HomeMy WebLinkAboutsprinkler tests �r�� 1301 L'Orient Street
St.Paul,Minnesota 55117
v � N� (651)558-3300 • (800)229-6263
AUTC�MATIC SPRINKLER CO. Fax: (651)558-3310
S,�#ting T.'he Standard...
� . AGREEMENT ANll KEPORT OF INSl'ECTION
SE[EF.T 1 0:2-Use sepa�ate sheet for each building inspected #INSPECTION �'���✓
MINNESO'TA LICE SE NO.C005
RF,PORT TO N K !fl G.�'�v►� '�.(IILDING OR LOCATION
STREET / ' v;� `Z / �;V� INSPECTOR �� ,�
CITY&STATE fA (? {1� DATE _ Z -
Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above locaHon or buildu�g,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)�t
A. Explain any occupancy hazard chan�es since the previons inspection: �v�`' ^
B. Describe fire protection modifications made since last inspection: "
a�. . 4
C Describe any fires since last inspection:
D. When was the system piping last checked for stoppa�e,conosion or fareign�e�al? �
E. When was t]ze��ry-piping system last checked for proper pit�t,�.?�
F. Are dry v es dequately protected from freezing? �
Sigilatur � � i��� TiHe Date
Inspector's ion(All responses reference current inspection) N/A=NOT APPLICABLE
1 General
a. Is the buildin�occupied?� Y ❑No
b. Are all systems in service? es ❑No � ��
c. Does there appear to be a minimum of 18 in.(457 mm)clearance beiween the top of the s orage and the sprinkler deflectors? `dYes u I�Io
d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? ❑Yes ❑No %A
2 Control Valves(See/feni 15) , �/
a. Do sprinkler system control valves appear to be in the appropriate open or closed position?, �-�Y,J"� o No
b. Are control valves in the open posi6on locked,sealed or equipped with a tamper switch? �1`"es o No
3 Water Supplies(See Item 16)
a. Was a water flow test of main drain made at the sprinkler riser(s)? es ❑No
4 Tanks,Pumps,Fire Department Connections
a. Are fire pumps,gravity tanks,reservoirs and pressure tanks in�ood condition and properly maintained? o Yes ❑N - �/A
b. Are fire department connecHons u1 sfactory condition,couplings free,caps in place,and check valves tight? �o No ❑N/A
Are they accessible and visible? es. ❑No ❑N/A
5 Wet Systems
a. Are cold weather valves(O.S.&Y.)in the appropriate open ar do d position? ❑Yes ❑No �I'1Q%A
b. Have antifreeze system solutions been tested? ❑Yes ❑No �A
c. Were the antifreeze test r ults satisfactory? ❑Yes o No �i�d/A
d. In areas protected by t system(s),does the building appear to be properly heated in all areas,includin�blind at'cs and perimeter areas
where accessible? es o No ❑N/A Do all exterior openings appear to be protected against freezing? es ❑No a N/A
6 Dry System(See 1 tems ll to 13)
a. Are dry valves(s)in service? ❑Yes ❑No ❑N/A
b. Are the air pressures and primin�water levels in accardance with the manufachxre's instructions? ❑Yes ❑No ❑N/A
�� c. Has the operation of the air or nitrogen supplies been tested? ❑Yes o No o N/A Are they in service? ❑Yes ❑No ❑N/A
d. Were all know low points drained during this inspection? o Yes o No i i N/A
e. Did yuick-openin�devices operate satisfactorily? ❑Yes u No o N/A
f. Did the dry valve(s)trip properly during the trip pressure test? ❑Yes u No ❑[�I/A
�. Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? ❑Yes ❑No ❑N/A
\� Special Systems(See Itent 14)
a. Did the deluge or pre-action valves operate properly duriny,testin�? ❑Yes ❑No ❑N/A
b. Did the heat-responsive devices operate properly duriny,tc�sting? ❑Yes ❑No ❑N/A
c. Did supervisory devices operate during tesrin�? n Yes ❑No n N/A
S Alarms � �
a. Did water motar(s)and gon�(s)iest saHsf�etorily? ❑Yes o No l�'N/A
b. Did electric alarm(s)test satisfactory? �es ❑No �b N/A
c. Did supervisory alarm service test saHsfactory7 ��s ❑No o N/A
9 Sprinklers �'�
a. Do visibie sprinklers appear to be free from corrosion,loading or obstruction to�pra�vdischar�e? �i'�es o No
b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing) tf�es u No /
c Are quick responsc and residential sp}in151ers less than 20 years old? (Older sprinklers require sample testing) �e'Yes ❑No ❑N/A
d. Is stock of spare sprinklers available? �r'1'es ❑No j'
e. Does the exterior condition of sprinkler system appear to be satisfactory? �'Yes ❑,Nj��
£ Do visible sprinklers appear to be of proper temperature rating for their locations? ta�Yes ❑No
10 Explain any"No"answers and comments:
Signature: �,/� ��� Date: 'i ��- '�
(Ruv.2/8/lHol
Terms and Limitations
1 This Agreement is for inspection services only. If Subscriber wants the Company to make any re�airs:
alterations or replacements as a result of this inspection, the Company will do so for additional compensation to `��.
