HomeMy WebLinkAboutFAI CF FS 8 2023 Roseleaf Fail Inspection, Testing, and Maintenance Cover Sheet
NFPA25 as amended by CCR, Title 19
Property Information:
Name: Roseleaf Oroville Occupancy/Use:
Address: 1900 20th Street Construction Type: �,�ti0f CA47fikiF
1
City: Oroville No. Stories: 1 "co rx( t l 75• I.I`
ZIP: 95965 Year Constructed: 2001 f` ,% ��,s
Diana Bingham �� E "�
Contact:
Telephone: (530)813-6217
Contractor Information: Number of System Risers
Name: Foothill Fire Protection, Inc. Copy sent to:
Address: 170 Erma Court ❑✓ Owner Date: 08/21/23
City: Chico E Fire AHJ Date: 08/21/23
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#: 30387161
2)Inspection items may be performed by the owner in
Performed b Doug Goebel 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
1E1
❑./ Automatic Sprinkler System 5 =-Hil, 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 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
of CA(`41
Property Information ( - 7fiQ)I, Contractor or Licensed Owner Information
Building Name i is I Name Foothill Fire Protection, Inc.
Roseleaf Oroville �4�'� 4.,,,..
Address 170 Erma Court
(Address 1900 20th Street ti.ilii.� _ City Chico St. CA Zip 95928
(License# 783132 (Phone(530)826-3013
City Oroville I❑ SFM (Job#30387161
IContact Person Diana Bingham I ❑ CSLB 'Misc.
Riser Location Riser Main Drain Initial Static Residual Final Static P,F, N/A
No. Diameter Diameter Pressure Pressure Pressure
1 Laundry Room 4 2 73 53 80 P
I I I I 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 08/21/23 P
1.2 I Control Valves-Inspection 13.3.2 08/21/23 P
1.3 I Waterflow Alarm Devices 5.2.5 08/21/23 P
1.4 I Supervisory Devices 5.2.5 08/21/23 NA
1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 08/21/23 P
1.6 I Hydraulic Design Information Sign 5.2.6 08/21/23 P
(For Hydraulically Designed Systems)
1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 08/21/23 psi NA
1.8 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 08/21/23 psi P
1.9 I Pressure Readings Acceptable 5.2.4.1 08/21/23 P
1.10 I General Information Sign 5.2.8 08/21/23 NA
(Not Required for System Prior to 2007 Edition NFPA 13)
1.11 I Heat Tape 5.2.7 08/21/23 NA
1.12 I Spare Sprinklers 5.2.1.4 08/21/23 P
1.13 I Fire Department Connections 13.7 08/21/23 P
1.14 I Alarm Valves-Exterior Inspection 13.4.1 08/21/23 P
1.15 I Pressure Reducing Valves 13.5.1.1 08/21/23 P
1.16 I Backflow Preventers 13.6.1 08/21/23 NA
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 Roseleaf Oroville 1i"{ )5;r Name Foothill Fire Protection, Inc.
(Address 1900 20th Street 1 +'';\ Q�,� Job# 30387161
'City Oroville I ti.;�E�'R
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 08/21/23 N/A
13.5.5.1
1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 08/21/23 N/A
1.19 I Buildings (Freeze Protection) 4.1.1.1 08/21/23 Owner's Responsibility P
1.20 I Sprinklers 5.2.1 08/21/23 F
1.21 I Sprinklers-Accessible Concealed Space 5.2.1.1.6 08/21/23 P
1.22 I Pipe and Fittings 5.2.2 08/21/23 P
1.23 I Pipe and Fittings-Accessible Concealed Space 5.2.2.3 08/21/23 P
1.24 I Hangers 5.2.3 08/21/23 P
1.25 I Hangers-Accessible Concealed Space 5.2.3.3 08/21/23 P
1.26 I Seismic Braces 5.2.3 08/21/23 P
1.27 I Seismic Braces-Accessible Concealed Space 5.2.3.3 08/21/23 P
1.28 I Unsprinklered Areas CFC 901.4 08/21/23 Yes Q No
2.1 T Field Service Test Required 5.3.1 08/21/23 If REQUIRED, Enter'F'until F
Send Report to Fire Code Official results are returned from Lab
2 2 T Recalled Sprinklers Title 19 08/21/23 P
If not present=Pass; If present=Fail 904.1(c)
2.3 T Water Flow Alarm Devices 5.3.3 08/21/23 61 sec. P
90 secs max. Enter time 13.2.6
2.4 T Main Drain Test 13.2.5 08/21/23 P
(Enter data on Page 1 of this form) 13.3.3.4
2.5 T Control Valve-Position 13.3.3.2 08/21/23 P
2.6 T Control Valve—Operation 13.3.3.1 08/21/23 P
2.7 T Supervisory Devices 13.3.3.5 08/21/23 N/A
2.8 T Backflow Preventer Assemblies 13.6.2 08/21/23 N/A
2 9 T Small Hose Connections* 13.5.2.3 08/21/23 N/A
w/PRV Hose Valves—Partial Flow Test 13.5.3.3
2.10 T PRV—Fire Sprinkler Systems 13.5.1.3 08/21/23 P
2.11 T Pressure Gauges-Calibration 5.3.2 08/21/23 P
2.12 T Small Hose Connections* 13.5.6.2.2 08/21/23 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 Roseleaf Oroville ;" --.. / q i Name Foothill Fire Protection, Inc.
(Address 1900 20th Street +'+M3 .� 7/ 1 Job# 30387161
(city Oroville `.,� a 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 References Date Comments Only I P,F,N/A
3.1 I (Check Valves- Internal inspection I 13.4.2 I 08/21/23 I I N/A
3.2 I (Control Valves I 13.3.4 I 08/21/23 I I P
3.3 I IFDC Backflush I 14.3.2.4 I 08/21/23 I I P
3.4 I 'Internal Pipe Inspection See Deficiencies and I 14.2 I 08/21/23 I ❑✓ Yes IP
Comments Section for Results. ri No
3.5
I I Obstruction Investigation Required. If"Yes", See I 14.3 I 08/21/23 I 1N/A
Deficiencies and Comments Section for Results
3.6 I (System Returned to Service I 4.5.3 I 08/21/23 I III 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
1.19 08/21/23 1 X Corroded Sprinklers in the following areas: (13) CH,QR,155 CH-401
(1) Middle Wing Janitors Closet(1) Room 8 Restroom (1) Room 11 Restroom,
(1) Room 12/14 Restroom, (1) Room 15/17 Restroom (1) Room 16/18 Restroom
(2) South East Patio, (5) Riser Room,
2.1 08/21/23 X Field Service Test Required sprinklers dated (2001) CH,QR,155 CH-401
1.19 08/21/23 1 X Did Not Enter THE FOLLOWING AREAS:
Upper Wing Maintenance Closet
❑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 Doug Goebel
Signature I Date 08/21/23
Form AES 2.2 Sept.3,2013