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HomeMy WebLinkAboutFAI18-0012 CF FS 2022 Inspection,testing, and Maintenance Cover Sheet NFPA25 as amended by�CCR�Tide 19 _. .-----._ . • Name u, l L Co • C; Q-L-6 -bi.r`- OceuPancY'lJse r h 01_6 � ',.- [ I �--� , -pF CA(�� ;t, Address Ntli4t ¶Ci t CCe.1 - .b Construction Type fi 'S ■ex .reil��,.- p City Q.A�"Q No. Stories. t .7co i . .s ZIP: ac9 54 Year Constructed '2-�o Z 9 i�p Contact: QSSe_e Telephone q5 $ - ' 1- 3 c 4 3 - • f {; - V$t Number of.Systettl Risers • . • Name Wilgus Fire Control Inc. Copy sent to:�O.vngr b Address 4544 Mountain Lakes Blvd Date 1 t . it • Z Z__ Redding III Fire AHJ Date City . 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 At aCfk(0. -3 , 2}Inspection items may be performed by the owner in r `L��k I `� accordance with California Code of Regulations,Title 19, Performed by `?��w^ l §904.1(a) &ttecksbay.for'each systeril.inspected and efilkethe number of forms used for Inspection . z5 zr A Checi boxes(Fail or Pass)to Indicate stattt*'of inspected system at end o_f inspection --- - ',...NFPA 25 urnher of Fam1s N/A Fail` Pass Forms included with this ReportpE '... g Automatic Sprinkler System - - ❑ Standpipe and Hose System 6 — — ❑ Private Water Supply System ❑ I1 ❑ 8 H Fire Pump❑ Water Storage Tank c, `n J I_ O Water Spray System 10 I L ❑ Foam Water Sprinkler System 11 n ❑ Water Mist System 12 n I I L} } ❑ Yes ❑ No ❑ Concerns that are not deficiencies(i.e. Non-Sprinklered Areas) 1 • tip section at end of each respective form. September 3:2013 AcS1 • - Lt y ., ;f J • T 1 hl- • z . _ tE !k` - - _ .t r • kL: T 9.. i = _ .,ems 'f._�4 Y• J'1 :' r • 01 - .. - .. - . - _ - -_ Wet Pipe California Code of Regulations-Title 19 ■ Quarterly and 1 of Fire Sprinkler System Inspection,Testing,and Maintenance •© Annual Report _- of CA&% Property Information titer' pt3 Contractor or Licensed Owner Information " � ri Building Nameeju - C fr; t~� CLI-'{UL C n Name Wilgus Fire Control Inc. ".� •,cc `1 f. .c_} , 'a; Address -1544 Mountain Lakes Blvd Address S(cL�rrr r e — �. _ z,^� �` SAE._14. City Redding St. Ca Zip 96003 City t/VlcLctc,!. License# 462979 Phone (530)241-2465 Contact Person --L5s t+ /L. 0SFM Job 4 —j 0 (p s 1 0 CSLB Misc. Riser Information Main Orain Test(Annual) Riser, Location Riser Main Drain Initial Static Residual Final Static P,F,N/A fyo :, Diameter ❑iameter Pressure Pressure Pressure I ?- -00h4 : ctt_ ell i.-SS1,‘a_i I � I! Zff Glti 4 SO 5F= (7 0 This building has more Than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached _ ... ___ =,_ Quarbar fnspectiOns —I =Inspection T=Test M=Maintenance P=Pass F=Fall NM=Not App!icabie rNFPA 25 CA ed. Date 5 Date Date Date _. item, •,, ,:. D• escription Reference 111 -4-24 i T� 1.1 I Control Valves—Identification Sign 13.3.1 P 1 2 I Control Valves—Inspection 13.3 2 Q 1.3 I Waterflow Alarm Devices 5.2 5 0 1.4 I Supervisory Devices 5.2.5 P - _ —__ 1.5 I Gauges(Wet Pipe Systems) 5.2.4 1 e 1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4 1 5-0 psi Fsi psi psi 1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4 1 ra 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 �1 `(for hydraulically designed systems) 1.10 i General Information Sign 5 2 8 (not required for system prior to 