HomeMy WebLinkAbout1999/01/02 -sprinkler tests/inspections 1301 L'ORIENT STREET - X71 V r
ST.PAUL,MINNESOTA 55117
(651)558-3300• (800)-229-626 v 2 2 1999
,! AUTOMATIC SPRINKLER CO. FAX: (651)558-3310 p ��44
SHEET 1 OF 2.Use separate sheet for each building inspection REPORT OF INSPECTION o�rY®1"®R®IYO
MINNESOTA LICENSE NO.C00005 ^ WISCONSIN LICENSE NO.265989
REPORT TO , �� `�'`=1 -'r'--HUILDING OR LOCATION
STREET t= • v� 1,z,isni L INSPECTOR
CITY & STATE �,f DATE /C. ) %pct
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.
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?
Title e
Inspector's Seetton(All responses�eference current inspection) NA =NOT APPLICABLE
1. General
a. Is the building occupied?4.,Yes ❑No
b. Are all systems in service?l! Yes ❑No
c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?flames ❑No
d. Does all electrical heat tape appear to he satisfactory?❑Yes ❑No 'ItNA
e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?❑Yes ❑No. 6NA
2. Control Valves (See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?tr7es ❑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)91;0 i'es ❑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 011*M
b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight?l$-Yes ❑No ❑NA
Are they accessible and visible? -'es ❑No ❑NA
5. Wet Systems
a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position?09-'fes ❑No ❑NA
b. Have antifreeze system solutions been tested?O Yes ❑No ##;i--NA
c. Were the antifreeze test results satisfactory?❑Yes ❑No SGA
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?jG Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?des ❑No ❑NA
6. Dry System(See Items 11 to 13.)
a. Are dry valve(s)in service?❑Yes ❑No of_-_�'NA
b. Are the air pressures and priming water levels in accordance with the manufacturer's instructions?❑Yes ❑No 105NA
c. Has the operation of the air or nitrogen supplies been tested?❑Yes ❑No o"A Are they in service?❑Yes ❑No feNA
d. Vkere low points drained during this inspection?❑Yes ❑No 'EBNA
e. Did quick-opening devices operate satisfactorily?❑Yes ❑No 64NA
f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes ❑No/SIA
g. Did the heating equipment in the dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No A-NA
7. Special Systems(See Item 14.)
a. Did the deluge or pre-action valves operate properly during testing?❑Yes ❑No ANA
b. Did the heat-responsive devices operate properly during testing?❑Yes ❑No Jo;-NA
c.Did supervisory devices operate during testing?❑Yes ❑No NA
8. Alarms
a. Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑No F!�MA
b.Did electric alarm(s)test satisfactory' -Yes 05�No ❑NA ->
c. Did supervisory alarm service test satisfactory?%C Yes ❑No ❑NA
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),i4-Yes ❑No
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?ce-Yes ❑No
e. Does the exterior condition of sprinkler system appear to be satisfactory ?, Yes ❑No l A
f. Are sprinklers of proper temperature rating for their locations?piLYes ❑No ;) 1 �:
10.Explain any"No;.-answer'a-n&.corpme�ts: 'Y _ J `f' r�,' / �' _, r 1`,yiJro y'
L c'
,
1 1
ILL
Signature: -r f��� 'x'.' �g .. ��, 'J jC7-- r/� I
Date:
1301 L'ORIENT STREET
<!F�t
ST.PAUL,MINNESOTA 55117
(651)558-3300•(800)-229-6263
MATIC SPRINKLER CO. FAX: (651)558-3310
SHEET 2 8F 2 Use separate sheet for each system inspection System No or Descriptio f 1'ple
mitts : 6UA: 7 : oa 4-r,\
Inspection Report
11. Date dry-pipe valve trip tested (control valve partially open) JZ, (See Trip Test Table which follows)
12. Date dry-pipe valve trip tested (control valve fully open) (See Trip Test Table 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
TEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
Without
Q.O.D.
