HomeMy WebLinkAboutFAI19-0015 056-030-030 FS 2022 Inspection, Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR, Title 19
Property Information:
Name: Youth with a Mission Occupancy/Use:
15850 Richardson Springs Rd of caC/`'1(
Address: Construction Type: s....--of
j�iF'
M-7 C� � -A�1�
City: Chico No. Stories: 1 S C� .fir a
ZIP: 95973 Year Constructed: f J:�S
Contact:
Telephone:
Contractor Information: Number of System Risers
Name: Foothill Fire Protection, Inc. Copy sent to:
Address: 170 Erma Court ❑✓ Owner Date: 12/01/22
City: Chico E Fire AHJ Date:
State: CA ❑Contractor Date:
(530)826-3013 NOTES:
Telephone: 1) For specific inspection,testing,and maintenance
783132 requirements and information,see NFPA 25,2011
CA License#: edition as amended by California Code of Regulations,
Title 19, §901 to§906.
Job#: 27333774
2)Inspection items may be performed by the owner in
Performed b Stephen Rampenthal 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.
Forms Included with Fail* Pass
--111, IIIII
❑./ Automatic Sprinkler System 5 E
❑ Standpipe and Hose System 6 ❑ ❑ 1 ❑
❑ Private Water Supply System 7 ❑ ❑ ❑
El Fire Pump 8 ❑ ❑ ❑
❑ Water Storage Tank 9 ❑ ❑ ❑
❑ Water Spray System 10 ❑ ❑
❑ Foam Water Sprinkler System 11 ❑ 0 1 ❑
❑ Water Mist System 12 0 ❑ 0 1 ❑
❑Concerns that are Not Deficiencies(i.e. Non-Sprinklered Areas) ❑ Yes 1 El 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 5-Year 1 of 3
Fire Sprinkler System Inspection, Testing, and Maintenance Report
Property Information ,r,�� 7fiQ4i Contractor or Licensed Owner Information
Building Name ; a/ Name Foothill Fire Protection, Inc.
Youth with a Mission ��� ��� f�`'� Address 170 Erma Court
AddressRichardson rin ' , E to.---- CityChico St. CA Zip95928
15850Springs Rd
(License# 783132 (Phone(530)826-3013
City Chico 10 SFM (Job#27333774
Contact Person I ❑ CSLB 'Misc.
Riser Location Riser Main Drain Initial Static Residual Final Static P,F, N/A
No. Diameter Diameter Pressure Pressure Pressure
1 North Exterior 2.5 1.25 90 80 90 P
I I I I 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 INSPECTION, TESTING,AND MAINTENANCE
Includes ALL Quarterly and Annual Inspections, Tests,and Maintenance Items
=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
NFPA 25 CA
Item Description ed. Date Comments Only P, F, N/A
Reference
1.1 I Control Valves—Identification Sign 13.3.1 12/01/22 P
1.2 I Control Valves—Inspection 13.3.2 12/01/22 P
1.3 I Waterflow Alarm Devices 5.2.5 12/01/22 P
1.4 I Supervisory Devices 5.2.5 12/01/22 NA
1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 12/01/22 P
1.6 I Hydraulic Design Information Sign 5.2.6 12/01/22 F
(For Hydraulically Designed Systems)
1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 12/01/22 psi NA
1.8 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 12/01/22 psi NA
1.9 I Pressure Readings Acceptable 5.2.4.1 12/01/22 P
1.10 I General Information Sign 5.2.8 12/01/22 NA
(Not Required for System Prior to 2007 Edition NFPA 13)
1.11 I Heat Tape 5.2.7 12/01/22 NA
1.12 I Spare Sprinklers 5.2.1.4 12/01/22 P
1.13 I Fire Department Connections 13.7 12/01/22 P
1.14 I Alarm Valves—Exterior Inspection 13.4.1 12/01/22 P
1.15 I Pressure Reducing Valves 13.5.1.1 12/01/22 P
1.16 I Backflow Preventers 13.6.1 12/01/22 P
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 ``,,, Contractor or Licensed Owner Information
of c A(��it
'Building Name Youth with a Mission 1 i wf �; Name Foothill Fire Protection, Inc.
'Address 15850 Richardson Springs Rd I +'';\ j„,,.0% Job# 27333774 1
Icity Chico I ``tiPi/FE to
ANNUAL INSPECTION, TESTING, AND MAINTENANCE
Include ALL Quarterly Inspections(See AES 2.1)
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
NFPA 25 CA ed.
