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HomeMy WebLinkAboutFAI20-0005 CF FA 2021 009-162-014 Hazel_Hotel_-_880_Hazel_St,_Gridley,_CA_95948 HAZEL HOTEL_ Fire Alarm Supplement-INITIATING DEVICES_ 8-18-2021 (Annual).pdf Fire Alarm Supplementary Form Location Code:045-821-1994 Contact:TRISH STILWELL Contact Address:880 HAZEL ST GRIDLEY, CA 95948 Phone:530-846-7800 Email: Property Evaluated:HAZEL HOTEL (Business) 880 HAZEL ST GRIDLEY, CA 95948 Description:Fire Alarm Supplement (INITIATING DEVICES) Company:Eagle Security Systems Address:3268 Esplanade Ste A Chico, CA 95973 Company Phone:530-345-6395 Inspector:Connor Dalton 152852 NICET I, Expires: 7/1/2023 Date of Work:8/18/2021 Frequency:Annual Attached Files There are no attachments for this submission Deficiency Summary There are no reported deficiencies for this submission General Comments There are no general comments for this submission VYANET Operating Group, Inc., 410 SW Columbia, Suite 120, Bend, OR, 97702 Phone: 541-812-6409Page 1 of 4 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 Fire Alarm Supplementary Form The work covered on this form is (select one):Annual Date of Work8/18/2021 Account Information Facility Name: HAZEL HOTEL Property Type: Business Location Code: 045-821-1994 Service Address: 880 HAZEL ST, GRIDLEY, CA, 95948 Owner: TRISH STILWELL Owner's Phone: 530-846-7800 Owner's Address: 880 HAZEL ST, GRIDLEY, CA, 95948 Legend PS - Pull StationSD - Smoke DetectorDD - Duct DetectorMM - Monitor Module (Ansul, temp, CO, etc) CM - Control ModuleWF - WaterflowTS - Tamper SwitchHD - Heat DetectorSC - Signal/Sounder Control OtherSPKR - SpeakersSTROBE - StrobesHORN - Horns/Horn-Strobes BATT - Batteries TypeTotalTestedNot Tested PassedFailedTypeTotalTestedNot Tested PassedFailed HD22020PS11010 SD38380380TS11010 WF11010 TypeAddressLocationNotesFrequencyLast TestedTest ResultsComments SD11 - Apt 1Annual8/18/2021Pass SD21 - Apt 1Annual8/18/2021Pass SD41 - Apt 2Annual8/18/2021Pass SD61 - Apt 3Annual8/18/2021Pass SD71 - Apt 3Annual8/18/2021Pass SD91 - Apt 4Annual8/18/2021Pass SD101 - Apt 4Annual8/18/2021Pass SD121 - Apt 5Annual8/18/2021Pass SD131 - Apt 5Annual8/18/2021Pass SD151 - Apt 6Annual8/18/2021Pass SD161 - Apt 6Annual8/18/2021Pass SD181 - Apt 7Annual8/18/2021Pass ©2014 FormLink Systems, Inc., Fire Alarm Supplement v1.1Page 2 of 4 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 TypeAddressLocationNotesFrequencyLast TestedTest ResultsComments SD191 - Apt 7Annual8/18/2021Pass SD211 - Apt 8Annual8/18/2021Pass SD231 - Apt 9Annual8/18/2021Pass SD241 - Apt 9Annual8/18/2021Pass SD261 - Apt 10Annual8/18/2021Pass SD271 - Apt 10Annual8/18/2021Pass SD291 - Apt 11Annual8/18/2021Pass SD301 - Apt 11Annual8/18/2021Pass SD321 - Apt 12Annual8/18/2021Pass SD341 - Apt 13Annual8/18/2021Pass HD34.4.11 - Elevator ShaftAnnual8/18/2021Pass HD34.4.21 - Elevator Control RoomAnnual8/18/2021Pass SD351 - Apt 13Annual8/18/2021Pass SD371 - Elevator RoomAnnual8/18/2021Pass SD381 - Elevator ShaftAnnual8/18/2021Pass SD411 - FACUAnnual8/18/2021Pass SD421 - 1st Floor Elevator LobbyAnnual8/18/2021Pass SD431 - 2nd Floor Elevator LobbyAnnual8/18/2021Pass TS441 - Butterfly ValveAnnual8/18/2021Pass WF451 - WaterflowAnnual8/18/2021Pass SD461 - Space BAnnual8/18/2021Pass SD471 - Space AAnnual8/18/2021Pass SD481 - Space AAnnual8/18/2021Pass SD491 - Space CAnnual8/18/2021Pass SD501 - Space C RestroomAnnual8/18/2021Pass SD511 - Space C WorkroomAnnual8/18/2021Pass SD521 - Space D2Annual8/18/2021Pass SD531 - Space D1Annual8/18/2021Pass SD541 - Women’s RRAnnual8/18/2021Pass SD551 - Men’s RRAnnual8/18/2021Pass PS571 - LobbyAnnual8/18/2021Pass