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Home My WebLink AboutFAi22-0007 056-410-004 CF FS 2022 Ft Z L—UUc7 6'56,-- Goy Inspection,Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19 Property Informatto ` .. Name: Cal-Fire Forest Ranch Occupancy/Use: B F/IF OF Address: CAL FIRE-Butte County Fire-Station 23536:Construction Type: Ill$ a CALF+n, City: Forest Ranch No.Stories: 1 '$3,,1101 ZIP: Year Constructed. Contact: Telephone: Name: Wilgus Fire Control Copy sent to: Address: 4544 Mountain Lakes Blvd ✓ Owner Date: ✓ Fire AHJ Date: City: Redding r Contractor Date: State: CA NOTES: Telephone: (530)241-2465 1)For specific inspection,testing,and maintenance requirements and information,see NFPA 25,2011 Edition as amended by California Code of CA License#: 462979 C-16,C-10 Regulations,Title 19,ua901 to u1906. Job#: 200000006422 2)Inspection items may be performed by the owner in accordance with California Code of Regulations,Title 19,ua904.1(a) Performed by Nathaniel Belmont .' a .v's_r.X.':>- mae .�.t" �e �� _C e =�t53tes e or~ass o rtdica e s.u c s. - a+°sys em a"en S'irroSpe icon. Forms Included with this Report NFPA 25 Number of Forms N/A Fail* Pass Chapter .4 Automatic Sprinkler System 5 1 r r 1- and Hose System 6 0 r r ' 1'" Private Water Supply System 7 0 r r r r Fire Pump 8 0 r Water Storage Tank 9 0 r r r r Water Spray System 10 0 l— r r r Foam Water Sprinkler System 11 0 f r r 1" Water Mist System 12 0 r Concerns that are not deficiencies(i.e.Non-Sprinklered Areas) r Yes No Wet Pipe California Code of Regulations -Title 19 Quarterly and 1 of 3 Fire Sprinkler System Inspection,Testing, and Maintenance Annual Report Property Information Contractor or Licensed Owner Information Building Name Cal-Fire Forest Ranch �, '` Name Wilgus Fire Control Address CAL FIRE-Butte County Fire-Station 235 " Address 4544 Mountain Lakes Blvd .>•:>_ City Redding St. CA Zip 96003 City Forest Ranch I License 462979 C-16,C-10,GI Phone (530)241-2465 I Contact Person 11-SFM I Job# 200000006422 I Phone I PI CSLB 'Misc. Riser Information Main Drain Test(AnnUa . ,, : Riser Location '( „ ",. r , , ,,." ► rr c Residual Final Static P,F,NlA No, "r s " , 4 ^ Pressure Pressure Pressure 1 I Pumphouse I 2" 1" I 125 I 85 100 Pass 2 I Barracks I 3" I 1-1/4" I 110 I 90 I 100 Pass 11 3 I Apparatus I 3" I 1-1/4" I 115 I 90 I 100 Pass I I I I I I I I I I I Ir This building has more than 5 risers.See additional AES 2.9 form attached Number of AES 2.9 forms attached Quarterly Inspections I=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item r.Description NFPA25 GA I Date Date Date Date ed. 4/6122 L 1 1 L' Reference 1.1 I Control Valves—Identification Sign 13.3.1 Pass I 1.2 I Control Valves—Inspection 13.3.2 Pass 1.3 I Waterflow Alarm Devices 5.2.5 Pass 1.4 I Supervisory Devices 5.2.5 Pass 1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 Pass I 1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi psi psi 1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi psi psi 1.8 I Pressure Readings Acceptable 5.2.4.1 N/A 1.9 I Hydraulic Design Information Sign 5.2.6 Pass (for hydraulically designed systems) 1.10 I General Information Sign 5.2.8 N/A (not required for system prior to 2007 edition of NFPA 13) 1.11 I Heat Tape 5.2.7 N/A 1.12 I Spare Sprinklers 5.2.1.4 Pass 1.13 I Fire Department Connections 13.7 N/A 1.14 I Alarm