be agreed upon in writing by the parties.
2 The Company does not know and does not represent whether the current fire protection system on the Property
was originally designed and installed in such a way that the system will perForm as originally intended or is
suitable and sufficient for its intended purpose given the way in which the Property has been or will be used. In
other words, the Property has been or may be used in ways such that the configuration of partition wal►s, the
location of and type of materials (including the presence of hazardous materials) and other conditions of the
Property's use are such that the fire protection system is inadequate, insufficient or unsuitable for the Property.
THIS REPORT IS NOT A GUARANTEE OR WARRANTY THAT THE SYSTEM WILL IN ALL CASES (A)
PROVIDE THE LEVEL OF PROTECTION FOR WHICH IT WAS ORIGINALLY INTENDED(B) IS FREE OF ALL
DEFECTS AND DEFICIENCIES(C)AND IS IN COMPLIANCE WITH ALL APPICABLE CODES.
3 The Company's inspection will not include every sprinkler head,pipe or other parts of the fire protection sprinkler
system that currently exist and is limited to a visual inspection of external readily accessible parts of the system.
The Company shall only be obligated to inspect a representative number or sample of the sprinkler heads, pipes,
hangers,valves or other devices and equipment in their current position.
4 The Company will be permitted, at all reasonable times, to enter the Property indicated above to conduct the
inspection as outlined in this Agreement.
5 The Company's potential liability arising out of its inspection services must be limited. THEREFORE, THE
LIABILITY, IF ANY, OF THE COMPANY TO THE SUBSCRIBER AND/OR OTHER OCCUPANTS OR VISITORS
OF THE PROPERTY ARISING OUT OF THE COMPANY'S INSPECTION, REPORT, ACT OR OMISSION OR
FAILURE TO ACT, OR ANY CLAIMED BREACH OF THIS AGREEMENT BY THE COMPANY, SHALL IN NO
EVENT EXCEED THE TOTAL FEE PAID BY THE SUBSCRIBER FOR THE INSPECTION SERVICES THAT
GIVE RISE TO ANY SUCH LIABILITY.
6 The Company, following each inspection, will provide to the Subscriber a written "Report of Inspection"
("Report"). If required by state or local codes, the Company will provide a copy of the Report to fire and/or
building o�cials. If desired, a copy of the Report will also be forwarded to the Subscriber's insurance company.
The Report and recommendations by the Company are only advisory in nature and are intended to assist the
Subscriber in reducing the possibility of loss to the Property by indicating obvious defects or impairments to the
fire protection system(s) which were discovered by the Company's inspection and which should receive prompt
attention.
7 Subscriber agrees to obtain and shall be soley responsible to maintain insurance for the Property, all contents
therein,and/or operations performed within or around the Property to be inspected.
8 The Subscriber agrees to assume the entire responsibility and liability, to the fullest extent permitted by law, for
all damages or injury to all persons, whether employees or otherwise, and to all property, arising out of it,
resulting from or in any manner connected with, the execution of the work provided for in this Inspection
Agreement or occurring or resulting from the use by the Company or its agents or employees of materials,
equipment, instrumentalities or other property, whether the same be owned by the Subscriber, the Company or
third parties, and the Subscriber, to the fullest extent permitted by law, agrees to indemnify and save harmless
the Company, its agents and employees from all such claims including, without limiting the generality of the
foregoing, claims for which the Company may be or may be claimed to be, liable and legal fees and
disbursement paid or incurred to enforce the provisions of this paragraph and the Subscriber further agrees to
obtain, maintain and pay for such generai liability insurance coverage and endorsements as will insure the
provisions of this paragraph.
