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HomeMy WebLinkAboutFAI17-0001 CF FS 2022 Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19 Property Information: Name' MID VALLEY BAPTIST CHURCH Occupancy/Use.B Address 2584 DURHAM DAYTON HWY Construction Type: Type I B i,�4F d_1(p,t 1 City: DURHAM No. Stories: 1 i� /fD+� ZIP: 95938 Year Constructed: N/a Contact: Mp Telephone 345-2141 Contractor Information: Number of System Risers Name Wilgus Fire Control Inc. Copy sent to: Address: 4544 Mountain Lakes Blvd. ❑Owner Date 11/22/2022 City: Redding ❑Fire AHJ Date: 11/22/2022 State: CA ❑Contractor Date: 11/22/2022 (530) 241-2465 NOTES: Telephone 1) For specific inspection,testing,and maintenance requirements and information,see NFPA 25, 2011 CA License#: 462979 License# Edition as amended by California Code of Regulations, Title 19,§901 to§906. Job# 3828112222 2)Inspection items may be performed by the owner in Performed by: JARED BERTOTTI accordance with California Code of Regulations, Title 19, §904.1(a) - hi c'tc'tfil t rdrieseh s}atet l i ioef:ted'and elitifttia 1M T t©i1i °'I led°!fir Ii info Check boxes(Fail or Pass)to indicate status of inspected system at end of inspection. Forms Included with this Report NFPA 25 Number of Forms NIA Fail* Pass Chapter ❑ Automatic Sprinkler System 5 X ❑ Standpipe and Hose System 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 ❑ Water Mist System 12 ❑ Concerns that are not deficiencies(i.e. Non-Sprinklered Areas) LI Yes No Ilk"Deficiencies and Comments"section fit.end of each respective form. AES 1 September 3.2013 K .`: 4. ._ - i . 'ie. a i_:. -:Sri- . _ h' _ fpa,:[i. _ • -:..1 f .. _ = w._ -g • + t - -- +-yaw 14-. ..- - -.y - - f» F ._... 7Y R _ _ - - I9 y ; Yam. t 4 0- y - . 1i -''DIY La'I .-4 • - - =try �I • t. ,. ^� 1' sue- `Wet Pipe California Code of Regulations -Title 19 5-Year 1 of 3 Fire Sprinkler System Inspection, Testing, and Maintenance Report of Property Information Sk`J CA4',A Contractor or Licensed Owner Information ff.¢ � Building Name MID VALLEY BAPTIST CHURCH Sy Name Wilgus Fire Control Inc. 10 ./v�f Address 4544 Mountain Lakes Blvd. 'Address 2584 DURHAM DAYTON HWY I r'i%k Mp City Redding St. CA Zip 96003 'License# 462979 (Phone (530) 241-2465 City DURHAM I❑ SFM IJob# 3628112222 Contact Person I❑ CSLB !Mist. Riser 111tOnliation Main gain Test(ANNUALMilini Riser Location Riser Main Drain Initial Static Residual Final Static P,F,N/A No. Diameter Diameter Pressure Pressure Pressure 1 I L side of building I 4" I 2" I 60 I 40 I 60 I P 1 I I I I I I I I 1 1 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. 5-Year INS CTION, TESTING AND MAINTENANCE c . ,..,f, pc1{l Annual inspections, Tests,and Maintenance items I=Inspection T=Test M = Maintenance P=Pass F=Fail NWA=Not Appiica,: Item I` NFPA 25 CA Description ed. Date Comments Only P,F, N/A Reference I 1.1 I Control Valves—Identification &gn 13.3.1 11/22/2022 P 1.2 I Control Valves—Inspection 13.3.2 11122i2022 Replaced P 1.3 I Waterfiow Alarm Devices 5.2.5 11/22/2022 P 1.4 I Supervisory Devices 5.2.5 il22/2022 P 1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 11/22n022 Replaced P 1.6 I Hydraulic Design Information Sign 5 2 6 11/22t2022 P (For hydraulically designed systems) 1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 iuz2no2z 60 psi P 1.8 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 11i22l2022 psi N/A 1.9 I Pressure Readings Acceptable 5.2.4.1 nJ22l2°22 P 1.10 I General Information Sign 5 2 8 11n2i2022 P (not required for system poor to 2007 Edition NFPA 13) I1 11 I Heat Tape 5.2.7 11/22/2022 N/A 1.12 I Spare Sprinklers 5.2.1.4 11/22/2022 P 1.13 I Fire Department Connections 13.7 11/22/2022 P 1.14 I Alarm Valves—Exterior Inspection 13.4.1 11/22/2022 N/A 1.15 I Pressure Reducing Valves 13.5.1.1 7 11/22/20221 N/A 1.16 I Backflow Preventers 13.6.1 11/22/2022 N/A Form AES 2.2 Sept.3.2013 Wet Pipe California Code of Regulations -Title 19 5 Year *2 of 3 Fire Sprinkler System Inspection, Testing, and Maintenance Report Property Information �o�caC/� Contractor or Licensed Owner Information - 'Building Name MID VALLEY BAPTIST CHURCH `� ,. —' 15 Name Wilgus Fire Control Inc. (Address 2584 DURHAM DAYTON HWY �`�� �.