HomeMy WebLinkAbout2009-12-22 Viking Automatic Sprinkler Co. Agreement & Report of Inspection 301 York Ave
St. Paul, Minnesota 55130
U (6503300 • (800) 229 -6263
AUTOIVAIIC 10.ER co. Fax ) 558 3310
:,. AGREEMENT AND REPORT OF INSPECTION
SHEET 1 of 2 - USe separate sheet for each building inspected - #INSPECTION S ) 0 5 fie 9
MINNESOTA LICENSE NO. C005
REPORT TO a y , Q Qr( ACq, (. LC BUILDING OR LOCATION 4' e s efA •�
STREET (o (pc) Q)( 1 ttlaie • JU • INSPECTOR per' 6. 40 J o ~ f
CITY & STATE k_ P, Q k N e. e Li c N DATE /; _; 2- Q !
Customer 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, customer agrees to terms •. - ••• • • • • ar of form
and will complete the Owner's Section of this document. Viking Automatic Sprinkler Company will not be held liable or inc
answers provided in the Owner's Section.
Owner's Section (To be answered by Owner, Occupant or Customer p
A. Explain any occupancy hazard changes since the previous inspection: 0 JA k •
B. Describe fire protection modifications made since last inspection: a LL • • " ' - HEIGHT
C. Describe any fires since last inspection: '}o J &.
D. When was the system piping last checked for stoppage, corrosion or foreign material? S • Ale A.) s '
E. When was the dry- piping system last checked for proper pitch? / • 4
Y
F. Are dry valves adequately protected from freezing? 0 5
G. Does the system contain any low point drains? 'es ❑ No If yes, please state how and the :eneral location of each:
i —( D e• ' K45S0 ' 0&
Signature 4 0• �. IO .r s Date
Inspector's Section (All re- 1! = es refe ntinspection) NJA = NOT APPLICABLE
1 General
a. Is the building occupied ? (es ❑ No
b. Are all systems in service? p es ❑ 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? ptes ❑ No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? ❑ Yes ❑ No ff N/A
2 Control Valves (See Item 15)
a. Do sprinkler system control valves appear to be in the appropriate open or dosed position? p (es ❑ No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch ?s ❑ No
3 Water Supplies (See Item 16)
a. Was a water flow test of main drain made at the sprinkler riser(s)? pies ❑ 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 [ I/A
b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight? Vies ❑ No ❑ N/A
Are they accessible and visible? ryes ❑ No ❑ N/A
5 Wet Systems
a. Are cold weather valves (O.S. & Y.) in the appropriate open or closed position? ❑ Yes ❑ No rN /A
b. Have antifreeze system solutions been tested? ❑ Yes ❑ No qy•/A
c. Were the antifreeze test results satisfactory? ❑ Yes ❑ No OIN /A
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? Okes ❑ No ❑ N/A Do all exterior openings appear to be protected against freezing? P"es ❑ No ❑ N/A
6 Dry System (See Items 11 to 13)
a. Are dry valves (s) in service? Yes ❑ No ❑ N/A
b. Are the air pressures and priming water levels in accordance with the manufacture's instructions? %Yes ❑ No ❑ N/A
c. Has the operation of the air or nitrogen supplies been tested? Yes ❑ No ❑ N/A Are they in service? Pales ❑ No ❑ N/A
d. Were all know low points drained during this inspection? ❑ Yes o No i/A
e. Did quick - opening devices operate satisfactorily? ❑ ❑ No 044/A
f. Did the dry valve(s) trip properly during the trip pressure test? P'es ❑ No ❑ N/A
g. Did the heating equipment in the dry-pipe valve room(s) operate at time of inspection ?(Ees ❑ No o N/A
7 Special Systems (See Item 14)
a. Did the deluge or pre -action valves operate properly during testing? ❑ Yes ❑ No p1Ci /A
b. Did the heat- responsive devices operate properly during testing? ❑ Yes ❑ No 1/A
c. Did supervisory devices operate during testing? ❑ Yes ❑ No 0I /A
8 Alarms
a. Did water motor(s) and gong(s) test satisfactorily? ❑ Yes ❑ No plit•I /A
b. Did electric alarm(s) test satisfactory? Wes ❑ No ❑ N/A
c. Did supervisory alarm service test satisfactory? oyes ❑ No ❑ N/A
9 Sprinklers
a. D9 visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? liltz(es ❑ No
b. Are sprinklers less than 50 years old? (Older sprinlders require sample testing) Ales ❑ No
c. Are quick response and residential sprinters less than 20 years old? (Older sprinlders require sample testing) ❑ Yes ❑ No F/
d. Is stock of spare sprinklers available? ❑ PS ❑ No
e. Does the exterior condition of sprinkler system appear to be satisfactory? Pr`Yes ❑ No
f. Do visible sprinklers appear to be of proper temperature rating for their locations? res ❑ No
10 Explain any "No" answers and c omments " :
Signature: L Date: /3 - at 3- o
(Rev. 9 /02/09)
Terms and Conditions r■
a �
1 This Agreement is for inspection services only. If Customer wants Viking Automatic Sprinkler Conpy, herein
after referred to as the Company, to make any repairs, alterations or replacements as a result of this insra ?tc ion,
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 APPLICABLE 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. d in tin -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 CUSTOMER 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 CUSTOMER FOR THE INSPECTION SERVICES THAT GIVE
RISE TO ANY SUCH LIABILITY.
