HomeMy WebLinkAbout2011-03-23 Viking Automatic Sprinkler Agreement & Report of Inspection 301 York Ave
St. Paul, Minnesota 55130
F; �� (651) 558 -3300 • (800) 229 -6263
Setting The Standard... Fax: (651) 558 -3310 RECEIVED
AGREEMENT AND REPORT OF INSPECTION
SHEET 1 of 2 - Use separate sheet for each building inspected #INSPECTION pp.
MINNESOTA LICENSE NO. C005
REPORT TO 111... - 1 BUILDING OR LOCATION
STREET 1 lir, • INSPECTOR 1 � L " PARK
s s
CITY & STATE J •`� t , . f „ DATE p ��,� �++.�P(H
Customer hires Viking Automatic Sprinkler Compan o 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 the terms and conditions on rear of
form and will complete the Owner's Section of this document. Viking Automatic Sprinkler Company will not be held liable for incorrect or unknown
answers provided in the Owner's Secti
Owner's Section TTo be answered by Owner, Occupant r Customer)
A. Explain any occupancy hazard changes since the previous inspection:
B. Describe fire protection modifications made since last inspection:
J
C. Describe any fires since last inspection:
D. When was the system piping last checked for stoppage, corrosion or fore' material?
E. When was the dry- piping system last checked for proper pitch?
F. Are dry valves adequately protected from freezing?
G. Does the system contain any low point drains? ❑ Yes ❑ No es, please state how many and theeneral location of each:
Customer's Signature AIIIIM ,. � ; Date //
Inspector's Section (All - ponces refer nce current inspection) C- N/A = NOT APPLICABLE
1 General
a. Is the building occupiedes ❑ No
b. Are all systems in service ?s ❑ 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? f ❑ No
d. Does the valve hose on the sprinkler system(s) appear to be satisfactory? ❑ Yes ❑ No . p.21f7A
2 Control Valves (See Item 15)
a. Do sprinkler= system control valves appear to be in the appropriate open or closed position ?s o No
b. Are control valves in the open position locked, sealed or equipped with a tamper switch ?es ❑ No
3 Water Supplies (See Item 16)
a. Was a water flow test of main drain made at the sprinkler riser(s)? es ❑ No
4 Tanks, Pumps, Fire Department Connections
a. Do fire pumps, gravity tanks, reservoirs and pressure tanks appear in good condition and properly maintained? ❑ Yes ❑ No A
b. Are fire department connections in satisfactory condition, couplings free, caps in place, and check valves tight? ❑ No ❑ N/A
Are they accessible and visible ?Xs ❑ No o N/A
5 Wet Systems
a. Are cold weather valves (O.S. & Y.) in the appropriate o . en or c1 d position? o Yes ❑ No Agri A
b. Have antifreeze system solutions been tested? ❑ = ❑ No A
c. Were the antifreeze test results satisfactory?, ' s ❑ No ,y /A
d. In areas protected by wet system(s), d.: = . "lding appear to be properly heated in all areas, including blind attics and perimeter areas
where accessible? ❑ No ❑ ► Do all exterior openings appear to be protected against freezing? res ❑ No ❑ N/A
6 Dry System (See Items 11 to 3)
a. Are dry valv (Lin ice? • • s ❑ No o N/A
b. Are the air ' i, • s and • ing water levels in accordance with the manufacture's instructions? ❑ Yes ❑ No ❑ N/A
c. Has the o ; n of . air or nitieogen supplies been tested? ❑ Yes ❑ No ❑ N/A Are they in service? ❑ Yes ❑ No ❑ N/A
d. Were all : own lo . . •ints drained during this inspection? o Yes ❑ No o N/A
e. Did quick -ope ' g devices operate satisfactorily? ❑ Yes ❑ No ❑ N/A
f. Did the dry , • ve(s) appear to trip properly during the trip pressure test? ❑ Yes ❑ No ❑ N/A
g. Did the h- g equipment in the dry-pipe valve room(s) appear to operate at time of inspection? ❑ Yes ❑ No ❑ N/A