9 While the Company will make every reasonable effort to prevent the discharge of water into or onto areas of
landscaping, decorative pavement, etc., it is the Subscriber's responsibility to provide sufficient and readily
accessible means to accept the full flow of water that may be required by tests as determined by the type of
inspection.
10 This Agreemenf may not be assigned by Subscriber without the written consent of the Company.
11 This Agreement may be signed in counterparts; a signed facsimile, photocopy, and/or electronic mail of this
Agreement shall be as binding on both parties just as though this Agreement were executed in its original, pre-
printed form.
12 If payment for work provided in this Agreement is not paid when due, Subscriber agrees to pay all costs of
collection including attorney's fees.
(Rev.2/8/O6)
�r01��,,,`` 1301 L'Orient Street
� St.Paul,Minnesota 55117
MATIG SPRINKLER GO. (651)558-3300 • (800)229-6263
Setti he Standard... Fax: (651)558-3310
, ,,,
SHEET 2 of 2-Use separate sheet far each system inspected System No.or Description if multiple
� systems
Inspectigp� o.�t_�
No. �l, t����
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 Table which follozoe)
13 Date quick-opening device tested See Trip Test Ta le which follows)
DRY va[.vE 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
� PERATING Thru Test Pipe Pressure Pressure Air Pressure Test Outlet I'roperly
TEST MIN. SEC. PSI PSI 1'SI MIN. SEC. YES NO
Without
Q.O.D
W ith
Q.O.D
14 Date deluge or preaction valve tested (See Trip Test Table wliidl follows)
TRIP TEST TABLE
� Operation ❑PNEUMATIC c ELECTRIC o HYDRAULIC
Piping Supervised ❑ YES ❑ NO Detecting Media Supervised ❑ YES ❑ NO
� DELUGE& Does valve operate froin the manual trip and/or remote control stations ❑ YES e NO
PREACTION ls there an accessible facility in each circuit far testing ❑ YES ❑ NO Method of Testin�Circuits
VALVES Does each circuit operate Does each circuit Maximum time to
MAKE MODEL supervision loss alarm operate valve release operate release
' YES NO YES NO YES NO
<
15 See Control Valve Maintenance Table
CONTROL VALVE MAINTENANCE TABLE •a: �
Explain
Abnormal �
Control Valves Number T pe Open Secured Closed Signs Condition
Cit Control Valves �
B ass Valves
Tank Control Valves
Pum Control Valves
Sectional Control Valves
S stem Control Valves
Other Control Valves
Kitchen Control Valves
16 Water Flow Test at Sprinkler Riser
Water Su 1 Source: Cit Tank Pum
Residual
Test Pipe Size of Static (Flow)
Dat �I.ocation Test��'i e Pr s re P ssure
Last Water Flow Test C1 .Q/• /
This Water Flow Test � �- �
17 Explain any"No"answers an comments:
18 A justments ar corrections ma e uring t is inspection:
19 A qugh these con��s,are not e resu t o n e�►gine�ering review,t e o lowing esira le improvements are recommended:
G� U�j .i� ypc.1 '1 V
Signature: o't,O Date: / '1,�
(Rev.2/8/06)
` . �
- —_
� �
L ;
_ ,. c.:. , . � �
_ _ _ _T�
�
* � �'°�c.
Terms and Limitations � �
�
1 This Agreement is for inspection services only. If Subscriber want� the Company t�, r.,'�:e �; : �; �:
alterations or replacements as a result of this inspection, the Company will do so for additional compensatio: to ,
be agreed upon in writing by the parties. � `
2 The Company does not know and does not represent whether the current fire protection system on the Property
was originally designed and installed in such a way that the system will perform as originally intended or is�-
suitable and sufficient for its intended purpose given the way in which the Property has been or will be used. In
` other words, the Property has been or may be used in ways such that the configuration of partition walls, the '" �
location of and type of materials (including the presence of hazardous materials) and other conditions of the
Property's use are such that the fire protection system is inadequate, insufficient or unsuitable for the Property.
THIS REPORT IS NOT A GUARANTEE OR WARRANTY THAT THE SYSTEM WILL IN ALL CASES (A)
PROVIDE THE LEVEL OF PROTECTION FOR WHICH IT WAS ORIGINALLY INTENDED(B) IS FREE OF ALL
DEFECTS AND DEFICIENCIES(C)AND IS IN COMPLIANCE WITH ALL APPICABLE CODES.
3 The Company's inspection will not include every sprinkler head, pipe or other parts of the fire protection sprinkler
system that currently exist and is limited to a visual inspection of externat readily accessible parts of the system.
