HomeMy WebLinkAbout040-310-087 CF ArchiveF L
Inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR. Title 19
Property Information:
NFPA 25
Chapter
Number of Forms
Name:
FAIL*
Occupancy/use:
6 OF�Ca i i
5
Address:
❑ Standpipe and Hose Systems
Construction Type:{
❑ Private Water Supply System
City:
No. Stories:
64��
❑ Fire Pump
g
ZIP:
`ti 7
Year Constructed:
❑ Water Storage Tank
Contact:
Telephone. -
❑ Water Spray System 1 10
Contractor Information:
Number of System Risers
Name:
HAYDEN FIRE PROTECTION
INC
Copy sent to:
Address:
15108 JACK PINE WAY
❑ Owner Date
City:
MAGALIA
❑ Fire AHJ Date
State:
CALIFORNIA, 95954
❑ Contractor Date
Telephone:
(800) 417-0440
NOTES:
C-16 827131
1) For specific inspection, testing, arrvd
CA License#
maintenance requireni:.nts and infonti,ation,
see NFPA 25, 2002 Edition as amended by
Job #
California Code of Regulations, Title 19, 001
to §906.
Performed by:
(Print)
2) Inspection Items may be performed by the
Owner in accordance with California Code of
Note: Contractor
information may be pre-printed
Regulations Title 19 §904.1(a)
Forms included with this report
NFPA 25
Chapter
Number of Forms
NIA
FAIL*
PASS
❑ Automatic Sprinkler System
5
❑ Standpipe and Hose Systems
6
❑ Private Water Supply System
7
❑ Fire Pump
g
❑ Water Storage Tank
9
❑ Water Spray System 1 10
❑ Foam Water Sprinkler System 11
*See Deficiencies and Comments" section at end of each respective form.
State Fire Marshal AES 1 March 21, 2006
ANNEX B
Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4
NFPA 25. Chapter 5 as amended by CCR. Title 19
Date of Inspection, Testing, Maintenance: System Riser !D:
P 9 f
Property information: f
ypp Type of System: ��pF CA41,
Name: Ga t-0. tit ❑ Wet Pipe
❑ Dry Pipe "� v
Address: ❑ Preaction
❑ Deluge
City:
Main Drain Test Results:
Abbreviation Key:
I = Inspection
Initial Static Pressure:
(psi)
T = Test
M = Maintenance
Residual Pressure:
W (psi)
i A -O = After Operation
i Mi = Per Manufacturer's
instructions
Restored Static Pressure:
(psi)
Item Activity
3 a
Frequency
Description NFPA 25
f Reference
Fail ! N/A Pass
a
Daisy
P reaction/De uge Valves – Enclosure 2 a 3
I
Wee{ Y
i temperature
i
1.2
Daisy
Dry Pipe Valves --cnciosure
12.4.4.1-1
!
Vveeky
temperature
1.3 I i i
r�ularteri.,
Gauges (!dry, Preaction; De;uge 5.2.4.2
in
� j ! �
f I
i JyStems. 5.2.4 3„.
1.4 I
Quarteriv
I Control Valves ( 12.3.2.1
i 1.5 I l
Quartery
+ Alarm Devices 5.2.6
l 1.6 i
Quarterly
I Gauges (Wet Pipe Systems) 15.2.4.1
I i
f 1.7 i i
Quarterly
I Hydraulic nameplate 5.2.7
1.8 1 ;
Quarter y
Pipe and Fittings 5.2.2
l
' 1.9 ':
Qua;-ter!y
I Sprinklers 15.2.1
i
'
1.10 i ,
Quarterly
i Spare Sprinklers 52.1.3
!
1.11 l
Quarterly
Fire Department Connections 12.7.1
!
1.12 !
Quarterly
Alarm Valves – Exterior inspection i 12.4.1 1
!
• !
Quarteriv
Preaction/Deluge Valves – Exteror1.13 12.4.3.1.6
s
i
:ns ection
j 1.14 f 1
Quarterly
Pressure Reducing Valves 12.5.1.1
j
1.15
Quartely Dry Pipe Valves – Exterior 'nspection ! 12.4.4.1.4
i
!
Quarteriv 1 Backflow Preventers 12.6.1
j 1.17 j !
Annually j Buildings 5.2.5
j
a
State Fire Marsha' AES 2 March 21. 2006
25-80 INSPECTION, TESTING.. MAINTENANCE OF WATER-BASED FIRE
SYSTEMS'
-
t
State Fire Marsha' AES 2 March 21. 2006
Inspection, Testing, and Maintenance Fire Sprinkler System
Page 2 of 4
NFPA 25, Chapter 5 as amended by CCR,
Title 19
Date of Inspection;
I
Testing. Maintenance:
i System Riser ID:
Property Information:
Type of System:
�
Name:
Address:
a
D.
❑
❑
,p�`�<,��2r
Wet Pipe "L'r'
Dry Pipe "'; v
Preaction
❑
Deluge
I Cir.
