HomeMy WebLinkAboutFAI20-0005 CF Sprinkler Test 2019 I-14 17s3 -ocx:)c' 009 - IL.-2, --o
Wet Pipe California Code of Regulations -Title 19 Quarterly and 2 of 3
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Fire Sprinkler System
Inspection,Testing, and Maintenance Annual Report
A9f-p—'4�✓fi Contractor or Licensed Owner Information
Property In�. �. :�. i �/' ��9
t
of q Name HAYDEN FIRE PROTECTIONBuilding Name t y��°' »�,� �-�'" i_..! � �
I r"�s' , Job#
Address . ` x
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ANNUAL INSPECTION,TESTING,AND MAINTENANCE
Fnchrde ALL Quarterly Inspections
I =Inspection =Test M=Maintenance P Pass F=Fail N/A=Not Apply
1.19 1 Sprinklers 5.2.1 w t
4.1.1.1 f Owner's Responsibility I '
(Freeze Protection) I
1.20 I Buildings 1.21 I Pipe and � ,
Fittingsp
� 5.2.2 (1.22 I I Mangers I 52.3 I I I I
1 1.23 I I Seismic Braces I 5.2.3 I I I
Field Service Test Required If REQUIRED,Enter'F'until
2.1 T5.3.1 Iresults are returned from Lab
(Send Report to Fire Code Official) Title 19
22 I T 'Recalled Sprinklers I 9Q 19 I
If not oresent=Pass: If present=Fail
ater Flow Alarm Devices 1 b.3•3 I .. Sec. �.
2.3 T 13.2.6 I J.��
90 sec.maximum - (Enter Trme) � � P-
Main Drain Test 1 13.2.5 I
2.4 T 1 (Enter data on Page 1 of this form) 13.3.3.4 i
2.5 T Control Valve-Position I 13'3'3'2 I I 11w,
I I � �:
2.6 1 T 'Control Valve—Operation I 13.3.3.1 I [[
2.7 I T Supervisory Devices 13.3.3.5 f I
I IA' brii l
2.8 I T Backflow preventer Assemblies I 13.6.2 � �
ISma1l nections' I 13.5.2.3 !
2.9 T w/PRV HHose Conose Valves—Pa rtiar Flow Test 13.5.3.3
2.10 I T IPRV—Fire Sprinkler Systems
I 13.5.1.3 I l I
3.1 I M 'Control Valves I 13.3.4 (
I I I
3.2 I M Small Hose Connections` I 13.5.6.3 I ; I 1 N j
iA
Obstruction Investigation required Yes
3.3 M (If`Yes'see Deffclencles and Comments Section 14.3 No
for Results.)
I
Ye s
e
3.4 I M System Returned to Service 4.5.3 Ye
*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.
D=Deficien C=Comment (in �= .
Itemiji711s1 Riser D C Ind,cxi" aft v4 'no7:,`
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Sept.3,2013
FormAES2.1
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Wet Pipe California Code of Regulations-Title 19 Quarterly and •
3 Fire Sprinkler System Inspection,Testing, and Maintenance Annual Report of 3
of cAc/ i
Property Information i• ------As s Contractor or Licensed Owner Information
Av--- -\\•clps.,
1
,Building Name )--ik. 7,r- '‘ ,4 c-1,, 1 p.P Name HAYDEN FIRE PROTECTION
}Address ..:!:),Pr, 1..1 jA r,,6 r , ,,.. Job#
ICitY 67 f i";I4,4,1Me.-
D=Deficlenc C=Co . nt / •icate j,•
Deficiencies and Comments(Cont.)
Item Date Rise:- D Indicate alieqUipMetit.devIC03 and parts thai were repaired or replaced
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[3 Check here if additional Deficiencies.and Comments are listed on Form AES9 Number attached:
0 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.
— .
C1160**10441nksid-Inspection,Testing&Maintenance items are Completed in the Indicated Quarter
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SSignature , ......r,_i 1 i 1
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'Poem Atlit 2.1 Sept.1 2013
Wet Pipe California Code of Regulations-Title 19 Quarterly and 1 of 3
`prinkler System inspection,Testing,and Maintenance Annual Report
C „
Property Information ��pf a p. + er Information
Q' �ir! II �ti Contractor or Licensed Ow
' n
'Building Name :/ / '4 (c1�'4 Name HAYDEN FIRE PROTECTION
"Address / ft>-- 1 /1 ' ``-�' `< , r`"'g . ' t. .rL-i Address 2515 ZANELLA WAY#5
City CHICO St. CA Zp 95928
City Cf�_Ar 1'
License# ' ` ; 7 'Phone 1-800-417-0440
Contact Person ''C I(I SFM IJob#
1.D,CSLB 'Misc.
Riser information Main Drain Test(Annual)
i 7` ' ' ( ,
i I 1 1 1 1 1
I I I I I I
I I I
I I I I
r This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached j [
Quarterly inspection
"�*I _.r .� !'r as _ ,.. ' =..aat NIA=NOLA�I�Ole
ws
1.1 I =iris `ngn " 13.3.1 ,r
1.2 I I IControl Valves—Inspection I 13.3.2 I - 1 I I
1.3 11 IWaterflow Alarm Devices I 5.2.5 I $` 1 I I
1.4 I I ISupervisory Devices I 5.2.5 I ,.
1.5 I I IGauges(Wet Pipe Systems) I 5.2.4.1 I
,r,
1.6 1 ,i 'Enter Water Supply Pressure Below Riser Check 1 5.2.4.1 1 #£ psil psil psil psi
1.7 1 I 'Enter Water Supply Pressure Above Riser Check I 5.2.4.1 I . psil psil psi' psi
1.8 I 'Pressure Readings Acceptable I 5.2.4.1 I I I I
1.9 I I '. lie Design Information Sign I 5.2.6 ' 1 I I
hydraulically designed systems)
1.10 1 General intimation Sign 5.2.8
1 I(not required for system prior to 2007 edition of NFPA 13) t
1.11 I I "Heat Tape I 5.2.7 1 �_ I I I
1.12 1 I 'Spare Sprinklers I 5.2.1.4 1 t` 1 I I
.
1.13 1 1 'Fire Department Connections 1 13.7 1 ,. I I I
1.14 I I (Alarm Valves—Exterior Inspection 1 13.4.1 1 1 A I I
1.15 1 1 'Pressure Reducing Valves 1 13.5.1.1 1 ti 1t4 1 I I
1.16 1 I 1Backflow Preventers 1 13.6.1 ( 1I H 1 I I
1.17 I I 'Small Hose Connections-Hose Valve* I 5.11.3:5.5.5 2 I 1,j if I I I
1.18 11 IPRV—Fire Sprinkler Systems ' 13.5.1.1 I 1 I I
*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.
Form AES 2.1 Sect 3.2013
i
< a y
FEE 96 2019
lns e .., ,,. Testing,and Maintenance Cover Sheet
NFRA25 as amended by CCR,Title 19
Name: _41 .. .A , f-.I _= Occupancy/Use: ":-, ,r i t,,* . f
Add ss;_ � I t r t . ,, ' Construction Type: Alti,., ,OF C_'_q 'O
.
City: € No.Stories: 41- •A ` \t
a)
C
ZIP:: 99Year Constructed: /i Oki '' 3 f�,Fi
Contact { t "' I �
Telephone: .,., ;,.
. ,•
Name: Hayden Fire Prot , Copy sent to:
Address: 2515 Zanella ', ` 5 .._ ❑(honer Date:
City: � Ctt Fire AHJ Date:
State: p Contractor Date: '' : :
1 NOTES:
Telephone: 1_800-417-0440 1)For specific inspection,testing,and maintenan n
requirements and information,see NFPA 25,2011
CA License#: aC-16`827131 Edition as amender!by California Code of ReguildiCers,
Title 19,§901 to§906.
Job#:
2)Inspection items may be performett pe011iltiliOi
Performed by: accordance with California Code of
1., oi §904.1(a)
Number of Formsc$
NFPA 25
Forms Included with thcN/A Fail Pass
: :�F!c:;�c�r� t;t�apter '�
1-1:3'Automatic Sprinkler System 5 0 11111
❑ Standpipe and Hose System 6I 0 ❑ 1 ❑ ❑
r Supply System 7 0 [:-.1❑ Private Wate
1 ❑ Fire Pump I 8 0 ❑
❑ Water Storage Tank 9 o C n
0 Water Spray System 1 10 I 0 El
' ° ❑ Foam Water Sprinkler System 1 11 0 C ❑ I ❑'
❑ Water Mist System 1 12 0 ❑ C
Concerns that are not deficiencies(t e. Non-Sprinklered Areas) I 0 Yes I c-No
': ' '.-ix'#� s e e{ r. "-¢ e g b - ; ! - fix..ee
}
AES 1 September 3.2013