HomeMy WebLinkAboutCF Overhead Sprinkler Hydro Test 201825-104 INSPECTION. TESTING, AND MAINTENANCE OF WA1hR-BASED FIRE PROTECTION SYS 1 EMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR, Title 19
1;
Name: ac. ,(.ti v4 5I Occupancy/Use:
At'�F Cq���o rr
41.
co '3 :—' D i
r1,' 9 " 441.1
, p�
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Address: ZS -Le tj ia1;f. tAtiti - Construction Type:
City:-: Cf�L4' 1 a No. Stones:0
ZIP Year Constructed:
Contact:
Telephone: 6 s-,,) 272,1 1
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Li
Name: j�, t h L C CI' S Copy sent to:
Address: 1 7 0 a3 5r,07l 7v'L- caner Date: ‘ •— 4 —) ri^
7 i
City: /ii Q,r (olire AHJ Date: — —�
(:67 -�
State: COI 'Contractor Date: ze ._6 _. / �(?
C
Telephone: ''''36.) - Y 2C// i' 5
NOTES:
1) For specific inspection, testing, and maintenance
CA License#: 1162.q-1°/
requirements and information, see NFPA 25, 2011
edition as amendedby California Code of Regulations,
Job #:
Title 19, §901 to §906.
Performed by: ,61.---)
2) Inspection items may be performed by the owner in
accordance with California Code of Regulations, Title 19,
§904.1(a)
Forms Included with this Report
�►�
a tomatic Sprinkler System
NFPA 25
Chapter
5
Number of Forms
0
NIA
✓
Fail'
❑K.
Pass
❑ Standpipe and Hose System
6
0
0 Private Water Supply System
7
0
i
E
C
❑ Fire Pump
8
0
❑ Water Storage Tank
9
0
• Water Spray System
10
0
/
E
❑
❑ Foam Water Sprinkler System
11
0
/
E
0 Water Mist System
12
0
.7
•,Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas)
•
Yes
• No
-!T j_"�, T a'-1 { 4 ' i •t�
�-n
AES 1
NOTE: — Strikeout items are not applicable in California
September 3, 2013
ANNEX B
25-105
Wet Pipe
Fire Sprinkler System
California Code of Regulations - Title 19 Quarterly and
Inspection, Testing. and Maintenance Annual Report
1 of 3
Property Information
Building Name ye. C 1--:,,A4,„ 5 ret /;
Address .6/"•5
City-trTlf 2:f J 4L �l
Contact Person
License # ii6.2. 7% l
0 SFM
Contractor or Licensed Owner Information
Name %;
Address 176, -'?C
Ivo
City /Z ,toile e.St. ?` ZIP 0
`I t'r�
Phone
Job #
[� CSLB
Misc.
Riser Information
Main Drain Test (Annual)
NMI
t
This building has more than 5 risers. See additional AES 2.9 form attached.
Number of AES 2.9 formsattached
Form AES 2.1
NOTE:fy— Strikeout items are not applicable in California
Sli: a
AP'
Sept. 3, 2013
=
w . ,- ion
Inspection T = Test M = Maintenance
1.1
1
Control Valves — Identification Sign
13.3.1
P = Pass
Far
Not
N/AApplicable
1.2
I
Control Valves — Inspection
13.3.2
r>
1.3
1
Waterflow Alarm Devices
5.2.5
a,.�
1.4
1
Supervisory Devices
5,2 5
1.5
I
Gauges (Wet Pipe Systems)
5.2.4.1
1.6
I
Enter Water Supply Pressure Below Riser Check
5.2.4,1
psi
psi
psi
psi
1.7
I
Enter Water Supply Pressure Above Riser Check
5.2.4.1
psi
psi
Psi
psi
1.8
I
Pressure Readings Acceptable
5.2.4.1
7
1.9
I
Hydraulic Design Information Sign
(For Hydraulically Designed Systems)
General Information Sign
(Not Required for System prior to 2007 Edition of NFPA 13)
5.2.6
5.2.8
/11/1
a
1.10
I
1.11
1
Heat Tape
5.2.7
i'Vf71
1.12
1
Spare Sprinklers
5.2.1.4
1.13
1
Fire Department Connections
13.7
>
4
1.14
1
Alarm Valves — Exterior Inspection
13.4.1
p
1.15
1
Pressure Reducing'Vaives
13.5.1.1
N!'/-
(if°'%/�
1.16
1
Backflow Preventers
13.6.1
(f��/,
1.17
1
Small Hose Connections - Hose Valve*
5.1.6, 13.5.2
13.5.5.1
1.18
*
I
PRV — Fire Sprinkler Systems
13.5.1.1
firl
Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include
standpipe systems.
