Loading...
HomeMy WebLinkAboutFAI20-0020 010-250-006 CF FS 1-9-24 Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19 Name: Orchard Hospital : Occupancy/Use. 240 Spruce St —F cA Address: Construction Type: �O t1 fizz TU1t 91 City: Gridley No. Stories: 1 I° Z ZIP: 95948 �D' Year Constructed: 111; f it Contact: Mike Newton `kN E Mr-- - Telephone: 701-7681 Wig iiu�iy�' ,op . t..E- • = •tRm ; . " ' U y e 'tsars ,. Name: Voltage Specialists Copy sent to: Address: 370 Apple Lane Q Owner Date: 01/09/24 City: Paradise ElFire AHJ Date: State: California ElContractor Date: • (530)624-4514 NOTES: Telephone: 1) For specific inspection,testing,and maintenance ,••1•0+ 880862 requirements and information,see NFPA 25,2011 CA License#: Edition as amended by California Code of Regulations, Title 19,§901 to§906. Job#: Mat Machado 2) Inspection items may be performed by the owner in Performed by: accordance with California Code of Regulations,Title 19, ' §904.1(a) "'P°°°ir" "r°'p'r"n"°""" 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 syst=m at end of inspection. Forms Included with this Report NFPA 25 Number of Forms N/A Fail* Pass Chapter © Automatic Sprinkler System 5 0 ❑ ❑ 0 ❑ Standpipe and Hose System 6 + 0 I ❑ I ElI ❑ ❑ Private Water Supply System 7 I 0 I ❑ I ❑ I ❑ ❑ Fire Pump 8 I 0 I ❑ I ❑ I ❑ ❑ Water Storage Tank 9 J 0 10 I LI I ❑ Water Spray System 10 j 0 1 Ell 0 I III ❑ Foam Water Sprinkler System 11 J 0I El ❑ I ❑ ❑ Water Mist System 12 J 0 I ❑ I ❑ I ❑ ❑ Concerns that are not deficiencies(i.e.Non-Sprinklered Areas) I ❑ Yes 1 0 No *See"Deficiencies and eornments"sectlon'at end of each respective form, - AES 1 September 3,2013 i k Wet Pipe California Code of Regulations-Title 19 Quarterly and Fire Sprinkler System Inspection,Testing,and Maintenance Annual Report 1 of 3 `11I Property Information .v- Cq�,-o Contractor or Licensed Owner Information i�~� �r j a 9b� 'Building Name Orchard Hospital y" A--- n i Name Voltage Specialists 'Address 240 Spruce St r4`3v'� ",� �1"� ' __%�%� Addres�370 Apple Lane `���RE Mp= City Paradise St. CA Zip 95969 'City Gridley License# 880862 Phone 530-362-2609 ° 'Contact Person 0 SFM Job#I-432 I Mike Newton p✓ CSLB Misc. Riser Information Main Drain Test(Annual) Riser - -- - Riser Main Drain (nit al Static Residual Final Static No. Location Diameter Diameter Pressure Pressure Pressure P,F,N/A 1 Outside Kitchen 4" 2" 1 I I I j I I I I r'—� I 11 I I I _.LJ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached [7 1 Quarterly Inspections I =Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item Description 25 Dat' Date DateI i Date * INFPA Refe en eed. 01/09/24 I i i- '' I 1.1 I Control Valves—Identification Sign I 13.3.1 P 1.2 I Control Valves—Inspection 13.3.2 P I 1.3 I Waterflow Alarm Devices 5.2.5 P I 1.4 I Supervisory Devices 5.2.5 P I 1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 P 1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi psi psi 1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi psi psi 1.8 I Pressure Readings Acceptable 5.2.4.1 P 1.9 I Hydraulic Design Information Sign (for hydraulically designed systems) 5 2 6 P 1.10 I General Information Sign (not