HomeMy WebLinkAboutFAI18-0012 CF FS 2021 ' Inspection,Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR,Title 19- , - . : i
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Name: gtx.A e.. . C i P- Ctk'-l--OcrArpancy/Use Li ti k t rt"o zate.11
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Construction Type: -' fi0 >
Address: (0(s q(�. 6 �(!, , }- .t' tJ" , �, Li - t , ' �
City / ,t" 1 + ‘ No. Stories: ,+
ZIP q Year Constructed .. `D . �
Contact .ct
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Telephone: 5 q'( 7 - 5-
.i I4'I.'t 1 i '!bills p =a 4.a S: ate
Name: Wilgus Fire Control Inc. Copy sent to:
1703 Sonoma St. ,Owner Date t: — $
Address.
Redding Fire AHJ Date
City: .
State: Califomia : ':Contractor Date
NOTES: '
Telephone: (530)241-2465 1)For specific inspection,testing, and maintenance
requirements and information, see NFPA 25, 2011
' CA License#: 462979 Edition as amended by California Code of Regulations, •.
' Title 19, §901 to§906.
Job#: '30 cc
j1 /( 2)Inspection Items may be performed by the owner in
Performed by: I b fvi u . 1 t e.+1I.---- accordance with California Code of Regulations,Title 19,
§904.1(a)
,w 1- " -. number of farms used fart �� �' �v
&',: f� „ sd ;4 e ,� ,3„` T s spectedsystem at end oft $ �a Ne a s
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onns Included with this Report NFPA 25 Number of Forms NIA - Fail'+ Pass
i i : Chapter
.Automatic Sprinkler System 5 E
❑ —. I IE
1 1 -Standpipe and Nose System 6 .., i
❑ Private Water Supply System
I I — —• —
❑ Fire Pump I 8 I —
❑ Water Storage Tank 1 9 1 1 -- 1 C 1
11
❑ Water Spray System I 10 I❑ 11
I _ I _ _
Foam Water Sprinkler System — -- t
I I 1 - _ I _
❑ Water Mist System ( 12 1 _ I --
❑ Concerns that are not deficiencies (i.e. Non-Spnnklered Areas) ( ❑ Yes li ❑ No �!
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Wet Pipe California Code of Regulations-Title 19 Quarterly and 1 of 3
Fire Sprinkler System Inspection,Testing, and Maintenance Annual Report
Property Information ,jF CAI,(0 1.. Contractor or Licensed Owner Information
olir(_
[Building Name' }u is Cb l a,L Name Wilgus Fire Control Inc.
'Address (y(s m-�t7 tj ; cP,�.,(a.- �' Address 1703 Sonoma St, 1
' RE MP City Redding St. Ca. Zip 96001
!City t'‘11 a.Uc.t ; ct. (License# 462979 (Phone 530-241-2465
!Contact Person ' -3-0_5 j Lk_.. I El SFM (Job# e c s- —7 j
1 I ® CSLB 'Misc.
ch.,.,,, xea }, a 'aiT 1Annl
<.av;m.�o� ��.a C.€t1188-- pvm� � a;�s _ :�.- a<a _ 1ntn Acaan ,Era1 urt .af
w ,
et' 1.' -- �--- '� ,� 1 i ser ` Main Drain Initial Static Residual Final Static P F NIA
7: n ��tt,�., i, !iif•ii ter Diameter Pressure Pressure Pressure '
,..‘- I e1e (n" . .1t► l'ti4._'S' ci tt 4 n I 7 tt I 'JC I !r I ;.'�""c
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7 This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached T` 1
_. • _ Quarterly Inspections ` , . :,;: �
1 =Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
a ate
1,1 I Control Valves-Identification Sign 13.3.1 F
1.2 I Control Valves-Inspection 13.3.2
1.3 I Waterfiow Alarm Devices 5.2.5
1.4 I Supervisory Devices 5.2.5 )C)
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 5 o psi psi psi psi
1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 C 0 psi psi psi ps1
1.8 I Pressure Readings Acceptable 5.2.4.1 P
1.9 I Hydraulic Design Information Sign 5.2.6
(for hydraulically designed systems)
General Information Sign !
1.10 i 5.2.8
(not required for system prior to 2007 edition of NFPA 13) A
1.11 I Heat Tape 5.2.7 i Pr-
1.12 I Spare Sprinklers 5.2.1,4 Q I
1.13 I Fire Department Connections 13.7 e
1.14 I Alarm Valves-Exterior Inspection 13.4.1 l,*D 1 €#k
1.15 I Pressure Reducing Valves 13,5.1.1 01 f
1.16 I Backflow Preventers 13.6.1 Q I l
1.17 I IsmaQ Hose Connections-Hose Valve* 5.1,6, 13.5.2 I N 1( pv
I I
13,5.5.1
1,18 I I IPRV-Fire Sprinkler Systems 13.5.1.1 113 11 - I 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 Ili standpipe systems.
