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Sprinkler inspections
`>;,„„,,.'.:: , ,;,::,,,,.%.,..:: x' „ :v. ti� v^. .;;..y ` ...,.1/4. �;.. ..•c- ..+..a..;,i.;,,,Y,�7."r•:4o« N. w" 'r 47*".. Yrt' '+' i,j..,:. _ :y jA„'4401420#44 1301 L'ORIENT STREET Iv, k I hi G ST.PAUL,MINNESOTA 55117 (651)558-3300•(800)-229-6263 AUTOMATIC SPRINKLER CO. FAX:(651)558-3310 SHEET 1 OF 2 Use separate sheet for each oudding inspection REPORT OF INSPECTION MINNESOTA LICENSE NO.C0000 WISCONSIN LICENSE NO.265989 REPORT TO L r..t.) 27' t wit' BUILDING OR LOCATION STREET 9 t "—, _ SrR.� INSPECTOR glire N� - DATE /C) / CITY.& STATE / / Owner's Section(To be answered by Owner or Occupant) • ' A. Explain any occupancy hazard changes since the previous inspection: N Q B. Describe fire protection modifications made since last inspectio ''"• ,..a I r•;' ;.: b.:. . -. - IC C. Describe any fires since last inspection. D. When was t system piping last ch ked for age,corrosion or foreign material? E. When wa a ry-pipi g system last Necked for proper pitch? F. Are dry e ade I protected f m freezing? Signat a Title Date Inspector's Section(All responses reference current inspection) NA =NOT APPLICABLE 1. General a. Is the building occupied?4-Yes No b. Are all systems in service?6-Yes. No c. Is there a minimum of 18 in. (457 mm)clearance between the top of the forage and the sprinkler deflectors?L-01.--Y-es ❑No d. Does aI le hheat tape appear to be satisfactory?❑Yes No A AA e. Dces the Nan se"2�fn the sprinkler systems)appear to be satisfactory? Yes No. 2. Control Valves(See Item 15.) a.Are all sprinkler system control valves and all other valves in the appropriate open or closed position?des ❑No b.Are all control valves in the open position locked, sealed or equipped with a tamper switch?des ❑No 3. Water Supplies(See Item 16.) a. Was a water flow test of main drain made at the sprinkler riser(s)?E 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 fjre_departmgnt congections in,satisfactory condition, ottplings free,caps in place,and check valves tight?iX.Yes ❑No ❑NA Are they accessible and:visible?Mali---❑No w NA 4 ' „i 5. Wet Systems a. Are cold weather valves(O.S. & Y.)in the appropriate open or closed position? 'lies 0 No 0 NA b. Have antifreeze system solutions been tested?U Yes ❑No t'NA c.Were the antifreeze test results satisfactory?❑Yes U No L'-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? Yes ❑No NA Do all exterior openings appear to be protected against freezing?[PI`Yes No NA 6. Dry System(See Items 11 to 13.) "" a. Are dry valve(s) in service?❑Yes 0 No 16-NA b. Are thelntlr pressures and priming water levels in accordance with the manufac er's instructions?❑Yes ❑No LTJ NA c. Has the operation of the air or nitrogen supplies been tested?❑Yes ❑No ,_J NA Are they in service?❑Yes ❑No [ZONA d.Were low points drained during this inspection?❑Yes 0 No 14-NA e. Did quick-opening devices operate satisfactorily?❑Yes 0 N Z bIA f. Did the dry valve(s)trip properly during the trip pressure test?❑Yes ❑No it'NA g. Did the heating equipment in the dry-pipe value room(s)operate at time of inspection ?❑Yes ❑No 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?E Yes 7 NoI1a'A c. Did supervisory devices operate during testing?E Yes 0 No 011tA 8. Alarms <: a. Did water motor(s)and gong(s)test sati§factotily?0 Yes 0 No WIC'd. b. Did electric alarm(s)test satisfactory?LR"Y'es 0 No 0 NA c. Did supervisory alarm service test satisfactory?V-Yes ❑No ❑NA 9. Sprinklers a.Ale all sprinklers free from corrosion,loading or obstruction to spray discharge?14-Yes 1 No b.Are sprinklers less de `5D"years old?