HomeMy WebLinkAboutB21-2756 CF FA 2021 FIRE ALARM
INSPECTION AND TESTING FORM
Date:
. SERVICE ORGANIZATION FACILITY LOCATION
Name: California Safety Company, Inc. Name: Huckleberry's
Address: 1410 Elmwood Street Address: 1586 HWY 99
City/State/Zip: Redding, CA 96001 City/State/Zip: Gridley, CA
Telephone: (530) 243-2521 Telephone: 797-2002
License #: 266257 Account#: 40071
MONITORING AGENCY APPROVING AGENCY (AHJ)
Contact: California Safety Company, Inc. Contact: Redding Fire Department
Telephone: (530) 243-2521 Telephone: (530) 225-4572
Testing: Annual
TYPE OF TRANSMISSION
__None (Local Only)
Digital Communicator (DACT) Manufacturer/Model: Telguard TG-7FS LTE
DE•ect Line Voltage: 12 VDC
xCellular Communicator
CELL POWER LOCATION: C:-/--/ANTENNA LOCATION: ///(- 1-,i(
Monitoring Station Signal by 90 Seconds:
Alarm: Yes No N/A
Supervisory/Trouble: AYes No N/A
Dialer Phone Line #1 Trouble by 4 Minutes: FA es No —N/A
• Dialer Phone Line #2 Trouble by 4 Minutes: Yes _No —IN/A
MAIN FIRE CONTROL PANEL CHECKS-Kitchen Storage
Conlfol Panel Manufacturer: Honeywell Model: Vista 32FB Voltage: 12 VDC
Initiating Circuits/ SLC Class Used: 5/B
Indicating Circuits/Class Used: 2/B
Static Battery Voltages/Size/Dates: fg Date,20/5- Inst Date 2/5
Battery Under Load Test: 9*C
AC Circuit Breaker Location: fi?..E.,e/ 0'1 10&/
Trouble Signal with AC Power Off: gYes _No —N/A
Circuits Operate on Standby Battery: Yes No I IN/A
Circuits Checked for Supervision: Yes [—No —N/A
Circuits Trouble on Ground Fault: LYes _No— I IN/A
Sprinkler Delay Time: Yes No RV/A
Lockout Tag#'s
Lamps/LED's: Yes _No N/A
Panel Key on Site: Yes No I IN/A
Operating Instructions at Annunciator/FACPMYes —No PN/A
Test/Service Records at Fire Panel: Yes I INo I IN/A
AUXILIARY PANEL CHECKS— Cellular Communicator
Panel Manufacturer: Honeywell Model: Telguard TG-7FS LTE Voltage: 12 VDC
Static Battery Voltages/Size/Dates: /;"/,' ./,- xiC„.,7-..-c Mfg Date H7 Inst Date --)...oie
Battery Under Load Test: k, x:,— f.4 r
AC Circuit Breaker Location: Same as eACP
Trouble Signal with AC Power Off: A Yes -No N/A
Circuits Operate on Standby Battery: II Yes No _N/A
Lamps/LED's: Yes _-No N/A
Panel Key on Site: Yes No N/A
AUXILIARY PANEL CHECKS Location: —' /---": --(-
Panel Manufacturer: Notifier Model: FCPS24-S6 Voltage: 24 VDC
Initiating Circuits/Class Used: 1/B
Indicating Circuits/Class Used: 2/B
Static Battery Voltages/Size/Dates: /31,.67„C7-- .. Mfg Date x 5—Inst Date "'?•C•ie
Battery Under Load Test:
AC Circuit Breaker Location: C.,,,, ,--
_
Trouble Signal with AC Power Off: M Yes .No 1—N/A
Circuits Operate on Standby Battery: k Yes _No [—N/A
Circuits Checked for Supervision: _ Yes No N/A
Circuits Trouble on Ground Fault: Yes No I—N/A
Lamps/LED's: k Yes I—INo PN/A
Panel Key on Site: Yes _No N/A
Operating Instructions at Panel: Ill Yes No XN/A
AUXILIARY PANEL CHECKS
Panel Manufacturer: Model: Voltage:
Initiating Circuits/Class Used:
Indicating Circuits/Class Used:
Static Battery Voltages/Size/Dates: Mfg Date Inst Date
Battery Under Load Test:
AC Circuit Breaker Location: _
Trouble Signal with AC Power Off: Yes _No EN/A
Circuits Operate on Standby Battery: _Yes _No N/A
Circuits Checked for Supervision: Yes riNo —IN/A
Circuits Trouble on Ground Fault: I—Yes No 1—N/A
Lamps/LED's: [Yes No EN/A
Panel Key on Site: I—Yes —INo EN/A
Operating Instructions at Panel: Yes No N/A
INITIATING AND SUPERVISORY
ZONE DEVICE LOCATIONS TESTED DEVICE TYPE
001 Above FACP Kitchen Storage v/ Smoke Detector
002 Kitchen Pull Station
003 Front Entry Pull Station
004 Back Door Pull Station
005 Kitchen Hood MODULE TEST ONLY Ansul
INDICATING DEVICE LOCATIONS ,- DEVICE TYPE
Womens Restroom Strobe
Mens Restroom Strobe
Exterior Horn/Strobe
Horn/Strobe
Horn/Strobe
Horn/Strobe
Horn/Strobe
EQUIPMENT TYPE TOTAL UNITS UNITS TESTED PASS/FAIL
1--Iorn PassL Fail_
Chime PassT Fail
Voice Speaker Pass Fail
Strobe 2 Pass' Fail' f
Horn/Strobe 5 S-' Pass;'- Fail1—
Chime/Strobe Pass_ Fail
Speaker Strobe Pass Fair
Bell Passr- Fair
Sprinkler Water Gong Pass-1 Fail!
Sprinkler Supervision Switch PassL Fail
Sprinkler Flow Switch Pass[_ Fail—
Heat
Detector Pass Fair
Smoke Detector 1 / Pass Fail_
Duct Detector PassE Fair f
Manual Pull Station 3 'a Pass Fail_
Generator Start Pass'_ Fail
HVAC/Ventilation Control Pass Fair_
Annunciator 1 / Pass Fail_
Elevator Recall Passe Fail
Fire Door Release PassE Fail
Secure Door Release Pass_ Fail_
Fire Phone/Microphone Pass(— Fail
Other-Ansul Module Test Only 1 1 Pass. c Fail
Other Pass Fair
Other PassE Fail
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Date Corrected: /2-7P--- 2 ( By: E
THIS CERTIFIES THAT THIS FIRE ALARM HAS BEEN PROPERLY INSPECTED FOR RELIABILITY TO
COVER THE ITEMS LISTED IN THIS REPORT AND IS CONSISTENT WITH FIRE ALARM MAINTENANCE
STANDARDS. DISCREPANCIES ARE NOTED AND HAVE BEEN REPORTED TO THE FACILITY
OWNER/MANAGER FOR CORRECTIVE ACTION.
PLEASE NOTE DISCLAIMER ON REVERSE
I W i ) - r-�5/ ��c‘-sue- a2—,2 i
SIGN TtiIIE: FACILY`TYOWNER/MANAGER SIGNATURE: INSPECTOR/TECHNICIAN DATE