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HomeMy WebLinkAboutFAI15-0057 028-240-005 CF FA 10-09-2023 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: Inspection/Test Completion Date/Time: lig Supplemental Form(s)Attached: Yes (yes/no) 1. PROPERTY INFORMATION Name of property: Bangor Union Elementary School District - Annual Fire Alarm Inspection Address: 7549 Oro Bangor Highway Description of property: School Name of property representative: Address: Phone: (530) 679-2434 Fax: E-mail: 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: Rapid Response Monitoring Srevices Address: 400 West Division Street,Syracuse, NY 13204 Phone: (800)932-3822 Fax: E-mail: Account number: Z570983 Phone line 1: 1-844-414-0165 Phone line 2: 1-855-259-2649 Means of transmission: On Board Built in Dialer to Cell Dialer Entity to which alarms are retransmitted: Monitoring Company Phone: 1-800-932-3822 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 Manufacturer: Silent Knight Model number: 6820EVS 4.2 Software and Firmware Firmware revision number: N/A 4.3 System Power 4.3.1 Primary(Main)Power Nominal voltage: 120VAC Amps: 20 Location: Utility Room 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: Panel C3 Ckt 24 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: Rapid Response Time: 7:00AM Building management Contact: Staff Time: 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 ❑ ❑ Ground-fault monitoring 0 0 Supervision 0 0 Local annunciator 0 El Remote annunciators 0 0 In Front Office Remote power panels 0 0 1Next to FACP &Above Ceiling in Pantry ❑ ❑ 6.2 Secondary Power Visual Functional Description Inspection Test Comments Battery condition 0 ❑ Load voltage ❑ CI (2) 12v 14ah install 7/7/22 FACP Discharge test ❑ 0 (2) 12v 8ah install 7/7/22 FAPS 1 Charger test ❑ p (2) 12v 8ah install 11/21/22 FAPS 2 Remote panel batteries ❑ 0 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: Rapid Response Time: Building management Contact: Staff Time: 11:30AM Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if Contact: Time: required 8. SYSTEM RESTORED TO NORMAL OPERATION Date: Time: 9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72,2013 edition,Chapter 14. Signed: Printed name: Date: a 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 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: Printed name: Date: Organization: Title: Phone: 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. (4a LO I I 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: g Inspection/Test Completion Date/Time: Number of Supplemental Pages Attached: 6 1. PROPERTY INFORMATION Name of property: Bangor Union Elementary School District Address: 7549 Oro Bangor Highway 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector M97:P001 Gym Girls RR Pass Smoke Detector I M97:P002 Gym Boys RR Pass Smoke Detector M97:P003 Gyms Janitor Closet Pull Station M97:P006 Gym North Exit Pass Smoke Detector M97:P007 Gymnasium Smoke Detector M97:P008 Gymnasium Smoke Detector I M97:P009 Gymnasium I� Smoke Detector M97:P010 Gymnasium Pass Smoke Detector I M97:P011 Gymnasium Smoke Detector M97:P012 Gymnasium Pass Smoke Detector I M97:P013 Gymnasium Pass Smoke Detector M97:P014 Gymnasium Smoke Detector M97:P015 Gymnasium Smoke Detector I M97:P016 Gymnasium Smoke Detector M97:P017 Gymnasium Smoke Detector I M97:P018 Gymnasium Smoke Detector M97:P019 Gymnasium Smoke Detector M97:P020 Gymnasium Pass Smoke Detector I M97:P021 Gymnasium Duct Detector (2) M97:P022 Gym HVAC N/A Smoke Detector M97:P023 Gymnasium 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. (4a LO I I 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: 10/9/2023@7:00AM Inspection/Test Completion Date/Time: Number of Supplemental Pages Attached: 6 1. PROPERTY INFORMATION Name of property: Bangor Union Elementary School District Address: 7549 Oro Bangor Highway 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector M97:P024 Gymnasium Smoke Detector I M97:P025 Gymnasium Pull Station M97:P026 Gym West Exit Pass Smoke Detector I M97:P027 Gym Office Pass Heat Detectors M97:P028 Gym Office Attic Pass Smoke Detector M97:P029 Gym Foyer Storage Pull Station M97:P030 Gym Foyer Smoke Detector M97:P031 Gym Foyer Pass Smoke Detector I M97:P032 Gym Kitchen Storage Pass Smoke Detector M97:P033 Gym Utility Room Anus! M97:P035 Gym Kitchen Insp. 8/18/22 by Hayden Smoke Detector M97:P036 Gym Kitchen East Pull Station M97:P038 Gym East Exit Pass Smoke