The Company shall only be obligated to inspect a representative number or sample of the sprinkler heads,pipes,
hangers,valves or other devices and equipment in their current position.
4 The Company will be perrnitted, at all reasonable times, to enter the Property indicated above to conduct the �
inspection as outlined in this Agreement.
5 The Company's potential liability arising out of its inspection services must be limited. THEREFORE, THE .
LIABILITY, IF ANY,OF THE COMPANY TO THE SUBSCRIBER AND/OR OTHER OCCUPANTS OR VISITORS
� OF THE PROPERTY ARISING OUT OF THE COMPANY'S INSPECTION, REPORT, ACT OR OMISSION OR
FAILURE TO ACT, OR ANY CLAIMED BREACN OF THIS AGREEMENT BY THE COMPANY, SHALL IN NO
EVENT EXCEED THE TOTAL FEE PAID BY THE SUBSCRIBER FOR THE INSPECTION SERVICES THAT •
GIVE RISE TO A�Y SUCH LIABILITY.
6 The Company, following each insp�ction, will provide to the Subscriber a written "Report of Inspection"
("Report"). If required by state or local codes, the Company will provide a copy of the Report to fire and/or
. building officials. If desired, a copy of the Report will also be forwarded to the Subscriber's insurance company.
The Report and recommendations by the Company are only advisory in nature and are intended to assist the
Subscriber in reducing the possibility of loss to the Property by indicating obvious defects or impairments to the
fire protection system(s) which were discovered by the Company's inspection and which should receive prompt
attention.
7 Subscriber agrees to obtain and shall be soley responsible to maintain insurance for the Property, all contents
therein,and/or operations performed within or around the Property to be inspected.
8 The Subscriber agrees to assume the entire responsibility and liability, to the fullest extent permitted by law, for
all damages or injury to all persons, whether employees or otherwise, and to all property, arising out of it,
resulting from or in any manner connected with, the execution of the work provided for in this Inspection
Agreement or occurring or resulting from the use by the Company or its agents or employees of materials,
equipment, instrumentalities or other property, whether the same be owned by the Subscriber, the Company or
third parties, and the Subscriber, to the fullest extent permitted by law, agrees to indemnify and save harmless
the Company, its agents and employees from all such claims including, without limiting the generality of the
foregoing, claims for which the Company may be or may be claimed to be, liable and legal fees and
disbursement paid or incurred to enforce the provisions of this paragraph and the Subscriber further agrees to
� obtain, maintain and pay for such general liability insurance coverage and endorsements as will insure the
provisions of this paragraph.
9 While the Company will make every reasonable effort to prevent the discharge of water into or onto areas of
landscaping, decorative pavement, etc., it is the Subscriber's responsibility to provide sufficient and readily
accessible means to accept the full flow of water that may be required by tests as determined by the type of
inspection.
10 This Agreement may not be assigned by Subscriber without the written consent of the Company.
11 This Agreement may be signed in counterparts; a signed facsimile, photocopy, and/or electronic mail of this
Agreement shall be as binding on both parties just as though this Agreement were executed in its original, pre-
printed form.
12 If payment for work provided in this Agreement is not paid when due, Subscriber agrees to pay all costs of
� collection including attorney's fees.
(Rev.2/8lO6)
� ' . rii 1.' �U�e � .�f- � -�f�i� �e- ��4 S �
.� . '. .,}��.:�.M
� � � SUMMIT FIRE PROTECTION �$�
575 l�innehaha Ave.W • St.Paul,MN 55103 • 651-251-1880 3026 40TH Ave.NW • Rochester,MN 55901 • 507-280-0622 t
- 418 Great Or.k Dr. • Waite Park,MN 56387 • 320-257-6390 760 Liberty Way • North Liberty,IA 52317 • 319-665-4330 `:
�;`� 4208 Enterprise Circle • Duluth,MN 55811 • 218-740-4412 4353 NW Urbandale Dr. • Urbandale,IA 50322 • 515-867-2424 ��
� -
�' SHEET 1 OF 2-Use sepazate sheet for each building inspection 3�
: REPORT OF INSPECTION Q /� �
�<<; MINNESOTA LICENSE NO. C0075/IOWA LICENSE NO.FP-036 JOB NUMBER ��/y�0�-� ��
f . �
INSPECTION NAME � 6 .G = "��:x. BUILDING/LOCATION — ILI �
STREET '`� �IC��E INSPECTOR ��''r Gk9� � ��
CITY&STATE �. /b'`�.' ����� DATE �i
� / ;�
� Owner's Section(to be answered by Owner or Occupant) �
�
� '� A. Explain any occupancy hazard changes since the previous inspection: ���,��
�' A �n�
�` ��i�^
dRc.: J *y511.
