HomeMy WebLinkAboutFAI15-0104 CF Fire Sprinkler 2018 Passed QUYRE Fire Protection
P.O. Box 3176 • Chico,California 95927 • Phone(530)345-1012 • Fax(530)345-1630
Inspection, Testing, and Maintenance Cover Sheet 1
NFPA25 as amended hX CCR, Title 19
s s � � 3 r ' ..� s rhe �' a i� �t rT; i ,� "i <�€'" .c� s�. i�' 3Y i �>
Migg
s j Zia . ;. .� "'c ; £ §o 11 1 111' k i sic £ Ya'r. . x,... '. ;1k
,,:.,;.�»� .::> r .:,a..»:�.,.,..sY� .�:� ,���.rr�. ....,,<>.�<�z<� ,,.<*�.,;�,a.��,:�., ,,��rn*�� �'��.. ,�s;��,�:3 &,�,;s�?a�,��;�w.,.�,�w�. .�s���,F���_��"�' aa.,s ;. c ..::��:' r� .
Name: 'Pi ZLpr -0D kJ? Occupancy/Use:
Address; 2 B " 4Az! ,k
Construction Type: ,A..7"-:', „0 s
City: ‘-'31(7 C7 S No. Stories; o) .. N _,:, Y,,i.
ZIP: (� rr��
"►S ”117 Year Constructed: ; � �, \.�,/
Contact:
E4�
Telephone: g t3,5—* 5500
contractor
s+¢ 3a µ. � y�,a. gg
s.✓nt re'i,cL"9 P' 4S$ t" $'c d' ,^F§.`a Com' >� a': ,v '+'C` st.�€,`3.•. _ r#;.£ a' W.
I i €•'a €°µxr ani d, ft
Brandon Squyres
Name: Copy sent to:
Address: P.O. Box 3176 0 Owner Date:
City: Chico 0 Fire AHJ Date:
State: California 12,1 Contractor Date:
(530)345-1012 NOTES:
Telephone: 1) For specific inspection,testing, and maintenance
275206 requirements and information,see NFPA 25, 2011
CA License#: Edition as amended by California Code of Regulations,
Title 19, §901 to§906.
Job#: Quarterly / Annual /`- Year
2) Inspection items may be performed by the owner in
Performed by: --g? N N(AOS accordance with California Code of Regulations,Title 19,
§904.1(x)
check boxes Fai • c fiza 3 a€ ; €� Sa r. s
Check box for each
1 riiiiis iriclutfdd, ith this a rt'<. Number of Forms N/A Fail" Pass
Chapter
El Automatic Sprinkler System 5 "'f E E Iii
❑ Standpipe and Hose System 6 C C C
❑ P• rivate Water Supply System 7 _- _ E ❑
❑ F• ire Pump 8 E E C
El Water Storage Tank 9 ._,. C E C
❑ Water Spray System 10 . — C E
El Foam Water Sprinkler System 11 _- _ C E
❑ Water Mist System 12 _ E E
O Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes 0 No
*See 1 e> ctehc es and pc amen s ea . 1,eff t each res;sere form ,
SQUVRES Fire Protection -
UI P.O.Box 3176 • Chico,California 95927 • Phone(530)345-1012 • Fax(530)345-1630
Wet Pipe California Code of Regulations -Title 19 5-Year , ..,„.,
Fire Sprinkler System Inspection,Testing, and Maintenance Report 1 ‘''' 4
f
..„,. ..01F cA,t,i''
Property Information ------- P.N Contractor or Licensed Owner Information
Building Name Vii7-74)% 9_000b vp hi*)(rk'r.,1
.‘Z.'
" 9,\ /...,
pi Name Brandon Squyres
4-993N,,..,J.S.:6 .4/ Address P.O. Box 3176
Address I._ 'C3 g — " \ PiFiEmg?'--
... _ , City Chico St. Ca Zip 95927
License if 275206 Phone 530-345-1012
IEMIMMIIIIIIIIIIIIIIIIIIIIIIIIIII Ell SFM Job if
Contact Person El CSLB C-16 Misc.