Form AES 2.1 Sept 3.2013
Wet Pipe California Code of Regulations-Title 19 Quarterly and
2 of 3
Fire Sprinkler System Inspection,Testing,and Maintenance Annual Report
of c c41.4,
'
Property Information ki', al Contractor or Licensed Owner Information
.4s.,r li
(^Building Name3A}la C .. Ei„ co,itt2_ r - 1" Name Wilgus Fire Control Inc.
'Address is,,(1.•,L‘(, S 1:v..... ccoit {2,‘" 1,4,\‘, ,,,L,z;:r Job# 770. C -7
ICity ilvVacz a (;c:,
Include ALL Quarterly inspections
I =Inspection T =Test M=Maintenance P=Pass F=Fail NIA=Not Applicable
1
.19 I Sprinklers 5.2.1 th--7-7t I
1.20 I Buildings(Freeze Protection) 4.1.1.1
1 Owner's Responsibility I p
1.21 I Pipe and Fittings 5.2.2
1 I P
1,22 1 Hangers 5.2.3
I I
1,23 I Seismic Braces 5.2.3 I I (7)
2.1 T Field Service Test Required 5.3.1 If REQUIRED, Enter'F.until I p
(Send Report to Fire Code Official) 1 results are returned from Lab
2.2 T
Recalled Sprinklers Title 19
I I (31
If not present=Pass: If Present=Fail 904.1(c)
Water Flow Alarm Devices 5.3.3f
2.3 T
90 sec.maximum - (Enter Time) 13.2.6 6 0 sec. I {)
2,4 T Main Drain Test 13.2.5
(Enter data on Page 1 of this form) 13.3.3.4 1 1 P
2.5 T Control Valve-Position 13.3.3.2
1 I P
2.6 T Control Valve—Operation 13.3.3.1
1 I P
2.7 T Supervisory Devices 13.3.3.5
I I e
2.8 T Backfiow Preventer Assemblies 13.6.2
I 1A Pt
Small Hose Connections* 13.5.2.3
2.9 T
w/PRV Hose Valves—Partial Flow Test 13.5.3.3 101 Pc
2.10 T PRV—Fire Sprinkler Systems 13.5.1.3
1 I t*'4 P't
3.1 M Control Valves 13.3.4
I I P
3.2 M Small Hose Connections* 13.5.6.3
I I 0 ik
Obstruction Investigation required •Yes
3,3 M (If"Yes",see Deficiencies and Comments Section 14.3 li'No P
for Results.)
3.4 1 M 'System Returned to Service 1 4.a3 I V kligYes
P
i '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)
;4.11.,I.,:t.,..4 '',..,,,......",'•".-.:.;.,1't ,, * i eficrencres an• onunen '
C indreate alt equipment,devrce.5 andparts trial were re.al-*or re•la -d .,
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Form AES 2.1 Sept.3.2013
Wet Pipe ' ! California Code of Regulations-Title 19 , , . , :Quarterly I,nd
. ; Fire Sprinkler System 1 Inspection Testing, and Maintenance ' i'' .Annual Repert,
......... --.........
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Property Information 4,71."-,-' v--"<40 i'f;i Contractor or Licensed Owner Information
, ffi4r/ t ,
lu)! , -4 15,'vi
Building Narne'6iA k-to„ Cc, ,„ -cl a e,Ccoxe.()-- , ", 1 1 v Name Wilgus Fire Control Inc
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Address 6.,C. Lt.e 5 To„...ts"c-Ce,?..., ab $:\, e '1,0'-' -1.4%4 Job it -3 O 5-A7 /
N\,----- - •••• _,
icity mck.Pet ri,A_ ..,,,A7RE.MP'
D=Deficiency C=Comment (indicate type)
';-...-.::, .,.„, •,, Def1c!encies And COmM ,10- 2.ents(06 *-' ::r.-•°, ' .
...,-;.,•.:•;•......‘:..-- ,...:", •••_:•----.;:,,,,„',..-;::::•-;,..„.'_:•.,,,,..-•°:',,,,.„.,..,i :-•,./nRicatealleguipipOnt devices end parts ii!atrete,repaifedfar.replaqed
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OCheck here if additional Deficiencies and Comments are listed on Form AES9 Number attacned
0 See Correction Form AES 10 for corrected deficienoes. 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
Date
i Print Name —1- ilex 1 fk e..,,it 0- 7
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