HomeMy WebLinkAboutFAI17-0001 CALFIRE OVERHEAD SPRINKLER HYDRO TEST 11 30 2017Inspection,'Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR, Title 19
Property Information: / / � /J
Name: 44 ,ia Vet ! La 5 J (— t‘IS4upancy/Use:.
C �'- Construction Type
C•1OF.Ca..1ICAddress:
9S
t;Pk.
City: A i/figt/f-- No. Stories
� �.-'`
2
- T
ZIP Year Constructed:
Contact: 1?...t/l,_
t ARE
1
Telephone
Contractor Information: Number of System Risers
Name: Wilgus Fire Control Inc. Copy sent to:
Address 1703 Sonoma St. i Owner Date:/ — /
City: Redding i Fire AHJ Date / L. -1 -7
State: California ' Contractor Date ' 1 - 30_ / 17
Telephone (530) 241-2465
NOTES:
1) For specific inspection, testing, and maintenance
462979
CA License#
requirements and information, see NFPA 25, 2011
Edition as amended by California Code of Regulations,
Job #:
Title 19, §901 to §906.
Performed by:
2) Inspection items may be performed by the owner in
accordance with California Code of Regulations, Title 19,
§904.1(a)
Check box for each system inspected and enter the number of forms used for inspection.
Check boxes (Fail or Pass) to indicate status of inspected system at end of inspection.
Forms Included with this Report
'1,
Z.2.utomatic Sprinkler System
Chapter
5
Number of Forms
N/A
•
Fail`
❑ Standpipe and Hose System
6
IJ
❑Private Water Supply System
7
E
❑ Fire Pump
8
-
I-I
i1
•
Water Storage. Tank
9
❑ Water Spray System
10
❑ Foam Water Sprinkler System
11
❑ Water Mist System
12
rj
❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas)
❑ Yes
•
No
*See "Deficiencies and Comments" section at end of each respective form.
AES 1
September 3, 2013
Job #
Wet Pipe California Code of Regulations - Title 19
Fire Sprinkler System Inspection, Testing, and Maintenance
5 -Year
Report
1 of 3
Property Information
OF' Cot; ,li
-,'Lt
S.' . � , -0 t�
Building,Name F E ', Iv�1
Address 25g—ti Ai✓ el7�17�tit L''I�RE`M��'"•/
License # 5/6,24779
City poty /100%.
Contact Person k
SFM
CSLB
Contractor or Licensed Owner Information
Name (tip k,S
Address 1793 Spy(,py�C
City St.
x y/ z'/ms s
Phone
Zip 900 1
Misc.
Form AES 2.2
Sent. 3. 2013
Riser
No.
Location
Riser
Diameter
Y''
Main Drain
Diameter
-
z'
Initial Static
Pressure
6-v
Residual
Pressure
5v
Final Static
Pressure
70
P F, NIA
P
P, F, N/A
1.1
1
Control Valves — Identification Sign
13.3.1 /
0-301
/
1.2
1
Control Valves — Inspection
13.3.2
G
1 3
1
Waterflow Alarm Devices
5.2.5
1.4
I
Supervisory Devices
5.2.5
This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached:
Form AES 2.2
Sent. 3. 2013
I = Inspection T = Test M = Maintenance
P = Pass F = Fail N/A = Not Applicable
Item
Description
NFPA 25 CA
ed.
Reference
Date
Comments Only
P, F, N/A
1.1
1
Control Valves — Identification Sign
13.3.1 /
0-301
/
1.2
1
Control Valves — Inspection
13.3.2
G
1 3
1
Waterflow Alarm Devices
5.2.5
1.4
I
Supervisory Devices
5.2.5
O
1.5
I
Gauges (Wet Pipe Systems)
5.2.4.1
if Cee,
1.6
I
Hydraulic Design Information Sign
(For hydraulically designed systems)
5.2.6
/J//j�
,r
1.7
1
Enter Water Supply Pressure Below Riser Check
5.2.4.1.
psi
1.8
I
Enter Water Supply Pressure Above Riser Check
5.2.4.1
G 0 psi
e
1.9
1
Pressure Readings Acceptable
5.2.4.1
P
1.10
I
General Information Sign
(not required for system prior to 2007 Edition NFPA 13)
Heat Tape
5.2.8
5.2.7
WAt-
1.11
1
1.12
1
Spare Sprinklers
5.2.1.4
P
1.13
I
Fire Department Connections
13.7'dI
/ A
�Y//�
/
.J
1.14
I
Alarm Valves —Exterior Inspection
13.4.1
1.15
1
Pressure Reducing Valves
13.5.1.1
1.16
I
Backflow Preventers
13.6.1
1V/4
Form AES 2.2
Sent. 3. 2013
i = nispeetiun 1 - 1 esl IVI - rnannenance P - ria, J r - ran w,H - neo[ HppncaDle
Item
Description
NFPA 25 CA ed.