Comments Any deficiencies or other problems found with the devices must be explained using the comment specific for each device. Additional comments can be added here. Please see the summary section at the top of the form for the comments. ©2014 FormLink Systems, Inc., Fire Alarm Supplement v1.1Page 3 of 4 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 Inspector's Information Inspected ByConnor Dalton I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments. Signature of Inspector Date8/18/2021 ©2014 FormLink Systems, Inc., Fire Alarm Supplement v1.1Page 4 of 4 HAZEL HOTEL_ Fire Alarm Supplement-NOTIFICATION APPLIANCES_ 8-18-2021 (Annual).pdf Fire Alarm Supplementary Form Location Code:045-821-1994 Contact:TRISH STILWELL Contact Address:880 HAZEL ST GRIDLEY, CA 95948 Phone:530-846-7800 Email: Property Evaluated:HAZEL HOTEL (Business) 880 HAZEL ST GRIDLEY, CA 95948 Description:Fire Alarm Supplement (NOTIFICATION APPLIANCES) Company:Eagle Security Systems Address:3268 Esplanade Ste A Chico, CA 95973 Company Phone:530-345-6395 Inspector:Connor Dalton 152852 NICET I, Expires: 7/1/2023 Date of Work:8/18/2021 Frequency:Annual Attached Files There are no attachments for this submission Deficiency Summary There are no reported deficiencies for this submission General Comments There are no general comments for this submission VYANET Operating Group, Inc., 410 SW Columbia, Suite 120, Bend, OR, 97702 Phone: 541-812-6409Page 1 of 3 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 Fire Alarm Supplementary Form The work covered on this form is (select one):Annual Date of Work8/18/2021 Account Information Facility Name: HAZEL HOTEL Property Type: Business Location Code: 045-821-1994 Service Address: 880 HAZEL ST, GRIDLEY, CA, 95948 Owner: TRISH STILWELL Owner's Phone: 530-846-7800 Owner's Address: 880 HAZEL ST, GRIDLEY, CA, 95948 Legend PS - Pull StationSD - Smoke DetectorDD - Duct DetectorMM - Monitor Module (Ansul, temp, CO, etc) CM - Control ModuleWF - WaterflowTS - Tamper SwitchHD - Heat DetectorSC - Signal/Sounder Control OtherSPKR - SpeakersSTROBE - StrobesHORN - Horns/Horn-Strobes BATT - Batteries TypeTotalTestedNot Tested PassedFailedTypeTotalTestedNot Tested PassedFailed Bell11010HORN27270270 STROBE33030 TypeAddressLocationNotesFrequencyLast TestedTest ResultsComments HORN11 - Apt 1Annual8/18/2021Pass HORN21 - Apt 1Annual8/18/2021Pass HORN31 - Apt 3Annual8/18/2021Pass HORN41 - Apt 3Annual8/18/2021Pass HORN51 - Apt 4Annual8/18/2021Pass HORN61 - Apt 4Annual8/18/2021Pass HORN71 - Apt 5Annual8/18/2021Pass HORN81 - Apt 5Annual8/18/2021Pass HORN91 - Apt 2Annual8/18/2021Pass HORN101 - Apt 6Annual8/18/2021Pass HORN111 - Apt 6Annual8/18/2021Pass HORN121 - Apt 7Annual8/18/2021Pass HORN131 - Apt 7Annual8/18/2021Pass ©2014 FormLink Systems, Inc., Fire Alarm Supplement v1.1Page 2 of 3 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 TypeAddressLocationNotesFrequencyLast TestedTest ResultsComments HORN141 - Apt 7Annual8/18/2021Pass HORN151 - Apt 8Annual8/18/2021Pass HORN161 - Apt 9Annual8/18/2021Pass HORN171 - Apt 9Annual8/18/2021Pass HORN181 - Apt 13Annual8/18/2021Pass HORN191 - Apt 13Annual8/18/2021Pass HORN201 - Apt 12Annual8/18/2021Pass HORN211 - Apt 11Annual8/18/2021Pass HORN221 - Apt 11Annual8/18/2021Pass HORN231 - Apt 10Annual8/18/2021Pass HORN241 - Apt 10Annual8/18/2021Pass STROBE251 - Men’s RRAnnual8/18/2021Pass STROBE261 - Women’s RRAnnual8/18/2021Pass HORN271 - Restroom HallwayAnnual8/18/2021Pass STROBE281 - Restroom HallAnnual8/18/2021Pass HORN291 - C2 RestroomAnnual8/18/2021Pass HORN301 - FACUAnnual8/18/2021Pass Bell311 - ExteriorAnnual8/18/2021Pass Comments Any