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Home My WebLink Aboutviking sprinkler info �� `' ��F 1301 L'ORIENT STREET �"`�` �` `� ' # , ` % ;;�'� � .;. � 1 �1 N G " ST. PAUL,MINNESOTA 55117 -' ,�- �� , -�� '- (651)558-3300 • 800-229-6263 �- �� " AuronMnc S�N�R CO. FAX: (651)558-3310) "�� :°' � � ,� �:; � SHEET 1 OF 2-Use separate sheet for each building inspection �pORT OF INSPECI'ION � f - ��t � MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989 � ��". �}�'�{� REPORT TO �� C/��5 Sc,�.�%��,� UN�:.�r BUILDING OR LOCATTONC;2 �'/J Y 1 {�S� b4 ),' , ' ` ��y` � STREET 3� 3 ? S ff o�e c �1�.J�= D,� , � i.i, ' INSPECTOR � 'i��T �.��!�I; i �P k �: ! v � �' CITY & STATE J"1,': ,�'�, f- h. � , a, ; ,, DATE /_. i , y-,'� 3�a Owner's Section(To be answered by Owner or Occupant) � � A. Explain any occupancy hazard changes since the previous inspection: ?�' �� '� �' B. Describe fire protection modifications made since last inspection. � � '�` �i � �� C. Describe any fires since last inspection. - � � �' �' � D. When was the system piping last checked for stoppage, corrosion or foreign material? '�_ � �; �- E. When was the dry-piping system last checked for proper pitch? � ��>. ; F. Are dry valves adequately protected from freezing? �� Signature Title Date � � Inspector's Section (All responses reference current inspection) NA =NOT APPLICABLE � 1. General �� .�,� ;7�,. a. Is the building occupied?�Yes ❑No � . � � �F+` b. Are all systems m serv�ce?�Yes ❑No ` ��;� �� c. Is there a minimum of 18 in. (457 mm)cleazance between the top of the storage and the sprinkler deflectors?j3�i''Yes ❑No a�� d. Does all electrical heat tape appear to be satisfactory?❑Yes ❑No �jNA ��'� _ , ;z a " � e. Does the hand hose on the sprinkler system(s)appear to be satisfactory?O Yes ❑No. [�NA � f r �h a �, 2. Control Valves(See Item IS.) a�,' �° � a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?,�Yes ❑No � ��`� b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?�Yes ❑No �r; 3. Water Supplies(See Item 16.) '" `f � �` a. Was a water flow test of main drain made at the sprinkler riser(s)?'�Yes ❑No ` p ,_ 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 fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight?�Yes ❑No ❑NA �� Are they accessible and visible?�Yes ❑No ❑NA �� ;� � 5. Wet Systems �� a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position?❑Yes ❑No L�NA b. Have antifreeze system solutions been tested?❑Yes ❑No �NA � � c. Were the antifreeze test results satisfactory?❑Yes ❑No '�NA � d. In areas protected by wet system(s),does the building appear to be properly heated in all azeas,including blind attics and perimeter areas � � where accessible?❑Yes �No ❑NA Do all exterior openings appeaz to be protected against freezing?❑Yes �No ';�NA �= 6. Dry System(See Items I1 to 13.) � �: a. Are dry valve(s)in service?❑Yes ❑No �`NA �� r� b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions?❑Yes ❑No F�'NA � � ��= c. Has the operation of the air or nitrogen supplies been tested7�J Yes ❑No Bl NA Are they in service?❑Yes ❑No C�NA � d. Were low points drained during this inspection?❑Yes ❑No �NA -.=��,�� ."� e.Did quick-opening devices operate satisfactorily7 O Yes ❑No J�NA �� f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes ❑No ,�NA " � g. Did the heating equipment in the dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No `J,�( NA '�-' �"`�:� S� � 7. Special Systems (See Item 14.) - �''`*�` � '* � a. Did the deluge or pre-action valves operate properly during testing?❑Yes ❑No .�NA ;.w. �' ' � � � b. Did the heat-responsive devices operate properly during testing?❑Yes ❑No S(NA �� .� � � c. Did su erviso devices o erate durin testin �f_�Yes ❑No �NA �" ` '� P rY P S g- 8. Alazms - 5. ¢ �:� .�.' � ; a. Did water motor(s) and gong(s)test satisfactorily?❑Yes ❑No �'NA " �� , ; , b. Did electric alarm(s)test satisfactory?�Yes �No ❑NA ;'�'�'`�r � � ` � �� c. Did supervisory alarm service test satisfa tory?T�Yes ❑No �NA x,._ ;: .�* .�,� � - 9. S rinklers �� Y p �" L „�j � a. Are all sprinklers free from corrosion, loading or obstruction to spray dischazge ?[�Yes ❑No a" :. � �.� �� a��- b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)�Yes ❑No �.;� ��'��'� c. A r e q u i c k r e s p o n s e a n d r e s i d e n t i a l s p ri n k l e r s l e s s t h a n 2 0 y e a r s o l d?(O l d e r s p ri n k l e r s r e q u i r e s a m p l e t e s ti n g�l Y e s ❑N o � � d. Is stock of spare sprinklers available 7�f Yes �No ��.�- ' e. Does t he ex terior con di tion o f sprin k fer sys tem appear to be sa tis fac tory ?�3 Yes ❑No = f. Are sprinklers of proper temperature rating for their locations?,�Yes ❑No �', � � �` .�,s$ . � '.S ' L� t "�` '"_.-�. �. �� 10.Explain any "No"answera�d comments: �. e� `� �{�` .w ;p l�ff 4� �iN r' o,� � � �; , � �� : `�,�„_ � .�t._. `,_ , , � Signature: /�� .ti--� �' - ---r�-�--�c--'' Date: - > 5;� '`��.� — � :� � - N�- ��. �� 4 _ �,; �t,` " `� ; � 1301 L'ORIENT STREET �� V� �I N G �� ' ST. PAUL, MINNESOTA 55117 ��'�'' ��_ � ,� �* '�� •,°� (651)558-3300 • (800)-229-6263 � �`-� �� ' �� = AUTOMATIC SPRINKLER CO. �� FAX: (651) 558-3310 � 4 �y SHEET 2 OF 2 - Use separate sheet for each system inspection System No. or Descr�tion if multiple �.� ` ,�� : i - systems i .,�� . , ,._ �� . R � s;�p��c t�c� L �,�t- „ Inspection Re�ort , _ ' .-n,-!l, Np '%;'i �`.s 4: .�.3 � ti S H.es�Q c�.�n i �. %'',�'; �J ��. �..!�(i,�' FY,�', �.. ,y; .�J �r� :"�._ �r 11. Date dry-pipe valve trip tested (control valve partially open) .�'�i� (See Trip Test Tab/e which follows) .,��„�� 12. Date dry-pipe valve trip tested (control valve fully open) ti�`� (See Trip Test Table which follows) ''�" a � 13. Date quick-opening device tested � �,� (See Trip Tesf Table which follows) „ ti ' ,� ..