‘4,,,t,',aA`-‘\„Wiltagfr''' -.-e'slii*VIcItainiX,tallaigglatlinagifika.Tlgklii0 •,,',1n'iv , '14,A., ••11..,;, a
.1,i0:„il,,',,A;tWMtli*:•,.<, \ •,;Z.,,,,,,It,-.,.......,‘,,i..;:,,,::44',.,..-zllfeele;.,..P4'llArz;,r"s;:-:: ;:i. ..:.zif,:i>:,,,.. 0,•-wwirr, /--,,, , ,,k,..,--• 1/o/*,,e, i 4 . .W-4-(...,• . •
Riser ' Riser•.• Main Drain Initial Static Residual Final Static
• Location F F NIA
No. , Diarneter _ Diameter Pressure Pressure Pressure '
i SOSn4510er OX-reSit cyg, q ii
. 2/1
60 116 6.C.) 3/F/NA
P/F/NA
P/F/NA
P/F/NA
,
P/F/NA
111 This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached:
"• V"•", •w.c•05/AOW.';c', .:',.IZ",...:ti:il eiro;::Ptag
&MAW/,;:,R,•;.;,:,Lt--,,i..,...,Ni,:-: - , , 3..."!;:.1^/,'",(V.%,4.gs;.:/,..1.;'",,g;/,‘ :' '-,;htitiSy0t#0144". ",;0/Ji,,';/C,/,;,',,-)r,,,,,;:„ ,!../p', -,4,n49.,;:zit Z".,''':',J4St.,:1,2::,,,O,
.*'••=o r•10`..,,c-- '.. ' - ''-',` -'''''. .1.1:. ,..,..?4.4.•,..g.i.........:,,e,-. .,.,,,.,..,,,,;....-•„,..<,-7,...,5..,,,,,,;),... '.., ,'''''',. 4.,,,V A,',G.,/ (t,• /
I=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
NFPA 25 CA
Item Description ed. Date Comments Only P,F,NIA
Reference
1.1 I Control Valves-Identification Sign 13.3.1 1/lel OF N/A
1.2 I Control Valves- Inspection 13.3.2 6 Jr)ii 0, (P)F N/A
1.3 I ,Waterflow Alarm Devices 5.2.5 F')F N/A
,
1.4 I Supervisory Devices 5.2.5 F N/A
1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 ( .')F N/A
,
Hydraulic Design Information Sign
1.6 I 5.2.6 P F 61
(For hydraulically designed systems)
1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 Oltp(psi P F 9
1.8 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 GO psi OF N/A
1,9 I Pressure Readings Acceptable 5.2.4.1
1)F N/A1
General Information Sign
1.10 I 5.2.8 P F ,E
(not required for system prior to 2007 Edition NFPA 13)
'
1.11 I Heat Tape 5.2.7 P F
1.12 1 Spare Sprinklers 5.2.1.4 $F N/A
1.13 I Fire Department Connections 13.7 P F N/A
1.14 I Alarm Valves-Exterior Inspection 13,4.1 (19) F N/A
. 1.15 1 Pressure Reducing Valves 13.5.1.1 P F 6
1 1.16 I Backflow Preventers 13.6.1 ,P F
SQUYRES Fire Protection
P.O. Box 3176 • Chico,California 95927 • Phone(530)345-1012 • Fax(530)345-1630
Wet Pipe California Code of Regulations -Title 19 5 Year
Fire Sprinkler System Inspection,Testing, and Maintenance Report 2 of 3
Property Information = 'C Contractor or Licensed Owner Information
O!AV A<to
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ,,i )
Building Name i .pc C2-co;`lc OP i'6 " �-. 1� Name Brandon Squyres
Address 2 L a �,t "'" ,,' fjar Job#
12.
�• .M
/% j fy/j/ I.
„ i r: ../ .'( i / j...,. i / r s �,s M PAA a Ct
.� �� 4, v��iGi� �„ / i-:;'fps ,v%;i s�/,�/U .pi� 3c j,. r ., ron / _
Sal. 3 /. '• ., > ,„ �,,,,i,•zi,,-,/Op/////,”/�///% ' / / jio aez.:1 v,g j seals kz ai s `. e *Rover,
loe/.
,.,...,,,,W., .;;, a:, s s� ..r,,.,.i,/ s i s., i '.c' $ �%/// k/y� � h�t x 2 r b .,�x�7 ' ., .. .,.
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
•Item • Description. NFPA 26 CA ed.