deficiencies or other problems found with the devices must be explained using the comment specific for each device. Additional comments can be added here. Please see the summary section at the top of the form for the comments. Inspector's Information Inspected ByConnor Dalton I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments. Signature of Inspector Date8/18/2021 ©2014 FormLink Systems, Inc., Fire Alarm Supplement v1.1Page 3 of 3 HAZEL HOTEL_ Fire Alarm-SILENT KNIGHT 5820XL_ 8-18-2021 (Annual).pdf Form for Inspection, Testing and Maintenance of Fire Alarms and Signaling Systems Location Code: 045-821-1994 Contact: TRISH STILWELL Contact Address: 880 HAZEL ST GRIDLEY, CA 95948 Phone: 530-846-7800 Email: Property Evaluated: HAZEL HOTEL (Business) 880 HAZEL ST GRIDLEY, CA 95948 Description: Fire Alarm (SILENT KNIGHT 5820XL) Company: Eagle Security Systems Address: 3268 Esplanade Ste A Chico, CA 95973 Company Phone: 530-345-6395 Inspector: Connor Dalton 152852 NICET I, Expires: 7/1/2023 Date of Work: 8/18/2021 Frequency: Annual Attached Files There are no attachments for this submission Deficiency Summary Please refer to the Deficiency Summary located on applicable Fire Alarm Supplementary Forms for additional deficiency details. General Comments There are no general comments for this submission VYANET Operating Group, Inc., 410 SW Columbia, Suite 120, Bend, OR, 97702 Phone: 541-812-6409 Page 1 of 4 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 Form for Inspection, Testing and Maintenance of Fire Alarms and Signaling Systems Separate forms are available for inspection, testing, and maintenance of the rest of the fire protection system of which the fire alarms and signaling systems are a part. More frequent inspection, testing, and maintenance may be necessary depending on the conditions of the occupancy and the water supply. Notes: All questions are to be answered Yes, No, or Not Applicable. All "No" answers are to be explained in the Comments for this form. 1. Refer to NFPA-72 for specific inspection frequency requirements for the different components. 2. The work covered on this form is (select one): Annual Date of Work 8/18/2021 All responses refer to the current work (inspection, testing and maintenance) performed on this date. 1. Property Information Owner: TRISH STILWELL Owner's Phone Number: 530-846-7800 Owner's Address: 880 HAZEL ST, GRIDLEY, CA, 95948 Property Being Evaluated: HAZEL HOTEL (Business) Property Address: 880 HAZEL ST, GRIDLEY, CA, 95948 Assembly Description: Fire Alarm (SILENT KNIGHT 5820XL) 2. Owner's Section A. Are the fire alarms and signaling systems in service? Yes No B. Have fire alarms and signaling systems remained in service since the last inspection? Yes No C. Was the system (of which the fire alarm and signaling systems are a part) free of actuation of devices or alarms since the last inspection? Yes No D. The required record documents are available and include the current revisions of all fire alarm software and the revisions of software of any systems with which the fire alarm software interfaces? Yes No Owner or Representative Trish Stilwell Signature Date 8/18/2021 3. Monitoring Information Monitoring organization: Vyanet Address: Phone: 541-241-1800 Fax: Email: Account number: 202-1994 Phone line 1: 530-846-6013 Phone line 2: 530-846-6014 Means of transmission: Pots Entity to which alarms are retransmitted: Phone: 4. System Information 4.1 Control Unit: Manufacturer: Silent knight Model number: 5820xl 4.2 Software and Firmware Revision number: 9.09 4.3 System Power: 4.3.1 Primary (Main) Power: Nominal voltage: 120 Amps: 20 Location: Old Office House Panel Overcurrent protection type: Breaker Amps: 20 Disconnecting means location: #11 4.3.2 Secondary Power: Type: Battery Location: Panel Battery type (if applicable): Lead-acid Nickelcadmium Primary (dry cell) Sealed lead-acid Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): 5. Notifications Made Prior To Testing Contact Time Monitoring organization: Vyanet 1300 Building management: Onsite 1300 Building occupants: Onsite 1300 Authority Having Jurisdiction: AHJ 1300 Other, if required: NFPA 72 v1.0 Page 2 of 4 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 6. Testing Results 6.1 Control Unit and Related Equipment Description Visual Inspection Functional Test Results Control unit Yes No Yes No Pass Fail N/A Lamps/LEDs/L CDs Yes No Yes No Pass Fail N/A Fuses Yes No Yes No Pass Fail N/A Trouble signals Yes No Yes No Pass Fail N/A Disconnect switches Yes No Yes No Pass Fail N/A Ground-fault monitoring Yes No Yes No Pass Fail N/A Supervision Yes No Yes No Pass Fail N/A Local annunciator Yes No Yes No Pass Fail N/A Remote annunciators Yes No Yes No Pass Fail N/A Remote power panels Yes No Yes No Pass Fail N/A Other: Yes No Yes No Pass Fail N/A 6.2 Secondary Power Description Visual Inspection Functional Test Results Battery condition Yes No Yes No Pass Fail N/A Load voltage Yes No Yes No Pass Fail N/A Discharge test Yes No Yes No Pass Fail N/A Charger test Yes No Yes No Pass Fail N/A Remote panel batteries Yes No Yes No Pass Fail N/A 6.3 Alarm and Supervisory Alarm Initiating Device Complete supplementary device test form for all initiating devices. 6.4 Notification Appliances Complete supplementary appliance test form for all notification appliances. 6.5 Interface Equipment Complete supplementary interface component test form for all interface components. Circuit Interface / Signaling Line Circuit Interface / Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes/No Time (sec) Results Alarm signal Yes No 48 Pass Fail N/A Alarm restoration Yes No 52 Pass Fail N/A Trouble signal Yes No 54 Pass Fail N/A Trouble restoration Yes No 47 Pass Fail N/A Supervisory signal Yes No 49 Pass Fail N/A Supervisory restoration Yes No 50 Pass Fail N/A 6.7 Public Emergency Alarm Reporting System Description Yes/No Time (seconds) Results Alarm signal Yes No Pass Fail N/A Alarm restoration Yes No Pass Fail N/A Trouble signal Yes No Pass Fail N/A Trouble restoration Yes No Pass Fail N/A Supervisory signal Yes No Pass Fail N/A Supervisory restoration Yes No Pass Fail N/A 7. Notifications That Testing Is Complete Contact Time Monitoring organization: Vyanet 1615 Building management: Onsite 1615 Building occupants: Onsite 1615 Authority Having Jurisdiction: Ahj 1615 Other, if required: 8. System Restored To Normal Operation Date: 8/18/2021 Time: 1615 9. Comments Any "No" answers, test failures or other problems found with the fire alarm system must be explained using the comment specific for each question. Additional comments can be added here. Please see the summary section at the top of the form for the comments. NFPA 72 v1.0 Page 3 of 4 Eagle Security Systems 3268 Esplanade Ste A Chico, CA 95973 Phone: 530-345-6395 10. Inspector's Information Inspected By Connor Dalton I state that the information on this form is correct at the time and place of my inspection, and that all equipment tested at this time was left in operating condition upon completion of this inspection except as noted in the Comments. This system as specified herein has been inspected and tested according to NFPA 72, 2013 edition, Chapter 14. Signature of Inspector Date 8/18/2021 NFPA 72 v1.0 Page 4 of 4