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1301 L'ORIENT STREET "
<br /> �� d� � � • aa-,
<br /> (yr, k, N ST.PAUL,MINNESOTA 55117(651)558-3300•(800)-229-6263 K;:#
<br /> * el AUTOMATIC SPRINKLER CO. FAX: (651)558-3310 s t � ,. &) �,,,
<br /> SHEET t OF 2-Use separate sheet for each bui ding inspection REPORT OF INSPECTION
<br /> MINNESOTA LICENSE NO.C00005 WISCONSIN LICENSE NO.265989 x 4
<br /> REPORT TO `; r — BUILDING OR LOCATION -'4 Y) . '""•' '
<br /> STREET 30 v C 0(1,5s--/-7 i. 34 INSPECTOR / )-5- 4 2
<br /> CITY & STATE OI Olin 17/,'1/ DATE 107/cy/Ol
<br /> r
<br /> Owner's Section(To be answered by Owner or Occupant)
<br /> A. Explain any occupancy hazard changes since the previous inspection:
<br /> B. Describe fire protection modifications made since last inspection. i c.
<br /> C. Describe any fires since last inspection. �.i
<br /> D. When was the system piping last checked for stoppage, corrosion or foreign material?
<br /> E. When was the dry-piping system last checked for proper pitch?
<br /> F
<br /> /Are dry valves adequately protected from freezing?
<br /> Signature Title Date
<br /> Inspector's Section(All responses reference current inspection) NA =NOT APPLICABLE
<br /> 1. General i - - '` 7,
<br /> a- Is the building occupied? Yes ❑No 7 , ,,. , e _`.r „ fl _ °,, ; 1
<br /> b. Are all systems in service Yes ❑No - -,'�,
<br /> C. Is there a minimum of 18 in. (457 mm)clearance between the top of the torage and the sprinkler deflectors?Q Yes ❑No ,r , 4. r
<br /> d. Does all electrical heat tape appear to be satisfactory?El Yes ❑NoA
<br /> e. Does the hand hose on the sprinkler system(s) appear to be satisfactory?❑Yes El No. ,5 NA ,,: ' ,' ., , '
<br /> 2. Control Valves(See Item 15.) �
<br /> a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?Q.'Yes ❑No
<br /> b- Are all control valves in the open position locked, sea .or equipped with a tamper switch Yes ❑No p --...,t1,,, >t� s,
<br /> 3. Water Supplies(See Item 16.) - X
<br /> a. Was a water flow test of main drain made at the sprinkler riser(s)?6Yes ❑No
<br /> 4. Tanks,Pumps, Fire Department Connections
<br /> a. Are fire pumps, gravity tanks,reservoirs and pressure tanks in good condition and properly maintained?❑Yes ❑No [ )NA
<br /> b. Are fire department connections in satisfactory condition,couplings free,caps in place, and check valves tight?i&Yes ❑No El NA
<br /> Are they accessible and visible?aYes ❑No El NA
<br /> 5. Wet Systems
<br /> a. Are cold weather valves (O.S. &Y.)in the appropriate open or closed position?RYes ❑No ❑NA
<br /> b. Have antifreeze system solutions been tested?❑Yes ❑No ETNA
<br /> c. Were the antifreeze test results satisfactory?El Yes ❑No n NA
<br /> d. In areas protected by wet system(s),does the building appeatto be properly heated in all areas, including b-Id attics and perimeter areas
<br /> where accessible?K5 Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?Le es ❑No ❑NA
<br /> 6. Dry System(See Items 11 to 13.) _ ;
<br /> a. Are dry valve(s)in service?❑Yes ❑No ❑NA ...+# `� .- - , T '�
<br /> b. Are the air pressures and priming water levels in accordance withthe manufacturer's instructions?❑Yes ❑No ❑NA "t.' -pv+ »> ,'s"
<br /> c. Has the operation sof the air or?itr gen supplies been tested?❑Yes ❑No ❑NA Are they in se ce?❑Yes ❑No ❑Nt
<br /> ? ..il.•; yrs. sy, h . .-.....4,-;.,v..-
<br /> •rte 54 ,'
<br /> d. Were low points tamed duri g this inspection- ❑Yes ❑No ❑NA
<br /> e. Did quick-openi deuces oper to satisfactorily?❑Yes ❑No ❑NA A „„ •':-t-5''''. i,
<br /> f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes ❑No ❑NA 4 •, 4 "I'll z.t 1
<br /> g. Did the heating equipment in the dry-pipe value room(s) operate at time of inspection ?❑Yes ❑No ❑NA ,- r .•:./' `-',* a
<br /> 7. Special Systems(See Item 14.) 1`
<br /> a. Did the deluge or pre-action valves operate properly during testing?El Yes ❑No ❑NA A '' . ` . '.. '& -.*‘1';'.:4..i.,...'fix.,,
<br /> b. Did the heat-responsive deviceperate properly during testing?El Yes El No ❑NA
<br /> c. Did supervisory devizes'opeateduring testing?❑Yes ❑No ❑NA
<br /> 8. Alarms , t' ,L •r; z,,
<br /> a. Did water motor(s) and gong(s)test satisfactorily?❑Yes ❑No EVNA ,, & - R '-*
<br /> b. Did electric alarm(s)test satisfactory?4N Yes ❑No ❑NA } s ,f., �'
<br /> c. Did supervisory alarm service test satisfactory?❑Yes El No pis' k•- ;•yk . "�`t` = k` -� 3 4:
<br /> 9. Sprinklers
<br /> a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?6 Yes ❑No .k f -:
<br /> b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing)L�Yes ❑No ,, i. {� r•
<br /> c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing)OYes ❑No .m
<br /> d. Is
<br /> f spare
<br /> e. Does thcke exterior sprinklers
<br /> of slable?rn Yes sprinkler system No appear to be satisfactory ? Yes ❑No - � f�1 l-'
<br /> P Y PPe . .- ,,°"i,^r , _,
<br /> f. Are sprinklers of proper temperature rating for their locations?[ DYes ❑No - '....,.3,,`;'!•-:'1"
<br /> 10.Explain any"No"answer and comments:
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<br /> Signature: sufl't- �/� - Z--(Ce Date: %'-1/l J/
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