� y,,. DRY VALVE TRIP TEST TABLE Q.O.D. � _ ,r° MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. �,.' � .�..,.;��.-* . ��'� �" k .� x# :. �";� DRY PIPE Time to Trip Water Air Trip Point Time Water Reached Alarm Operated ' ' �� "" �' i Thru Test Pipe Pressure pressure Air Pressure Test Outlet Properly � ��# OPERATING -`� � �� +` TEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO �� t Without ; ,�;, �.`'� � Q.O.D. �„s � � �� With , ; � � � Q.O.D. � � � r � � � T �_„� .�� ,� � ` ,:: � x t `' 14. Date deluge or preaction valve tested ��- (See Trip Test Tab/e which follows) 4, � '� � � `��'�'w' TRIP TEST TABLE ' -� � r� ; K � - Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC ��, � "� � _ � Piping Supervised ❑ YES ❑ NO Detecting media supewised ❑ YES ❑ NO � `-' -'�r � - DELUGE& Does valve operate from the manual trip and/or remote control stations � ❑ YES ❑ NO '� �'� " a��,� PREACTION Is there an accessible faal�ty in each circmt for testing Method of testing-circuits ; `;��'� �- " �� VALVES ❑ YES ❑ NO . ;�.;, "� �,-�`'* Does each circuit operate Does each circuit Maximum time to �" � w a; 'xs r �,,` MAKE MODEL su ervision loss alarm o erate valve release o erate release - � ��r;. - YES NO YES NO YES NO x �+�i w� F� ,. 15. See Control Valve Maintenance Table. �.' � r �� Control Valve Maintenance Table �,. Explain � �'^� # Abnormal ,�,� , Control Valves Number Type Open Secured Closed Signs Condition � City Connection Control ��"' �t �:a Valve _ _ Tank Control Valves - �� ' Pump Control Valves ,� �� „� Sectional Control Valves �. � J �` :�;'i ��', System Control Valves _ �f f�(Z .� 4� � Other Control Valves � Kitchen Control Valve R S . ' �-;�; �� : -J p s �'`��` 16. Water Flow Test at Sprinkler Riser � -•:: :. { Water Supply Source: City �,,�'" Tank ,�,i,.=� Pump �,f� �, Date `. Test Pipe Size of Static Residual Location Test Pipe Pressure (Flow) ��:::_ . _ Pressure �.= Last Water Flow Test � 1 ' � �-f� I ,� , _ %::_ �,' (G�s- �-'"- �� This Wate Flow Test �� /d— Q { e/Z 2 '' � �`�"' ��` �" .. �_ � 17. Explain any "No" answers and comments: �� _ �s� �r�;' 18. Adjustments or corrections made during this inspection: �: �., ��. , 19. Although these comments are not the result of an engineering review, the following desirable improvements are recommended: ��j �.. � � �� d � � ��;� ti . ; �� Si nature: ��, � � ��-f i/* f J �'�'� g �tl�' Date: �—'!�,�� z,,�k _ �. -,A�,��-.. _ � y-�r � ` ` �'' �...'��'+�`�� ; VIKING AUTOMATIC SPRINKLER COMPANY �� 1��a �`�`�; � �� 2400 ROSE PLACE • ST. PAUL, MINNESOTA 55113 • (612) 636 4680 • 1-800-229-6263 w11+�1X:�612) 636-4685 �� , ; � SHEET 1 OF 2-Use se arate sheet for each buildin ms ection �� r` � '�d. P 9� P � v�i �,�i'1V� '+- "�� RF,PORT OF INSPECTION �� MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. SC0000115 � �. REPORT TO BUILDING OR LOCATION � � STREET INSPECTOR � �� x ' CITY & STATE DATE � `` � �s,� Owner's Section (To be answered by Owner or Occupant) ��.�. '�F` ' A. Explain any occupancy hazard changes since the previous inspection: �� B. Describe fire protection modifications made since last inspection. � TM � ` � � C. Describe any fires since last inspection. ' � �" �" �= � ,''� � � �.� �—'� r, � D. When was the system piping last checked for stoppage, carrosion or foreign material? ��„� E. When was the dry-piping system last checked for proper pitch? , �; F. Are dry valves adequately protected from freezing?� � � Signature � - _ Title � Date � Inspector's Section (All responses reference current inspection) NA =NOT APPLICABLE " t= �� r; 1. General �x,,,,:.'�� ' a. Is the building occupied?� Yes �:No ,.� ,, > � � b. Are all systems in service?�Yes ❑ No r � <� + c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?�Yes ❑No ; � � d. Does all electrical heat tape appear to be satisfactory?L_.Yes ❑No �-�NA �� e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?—Yes —No. ��NA - �. "' 2. Control Valves (See Item I5.) �- _ a. Are all sprinkler system control valves and all other valves in the appropriate open or closed posiCion?�-1'es ❑No -_ �. � b. Are all co�trol va►ves in the open position locked, sealed or equipped with a tamper switch?�Yes �No '"` 3. Water Supplies (See ltem 16.) "' � � � a. Was a water flow test of main drain made at the sprinkler riser(s)?yL_yes �No � � �� 4. Tanks, Pumps, Fire Department Connections �� " a. Are fire pumps, gravity ta�ks, reservoirs and pressure tanks in good condition and properly maintained?�Yes ❑No C�IA � ; b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves�tight?�Yes �No ❑ NA � �� Are they accessible and visible?�Yes -No _- NA ��"_'� 5. Wet Systems � �` a. Are cold weather valves (OS. &Y.)in the appropriate open or closed position?ec Yes �No ❑ NA �'�� b. Have antifreeze system solutions been tested?�' Yes —No �--AIA c. Were the antifreeze test results satisfactory?_ Yes -�No e��-NA � � d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including blind atUcs and perimeter areas � � where accessible?'�-Yes ❑No ��NA Do all exterior openings appear to be protected against freezing?�Yes C No ❑NA � 6. Dry System(See Items 11 to 13.) , � � _z � a. Are dry valve(s) in service?�Yes —No ��4 NA ,:, ��' b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions?u Yes ❑No C��IA �.'��,__ c. Has the operation of the air or nitrogen supplies been tested?�—Yes _No I�NA Are they in service?❑Yes ❑No �A �` ` " d. Were low points drained during this inspection?-Yes —No �NA : . .�� ':: e. Did quick-opening devices operate satisfactorily?❑Yes `No !�.NA � : , . : f. Did the dry valve(s) trip properly during the trip pressure test?f_ Yes _No �NA � g. Did the heating equipment in the dry-pipe value room(s) operate at time of inspection ?C Yes C7 No ,�NA -_ �, ,��,. 7. Special Systems (See Item 14.) � � -'� - � a. Did the deluge or pre-actio❑ valves operate properly during testing?❑Yes No �ax-I�IA , -�' �. .,� � ;� �- "`' ' '� b. Did the heat-responsive devices operate properly during testing? Yes �No �AIA - - - � �'� c. Did supervisory devices operate during testing?_ Yes _. No �1A � �� 8. Alarms ,��,,: �� a. Did water motor(s) and gong(s) test satisfactorily?C Yes -No �_NA _ _ b. Did electric alarm(s) test satisfactory?��Yes '-'No �� NA � � � � . �� c. Did supervisory alarm service test satisfactory? _ Yes _ No �.NA 9. Sprinklers , w a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?�I'es -No b. Are sprinklers less than 50 years old? (Older sprinklers require sample tesUng) _�'�� Yes ��7 No � a Are quick response and residential sprinklers]ess than 20 years old:' (Older sprinklers require sample testing)+��Yes l.-No _ .� ,,," d. Is stock of spare sprinklers available?�I Yes '�:_ No e. Does the exterior condition of sprinkler system appear to be satisfacCory '?�-Yes -No f. Are sprinklers of proper temperature rating for their locations'?-�Yes �_. No 10.Explain any "No" answer and comments: Signature: -� ;` - Date: � � �-�-�e a :.�. .�'� { ..�:;: .r.t.o- , � VIKING AUTOMATIC SPRINKLER COMPANY � s 2400 ROSE PLACE • ST. PAUL, MINNESOTA 55ll3 • (612) 636-4680 • 1-800-229-6263 • FAX: (612) 636-4685 � �#; � �t� SHEET 2 OF 2 - Use separate sheet for each system inspection System No. or Description if multiple j �"'' systems �� ' Inspection Report �' �=�: Na :a " � , � 11. Date dry-pipe valve trip tested (control valve partially open) (See Trip Test Table which follows) � 12. Date dry-pipe valve trip tested (control valve fully open) (See Trip Test Tab/e which follows) 13. Date quick-opening device tested (See Trip Test Table which follows) DRY VALVE TRIP TEST TABLE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. ,..; DRY PIPE Time to Trip Water Air Trip Point Time Water Reached Alarm Operated � '� OPERATING Thru Test Pipe Pressure pressure Air Pressure Test Outlet Properly 4 J rEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO ��..� Withaul � Q.O.D. �� :x':5�� With ��: Q.O.D. � ,;;-� � ; 14. Date deluge or preaction valve tested (See Trip Test Tab/e which follows) � � TRIP TEST TABLE � ,��:�� Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC � � Piping Supervised ❑ YES ❑ NO Detecting media supervised ❑ YES ❑ NO E� k`+ �^ i �s "�o- �,.,� ,� DEWGE& Does valve operate from the manual trip and/or remote control stations ❑ YES ❑ NO �y "f" ��,"s�'�'t �� PREACTION Is there an accessible facility in each circuit for testing Method of testing-circuits � �� +�.rx.� VALVES ❑ YES ❑ NO 6 F at- Does each circuit operate Does each circuit Maximum time to n MAKE MODEL su ervision loss alarm o erate valve release o erate release �' - YES NO YES NO YES NO �;� . � 15. See Control Valve Maintenance Table. Control Valve Maintenance Table � �µ Ex lain Abnormal �� :� Control Vaives Number Type Open Secured Ctosed Signs Condition ' City Connection Control ,g � Valve �-ie'. Tank Control Valves �"� Pump Control Vabes � �' 4 ,� Sectional Control Valves F �$ System Control Valves � I� �c Other Control Valves '' �� Kitchen Control Valve £j �;�� 16. Water Flow Test at Sprinkler Riser � � N�� Water Su I Source: City Tank Pump � �. �'� Date Test Pipe Size of Static Residual r � �� Location Test Pipe Pressure (Flow) � , k :': Pressure �` :� �:� Last Water Flow Test r ;z� `'"�' This Water Flow Test '� �''��, ,;; �;� ��,��,_, 17. Explain any "No" answers and comments: � � �,4::�,. � y�: �. %��;: t{' �i ' +y� i: � 18. Adjustments or corrections made during this inspection: �� ''� �` � ;<� °�; � � 19. Although these comments are not the result of an engineering review, the foliowing desirable improvements are recommended: � ��' � ��r� � � ��.� ,.._ Signature: Date: ., VIKING AUTOMATIC SPRINKLER COMPANY . -� 1301 L'ORIENT STREET• ST.PAUL,MINNESOTA 55117 • (651)558-3300 • 1-800-229-6263 •FAX: (651) 558-3310 r'; � � SHEET 1 OF 2-Use separate sheet for each building inspection '�,�`` REPORT OF INSPECTION _ ,�, .�- MINNESOTA LICENSE NO. CO0005 WISCONSIN LICENSE NO. SC0000115 _ ;� REPORT TO BUILDING OR LOCATION STREET INSPECTOR CITY & STATE DATE �;', Owner's Section(To be answered by Owner or Occupant) �' :� A. Explain any occupancy hazard changes since the previous inspection: ;�: . -3' •>, s>,; B. Describe fire protection modifications made since last inspection. �- C. Describe any fires since last inspection. -- D. When was the system piping last checked for stoppage, corrosion or foreign material? E. When was the dry-piping system last checked for proper pitch? F. Are dry valves adequately protected from freezing? - Signature � Title � � Date �� _ ;. Inspector's Section (All responses reference current inspection) NA =NOT APPLICABLE - 1. General ' a. Is the building occupied?�Yes � No �� ;� b. Are all systems in service?p Yes ❑No ��'"' � c. Is there a minimum of 18 in. (457 mm)cleazance between the top of the storage and the sprinkler deflectors?6�--Yes ❑No '- ' d. Does all electrical heat tape appear to be satisfactory?�Yes ❑No !�-�VA �y +� e. Does the hand hose on the sprinkler system(s) appear to be satisfactory? - Yes �Na �NA �� 2. Control Valves(See Item I5.) a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?�-Yes ❑No + ��- b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?�Yes ❑No 3. Water Supplies (See Item 16.) a. Was a water flow test of main drain made at the sprinkler riser(s)?�Yes u 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 C�AfA � � b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight?�r3Yes ❑No ❑NA '" Are they accessible and visible?{�J_Yes ❑No ❑NA � 5. Wet Systems ti� a. Are cold weather valves (O.S. & Y.) in the appropriate open or closed position?��'es ❑No ❑NA "��x" b. Have antifreeze system solutions been tested?❑Yes '�No �--AIA � �� c. Were the antifreeze test results satisfactory?- Yes ` No �-NA �� } a, 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?t_.�Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?G�..yes ❑No ❑NA 6. Dry System(See Items 11 to 13.) a. Are dry valve(s) in service?❑Yes ❑No �NA - b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions?❑Yes ❑No @-NA , x �:°, c. Has the operation of the air or nitrogen supplies been tested?❑Yes ❑No 'r�NA Are they in service?❑Yes ❑No �-�TA •_� d. Were low points drained during this inspection?❑Yes - No ;NA ' - e. Did quick-opening devices operate satisfactorily?'` Yes �No �-NA f. Did the dry valve(s) trip properly during the trip pressure test?❑ Yes �No �-NA g. Did the heating equipment in the dry-pipe value room(s) operate at time of inspection ?❑Yes ❑No 0 NA '� f 7. Special Systems (See Item 14.) �." a. Did the deluge or pre-action valves operate properly during testing?� Yes �'No C�'�AIt� ' b. Did the heat-responsive devices operate properly during testing?U Yes �No �NA �•�, c. Did supervisory devices operate during testing? J Yes ❑No C3-Ia1A _ 8. Alarms � a. Did water motor(s) and gong(s)test satisfactorily?CI Yes �J No �1-�IA b. Did electric alarm(s) test satisfactory?C✓1_Yes r No ❑NA � - c. Did supervisory alarm service test satisfactory?�Yes `No �J NA , :. ; ; 9. Sprinklers Y � a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?�Yes ❑No - b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) �'Yes ❑No T" c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)[�Yes ❑No d. Is stock of spare sprinklers available?�Yes -No ` ' ' e. Does the exterior condition of sprinkler system appear to be satisfactory ?�Yes C No f. Are sprinklers of proper temperature rating for their locations?�Yes -No ,; ' 10.Explain any "No" answer and comments: Signature: � Date: �€ `'�" VIKING AUTOMATIC SPRINKLER COMPANY � � ,�;. �, �� 1301 L'ORIENT STREET • ST. PAUL, MINNESOTA 551 17 • (612) SSK-33(x) • I-800-229-6263 • FAX: (612) SSK-3310 �-.�' � '�'! t.r:-, SHEET 2 OF 2 - Use separate sheet for each system inspection System No. or Description if multiple a ��' �� systems t;, � ,�; Inspection Report , � ' No. ' � '� ,f�� F si � 11. Date dry-pipe valve trip tested (control valve partially open) r A ' � '� (See Trip Test Table which fo/lows) , i' 4� 12. Date dry-pine valve trip tested (control valve fully open) (See Trip Test Table which follows) ,=; ¢ �,r� 13. Date quick-opening device tested (See Trip Test Table which follows) -� � �� DRY VALVE TRIP TEST TABLE �.0.0. { � � MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. rs ;-r� � r ` � " DRY PIPE Time to Trip Water Air Trip Point Time Water Reached Alarm Operated OPERATING Thru Test Pipe Pressure pressure Air Pressure Test Outlet Praperly „i MIN. SEC. PSI PSI PSI MIN. SEC. YES NO .; -"� TEST yyithout Q.O.D. +.� , >U With a . — _. Q.O.D. r r 4 14. Date deluge or preaction valve tested � (See Trip Test Table which follows) '"-� � TRIP TEST TABLE ' � ' : ,,. . ; $ ;.� Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC -�� ; '�� s 'TM�'. � .. � Piping Supervised ❑ YES ❑ NO Detecting media supervised ❑ YES ❑ NO � DEWGE& Does valve operate from the manual trip and/or remote control stations ❑ YES ❑ NO � �� PREACTION Is there an accessible facility in each circuit for testing Method of testing-circuits °��'�� '� ` ❑ YES ❑ NO - � � - VALVES ;f*„�p��, � - Does each circuit operate Does each circuit Maximum time to ' MAKE MODEL su ervision loss alarm o erate valve release o erate release �; � >:�j ,�y,` YES NO YES NO YES NO t ' s � � '� �� `�i� �s S ' � � � 'fy` Sd;� "�4�"*� � 15. See Control Valve Maintenance Table. �� '" � � .'�� ; Control Valve Maintenance Table �'��.�- �,,�,�,.t� � z Explain �" �� Abnormal �*�� , 7 Control Valves Number Type Open Secured Closed Signs Condition '� � City Connection Control ' � � �, Valve � Tank Control Valves ` ' - Pump Control Valves � ;� - Sectional Control Valves � � � +� ,. System Control Valves a +� Other Control Valves ��5 ,,,,y.' Kitchen Control Valve � .; c�; m.* ��`" � 16. Water Flow Test at Sprinkler Riser � °� °�` � °� Water Su ly Source: City Tank Pump `��`�° ��- Date Test Pipe Size of Static Residual � � �`' Location Test Pipe Pressure (Flow) fi Pressure - �, Last Water Flow Test �� -� This Water Flow Test ! :_- � �'��`�` � F: . s� L �.. - 17. Explain any "Nd' answers and comments: :� z � ��`�� s "� � 18. Adjustments or corrections made during this inspection: s�+, - `� 'a� � z� :� ,,<_�� 19. Although these comments are not the result of an engineering review, the following desirable improvements are recommended: .�; �; : Signature: Date: y - � i :� VIKING AUTOMATIC SPRINKLER COMPANY �.._;. 2400 ROSE PLACE • ST, PAUL, MINNESOTA 55113 • (612) 636-4680 • 1-800-229-6263 • FAX; (612) 636-4685 SHEET 1 OF 2- Use separate sheet for each building msprction Ins�ctiun ReFwrt N��. REPORT OF INSPECTION ►nsperticin Contract No. ____ __-_— ' " ' Conferred With _ _ _ Bureau Filr No. _ _- __ _ -_--- - - ". , Rf?I'ORTTO _ _:. _ _ BUII.I�ING OR I_(�CATION _ `, - --- -� _ _ __ __ , �: : � � , ST'REF.T - r _ _ - _ _ INSPECTOR = ---'- -- - - - -- _ .ti,'. CITY & S"I'ATE i � ," �_' _ _ DAT'E ' �-,�----___.---- a Owners Section (To be answered by Owner or Occupant) � w A. F.xplain any occupancy hazard chan�;cs sinc��th�• pr�viuus mtip��rti��n. _ _ __ __. _- !-__--___- -- - ___ ___-_-__-- ��,�.--�e ----- ——--— --- — — ` _.�.