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HomeMy WebLinkAboutFAI19-0015 056-030-030 FA 2022 oOTHILL FIRE flo PROTECTION INC. ji 170 Erma Court Chico CA 95928 (530)826-3013 C10#783132 SYSTEM RECORD OF INSPECTION AND TESTING This form is to be completed by the system inspection and testing contractor at the time of a system test. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. Inspection/Test Start Date/Time: 12/1/2022@7:00AM Inspection/Test Completion Date/Time: 12/1/2022@ 12:00PM Supplemental Form(s)Attached: Yes (yes/no) 1. PROPERTY INFORMATION Name of property: Youth with a Mission - Multipurpose Building -Annual Fire Alarm Inspection. Address: 15850 Richardson Springs Rd Description of property: Educational Name of property representative: Lizeth Gonzalez Address: Phone: (530) 893-6764 Fax: E-mail: craig.anderson@ywamchico.org 2. TESTING AND MONITORING INFORMATION Testing organization: Foothill Fire Protection, Inc. Address: 170 Erma Court Chico CA 95928 Phone: (530)826-3013 Fax: E-mail: Monitoring organization: Local System Address: Phone: Fax: E-mail: Account number: Phone line 1: Phone line 2: Means of transmission: Phone Entity to which alarms are retransmitted: Emergency Operator Phone: 911 3. DOCUMENTATION On-site location of the required record documents and site-specific software: FACP 4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Radionics Model number: D7024 Manufacturer: 4.2 Software and Firmware Firmware revision number: 4.3 System Power 4.3.1 Primary(Main)Power Nominal voltage: 1 20VAC Amps: 20 Location: Panel A Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF INSPECTION AND TESTING (continued) Overcurrent protection type: Breaker Amps: 20 Disconnecting means location: Circuit 25 4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: Battery Backup Location: FACP Battery type(if applicable): SLA capacity of batteries to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 5. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: Time: Building management Contact: Staff Time: 7:00AM Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if Contact: Time: required 6. TESTING RESULTS 6.1 Control Unit and Related Equipment Visual Functional Description Inspection Test Comments Control unit 0 0 Lamps/LEDs/LCDs 0 0 Fuses ❑ ❑ N/A Trouble signals 0 0 Disconnect switches ❑ ❑ Marked not Locked Ground-fault monitoring 0 0 Supervision 0 0 Local annunciator 0 l= Remote annunciators 0 0 Remote power panels 0 0 ❑ ❑ 6.2 Secondary Power Visual Functional Description Inspection Test Comments Battery condition 0 ❑ Load voltage ❑ p (2) 12v 8ah install no date FACP Discharge test ❑ 0 Charger test ❑ 0 Remote panel batteries ❑ p (2) 12v 7ah install 10/18/19 EVAC System Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF INSPECTION AND TESTING (continued) 6. TESTING RESULTS (continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices. 6.4 Notification Appliances Attach supplementary appliance test sheets for all notification appliances. 6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface/Signaling Line Circuit Interface/Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes No Time Comments Alarm signal ❑ ❑ N/A Alarm restoration ❑ ❑ N/A Trouble signal ❑ ❑ N/A Trouble restoration ❑ ❑ N/A Supervisory signal ❑ ❑ N/A Supervisory restoration ❑ ❑ N/A 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal ❑ ❑ N/A Alarm restoration ❑ ❑ N/A Trouble signal ❑ ❑ N/A Trouble restoration ❑ ❑ N/A Supervisory signal ❑ ❑ N/A Supervisory restoration ❑ ❑ N/A Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF INSPECTION AND TESTING (continued) 7. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Time: Building management Contact: Staff Time: 12:00PM Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if Contact: Time: required 8. SYSTEM RESTORED TO NORMAL OPERATION Date: 12/1/2022 Time: 12:00PM 9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72,2013 edition,Chapter 14. Signed: Printed name: Enrique Ramos Date: 12/1/2022 Organization: Foothill Fire Protection, Inc. Title: Inspector Phone: (530) 826-3013 Qualifications(refer to 10.5.3): C10 License(#783132) 10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE Pass - No issues found at time of Annual Fire Alarm Inspection. Note- ITV Located On Rear Wall Of Stage. -Batteries in EVAC system are low. 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: Printed name: Joy Coverstone Date: 12/1/2022 Organization: YWAM Title: Phone: 1-682-558-9815 Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. OOTHILL FIRE I I C O If. PROTECTION, INC. 170 Erma Court Chico CA 95928 (530)826-3013 C10#783132 INITIATING DEVICE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. It includes an initiating device test record. This form is to be completed by the system inspection and testing contractor at the time of the inspection and/or test. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Inspection/Test Start Date/Time: 12/1/2022@7:00AM Inspection/Test Completion Date/Time: 12/1/2022@ 12:00PM Number of Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: Youth with a Mission Address: 15850 Richardson Springs Rd 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Pull Station (5) I Zone 1 At Exits (5) Pass Smoke Detector Zone 2 Above FACP Pass Not Used Zone 3 N/A N/A Water Flow Zone 4 Building Riser Pass Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.