(bider sprinklers require sample-testing)[ e¢ E No c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing).19-Yes iE No d. Is stock of spare sprinklers available? ..Yes ❑No e. Does the exterior condition of sprinkler system appear to be satisfactory ?,6 res 0 No f. Are sprinklers of proper temperature rati f: . -ir locations?4•Y'es No 10.Explain any"No"ans . o corn 'e Signature: - • ate 1301 L'ORIENT STREET _ '` 1 ST. PAUL,MINNESOTA 55117 . � ,; >rii•el . . ;_ (651)558-3300• (800) 229 6263 x , y,� td AUTOMATIC SPRINKLER CO ? t ,...::.,-4,1,t.,,,,,,,,,,,,:.- FAX (651)558-3310 r ,!.';45,.' r`' SHEET 2, - ..separate sheet for each system inspection "t, 4, �; < z,.,. System No. Descriptio multiple ,T t- -;�s-> '� .� a �, . ."i' 5i, x ' - ' v- at.r: systems j�^,7'�—(� f> '`— t.. Inspection Report - �. ' .: a k 1-. 'v;, / ,J '5-) s H_ ,1 OSx , ,a . ..z /] No } :. `1 r r � / ♦ ��"CCJJ,ry v J am` �' "'ivy x 4 l 7i,...xl,_,_.:,-1 , 11. Date dry-pipe valve trip tested (control valve'partially open) L • (See Trip Test Table which follows) r , Y� »' 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) tl ar ' _ DRY VALVE TRIP TEST TABLE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. r DRY PIPE Time tos 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. WithQ.O.D. ' ` tet'. ., 'T 14. Date deluge or preaction valve tested Ai. ` (See Trip Test Table which follows) v , { TRIP TEST TABLE . y. . e.' rt y* '-'4'''''''''," �,,.�, ,-z a Operation 0 PNEUMATIC 0 ELECTRIC 0 HYDRAULIC 4-,.� a Yg ' Piping Supervised 0 YES 0 NO Detecting media supervised 0 YES 0 NO r a t _,. acrd z S; DELUGE& 4 Does valve operate from the manual trip and/or remote control stations El YES 0 NO ^.^ r I sr c ,� �, v PREACTION Is there an accessible facility in each circuit for testing Method of testing-circuits �` :: ... T�„k,� _� VALVES 0 YES 0 NO q ' °3' �, Does each circuit operate Does each circuit Maximum time to .: z`' �s ' * ,, MAKE MODEL supervision loss alarm operate valve release operate release , YES NO YES NO YES NO t, _ Y xN b1,-;.--%-,-;;; ,':;:,,:;:,:-.', ...;.;::::.--r.. Py ,4 4 b z 'i5 'f�yggx: P15. 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 Valvests)Itis'' � � 72 r �k i(U,e/[f) Other Control Valves ' � J "s Kitchen Control Valve / �, 13 16. Water Flow Tact Sprinkler Riser _- tea ` Water Supply Source: City Tank Pump' a Date Test Pipe Size of Static Residual i1 Location = , Test Pipe Pressure (Flow) s x . Pressure , Last Water Flow Test -` - � '' r. This Water Flow Test a i II `' ( , 5-/ " 17. Explain any "No" answers and comments: (1),,,2 le �/7�� 1' 1) 18. Adjustments or corrections made during this inspection: To l��,2 k' ri°d�' '���!'• i'!�- �rti /',1i:ic.a '`,.C. x�. Itr ')- ItEIz S . g ( 7 S 70 ,v — le ,� f S,g� ble irr ovements re reco ended: 19. Although these comments a of the result of an en eeringview, the followin esir (41.!‘ S E� . Yl %`_ • (4 k "' ' - 1 .. .„.„...,.,,...._... c,..tt a� - ,°irgr ^ ,' ' : ',. ..i..,,....:'1,...-;:':'. -'•,-/-::'-'. -:-.;'' '..