•� �}F: _ _—-- --- — -- ;: -----_--- _ _ _ _ _ r - - B. l�escribe fire prc�tectiun mudifications made since last inspecticin. _ _ __ ________ ��p��___ � -- --- - - _ - - - __ �� r�� n� �i � � . _ - _ _. __ - _ _ _---- -- - J r" ' C. Descnbe any f�res smce last insperhon. ____---- ------ --- -- -- — � --- --- --- - - - - -_ _ _ _ _ --- ------ ------ ; D. When was the svstem piping last rhecked f�ir st��ppa�;e, corr��si�m �>r foreign material? _ � , • > E. When was the dry-piping syst��m last check��d fe�r pre�per pi;ch? __ _ __ , ;; - - -- -- -------- , F. Are dry valves adeyuately F�mtected from frcezing7 _.__ = ` . Signature - --- - - _ _ _ Titl�• _ _ Date----- ' _- - _ --- - - - ;.a>.::; Inspector's Section (All responses reference current inspection) NA = NOT APPI.ICABLF, 1. General a. Is the building occupied?� Yes ❑ Nu � b. Are all systems in service? [�Yrs �] N<� �� c. Is there a minimum��f 1R in. (457 mm)��Iearance brtwe��n the tup uf the storage and the sprinkler deflrctors7(�,Yes ❑ No � � � � d. Does all electrical heat tape appear to be satisfactory? ❑Yes ❑ No [s]�.�ilA �."�.: e. Does the hand hosr un the sprinkler system(s) appcar to be satisfactory? ❑ Yes ❑ Nu [�dy,.A '•��a 2. Control Valves (See Item 1.5.) Ai- �: a. Are all spnnkler system cuntrol valves and all other valves in the appropriate open or closed position? �--Y�s ❑ No ` b. Are all control valves in the open position lockrd, sealed cx equipped with a tamper switch?�„�es ❑ No � 3. Water Supplies (See Item 16.) a. Was a water flow test of main drain made at the sprinkler riser(s)? [�-�is ❑ N� 4. Tanks, Pumps, Fire Department Connections � `'- a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?�Yes ❑ No []�IYA : � b. Are fire department connectio�s in satisf�ctory condition,co�plings free, caps in place,and check valves tEght?�es ❑No ❑17A _ Are they accessible and visible?[�-�a=s ❑ No ❑ NA 5. Wet Systems � a. Are cold weather valves (C).S. & Y.).in the appropriate upen or closed position? [�Yes ❑ Nc� ❑ NA b. Have antifreeze system solutions been tested? [J Yes ❑ No �,.L�IA : �'� c Were the antifreere test results satisfactory? [� Yes ❑ No �o��iiA d. In areas rotected b wet s Stem s, dcxs the buildin a ar to be ru erl -heated in all areas, includin blind attics and erimeter areas P Y Y- O K Pf'e P P 7 K P where accessible? [�-Xes ❑No ❑NA [k�all extenor openings appear to be protected against freezing? .[c�Yes ❑No ❑NA 6. Dry Systems (See (tems ]1 to 73.) a. Are dry valve(s) in service? ❑Yes ❑ No [�NA - b. Are the air pressures and priminK water Ievels in acc��rdance with the manufacturer's instructions? ❑ Yes ❑ No [�j�lA c. Has the operatiun of the air or nitrogen supplies been tested?❑Yes ❑N�� [�TtA Are they in service? ❑Yes, ❑No (�,�IA d. Were low points drained during this inspection? �Yes ❑ I�lo [,�NA ��'Y e. Did quick-opening devices operate satisfactorily?❑ Yes ❑ No �_NA ��;-�� f. Did the dry valve(s) trip properly durin� the trip pressure test? 0 Yes ❑ No [�.NA � g. Did the heating equipment in the dry-pipe valve room(s) operate at the time <�f inspectic�n? � Yes ❑ No [�VA 7. Special Systems (See Item 14.) ,� , a. Did the deluge or pre-action valves operate properly during testing? ❑ Yes ❑ Nc�, [�.NA � �? b. Did the heat-responsive devices operate properly during testing? ❑Yes ❑ No (�.NA �� c Did the supervisory devices operate durinR testing? ❑ Yes ❑ No [a�NA �t 4'� � : 8. Alarms �5 a. Did water motor(s) and gong(s) test satisfactorily? ❑ Yes ❑ No [.}�lA , � � �'�,� �` b. Did electric alarm(s) test satisfactorily?[�Yes �No ❑ NA ' �� xa� �+�: 1 _ c Did supervisory alarm service test satisfactorily?�Yes ❑ No [�NA �;,; � 9. Sprinklers 4"� `�, a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge? C�.Yes [7 No � " b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) [-,Yes �] No �,�- � c Are yuick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)��Yes ❑ No �.• � d. Is stock of spare sprinklers available? ❑Yes C�No � '� -- e. Does the exterior condition of sprinkler system appear to be satisfactory? �`Yes ❑No � , ' f. Are sprinklers of proper temperature ratings for thc ir locations? [�es ❑ No r ,,, � , _ , �/ _"' 10. F.xptai�any"No"answers and comments: i - �� . __ - ___ __�.' p`-�L�� - if�-'!� v � _ - `' K_ -�: _ ,��f�' r, -__ ,�F . t'..`�% ✓u � !J r' � � Signalure: ..��___��..�.� --- ------- Date: �c� /L , �� . , .. � . . : : ,... .. ,, �'� � VIKING AUTOMATIC SPRINKLER COMPANY � r -�.'� 2400 ROSE PLACE • ST, PAUL, MINNESOTA 55113 • (612) 636-4680 • 1-800-229-6263 • FAX: (612) 636-4685 ,,.. ,. SHEET 2 OF 2- Uae separate sheet for each system mspection System No. or Description if multiple :`^: � ;j systems ;� � � Inspection Repurt _ '� " � No. �� -�a,,,�fi� � - --- / � , ' . 1 ,� � Q,� � � 11. Date dry-pipe valve trip tested (control valve partially open) _ �/ F ' (See�ri� Test Table mhich'follows.) """"; � 12. C?ate dry-pipe valve trip tested (control valve fully open) (See Trip Test Table which follou�s.) '� 13. Date quick-opening device tested (S��t� Triy Test Table which follows.) ,�� C � ORY VALVE TR[P TEST TABLE C O D. �„ � � MAKE MOOEL SERIAL NO. MAKE MODEL SERtAL NO. - x '3 t - - DRY PIPE Time to Trip Water Av Tnp Point Tlme Water Reached Alarm Operated - OPERATING Thru Test Pipe Preuure Pressure Air Pressure Test OuUet P.oDerly TEST MtN SEC PSI PSI PSI MIN SEC. YES Nd - � Without i.�:,.. �O.D. With 4.•.,_ �.O.D. . r i ' � ' , �-.s �s � � 14. Date deluge or preaction valve lested ' � � _ (See Tri�� Test Table zi�{rich foUows.) � � TRIP TESi'TABLE OpereLon �_j PNEUMATIC ❑ ELECTRIC O HYDRAUUC wt, z`; � ��-. Pipmg $upervised i.] VES C NO Detec�ing media supervised CJVES ONO `'�` � � � DELUGE & Dces valve operate from the manual tnp anA!or remote control stations ClVES ❑NO �'""" ,,,�V'r-n��'�� - P VALVESN Is the�e an accessible facility in each urcwt lor testirg Method of testmg�arcuits � ❑V E S L 1 NO '� ,,''� � _.