Valves—Exterior Inspection 13.4.1 N/A I 1.15 I Pressure Reducing Valves 13.5.1.1 N/A 1.16 I Backflow Preventers 13.6.1 N/A I 1.17 I Small Hose Connections-Hose Valve* 5.1.6,13.5.2 N/A 13.5.5.1 I 1.18 I PRV—Fire Sprinkler Systems 13.5.5.1 I I N/A 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 III standpipe systems. I Wet Pipe California Code of Regulations -Title 19 Quarterly and 2 of 3 Fire Sprinkler System Inspection,Testing, and Maintenance Annual Report Property Information ca , Contractor or Licensed Owner Information Building Name Cal-Fire Forest Ranch t'''.!.,W.'9y f 'Name Wilgus Fire Control Address CAL FIRE-Butte County Fire-Station 23E `d a- ai Job# 200000006422 kkt1.1 City Forest Ranch 1-,,,..,.....-- ANNUAL INSPECTION,TESTING,AND MAINTENANCE Include ALL.Quarterly Inspections I=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item Description fi, . �; 1 , E3a iNa j jlr"'.d a l Tsai lad;. i s" 1 s::..: k I 1.19 I 'Sprinklers 5.2.1 [ 04/09/22 Pass 1.20 I 'Buildings(Freeze Protection) 4.1.1.1 04/09/22 Owner's Responsibility Pass 1.21 I 'Pipe and Fittings 5.2.2 04/09/22 Pass 1.22 I 'Hangers 5.2.3 04/09/22 Pass 1.23 I 'Seismic Braces 5.2.3 04/09/22 Pass 2.1 I T Field Service Test Required 5.3.1 04/09/22 If REQUIRED,Enter'F'until Pass (Send Report to Fire Code Official) results are returned from Lab 2.2 T Recalled Sprinklers Title 19 04/09/22 Pass If not present=Pass;If present=Fail 904.1(c) 2.3 T 1 Water Flow Alarm Devices 5.3.3 04/09/22 45 sec. Pass 90 sec.maximum-(Enter Time) 13.2.6 2.4 T 'Main Drain Test 13.2.5 04/09/22' Pass (Enter data on Page 1 of this form) 13.3.3.4 2.5 ' T 'Control Valve-Position 13.3.3.2 04/09/22 Pass 2.6 ' T 'Control Valve-Operation 13.3.3.1 04/09/22 Pass 2.7 ' T 'Supervisory Devices 13.3.3.5 04/09/22 ' Pass 2.8 ' T 'BackflowPreventerAssemblies 13.6.2 04/09/22 N/A 2.9 T (Small Hose Connections* 13.5.2.3 04/09/22-J., N/A w/PRV Hose Valves-Partial Flow Test 13.5.3.3 2.10 T I PRV-Fire Sprinkler Systems 13.5.1.3 04/09/22 N/A 3.1 M 'Control Valves ' 13.3.4 04/09/22 Pass 3.2 M 'Small Hose Connections* 13.5.6.3 04/09/22 N/A 3.3 M Obstruction Investigation required 14.3 04/09/22 r Yes Pass (If"Yes",see Deficiencies and Comments Section 14 No for Results. 3.4 M'System Returned to Service 5.4.3 04/09/22 14 Yes Pass r No 1*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) Item Date` Riser D C Deficiencies and Comments indicate all equipment,devices and parts that were repaired or replaced r IIrIrI I r lal IIrIrl I IrIrI Wet Pipe California Code of Regulations -Title 19 Quarterly and 3 of 3 Fire Sprinkler System Inspection,Testing, and Maintenance Annual Report Property Information -o cg7s Contractor or Licensed Owner Information Building Name Cal-Fire Forest Ranch �laa C ' 4 'Name Wilgus Fire Control Address CAL FIRE-Butte County Fire-Station 23E11f, Job# 200000006422 Vie City Forest Ranch '� D=Deficiency C=Comment (Indicate type) Item Date Riser D C '- Indicate all ego tpm led or replaced I' I ✓ r F F r r I- ✓ r ✓ r F r r ✓ r r r ✓ r F r� ✓ r ✓ r F r ✓ r fw. r ✓ r ✓ r r Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached. r 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. Check box if Annual Inspection,Testing&Maintenance Items are Completed in the Indicated Quarter 2nd-lV Annual f 3rd-r Annual I dth r Annual Date 4/9/22 I Print Name I Nathaniel Belmont I I Signature