of the air or nitrogen supplies been tested? o Yes o No,N/A Are they in service? o Yes a No OW/ d. Were all know low points drained during this inspection? o Yes o No AN/A e. Did quick-opening devices operate satisfactorily? a Yes o No OLN/A f. Did the dry valve(s)trip properly during the trip pressure test? a Yes a No .N/A g. Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? o.Yes a No ofN/A 7 Special Systems(See Item 14) a. Did the deluge or pre-action valves operate properly during testing? a Yes o No 06.N/A b. Did the heat-responsive devices operate properly during testing? o Yes a No 49.N/A c. Did supervisory devices operate during testing? o Yes o No /A 8 Alarms a. Did water motor(s)and gong(s)test satisfactorily? a Yes o No N/A b. Did electric alarm(s)test satisfactory?of Yes a No a N/A c. Did supervisory alarm service test satisfactory?f Yes a No a N/A 9 Sprinklers a. Do visible sprinklers appear to be free from corrosion,loading or obstruction to spray discharge? OfYes o No b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing)pYes o No c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testg)(0Yes• a No o N/A d. Is stock of spare sprinklers available? kYes a No e. Does the exterior condition of sprinIdesystem appear to be satisfactory?A.Yes a No f. Do visible sprinklers appear to be of proper temperature rating for their locationslt Yes o No 10 Explain any"No"answers and comments: Signature: 1 Date: /0 -f fo- ir (Rev.2/8/0% - _