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Home My WebLink AboutFAI21-0018 078-160-021 CF FA Helen Wilcox 6.22.21 ALARM AND DETECTION REPORT Page 1 of 5 VOLTAG PECIALisTs 530-624-4514 C701C16 License#880862 www.VoltageSpecialists.com Inspection # ALARM & DETECTION EQUIPMENT TEST REPORT Type of Inspection: Annual Date: 6/22/21 site: Helen Wilcox Customer: Palermo Schools street: 5737 Autrey Lane Contact: Carlos Aguilar City/State: Oroville, CA Phone#: 530-864-8619 Fax#: 1. Before Test Notify Proper Authorities: Name Phone # A. Owner or Owner's Rep Carlos Aguilar 530-864-8619 B. Fire Department Oroville FA 530-538-2444 C. Central Station NA D. Central Station Acct# NA 2. Control Panel Status Yes No Note # A. Is the system monitored by Central Station? X On Test Time: 7:00 Return to Service Time: 10:00 B. Is the Power Light on? X C. Does the Panel indicate Normal conditions? X D. Are all indicating Lamp Bulbs in Operator order? X E. Does the Trouble Light operate? X F. Does the Silence Switch Operate? X G. Battery A.H. 12 Date Batteries Installed: 7/31/18 H. Does the Panel have Non-Operational Zones? X I. Does the Panel have Battery Backup? X J. Do the batteries indicate they are Properly Charged? X Condition of Batteries: God Note# Battery Voltage with AC Power: 26.76 Battery Voltage without AC Power: K. List any trouble conditions on panel before test: Note# Upon arrival"Manual Evacuation"Alarm had been activated.Reset panel issue resolved. Note# Comments: Note# Note# 3. FACP Manufacturer: Simplex Model# 4005 System Type: Hardwire Location of Annunciators: Location of Primary Power Source: Panel# Breaker Comments: Note# Note# FCPS: Manufacturer: Silent Knight Model# 5495 Panel/Breaker# Location:Above FACP Battery Voltage with A/C Power: 27.40 w/o A/C Power 2720 Date: 7-31-18 FCPS: Manufacturer: Fire Lite Model# 24F Panel/Breaker# Location:Rm 27 Battery Voltage with A/C Power: 27.64 w/o A/C Power 27.60 Date: FCPS: Manufacturer: Simplex Model# 4005 Panel/Breaker# Location:Speech office Battery Voltage with A/C Power: 26.54 w/o A/C Power 26.47 Date: 4/17 Owner/Rep: Phone#: Date: Inspector: Mat Machado Phone#: 530-362-2609 Date:6/22/21 Owners Rep Sign: Date:6/22/21 Inspector Sign: ALARM AND DETECTION REPORT Page 2 of 5 Property Site: Helen Wilcox Operational #Tested This Equipment Total# Report Yes N/A Note# 4. Remote Annunciators 1 1 X 5. Zones 9 9 X 6. Manual Stations (Pull) Hardwire 30 30 X Addressable 7. Detectors Photoelectric 2 2 X Ionization Heats/Fixed or R of R 2 2 X Flame Duct(See#15) 1 1 X 8. Horn/Strobe 6 6 X Strobe Only 4 4 X Bell Speakers Horn 36 36 X Ansul System 1 1 X 9. 10. Automatic Door Release X 11. Water Flow switches X Did W/F Ring Outside Bell? X Did W/F Activate Alarm Panel? X 12. Tamper Switches X 13. PIV X OS &Y X 14. 15. Did test of Duct Detectors shut down air handling units? X 16. Did the Monitoring Center(Fire Dept, Central Station, Lease Line) receive signal? X 17. Is system reset for normal conditions? X 18. Is system restored to operational service? X 19. Have Proper Authorities (see#1)been notified system is back in service? X List Proper Authorities:Butte Sheriff 20. Indicate %of equipment tested this report 25% 50% 75% if 100% 21. Indicate %of equipment tested YTD 25% 50% 75% if 100% Comments for any"no"answers or explanations (Note#): 6/22/21 C/'S Owners Rep Sign: Date: Inspector Sign: ALARM AND DETECTION REPORT Page 3 of 5 Property Site: Helen Wilcox DEVICE zone or SLC DEVICE # TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL PS Outside Kitchen X 1 PS Cafeteria X 1 PS Hall @ Class Rm 2 X 1 PS Hall @ Class Rm 8 X 1 PS Outside Hall by Office X 1 PS Office X 2 PS Outside Staff RM X 2 PS Outside Preschool X 3 PS Outside Class Rm 11 X 3 PS Outside Portable 23 X 4 PS Portable 26 X 6 PS Portable 27 X 6 PS Portable 28 X 6 PS Portable 29 X 6 PS Portable 30 X 6 PS Portable 31 X 6 PS Porta4ble 32 X 6 PS Portable 33 X 6 • PS Portable 34 X 6 PS Portable 35 X 6 PS Outside Library X 5 PS Library X 5 PS Library X 5 PS Class Rm 18 X 5 PS Outside Class Rm 18 X 5 PS Class Rm 19 X 5 PS Class Rm 20 X 5 PS Portable 21 X 5 PS Portable 17 X 5 PS Class Rm 16 X 5 4S Owners Rep Sign: Date: 6/22/21 Inspector Sign: p J ALARM AND DETECTION REPORT Helen Wilcox Page 4 of 5 DEVICE Zone or SLC DEVICE # TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL HT Kitchen Hall X 9 1 HT Kitchen X 9 2 HT Kitchen X 9 3 PDD Kitchen Roof X 11 1 PSD Above FACP X 8 1 PSD Office by Library X 5 11 KH Kitchen Ansul X 10 1 • • 6/22/21 Owners Rep Sign: Date: Inspector Sign: ALARM AND DETECTION REPORT Helen Wilcox Page 5 of 5 Zone or DEVICE DEVICE SLC # TYPE DEVICE LOCATION PASS FAIL NOTE# CHANNEL LEGEND PSD—Photoelectric Smoke Detector BD—Beam Detector H—Horn V—Visual ISD—Ionization Smoke Detector PS—Pull Station WPH—Weather Proof Horn TS—Tamper Switch PDD—Photo Duct Smoke Detector RR—Rate of Rise Heat Detector C—Chime WF—Water Flow Switch IDD—Ion Duct Smoke Detector HT—Fixed Temp Heat Detector CV—Chime Visual DH—Door Holder DHS—Door Holder&Smoke Detector FD—Flame Detector S—Speaker OSY—Outside Stem&Yoke Tamper Valve SSD—SignalStationSmokeDetector B—Bell AV—Audible Visual PIV—Post Indicator Valve Cur-Elevator Curtains FRD-Fire Rolldown Door SDC Smoke Detector&Door Holder Combo CO-Carbon Monoxide Detector - - - NOTE # COMMENT Discrepancies Found? Yes ✓ No s See Discrepancy Report? Yes ✓ No 6/22/21 C r ) Owners Rep Sign: Date: Inspector Sign: