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HomeMy WebLinkAboutFAI20-0004 028-300-027 CF FS 2022 F.-A ( zo _°001-1 . ance Cover Sheet Inspe i _ NFPA25 as amended,b ,CC "' ' '•' g, and Malnten u...Y � R,Tltlila 19 Name tl t. Occupancy Use t. Gt'a 2G fi.'t �-ry -oF C4<<�7. Address -7 ti Li(1 attA R� u:VW V`6'1 It. Construction Type - � t� h a i 4 ,.., �,,� •'. O't, City: ----Ft Cf-J1.CA tl t►:�. y No. Stones: I r! -.. >r4 ZIPS 41 <Ct 0 ( Year Constructed G- l 0 . (.ti '.,C- 1-.'1,Y1� 1 ° r� Contact Co—rr , e..e4-1A. Telephone t;11' 24 t U. .. 1 p qtliirri:t. fil i ,ir p ,, Number of System Risers Name. Wilgus Fire Control Inc. Copy sent to: Address; 4544 Mountain Lakes Blvd Owner Date City Redding ❑Fire AHJ Date , State • California ❑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# 3 (11-G. t 0 '1�,� (i i 2)Inspection items may he performed by the owner in Performed by: Q pet ti t i�. t L�-- -- accordance with California Code of Regulations, Title 19,• §904,1(a) •-'--Chedidioi for each system inspected and enter the number of forms used for Inspection: „ , f ,Check`boxes(Fail or Pass)to,indicate stat .of ins eected system at end of inspection ,•r a: -.= NFPA 25 Forms Included with this Rep©rt Chapter Number of Forms WA , Fail` i Pass , fIAutomatic Sprinkler System 5 lam, I 1 ._... . 1 ❑ Standpipe and Hose System I 11 1 1 1 1 ❑ Private Water Supply System I L i I l 1 I r I ❑ Fire Pump 8 I I I I 1 •❑ Water Storage Tank I I 11 I .._ I ❑ Water Spray System 10 I i I Li I ❑ Foam Water Sprinkler System 11 II ❑ Water Mist System 12 III 0 Concerns that are not deficiencies (i e Non-Sprinkiered Areas? I ❑ Yes ❑ No I ft,.. I gt., n►. firri.Onttelegt CiVief e-rid each respective form: September 3.2013 1 /i/ _ / ' Wet Pipe California Code of Regulations-Title 19 *' Quarterly and 1 of 3•'' Fire Sprinkler System' Inspection,Testing,and Maintenance ;13 Annual Report of �� � Contractor or Licensed Owner Information Property Information ,��,- �' -•�,ptt 'Buildingof Name (!~t� Name Wilgus Fire Control Inc. 'Address "N- .�r Address 4544 Mountain Lakes Blvd. �0 k t�r'�iG �Ba� � IMA City Redding St. Ca Zip 96003 (City r. e04,3 .''Z-- 'ILicense# 462979 (Phone (530)241-2465 (Contact Person(3_1. ... Ort ..ra.* A I❑ SFM IJob# '"R,.(..Q., t 1 I E71 CSLB 'Misc. Riser Information Main Drain Test(Annual) yti', 111 'A. .. *3 x r' a. 1 S`ei` aln O fit initial Static` fresldual' Final Static' p,t=;NlA' t' .o atfAn z E ,-r.s'"�y� * l.�5.f � ; i,_ :. „1 pt,t't;eter �: Dime_er; Pressure, Pressure Pressure 1 I I ..-,_. `-t- c e4,4/ ? I/T I l flu 5. L O. I G e I I I ' I I I I I I I I I I I ! I I This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached I i ...a.. ... .. .... . .._,,„...__Quarterly_,Inepectioins.. _____ ._=w T .._ ___.:_ .. . u. ~V M1I Inspection T Test M Maintenance PPass F=Fail N/A Not Applicable �,�,� , � K � ', '.'Date r , �„ of> A Date Date 4,,, ,- .,n �ll � l k 1 �'-, ,t g•ssrrlptlon . „`Reteran g_ . :� i . , . ._I 1.1 I Control Valves—Identification Sign 13.3.1 P 1.2 I Control Valves—Inspection 13.3.2 ;P ' II 1.3 I IWaterflow Alarm Devices 5.2.5 1.4 I Supervisory Devices 5.2.5 T'" 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 W psi psi psi psi 1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 5 0 psi psi psi psi 1.8 I Pressure Readings Acceptable 5.2,4.1 1.9 I Hydraulic Design Information Sign 5.2.6 Q (for hydraulically desloned systems) U General Information Sign 5 2 8 t 1.10 I (not required for system prior to 2007 edition of NFPA 13) t. t ... 