Class I
II, or III
Form AES 2.1
NOTE:fy— Strikeout items are not applicable in California
Sli: a
AP'
Sept. 3, 2013
25-106 INSPECTION, TESTING, AND MAINTENANCE OF WATER-BASED FIRE PROTECTION SYSTEMS
Wet Pipe
Fire Sprinkler System
California Code of Regulations - Title 19 Quarterly and
Inspection, Testing, and Maintenance Annual Report
2 of 3
Property Information
Building Name
t�,�. L l=. rte. j �i� � I
Address 2i' t„01
City r`'e4 Xigij r-;;16
Contractor or Licensed Owner Information
Name
LLL L.,
Job #
ANNUAL INSPECTION, TESTING, AND MAINTENANCE
include ALL Quarterly Inspections
1.19
I
= Ins.ection T = Test M = Maintenance
Sprinklers
P = Pass
F = Fail N/A = Not Alicable
r
5.2.1
1
Buildings (Freeze Protection)
4.1.1.1
Owner's Responsibility
1/%11.20
11//A-
.21
1.21
I
Pipe and Fittings
5.2.2
��
1.22
1
Hangers
5.2.3-7
1.23
I
Seismic Braces
5.2.3.
2.1
T
Field Service Test Required
(Send Report to Fire Code Official)
5 3 1
If REQUIRED, Enter 'F' until
results are returned from Lab
AN /r/
/V//�
2.2
T
Recalled Sprinklers
If not present = Pass: If present = Fail
Title 19
904.1(c)
%61
2.3
T
Water Flow Alarm Devices
90 sec. maximum - (Enter Time)
5.3.3
13.2.6
sec.
2.4
T
Main Drain Test
(Enter Data on Page 1 of this Form)
13.2.5
13.3.3.4
p
//`
2.5
T
Control Valve - Position
13.3.3.2
2.6
T
Control Valve - Operation
13.3.3.1
2.7
T
Supervisory Devices
13.3.3.5
2.8
T
Backflow Preventer Assemblies
13.6.2
vi
/VIM
2.9
T
Small Hose Connections*
Hose Valves- Partial Flow Test
13.5.2.3
13.5.3.3
'//w
%y .i i .
2.10
T
PRV - Fire Sprinkler Systems
13.5.1.3
/4--
3.1
M
Control Valves
13.3.4
fr
3.2
M
Small Hose Connections*
13.5.6.3
3.3
M
Obstruction Investigation required
(If "Yes", see Deficiencies and Comments Section
for Results.)
14.3
Res
0
��'
3.4
M
System Returned to Service
4.5.3
es
go
j
V
' Smal hose connections are hose valves and optional hose supp ied by the fire spnnkler system. They do not include Class I, II, or III
standp pe systems.
D = Deficient C : Comment (indicate •e
Item
Date
Riser
Deficiencies and Comments
inc;cate art equ,pn?ent, dewres and parts that were repaired or replaced
aim
Form AES 2.1
NOTE:�— Strikeout items are not applicable in California
Shalt i6. o _..0.4%.04„„ Vats
Sept. 3.2013
ANNEX B
Wet Pipe California Code of Regulations Title 19
Fire Sprinkler System Inspection, Testing, and Maintenance
Property Information
Building Name Gl i t `777;►
Address �,1 f%
city
r,31-7/6, f/
D = Deficient C = Comment indicate
Item Date Riser D C
25-10
Contractor or Licensed Owner Information
Name
Job #
Deficiencies and Comments (cont.) ' -
indicate al! equipment devices and parts that were repaired or replaced
FA 300 .54
DCheck here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
See Correction Form AES 10 for corrected deficiencies.
Number anached-
I hereby certify that the fire protect/on equipment listed above has been fully inspected, tested, and maintained on this date by
the company Indicated above, In accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable
except as noted in the "Deficiencies and Comments" section of this form.
Date
Print Name
Signature
Form AES 2.1
Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter
NOTE: — Strikeout items are not applicable in California
Sept. 3, 2013