- '::•i:,'",,;—=•*•••' Signature:, c;: Date: /Y 7.2 ','h ;-74,71,11::‘:^:40K"Y - R`�` 3 '- :T # JLC` + `` �' L'� 1301 L'ORIENT STREET v'' ST.PAUL,MINNESOTA 55117 - V I I'I N G - ` ��� �� � �`•�' (651)558-3300•(800)-229-6263 ��- AUTOMATIC SPRINKLER CO • _ ,. } °_," c FAX: (651)558-3310 SHEET 1 OF 2-Use separate sheet tor each buildinginspection '"�`"`} ` "�e4M''� "' 5 r'�' P P REPORT OF INSPECTION .�. MINNESOTA LICENSE NO.C00005 WISCONSIN LICENSE NO.265989 If REPORT TO QR()/43.-- ---- • J: v • BUILDING OR LOCATION,c STREET '7 9`� 42Z-:-.1 C 7/AL -RA( R-0, INSPECTOR` fi - • CITY & STATE )'~FUND i Ry N, DATE i E)%14461' D/ 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. f, . 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 Insp tor's Section(All responses reference current inspection) NA =NOT APPLICABLE :, 1. General - a. Is the building occupied?1�J Yes ❑No : , :_ { R ._Y" -, ; - b. Are all systems in service?A9 Yes ❑No c. Is there a minimum of 18 in. (457 mm)clearance between the top of the storage and the sprinkler deflectors?D Yes ❑No - r ; Ac,- 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 satisfactoryes ❑No. CMN < , Rmf , 2. Control Valves(See Item 15.) ", ' .,. .`? . . ,f. n4;,,- 77 ` r ,41- ',7'• a. Are all sprinkler system control valves and all other valves in the appropriate open or closed position?i Yes ❑No -'?,*4-',.,,i. � x�?�- b. Are all control valves in the open position locked,-se31�d_or equipped with a tamper switch?p Yes •No »s Sa .:I •w 3. Water Supplies(See Item 16) ';; ' „ a. Was a water flow test of main drain made at the sprinkler riser(s)?rYYes ❑No —,,..„-,4,•"-„: E"-,;;;Aa:,,, -:,'-',2,-;;*--44, . `,1,.- '1&:-',r---,. , 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? 3 Yes ❑No ❑NA Are they accessible and visible?P'Yes ❑No ❑NA 5. Wet Systems WY a. Are cold weather valves (O.S. &Y.)in the appropriate open or closed position?L 1 I es ❑No ❑NA b. Have antifreeze system solutions been tested?❑Yes ❑No ®NA c. Were the antifreeze test results satisfactory?IDQ Yes ❑No , "NA d. In areas protected by wet system(s), does the building,_.;pea:to be properly heated in all areas, including blind attics and perimeter areas where accessible?$ Yes ❑No ❑NA Do all exterior openings appear to be protected against freezing?p Yes ❑No ❑NA 6. Dry System(See Items 11 to 13.) a. Are dry valve(s)in service?❑Y's Li No ❑NA b. Are the air pressures and riming dater levels in accordance with the manufacturer's instructions?❑Yes ❑No CI NA c. Has the operation of the a or nitro, ei1 siipplies been tested?El Yes ❑No ❑NA Are they in service?❑Yes ❑No ❑NA �_, A: d. Were low points drained uring'thi§ inspp ction?❑Yes ❑No CI NA e. Did quick-opening device operate'saFf4ctorily?CI DI No ❑NA f. Did the dry valve(s)trip properly durWhe 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 V lve4 operate properly during testing?❑Yes ❑No ❑NA b. Did the heat-responsive devi o rate properly during testing?❑Yes ❑No ❑NA Ac. Did supervisory devices opera d rii g testing?❑Yes ❑No ❑NA fu 8. Alarms i W. ,, ` • t :',. a. Did water motor(s)and on /s test satisfactorily?❑Yes ❑No 1�$INA ,e ,,',,a,`," .. `. b. Did electric alarm(s)test satisfactory`]Yes ❑No ❑NA ,. ."---D ` c. Did supervisory alarm service test satisfactory?(D Yes ❑No ❑NA . ✓Q. ~• �*g ',..,,,•,,,,,,,,„,..r.,,,x + 9. Sprinklers t t, a. Are all sprinklers free from corrosion, loading or obstruction to spray discharge ?Pres ❑No ,' r"'",- r ' rte' "Ar- b. Are sprinklers less than 50 years old?(Older sprinklers require sample testing)$Yes ❑No � `2 c. Are quick response and residential sprinklers less than 20 years old?