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4 ;-4'� 1301 L'ORIENT STREET
<br /> (c7iiIio
<br /> ST.PAUL,MINNESOTA 55117
<br /> t;. {a `� (651)558-3300•(800)-229-6263
<br /> • 4oir
<br /> AUTOMATIC SPRINKLER CO. FAX: (651)558-3310
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<br /> SHEET 1 OF 2-Use separate sheet for each building inspection REPORT OF INSPECTION
<br /> v,-., " MINNESOTA LICENSE NO.C00005 Ts . WISCONSIN LICENSE NO.265989
<br /> REPORT TO C1(2-614(--- , - - - ,- .- .4-' •- BUILDING OR LOCATION SA-,i F"
<br /> STREET ?()O (94--- C
<br /> / S
<br /> L c %YRS -7
<br /> CITY & STATE 1�0��• i �-_ /.
<br /> DATE /4-4//q/v/
<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. , .n :-3ii -
<br /> • ' C. Describe any fires since last inspection. 1
<br /> ID. When was the system piping last checked for stoppage, corrosion or foreign material?
<br /> A.E. When was the dry-piping system last checked for proper pitch?
<br /> i,,,...4.4-.,.,„-„..,,,;,,,y. t
<br /> .\ Are dry valves adequately protected from freezing?
<br /> t I Signa e 1. t Title Date
<br /> v
<br /> Insptor's Section(All responses reference current inspection) NA =NOT APPLICABLE r
<br /> 1 General '` 10 t y'"* �,
<br /> - a a. Is the building occupied? -1 Yes ❑No .r .,. (� F. f :_z - ',� > 4
<br /> :� : - b. Are all systems in service?e Yes ❑No k
<br /> ;t ,l; c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?'Yes E No Mr AT,
<br /> ,';;;I:14. d. Does all electrical heat tape appear to be satisfactory?❑Yes ❑No LST- lA
<br /> e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?❑Yes ❑No. Ie NA
<br /> 2. Control Valves (See Item 15.) '; >:5 n .h.-
<br /> X a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?E Yes ❑No
<br /> fy = ` b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?E Yes ❑No ..
<br /> Water
<br /> 1
<br /> e,
<br /> 434.7,„„, -,3- 3. a. Was Supplies ater flow testtof main drain made at the sprinkler riser(s)? l Yes ❑No
<br /> A 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 NA
<br /> b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight?laYes ❑No ❑NA
<br /> Are they accessible and visible?P1'es El No El NA
<br /> 5. Wet Systems
<br />---14 a. Are cold weather valves (O.S. &Y.)in the appropriate open or closed position? Yes ❑No ❑NA
<br /> ' b. Have antifreeze system solutions been tested?❑Yes El No ❑NA
<br /> c. Were the antifreeze test results satisfactory?El Yes ❑No 'NA
<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 accessible71 Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?{*Yes El No El NA
<br /> 6. Dry System(See Items 11 to 13.)
<br /> a. Are dry valve(s) in service?❑Yes ❑No ❑NA
<br />, `- :-u. b. Are the air pressures and pri1hing water levels in accordance with the manufacturer's instructions?❑Yes ❑No El NA
<br /> w .
<br /> c. Has the operation of the air;or nitrogen supplies been tested?❑Yes ❑No ❑NA Are they in service?❑Yes El No El NA
<br /> d.Were low points drained during this inspection?❑Yes El No ❑NA *,r t
<br /> e. Did quick-opening devices toperate, atisfactorily?❑Yes El No El NA -4'43 .,
<br /> i`` f. Did the dryvalve s)stri o erl aurin the trippressure El Yes ❑No ❑NA -r�`
<br /> ( P�' P Y gtest? ��
<br /> �' ,''''''-t,e g. Did the heating equipment in'the'dry-pipe value room(s) operate at time of inspection ?❑Yes C No ❑NA
<br /> , 7. Special Systems(See Item 14.) v
<br /> a. Did the deluge or pre-action valves operate properly during testing?❑Yes El No ❑NA '?. ., $. '�
<br /> ` -.. b: Did the heat-responsive devices operate properly during testing?El Yes El No ❑NA „ ;
<br /> c. Did supervisory devices oiiierate during testing?❑Yes ❑No ❑NA , , s ' * �= s� , ' xs ' -
<br /> t
<br /> 8. Alarms r = � , �� ,,V4Z-,
<br /> . a. Did water motor(s) and gong(s)test satisfactorily?❑Yes '0 No �N y - -;_,-.,,,.-",.,-;-.7;i--- '4_i
<br /> b. Did electric alarms)test satisfactory?�Yes El No ❑NA ., , ' , - � L
<br /> c. Did supervisory alarm service test satisfactory?4,Yes ❑No El NA .Sa '�r`° at r - .tea =gyp
<br /> �'- 9. Sprinklers ,,,-:c.-'''.",3, - $ k ,,a -7",-7t---,
<br /> a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?N'Yes ❑No f : .� r .,--.-3-'7,...,,,,' ""
<br /> • 1. b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)j)Yes El No
<br /> klc. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)rYes ❑No
<br /> d. Is stock of spare sprinklers available?(N 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?p Yes ElNo
<br /> kil10.Explain any "No" answer and comments:
<br /> Signature: fC�✓�`d /I /' 4.55 5,); 2 Date: 7/t)/i7/c)
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