� � �� Does each urcwt operate Dces each arcwt Maximum time to �� :,�. �j� .. MAKE MODEL su>erv�s�on loss alarm o rate �alve release o erate release � ' VES NO YES NO YES NO � ,a�'; � . .. � � � - � � ' 15. See Control Valve Maintenance Table. �;, � � Control Valve Maintenance Table �� :.;a >«� Explain �� Abnormal :� E Control Valves Number Type Open Secured Closed Signs I Condition . �R � ' City Connection Control „ � � Valve � ��h --< Tank Control Valves �� :� Pump Control Valves � , � �:; Sectional Control Valves �� C/��'� �j, � �. r_�Cl/. �z= ; � � System Control Valves / — i � `� S2, =� Other ContPbi Valves ` r �.� i; " 16. Water Flow Test at Sprinkler Riser `- ' Water Supply Source: City Tank Pump �`� � .. 4""�:4�'�. Date Test Pipe Size of Static Residual Location Test Pipe Pressure (Flow) � Pressure -� � Last Water Flow Test This Water F7ow Test �;' /,�'i�� ' � %� r" �� !:' :� 17. Explain any"No"answers and comments: _ ,�_� � � � �.»�E '�,-'� �' t.;� 18. Adjustments or corrections made during this inspection: y� — � ,:t � ��;. 19. Although these comments are not the result of an engineering review, the following desirable improvements are recommended: .�.��.' ' ' =� r �_ _ _ �^ � �".. i �,� � `t/ ,� '�,T' � ;' Signature: ,�=°��"'� _ �---"'- _ Date• �= � � � �, - ,1J ��J` �� ,-._ -�` VIKING AUTOMATIC SPRINKLER �` ,, COMPANY ,�C' . �:,'��"i� �400 ROSE PLACE • ST, PAUL, MINNESOTA 55113 • (612) 636-4680 • 1-800-229-6263 • FAX: (612) 636-4685 <:� �# SHEET 1 OF 2-Use separate sheet for each bwld�ng mspectwn lns��ctiun_ReFn��t Nu. _ _ _ REPORT OF INSPECTION �nsprcti�in Contract No. _ _ �� '"' � Conferred With � Rureau File No. _ _ _-__- _ - ---- :`° s� � RF.I'ORT TC) - '-� g-�` K._ /`� ��: _ BUII.DW(� OR L(�(A�ION _ '� - - - /`1 7 :' -: , STRF.F,T _.�' 1_�' �.� -'.i ,� r �it.F � �"_ INSI'EiCTOR _ C _� t, Y _ ,� _ / , , - / = _ _ _ _ � i. '7 ( !_ _ __ ' -' C'ITY & STATE /t�ii � � - � ,,< ; /Jv . -- [)ATF: _�' �`-�--,�- � .: � ,.. - - - � . Owner's Section (To be answered by Owner or Occupant► ', i A. I?xplain any c�rciipancy hai.ard chan�;es sinc��thE• previuus insperti��n. _ _ _ ,i _ - �t�t�-=.- - - c � ,�.� B. f)escribe fire prc�terhon mudif�cationti madc tiincr latit inspect�un. _�___j�_,_n/;/ —�RONO �\.J v' � -- ;� __ .:; ' _ ___ _ .- - - - - - - - ---- - 4' ----- C. I�escribe any f�rt s�incr�latit �ntipei ticin. _ a_ 'J ____ � _ - --- -- . �`� C - '_ - - -- _- - - - - - �_= =r- --- --- — " .. --- - - . - -- - - <- - --- -- - - - - - - - -- _ - D. Wh�n was thc tiyst��m pipinK last rhecked F'f ippa},e�, c�irr�isiun ur f��r��i�n material� .---__ � 1J►� �,+ �p� �, �.,x E. When was the dry-pipin�;sytitem last ch<�cked hir�r�ip��r�i,rh? _ _ �� lV �1� � .,_,� - --- - - ---- =' F. Are clry valye5 adt�yuately Fx�itected frc>m fine�in�;? � _ -r�^ n � _ _ �p - - - - � : Si�;nature.: ._ •rnnr- ' ,,.�`-'��`� Titic t�-��r`� t'`� 'V Date _ �. �.,�; _ Inspector's Section (All res nses referen f current inspection) NA NOT APPLICABLE 'i 1. General �- :� a. Is the building uccupi�•d7�Ycs [] Nu ' �� ' b. Are all systems in service?�Yes �] No � ' � r. Is there a minimum��f IS in. (457 mm)clearance betwern the tup uf the storage and the sprinkler deflect��rs?�Yes ❑ No " d. Dc�es all electrical heat tape appear to be satisfactory?❑ Yes ❑ No �!�[A ,� e. Does the hand hose on the sprinkler system(s) appear t�i be satisfactoryZ ❑ Yes ❑ No �NA - �� '� 2. Control Valves (See It�m l5.) r�� .. a. Are all spnnkler system control valves and all other valves in the appropriate open or closed position?,�Yes ❑ No ;Y�� b. Are all control valves in the open position locked, sealed cx equipped with a tamper switch?,�Yes ❑ No ��- ^�`"��`: ��„ 3. Water Supplies (See Item I6.) ��,•,�� a. Was a water flow test of main drain made at the sprinkler riser(s)?�es ❑ Nc� � "'``` � 4. Tanks, Pumps, Fire Department Connections - _ a. Are fire pumps, gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?Q Yes ❑ No �NA ��_ b. Are fire department connectio�s in satisfactory condition,couplings free,caps in Place,and check valves tight?�Yes ❑No �lA _, �'� Are they accessible and visible?'�Yes ❑ No ❑ NA - �.�' E-�'; � i 5. Wet Systems �'t� a. Are cold weather valves (O.S. & Y.).in the appropriate open or closed position?�Yes ❑ No ❑ NA =� b. Have antifreeze system solutions been tested7 ❑ Yes ❑ Nc�NA � �'�� _� c Were the antifreeze test results satisfactory? �Yes ❑ No NA 4� - � d. In areas protected by wet system(s),does the building a�ear to be properly heated in all areas, including blind attics and perimeter areas � where accessible? Yes No NA Do all exterior o nin 5 a tar to be rotected a ainst freezin ��Yes No NA �-��-"s�' :a's�; ,�CL. ❑ ❑ F'f K PP' P S g ❑ ❑ � .� � 6. Dry Systems (See ltems 1] to 13.) �? �,.,�',� a. Are dry valve(s) in sr�rvice? ❑ Yes ❑ No �NA �; �.: b. Are the air pressures and primin�water levels in accurdance with the manufaiturer's instructions? [� Yes ❑ No NA � c Has the operatiun of th��air or nitrogen wpplies been tested?[]Yes ❑N<� �,�lA Are they in servire? �Yes, ❑No�NA �"� - d. Werc low points drained during this inspection? []Yes ❑ 1�{0 [�fVA �� e. Did quick-opening devices operate satisfactorily?❑ Yes ❑ No �.NA �3 � f. Did the dry valve(s) trip properly during thc trip pressure test? 0 Yes [� Nc� ,�],NA �'� � Did the heatin e ui ment in the d � valve room s u �rate at the time ��f ins��tion? Yes [Vo �NA �' K K 9 P rY-P Pf ( ) p' E ❑ ❑ _ ` � _ 7. Special Systems (See Item 14.) - " , a. Did the deluge or pre-action valves operate properly durin� testing? ❑Yes ❑ NQ_ �NA "` b. Did the heat-responsive devices operate properly during testing?