(Older sprinklers require sample testing) Yes ❑No a 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 rating for their locations?517i'es ❑No 10.Explain any"No"answer and comments: Signature: /'su 7t /.,j .�'`��' ` 2 Date: f i ✓���/�� ' 1301 L'ORIENT STREET V, I� ST.PAUL, MINNESOTA 55117 ,; , AUTOMATIC SPRINKLER CO i (651)558-3300• (800)-229 6263 • , - n�, ; FAX: (651)558-3310 SHEET 2 OF 2 - Use separate sheet for each system inspection *„ �^* .. System No. 9r Description if multiple , systems tot i S ' Inspe n/ eport •, j/�' 2. r .. .r. S_Is, e•-+J [r x '� 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) II PA! (See Trip Test Table which follows) 13. Date quick-opening device tested (See Trip Test Table which follows) • DRY VALVE RIP TEST TABLE O.O.D. w tom'!°::,:-4, .'....- MAKE MODEL- SERIAL NO. MAKE MODEL SERIAL NO. ,`T ": .► 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 I PSI PSI MIN. SEC. YES NO a Without ( Q.O.D. . e With i : ,.,, ,4. Q.O.D. ,, W;t"'4.--;.;.'-i;-- •''-4' ' ' . , '''' "; - — ; ; - - , ::.--, < ,.' ' Y' ' 'i- "---. •Ar--"..*';,--'..-7""4,V•,:-",. y 14. Date deluge or preaction valve tested ,'.-4-1'.'.. 4.; (See Trip Test Table which follows) t.. '- t TRIP TEST TABLE ,'; �"' Operation ❑ PNEUMATIC 0 ELECTRIC 0 HYDRAULIC �fx= { Piping Supervised 0 YES 0 NO Detecting media supervised 0 YES 0 NO T-T. '''''f';'4...;,411,-'. 'e: — DELUGE& Does valve operate from the manual trip and/or remote control stations 0 YES 0 NO PREACTION Is there an accessible facility in each circuit for testing Method of testing-circuits 4 . ,VALVES 0 YES 0 NO 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 . 1,' x ' 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 41 /y 55 )s_-s-- Other Control Valves #i QiY t/e'.S `S ..---- Kitchen `Kitchen Control Valve - $r.; p i�c - — 16. Water Flow Test at Sprinkler Riser 'Y Water Supply Source: City Tank Pump Date Test Pipe Size of Static Residual Location Test Pipe Pressure (Flow) Pressure Last Water Flow Test J o//9i ,(')"Svc ^`k p)66 2) lab i) c; S` • This Water Flow Test /;J03'/ 1) j (o7 2) 7c7 i)S 3 2) S'g' 17. Explain any "No" answers and comments: 18. Adjustments or corrections made during this inspection: .. .7.-(1.,2 —1 .:P .-4 4/4"*"' l adj L/t10r-,s rs 0ci'p---._x.S - � _ ,t'4(.. A Z(--,?mss —„ 21rnl) i r _Si/Jr/wit, 19. Although these comments are not the result of an engin eview th followi g desirable improvements are recommended: ” is F , �y� ux. f Signa a -4� - Tri .� .r�£ ,�a.� Date: / <')! • � `~ , I Ar•'° • i 3� r 1301 L'Orient Street do St.Paul,Minnesota 55117 C‘irN (651)558-3300 • (800)2219-6263 AUTOMATIC SPRINKLER CO. Fax: (651)558-3310 Setting Tice Standard... AGREEMENT AND REPORT OF INSPECTION SHEET 1 of 2-'Use separate sheet for each building inspected = #INSPECTION d /3 J S MINNESOTA LICENSE NO.C005 REPORT TO OR won fy L L BUILDINGQOR LOCATION SA en STREET 47j q s Q Ld C1 rlAC AA 'Ga INSPECTOR "A 7- CITY CITY&STATE 0 /040 . r14 d _ DATE f fj Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or building,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) A. Explain any occupancy hazard changes since the previous inspection: AJA,Aig B. Describe fire protection modifications made since last inspection: /JO id C. Describe arty fires since last inspection: /O OA)l D. When was the systenipiping last checked for stoppage,corrosion or foreign material? , E. When was the dry-piping system last checked for proper pitch? /0 f{. F. Are dry valves equately protected from freezing? iiJ 14- Signature Title_ Date Inspector's Section( responses reference current inspection) N/A=NOT APPLICABLE 1 General a. Is the building occupied? Yes o No b. Are all systems in service.f'i Yes a No c. Does there appear to be a minimum of 18 in.