th
14 14. Date deluge or preaction valve tested (See Trip Test Table which follows)
TRIP TEST TABLE
Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
Piping Supervised ❑ YES ❑ NO I Detecting media supervised ❑ YES ❑ NO
DELUGE R 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
VALVES ❑ YES ❑ NO
Does each circuit operate Does each circuit Maximum time to
_ MAKEMODEL supervision loss alarm operate valve release operate release
YES NO YES NO YES NO
15. See Control Valve Maintenance Table.
Control Valve Maintenance Table
Explain
Abnormal
Control Valves Number Type Open Secured CI Signs Condition
City Connection Contrpl ij
Valve 1-491-11 &/'
Tank Control Valves
Pump Control Valves
Sectional Control Valves -
System Control Valves
Other Control Valves ,Q
Kitchen Control Valve
16. Water Flow Test at Sprinkler Riser
Water Supply Source: City Tank Pump
Date Test Pipe Size of Static Residual
Location Test Pipe Pressure (Flow)
Pressure
Last Water Flow Test
This Water Flow Test ; `, rG_S l
17. Explain any "No" answers and comments:
t
18. Adjustments or corrections made during thisinspection: ° '
T' f
6�
19. Although these comments are not the result of an engineering review, the following desirable improvements are recommended:
Signature: =� � Date: i ��
1301 UORIENT STREET
ST.PAUL,MINNESOTA 55117
(651)558-3300•(800)-229-6263
AIJTC�MATIC SPNNKM CO. FAX: (651)558-3310
SHEET 1 OF 2-Use separate sheet for each building inspection REPORT OF INSPECTION
MINNESOTA LICENSE NO.C00005 WISCONSIN LICENSE NO.265989
REPORT TO BUILDING OR LOCATION
STREET �'--, ' 0 ' - L y. --4 L- 12f,A INSPECTOR7!f
CITY & STATE 2L,)^20 DATE J OLI Z611
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.
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?�Q Yes ❑No
b. Are all systems in service?10 Yes ❑No
c. Is there a minimum of 18 in. (457 mm)clearance between the top of thstorage and the sprinkler deflectors? Yes ❑No
d. Does all electrical heat tape appear to be satisfactory?El Yes ❑No 9NA �.
e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?ElrW
Yes ❑No. IOA
2. Control Valves(See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closedsition?(PYes ❑No
b. Are all control valves in the open position locked, sealed or equipped with a tamper switch?WYes ❑No
3. Water Supplies(See Item 16.)
a.Was a water flow test of main drain made at the sprinkler riser(s)?kt>Yes ❑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 92NA
b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight?Foxes ❑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)O Yes ❑No ❑NA
b. Have antifreeze system solutions been tested?❑Yes ❑No CLIA
c. Were the antifreeze test results satisfactory?❑Yes ❑No P NA
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?,ALi Yes [:]No ❑NA Do all exterior openings app be protected against freezing?)DYes ❑No ❑NA
6. Dry System(See Items 11 to 13.)
a. Are dry valve(s) in servicg?❑Yes 13 o ❑NA
b. Are the air pressures and prim g/water vels in accordance with the manufacturer's instructions?El Yes ❑No El NA
c. Has the operation of the air or�nitrogen lies been tested?❑Yes ❑No ❑NA Are they in service?❑Yes ❑No ❑NA
d. Were low points drained during this n ction?❑Yes ❑No ❑NA
e. Did quick-opening devices operate'sa' factorily?❑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 ❑NA
7. 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 ❑NA
c. Did supervisory devices�iper to during testing?❑Yes ❑No ElNA
8. Alarms
a. Did water motor(s) and gong(s)testsatisfactorily?❑Yes ❑No ,SNA
b. Did electric alarm(s)test satisfactory? Yes ❑No ❑NA
c. Did supervisory alarm service test satisfactory?ElYes ANo El NA
9. Sprinklers !
a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?82 Yes ❑No
b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)rpYes ❑No
c.Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testingm Yes ❑No
d. Is stock of spare sprinklers available?MYes ❑No
e.Does the exterior condition of sprinkler system appear to be satisfactory ?El-,Yes ❑No
f. Are sprinklers of proper temperature rating for their locations? Yes ❑No
10.Explain any "No",answer and comments: r " 4,Ae_." X AaOh,)C� '� Si��,.1�C s �-%veyf ,�.✓/S� ��ri
i
Signature: '�':f��� `� ` `�`_Sr' '� ��� Date: J � v
1301 UORIENT STREET
V, ST.PAUL,MINNESOTA 55117
(651)558-3300•(800)-229-6263
AUTOMATIC SPRINKLER CO. FAX: (651)558-3310
SAEET 2 OF 2 - Use separate sheet for each system inspection System No. or Description if multiple
systems
Inspection Report 7 a
s
No. !234911
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 follows)
13. Date quick-opening device tested (See Trip Test Table which follows)
DRY VALVE TRIP TEST TABLE Q.O.D.
