HomeMy WebLinkAboutFAI15-0094 026-152-001 CF FS Palermo Stage Sprink 6.23.21 Inspection, Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR, Title 19
Property Information:
'Name: Palarmo School Stage Occupancy/Use:
Address: 7390 Bulldog Way Construction Type: ��tiof CAL7fiOtiE
1 Rol `l■'l 'A IV°,
City: Palermo No. Stories: ct � r ,
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ZIP: 95965 Year Constructed: Q-,
Contact: Carlos Aguilar � :'i lieNNN,M "
Telephone: (530)864-8619
Contractor Information: Number of System Risers
Name: Voltage Specialists Copy sent to:
PO Box 828 E Owner Date: 06/23/21
Address:
City: Oroville ❑Fire AHJ Date:
State: California ElContractor Date:
(530)624-4514 NOTES:
Telephone: 1) For specific inspection,testing,and maintenance
880862 requirements and information, see NFPA 25, 2011
CA License#: Edition as amended by California Code of Regulations,
Title 19, §901 to§906.
Job#:
2) Inspection items may be performed by the owner in
Performed b Mat Machado accordance with California Code of Regulations,Title 19,
Y:
§904.1(a)
Check box for each system inspected and enter the number of forms used for inspection.
Check boxes(Fail or Pass)to indicate status of inspected system at end of inspection.
NFPA I
Forms Included with this Report Chapt 25 Number of Forms N/A Fail* Pass
r
❑./ Automatic Sprinkler System 5 0 ❑ ❑ ✓❑
❑ Standpipe and Hose System 6 0 ❑ ❑ ❑
❑ Private Water Supply System 7 0 ❑ ❑ ❑
❑ Fire Pump 8 0 ❑ ❑ ❑
❑ Water Storage Tank 9 0 ❑ ❑ ❑
❑ Water Spray System 10 0 ❑ ❑ ❑
❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑
❑ Water Mist System 12 0 ❑ ❑ ❑
❑ Concerns that are not deficiencies(i.e. Non-Sprinklered Areas) El Yes 0 No
*See "Deficiencies and Comments" section at end of each respective form.
AES 1 September 3,2013
Wet Pipe California Code of Regulations -Title 19 Quarterly and 1 of 3
Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report
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Property Information �� — �fiQ��� Contractor or Licensed Owner Information
Building Name Palarmo School stage 1�[ }a% Name Voltage Specialists
Address +Fic&\,. Q Address 370 Apple Lane
'Ifs
�4E M
7390 Bulldog Way ti. :� _ City Paradise St. CA Zip 95969
City Palermo License# 880862 Phone 530-362-2609
Contact Person 0 SFM Job#
Carlos Aguilar 530-864-8619 ✓❑ CSLB Misc.
Riser Information Main Diain Test(Annual)
Riser Location Riser Main Drain Initial Static Residual Final Static p F,N/A
No. Diameter Diameter Pressure Pressure Pressure
1 Stage 4" 2.5" 50 30 45 P
❑ 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
NFPA 25 CA ed. Date Date Date Date
Item Description Reference 106/23/21 JI1.1 I Control Valves—Identification Sign 13.3.1 P
1.2 I Control Valves—Inspection 13.3.2 P
1.3 I Waterflow Alarm Devices 5.2.5 P
1.4 I Supervisory Devices 5.2.5 P
1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 P
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 P
1.9 I Hydraulic Design Information Sign 5.2.6 N/A
(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 P
1.13 I Fire Department Connections 13.7 P
1.14 I Alarm Valves—Exterior Inspection 13.4.1 P
1.15 I Pressure Reducing Valves 13.5.1.1 N/A
1.16 I Backflow Preventers 13.6.1 N/A
1.17 I Small Hose Connections- Hose Valve* 5.1.6, 13.5.2 N/A
13.5.5.1
1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 N/A
*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.
Form AES 2.1 Sept.3,2013
Wet Pipe California Code of Regulations -Title 19 Quarterly and 2
Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report
pF c fZ>,1
Property Information :,�� 'gyp o$ Contractor or Licensed Owner Information
Building Name Palarmo School stage i Jz''0 Name Voltage Specialists
Address 7390 Bulldog Way r�Ft e Job#
City Palermo ;ti� E M =
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 NFPA 25 CA ed. Date Comments Only P,F,N/A
Reference
1.19 I Sprinklers 5.2.1 / 6/23/21 P
1.20 I Buildings(Freeze Protection) 4.1.1.1 Owner's Responsibility N/A
1.21 I Pipe and Fittings 5.2.2 6/23/21 P
1.22 I Hangers 5.2.3 6/23/21 P
1.23 I Seismic Braces 5.2.3 6/23/21 P
2.1 T Field Service Test Required 5.3.1 6/23/21 If REQUIRED, Enter'F' until P
(Send Report to Fire Code Official) results are returned from Lab
2 2 T Recalled Sprinklers Title 19 6/23/21 P
If not present=Pass; If present=Fail 904.1(c)
2.3 T Water Flow Alarm Devices 5.3.3 6/23/21 30 sec. P
90 sec. maximum - (Enter Time) 13.2.6
2.4 T Main Drain Test 13.2.5 6/23/21 P
(Enter data on Page 1 of this form) 13.3.3.4
2.5 T Control Valve-Position 13.3.3.2 6/23/21 P
2.6 T Control Valve—Operation 13.3.3.1 6/23/21 P
2.7 T Supervisory Devices 13.3.3.5 6/23/21 P
2.8 T Backflow Preventer Assemblies 13.6.2 N/A
Small Hose Connections* 13.5.2.3
2.9 T w/PRV Hose Valves—Partial Flow Test 13.5.3.3 N/A
2.10 T PRV—Fire Sprinkler Systems 13.5.1.3 N/A
3.1 M Control Valves 13.3.4 6/23/21 P
3.2 M Small Hose Connections* 13.5.6.3 N/A
Obstruction Investigation required Yes
3.3 M (If"Yes", see Deficiencies and Comments Section 14.3 6/23/21 R
No P
for Results.)
3.4 M System Returned to Service 4.5.3 6/23/21 8 Nos P
*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 I Date R' r Deficiencies and Comments
iiiiIndicate all equipment,devices and parts that were repair-. . .
IL_
J L
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Form AES 2.1 Sept.3,2013
Wet Pipe California Code of Regulations -Title 19 Quarterly and
Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report
Property Information :,st _AC�,��trr Contractor or Licensed Owner Information
Building Name Palarmo School stage 3 / Name Voltage Specialists
Address 7390 Bulldog Way � irl Job#
ItiF�4E
City Palermo �•�
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D=Deficiency C=Comment (Indicate type)
Item Date Riser Deficiencies and Comments(cont.)
Indicate all equipment,devices and parts that were repaired or replaced
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▪Check here if additional Deficiencies 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
iThuartz 0 A _■_ ■ ■ Annual
Date 06/23/21
Print Name Mat Machado
Signature
Form AES 2.1 Sept.3,2013