❑ Yes ❑ No �NA "�`� c Did the supervisory devices operat2 during testing?❑Yes ❑ No [p�.�IA .� _ 8. Alarms . t} k _ a. Did water motor(s) and gong(s) test satisfactorily?0 Yes ❑ No �..1�U1 - �: � a� b. Did electric alarm(s) test satisfactorily?�Yes ❑ No ❑ NA � � � � � � �,��: � ;,` c Did supervisory alarm service test satisfactorily?� Yes ❑ No y�IVA � �; 9. Sprinklers ��'� � �; a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge? ❑ Yes ❑ No � b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) ❑Yes ❑ No �,;;� _ c. Are quick i•esponse and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)❑Yes ❑ No '� 7:; - d. Is stock of spare sprinklers available? ❑ Yes ❑No � e. Does the exterior condition of sprinkler system appear to be satisfactory? ❑Yes ❑No � f. Are sprinklers of proper temperature ratin s for their locations? ❑Yes ❑No� � � `� '/ r-- � 10. Ex lain an ` "answers and comments: �-��_ � 671 c�� ` f�'� � ✓ °' P Y� �__�'7!L_ Gs.�� ' :� � u � Signature: �� _ Date: / � ��.' l� r_ .� � .. � � �"� VIKING AUTOMATIC SPRINKLER COMPANY 2400 ROSE PLACE • ST. PAUL, MINNESOTA 55113 • (612) 636-4680 • 1-800-229-6263 • FAX: (612) 636-4685 ,, - f,: SHEET 2 OF 2-Use separate sheet for each system mspecfion. System No�or Descrivtion if m fiple � ; ,��., sVstems � _ �. .� ': '�'• Inspectiun Repurt G � ^, ..� �� .�;: Nu. — �. �: � ) � � � "� , � U�� i�� _. �'``' 11. Date dry-pipe valve trip tested (control valve partially open) _/� � (See Trip Tesf Tab(e u�hich follows.) f .�, 12. Qate dry-pipe valve trip tested (control valve fully open) (See Trip Test Table which follozus.) - �: �� 13. Date quick-opening device tested _ (See Trip Test Table zohrch follozos.) � _ � oRv VALVE TRIP TEST TABLE c o o � MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. ��,� t:. _�a t '.� DRY PIPE T�me to Tnp Water Alr Trlp Point Time Water Reached Alarm Operated ��,R �' " OPERATING Thru Test Pipe Pre�sure Pressure Air Pressure Test Outle� Propeily k ra''-;�'` TEST MIN. SEC. PSI PSI PSI MIN. SEC. YES N6' � �� Wrthout � '" QA.D. s _�;� mc:;�. �,�.: _ With -' „ �t� - .. _ �.O.D. �� h �. � �. fi ', y � `� 14. Date deluge or preaction valve tested ��.__ (See Tri� Test Table ro{iich follows.) .� � �`�' TRIP TEST TABLE � „ � Operat�on ❑PNEUMATIC ❑ ELECTRIC ❑ HYDflAULIC V� V � �.� ,�� b?� � a::��':�- Pipmg Supervised ❑ YE$ C NO Dececting media supervised ❑VES ❑NO � '��y, �� OEIUGE & Dces valve operate from the manual tnp and/or remote control staUons OVES ❑NO �� r..�' PREACTION . . . . � ��. VALVES �s [here an accessible facility in each cncwt lor resUng Method of testmg�cucuits �. �; ❑YES UNO Y'`"`� �.•;, Dces each urcuit operate Dces each arwit Maximum t�me to = „ty��,��. MAKE MODEL su>ervis�on loss alarm o rate �atve release o erate release � � � YES NO VES NO VES NO " "f� w 4 s� "'�£. „��.�5.�;,"�A Z z�' �`;d, "x.rr� ; � � '. - +'x� t' 15. See Control Valve Maintenance Table. � ' ' 4 � �^ Control Valve Maintenance Table Ex tain �k , � P �� -� ,� Abnormal `. Control Valves Number Type Open Secured Closed Signs Condition x � �,� City Connection Control „� Valve ===� Tank Control Valves Pump Control Valves � �= � ` Sectional Control Valves _ G'S .�-- �- L �� . � -.�r. f Svstem Control Valves _1 � 1.�� ` �._ ,�y,' Other Control Valves ��'' �� ` 16. Water Flow Test at Sprinkler Riser ; Water Supply Source: City Tank Pump � <' Date TestPipe Sizeof Static Residual {` �` ��.= '' Locallon Test Pipe Pressure (Flow) �: ,. �, �. � Pressure t Last Water Flow Test `` This Water Flow Test i/ %,,1; ,^i � ..� -�..:a ,�,., ,//° �.'� 17. Explain any"No"answers and comments: _ / 1 % � !% � � '�' c� � , .� l ..�J 2 G�- y -�y r ��i., ��"' � � + � 18. Adjustments or corrections made during this inspection: • �Y �'. <,;; � 19. Although these comments are not the result of an engineering revizw, the following desirable improvements are recommended: �'+ _ � _ — _ x �1 � � �/ �-�� "_ Signature: _ _ Date• ��, l � �� . _ / � 1301 L'ORIENT STREET � V, �1 N G ST. PAUL, MINNESOTA 55117 � (651)558-3300 • (800)-229-6263 ' AUTOMATIC SPRINKLER CO. FAX: (651) 558-3310 SHEET 1 OF 2-Use seQarate sheet for each building inspection REPORT OF INSPECTION MINNESOTA LI('ENSE NO. C00005 WISCONSIN LICENSE NO. 265989 REPORT TO `' a:'. ��`" ��'��' ''✓�� a- BUILDING OR LOCATION �''? ' � STREET � ;��k��x �:p INSPECTOR ;��~.�� ,-F' "S' _ .��. CITY & STATE Il �►�'�-t'-P� j;��`�.1 }`i �'� �'- DATE E — � � ';;,' Owner's Section (To be answered by Owner or Occupant) A. Explain any occupancy bazard changes since the previous inspection: � �` B. Describe fire protection modifications made since last inspection. 'F C. Describe any fires since last inspection. �ON�_ f D. When was the system piping last checked for stoppage, conosion or foreign material? E. When was the dry-piping system l,�st checked for proper pitch? ,_ �, F. Are dry valves ad ely proteCted from freezing? �; Signature -" " �'=�-� Title y` 'r` � Date , �' Inspector's Section (All responses reference current inspection) NA =NOT APPLICABLE 1. General a. Is the building occupied?'�Yes ❑No b. Are all systems in service?�Yes ❑ No � �'' � c. Is there a minimum of 18 in. (457 mm)clearance between the top of th storage and the sprinkler deflectors?�Yes ❑No �'' d. Does all electrical heat tape appear to be satisfactory?❑Yes ;=No �NA =` e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?Ll Yes ❑No. �NA � 2. Control Valves (See Item I5.) �� a. Are all sprinkler system contro] valves and all other valves in the appropriate open or closed osition?C�es ❑No * b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?�Yes ❑No .� � 3. Water Supplies (See Item 16.) � a. Was a water flow test of main drain made at the sprinkler riser(s)`�l Yes ��No 4. Tanks;Pumps, Fire Department Connections a. Are fire pumps,gravity tanks, reservoirs and pressure tanks in good condition and properly maintained?f7 Yes ❑No f�„�GA � b. Are fire department connections in atisfactory condition, couplings free,caps in place, and check valves tight?.�Yes ❑No ❑NA Are they accessible and visible?I�Yes !1 No ❑NA 5. Wet Systems a. Are cold weather valves(O.S. &Y.) in the appropriate open or�d9sed position?C�Yes C No L]NA � _��`� �� n r b. Have antifreeze system solutions been tested?- Yes LJ No L�NA c. Were the antifreeze test results satisfactory?��Yes ❑No C�IA � - d. In areas protected by wet system(s), does the building appear to be properly heated in all areas, including b�ind attics and perimeter areas where accessible?�Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?�c't'es ❑No ❑NA �°�' 6. Dry System (See Ltems 11 to 13.) %�� a. Are dry valve(s) in service?C7 Yes ❑ No �NA b. Are the air pressures and priming water levels in accordance with the manufacturer's instruc[ions?C� Yes ❑No �NA � c. Has the operation of the air or nitrogen supplies been tested?L7 Yes �-:No L�NA Are they in service?L7 Yes C7 No [�NA �'`` d. Were low points drained during this inspection?'= Yes �i No �VA �' r � e. Did quick-opening devices operate satisfactorily?�Yes �]No �NA � p, f. Did the dry valve(s)trip properly during the trip pressure test?C-!Yes I�No �A == r��`,� � � g. Did the heating equipment in the dry-pipe value room(s) operate at time of inspection ?'� Yes `��No ]�NA `a�'�� '�� ; ��`�"� 7. Special Systems (See/tem 14.) � "'�`s � a. Did the delu e or re-action valves o erate ro erl durin testin �CJ Yes ❑No � � ��-��`: g P P P P Y � g• `�NA �- �, r �. � b. Did the heat-responsive devices operate properly during testing?�❑�}'es ❑No �,�'NA `.� �� c. Did supervisory devices operate during testing?I !Yes ❑No I_i�NA � ,s.; �� ' �' �` �� . �w 3'" a 8. Alarms � , � -� �;, � k, �. �' �� a. Did water motor(s)�and gong(s)test sarisfactorily?❑Yes ❑No NA� �' _ ' �� ` � �" b, Did electric alarm(s)test satisfactory?�Yes ❑No ❑NA � ;>..�,k� �.�,?_ ,;°� �- �� 's�� _� ��_ _ ..-a:�^�.��__" � � ,�, �,; c. Did supervisory alarm service test satisfactory? 5�,'Yes ❑No ❑NA � � �� ''"�`"� � �� 9. Sprinklers 3 � ,�`°'"�'+ , ; a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?L�Yes �!No �°' � b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)�1'es C No a �; � c. Are quick response�and residential sprinklers less than 20 years old?{Older sprinklers require sample�testing)��`�es �� i No ,� �"� d. Is stock of spare sprinklers available?I�Yes ❑ No �� e. Does the exterior condition of sprinkler system appear to be satisfactory ?'�Yes ❑ No f. Are sprinklers of proper temperature rating for their locations?i�Yes I No 10. Explain any "No" answer and comments: � �� ` :�� . ° }-- ?.,. Signature: ' ' Date: ' � :� :,. �:��< ,�<., �. , . 1301 L'ORIENT STREET t V I �, N G ST. PAUL, MINNESOTA 55117 ;:�_� . � . _� �� (651)558-3300 • (800)-229-6263 � - _ . ; AUTOMATIC SPRINKLER CO. FAX: (651) 558-33]0 �� SHEET 2 OF 2 - Use separate sheet for each system inspection System No. or Description if multiple �� systems N spection Report t � , �%-,<� �n o. `,�1( � � (t��'-f 11. Date dry-pipe valve trip tested (control valve partially open) (See Trip Test Table which tollows) ' 12. Date dry-pipe valve trip tested (control valve fully open) (See Trip Tesf Tab/e which follows) 13. Date quick-opening device tested (See Trip Test Table which follows) DRY VALVE TRIP TEST TABLE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. �� ,. ,. s�. ` -` _ �� !=�� DRY PIPE Time to Trip Water Air Trip Point Time Water Reached Alarm Operated — r�'`.�. � Thru Test Pipe Pressure pressure Air Pressure Test Outlet Properly � .y. _�� _�r' OPERATING MIN. SEC. PSI PSI PSI MIN. SEC. YES NO rt� i`...� a�"x�_ - TEST Without � � � :�^C ha _.. . Q.�.�. � �� ' "`�"-..a�s¢��. ,��.� . Wlth '` '��;�"�`'*.,.:�-�5 Q.O.D. }s x 14. Date deluge or-preaction valve tested � �: (See Trip Test Table which fol/ows) ' �`" TRIP TEST TABLE ';,... � Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC .:.,;:'�`� r fi�ti ,�� -� Piping Supervised ❑ YES ❑ NO Detecting media supervised ❑ YES ❑ NO ��- �= w� �a`'$;�'� � DELUGE& Does valve operate from the manual trip and/or remote control stations ❑ YES ❑ NO � � � �'� x #�' • PREACTION Is there an accessible tacility in each circuit for testing Method of testing-circuits � �4 �'� „�, VALVES ❑ YES ❑ NO �� ,�',� � Does each circuit operate Does each circuit Maximum time to _,:y�$ - MAKE MODEL su ervision loss alarm o erate valve release o erate release � ��, d �;�` YES NO YES NO YES NO '�> 15. See Control Valve Maintenance Table. � Control Valve Maintenance Table Explain Abnormal Control Valves Number Type Open Secured Closed Signs Condition City Connection Control Valve ' r �'� �� Tank Control Valves Pump Control Valves ,�+t� Sectional Control Valves � � System Control Valves � �� Other Control Valves '"*.�� Kitchen Control Valve ' 16. Water Flow Test at Sprinkler Riser Water Su 1 Source: � , Cit � Tank Pump �� Date Test Pipe � Size of Static Residual �� Location Test Pipe Pressure (Flow) ��'- Pressure �'�" Last Water Flow Test �-3�— � �� ;:�,-� �� / � '�,�-' This Water Flow Test — e� ,� .p--- � � � �, �--' �:. � �,:� 17. Explain any "No" answers and comments: � �;+.; f 18. Adjust�ents or corrections made during thi�s ir�spectio : - ' ��' � — ' ' �� . 'l �� , �' ��; ` tt _ `�, - •� ! 3 - 19. Although these comments are not the result of an engineering review, the following desirable improvements are recommended: s,AJ 3� $ � �� 1 � �' � ; \; �/�� fi � ji �.�,;-' � —``l l.J�� s� � �, Signature: Date: , �� , °