HomeMy WebLinkAboutCF FA Inspection 2022 ALARM AND DETECTION REPORT Page 1 of 3
VOLTAGE\5PECIAusTs
530-624-4514
CIO/C16 License C880862 www.VoItag.Specialists.com Inspection # p - -z2d r
ALARM & DETECTION EQUIPMENT TEST REPORT
Type of inspection: Annual fire alarm Date: 1 20 22
Site: Gorrill Ranch
Customer: Gorrill Ranch
Street: 7935 Midway Contact: Amanda
city/state: Durham, California Phone#: 530 342-6867
Fax#:
1. Before Test Notify Proper Authorities: Name Cal Fire Phone # 530 533-6363
A. Owner or Owner's Rep
B. Fire Department Cal Fire 530 533-6363
C. Central Station CSM UL
D. Central Station Acct# 2002-1330
2. Control Panel Status Yes No Note#
A. Is the system monitored by Central Station? X
On Test Time: f 0 610 ni Return to Service Time://T'Ai'
B. Is the Power Light on? )�
C. Does the Panel indicate Normal conditions? )C
D. Are all indicating Lamp Bulbs in Operator order? X'
E. Does the Trouble Light operate? X
F. Does the Silence Switch Operate?
G. Battery A.H. g Date Batteries Installed: J-2c' a2
H. Does the Panel have Non-Operational Zones? X
I. Does the Panel have Battery Backup? K
J. Do the batteries indicate they are Properly Charged?
Condition of Batteries: Note#
Battery Voltage with AC Power: f ��7 Battery Voltage without AC Power: Zy L V/gG
K. List any trouble conditions on panel before test: Note#
Note#
Comments: Note#
Note#
3. FACP Manufacturer: 5 (€-t kiV4ter Model# 5-2 System Type: /ii 2W
Location of Annunciators:
Location of Primary Power Source: 7c Panel# htose Breaker
Comments: Note#
Note#
FCPS: Manufacturer Model#
PaneVBreaker# Location:
Battery Voltage with A/C Power: w/o A/C Power Date:
FCPS: Manufacturer: Model# Panel/Breaker# Location:
Battery Voltage with NC Power: w/o A/C Power Date:
FCPS: Manufacturer: Model# Panel/Breaker# Location:
Battery Voltage with NC Power: w/o A/C Power Date:
Owner/Rep: Phone#: Date:
Inspector: Phone#: Date:
/Owners Rep Sign_ ,�1� Date:1-20-22
Inspector Sign: i
� ✓
ALARM AND DETECTION REPORT Page 2 of 3
Property site: Garrill Ranch
I Operational
#Tested
This
Equipment Total# Report Yes N/A Note#
4. Remote Annunciators j
5. Zones
6. Manual Stations (Pull)
Hardwire 5 5-
Addressable
7. Detectors
Photoelectric lc( X
Ionization
Heats/Fixed or R of R 1 /
Flame
Duct(See#15)
8. Horn/Strobe 1rJ
Strobe Only
Bell
Speakers
Horn
9.
10. Automatic Door Release
11. Water Flow switches
Did W/F Ring Outside Bell? V
Did W/F Activate Alarm Panel? ✓
12. Tamper Switches
13. PIV
OS&Y
14.
15. Did test of Duct Detectors shut down air handling units?
16. Did the Monitoring Center(Fire Dept, Central Station, Lease Line)receive signal? t/
17. Is system reset for normal conditions? 1/
18. Is system restored to operational service? f✓
19. Have Proper Authorities (see#1)been notified system is back in service? ✓
List Proper Authorities: reel fre I 5T79p7o i
20. indicate %of equipment tested this report 25% 50% 75% 00%
21. Indicate %of equipment tested YTD 25% 50% 75% 1 0 0%
Comments for any"no"answers or explanations (Note#):
1 1-20-22 (4/1
Owners Rep Sign: Date: Inspector Sign:
ALARM AND DETECTION REPORT Gorrill Ranch Page 3 of 3
DEVICE Zone or DEVICE
SLC #
TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL
PSD SMOKE ABOVE FACP 001
PSD SW BUILDING 002
PSD RESTROOMS & HALLWAY 003
PSD GALLERY 004
SUPV GSM TROUBLE 005
PS NORTH EXIT 006
PS WEST EXIT 007
PS MAIN ENTRY 008
PS GALLERY 009
HT KITCHEN 010
LEGEND
PSD—Photoelectric Smoke Detector BD—Beam Detector H—Horn V—Visual
ISD—Ionization Smoke Detector PS—Pull Station WPH—Weather Proof Horn TS—Tamper Switch
PDD—Photo Duct Smoke Detector RR—Rate of Rise Heat Detector C—Chime WF—Water Flow Switch
IDD—Jon Duct Smoke Detector HT—Fixed Temp Heat Detector CV—ChimeVisu al OH—Door Holder
OHS—Door Hdder&Smoke Detector FD—Flame Detector S—Speaker OSY—Outside Stem&Yoke Tamper Valve
S D—Siam!Station Smoke Detector R—Ret AV—Audible Visual Ply—Post Indicator Valve
Cur-Elevator Curtains FRD-Fire Rolldown Door SDC Smoke Detector&Door Holder Combo
CO-Carbon Monoxide Detector - -
NOTE# COMMENT
(Ze Her Ceel A' ice ,
Ile F i-ceA / % u7 /.J CSC 0i..q6(___
Discrepancies Found? I 1 Yes 1 Y I No
See Discrepancy Report? n Yes No
7) Q;...L
1-20-22 /11 /14
Owners Rep Sign: � Date: Inspector Sign: