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Home My WebLink AboutFAI15-0060 CF Sprinkler Test 2019 Sierra Ave FA 4.23.19.pdf ALARM AND DETECTION REPORT Page ____ of _____ Site: Street: City/State: Date: Customer: Contact: Phone #: Fax #: 1. Before Test Notify Proper Authorities: Phone # A. Owner or Owner's Rep B. Fire Department C. Central Station D. Central Station Acct # 2. Control Panel Status Yes No Note # A. Is the system monitored by Central Station? B. Is the Power Light on? C. Does the Panel indicate Normal conditions? D. Are all indicating Lamp Bulbs in Operator order? E. Does the Trouble Light operate? F. Does the Silence Switch Operate? H. Does the Panel have Inactive Zones? I. Does the Panel have Battery Backup? J. Do the batteries indicate they are Properly Charged? Note # 3. FACP Manufacturer: Location of Primary Power Source: FCPS: Manufacturer: Model # Battery Voltage with A/C Power: Date: FCPS: Manufacturer: Model # Battery Voltage with A/C Power: Date: FCPS: Manufacturer: Model # Battery Voltage with A/C Power: Date: Owner/Rep: Phone #: Date: Inspector: Phone #: Model # System Type: Panel # Breaker Condition of Batteries: Battery Voltage without AC Power: w/o A/C Power Panel/Brker: Panel/Brker: Comments: Note # Note # Date: ALARM & DETECTION EQUIPMENT TEST REPORT Name On Test Time: Return to Service Time: G. Battery A.H. Date Batteries Installed: Panel/Brker: Location: w/o A/C Power Inspection # Location: Note # K. List any trouble conditions on panel before test: Note # Battery Voltage with AC Power: Location of Annunciators: Comments: Note # Note # Location: w/o A/C Power Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: _____________________ ___________ Type of Inspection: ALARM AND DETECTION REPORT Page ____ of _____ Total # # Tested This Report Yes N/A Note # 16. Did the Monitoring Center (Fire Dept, Central Station, Lease Line) receive signal? 17. Is system reset for normal conditions? 18. Is system restored to operational service? 19. Have Proper Authorities (see #1) been notified system is back in service? List Proper Authorities: 20. Indicate % of equipment tested this report 25% 50% 75% 100% 21. Indicate % of equipment tested YTD 25% 50% 75% 100% 5. Zones Comments for any "no" answers or explanations (Note #): Property Site: __________________________ Operational Equipment 4. Remote Annunciators 14. 15. Did test of Duct Detectors shut down air handling units? 13. PIV OS & Y 8. Horn / Strobe Strobe Only Bell Speakers Horn 7. Detectors Photoelectric Flame Ionization Heats / Fixed or R of R 9. 10. Automatic Door Release 11. Water Flow switches Did W/F Ring Outside Bell? Did W/F Activate Alarm Panel? 12. Tamper Switches Duct (See #15) Addressable 6. Manual Stations (Pull) Hardwire Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: ________________________________ ALARM AND DETECTION REPORT Page ____ of _____ DEVICE TYPE DEVICE LOCATION PASS FAIL NOTE # SLC Channel ZONE # DEVICE # Device Count Property Site: __________________________ Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: ________________________________ ALARM AND DETECTION REPORT Page ____ of _____ DEVICE TYPE DEVICE LOCATION PASS FAIL NOTE # SLC Channel ZONE # DEVICE # Device Count Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: ________________________________ ALARM AND DETECTION REPORT Page ____ of _____ DEVICE TYPE DEVICE LOCATION PASS FAIL NOTE # SLC Channel ZONE # DEVICE # Device Count Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: ________________________________ ALARM AND DETECTION REPORT Page ____ of _____ DEVICE TYPE DEVICE LOCATION PASS FAIL NOTE # SLC Channel ZONE # DEVICE # Device Count Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: ________________________________ ALARM AND DETECTION REPORT Page ____ of _____ DEVICE TYPE DEVICE LOCATION PASS FAIL NOTE # SLC Channel ZONE # DEVICE # Device Count Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: ________________________________ ALARM AND DETECTION REPORT Page ____ of _____ DEVICE TYPE DEVICE LOCATION PASS FAIL NOTE # SLC Channel ZONE # DEVICE # Device Count NOTE # LEGEND COMMENT Owners Rep Sign: ________________________________ Date: ________________ Inspector Sign: ________________________________ Sierra ave school sprinklers 4.30.19.pdfMicrosoft InfoPath - Form1 Wet Pipe Fire Sprinkler System California Code of Regulations - Title 19 Inspection, Testing, and Maintenance Quarterly and Annual Report 1 of 3 Property Information Contractor or Licensed Owner Information Building Name Name Address Address City St. Zip City License # Phone Contact Person SFM Job # CSLB Misc. Riser Information Main Drain Test (Annual) Riser No. Location Riser Diameter Main Drain Diameter Initial Static Pressure Residual Pressure Final Static Pressure P,F,N/A This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached Quarterly Inspections I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Item Description NFPA 25 CA ed. Reference Date Date Date Date 1.1 I Control Valves – Identification Sign 13.3.1 1.2 I Control Valves – Inspection 13.3.2 1.3 I Waterflow Alarm Devices 5.2.5 1.4 I Supervisory Devices 5.2.5 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi psi psi 1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi psi psi 1.8 I Pressure Readings Acceptable 5.2.4.1 1.9 I Hydraulic Design Information Sign (for hydraulically designed systems) 5.2.6 1.10 I General Information Sign (not required for system prior to 2007 edition of NFPA 13) 5.2.8 1.11 I Heat Tape 5.2.7 1.12 I Spare Sprinklers 5.2.1.4 1.13 I Fire Department Connections 13.7 1.14 I Alarm Valves – Exterior Inspection 13.4.1 1.15 I Pressure Reducing Valves 13.5.1.1 1.16 I Backflow Preventers 13.6.1 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 *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 Sept. 3, 2013 Wet Pipe Fire Sprinkler System California Code of Regulations - Title 19 Inspection, Testing, and Maintenance Quarterly and Annual Report 2 of 3 Property Information Contractor or Licensed Owner Information Building Name Name Address Job # City ANNUAL INSPECTION, TESTING, AND MAINTENANCE Include ALL Quarterly Inspections 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 1.19 I Sprinklers 5.2.1 1.20 I Buildings (Freeze Protection) 4.1.1.1 Owner’s Responsibility 1.21 I Pipe and Fittings 5.2.2 1.22 I Hangers 5.2.3 1.23 I Seismic Braces 5.2.3 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 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 sec. maximum - (Enter Time ) 5.3.3 13.2.6 sec. 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 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 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 2.10 T PRV – Fire Sprinkler Systems 13.5.1.3 3.1 M Control Valves 13.3.4 3.2 M Small Hose Connections* 13.5.6.3 3.3 M Obstruction Investigation required (If “Yes”, see Deficiencies and Comments Section for Results.) 14.3 Yes No 3.4 M System Returned to Service 4.5.3 Yes No * 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 = Deficiency C = Comment (Indicate type ) Item Date Riser D C Deficiencies and Comments Indicate all equipment, devices and parts that were repaired or replaced Form AES 2.1 Sept. 3, 2013 Wet Pipe Fire Sprinkler System California Code of Regulations - Title 19 Inspection, Testing, and Maintenance Quarterly and Annual Report 3 of 3 Property Information Contractor or Licensed Owner Information Building Name Name Address Job # City D = Deficiency C = Comment (Indicate type ) Item Date Riser D C Deficiencies and Comments (cont.) Indicate all equipment, devices and parts that were repaired or replaced Check here if additional Deficiencies and Comments are listed on Form AES9 See Correction Form AES 10 for corrected deficiencies. Number attached: 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. Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual Date Print Name Signature Form AES 2.1 Sept. 3, 2013