MAKE MODEL 1=RIAL�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
TEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
Without j
Q.O.D.
With
Q.O.D.
14. Date deluge or preaction valve tested Z''�+,' (See Trip Test Table which follows)
TRIP TEST TABLE
Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
Piping Supervised ❑ YES ❑ NO; Detecting media supervised ❑ YES ❑ NO
DELUGE& Does valve operate from the manual trip and/or rem a control stations ❑ YES ❑ NO
PREACTION Is there an accessible facility in each circuit for test' g Method of testing-circuits
VALVES ❑ YES ❑ NO
Do s each circuit operate Does each circuit Maximum time to
MAKE MODEL supervision loss alarm o erate valve release operate release
ES 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
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves
Other Control Valves
Kitchen Control Valve
16. Water Flow Test at Sprinkler Riser
Water Supply Source: City Tank Pump
Date Test Pipe Size of Static Residual
Location Test Pipe Pressure (Flow)
Pressure
Last Water Flow Test
This Water Flow Test i53
17. Explain any "No" answers and comments:
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:
Signature: �9 SSC 0'�'� Date:
lr w
r 1301 L'ORIENT STREET
<!F1
ST. PAUL, MINNESOTA 55117
(651)558-3300 • (800)-229-6263
nC SPRINKLER CO. FAX: (651) 558-3310
SHEET 1 OF 2-Use separate sheet for each building inspection REPORT OF INSPECTION
i
MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989
REPORT TO ill47E SO BUILDING OR LOCATIONS F
STREET / 01 INSPECTOR,/
CITY & STATE b�C l)Al DATE /'�
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.
0
N C
When was the system piping last checked for stoppage, corrosion or foreign material?
When was the dry-piping system last checked for,proper pitch?
F. Are dry valves adequately protected from freezing? s
SignaturdtAC) Y'� Title Date
Ins_pect6 s Section(All responses reference current inspection) NA =NOT APPLICABLE
General
a. Is the building occupied��Yes ❑No
b. Are all systems in service?fixes ❑No
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?❑Yes ❑No SNA
e. Does the hand hose on the sprinkler system(s)appear to be satisfactory?❑Yes ❑No. ,9NA
2. Control Valves (See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?p Yes ❑No r
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)?PYes ❑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 ;ONA
b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight?,kYes ❑No ❑NA
Are they accessible and visible?pYes ❑No ❑NA
5. Wet Systems
a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position? Yes ❑No ❑NA
b. Have antifreeze system solutions been tested?❑Yes ❑No V9NA
c.Were the antifreeze test results satisfactory?❑Yes ❑No NA
d. In areas protected by wet system(s),does the buildine annear o be properly heated in all areas,including blind attics and perimeter areas
where accessible?PYes ❑No ❑NA Do all exterior openings appear to be protected against freezing? es []No ❑NA
6. Dry System (See Items 11 to 13.)
a. Are dry valve(s)in service?❑Y s ❑No ❑NA
b. Are the air pressures and rimi ate levels in accordance with the manufwturer's instructions?❑Yes ❑No ❑NA
c. Has the operation of the or i og h!supplies been tested?El Yes ❑Nv -�]NA Are they in service?❑Yes ❑No ❑NA
