HomeMy WebLinkAboutFAI15-0062 CF Sprinkler Inspection 2020 4h
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.,-,t`-, k. .i I'.O. I3ox 3176 • Chico, California 95977 • Ohmic(530)3=15-1012 Fax (530)345-1630
Propert 1nforrnatton:
Name: Roseleaf - Occupancy/Use: �' . .:. � r . =
Address: 1900 20th st c3 CLQ`` �
Construction Type: � � ;-, 0..1
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City: Oroville No. Stories: r(*f ,'k---1,-.N. t 'j
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ZIP: 95965 °5; L :;
Year Constructed: }-y . ct i;, , y.3..yf.9 i
Contact:
Chito ,� r'4E�h 14`y I
Telephone: 538-8200
}CContt'aott(J tfoi atjon Number;of Systerri d3rsera ! ,3 ' te
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Brandon Squyres
Name: Copy sent to:
Address: P.O. Box 3176 L Ow,vner Date:
City: Chico L.;Fire AHJ Date:
State: California [2!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 I 5 Year
2) Inspection items may be performed by the owner in
Performed by: 4.4 accordance with California Code of Regulations,Title 19,
§904,1(a)
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—El Automatic Sprinkler System 5 3 [1
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EllStandpipe and Hose System 6 X ___
❑ Private Water Supply System 7
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❑ Fire PumpMI= _
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❑ Water Storage Tank 9 X
ElWater Spray System 10 X _ .--.
❑ Foam Water Sprinkler System _
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❑ Water Mist System
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1 ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) El Yes 0 No
*S re ficiencies•and Cort ` _i`, section at end of c C., respective form.
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Property Information f F` z!m =tContractor or Licensed Owner Information
Building Name Roseleaf € i , s .n 15 p4 Name Brandon Squyres
Address ' ice,,,,,
1900 20th st \ ',).,.,?RE �.,,/—J/ Address P.O. Box 3176
i:11, -i City Chico St. CA Zip 95927
City OrovilleLicense# 275206 Phone 530-345-1012
Contact Person
El Job#
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,, a atbx &^ *',���ts�-�1v1� 7" I „ Static R£S1auai , final sit ,il£ ItrtmsR '; , , E & 0 -4: k� ' rt-ixl^ is "bi:;ritGr �re L t 5 !2i£ PrL urf,._.s - , of#„s ' , . ,, ;, t1. Laundry Rm 4 P/F/NA
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P/F/NA
P/F/NA
P/F/NA
P/F/NA
— This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached
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I =Inspection T=Test M=Maintenance P=Pass F=Fail N/A =Not A,ni�iicable
hem i = ,, NEPA 2aCAucilL :- Inas• te. I ,
t r)c�cr=axion € ' � .
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1.1 I Control Valves—identification Sign 13.3.1 Fjt/F/NA P/F/NA P/F/NA _ P/F/NA
1.2 I Control Valves—Inspection 13.3.2 l /FINA P/F/NA P/F/NA P/F/NA
1.3 .I Waterflow Alarm Devices 5.2.5 • FX/F/NA• P/F/NA P/F/NA . P/F/NA
1.4 I Supervisory Devices 5.2.5 FX/F/NA P/F/NA P/F/NA PI F I NA
1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 FX/F/NA P/F/NA P/F/NAPIF/NA
1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 NA psi psi psi psi
1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi psi 1 psi
1.8 I Pressure Readings Acceptable 5.2.4.1 F3/F/NA P/F/NA P/F/NA P t F/NA
1 9 I Hydraulic Design Information Sign 5.2.6 P/F/brA P/F/NA P/F/NA PIF/NA
(for hydraulically designed systems) }
1.10 i GenerallnformationSign 5.2.8 P/F/ISA P/F/NA PIF/NA P/F/NA
(not required for system prior to 2007 edition of NFPA 13)
1.11 I Heat Tape 5.2.7 PIF/l1A P/F/NA P/F/NAP/F/NA
Spare 1.12 I S Sprinklers {
p p 5.2.1.4 FX/FJNA P/F/NA P/F/NA P/F/NA
1.13 I Fire Department Connections 13.7 FX/F/NA P/F/NA P/F/NA P/F/NA !I
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1 1.14 I Alarm Valves—Exterior Inspection 13.4.1 FXi F/NA . P/F/NA P 1 F J NA P/F t NA
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1.15 I Pressure Reducing Valves 13.5.1.1 P/F/WA P/F/NA P/F/NA P/ F/NA
1.16 I Backflow Preventers 13.6.1 P/F/t4A P/F/NA P/F/NA P/F/NA
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1.17 I Small Hose Connections-Hose Valve" 5.113.5.51.6, 13'5.2
P/F/NA P/F/NA P/F/NA P/F/NA
1.18I PRV—Fire Sprinkler Systems 13.5.1.1 P?F i i A PIF/NA P/F/NA P/F/NA
*Smatll hose connections are hose varves and optional hose supaied by the fire sprinkler system. They do not include Class I. II, or III
standpipe systems.
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P.O. Box 3175 ( ii i, C allot-pia 95927 'lht,n (530)345- 012 I:'\1„5,30)345-1630
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Property information .x " �lc64t. Contractor o-Licensed Owner Information
,Building Name Roseleaf �_� —�-- - �' , '- ' 'mac Name �� Brandon Squyres
Address 1900 20th st '�`y' � ,'fl ;''<f' — _--i
�> \ Ls�'s ,017
,amity V---- Oroville ; zn�` 1
" "�'� r77 '`c ' 7p ^�5^'# r.w-ra r a it .=.a
ANDANSF fh bi -4, - '
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1 - Inspection T =Test M Maintenance �' �=Pass = -
P F Fail N A Not Applicable i
Item<4 g ,, Descry tion ,e • : x N - 25 C .ed.�'
p "-..,5,'''' 4 NDat Comments OnlyP, ,PIIk
� : ��;f. rReference' - -, r1
1.19 1 °Sprinklers 5.2.1 :- •.
Z, .-1.0 : lx.F,N/A l
1.20 I Buildings (Freeze Protection) ----t 4.1.1.1 Owner's Responsibility Pt,F,NiA
1.21 I Pipe and Fittings 5.2.2
1.22 I Hangers 5.2.3 I ,F,NlA
1.23 I Seismic Braces 5.2.3 I ,F,NiA
D= Deficiency C=Comment (Indicate type) Wet Quarterly Report I
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/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.
Check box if Annual Inspection. Testing&Maintenance Items are Completed in the Indicated Quarter
Quarter 1st - 0 Annual 2nd = 0 Annual 3rd --D Annual 4th -,D Annual -
Date ZZ. "Zo
Print Name ff2 4^ /���
Signature: