HomeMy WebLinkAboutFAI15-0039 CF Sprinkler Test 2019 Inspection,Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR, Title 19
Property Information:
Name: Springs of Living Water-Main Building Occupancy/Use: Hotel/Boarding
sem.
15850 Richardson Springs Rd Concrete/Brick/Wood Of_CAC/
•C‘2. - �
Address: Construction Type: ,C 04
City: Chico No. Stories: 6 0 r "Z
ZIP: 95973 Year Constructed: 1920 9t\\� "''\
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Contact Craig Anderson
{,AP
Telephone: (530)893-6764
Contractor Information: Number of System Risers
Name: Foothill Fire Protection, Inc. Copy sent to:
Address: 170 Erma Ct ✓ Owner Date: 11/18/19
City: Chico Fire AHJ Date:
State: CA Contractor Date:
(530)826-3013 NOTES:
Telephone: 1) For specific inspection,testing,and maintenance
783132 requirements and information,see NFPA 25, 2011
CA License#: edition as amended by California Code of Regulations,
Title 19, §901 to§906.
Job#: 15850R1
2)Inspection items may be performed by the owner in
Performed by: Stephen Rampenthal accordance with California Code of Regulations,Title 19,
§904.1(a)
Check box for each system inspected and enter the number of forms used for inspection.
Check boxes(Fail or Pass)to indicate status of inspected system at end of inspection.
Forms Included with this Report NFPA 25 Number of Forms N/A '' Fail* Pass
Chapter
171 Automatic Sprinkler System 5 4 ❑ 0 El
❑ Standpipe and Hose System 6 0 2 0 ❑
O Private Water Supply System 7 0 0 10 E
❑ Fire Pump 8 0 0 0 El
O Water Storage Tank 9 0 E El E
O Water Spray System 10 0 E 10
O Foam Water Sprinkler System 11 0 E ❑
LI
❑ Water Mist System 12 0 ✓❑ ❑ 0
O Concerns that are Not Deficiencies(i.e. Non-Sprinklered Areas) 0 Yes ZI No
*See"Deficiencies and Comments"section at end of each respective form.
AES 1 September 3,2013
Wet Pipe California Code of Regulations-Title 19 Quarterly and limy
Fire Sprinkler System Inspection,Testing, and Maintenance Annual Report 1 of 3
Property Informationp,�� cA�No Contractor or Licensed Owner Information
Building Name Springs of Living Water-Main Building '°I ('''4'-- )5't Name Foothill Fire Protection, Inc.
Address 15850 Richardson Springs Rd Address 170 Erma Ct.
'h..- M City Chico St. CA Zip 95928
City Chico License# 783132 Phone (530)826-3013
Contact Person Craig Anderson 0 SFM Job# 15850R1
❑✓ CSLB C-16 Misc.
Riser Location Riser Main Drain Initial Static Residual Final Static P,F,N/A
No. Diameter Diameter Pressure Pressure Pressure
1 N.E Exterior 2 1.5 76 56 79 P
❑ This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached
=£ Q - .erly Inspectio,
1 =Inspection T=Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item Description NFPA 25 CA ed. Date Date Date Date
p Reference 11/18/19
i
1.1 I Control Valves—Identification Sign 13.3.1 P
1.2 I Control Valves—Inspection 13.3.2 P
1.3 I Waterflow Alarm Devices 5.2.5 P
1.4 I Supervisory Devices 5.2.5 P
1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 P
1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi psi psi
1.7 1 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 P
' 1.9 I Hydraulic Design Information Sign 5.2.6 F
(For Hydraulically Designed Systems)
1.10 I General Information Sign 5 2 8 N/A
(Not Required for System prior to 2007 Edition of NFPA 13)
1.11 I Heat Tape 5.2.7 N/A
1.12 1 Spare Sprinklers 5.2.1.4 P
1.13 I Fire Department Connections 13.7 P
1.14 I Alarm Valves—Exterior Inspection 13.4.1 P
1.15 I Pressure Reducing Valves 13.5.1.1 P
1.16 1 Backflow Preventers 13.6.1 P
1.17 1 Small Hose Connections-Hose Valve 5.1.6, 13.5.2 N/A
13.5.5.1
1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 N/A
*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 California Code of Regulations-Title 19 Quarterly and 3 of 3
Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report
of
Property Information ,�,-�� _ ,�p Contractor or Licensed Owner Information
f41;,/ cir 1
Building Name Springs of Living Water-Main Building i yi S � D v Name Foothill Fire Protection, Inc.
