HomeMy WebLinkAboutsprinkler info �� 1301 L'Orient Street I
�� �� �� (t.j ul,Minneso(a 5)117 I
657 558-3300 • 800 229-6263
AUTOMA'ftC SPRINKLER CO. Fax: (651)558-3310
Set#in� "I'hp Standard... i
, *►. AGREEMENT AND REPORT OF INSPECTION
SHEF.T 1 of 2-U!�se}��rate sheet for each building inspected #INSPECTION
MINNESOTA LICENSE NO.C005
REPORT TO BUILDING OR LOCATION
STREET INSPECTOR �
CITY&STATE DAT'E -
Owner hires Viking Automatic Sprinl:ler Company to conduct an inspection of the fire suppression system at the above locafion or Uuilding,and
prepare a written report of that iiispec6on for an agreed upon fee. As part of this agreement,owner agrees to ternis and condidons on r�ar of forni 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: _
B. Describe fire protecfion modifications made since last inspection:
G Describe any fires since last inspecfion: ` ' "
D. When was the system piping last checked for stoppage,corrosion or foreign material? -
E. When was the dry-piping systein last checked for proper pitcil? I
F. Are dry valves adequately protected from freezin�?
SiKnature Title Date I
Inspector's Section(All responses reference cunent inspection) N/A=NOT APPLICABLE
1 General I
a. Ls the building occupied? �Yes ❑No
b. Are all systems in service? �Yes ❑No
c. Does there appear to be a minimum of 18 in.(457 mm)clearance between the top of the storaQe and the sprinkler deflectors? r��"es ❑No
d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? i�Yes n No +�N/A
2 Control Valves(See Item 15) i
a. Do sprinkler system control valves appear to be in the appmpriate open ar closed position? �`Yes ❑No
b. Are control valves in the open position locked,sealed or equipped with a tamper switch?__p�'Yes ❑No
3 Water Supplies(See 1 tent 16) '
a. Was a water flow test of main drain made at the sprinkler riser(s)? u'Yes ❑No
4 Tanks,Pumps,Fire Department Coiuiections
a. Are fire pumps,gravity tanks,reservoirs and pressure tanks in good condifion and properly maintained? n Yes ❑No d�N/A
b. Are fire deparhnent connecHons in satisfactory condition,couplings free,caps in place,and check valves tight? rrYes ��No ��N/A
Are they accessible and visible? o Yes ❑No ❑N/A
5 Wet Systems
a. Are cold weather valves(O.S.&Y.)in the appropriate open or closed position? ❑Yes ❑No ❑N/A I
b. Have antifree•r.e system soluHons been tested? ;.Yes ❑No r�N/A
c. Were the antifreeze test results satisfactory? ❑Yes ❑No �N/A
d. In areas protxted ry wet system(s),does the building appear to be properly heated in all areas,u�cludin�blind attics and perimleter areas
where accessible? n Yes u No r�N/A Do all exterior openings appear to Ue protected against freezin�? o Yes ❑No ❑N/A
6 Dry System(See Itenu 11 to 13)
a. Are dry valves(s)in service? ,Yes ❑No 6 N/A
b. Are the air pressures and priming water levels in accordance with the manufacture's instrucHons? ❑Yes ❑No ,2i N/A
c. Has the operafion of the air or nitrogen supplies been tested? ❑Yes ❑No i��N/A Are tliey in service? ❑Yes ❑No �N/A
d. Were all lmow low points drained during this inspection? ❑Yes ❑No n N/A
e. Did quick-opening devices operate satisfactorily? ❑Yes ❑No �c5 N/A
f. Did the dry valve(s)trip properly during the trip pressure test? ❑Yes ❑No a N/A
�. Did the hearin�equipment in fl�e dry-pipe valve room(s)operate at time of inspection? n Yes ❑No :F}N/A
7 Special Systems(See Item 14)
a. Did the deluge or pre-action valves operate properly during testing? ❑Yes u No �N/A
b. Did the heat-responsive devices operate properly durin�testing? ❑Yes ❑No 'o N/A
c. Did supervisory devices operate during testing? ❑Yes ❑No a N/A
8 Alarms
a. Did water motor(s)and�ong(s)test satisfactorily? ❑Yes u No �j5 N/A
b. Did electric alarm(s)test satisfactory?.o Yes ❑No ❑N/A
c. Did supervisory alarm service test satisfactory?:L5 Yes ❑No ❑N/A
9 Sprinklers
a. Do visible sprinklers appear to be free from corrosion,loading or obstrucrion to spray dischar�e? ❑Yes ��No
b. Are sprinklers less than 50 years old? (Older sprinklers reyuire santple testing) ,��Yes ❑No
c. Are quick response and residential sprinklers less thaz120 years old? (Older spruilders require sample testin�) ri Yes n No �i N/A
d. Is stock of spare sprinklers available? [�"Yes ❑No
e. Does the exterior condition of sprinkler system appear to be satisfactory? p Yes ❑No
f. Do visible sprinklers appear to be of proper temperature rating for their locaHons? r�Yes ��No
10 Explain any"No"answers and comments: _
Signature: Date: '
(Rev.�/8/�) , -
Terms and Limitations
1 This Agreement is for inspection services only. If Subscriber wants the Company to m: y ,.
alterations or replacements as a result of this inspection, the Company will do so for additionai . i
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 N/HICH 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 sprinkier heads, pipes,
hangers,valves or other devices and equipment in their current position.
