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HomeMy WebLinkAbout2007-12-05 Viking Automatic Sprinkler Co. Agreement & Report of Inspection 1301 L'Orient Street ,�� St. Paul, Minnesota 55117 111 114t11 IC SPRIN + . _< ..� ^ (653300 • (800) 229 -6263 Fax: ) 558-3310 Setting The Standard... ' AGREEMENT AND REPORT OF INSPECTION / 17 SHEET I of 2 - Use separate sheet for each building inspected #INSPECTION t3 MINNESOTA LICENSE NO. C005 REPORT TO o k Q ,' Q f/, tv I t c BUILDING OR LOCATION ,4 e STREET C t E3 Qy b ©r2 Q Aik , 1.J INSPECTOR S) 7 C;7414 A. .) P' CITY & STATE Oc,t P„ g k hie, 6,41t S , fri A , DATE /2 - 6" - 6 Owner hires Vildng 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: /t J o /J 2 B. Describe fire protection modifications made since last inspection: 4.) O A ) R C. Describe any fires since last inspection: /t) v A) z D. When was the system piping last checked for stoppage, corrosion or foreign material? T, «s c i xi 0 W E. When was the dry- piping system last checked for proper pitch? �) F. Are dry valves tely tected from freezing? r Q 5 Signature t) <.e, Title Date Inspector's Section (All responses reference current inspection) N/A = NOT APPLICABLE 1 General a. Is the building occupied? Yes ❑ No b. Are all systems in service? ird,Yes ❑ 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? Otr ❑ No d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? ❑ Yes ❑ No vitN /A 2 Control Valves (See Item 15) a. Do sprinkler system control valves appear to be in the appropriate open or dosed position? 04 -Yes ❑ No b. Are control valves in the open position locked, sealed or equipped with 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)? cieles ❑ 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 pi-N/A b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight? ..Yes ❑ No ❑ N/A Are they accessible and visible? -Yes ❑ No ❑ N/A 5 Wet Systems a. Are cold weather valves (O.S. & Y.) in the appropriate open or dosed position? ❑ Yes ❑ No Od.N /A b. Have antifreeze system solutions been tested? ❑ Yes ❑ No oiN /A c. Were the antifreeze test results satisfactory? ❑ Yes ❑ No ip(N/ 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 ?,LXes ❑ No ❑ N/A Do all exterior openings appear to be protected against freezing ?.Yes ❑ No ❑ N/A 6 Dry System (See Items 11 to 13) a. Are dry valves (s) in service? t fes ❑ 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? Saes ❑ No ❑ N/A d. Were all know low points drained during this inspection? p4-Yes ❑ No ❑ N/A e. Did quick- opening devices operate satisfactorily? ❑ Yes ❑ No /A f. Did the dry valve(s) trip properly during the trip pressure test? es ❑ No ❑ N/A g. Did the heating equipment in the dry-pipe valve room(s) opera at time of inspectionV Yes ❑ No ❑ N/A 7 Special Systems (See Item 14) a. Did the deluge or pre- action valves operate properly during testing? ❑ Yes ❑ No / A b. Did the heat- responsive devices operate properly during testing? ❑ Yes ❑ No eta / A c. Did supervisory devices operate during testing? ❑ Yes o No c id N/A 8 Alarms a. Did water motor(s) and gong(s) test satisfactorily? o Yes ❑ No -N/ A b. Did electric alarm(s) test satisfactory? p Yes ❑ No ❑ N/A c. Did supervisory alarm service test satisfactory?p Yes ❑ No ❑ N/A 9 Sprinklers a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? 24 -Yes ❑ 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) 04.Yes ❑ No ❑ N/A d. Is stock of spare sprinklers available? BLYes ❑ No e. Does the exterior condition of sprinIdgr system appear to be satisfactory?pb Yes ❑ No f. Do visible sprinklers appear to be of proper temperature rating for their locations? ( yes ❑ No 10 Explain any "No" answers and comments: Signature: 1 y / .vd T . ' Date: / 2 • 5 x. 2/8 /a) _,. ' and Limitotions /'` ' • 1 This Agreement is for inspection services only. If Subscriber wants the Company lo 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 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 oniy 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. h The Company •.),W be_pe;mitted, 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 L':ABIL ITY, 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 taw, 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, i nstrumentaiities .er- other,,property, whether the sarpe,,be ovyned y.th €,$ubscrib_er,_ 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) 1301 L'Orient Street ' 41 l i tidi r 1 Mt %t. Paul, Minnesota 55117 UTOMATIC SPRINKLER CO. , 651) 558 -3300 • (800) 229 -6263 Setting The Standard... Fax: (651) 558 -3310 SHEET 2 of 2 - Use separate sheet for each system inspected System No. or Description if multiple systems Inspection Report 1 C 4 e 4 e H e o c No. A ?%3 11 Date dry -pipe valve trip tested (control valve partially open) / Z . S _ v r7 (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 /0 $ (See Trip Test Table which follows) DRY VALVE TRIP TEST TABLE Q.O.D. r MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. 4 - P AJ d R ,c ( y t' — DRY PIPE Time to Trip ater 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 Z./ 0 7 (, 4 / y / C. — With Q.O.D -° - 14 Date deluge or preaction valve tested iki 19-- (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 ❑ 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 / - (, t ' A 1 y , S i 1) C 0 5 Bypass Valves Ciu`^e Talk-Control Valves (- / " Sal t , It t, guami.Control Valves e s- r/ - L.4)01.,( ? , , / 1 I t Sectional Control Valves I. / - ( t' fa) 04 4 .0 e 1 ft It 09 System Control Valves /. c/ f, l 1 I t ol'Q If Other Control Valves _ q t ` it) p{ pI , II ft II Kitchen Control Valves j... > t • AR / ( J , f t I / 16 Water Flow Test at Sprinkler Riser Water Supply Source: feliP $ 11 Tank Pump Residual Test Pipe Size of Static (Flow) Date Location Test Pipe Pressure Pressure Last Water Flow Test /2- go o ,' 5 , / S k / This Water Flow Test /7 /‘- • � 4 ,C 1 X 4 2 l' I 95 17 Explain any "No" answers and comments: 18 Adjustments or orrections made during this inspection: s Lt_ n, , oX C e�✓OtiP n f cJ Pte, --- (‘tsckod 0 tr9R441 5' 1 c ■f.clAtiS —.. PP(.. v 5 h /44 Q 4x • Q bl { tiP w.-- 19 Although these comments are not the result of an engineering review, the following desirable improvements are recommended: Signature: Date: / Z - S - p "7 (Rev. 2/8/06) � n � arms and Limitations 1 This Agreement is for inspection services only. If Subscriber wants 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 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 attomey's fees. (Rev. 2/8/06)