HomeMy WebLinkAboutFAI16-0002 Overhead Sprinkler Test 2018 i
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Inspection,Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR,Title 19
Property Information:
Name (H .0/4 7o11 C- C "_ . Occupancy/Use. _
I �' /_`�C[/,�1)
Address. i ito C Sr -AU-L Construction Type: 7% �' ,,t .;0 ?,
City. C/7;GCP No. Stories. c( ( `'�`,4 r.��_' iD ri,
.-4/ '
ZIP q l�K Year Constructed: y P
L\I\NE`M �
Contact. J o�yw .
Telephone. l (-12,_ 7 i -/ 3
Contractor Information: Number of System Risers
Name: Wilgus Fire Control Inc. Copy sent to:
1703 Sonoma St. 04Owner Date: i J _ i 2 Address
_i
Redding Fire AHJ Date.
City
State California Contractor Date- .1 —/2.—i
NOTES:
(530)241-2465 1) For specific inspection,testing, and maintenance
Telephone. P P
requirements and information,see NFPA 25, 2011
CA License#: 462979 Edition as amended by California Code of Regulations,
Title 19, §901 to §906.
Job#
2)Inspection items may be performed by the owner in
Performed by accordance with California Code of Regulations,Title 19,
§904.1(a)
Check box for each system inspected and enter tie 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 'h, 5 N� N/A Pail`` Pass
IAutomatic Sprinkler System 5 n
❑ Standpipe and Hose System 6 1 I Lj ❑
❑ Private Water Supply System I 7 I _ Ti
❑ Fire Pump 8 I - Ti
❑ Water Storage Tank 9
El Water Spray System 10I
❑ Foam Water Sprinkler System ( 11
❑ Water Mist System 12 I n
❑ Concerns that are not deficiencies(i.e. Non-Sprinklered Areas) ❑ Yes ❑ No
*See "Deficiencies and Comments"section at end of each respective form.
AES 1
September 3,2013
RECEIVED 11/12/2018 09:00AM 5308931276 i
- Nov. 12. 2018 9:01AM Fedex Redding No, 0063 P. 1
Wet Pipe California ore of -ecculations-Title 19 5-Year 1 of 3
Fire Sprinkler System Inspection,Testing,and Maintenance Report
Property Information �,--Zar G Qh" Contractor or Licensed Owner Information
Building Name,d,b',,,� 17��c(J� ; " 1pv• y; Name Wilgus•Fire Control Inc,
1 ,' Address 1703 Sonoma St -
Address 1 r/0 U)r„r;j*kJc ',,' _ City Redding St Ca. Zip 96001
(License# 462979 (Phone (530)241-2465
City (// Ico I0 SFM (.lob#
Contact Person 0.---0 git, I 171 CSLB IMisc.
Riser Information Main brain Test(ANNUAL)
..u�:.<'.1 A ::i. ,'�.:!-'+".� ::tl'4. :4i't•.•-I;':li; ,fir .cR'_-.p• wt:7,� .r^R^"I'+\}�..,.np
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1 El This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached:
6-Year INSPECTION,TESTING AND MAINTENANCE
Includes ALL( uarter1y and Annt,)Inspections. Tests,and Maintenance hems
I=Inspection T=Test M=Maintenance Phi Pass F=Fail N/A=Not Applicable
1 11- ,, yr Li f d u . i, ilL g +q iitt, i' Sy I('.•. i! '1ir )lfV 4
s
,1} �<i i ,ktLi } lk}!I4t ,..I}i r fF1 I:.l'1 R1 .I t{ 11i r-i tt v I ,:iie f1+ ^ i1, ir+ 0li i iIi, ;, I:�t1.. 1' L s=- i "iIli 11, '"O'',ii i1lnlitl 1. .. 1._, ,. ''- *4,1i ai :- -. . . .,r 1..:Jiiiin . t : '1!i1:'i a,.,tAcn�a �T ,; 11
1
11
il 1.1 I Control Valves—Identification Sign 13.3.1 I /0
1 1.2 I I Control Valves—Inspection 13.3.2 I I 0
I1.3 I I Waterfow Alarm Devices 5.2.5 I I 0
1.4 I I Supervisory Devices 5.2.5 I I P
1.5 I I Gauges(Wet Pipe Systems) 5.2.4.1 I I pf
1.6 I
Hydraulic Design Information Sign 5.2.6
(For hydraulically designed systems) I ;J!
1.7 I I Enter Water Supply Pressure Below Riser Check 5.2.4.1 I psi I//4
1.8 I I Enter Water Supply Pressure Above Riser Check 5.2.4.1 I psi 7C7
1.9 I I Pressure Readings Acceptable I 5.2.4.1 I I 1 1
/fir
1.10 I I General Information Sign —
(not required for system prior to 2007 Edition NFPA 13)I 5 2 8
I �^
1.11 I I Heat Tape I 5.2,7 I __ '4
1.12 I I Spare Sprinklers I 5.2.1,4 I IP
I1.13 I I Fire Department Connections I 13.7 I I /,_
I1.14 I I Alarm Valves—Exterior Inspection I 13.4.1 I e
1.15 I I Pressure Reducing Valves I 13.5.1.1 I `V/4-
1.16 1 1 Backflow Preventers I 13.6.1 r )V6- I
•
Form AES 2.2
Sept.3,2013
RECEIVED 11/12/2018 09:00AM 5308931276
Nov. 12. 2018 9: 1AM Fedex Redding No. 0063 P. 2
Wet Pipe California Lode of tegulations-Title 19 5 Year
Fire Sprinkler System Inspection,Testing,end Maintenance Report 2 °t'
Property Information -e- Contractor or Licensed Owner Information
Building Name("t-/,''(,,,t Mfi of A4,,, ?v Cj ,,L y' 3l, 5 Name Wilgus Fire Control Inc.
