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HomeMy WebLinkAboutFAI18-0012 CF FS 2022 Inspection,Testing, and Maintenance Cover Sheet NFPA25 as amended by�CCRt Title 19 _ :----- -iiir ,r►• cg iiti r ; -,: i Name u..tk L CO - C r 0-Q--l.+t- 11. - Occupancy'Use ( ;4 ht Hazand _ ( f/ f1sp�� c—� f� t� 1 f C~A `41' Address ( 6AD CLt M..il—�t1 Type0,SS 4&I1 .. �0....—i L� �,`s Construction ,•4,,- .O , Citya� No Stories i. r itoi L ...A . ;.--i. ZIP CI ri 9 7 4 Year Constructed Z as 2... \�9,� �. jr,,? ` t= tiAP�' ' Contact. �QSs �_� Telephone O s lic - Cl-[1- 3 c 4 — l `, kb`'- p N•urriber of System Risers . . .4 ':�iili�Tl�aY;lfiSTlii�lfrlf1 p'} #` .#-�_ •, • Name Wilgus Fire Control Inc Copy sent to: ` 5 Address: 4544 Mountain Lakes Blvd Owner Date I ! . 11 - 2 7, City Redding ❑Fi€e 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 2)Inspection items may be performed by the owner in M I'M LA I ..t accordance with California Code of Regulations,Title 19, Performed by. i §904.1(a) ,p E t-,* s;.,.«or each'sy q inspected and enter the number of forms used for Inspection .i..' ec ,boxes (Fail or Pass)to Indicate status-of inspec/ed§ystem at end of inspection . ---� `.1 NFPA 2S '3.Number of Forms N/A Fail` Pass Farms included with this Report . ' ,N r - . . ,. .. tg Automatic Sprinkler System U ❑ Standpipe and Hose System I 6 I E. I I El Private Water Supply System I -IElI E f I � I �-, I ❑ Fire Pump l 5 -; 1 ❑ Water Storage Tank I 9 1 0 I I ❑ Water Spray System 1 10 InIn II I fI � � I ❑ Foam Water Sprinkler System 11 ___, ❑ Water Mist System I 12 I - I Li 1 I ❑ Yes ❑ No ElConcerns that are not deficiencies(i.e. Non-Spnnklered Areas) I t& �rirnery "section at endof each respective form.... • September 3:2013 AES 5 i 1 Wet Pipe California Code of Regulations-Title 19 ■ Quarterly and 1 of 3 Fire Sprinkler System Inspection,Testing,and Maintenance •© Annual Report Property Information �,t� CA ,q�� Contractor or Licensed Owner Information 'Building Name ix H L Ca. ez R� C4 l! C -,'d Name Wilgus Fire Control Inc. Address tu st�-tuft— �b `� b . a' Address 4544 Mountain Lakes Blvd ��AE 1Jit City Redding St. Ca Zip 96003 - City IIAAa-q e.4.I:c !License# 462979 IPhone (530)241-2465 Contact Person ~ �LSS Zc_ I❑ SFM 'Job# -3 U Lr 3 I I P1 CSLB 'Misc. 1 Riser information Main Drain Test(Annual) - _z:L ,, s aa } 1 , j;' se-r r ralfIn Ufa Stti - . ResidualFinal e ' o� ee a PsFNiA ? , ,, .,-.,..,-..,.,,,,,I- c Diameter - Diameter� Pressue Pressure Pressure r e_:4+nks: dm h & k 1 11 IzlI I 'c" I cv 15o I P I I - I I II I I I I I I 1 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 L i Quarterly Inspections -- - Inspection T=Test M Maintenance P= -Pass TF= ___ !- -Far! N/A NotApplicable i : z :. l'jFPA:2S,C ed. Date Date ____ ate Ir,rr ;: i 1c- r` ' ':j 1 :4tpference 'III' I 1.1 1 Control Valves-Identification Sign I 13.3.1 I P 1.2 I Control Valves-Inspection I 13.3.2 I f) 4 1.3 1 IWaterftow Alarm Devices I 5.2,5 I p lI 1.4 I Supervisory Devices I 5.2.5 1 e 1.5 I Gauges(Wet Pipe Systems) I 5.2.4.1 1 e 1.6 1 Enter Water Supply Pressure Below Riser Check I 5.2.4.1 50 psi psi psi psi 1.7 t Enter Water Supply Pressure Above Riser Check I 5.2.4.1 so psi psi Psi psi I 1.8 I Pressure Readings Acceptable _ I 5.2.4.1 Q 1 9 I Hydraulic Design Information Sign I 5.2.6 P (for hydraulically designed systems) t.10 I General Information Sign 5.2.8 (not required for system prior fo 2007 edition of NFPA 13) 1.