1.11 I Heat Tape 5.2.7 A 1.12 I Spare Sprinklers 5.2.1.4 f 1.13 I Fire Department Connections 13.7 (3 1.14 I 'Alarm Valves—Exterior Inspection 13.4.1 tr,.i 0 t A 1.15 I Pressure Reducing Valves 13.5.1.1 ‘,3 t 0 1.16 I Backflow Preventers 13.6.1 h - 5.1.6, 13.5.2 1.17 I Small Hose Connections-Hose Valve` 13.5.5.1 R 1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 01 ft 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. Sept.3.2013 Form AES 2.1 - Fire Sprinkler System inspection,Testing,and Maintenance ' 'Et Annual Report ,,,c,.....,-;.,,,,,,,. ,o ...C.4_40i Property Information z,c;5,6.- ,,,,p,\.i.‘ Contractor or Licensed Owner Information co/ g.--„,._. 1Building Name"Z.kkAL Cc -5-i-pt. rz"5- ,,jQ,..kr,,;,..vir,--ri Name Wilgus Fire Control Inc. Address 7c,:,-1- -30..vt.i00....1„,k.1/443 73 ictIS t. +4./; Job# --3(9. ( 0 ‘ „..,.... „.„..,..cep, •41);:f2E City A NUAL I PE" • , STIIN '' D 71 " Alt." Include AU QUaefri 9ns rtrllsOctf _ , i =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item •—" t1.*..,f,'-..k9P..'ttat --, '1 NF.PFiAe f2e6fe-Cnk"ce PateII Comments P-et""'ye....,'Fm- N/A 1 ,19 I 'Sprinklers 5.2.1 13-17-221- 1.20 I !Buildings(Freeze Protection) 4.1.1.1 i I Owner's Responsibility 1.21 I Pipe and Fittings 5.2.2 I II .22 I 'Hangers J 5.2.3 P 1.23 I !Seismic Braces 5.2.3 I I (") 2.1 !Field Service Test Required I i If REQUIRED, Enter'F'until otA T 5.3.1 I (Send Report to Fire Code Official) I results are returned from Lab 2.2 T Recalled Sprinklers Title 19 1'3 i Pf if not present=Pass: If present=Fail 904.1(c) I 2.3 T Water Flow Alarm Devices 5.3.3 t tj (:) 90 sec.maximum - (Enter Time) 13.2.6 sec. 2.4 T Main Drain Test 13.2,5 (Enter data on Page 1 of this form) 13.3.3.4 1 P 2.5 T 'Control Valve- Position 13.3.3.2 I IC> 2.6 T 'Control Valve-Operation 13.3.3.1 i P 2.7 T 'Supervisory Devices 13.3.3.5 1. P 2.8 T IBackflow Preventer Assemblies 13.6.2 I Oil; 2.9 T 'Small Hose Connections* 13.5.2.3 w/PRV Hose Valves-Partial Flow Test 13.5.3.3 1 toi 1 A 2.10 T IPRV-Fire Sprinkler Systems 13.5.1.3 1 '014 3.1 M !Control Valves 13.3.4 iI e 3.2 M 'Small Hose Connections* 13 5.6.3 1 1-11 A' Obstruction Investigation required I 1 3.3 M (If'Yes",see Deficiencies and Comments Section No for Results.) 14.3 El Yes Yes 3.4 4.5.3 1 r M 'System Returned to Service 4‘,10, I c 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) ' ,-;;-" '''',','•.;',:', Riser;- ;'II"'‘."h-„- .,:4,:),•, -' ''';',*.';',i,'',:""-"'" '. ':"" ', ', ,''''.---:..!.;11:1Atfito9/4„*TfratEir''''''4-2Z:'ffil.'''''''.!''L'°'• .--1'''' ' "' '''' ''":::,:"', ,, . I . 1111 . I I I I I II..'"•1I I I I11--111 11 Form AES 2.1 Sept,3,2013 Wet Pipe California Code of Regulations=:Title 19 S Quarterly and g of 3 � Fire Sprinkler System Inspection, Testing, and Maintenance El Annual Report oca ;=t Property Information �� �o Contractor or Licensed Owner Information l�Q 'ti9 (Building Name ] ('� , S T IN 5 DPP' Name Wilgus Fire Control Inc. 1I 'Address `1540 t)ii`c-i< k :. .tt'tc"nft_4 t3J ` '�_y J,Q � Job# ":34414. 1 t 'Cit .�^� `1,�REM � y - 1C7 0,-,A r) D=Deficienc C=Comment (Indicate t •e) e - 1,1 IUIV ; �, 0,j1 1tl I1 'I I� Item Date Riser • D G indicate all equipment,devices and pads that were repaired or reptated L l 77 L L 1 1 l.._ _I 11......,..I 1 ..1L1 l;;J l 1. Iln Llll I [...._.,Ill I 1.L".1117 Check here if additional Deficiencies ies and Comments are listed on Form AES9 Number attached. ❑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 Y ntial 2nd Annual 3rd - t�Annual 4th ❑ Annual �. ��.fin �"� �` Date 43-- ('7 .- Z z Print Name r014,1 At ael( �t Signature Form AES 2.1 Sept.3,2013 FINAL_ I -