d. Were low points drained ' g is n ' n?❑Yes ❑No ❑NA `
e.Did quick-opening devic ra 1 factorily?❑Yes ❑No ❑NA
f. Did the dry valve(s)trip
to rl ri' 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 ❑NA
7. Special Systems(See Item 14.)
a. Did the deluge or pre-act n v$S operate properly during testing?1-1Yes El No L1 NA
b. Did the heat-responsive c s e properly during testing?❑Yes El No El NA
c. Did supervisory devices r t ring testing? Yes ElNo El NA
8. Alarms
a. Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑No�NA
b. Did electric alarm(s)test satisfactory? YemgWk io ❑NA
c. Did supervisory alarm service test sa isfactory;A Yes* �6No ❑NA
9. Sprinklers
a. Are all sprinklers free from corrosion,loading or obstruction to spray discharge ?ZYes` ❑No
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 Yes ❑No
d. Is stock of spare sprinklers available? Yes ❑No
e. Does the exterior condition of sprinkler system appear to be satisfactory ?$OYes ❑No
f. Are sprinklers of proper temperature rating for their locations9pyes'\❑No
10.Explain any "No"an r and comments: �l f�1�E >�.� , /1���C.t)f 7,6 NES ?�W_fc//
Signa Date:
° 1301 L'ORIENT STREET
f ST. PAUL, MINNESOTA 55117
N (651)558-3300 • (800)-229-6263
auronnpnC SPrtIN�ER Co. FAX: (651) 558-3310
SHEET 2 OF 2 - se separate sheet for each system inspection System No or Description if multiple
Insp t' a old �ry'rE�l/
Ni .� ev f rT A 44tod'
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 follows)
13. Date quick-opening device tested (See Trip Test Table which follows)
DRY VALVE TRIP TEST TABLE Q.O.D.
MAKE MODEL SE MAKE MODEL SERIAL NO.
DRY PIPEElfth.ut
Time to Trip Water Air Trip Point Time Water Reached Alarm Operated
OPERATINGThru Test Pipe Pressure pres re Air Pressure Test Outlet Properly
MIN. SEC. PSI SI PSI MIN. SEC. YES NO
TEST
14. Date deluge or preaction valve tested J ` (See Trip Test Table which follows)
TRIP TEST TABLE
Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
Piping Supervised ❑ YES ❑ NO Detecting media supervised ❑ YES ❑ NO
DELUGE& Does valve operate from the manual tri nd/or remote control stations ❑ YES ❑ NO
PREACTION Is there an accessible facility in each tuit for testing Method of testing-circuits
VALVES ❑ YES NO
Does each circuit operate Does each circuit Maximum time to
MAKE MODEL su ervision loss alarm operate valve release operate release
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 ✓;
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves
Other Control ValvesAl
Kitchen Control Valve Fj
16. Water Flow Test at Sprinkler Riser
Water Supply Source: City Tank Pump
Date Test Pipe Size of Static Residual
Location Test Pipe Pressure (Flow)
Pressure
Last Water Flow Test 1,0112 J tz
This Water F1ow:Test
17. Explain any "No" answers and comments:'
18. Adjustments or corrections made during this inspection: f �'`
F£, f ;,
19. Although these comments are not the result of an engineering review, the following desirable improvements are recommended:
;,J;: J, Y1lL:[ <✓ :yaa{( i '/`��' �.tl�'t./n;� ' :,,J� 5 ,.J,P�.T/ `_
Signature: �'��� Date: /���
` 1301 L'ORIENT STREET
kM
, ST. PAUL, MINNESOTA 55117
(651)558-3300 • (800)-229-6263
AUIOMASPRINKLER CO. FAX: (651) 558-3310
SHEET t OF 2-Use-separate sheet for each building inspection REPORT OF INSPECTION
MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989
REPORT TO (� —J��� <� a-J7 Z— BUILDING OR LOCATION
STREET —INSPECTOR
CITY & STATE O /17*1 DATE
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.
C. Describe any fires since last inspection.
D. When was the system piping last hecked for stoppage, corrosion or foreign material?
E. When was the dry-pipiirg sys mast checked-for proper pitch?
F. Are dry van a ,ately t om ing?
`• f �� '.�
Signature 7. Title -��`: _-� -' ',' } / < Date
Inspector's SectiAll responses reference current inspection) NA =NOT APPLICABLE
1. General
a. Is the building occupief�Yes ❑No
b.Are all systems in service Yes ❑No
c. Is there a minimum of 19 in. (457 mm)clearance between the top of th torage and the sprinkler deflectors?�PCes ❑No
d.Does all electrical heat tape appear to be satisfactory?❑Yes ❑No A
e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?❑Yes ❑No. /`�,NA
2. Control Valves(See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?(1-0 ❑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)?�AYes ❑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 XNA
b. Are fire department connections in satisfactory condition,couplings free, caps in place, and check valves tight? es ❑No ❑NA
Are they accessible and visible?Wes ❑No ❑NA ((
5. Wet Systems
a. Are cold weather valves(O.S.&Y.)in the appropriate open orcl sed position?�es 11 No El NA
b. Have antifreeze system solutions been tested?El Yes 11 No TNA
c. Were the antifreeze test results satisfactory?❑Yes ❑No NA
d. In areas protected by wet system(s),does the building appe a properly heated in all areas, including blind attics and perimeter areas
where accessible?p Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing? Yes ❑No ❑NA