Detector I M97:P039 Gym Kitchen West I� Heat Detector M97:P040 Gym Kitchen Attic Pass Pull Station M97:P041 Gym Kitchen Exit I� Water Flow M97:P043 Pump House Riser Pass Tamper M97:P044 Pump House Tamper M97:P045 Pump House Pass Tamper M97:P046 Pump House Tamper M97:P047 Pump House 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. (4a LO I I 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: g Inspection/Test Completion Date/Time: g Number of Supplemental Pages Attached: 6 1. PROPERTY INFORMATION Name of property: Bangor Union Elementary School District Address: 7549 Oro Bangor Highway 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Tamper M97:P048 Pump House Supervisory M97:P049 Pump Running I� Trouble Monitor M97:P050 Pump Trouble Pass Supervisory M97:P051 Fire Pump Mis Set I� Water Flow M97:P052 Gym Riser Tamper M97:P053 Gym Riser Supervisory M97:P057 Gym PS Low Battery Heat Detector I M97:P058 Gym PS Attic Smoke Detector M97:P061 Gym Anteroom Heat Detector I M97:P062 Gym Restroom Attic Pass Smoke Detector M97:P063 Admin RR Pass Smoke Detector M97:P064 Admin Staff Room Pull Station M97:P065 Admin Reception Smoke Detector I M97:P066 Admin Reception Pass Heat Detectors M97:P067 Admin Attic (1) Pass (1) Visual Smoke Detector I M97:P068 Admin Reception Entry Smoke Detector M97:P069 Principals Office Pass Smoke Detector M97:P070 Business Office Storage Smoke Detector I M97:P071 Business Office Pass Smoke Detector M97:P074 Payroll Office Storage Smoke Detector M97:P075 Admin Entry Southwest 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 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: Inspection/Test Completion Date/Time: g Number of Supplemental Pages Attached: 6 1. PROPERTY INFORMATION Name of property: Bangor Union Elementary School District Address: 7549 Oro Bangor Highway 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector M97:P076 Nurse's Office Heat Detector I M97:P078 Admin Break Room Pass Smoke Detector M97:P079 Payroll Office I Smoke Detector I M97:P080 Kindergarten Girls RR I� Smoke Detector M97:P081 Kindergarten Boys RR Pass Smoke Detector M97:P082 Kindergarten Smoke Detector I M97:P083 Kindergarten I� Heat Detector M97:P084 Kindergarten Attic W Smoke Detector I M01:002 Old Admin Office Pass Smoke Detector M01:003 Old Principals Office (2) Heat Detectors M01:004 Old Admin Attic Rm. 4&Above FACP Smoke Detector M01:006 Teachers Break Room West I� Smoke Detector M01:007 Teachers Break Room East Pass Smoke Detector I M01:009 Old Admin Reception Above FACP I� Smoke Detector M01:010 Room 3 Smoke Detector M01:011 Room 3 Pass Smoke Detector I M01:012 Specialists Room Smoke Detector M01:013 Utility Room between Rooms 2&3 Smoke Detector M01:014 Room 2 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. (4a LO I I 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: 10/9/2023@7:00AM Inspection/Test Completion Date/Time: g Number of Supplemental Pages Attached: 6 1. PROPERTY INFORMATION Name of property: Bangor Union Elementary School District Address: 7549 Oro Bangor Highway 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector M01:015 Room 2 I Heat Detector I M01:016 Rooms 2&3 Attic I� Smoke Detector M01:017 Room 6 Heat Detectors I M01:018 Room 6 Attic (1) Pass (1) Visual Smoke Detector M01:019 Room 6 Pass Smoke Detector M01:020 Room 7 Heat Detector I M01:021 Room 7 Attic Smoke Detector M01:022 Room 7 Smoke Detector I M01:023 Rooms 5-7 Women's RR Smoke Detector M01:024 Rooms 5-7 Men's RR Smoke Detector I M01:025 Room 5 Pass Heat Detector M01:026 Room 5 Attic Pass Smoke Detector M01:027 Room 5 Smoke Detector I M01:028 Room 8 Heat Detector M01:029 Room 8 Attic Pass Smoke Detector I M01:030 Room 8 I� Smoke Detector M01:031 Room 9 Heat Detector M01:032 Room 9 Attic Smoke Detector I M01:033 Room 9 Smoke Detector M01:034 Room 10 (2) Heat Detectors I M01:035 Room 10 Attic (1) Pass (1) Visual 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. (4a LO I I 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: Inspection/Test Completion Date/Time: g Number of Supplemental Pages Attached: 6 1. PROPERTY INFORMATION Name of property: Address: 7549 Oro Bangor Highway 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector M01:036 Room 10 Pass Smoke Detector I M01:037 Room 11 Heat Detectors M01:038 Room 11 Attic (1) Pass (1) Visual Smoke Detector I M01:039 Room 11 I� Smoke Detector M01:040 Room 7 RR 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.