•Address C(ter) �> it ti'7"4I/r �'; ,✓ tr Job#
ICE' ( kf ! ,�'P ' , ,w "
ANNUAL INSPECTION,TESTING:AND MAINTENANCE
Include ALL Quarterly Inspections(See AES 2.1)
I =Inspection T -Test M=Maintenance P=Pass F=Fall N/A r NotApprcabie
i � ' I
..
'
Iiii l=ni ,i I IL,�L4i,F .,l>�� k. •
1.17 I Small Hose Connections-Hose Valve* 5.1.6, 13.5.2 )//
13.5.5,1 b
1.18 I PRV-Fire Sprinkler Systems 13.5.1.1 I A
i O ! a 4 1 I
1 1.19 I Buildings(Freeze Protection) 4...1.. Owners Responsibility (ir/4_•-
1.20 I Sprinklers 5.2.1
1.21 I Sprinklers-Accessible Concealed Space 5.2.1.1.6 le
1.221- I Pipe and Fittings 5.2.2 f
1.23 I Pipe and Fittings-Accessible Concealed Space 5.2.2.3 P
11.24 I Hangers 5.2.3 7i
1.25 I Hangers-Accessible Concealed Space 5,2.3.3 t
1.26 I Seismic Braces 5.2.3 P
1.27 I Seismic Braces-Accessible Concealed Space 6.2.3.3 r/
1.28 I Unsprinldered Areas CFC 901.4 0 Yes RI No
Field Service Test Required If R> QUIRED,Enter'P until A/�
2.1 T Send Report to Fire Code Official 5.3.1 results are returned from Lab /Y
2.2 T Recalled Sprinklers Title 19
If not present•Pass; If present=Fail 904.1(c)
ter Flow Alarm Devices 5.3.3
2.3 T gp secs max. Enter time 13.2.6 mac' v
2.4 T Main Drain Test 13.2,5 )
(Enter data on Pagel of this form) 13.3.3.4
2.5 T Control Valve-Position 13.3.3.2 r
2.6 f T Control Valve-Operation 13.3.3.1 i 1/
2.7 I T Supervisory Devices 13,3.3.5 I 1� / �f 2.6 I T Backflow Preventer Assemblies 13.6.2 I I /v/4.
Small Hose Connections' 13.5.2.3 �/!Q
2.9 T wIPRV Hose Valves-Partial Flow Test 13.5.3.3 Ai I
2.10 I T PRV-Fire Sprinkler Systems 13.5.1.3 I /4-
2.11 I T Pressure Gauges-Calibration 5,3.2 I IVit, • k- 0 P
2.12 rT Small Hose Connections* 13.5.6.2.2 I- I 11/4-
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 22 Sept.3,2013
RECEIVED 11/12/2018 09:00AM 5308931276
' Nov. 12, 2018 9:01AM Fedex Redding No. 0063 P. 3
Wet Pipe California oilo of'epulations-Title 19 5 Year
Fire Sprinkler System Inspection, Testing, and Maintenance Report 3 of 3
Property Information =-OF,cqt./A:,,l Contractor or Licensed Owner Information
'iName l �' '.v�
Buildingl� /las�,n . ;,i , 0,31;�r� a Name Wilgus Fire Control Inc.
'Address j j/O W s!!ct'l . 11,` ' \. Job#
iCity 1�- �' �,;
ANNUAL INSPECTION.TESTING;AND MAINTENANCE
include ALL Quarterly Inspections(See AES 2.1)
I =Inspection T --Test M=Maintenance P=Pass F=Fail IVA=Not 400:Cable
i 3'tir! i t•1-, t i �w. p 1� ,zit `y,. �$ I c n - - ,.. .
il 'f.R _' ' ``i;!+]7�!i) ♦ .. l ,,,ion.:,.,,„-;,...-,,..,'s ! 'lid 'th i{�y� :y{(€tit i
t l, $ .r1'f'tii ,'\�ll,fF1. i .i FI r ,,. - i ..r'F.1rJ; I'I'I,y'�:4 l'i S r.;Ti:11;, •sv..!, ,.,"5,.;
3.1 M Check Valves-internal inspection 13.4.2 ,+r
3.2 M 'Control Valves 13.3.4 1 I t(J
3.3 M `FDC-Backflush 14.3.2.3 I '
"
14.3.2. �3.4 M 'internal Pipe Inspection-See Deficiencies and 14.2 I I fiYNeso I J/j
Comments Section for Results.
3.5 M I Obstruction Investigation Required. If"Yes",see 14,3 I * I��jq
Deflaenaes and Comments Section for Results + 1,�'
3.6 I M 'System Returned to Service 4.5.3 I I
e 1
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D=Deficiency C;Comment (indicate type) - — '
ii �r•t•'. 1�1 t.,",1 L., 1'.,•1' t 1.''.{• {{lcii):l},r .. P , t t"--_y r''27 1. _' „gi 7' yU c
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den t itht 11 rt.p1t t t i } ;t; i.-� -I L '�t r',1,i,r'J i �F,�r. ,-max{u11•�,TTn �1r"'.- n,�•i,, i 1,,- la -, :-,i,:�►.1
t 1 ;Ns ���#���., � �-;1:��_#'.A't,G..:�J:.. ,.. .�' ,�.:a�'u!ur i,�_ =!��..t�'1[ � iN ,t. � t
1 =
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MIN
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0 Check here if additional Deficiencies and Comments are listed on Form ASS 9 Number attached:
El 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.
Print Name I it t'„l _ /l t I/A t1.A--C Jr-"".
Signature I c�dI / yr Date j , 'I� ..j
R
.Y V u ._
Foam AES 2.2 Sept.3,2013