6. Dry System(See Items 11 to 13.)
a. Are dry valve(s)in service? s ❑No ❑NA
b. Are the air pressures and p�Vjn
at levels in accordance with the manufacturer's instructions?❑Yes ❑No ❑NA
c. Has the operation of the ' gaff upplies been,tested?❑Yes ❑No. LVNA Are they in service?❑Yes ❑No ❑NA
d. Were low points drained 's ins ction?❑Yes ❑No ❑NA
e. Did quick-opening device s actorily?❑Yes ❑No ❑NA
f. Did the dry valve(s)trip d 'ri the trip pressure test?❑Yes ❑No ❑NA
g. Did the heating equipme -pi value room(s)operate at time of inspection ?❑Yes ❑No ❑NA
7. Special Systems(See Item 14.)
a. Did the deluge or pre-actio vtPAn
r properly during testing?1-1Yes 11 No El NA
b.Did the heat-responsive de aproperly during testing?L1 Yes Ll No El NA
c. Did supervisory devices o 1testing?❑Yes ❑No ❑NA
8. Alarms t
a. Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑No )OqA
b. Did electric alarm(s)test satisfactory? Yes ❑No ❑NA
c. Did supervisory alarm service test satisfactory?❑Yes ❑No 'INA
9. Sprinklers
a. Are all sprinklers free from corrosion,loading or obstruction to spray discharge ? CesElNo
b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing?14Nes ❑No
c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testing),11aes ❑No
d. Is stock of spare sprinklers available es ❑No
e. Does the exterior condition of sprinkler system appear to be satisfactory ?'t�Zves ❑No
f. Are sprinklers of prope temperature rating for their locations es ❑No
10.Explain any "No" swer d comments:
Signat Date:
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1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651)558-3300 9 (800)-229-6263
AuronnAnc SPRINKLER Co. FAX: (651)558-3310
SHEET 1 OF 2-Use separate sheet for each building inspection REPORT OF INSPECTION
MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989
REPORT TO OIZD4 0 All rld S BUILDING OR LOCATION �
_ 5L
STREET INSPECTORE'
CITY & STATE DATE1-
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 mode since last inspection. 014, I:v2t� /Yl
pCecnbean, fires since last inspection.
st prping,lgst checked fop stoppage, corrosion or foreign mat rial?
e ping sgstim st chbcWd for proper pitch?
equate ; eezing?r Tit l Date
I tor's SAtion (All responses reference current inspection) NA =NOT APPLI."ABLE
1. General
a. Is the building occupied Yes ❑No
b. Are all systems in service?tl�J Yes ❑No
c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?KYes ❑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?❑Yes ❑No. �NA
2. Control Valves (See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closedosition?A Yes ElNo
b.Are all control valves in the open position locked, sealed Qr 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)?p Yes ❑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 �NA
b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight? es No ❑NA
Are they accessible and visible? Yes ElNo El NA
5. Wet Systems /
a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position?/OYes ❑No ❑NA
b. Have antifreeze system solutions been tested?❑Yes ❑No �NA
c.Were the antifreeze test results satisfactory?❑Yes ❑No X)NA
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?Jki Yes ❑No ❑NA Do all extertar-'bgMings appear to be protected against freezing? Yes ❑No ❑NA
6. Dry System(See Itdms 11 to 13.) /
a. Are dry valve(s)in service?EI/Yes F1No F1 NA
b.Are the air pressures and prin water levels in accordance with the manufacturer's instructions?❑Yes ❑No ❑NA
c. Has the operation of the.air r rt n supplies been-tested?El Yes 11Noi LANA Are they in service?1:1 Yes 11 No ❑NA
d.Were low points drain dt in this' ction?11 Yes 11 No ❑NA
e.Did quick-opening dc4c s ope t sa'sfactorily?El Yes 11 No [INA
f.Did the dry valves)ttrIpp ope y u g the trip pressure test?Ll Yes ❑No L1 NA
g.Did the heating equipme in a dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No ❑NA