required for system prior to 2007 edition of NFPA 13) 5'2'8 P 1.11 I Heat Tape 5.2.7 /A N/A N/A 1.12 I Spare Sprinklers 5.2.1.4 P 1.13 I Fire Department Connections 13.7 P 1.14 I Alarm Valves—Exterior Inspection 13.4.1 P 1.15 I Pressure Reducing Valves 13.5.1.1 I4/A N/A N/A 1.16 I Backflow Preventers 13.6.1 N/A N/A N/A 1.17 I Small Hose Connections-Hose Valve* 5.1.6, 13.5.2 Ni/A N/A N/A 13.5.5.1 'I 1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 14/A N/A N/A *Small hose connections are hose valves and optional hose supplied by the fire sprinklers(stem. They do not include Class I, II,or III standpipe systems. Form AES 2.1 Sept.3,2013 Wet Pipe California Code of Regulations-Title 19 Quarterly and Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report 2 of 3 Property Information o7Z�' .c p y Contractor or Licensed Owner Information 'Building NameOrchard Hospital f w 4K - v i Name I Voltage Specialists 'Address ����9, '41 •• Q�' Job#14132 k ICity Gridley % liRE MO:- ANNUAL INSPECTION,TESTING,AND MAINTENANCE Include ALL Quarterly Inspections Inspection T =Test M=Maintenance P Pass F=Fail N/A=Not Applicable N �C ''e o...I....on, :- = d a ' Iff rig 11t• ,°4rt 22_ 1.19 I Sprinklers 5.2.1 , I I. 1.20 I I 'Buildings(Freeze Protection) 4.1.1.1 I I Owner's Responsibility + N/A 1.21 I I 'Pipe and Fittings 5 2 2 I 1.22 I I 'Hangers 5.2.3 I 1.23 I I 'Seismic Braces 5.2.3 I 2.1 I T 'Field Service Test Required 5.3.1 If REQUIRED, Enter'F'until (Send Report to Fire Code Official) results are returned from Lab I 2.2 ' T 'Recalled Sprinklers Title 19 I I If not present=Pass: If present=Fail 904.1(c) 2.3 I T 'Water Flow Alarm Devices 5.3.3 f. 90 sec.maximum - (Enter Time) 13.2.6 I 129 sec. 2.4 I T 'Main Drain Test 13.2.5 (Enter data on Page 1 of this form) 13.3.3.4 1 i 2.5 I T 'Control Valve-Position 13.3.3.2 I 2.6 I T 'Control Valve—Operation 13.3.3.1 I 2.7 I T 'Supervisory Devices 13.3.3.5 I I2.8 I T jBackflow Preventer Assemblies 13.6.2 I N/A Small Hose Connections* 13.5.2.3 13.5.3.3? 2.9 T w/PRV Hose Valves—Partial Flow Test I N/A 12.10 I T IPRV—Fire Sprinkler Systems 13.5.1.3 I ' N/A I3.1 I M 'Control Valves 13.3.4 I I3.2 I M 'Small Hose Connections* 13.5.6.3 I I N/A Obstruction Investigation required Yes 3.3 M (If"Yes"see Deficiencies and Comments Section 14.31 E for Results.) No 3.4 I M 'System Returned to Service 4.5.3 1 Yes :. No Small hose connections are hose valves and optional hose supplied by the fire sprinkler sy;tem. They do not include Class I, II,or III standpipe systems. D=Deficienc C=Comment Indicate •e Item Date Riser D C ' Deficiencies and Comments Indicate ail equipment,devices and pa Is that were repaired or replaced I IVow I Form AES 2.1 Sept.3,2013 Wet Pipe California Code of Regulations-Title 19 Quarterly and 3 of 3 Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report _of cA 1,, Property Information fc4 p i, Contractor or Licensed Owner Information Building Name Orchard Hospital ;4 v i Name Voltage Specialists Address ��y� 'Jl� % Job# 14432 1 _4,7/ 'City Gridley ��Az.E MA D=Deficienc C=Comment Indicate t pe Item Date Riser D C Deficiencies and Comments(coot.) Indicate all equipment,devices and parts that were repaired or replaced f i H .1.1111.111.1.11 I 1 Check here if additional Deficiencies and Comments are listed on Form AES9 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. Check box if Annual Inspection,Testing&Maintenance Items are Competed in the Indicated Quarter Ill��rvl I - Sry �/RMm u�rvr�ry Fyn I i '� �III��hi �. � u ul it nr' � w III Qtl81�H 5 �IIII �' I I�'` � g �.,, PH � NIIII IJ I��I it I�w II "r 4"'• ^�i N ,' I� Ip', PiII PHI��lll i a rl�l6 III VI�U�uW'i'1PII tli; °° i�$ .Y � lu.VtlVVII�I9i III Ii Date 01/09/24 Print Name Mat Machado �A y SignatureDIX v �� Form AES 2.1 Sept.3,2013 ionuw „......., '4.— -''', VOLVOLTAGpEcIALIsTsiti � ; 370 Apple Lane, Paradise, CA 95969 Phone K0-624-4514 www.VoltageSpecialists.com t State of Calif Fire/Life Safety#113568 Calif C10,'C16 880862 NICET#87630 DIR 10000141915 Local 340 Live Scanned & Fire Life Safety Certified Personnel EP 2 - Tamper Switches & Water Flows Date: 1/9/24 Inspe tor: Mat Machado Location: Orchard Hospital Addr ss: 240 Spruce Street, Gridley Riser Time fdr W/F to Location # Device Type Report to Panel Pass Fail Notes Outside Medical Records WF-1 Water Flow 29 sect X On Riser Outside Kitchen TS-1 Tamper Switch 1 turn X L. Comments/Notes 1 EC.02.03.05 EP 25 Testing Activity:EP 2:Tampers and Flow Devices Required Frequency of activity:Quarterly For additional guidance,reference NFPA standard(s):NFPA 72-2016 Edition;Table 14.4.3.2; NFPA 25-Table 13.1.1.2;Reference 13.2.6 0.:' ''' 1/9/24 CUSTOMER SIGNATURE DATE TECH SIGNATURE VOLTAGPECIALISTS 370 Apple Lane, Paradise, CA 95969 www.VoltageSpecialists.com EP 10 - Quarterly Fire Department Inspections Date: 1/9/24 Inspector: Mat Machado 4J; Location: Orchard Hospital Address: 240 Spruce Street,Gridley FDC Riser Location I # Pass Fail I Note# j Cause of Failure Outside Kitchen I X I I I I I � i I I I I I I I I Comments/Notes EC.02.03.05 EP 25 Testing Activity:EP 10:Fire Department Connections Required Frequency of activity:Quarterly For additional guidance referenced NFPA standard(s):NFPA 25-2013 CA Edition;Table 13.1,1.2 Reference 13.7.1 Nur" /// C1P ' 1/9/24 CUSTOMER SIGNATURE DATE TECH SIGNATURE r r yO ,AGPECIALISTS 370 Apple Lane, Paradise, CA 95969 Phone 530L624-4514 www.VoltageSpecialists.com State of Calif Fire/Life Safety#113568 Calif C10/C 16 880862 NICET#87630 DIR 10000141915 Local 340 Live Scanned & Fire Life Safety Certified Per:>onnel EP 5 QUARTERLY ALARM VERIFICATION TEST Orchard Hospital 1/9/24 Customer Test Date Orchard Hospital CSM Site M onitoring Company 240 Spruce Street, Gridley 40-3704 Address Account Number ` ' Silent Knight 5280 8:20:41 9:33:38 Panel Type Panel Time Time Alarm Transmitted Pull Station 8:22:1k 9:34:09 Device Tested Monitoring co. Time Time Alarm Rec'd 31 seconds Gridley Police Department Time for Monitoring Company to Respond Fire Department 530-846-5678 Fire Dept Phone Number EC.02.03.05 EP 25 Testing Activity:EP 5:Emergency Services Notification Required Frequency of activity:Quarterly For additional guidance referenced NFPA standard(s):NFPA 72-2016 Edition;(Table 14.4.3.2) Y X 74100" vv � INSPECTOR SIGNATURE USTOMER SIGNATURE TEST DATE: 11/9/24