=�t B. Describe fire protection modifications made since last inspection:� ��
f
.
.
C. Describe any fires since last inspection: C� � ,��
..:��
r �'>�-�
� D. When was the system piping last checked for stoppage,corrosion of fpj�ign material? � :�
.�� E. When was the dry-piping sy�tem last checked for proper p t h? i(iJ�''� �'�„�
�, E Are dry valves adeyuate(y protected from freezing? �/��"' �
Signature `�� � Title - � �"���. �£. :` Date � �
�� Inspector's Section(All responses reference current inspection) NA=NOT APPLICABLE ��..
��� 1. General "` �..�
��� a.Is the building occupied?;�Y ❑No �
� J� b.Are all systems in service?�Yes❑No
;.;;
�� c.Is there a minimum of 18 in.(457 mm)clearance between the top of the storage and the sprinkler deftectors? ld'�'es ❑No
��= d.Does the hand hose or standpipe on the sprinkler system(s)appear to be satisfactory? ❑Yes ❑N�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?�es ❑No
� b.Are all control valves in the open position locked,sealed or equipped with a tamper switch?�a'Yes 0 No ' �x
�;,' 3. Tanks,Pumps,Fire Department Connections `
��
�,?; a.When was fire pump last tested for performance? �
�;�: b.Are fire pumps,gravity tanks,reservoirs and pressure tanks in good condition and properly maintained? ❑Yes 0 No �NA
�'� c.Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight?�es ❑No ❑NA
`�'� � Are they accessible and visible? �'�1'es 0 No ❑NA
�-� 4. Wet Systems r � "�
a. Have antifreeze system solutio een tested? ❑Yes ❑No�NA `� -��"�� ,�
b.What temp is antifreeze?� a � � `'�����
- a In areas protected by wet system(s),does the building appear to be properly heated in all areas? C�'es ❑No 0 NA .�" � '} f " ' R 3�.�-;
',„�:� 5. 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 1�4e1s in accordance with the manufacturer's instructions? ❑Yes ❑No�NA �� ;� .
� c.Has the operation of the air or nitrogen supplies been tested? ❑Yes 0 No fd"NA Are h y in service? ❑Yes❑No�NA ;� ����
d.Were low points drained during this inspection?OYes ❑No J�NA How many? � �` �
= e.Did quick-opening devices operate satisfactorily? ❑Yes ❑No,.�NA �*�`�'z a'�
k ' f.Did the dry valve(s)trip properly during the trip pressure test? ❑Yes ❑No�]'NA � a� -. 2�
� g.Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? ❑Yes ❑No I�- 'NA '`k � �
� 6. Special Systems(See Item 14.) � �� �
� :;� a.Did the deluge or pre-action valves operate properly during testing? ❑Yes ❑No.�NA �` "� ;�
b.Did the heat-responsive devices operate properly during testing? ❑Yes ❑No C�NA RECE���D II
c.Did supervisory devices operate during testing? ❑Yes 0 No�NA - '� +
d.Did flow for ldtchen hood system shut off gas or electric? ❑ es 0 No fd'NA `�� �
. d
� z �y � �
7. f��al"Il7S ' , a.. �i � ~�1 !��� �y ,�
�C. ,; F`- ri� d �- � �
c:� a.Did water motor(s)and gong(s)test satisfactorily? ❑Yes ❑No Q°NA � ,, „, v� �„.
b.Did electric alarm(s)test satisfactorily? �Yes 0 No ❑NA ; -� �^ ,�_� � ;�,�'��
c.Did supervisory alarm service test satisfactorily?.�Yes ❑No ❑NA � ' � C�N OF ����� �'�
���� d.Did tamper switches test satisfactorily?�'Yes ❑No❑NA � � � � �� �
� ` S. Sprinklers +''*.� ��
�.. .
