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IE P.,,....4301 York Ave St.Paul,Minnesota 55130 -- ‘4 ;71.11.2.71 K 1 N (651)558-3300 • (800)229-6263 AUTOMATIC SPRINKLER CO. Fax: (651)558 3310 AGREEMENT AND REPORT OF INSPECTION fip '91 SHEEP 1 of 2-Use separate sheet for each building inspected #INSPECTION t q 9 5 I MINNESOTA LICENSE NO.C , 41 REPORT TO i,D 4& ci E o _ BUILOCATION a STREET ; ♦,r " $LDG OR INSPECTOR I CITY&STATE kb / d ij DATE if©4/ /3 4 Customer hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or building,and prepare a written report of that inspection for.an agreed upon fee.As part of this agreement,customer agrees to terms and conditions on rear of form and will complete the Owner's Section of this document. Viking Automatic Sprinkler Company will not be held liable for incorrect or unkown answers provided in the Owner's Section. Owner's Section(To be answered by Owner,Occupant or Customer) A. Explain any occupancy hazard changes since the previous inspection 4J4 4) B. Describe fire protection modifications made since last inspection: Q#..) ,.. C. Describe any fires since last inspection: N 0 eti 2.. t f D.When was the system piping last checked for stoppage,corrosion or foreign ma rial? /1..J g$ E. When was the thy-piping system last checked for proper pitch? , g} A It F. Are dry valves adequately protected from freezing? I,.)I G.Does the system tain low point drains? o Yes Of. If yes,please state how many and the general location of each: Signature Title Date Inspector's Section(All reference current inspection) N/A=NOT APPLICABLE 1 General a. Is the building occupied?.glees o No b. Are all systems in service? iiptes a No c. Does there appear to be a minimum of 184n.(457 mm)clearance between the top of the storage and the sprinkler deflectors? PKYes o No d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? o Yes a No tll/A S 2 Control Valves(See Item 15) V 0,-. a. Do sprinkler system control valves appear to be in the appropriate open or closed position? IX/es o No b. Are control valves in the open position locked,sealed or equipped with a tamper switch? p'es o No 3 Water Supplies(See Item 16) ....................... a. Was a water flow test of main drain made at the sprinkler riser(s)? (likes 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 o No Vlll/A b. Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight? ,es a No o N/A Are they accessible and visible?Oes a No o N/A 5' Wet Systems a. Are cold weather valves(OS.&Y.)in the appropriate open or closed position? pies a No o N/A b. Have antifreeze system solutions been tested? o Yes o No ViAl/A c. Were the antifreeze test results satisfactory? o-Yes a No: 0,41/A _ if. 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? Q 1'es •❑No o N/A Doall exterior openings appear to be protected against freezing?totes. a No o N/A 6 Dry System(See Items 11 to 13) a. Are day valves(s)in service? o Yes o No PN/A b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? o Yes o No N/A c. Has the operation of the air ornitrogen supplies been tested? u Yes a No T/A Are they in service? o Yes a No l/A d. Were all know low points drained during this inspection? a Yes o No l/A e. Did quick-opening devices operate satisfactorily? o Yes o No ( N/A y f. Did the dry valve(s)trip properly during the trip pressure test? a Yes a No fi;01.l/A 'g. Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? o Yes '❑No p¢A 7 Special Systems(See Item 14) .: a. Did the deluge or pre action valves operate properly during testing? o Yes ❑NoT/A b. Did the heat-responsive devices operate,properly during testing? o Yes o No opt. c. Did supervisory devices operate during testing? o Yes ❑No fltl/A 8 Alarms a. Did water motor(s)and gong(s)test satisfactorily? o Yes o No` "f+I/A b. Did electric alarm(s)test satisfactory? latiles ❑No o N/A - c. Did supervisory alarm service test satisfactory?O..Yes o No o N/A o' 9 Sprinklers a a. Do visible sprinklers appear to be free from corrosion,loading Or obstruction to spray discharge? les a No •"• x b: Are sprinklers less than 50 years,old? (Older sprinklers require sample testing). 1� a No .. - c. Are quick response and residential sprinklers less than 20'years old? (Older sprinklers require sample testing) pies o No a*A. d. Is stock of spare sprinklers available? Yes o No ..' 1 e. Does the exterior condition of sprinkler system appear to be satisfactory? t fes`o No g`I f. Do visible sprinklers appear to be of proper temperature rating for their locations?*Yes o No _ . 1A Explain'any"Nb'answers and comments:; ; u Signature: •r .till Date: IC) /5. � -I (R.,9/02/09) . ,.