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1301 L'Orient Street <br /> St Paul,Minnesota 55117 <br /> (651)558-3300 • (800)229-6263 <br /> AUTOMATIC SPRINKLER CO. Fax: (651)558-3310 <br /> SettingZbe Standard... <br /> AGREEMENT AND REPORT OF INSPECTION <br /> SHEET 1 of fuse separate sheet for each building inspected #INSPECTION , / 3 5 <br /> MINNESOTA LICENSE NO.COOS <br /> REPORT TO in i ela a ctrl B DING OR LOCATION ,q/1.1 Q <br /> STREET t CPyc 11a QA t /C p INSPECTOR '7— ,q,u <br /> Lr1Y&STATE ©R,04,387 t,.,). DATE Jo../6..6 g' <br /> Owner hires Viking Automatic Sprinkler Company to conduct an inspection of the fire suppression system at the above location or gilding,and <br /> 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 <br /> will complete the Owner's Section of this document. <br /> Owner's Section(To be answered by Owner or Occupant) <br /> A. Explain any occupancy hazard changes since the previous inspection: /0(),4,,) Q <br /> B. Describe fire protection modifications made since last inspection: p.)a1J o , <br /> C. Describe any fires since last inspection: ,)O/,..) Q <br /> D. When was the system piping last checked for stoppage,corrosion or foreign material? ILL..— <br /> E. When was the dry-piping system last checked for proper pitch? g4 <br /> F. Are dry valvesuately protected from freezing? A)A.. <br /> / r <br /> Signature /l 1/‘ Title Date <br /> Inspector's Section(All responses reference c ' eat inspection) N/A=NOT APPLICABLE <br /> 1 General <br /> a. Is the building occupied?es Yes a No <br /> b. Are all systems in service? f-Yes o No <br /> 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 <br /> d. Does the valve hose on the sprinkler system(s)appear to be satisfactory? o Yes o No N/A <br /> 2 Control Valves(See Ilm'I5) s., <br /> a. Do sprinkler system control valves appear to be in the appropriate open or closed position? pt.Yes o No <br /> b. Are control valves in the open position locked,sealed or equipped with a tamper switch?,pes o No <br /> 3 Water Supplies(See Item 16) <br /> a. Was a water flow test of main drain made at the sprinkler riser(s)?y2 Yes o 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? o Yes o No 14N/A' <br /> b. Are fire department connections in satisfactory condition,couplings free,caps in place,and check valves tight?cp..Yes diNo o N/A <br /> Are they accessible and visible?w�Yes ❑No o N/A <br /> 5 Wet Systems /_ <br /> a. Are cold weather valves(U.S.&Y.)in the appropriate open or closed position?tia Yes o No o N/A <br /> b. Have antifreeze system solutions been tested? o Yes o No phi N/A <br /> c. Were the antifreeze test results satisfactory? o Yes o No (p N/A <br /> d. In areas protected wet system(s),does the building appear to be properly heated in all areas,including blind attics and perimeter areas <br /> where accessible? Yes o No .❑N/A Do all exterior openings appear to be protected against freezing?lees o No ,N/A <br /> 6 Dry System(See Items 11 to 13) <br /> a. Are dry valves(s)in service? o Yes o No of-N/A <br /> b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? a Yes a No /A <br /> c. Has the operation of the air or nitrogen supplies been tested? o Yes o No ON/A Are they in service? o Yes o No N/A ' <br /> d. Were all know low points drained during this inspection? o Yes o No p.N/A <br /> e. Did quick-opening devices operate satisfactorily? o Yes ❑No ALN/A <br /> f. Did the dry valve(s)trip properly during the trip pressure test?, a Yes o No 0►.N/A <br /> g. Did the heating equipment in the dry-pipe valve room(s)operate at time of inspection? o Yes o No CpLN/A <br /> 7 Special Systems(See Item 14) <br /> a. Did the deluge or pre-action valves operate properly during testing? o Yes o No F N/A <br /> b. Did the heat-responsive devices operate properly during testing? o Yes o No /A <br /> c. Did supervisory devices operate during testing? o Yes o No pN/A <br /> 8 Alarms <br /> a. Did water motor(s)and gong(s)test satisfactorily? o Yes o No $N/A <br /> b. Did electric alarm(s)test satisfactory?id Yes a No a N/A <br /> c. Did supervisory alarm service test satisfactory?'Yes o No o N/A <br /> 9 Sprinklers <br /> a. Do visible sprinklers appear to be free from corrosion,loading or obstruction to spray discharge?pi Yes o No <br /> b. Are sprinklers less than 50 years old? (Older sprinklers require sample testing)*Yes o No <br /> c. Are quick response and residential sprinklers less than 20 yearsold? (Older sprinklers require sample testing)ptYes o No . o N/A <br /> d. Is stock of spare sprinklers available?(> es o No <br /> e. Does the exterior condition of sprinkler system appear to be satisfactory?pti Yes o No <br /> f. Do visible sprinklers appear to be of proper temperature rating for their locations Yes o No <br /> 10 Explain any"No",answers and comments: a <br /> Signature: 15C11"-. 7/13j"ii.,t I Date: /iO" /C- tr <br /> 2/3/061(R.... aias, - ., <br />