7. Special Systems (See Item 14.)
a. Did the deluge or pre-actio al operate properly during testing?❑Yes ❑No ❑NA
b.Did the heat-responsive i es properly during testing?❑Yes ❑No ❑NA
c. Did supervisory devices ` 'ng testing?❑Yes ❑No ❑NA
8. Alarms
a. Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑No )INA
b. Did electric alarm(s)test satisfactory??�3 Yes ❑No ❑NA
c. Did supervisory alarm service test safisfactory? Yes ❑No ❑NA ��1 r/Zvz,
9. Sprinklers � _
a. Are all sprinklers free from corrosion,loading or obstruction to spray discharge ?jOYes ❑No
b.Are sprinklers less than 50 years old?(Older sprinklers require sample testing)>5pyes ❑No
c.Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)JqYes ❑No
d.Is stock of spare sprinklers available?"Yes ❑No
e.Does the exterior condition of sprinkler system appear to be satisfactory ?/fg Yes ❑No
f.Are sprinklers of proper temperature rating for their locations�Yes ❑No
10.Explain any "No" er and comments:
Signatu �� Date:
1301 L'ORIENT STREET
k 0 "50111hST. PAUL, MINNESOTA 5511.7
(651) 558-3300 • (800)-229-6263
,r AUTOMATIC SPRINKLER CO. FAX: (651) 558-3310
SHEET 2FOF 2 - Use separate sheet for each system inspection System No.or Description if multiple r_
;-� / systems 1; I"t s
InspiNtion Report
No. =' ",--.-, 1 �i C c70 j
J
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 follows)
13. Date quick-opening device tested (See Trip Test Table which follows)
DRY VALVE TIP TEST TABLE Q.O.D.
MAKE MODEL RIAL NO. MAKE MODEL SERIAL NO.
DRY PIPE Time to Trip Water Air Trip Point Time Water Reached Alarm Operated
OPERATING Thru Test Pipe Pressur pressure Air Pressure Test Outlet Properly
MIN. I SEC. PRf PSI f MIN. SEC. YES I NO
TEST Without
Q.O.D.
With
O.O.D.
14. Date deluge or preaction valve tested / (See Trip Test Table which follows)
TRIP TEST TABLE
Operation ❑ P ATIC ❑ ELECTRIC ❑ HYDRAULIC
Piping Supervised ❑ YES ❑ NO Detecting media supervised ❑ YES ❑ NO
DELUGE& Does valve operate from the manual trjt and/or remote control stations ❑ YES ❑ NO
PREACTION Is there an accessible facility in each ircuit for testing Method of testing-circuits
VALVES ❑ YES ❑ NO
Does each circuit operate Does each circuit Maximum time to
MAKE MOD su ervisioalarm o erste valve release o erate release
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
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves 0C y 5
Other Control Valves
Kitchen Control Valve
16. Water Flow Test at Sprinkler Riser
Water Supply Source: City Tank Pump
Date Test Pipe Size of Static Residual
Location Test Pipe Pressure (Flow)
Pressure
Last Water Flow Test /0 ) 157pZ v 2 7J -J ?
This Water Flow Test f / 62 71) ;;_3 J s,
17. Explain any "No" answers and comments:
18. Adjustments or corrections made during this inspection: '/ f
/
19. Although these co ents are not the result of a engipeering review, the following desirable improvements are recommended:
i
Signatuc • � cYt Date: ,
1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651)558-3300 • (800)-229-6263
nulnMw11C SPRINKLER CO. FAX: (651)558-3310
SHEET 1 OF 2-Use separate sheet for each building inspection REPORT OF INSPECTION
MINNESOTA LICENSE NO. C00005 WISCONSIN LICENSE NO. 265989
REPORT TO BUILDING OR LOCATION—i422 E
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:
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 plpmg system last ctmeked for proper pitch?