6 The Company, following each inspection, will provide to the Customer 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 Customer's insurance company. The Report and
recommendations by the Company are only advisory in nature and are intended to assist the Customer 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 Customer agrees to obtain and shall be solely responsible to maintain insurance for the Property, all contents
therein, and /or operations performed within or around the Property to be inspected.
8 The Customer 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 Customer, the Company or third parties,
and the Customer, to the fullest 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 Customer 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 Customer'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 Customer 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, Customer agrees to pay all costs of
collection including attorney's fees.
(Rev. 9 /02/09)
301 York Ave
1'- RECEIVED t St. Paul, Minnesota 55130
'v I i N G (651) 558 -3300 • (800) 229 -6263
A11 C ies:La°o. JAN 25 2010 Fax: (651) 558 -3310
SHEET 2 of 2 - Use separate sheet for each system inspected System No. or De ription if multiple
CITY OF OAK PARK HEIGHTS
p M Pm systems /- `l� ! / - d k cf /�
Inspection Report 3- SP . r r -i c, t 1- ydb CY
No. g ;0599'
11 Date dry-pipe valve trip tested (control valve partially open) /) - )02 - Off (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 !C) r+- (See Trip Test Table which follows)
DRY VALVE _ TRIP TEST TABLE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
C4 "a4p4t K 1/" --
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 / 30 , ? //3 3 / 9 -- - (/
With
Q.O.D
14 Date deluge or preaction valve tested A (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 remote control stations ❑ YES ❑ NO
PREACTION Is there an accessible facility in each circuit for testing o 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 � O� en ed Closed Sirs Condition
'. City Control Valves J- �a '' (j5CY YreS Y
s aS
t ,, - Bypass Valves '
Tank Control Valves
Pump Control Valves � j
Sectional Control Valves 3-q" r S V f ; ce!Q 5
System Control Valves 2 - 4/" A { Y eft h � jj 1 44 S V.5
Other Control Valves / - Co f ' dJ$44R Yo 5 kr P ! � of
Kitchen Control Valves 1- 2 '' / $ Y
( L e S �.a 1 S
16 Water Flow Test at Sprinkler Riser
Water Supply Source: City Tank Pump
Residual
Test Pipe Size of Static (Flow)
Date Location Test Pipe Pressure Pressure
Last Water Flow Test 1 j -0 : 5 +2 S ., 9 5 3
This Water Flow Test /2 _ ,2a.. 69 'A !t_ t 5 4 /L 5 9 7 R y 'L
17 Explain any "No" answers and comments:
18 Adjgstments or rrections made during this inspection: A' a k e� r a ^ y .1. p $ t , i+ t ( d ,� �
,
CkeC VOA' fttAPwtS 1 3, 4uir�(5 -� , �Q e S i!
A f
/ ' e &t L M - COQ --
19 Although these comments are not the result of an engineering revie the following desira le improvements are recommended:
Signature: 4 -/ f 1L .t.vA Date: / / - -n?
(Rev. 2/26/09) -
� S
Terms and Conditions
1 This Agreement is for inspection services only. If Customer wants Viking Automatic Sprinkle a ij,a herein
after referred to as the Company, to make any repairs, 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 APPLICABLE 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 shalt 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 oUtlmed 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 CUSTOMER ANDiOR 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 CUSTOMER FOR THE INSPECTION SERVICES THAT GIVE
RISE TO ANY SUCH LIABILITY.
6 The Company, following each inspection, will provide to the Customer 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 Customer's insurance company. The Report and
recommendations by the Company are only advisory in nature and are intended to assist the Customer 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 Customer agrees to obtain and shall be solely responsible to maintain insurance for the Property, all contents
therein, and /or operations performed within or around the Property to be inspected.
8 The Customer 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 rnateriats, equipment,
instrumentalities or other property, whether the same be owned by the Customer, the Company or third parties,
and the Customer, 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 Customer further agrees to obtain, maintain and pay for such
general liability insurance coverage and endorsements as will insure the provisions of this paragraph.
9 White 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 Customer'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 Customer 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, Customer agrees to pay all costs of
collection including attorney's fees.
(Rev. 9/02/09)