Reference
Date
Comments Only
P,F,N/A
1.17
1
Small Hose Connections - Hose Valve`
5.1.6, 13.5.2
13.5.5.1
,� //4
/V
1.18
1
PRV — Fire Sprinkler Systems
13.5.1.1
WM
1.19
1
Buildings (Freeze Protection)
Sprinklers
4.1,1.1
5.2.1
Owner's Responsibility
D_
1.20
1
1.21
1
Sprinklers - Accessible Concealed Space
5.2.1.1.6
1.22
1
Pipe and Fittings
5.2.2
P
1.23
1
Pipe and Fittings - Accessible Concealed Space
5.2.2.3
1.24
1
Hangers
5.2.3
1.25
1
Hangers - Accessible Concealed Space
5.2.3.3
1.26
1
Seismic Braces
5.2.3
P
1.27
1
Seismic Braces - Accessible Concealed Space
5.2.3.3
P
1.28
1
Unsprinklered Areas
CFC 901.4
gNo
RYes
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
Aim.
2.2
T
Recalled Sprinklers
If not present = Pass; If present = Fail
Title 19
904.1(c)
2.3
T
Water Flow Alarm Devices
90 secs max. Enter time
5.3.3
13.2.6
(�Qsec.
id
2.4
T
Main Drain Test
(Enter data on Page 1 of this form)
13.2.5
13.3.3.4
rj
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
1
'I/n
Np�
2.8
T
Backflow Preventer Assemblies
13.6.2
2.9
T
Small Hose Connections'
w/PRV Hose Valves — Partial Flow Test
13.5.2.3
13.5.3.3
r4„4
/) %,4
/V,2.12
2.10
T
PRV — Fire Sprinkler Systems
13.5.1.3
2.11
T
Pressure Gauges - Calibration
5.3.2
T
Small Hose Connections.
13.5.6.2.2
/,Q
* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III
standpipe systems.
Wet Pipe
Fire Sprinkler System
California Code of Regulations - Title 19
Inspection, Testing, and Maintenance
5 Year
Report
2 of 3
Property Information
Building Name mi I/C�,!�, A/7> 0-c /u
Address .Z5-/ IL940AAA4 D2,7;;, hi0
City jltylyairt
of cAt%Zp?
1-"•((•.- o
'r
1, %E tAilsk
Contractor or Licensed Owner Information
Name W G9c5
Job # f/�
Form AES 2.2
Sept. 3. 2013
Wet Pipe
Fire Sprinkler System
California Code of Regulations - Title 19
Inspection, Testing, and Maintenan'e w ;
S Year
Report
3 of 3
> Property Information
G- pf CACio,
-- *, •Qt
%Building Name jail
� 1i 5 j G /"hies- i �( �Z�%;,=, ' w
Address X5-16/ 110 oq % 4;91... ,..__5'6 � �
City �Gf:Y �kl'E rn�. '
Contractor or Licensed Owner Information
N77,77)j �
Job #
D = Deficiency C = Comment (Indicate type )
I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable
Item
Riser
Description
NFPA 25 CA ed.
Reference
Date
Comments Only
P,F,N/A
3.1
M
Check Valves - Internal inspection
13.4.2
0
3.2
M
Control Valves
13.3.4
6:7
_ 3.3
M
FDC - Backflush
14.3.2.3
14.3.2.4
3.4
M
Internal Pipe Inspection - See Deficiencies and
Comments Section for Results.
14.2
es0
/�r�/ ,� / /�
3.5
M
Obstruction Investigation Required. If "Yes", see
Deficiencies and Comments Section for Results
14.3
;!4 Yes
,�
/(� //�
p3.6
M
System Returned to Service
4.5.3No
D = Deficiency C = Comment (Indicate type )
Item
Date
Riser
D
C
Deficiencies and Comments
Indicate all equipment, devices and parts that were repaired or replaced
C t 'kztoal
Check here if add tional Deficiencies and Comments are listed on Form AES 9 Number attached.
See Correction Form AES 10 for corrected deficiencies. Number attached:
I hereby certify that the fire protection equipment listed above has been fully inspected, rested, 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.
Print Name
Signature
Date
0
Form AES 2.2