F. Are dry valves uatelglpro gcted om freezing?
Signature Il( r r`'Zt t Title Date
Inspector's Secti'(All responses reference current inspection) NA=NOT APPLICA LE
1. General
a. Is the building occupieYes L-1No
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 deflectors�IOYes ❑No
d. Does all electrical heat tape appear to be satisfactory?❑Yes ❑No/C;NA
e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?❑Yes ❑No./UA
2. Control Valves(See Item 15.)
a. Are all sprinkler system control valves and all other valves in the appropriate open or closed positiow-1c)fes ❑No
b. Are all control valves in the open position locked,sealed or 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)'?�iYes ❑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 /Q: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 visibletYes ❑No ❑NA
5. Wet Systems
a. Are cold weather valves(O.S. &Y.)in the appropriate open or closed position?,l"Yes ❑No ❑NA
b. Have antifreeze system solutions been tested?❑Yes ❑No CNA
c. Were the antifreeze test results satisfactory?❑Yes ❑No ANA
d. In areas protected by wet system(s),does the buildigQ app pe to be properly heated in all areas,including blind attics and perimeter areas
where accessible? es ❑No ❑NA Do all exterior openings appear to be protected against freezing?J I'es [-]No ❑NA
6. Dry System(See Items 11 to 13.) f _
a. Are dry valve(s)in service es ❑No ❑NA
b. Are the air pressu s an in ter levels in accordance with the manufacturer's instructions?❑Yes ❑No ❑NA
c. Has the operation th air r-#r en supplies been tested?❑Yes ❑No ❑NA Are they in service?❑Yes ❑No ❑NA
d. Were low points d n ins tion?❑Yes ❑No ❑NA
e. Did quick-ope ' g ices op rat satisfactorily?❑Yes ❑No ❑NA
f. Did the dry v e(s p o rly uring the trip pressure test?❑Yes Ll No L1 NA
g. Did the heating equipm t int the dry-pipe value room(s)operate at time of inspection?❑Yes ❑No ❑NA
7. Special Systems(See 4tio
a. Did the deluge or pe perate properly during testing?❑Yes ❑No ❑NA
b. Did the heat-respone properly during testing?❑Yes ❑No ❑NA
c. Did supervisory deve kng testing?❑Yes ❑No ❑NA
8. Alarms
a.Did water motor(s)and gong(s)test satisfactorily?❑Yes ❑NojVA
b.Did electric alarm(s)test satisfactory?XYes El No El NA
c.Did supervisory alarm service test satisfactory? Yes El L1NA Ja J I
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 response and residential spurs less than 20 years old?(Older sprinklers require sample testinvfZyes ❑No
d. Is stock of spare sprinklers available?)Z"es ❑No
e. Does the exterior condition of sprinkl r system appear to be satisfactory ?,�1�Yes El No
E�Y
f. Are sprinklers of proper temperature rating for their locations?, es ?,;Oyes
10.Explain any "No"answ comments:
Signature: e 7 Date:
1301 L'ORIENT STREET
ST. PAUL, MINNESOTA 55117
(651)558-3300 9 (800)-229-6263
�l1TOMAl1C SPRINKLER CO. FAX: (651) 558-3310
SHEEP 2 OF 2 - Use separate sheet for each system inspection System No. or Description if multiple
vlems 1 2 'W A
l� +3
Ins pe tioort /.�; ii`C j��/4JJ� 1 vc�t �,fitilA[ A(o2
11. Date dry-pipe valve trip tested (control valve partially open) (See Trip Test Table which to
12. Date dry-pipe valve trip tested (control valve fully open) (See Trip Test Table which follows)
13. Date quick-opening device tested (See Trip Test Table which follows)
DRY VALVE TRIP TEST TABLE Q.O.D.
MAKE MODEL-- AL NO. MAKE MODEL SERIAL NO.
DRY PIPE Time to Trip Water Trip Point Time Water Reached Alarm Operated
OPERATING Thru Test Pipe Pressure _Xel Air Pressure Test Outlet Properly
MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
TEST Without
Q.O.D.
With
Q.O.D.
14. Date deluge or preaction valve tested (See Trip Test Table which follows)
TRIP TEST TABLE
Operation MATT ❑ ELECTRIC ❑ HYDRAULIC
Piping Supervised ❑ YES ❑ NO Detecting media supervised ❑ YES ❑ NO
DELUGE& Does valve operate from the manual tri and/or remote control stations ❑ YES ❑ NO
PREACTION Is there an accessible facility in ea circuit for testing Method of testing-circuits
VALVES [3 YES ❑ NO
Does each circuit operate Does each circuit Maximum time to
MAKE ODEL su ervision loss alarm o erate valve release operate release
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
Tank Control Valves
Pump Control Valves
Sectional Control Valves
System Control Valves
Other Control Valves "p
Kitchen Control Valve
16. Water Flow Test at Sprinkler Riser
Water Supply Source: City Tank Pump
Date Test Pipe Size of Static Residual
Location Test Pipe Pressure (Flow)
Pressure
Last Water Flow Test O 2_ .2` CD
This Water Flow Test S
17. Explain any "No" answers and comments:
18. Adjustments or corrections made during this inspection:
19. Although these comments are not the result of an engineeri g review, the following desirable improvements are recommended:
Signatu Date: ��� ��2---