7 Special Sys • ms (See Item 14)
a. Did e deluge or pre -action valves operate properly during testing? ❑ Yes ❑ No ❑ N/A
b. D' . the heat- responsive devices operate properly during testing? ❑ Yes ❑ No o N/A
c. # id supervisory devices operate during testing? ❑ Yes ❑ No ❑ N/A
8 arms
a. Did water motor(s) and gong(s) test satisfa rily? o Yes ❑ No A
b. Did electric alarm(s) test satisfactory es ❑ No ❑ N/A
c. Did supervisory alarm service test satisfactory? ❑ Yes ❑ No o N/A
9 Sprinklers /781( g;
a. Do visible sprinklers appear to be free from corrosion, loading or obstruction to spray discharge? o Ye ❑ No
b. Do visible sprinklers appear to be less than 50 years old? : (Older sprinklers require sample testing) ❑ No
c. Do quick response and residential sprinklers appear less than 20 years old? (Older sprinklers require sample testing) ❑ Yes i d<o N/A
d. Is stock of spare sprinklers available? es ❑ No
e. Does the exterior condition of sprinkler system appear to be satisfactory Yes ❑ No/
f. Do visible sprinklers appear to be of properr temperature rating for their locations? . Yes ❑ No
10 Explain any "No" answers and comments:
/ �L' �.. Date: � — 5r)/
Inspector's Signature•" /
1. specs on Form P12 -1 -10
v al N RECEIt '� j kAv!
Mir 55130
AUTOMATIC SPRINKLER CO. y 37c 5 -330 • (800) 229 -6263
Setting The Standard... / r - APR 2 IFkli i (651) 55 - 3310
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SHEET 2 of 2 - Use separate sheet for each system inspected 5S OF OAK PAWN i
aM C +'- ' ) y , 4 t t 3 ,' /
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) (See Trip Test Table which follows)
13 Date quick - opening device tested (See Trip Test Table which follows)
DRY VALVE TRIP TEST TABLE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL SERIAL NO.
DRY PIPE Time to Trip Water Air Trip Point - e Water Reached Alarm Operated
OPERATING Thru Test Pipe Pressure Pressure Air Pr - - Test Outlet Properly
TEST MIN. SEC. PSI ° I MIN. SEC. YES NO
Without
Q.O.D i I 1
With
Q.O.D i
14 Date deluge or preaction valve tested (See Trip Test Table which follows)
TRIP TEST TABLE
Operation ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
Piping Supervised ❑ o%- ❑ NO Detecting Media Supervised ❑ YES ❑ NO
DELUGE Sr Does valve operate from the • r ual trip and/or remote control stations ❑ YES ❑ NO
PREACTION Is there an accessible fac' ' in each circuit for testing o YES ❑ NO (Method of Testing Circuits
VALVES Does each circuit operate Does each circuit Maximum time to
M ' MODEL supervision loss alarm operate valve release operate release
YES NO YES NO YES NO
1
15 See Control Valve Maintenance Table
CONTROL VALVE MAINTENANCE TABLE
Explain
Abnormal
Control Valves Num er T f Open Secured C - ed i'gns ,. ndition
Ci Control Valves %Mail `(` Maid �.�[� ritGOV
nil
Bypass Valves
Tank Control Valves
Pump Control Valves
Sectional Control Valves A
S stem Control Valves 1MIllrbAll[TI Pl
Other Control Valves
Kitchen Control Valves
16 Water Flow Test at Sprinkler Riser
Water Supply Source: City Tank Pump
Residual
Test Pipe Size of Static (Flow)
ate / Location T t�F ei / Pres e g , {G� " s l�ssure
Last Water Flow Test / - 0k 1f 7
This W Flow Test 3 Z3 - ,/ "if'? !) 9
17 Explain any "No" answers and comments:
II 'I 18 Adjustments or corrections made during this inspection:
19 Although the comments are not the result of an en ' eering review, please see the attached Non - Inspection Related Deficiencies
form for additional items) during cour inspection (only attached if applicable). /
Inspector's Signature: 7 fill i Date: Z -- /
Inspection Form P2 2 -1 -10
i