2007 edition of NFPA 13) ` 1'J f Ar 1,11 I Heat Tape 5.2.7 N J Ak 1.12 1 Spare Sprinklers 52 1 4 P 1.13 I Fire Department Connections 13 7 P 1.14 I Alarm Valves—Exterior Inspection 13.4 1 t ( Pc 1.15 I Pressure Reducing Valves 13.5.1.1 ,�1 rk 1.16 1 Backiow Preventers 13.6.1 P 516 13.5.2 1.17 I Small Hose Connections- Hose Valve' 13.5.5.1 01 a- _ - 1.18 I PRV—Fire Sprinkler Systems 13 5 1.1 0(Pr 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 Wet Pipe California Code of Regulations-Title 19 r Quarterly and 2 of 3 Fire Sprinkler System Inspection, Testing,and Maintenance © Annual Report of C4�t� Contractor or Licensed Owner Information Property Information ti1- t�.r Z Building Name'�j� Q Co. (I ea_ � 1 j� Name Wilgus Fire Control Inc. Address 'r'' Job# 3( (� City Latta(: ANNUAL INSPECTION,TESTING,AND MiNTENANCE include ALL Quarterly ir:apections �_ . I =Inspection T =Test M=Maintenance _Pass F=Fail N/A=Not Applicable Item Description NFPA 25 CA ed. Date Comments Only 'P,F,N/A Reference t 1.19 1 Sprinklers 5.2.1 t E-1/-zz- P 1.20 I Buildings(Freeze Protection) 4.1.1.1 Owner's Responsibility P 1.21 I Pipe and Fittings 5.2.2 p 1.22 I Hangers 5.2.3 P 1.23 1 Seismic Braces 5.2.3 P 2.1 T Field Service Test Required 5.3.1 If REQUIRED. Enter'F'until n (Send Report to Fife Code Official) results are returned from Lab [" 2.2 T Recalled Sprinklers Title 19 ['� final present=Pass, If present=Fail 904.1{c} .- i� 2.3 T Water Flow Alarm Devices 5.3.3 90 sec.maximum - (Enter Time) _ 13.2.6 0 sec. P 2.4 T Main Drain Test 13.2.5 (Enter data on Page 1 of this form) 13.3.3.4 r 2.5 T Control Valve-Position 13.3.3.2 P 2.6 T Control Valve—Operation 13.3.3.1 P r 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 F _i4 1PC 2.9 T Small Hose Connections' 13.5.2.3 � w/PRV Nose Valves—Partial Flow Test 13.5.3.3 _A l� 2.10• T T PRV--Fire Sprinkler Systems 13.5.1.3 ki I A- 3.1 M Control Valves 13.3.4 r 3.2 M Small Hose Connections' 13.5.6.3 TZ.11A' Obstruction Investigation required , EI Yes 3.3 M (11'Yes",see Deficiencies and Comments Section 14.3 ®No e for Results.) Yes 3.4 M System Returned to Service 4.5.3 11 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 t •e x, Defklerrries and Coirlments ltBn1i:, - bate Riser D u Inds ,: F_.,T`>..-.`%.. ..;. :d p.tuff(h_at repaued arrplaeeC 1 Sept,3,2013 Farrn,:ES� ti • a a Wet Pipe California Code of Regulations-Title 19 tilt Quarterly and Fire Sprinkler System Inspection, Testing, and Maintenance Di Annual Report 3 of 3 of Cq Property Information t Contractor or Licensed Owner Information .`�,- �p tq( Building Name-6 i, L C_O.�+n�.� fy a — ) i Name Wilgus Fire Control Inc• Address(fib Lt E, CF-€2. ,_ i yi 'J 1., Join# �C kiirE City jlrV�Cti[ cL ; � D=Deficiency C=Comment (Indicate type) Deficiencies and Comments(cont.) . Item Date Riser D C India.?all e j n Teif dericesaid aria Mai ere.r red f r rep.'W ced ri T r P Fa r F • 4 [ a IFk�.e..l f_�.{ L € j ❑Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached ❑ See Correction Form ASS 10 for corrected deficiencies. Number attached l 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 Quarter 1st - Annual 2nd - ❑ Annual 3rd - ❑ Annual 4th - ❑ Annual QDate f; -Aft-KZ'2 Print Name p..� OA.v-��4 �(�-- Signatur ro_t� Form ASS 2 1 Sept-3.2013 • 'I �I