I
item Activi
Fre uenc
q Y
Descr tion
p
NFPA 25
Reference
=FailN/A Pass
1.18 l
Annually
I Hangers
5.2.3
i
I 1.19 1
Annually
Seismic Braces
1.20 1
'5 Years
—1-5.2.3-
Hangers (Accessible concealed spaces)
1 5.2.3.3
i
1.21 j i
5 Years
( Seismi c Braces (Accessibie concealed
52.3.3
I spaces
j 1.22 j l
j 5 Years
Pipe and Fittings (Accessible concealed
spaces)
5.2.2.3
! i
1.23 j i
5 Years
Sprini iers (Accessible concealed spaces)
i 5.2.1.1.4
i
1.24 ! 1
4 5 Years
i Alarm Valves - Interior Inspection
! 12.4.1.2
i I
1.25 l
5 Years i
Hann Valves - Shiners, filters, orifices
1 zAA .z
1.26_ __
5 Years
aptlnteriorinspect-o-n
1%.4.2.1
- -
o Years
rr�actionrDeou e Varves - Interior
Inspection --
i 12.4.3.1 .7
i
1.28
5 Years
PreactiontDeluge Valves - Strai
Strainers,
12.4.3.1.8
fi- —f— -T- - -
'
I I
!filters,
orifices
I
129 I
5 Years I Dry Pipe Valves - interior Inspection
12.4.4.1.5 I
��
1.30 ! 1 !
5 Years It Dry Pipe Valves - Strainers, filters, orifices
j 12.4.4.1.6
I l
2.1 T
Annually Alarm Devices (90 Serf
c ' 0
5.3.3
12.2.7
!
I
j 2.2 T
!
Annually
Main Drain Test (Enter data on Page 1)
! 12.2.6
12.2.6.1
i
12.3.3.4
2.3 T
Annually Antifreeze Test
1 5.3.4
2.4 T
--T
Annually Control Valve - Posfion
12.3.3.1
2.5 1
Annually
Control Valve - Operation
2.6
Annually j
Supervisory
j 12.3.3.5:
2.7 1i T i
Annually Preaction Valve- Priming V`tilater
' ":2.4.3.2.1
I I I
; I
2.8 T ;
Annually! Preaction Vaive - Low Air Pressure Alarm j 12.4.3.2.10
2.9 T
Annually Preaction Valve - Fu:. Flow Trp Test
! 12.4.3.2.2
-
t
State Fire Marsha' AES 2 March 21. 2006
U' ..
ANNEX B 25-81
Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4
NFPA 25, Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance:
System Riser ID:
Property Information:
Name: nr. (•
Type of System:_ -A 1
El Wet Pipe c�°9?''/j.
❑ Dry Pipe
Address:
❑ Preaction,`.
❑ Deluge
City:
Item
Activity
Frequency
Description
NFPA 25
Fail
N/A
Pass
Reference
2.10
T
Annually
Dry Pipe Valve — Priming Water
12.4.4.2.1
2.11
T
Annually
Dry Pipe Valve — Low Air Pressure
12.4.4.2.6
Alarm
2.12
T
Annually
Dry Pipe Valve — Quick -Opening
12.4.4.2.4
Device
2.13
T
Annually
Dry Pipe Valve — Trip Test
12.4.4.2.2
2.14
T
Annually
Backflow Preventer Assemblies
12.6.2
2.15
T
3 Years
Dry Pipe Valve — Full Flow Trip Test
12.4.4.2.2.2
2.16
T
5 Years
Gauges
5.3.2
2.17
T
5 Years
Pressure Reducing Valve
12.5.1.2
2.18
T
5 Years
Fire Department Connection Backflush
12.7.4
2.19
T
5 Years
Sprinklers — Extra High Temperature
5.3.1.1.1.3
2.20
T
5 Years
Sprinklers — Corrosive environment or
5.3.1.1.2
corrosive water
2.21
T
10 Years
Sprinklers - Dry
5.3.1.1.1.5
2.22
T
20 Years
Sprinklers - Fast Response
5.3.1.1.1.2
2.23
T
50 Years
Sprinklers
5.3.1.1.1
2.24
T
75 Years
Sprinklers 75 years in service
5.3.1.1.1.4
225
I T
Sprinklers
ri kace lmanufactured prior to 1920
5-3.1.1.1.1
3.1
M
Annually
Control Valves
12.3.4
3.2
M
Annually
Preaction/Deluge Valves
12.4.3.3.2
3.3
M
Annually
Dry PipeValves/Quick-Opening
12.4.4.3.2
Devices
F3-4
M
Annually
Dry Pipe Valve — Low Point Drains
12.4.4.3.3
i
3.5
M i
5 Years
Obstruction investigation
Chapter 13
State Fire Marshal AES 2 March 21. 2006
25-82,. INSPECTION, TESTING, ANo MAINTENANCE OF WATER-BASED FIRE PriOTECTION SYSTEMS
Item
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25, Chapter 5 as amended by CCR, Title 19
Page 4 of 4
Date of Inspection, Testing, Maintenance.-
System Riser ID:
Property Information:
CAj_j'
Name:
Type of System:
❑ Wet Pipes
❑ Dry Pipe
OF
;D
Address:
❑ Preaction�3;..
amu.
❑ Deluge
'��F�_�a,;�Z',.•�
City:
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activity listed above:
6 d
I or— `��Z��
YITSeeContinuation Page(s) (Indicate the number of continuation pages)
❑ PASS
❑ FAIL
Signature Date
State Fire Marshal AES 2 March 21, 2006