�(>4 - Y 1.11 I Heat Tape I 5.2.7 f 1.12 I Spare Sprinklers I 5.2 1.4 P 1.13 I Fire Department Connections I 13.7 Q 1.14 1 'Alarm Valves-Exterior Inspection I 13.4.1 ttZt >ar 1.15 I Pressure Reducing Valves I 13.5.1.1 V3I N 1.16 I Backflow Preventers I 13.6.1 P i 51.6, 13.5.2 1.17 I Small Hose Connections-Hose Valve' 13.5.5.1 tt�I g` _ _ 1.18 I PRV-Fire Sprinkler Systems I 13.5.1,1 01 Pc- •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. _ _ -_ -- J Sept ). 20/3 Form AES 2.1 Wet Pipe California Code of Regulations-Title 19 IIIQuarterly and 2 of 3 . Fire Sprinkler System Inspection, Testing,and Maintenance © Annual Report of CALt.----C t Contractor or Licensed Owner Information Property Information ���,•-" \pi BuildingName ,y! Name Wilgus Fire Control Inc. "$��t� et). �'��e.. Ca.r.-te� � �. "11� Address[i1to 0 5-t . tl-C'.4—�D ; '� �'' Jobs -361.0 '3 City 0. . c� 4E M ANNUAL INSPECTION,TESTING,AND MAINTENANCE include ALL QuatteNy lnspegtlons I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable ItemI Description NFPA 25 CA ed. Date Comments Only P,F,NiA Reference . 1.19 I I Sprinklers 5.2.1 t(_; .2 Q 1.20 I I Buildings(Freeze Protection) 4.1.1.1 f Owner's Responsibility P 1.21 I 1 Pipe and Fittings 5.2.2 I p 1.22 I I Hangers 5.2.3 I P 1.23 I I Seismic Braces 5.2.3 I P 2.1 I T Field Service Test Required 5 3 1 I If REQUIRED. Enter'F'until p (Send Report to Fire Code Official) results are returned from Lab C 2.2 I T Recalled Sprinklers Title 19 If not present=Pass; If present=Fail 904.1(c) 1 i' 2.3 I T Water Flow Alarm Devices 5.3.31 to p sec. 90 sec.maximum - (Enter Time) 13.2.6 Main Drain Test 13.2.5 2.4 I T ;Enter data on Page 1 of this form) 13.3.3.4 f 2.5 T Control Valve-Position 13.3.3.2 I I P 2.5 T Control Valve—Operation 13.3.3.t --r I P 2.7 I T 'Supervisory Devices 13.3.3.5 I I '+Q 2.8 I T IBackflow Preventer Assemblies 13.6.2 ( p 1 Pc 2 9 I T 'Small Hose Connections`w/PRV Hose Valves—Partial Flow Test 13.5.2.313.5.3.3 I k 2.10 I T IPRV—Fire Sprinkler Systems 13.5.1.3 I ki I A- ' 3.1 I 'Control Valves 13.3.4 I 1 3.2 I M 'Small Hose Connections' 13.5.6.3 I 1 t1.11 AC Obstruction Investigation required Eves 3.3 M (If'Yes",see Deficiencies and Comments Section 14.3 Is No for Results.) lEves i e I ' f Yes 3.4 I M 'System Returned to Service 4.5.3 ' I 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) lEein Date . Riser A `I, C Deft '- Id Comments . ._,..7_' .__.•,� .;i indeateailelujil7ren(_devioes nrlpa o:thattre:e,mpciredvrreplaceC Ili 1111 I II--IIL_II I I 1E11E11 ( I I Ifif1 Form AES 2.1 Sept,3,2013 a Wet Pipe California Code of Regulations-Title 19 ■ Quarterly and 3 of 3 Fire Sprinkler System Inspection, Testing, and Maintenance 13•Annual Report OF c.a Property Information ....t.'" p t Contractor or Licensed Owner Information cty .t,IBuilding Names IA t{t Lip. t %p-e- ezit+u-R- 1 r ) t' Name Wilgus Fire Control Inc. 'Address(vb.` (J s—c �proms— E_> ''41;% ° 7/ Job# 3 662 S I ICity VvtcEge(: cam. ti ' E M D=Deficiency C=Comment (Indicate type) Item gate Riser D • G Deficiencies and Comments(corn.) fndicete SIegurpraeta,i Yices aid parts that xcra repai ed crrep'a: i _,. .__,:I L I-1 L,J 7 ❑ 171 LJL] I I---.I 1 L r i - L_ un nn nn rn uo L J uJ n i H li L1n El Li If. ,II Check here if additional Deficiencies and Comments are listed on Form AESe Number attached 0 See Correction Form AES 10 for corrected deficiencies. Number attached 1 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 WAx ,- Annual 3rd �'" `�� =r,--.. . t?�ia1 2d t.�`�] 0:Annual 41h=- 0 Annual Date t t --*i5 . IPrint Name - OA.t-t-t k -n---- ISignature- y rii�`, 1. Form AES 2.1 Sept,3.2013 .� - - r � - -- = - - - I