Item Description Reference Date Comments Only P,F,N/A
1.17 I Small Hose Connections-Hose Valve* 5.1.6, 13.5.2 12/01/22 N/A
13.5.5.1
1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 12/01/22 N/A
1.19 I Buildings (Freeze Protection) 4.1.1.1 12/01/22 Owner's Responsibility P
1.20 I Sprinklers 5.2.1 12/01/22 P
1.21 I Sprinklers-Accessible Concealed Space 5.2.1.1.6 12/01/22 P
1.22 I Pipe and Fittings 5.2.2 12/01/22 P
1.23 I Pipe and Fittings-Accessible Concealed Space 5.2.2.3 12/01/22 P
1.24 I Hangers 5.2.3 12/01/22 P
1.25 I Hangers-Accessible Concealed Space 5.2.3.3 12/01/22 P
1.26 I Seismic Braces 5.2.3 12/01/22 P
1.27 I Seismic Braces-Accessible Concealed Space 5.2.3.3 12/01/22 P
1.28 I Unsprinklered Areas CFC 901.4 12/01/22 Yes Q No
2.1 T Field Service Test Required 5.3.1 12/01/22 If REQUIRED, Enter'F'until N/A
Send Report to Fire Code Official results are returned from Lab
2 2 T Recalled Sprinklers Title 19 12/01/22 P
If not present=Pass; If present=Fail 904.1(c)
2.3 T Water Flow Alarm Devices 5.3.3 12/01/22 45 sec. P
90 secs max. Enter time 13.2.6
2.4 T Main Drain Test 13.2.5 12/01/22 P
(Enter data on Page 1 of this form) 13.3.3.4
2.5 T Control Valve-Position 13.3.3.2 12/01/22 N/A
2.6 T Control Valve—Operation 13.3.3.1 12/01/22 P
2.7 T Supervisory Devices 13.3.3.5 12/01/22 N/A
2.8 T Backflow Preventer Assemblies 13.6.2 12/01/22 P
2 9 T Small Hose Connections* 13.5.2.3 12/01/22 N/A
w/PRV Hose Valves—Partial Flow Test 13.5.3.3
2.10 T PRV—Fire Sprinkler Systems 13.5.1.3 12/01/22 N/A
2.11 T Pressure Gauges-Calibration 5.3.2 12/01/22 P
2.12 T Small Hose Connections* 13.5.6.2.2 12/01/22 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 2.2 Sept.3,2013
Wet Pipe California Code of Regulations -Title 19 Year
Fire Sprinkler System Inspection, Testing, and Maintenance epo 3 of 3
Property Information .....--of CaC1,�h Contractor or Licensed Owner Information
'Building Name Youth with a Mission to -- t. y Name Foothill Fire Protection, Inc.
(Address 15850 Richardson Springs Rd �'+,`� i ‘ fI�s Job# 27333774i
(City Chico i' �7RE P
ANNUAL INSPECTION, TESTING, AND MAINTENANCE
Include ALL Quarterly Inspections(See AES 2.1)
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item I I Description I N Referencee Comments Only I P,F,N/A
3.1 I (Check Valves- Internal inspection I 13.4.2 I 12/01/22 I I N/A
3.2 I (Control Valves I 13.3.4 I 12/01/22 I I P
3.3 I IFDC Backflush I 14.3.2.4 I 12/01/22 I I P
3.4 I 'Internal Pipe Inspection-See Deficiencies and I
14.2 I 12/01/22 I Yes IP
Comments Section for Results. j No
3.5
I I Obstruction Investigation Required. If"Yes", See I
14.3 I 12/01/22 I 1N/A
Deficiencies and Comments Section for Results
3.6 I 'System Returned to Service I 4.5.3 I 12/01/22 I Nos I P
D=Deficiency C=Comment (Indicate type)
Item I Date I Riser I D I C I Deficiencies and Comments
Indicate all equipment,devices and parts that were repaired or replaced
FAILED ITEMS THAT SHALL BE CORRECTED FOR PASSING REPORTS:
1.6 12/1/22 1 X Missing hydraulic design information sign.
❑Check here if additional Deficiencies and Comments are listed on Form AES 9. 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.
Print Name I Stephen Rampenthal
Signature I Date 12/01/22
Form AES 2.2 Sept.3,2013