� a.Are all sprinklers free from corrosion,paint,loading or obstruction to spray discharge? 0'Yes ❑No t�x,�`•
b.Are sprinklers less than 50 years old?(Older sprinklers require sample testing)�Yes ❑No � ��'
� c.Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)�dYes ❑No ❑NA
" d.Is stock of spare sprinklers available? �Vi"es ❑No �
�g e.Does the exterior condition of spri�kler system appear to be satisfactory?,0'f'es❑ No � ��'�' ;;
� f.Are sprinklers of proper temperature rating for their locations?,�'es❑No � s ; a ""�
� g.Is location free of recalled heads�Yes ❑No ,.�`� : �^,- �,�a� �,• � '� ,��
u,z
'�"�„'- ,",,' "" , �,
� � ��
> . � `;�
.. �- '.;-
Signature: Date: � � �.s;�
x��..
�'�,�
� �s�' c �.
s, t_y � _: � � P, .
`''` �
� �,. ��C
'� SUMMIT FIRE PROTECTION = ��
� �
575 Minnehaha?4ve.W. • St.Paul,MN 55103 • 651-251-1880 3026 40th Ave.NW • Rochester,MN 55901 • 507-280-0622 .�
��.: 418 Great Oak,Dr. �Waite Park,MN 56387 • 320-257-6390 760 Liberty Way • North Liberty,IA 52317 • 319-665-4330
,, 4208 Enterprise Circle • Duluth,MN 55811 • 218-740-4412 4353 NW Urbandale Dr. • Urbandale,IA 50322 • 515-867-2424
�-� SHEET 2 OF 2-Us��ate she�t fo�each,Yv.stem inspe i `� Type of System �����
,� �`-.__ ; ' f
'- Inspection Name £ �� r ''f'�� How Many?
�" ' i ''� 1 -a_ /O /I
: Inspection Work Order -'�� ?-' b ��--' Wha[Size? "+'� -
Flow SwiCch or Alarm Check with Pressure Switch
�
9. Date dry-pipe valve trip tested(control valve partially open) -^�'"'"�� (see Trip Test Table which follows) �
�
��� 10. Date dry-pipe valve trip tested(control valve fully open) �� (see Trip Test Table which follows) ,'+a,:. �
11. Date quick-opeuing device tested (see Trip Test Table which follows) '
�'
� nRY vnLVE TRIP TEST TABLE Q.o.n. �
t.t�.- MAKE MODEL S RIAL NO. MAKE MODEL SERIAL NO. �
�
,
DRY PIPE Time to Trip Trip Point Time Water Reached Alann Operated '.
� Wa[er Pressure Air Pressure
�PERATING Tl�ru Tes[Pipe Air Pressure Tes[Outlet Propedy
��° TEST Min. �� Sec. SI� �- PSt � PSI � Ivtia Sec. Yes No
j.� Without � ��
�.��� .O.D. �.p,:�
�'Yi.i� With ;i.;4
Q.O.D.
z��, ,�
� 12. Date deluge or preaction valve tested (see Trip Test Table which follows) '
,,:�
,
�, «F.
, TRIP TEST TABLE �
,� �
Operation ❑Pneuma[ic ❑Electric ❑Hydraulic
.�, �
Piping Supervised ❑Yes ❑No Detecting Media Supervised ❑Yes ❑No �
DELUGE& Dces valve operate from the manual vip andiiir remote control stations? ❑Yes ❑No
'. PREACTION d:ir
VALVES �s there an accessible facility in each circuit�or`t�sfp�gY=- ❑Yes ❑No Method of Testing Circuits:
MAKE M�EL Does Each Circuit Operate Does Each Circuit Maximum Time to
� Supervision Loss Alarm? Operate Valve Release? Operate Release?
❑Yes ❑No ❑Yes ❑No ❑Yes ❑No
:;� "k
�,; 13. See Control valve Maincenance Table CONTROL VALVE MAINTENANCE TABLE �
„. �
"�' CONTROL VALVES NUMBER SIZE&'�YPE OPEN SECURED CLOSED SIGNS EXPLAIN ABNORMAL CONDITIONS i;�
City Connection Control Valve �.��� �� j �/) ""'� �'� �, �
�s c�
Jockey ContTol Valve ' ��
� �
Pump Control Valves �'�
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t ' Additiona]Pump Control Valves
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o- �: Other Control Valves
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`.�. Kitchen Con[rol Valves
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�, Water Flow Test at Sprinkl f.Riser
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k:`. Water Supply Source: City Well Tank Pump 7
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ATE TEST PIPE CATIQN SIZE OF'CEST PIPE pRE TEST POST TEST PRESSURE DIFFERENTIAL
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14. Explain any"No"aoswers and comments:
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