HomeMy WebLinkAboutFAI19-0007 CF FS 5 YR 2018 Pass SOUYRES Fire Protection
P.O. Box 3176 • Chico, California 95927 • Phone(530)345-1012 • Fax(530)345-1630
I spectioni Testing, rnd Maintenance Cover Shee
: ' NFPAZS°as ari enc ed b} CCR, "tie 19
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Name: AZ 4/ii,c/047 Occupancy/Use:
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Address: 7 X° Construction Type: .µ—'" O•
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/ Year Constructed: ' E-iiis
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Name: Brandon Squyres Copy sent to:
Address: P.O. Box 3176 1 Owner Date:
City: Chico C)Fire AHJ Date:
State: California %i Contractor Date:
(530)345-1012 NOTES:
Telephone: 1) For specific inspection, testing, and maintenance
275206 requirements and information, see NFPA 25, 2011
CA License#: Edition as amended by California Code of Regulations,
.;\ Title 19, §901 to§906.
Job#: Quarterly / Annual /(Yet
� 2) Inspection items may be performed by the owner in
Performed by: U/VV-t /V'f,f accordance with California Code of Regulations,Title 19,
§904.1(a)
Ileinalp j m Cb o e its star•s f i 6 , t1tee'n4 f tii*i1 loin s
Fonns;insluded witf tlaes Report .< I'4umber of Farms N/A IFair Parse
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ptr
Automatic Sprinkler System 5 a
❑ Standpipe and Hose System I 6 _ C C
❑ Private Water Supply System I 7 E C
❑ Fire Pump 8 C C
❑ Water Storage Tank 9 _ C C
❑ Water Spray System 10 — C L_._
❑ Foam Water Sprinkler System 11 — C C
❑ WMist System 12 _ III C
Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) 0 Yes Lr No
'Sod"Defciencjes anct 6.660iiiiiteggalawgfe d,e'f e i repecit e form
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SQUYRES Fire Protection
P.O. Box 3176 • Chico, California 95927 • Phone(530)345-1012 • Fax(530)345-1630
r r et •ipe "a i orma , o•e o< 'egu a ions- -1 e '` -wear 1 of 3
Fire Sprinkler system inspection,Testing, and Maintenance Report
Property Information Cqt��
p y ��+�,• -,,lob Contractor or Licensed Owner Information
•
Building Name /zz4, 4,,eyi, ;fit C J > Name Brandon Squyres
�' 9j,\, .i ,,z`' Address P,O, Box 3176
(Address 2, 4' Vie— City City Chico St. Ca Zip 95927
I (License# 275206 (Phone 530-345-1012
1 City 0'G4J I SFM IJob#
'Contact Person I 0 CSLB C-16 'Misc.
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Rif4
, !O/Msgs%/b %�0 �' ' ,AU�,ti0,.a, 4167'
Riser I Riser Main Grain Initial Static Residual Final Static
No. Location Diameter Diameter Pressure Pressure Pressure P,'F3 WA
4 I -1‘ /.1)/er e5c4/Yd,,c' I f 4 12' I 6° I Va 160 O F/NA
I I I I I I IP/F/NAI
I I I il I IP/FINAl
I I I I I I IP/F/NAI
I I I I I I IP/F/NAI
i J This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I
� C l % 4.1570ri7 fa / tri/f . f o„ 7r s, 7Y � � N sL A��9? t
/
1=Inspection T=Test M=Maintenance I P=Pass F=Fail N/A=Not Applicable I
item Description Refe encs Date Comments Only P,F,NIA
1.1 I Control Valves-Identification Sign 13.3.1 16 L7._/d lP ( N/A
1.2 I !Control Valves- Inspection 13.3.2 I ! It N/A
1.3 I Waterflow Alarm Devices 5.2.5 F N/A
1.4 I Supervisory Devices 5.2.5 I ' I 1 F N/A
1.5 I 'Gauges(Wet Pipe Systems) 5.2.4.1 ' ib F N/A
Hydraulic Design Information Sign
1.6 I I
(For hydraulically designed systems) 5.2.6 i
�P F ��
1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 Wit psi IP F /
1.8 I 'Enter Water Supply Pressure Above Riser Check 5.2.4.1 I I psi & F N/A
1.9 1 (Pressure Readings Acceptable 5.2.4.1 I I Y=/)F N/A1
1.10 I General Information Sign 5 2 8 P F /
(not required for system prior to 2007 Edition NFPA 13) I I
1.11 I IHeat Tape 5.2.7 I I EID F 0
1.12 I (Spare Sprinklers 5.2.1.4 I I ig F N/A
1.13 I 'Fire Department Connections 13.7 I 1 F N/A
1.14 I 'Alarm Valves-Exterior Inspection 13.4.1 I I F N/A
1.15 I 'Pressure Reducing Valves 13.5.1.1 I I IP F /A
1.16 I I IBackflow Preventers 13.6.1 1 IP
4A,,,..„.
1 SQUYRES Fire Protection
P.O. Box 3176 • Chico,California 95927 • Phone(530)345-1012 • Fax(530)345-1630
' 9:r,l Il IIIIIN uil i'I il' li iitll "lilt ill di ,,ii n 11 Yri a u
•I• I • I • • - • -�I• i - . I •' 2of3
Fire Sprinkler System' inspection,Testing, and Maintenance Report_
Property Information t '�` Contractor or Licensed Owner Information
tiO ! h
'cis' - \?,9
'Building Name f =Z7-1 , 0 Cam, iD f Name Brandon Squyres
!Address ��— ,� iieYA46 Job#
'Citya6l_ ( .. :
`_; i� i /�1j7 y;.wrai�ra;�•, ua,.- Drys y./ ,. may,. ,r..,,,,,,,eylrri y
I =Inspection T =Test M=Maintenance P=Pass F-Fail �N/A=Not Appli
cable
NFPA 25 CA ed.
item Description Date Comments Only I P,F,NfA
Reference
1.17 I Small Hose Connections-Hose Valve* I 5.1.6, 13. /
5.5.1 U ���� I5.2 P F
1 3.
1.18 I PRV—Fire Sprinkler Systems I 13.5.1.1 IP F /A
1.19 I Buildings (Freeze Protection) I 4.1.1.1 I Owner's Responsibility F N/A
1,20 I Sprinklers I 5.2.1 I V ) NIA
1.21 I Sprinklers-Accessible Concealed Space I 5.2.1.1.6 I110 F N/A
1.22 I Pipe and Fittings I 5.2.2 I IV F N/A
1.23 I Pipe and Fittings-Accessible Concealed Space I 5.2.2.3 I (Ii F N/A
1.24 I Hangers I 5.2.3 I F NIA i
1.25 I Hangers-Accessible Concealed Space I 5.2.3.3 I P,F N/A
1.26 I Seismic Braces I 5.2.3 I Y F N/A
1.27 I Seismic Braces-Accessible Concealed Space I 5.2.3,3 I I t F >I I/A
1.28 I I Unsprinklered Areas I CFC 901.4 I EYes ENo
2.1 l T Field Service Test Required �,
Send Report to Fire Code Official 5.3.1 results are returned from Lab �P F VV /KY
2.2 1 T Recalled Sprinklers i Title 19 I
If not present=Pass; If present=Fail 904.1(c) P F N/A
2.3 I T Water Flow Alarm Devices 5,3.3 I IFO90 secs max. Enter time 13.2.E sec. N/A'
2.4 T Main Drain Test 13.2.5 SOP F N/A
(Enter data on Page 1 of this form) 13.3.3.4
2.5 I T 'Control Valve- Position I 13.3.3.2 I I P F N/A
2.6 I T 'Control Valve—Operation I 13.3.3.1 I F N/A
2.7 I T ISupervisory Devices I 13.3.3.5 i IPON/A
2.8 I T IBackflow Preventer Assemblies I 13.6.2 I I IP F
2.9
Small Hose Connections* 13.5.2,3 P F T w!PRV Hose Valves—Partial Flow Test 13.5.3.3 I /
2.10 I T IPRV—Fire Sprinkler Systems I 13.5.1.3 I I IP F I
2.11 I T 'Pressure Gauges-Calibration I 5.3.2 I spF N/A
2.12 I T 'Small Hose Connections* I 13.5.6.2,2 .J I IP F I 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,
4 SQUYRES Fire Protection
, ,
P.O. Box 3176 • Chico,California 95927 • Phone(530)345-1012 • Fax(530)345-1630
Wet Pips California Code of Regulations-;Title 19 §Year,
Fire Sprinkler System Inspection, Testing, and Maintenance .: Report 3 of 3
Property Information aFrqqt7 Contractor or Licensed Owner Information
IBuilding Name &zo, Name Brandon SquyresAddress J �� � .'Q., Job#
!City k6-, , NAN I
� �` sue; '� �: „-w , r w _ '/-,,"' "
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
I I I NFPA 2$CA ett,I
item 1 Description Date 'Comments Only [PFNIA
Reference
3.1 I M 'Check Valves- Internal inspection I 13.4.2 J 1`7/, ' P F N/A
3.2 I
M !Control Valves I 13.3.4 I ( I (t/F N/A
3.3 I M IFDC Backflush 1 14.3.2.4 I I I N/A
IInternal Pipe Inspection-See Deficiencies and IF N/A
3.4 M Comments Section for Results. 14.2 FjeY
3.5 I M Obstruction Investigation Required. if"Yes", see 14.3 I I i/
I
Deficiencies and Comments Section for Results N/A
3.6 M System Returned to ServiceI 4.5.3 I I ✓Yes0F N/A
j i No
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
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Li Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached:
Li 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.
I Print Name I C:‘,04, IVi- c s 1
[Signature g turel_j31 '/ - Date 1.-2-?-10.-