4 The Company will be permitted, at ail reasonable times, to enter the Property indicated above to conduct the
inspection as outlined in this Agreement.
5 The Companys potential liability arisir�g 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 PROFERTY ARISING OUT OF THE COMPANY'S INSPECTION, REPORT, ACT OR OMISSION OR
FAILURE TO ACT, OR ANY CLAIMED BREACH OF THIS AGRFEMENT BY THE COMPANY, SHALL tN NO
EVENT EXCEED THE TOTAL FEE PAID BY THE SUBSCRIBER FOR THE INSPECTION SERVICES THAT
GIVE RISE TO ANY SUCH LIABILITY.
6 The Company, followiny each inspection, will provide to the Subscriber- a wr�tten "Report of Inspection"
("Repo'�"). 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 aiso 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 Irspection
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 aqents and employees from all such claims including, without limiting the generality of the
foregoing, cl� . r �;�hich 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.2/8/O6) �
��� 1301 L'Orient Street
. � � St.Paul,Minnesota 55117
AUTOMATIC SPRINKLER Cf.�. (651)558-3300 • (800)22�-6263
Setting.Tht�.Standard... Fax: (651)558-3310
SHEET 2 oE 2-Use separate sheet for each system inspected System No.or Description ifl multiple
systems %- .��.., �:
Inspection Report f_ �,���, ( � i` �
No. � C��;���`��
11 Date dry-pipe valve trip tested(control valve partially open) �� �-: (See Trip Test Table which f Ilows)
12 Date dry-pipe valve trip tested(control valve fully open) � ��J� (See Trip Test Table wliidi f�Ilows)
13 Date quick-opening device tested �� (See Trip Test Table wliich follows)
DrzY vaLVE TRIP TEST TABLE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL ERIAL NO.
DRY PIPE Time to Trip Water Air Trip Point Time lti'ater Reached A arin Operated
OPERATII�G Thru Test Pipe Pressure Pressure Air Pressure Test Outlet Properly
TEST MIN. SEC. PSI PSI PSI MIN. SEC. YE NO
Without '
Q.O.D
With I
Q.O.D
14 Date deluge or preaction valve tested N � (See Trip Test Tnble wliicll follows)
TRIP TEST TABLE
Operation ❑P[�IEUMATIC ❑ELECTRIC ❑HYDRAULIC
Piping Supervised ❑ YES ❑ NO Detecting Media Supervised ❑ YES ❑ NO
DELUGE& 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 ❑ YES ❑ NO Method of Testing Circuits
VALVES Does each circuit operate Does each circuit Maximum time to
MAKE MODEL supervision loss alarm operate valve release o�crate release
YES NO YES NO YE NO
15 See Control Valve Maintenance Table
CONTROL VALVE MAINTENANCE TABLE
Explain
Abnormal
Control Valves Number Type Open Secured Closed Signs Condition
Cit Control Valves
B ass Valves
Tank Control Valves
Pump Control Valves
Sectional Control Valves
, S stem Control Valves � • �* ' . � �
�{��,Other Control Valves h�' +� � �� �`t'f �
Kitchen Control Valves
16 Water Flow Test at Sprinkler Riser
r
Water Su 1 Source: �'Cit ,. ` �.% Tank I Pum
esidual
Test Pipe Size of Static (Flow)
Date Location Test Pi e Pressure ressure
Last Water Flow Test ,: ��
>
This Water Flow Test �' '
17 Explain any"No"answers and comments:
18 Adjustments or corrections ma e during this inspection: -- ,s� �,�" L�f= - ,, Y'r:' :� ;, f5 U�. ,._
.-- � � P�; t p f . t ` '` i _. ��/4' ��� -^
19 A though t ese comments are not t e resu t o an engineering review,t e o owing esirable improvements are recom en ed:
, _, � - •-�
Signature: � ,�t..�_ � -�-���--�' Date: �iJ -��-� ��-%�,% �
(Rev.2/8/O6)
Terms and Limitations
1 This Agreement is for inspection services only. If Subscriber wants the Company to make ary ;epai�,
alterations or replacements as a result of this inspection, the Company will do so for additional compensatior�Ro
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 instailed in such a way that the sys;em wili 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 walis; the
location of and type of materials (including the presence of hazardous materials) and other conditions of the
Y Property's use are such that the fire protection system is inadequate, insufficient or unsuitabie for the Property.
THIS REPORT IS NOT A GUARANTEE OR WARRANTY THAT THE SYSTEM WILL IN ALL CASES (A)
PROVIDE THE LEVEL OF PROTECT!ON FOR WHICH IT WAS ORIGINALLY INTENDED(B) IS FREE OF ALL
DEFECTS AND DEFICIENCIES (C)AND IS IN COh1PLIANCE WITH ALL APPICAB�E 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 obiigated 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"
("ReporY'). 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 wili aiso 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 shouid receive prompt
attention.
7 Subscriber agrees to obtain and shall be soley responsible to maintain insurance for the Property, ali 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 t
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 harmiess
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 ciaimed 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 Whi�e 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 fuli 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 wriiten 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.2/8l06)