p Reference Date Comments Only P,F,N/A
1.17 I Small Hose Connections-Hose Valve* 5.1.6, 13.
5.2 P F N/A
13.5.5.1 "Z?'��
1.18 I PRV-Fire Sprinkler Systems 13.5.1.1 P F N/A
1.19 I Buildings(Freeze Protection) 4.1.1.1 Owner's Responsibility P F N/A
1.20 I Sprinklers 5.2.1 I-.- I ct iP N/A
1.21 I Sprinklers-Accessible Concealed Space 5.2.1.1.6 6 134o P F N/A
1.22 Pipe and Fittings 5.2.2 P F N/A
1.23 Pipe and Fittings-Accessible Concealed Space 5.2.2.3 P F N/A
1.24 Hangers 5.2.3 III P F N/A
1.25 Hangers-Accessible Concealed Space 5.2.3.3 P F N/A
1.26 Seismic Braces 5.2.3 P F N/A
1.27 Seismic Braces-Accessible Concealed Space 5.2.3.3 P F N/A
1.28 Unsprinklered Areas CFC 901.4 DYes X41'..4 No
2.1 Field Service Test Required 5 3 1 If REQUIRED, Enter'F'until
Send Report to Fire Code Official results are returned from Lab P F N/A
2 2 Recalled Sprinklers Title 191 F N/A
if not present=Pass; if present=Fail 904,1(c)
2.3 Water Flow Alarm Devices 5.3.3 , _.' \ �5-sec. P F N/A
90 secs max. Enter time 13.2.6
2 4 Main Drain Test 13.2.5 "Z-�'�� GP F N/A
(Enter data on Page 1 of this form) 13.3.3.4
2.5 Control Valve- Position 13.3.3.2 65Y N/A
2.6 Control Valve-Operation 13.3,3.1 N/A
2.7 Supervisory Devices 13.3.3.5 I —ilk OF N/A
2.8 Backflow Preventer Assemblies 13.6.2 6 2?_i(a. P F Na
2 Small Hose Connections* 13.5.2,3 P F /
w/PRV Hose Valves-Partial Flow Test 13.5.3.3
2.10PRV-Fire Sprinkler Systems 13.5.1.3 P F /A
2.11 Pressure Gauges-Calibration 5.3.2 e F N/A
t 2.12 Small Hose Connections* 13.5.6.2.2 P F /A
*Small hose connections are hose valves and optional hose supplied by the fire sprinkle sstem. They do not include Class I, II, or III
standpipe systems.
SQUYRES Fire Protection
P.O. Box 3176 • Chico,California 95927 • Phone(530)345-1012 • Fax(530)345-1630
Wet Pipe California Code of Regulations-Title 19 5 Year
Fire Sprinkler System Inspection, Testing, and Maintenance Report 3 of 3
Property Information Contractor or Licensed Owner Information
IIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIIII if ":4K44\5* 1111111111111111111111111111111111111111111111111111111111111
Building Name -F. ,. ► ry �.a2'l Name Brandon S u res
Address •7-- (3 ,--- ` ;..Iv Job#
"„, M
-- IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
r",.\ ..��kt r a f�:.;.YC .a ri�2;£�.� ...:. .�..� e�'Y o.. ..a'x� rimN�:'ss£i.cr.. a.✓ri //yr¢%%%/m�li�,'y//.'iv%y L�� �9” �.:..,.:,.. .ti..,
'" % ��� ��`\\�'�\ ���.. ...t'7 r 1 I z g E d .,is ..., , ,. 'r/ ;'fI%/r/�Cy���y/ %A \'Iii '
far, ,",, rs.,ir4"',‘,', .;,\� \� NO 's. lt,, •,.14 \: �.` 'N f,, 5.:.
oo/ % ;.-'7.;,;1„;.,: /j/ g%//;,xe r /ice i � � A \
�, „....,g',.., '-"::.,,", .��”, �- ;.. ,..��:�-���/G////,�i'i/sn!�aiisam:�,r,rvi�iara�ra// �.�,�.,,,, >„•r� �ra� ��, � ::1. :�,s%�r%/// ��a!���r' //�/�ir
I =Inspection T =Test M =Maintenance P=Peas F=Fail N/A=Not Applicable
Item a Description NFRe Reference
,A . .i:. Date [. Comments OnlyP,F,NtA
1 f2eference
3.1 M Check Valves- Internal inspection 13.4.2 6Z7—i$ °F N/A
•
3.2 M Control Valves 13.3.4 ( F N/A
3.3 M FDC-Backflush 14.3.2.3 M F N/A
14.3.2.4
Internal Pipe Inspection-See Deficiencies and Ye F N/A
3.4 M 14
Comments Section for Results. .2 li"o `/
3.5 M Obstruction Investigation Required. If"Yes", see 14.3
Deficiencies and Comments Section for Results l`/ F NIA
3.6 M System Returned to Service 4.5.3 `►� es ,)F
N/A
E No
D=Deficiency C=Comment (Indicate type)
)tem Date
Riser c , C Deficiencies and Comments
Indicate all equipment devices and parts that were repaired or replaced
cLL C OCi(i&1101-6 tfY% 0 N TFtl LED 6--Z7-18
Li Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached:
El See Correction Form AES 10 for corrected deficiencies. Number attached:
I hereby certify that the fire protection 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.
Print Name. ZP<N (\P.C(4 0
Signature Date 6 ._27_1 U