Address 15850 Richardson Springs Rd ry jj * Job# 15850R1
City Chico 1 MP
D=Deficiency C=Comment (Indicate type)
Deficiencies and Comments(cont.)
Indicate all equipment,deviceq.and parts th Y:-red or replaced
1.9 11/18/19 1 Missing Hydraulic Design Information Sign.
i
Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
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.
Check box if Annual Inspection,Testing& Maintenance Items are Completed in the Indicated Quarter
Quarter 1st - fl Annual 2nd - ❑ Annual 3rd - ❑ Annual 4th - Annual
Date 11/18/19
Print Name Stephen Rampenthal
w.
Signature
Form AES 2.1 Sept.3,2013
Wet Pipe California Code of Regulations -Title 19 Quarterly and 2 of 3
Fire Sprinkler System Inspe tion,Testing, and Maintenance Annual Report
Property Information .S Z—44' Contractor or Licensed Owner Information
Building Name Springs of Living Water-Main Building 'o\ C , !D d Name Foothill Fire Protection, Inc.
Address 15850 Richardson Springs Rd it� ` JP1 Job# 15850R1
City Chico , M
ANNUAL INSPECTION, TESTING,AND MAINTENANCE
Include ALL Quarterly Inspections
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
NFPA 25 CA ed.
Item Description Reference Date Comments Only P,F,N/A
1.19 1 Sprinklers 5.2.1 11/18/19 P
1.20 I Buildings(Freeze Protection) 4.1.1.1 11/18/19 Owner's Responsibility P
1.21 I Pipe and Fittings 5.2.2 11/18/19 P
1.22 I Hangers 5.2.3 11/18/19 P
1.23 1 Seismic Braces 5.2.3 11/18/19 P
2.1 T Field Service Test Required 5.3.1 11/18/19 If REQUIRED, Enter'F' until N/A
(Send Report to Fire Code Official) results are returned from Lab
2 2 T Recalled Sprinklers Title 19 11/18/19 P
If not present=Pass; If present=Fail 904.1(c)
2.3 T Water Flow Alarm Devices 5.3.3 11/18/19 28 sec. P
90 sec. maximum - (Enter Time) 13.2.6
2.4 T Main Drain Test 13.2.5 11/18/19 P
(Enter Data on Page 1 of this Form) 13.3.3.4
2.5 T Control Valve-Position 13.3.3.2 11/18/19 P
2.6 T Control Valve—Operation 13.3.3.1 11/18/19 P
2.7 T Supervisory Devices 13.3.3.5 11/18/19 P
2.8 T Backflow Preventer Assemblies 13.6.2 11/18/19 P
2 9 T Small Hose Connections* 13.5.2.3 11/18/19 N/A
w/PRV Hose Valves—Partial Flow Test 13.5.3.3
2.10 T PRV—Fire Sprinkler Systems 13.5.1.3 11/18/19 N/A
3.1 M Control Valves 13.3.4 11/18/19 P
3.2 M Small Hose Connections* 13.5.6.3 11/18/19 N/A
Obstruction Investigation required Ej Yes
3.3 M (If"Yes", see Deficiencies and Comments Section 14.3 11/18/19No N/A
for Results.)
❑✓ Yes
3.4 M System Returned to Service 4.5.3 11/18/19 0 No P
*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)
ar. .,•. ass,�_ �, ,.,; •.r. ;€_,......,a,- a €ss;;� reply .
1 Owner maintains system
Performed CA NFPA 25 Inspection per Chapter 5.
Form AES 2.1 Sept.3,2013