(457 mm)clearance between the top of the storage and the sprinkler deflectors? Yes o No d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? a Yes a No p.N/A 2-Control Val'vesYSee 1 05) ; , ; a. Do sprinkler system control valves appear to be in the appropriate open or closed position?$Yes a No b. Are control valves in the open position locked,sealed or equipped with a tamper switch?it.Yes o No 3 Water Supplies(See Item 16) a. Was a water flow test of main drain made at the sprinkler riser(s)?0-Yes o No 4 Tanks,Pumps,Fire Department Connections a. Are fire pumps,gravity tanks,reservoirs and pressure tanks in good condition and properly maintained? o Yes a No 10 N/A b. Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight?pf.Yes a No o N/A Are they accessible and visible?0-Yes o No o N/A 5 Wet Systems a. Are cold weather valves-(O.S.&Y.)in the appropriate open or closed position? a Yes a No N/A b. Have antifreeze system solutions been tested? a Yes o No FIN/A c. Were the antifreeze test results satisfactory? o Yes o No vot N/A d. In areas protected by wet system(s),does the building appearto be properly heated in-all areas,including blind attics and perimeter areas where accessible?O.Yes o No o N/A Do all exterior openings appear to be protected against freezing?pt.Yes o No o N/A 6 Dry System(See Items 11 to 13) a. Are dry valves(s)in service? a Yes o No bp N/A b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? o Yes a No ;fa N/A c. Has the operation of the air or nitrogen supplies been tested? o Yes o No,N/A Are they in service? o Yes a No OW/ d. Were all know low points drained during this inspection? o Yes o No AN/A e. Did quick-opening devices operate satisfactorily? a Yes o No OLN/A f. Did the dry valve(s)trip properly during the trip pressure test? a Yes a No .N/A g. Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? o.Yes a No ofN/A 7 Special Systems(See Item 14) a. Did the deluge or pre-action valves operate properly during testing? a Yes o No 06.N/A b. Did the heat-responsive devices operate properly during testing? o Yes a No 49.N/A c. Did supervisory devices operate during testing? o Yes o No /A 8 Alarms a. Did water motor(s)and gong(s)test satisfactorily? a Yes o No N/A b. Did electric alarm(s)test satisfactory?of Yes a No a N/A c. Did supervisory alarm service test satisfactory?f Yes a No a N/A 9 Sprinklers a. Do visible sprinklers appear to be free from corrosion,loading or obstruction to spray discharge? OfYes o No b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing)pYes o No c. Are quick response and residential sprinklers less than 20 years old? (Older sprinklers require sample testg)(0Yes• a No o N/A d. Is stock of spare sprinklers available? kYes a No e. Does the exterior condition of sprinIdesystem appear to be satisfactory?A.Yes a No f. Do visible sprinklers appear to be of proper temperature rating for their locationslt Yes o No 10 Explain any"No"answers and comments: Signature: 1 Date: /0 -f fo- ir (Rev.2/8/0% - _ Terms and Limitations 1 This Agreement is for inspection services only. If Subscriber wants the Company to make anycr"epairs, 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 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 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 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.2/8/06) A1301 L'Orient Street . e - St.Paul,Minnesota 55117 AUTOMATIC SPRINKLER CO. (651)558-3300 • (800)229-6263 Setting Tile Standard... Fax: (651)558-3310 s SHEET 2 of 2-Use separate sheet for each system inspected System No.or Description if multiple systems ;_ y'(iCT � t Inspection Report /- nc�oy' No. f2/155* 11 Date dry-pipe valve trip tested(control valve partially open) Ai l4 (See Trip Test Table which follows) 12 Date dry-pipe valve trip tested(control valve fully open) IQ/k (See Trip Test Table which follows) 13 Date quick-opening device tested A) IQ.- (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 With Q.O.D 14 Date deluge or preaction valve tested Aht (See Trip Test Table which follows) TRIP TEST TABLE Operation ❑PNEUMATIC o ELECTRIC ❑HYDRAULIC Piping Supervised ❑ YES ❑ NO Detecting Media Supervised ❑ YES ❑ NO DELUGE& Does valve operate from the manual trip and/or remote control stations o YES o NO PREACTION Is there an accessible facility in each circuit for testing D 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 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 Control Valves Bypass Valves Tank Control Valves Pump Control Valves Sectional Control Valves ��i System Control Valves i-4" 057 J � �'< e 4 S Other Control Valves I (0" 8 k- YPS Q S t�S Kitchen Control Valves (- / '' A F OS • Ye 1 ,eS 16 Water Flow Test at Sprinkler Riser Water Supply Source: Ci L e Tank Pump Residual Test Pipe Size of Static (Flow) Date Location Test Pipe Pressure Pressure Last Water Flow Test lo-n.09 12 . S 2A°S 7 r 6,3 ST This Water Flow Test /(}..f -OS se i S P A S 2 `' 41/ _S-S" 17 Explain any"No"answers and comments: 18 Adjustments or c erections made during this inspection: _ 0),,,, k e D&)/Q v I J A too S P (fe9 t,A(AA#1.1 i S r�9,tlf1C5 19 Although these comments are nfc t the resultlof an engineering review,the following diRIsirable improvements are recommended: C?,JI�R A t KPret f1 el9 /i4....15 art? I.i 54* RJ o 4 C L.a.1 4 O y Q V— Signature: �r'./ Date: /0-(I, -©Q (Rev.2/8/06) Terms and Limitations 1 This Agreement is for inspection services only. If Subscriber wants the Company to make any ‘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„1he Property has been or may be used in ways such that the configuration of partition Wa "' "— location of:and type of materials (including the presence of haiardous materials) androther conditions o '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"'fN ALL CASES` (A) PROVIDE THE LEVEL OFPROTECTION 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 rinclude 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 accessibleparts of the system. The Company shall only be obligated to inspect a representative number or sample of the sprinkler heads, pipes, hangers,valvas 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 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 toall 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_nottbe esaigned by Subscriber without the written consent of the Company. 11 This Agreement ri'tay Ali eigned in counterparta;,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.2/8/06)