���f ��. Job# 3828112222 (City DURHAM �N - ANNUAL INSPECTION, TESTING,AND MAINTENANCE Include ALL Quarterly Inspections(See AES 2.1) I = Inspection T =Test M=Maintenance P='Pass F=Fair N/A=Not Applicable Item Description NFPA 25 CA ed. Date Comments Only P,F,NIA Reference 5.1.6, 13.5.2 22 2022 1.17 I' Small Hose Connections-Hose Valve* 13.5.5.1 N/A 11/22/2022 i 1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 N/A 11/22/2022 1.19 I Buildings(Freeze Protection) 4.1.1.1 Owner's Responsibility P 1.20 I Sprinklers 5.2.1 1102/2022 P 1.21 I Sprinklers-Accessible Concealed Space 5.2.1.1.6 1102/2022 P 1,22 P g 11/22/2022 I Pipe and Fittings 5.2.2 P 1.23 p g p 11/22/2022 I Pi a and Fittings-Accessible Concealed Space 5.2.2.3 P 11/22/2022 1.24 I Hangers 5.2.3 P 11/22/2022 1.25 I Hangers-Accessible Concealed Space 5.2.3.3 P 11/22/2022 1.26 I Seismic Braces 5.2.3 P 11/22/2022 1.27 I Seismic Braces-Accessible Concealed Space 5.2.3.3 P 11/22/2022 1.28 I Unsprinklered Areas CFC 901.4 D Yes K No Field Service Test Required 11/22/2022 If REQUIRED, Enter'F'until 2.1 T Send Report to Fire Code Official 5.3.1 results are returned from Lab P 2 2 T Recalled Sprinklers Title 19 11/22/2022 P If not present=Pass; If present=Fail 904.1(c) Water Flow Alarm Devices 5.3.3 11/22/2022 2 3 T 90 secs max. Enter time 13.2.6 43 sec. P Main Drain Test 13.2.5 11122/2022 24 T (Enter data on Page 1 of this form) 13.3.3.4 P 11/22/2022 2.5 T Control Valve-Position 13.3.3.2 P 1112 2/2 0 2 2 2.6 T Control Valve—Operation 13.3.3.1 P 11/22/2022 2.7 T Supervisory Devices 13.3.3.5 P 11/22/2022 2.8 T Backflow Preventer Assemblies 13.6.2 N/A Small.Hose Connections* 13.5.2.3 11/22/2022 2.9 T wIPRV Hose Valves—Partial Flow Test 13.5.3.3 N/A 11/22/2022 2.10 T PRV—Fire Sprinkler Systems 13.5.1.3 N/A 11/22/2022 2.11 T Pressure Gauges-Calibration 5.3.2 Replaced P 11/22/2022 2.12 T Small Hose Connections* 13.5.6.2.2 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 Ill standpipe systems. Form AES 2.2 Sept.3,2013 Wet Pipe California Code of Regulations -Title 19 5 Year Fire Sprinkler System Inspection, Testing, and Maintenance Report 3 of 3 Property Information C4C/,p 1 Contractor or Licensed Owner Information I '�f o ,, �V 9 'Building Name MID VALLEY BAPTIST CHURCH r o )p; Name Wilgus Fire Control Inc. 'Address 2584 DURHAM DAYTON HWY rt , .4 f Job# 3828112222 (City DURHAM tt'1‘,RE TA -- ANNUAL INSPECTION, TESTING, AND MAINTENANCE include ALL Quarterly Inspections.(See AES 2,1) I -Inspection T =Test All=Maintenance P=Pass F=Fail N/A=NotApplicable mot. ` ' �..r t: I P,F,NIA 3 3.1 M Check Valves-Internal inspection 13.4.2 11/22/2022 I p 3.2 ' M 'Control Valves I 13.3.4 1 11/22/2022 I I P 3.3 I M IFDC-Backflush 14.3.2.4 1 14.3.2.3 11122t2022 I Replaced P 1 Internal Pipe Inspection-See Deficiencies and 11/22/2022 LC Yes 3.4 I M 'Comments Section for Results. 14.2 I -No P I Obstruction Investigation Required. If"Yes",see I 11/22/2022I I 3.5 M Deficiencies and Comments Section#or Results 14.3 N/A • 3.6 I M System Returned to Service III 4.5.3 I 11/22,12022 I El Nos P D=Deficiency C=Comment (Indicate type) Item I Date I Riser 10 I C I Deficiencies and Comments Indicate all equipment,devices and parts that were repaired or replaced 1 1I Replaced check valve 1 YE Replaced Control valve I f I 1 ❑Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ElSee 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. Print Name I Jared Bertotti ISignature I ...,, z . Date 11/22/2022 Form AES 2.2 Sept.3,2013