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HomeMy WebLinkAboutFAI CF FA 9 3 2024 Roseleaf 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: 9/03/2024@9:30AM Inspection/Test Completion Date/Time: 9/03/2024@3:00PM Supplemental Form(s)Attached: Yes (yes/no) 1. PROPERTY INFORMATION Name of property: Roseleaf Oroville -Annual Fire Alarm Inspection Address: 1900 20th Street Description of property: Name of property representative: Address: Phone: (530) 444-8511 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: Foothill Fire-Rapid Response Monitoring Services Address: 400 West Division Street,Syracuse, NY 13204 Phone: (800)932-3822 Fax: E-mail: Account number: Z571201 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: Rapid Response Phone: 1-800-932-3822 3. DOCUMENTATION On-site location of the required record documents and site-specific software: At FACP 4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Ademco Model number: Vista 128 Manufacturer: 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: Boiler 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 AC Ckt 2 4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: Battery Backup Location: FACP Battery type(if applicable): Sealed Lead Acid 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: 9:30AM Building management Contact: Staff Time: 9:30AM 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 0 ❑ Located on positive terminals of battery Trouble signals 0 0 Disconnect switches ❑ ❑ Ground-fault monitoring 0 0 Supervision 0 0 Local annunciator ❑ ❑ N/A Remote annunciators 0 p 1 in front lobby. 1 in Activity Room. 1 on B side Remote power panels 0 0 Telecom Room Side A ❑ ❑ 6.2 Secondary Power Visual Functional Description Inspection Test Comments Battery condition 0 ❑ Load voltage ❑ p (2) 12v 8ah install 6/24/24 Discharge test ❑ 0 Charger test ❑ 0 Remote panel batteries ❑ 0 (2) 12v 8ah install 6/17/22 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: 3:00PM Building management Contact: Staff Time: 3:00PM Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if Contact: Time: required 8. SYSTEM RESTORED TO NORMAL OPERATION Date: 9/03/2024 Time: 3:00AM 9. CERTIFICATION This system as specified herein has jbeen inspected and tested according to NFPA 72,2013 edition,Chapter 14. Signed: Jj./L�'I'T 1PW 4 � Printed name: Makenna Smith Date: 9/03/2024 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 Fail- Panel in trouble on arrival for Bell Ckt 2. Horn strobes in Building A North Hallway Starting from main lobby door down to common area did not activate when in alarm. 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: Printed name: Diana Date: 9/03/2024 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. t� I I o PROTECTION,LO 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: 9/03/2024@9:30AM Inspection/Test Completion Date/Time: 9/03/2024@3:00AM Number of Supplemental Pages Attached: 5 1. PROPERTY INFORMATION Name of property: Roseleaf Orovilie Address: 1900 20th Street 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Pull Stations 1 Side B West Area Pass Pull Stations 2 Side B Middle Area Pass Pull Stations 3 Side B East Area Pass Smoke Detector I 10 Room 19 Pass Smoke Detector 11 Side B Laundry Room Pass Smoke Detector I 12 Side B Medication Room Pass Smoke Detector 13 Room 21 Pass Smoke Detector I 14 Room 23 Pass Smoke Detector 15 Room 25 Pass Smoke Detector I 16 Room 27 Pass Smoke Detector 17 Room 29 Pass Smoke Detector I 18 Room 31 Pass Smoke Detector 19 Room 30 Pass Smoke Detector I 20 Room 28 Pass Smoke Detector 21 Room 26 Pass Smoke Detector I 22 Room 24 Pass Smoke Detector 23 Room 22 Pass Smoke Detector I 24 Room 20 Pass Smoke Detector 25 Side B East Rear Hallway Pass Smoke Detector I 26 Side B East Hallway- Center Pass Smoke Detector 27 Side B East Hallway- Front Area 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. t� I I o PROTECTION,LO 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: 9/03/2024@9:30AM Inspection/Test Completion Date/Time: 9/03/2024@3:00PM Number of Supplemental Pages Attached: 5 1. PROPERTY INFORMATION Name of property: Roseleaf Orovilie Address: 1900 20th Street 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector I 28 Side B West Rear Area Pass Smoke Detector 29 Side B West Middle Area Pass Smoke Detector I 30 Side B Reception Area Pass Smoke Detector 31 Side B West Front Area Pass Smoke Detector I 32 Side B Lounge West Area Pass Smoke Detector 33 Side B Lounge East Area Pass Smoke Detecor 34 Side B Break Room Pass CO Sensor 35 Side B Hot Water Room Visual Pass CO Sensor 36 Pantry Closet Visual Pass CO Sensor 37 Kitchen Visual Pass Water Flow I 1 Building Riser Pass Smoke Detector 10 Side A Soda Shop Pass Smoke Detector I 11 Room 2 Pass Heat Detector 12 Side A Nelson Storage Room Visual Pass Heat Detector 13 Side A Water Heater Closet Visual Pass Smoke Detector I 14 Room 4 Pass Smoke Detector 15 Nelson Wing Hallway Pass Smoke Detector I 16 Room 6 Pass Smoke Detector 17 Room 1 Pass Smoke Detector I 18 Room 3 Pass Smoke Detector 19 Room 5 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. t� I I o PROTECTION,LO 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: 9/03/2024@9:30AM Inspection/Test Completion Date/Time: 9/03/2024@3:00PM Number of Supplemental Pages Attached: 5 1. PROPERTY INFORMATION Name of property: Roseleaf Orovilie Address: 1900 20th Street 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector I 20 Room 7A Pass Smoke Detector 21 Room 7B Pass Smoke Detector I 22 Room 8B Pass Smoke Detector 23 Room 8A Pass Smoke Detector I 24 Activity Room Pass Smoke Detector 25 Activity Office Pass Smoke Detector I 26 Beauty Shop Pass Smoke Detector 27 Room 9A Pass Smoke Detector I 28 Room 9B Pass Smoke Detector 29 Room 10B Pass Smoke Detector I 30 Room 10A Pass Smoke Detector 31 Sierra Hallway Pass Smoke Detector I 32 Room 12 Pass Smoke Detector 33 Room 14 Pass Smoke Detector I 34 Room 16 Pass Smoke Detector 35 Room 18 Pass Smoke Detector I 36 Grand Wing Hallway Pass Smoke Detector 37 Room 11 Pass Smoke Detector I 38 Room 15 Pass Smoke Detector 39 Room 17 Pass Smoke Detector 40 Side A Janitorial Room 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. t� I I o PROTECTION,LO 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: 9/03/2024@9:30AM Inspection/Test Completion Date/Time: 9/03/2024@3:00PM Number of Supplemental Pages Attached: 5 1. PROPERTY INFORMATION Name of property: Roseleaf Orovilie Address: 1900 20th Street 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Smoke Detector I 41 Side A Dining Hallway Pass Smoke Detector 42 Side A Dining Room Pass Smoke Detector I 43 Laundry/Riser Room Pass Heat Detector 44 Kitchen Visual Pass Smoke Detector I 45 Side A Living Room Pass Smoke Detector 46 Side A Front Entry Hall Pass Smoke Detector I 47 Side A Conference Room Pass Smoke Detector 48 Reception Area Pass Smoke Detector I 49 Side A Front Entry Pass Smoke Detector 50 Side A Electrical Room Pass Pull Station I 51 Side A Front Entry Hallway Pass Pull Station 52 Side A Soda Shop Pass Pull Station I 53 Nelson Wing Pass Pull Station 54 Activity Room Pass Pull Station I 55 Sierra Wing Pass Pull Station 56 Grand Hall Pass Pull Station I 57 Side A Dining Room Pass Smoke Detector 58 Cottage Great Room Pass Smoke Detector I 59 Cottage East Room Pass Smoke Detector 60 Cottage West Room Pass Smoke Detector 61 Cottage Middle Room 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. OOTHILL FIR E C 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: 9/03/2024@9:30AM Inspection/Test Completion Date/Time: 9/03/2024@3:00PM Number of Supplemental Pages Attached: 5 1. PROPERTY INFORMATION Name of property: Roseleaf Orovilie Address: 1900 20th Street 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results Pull Station I 62 Cottage Pass CO Sensor 67 Cottage Hot Water Heater Room 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.