The URL can be used to link to this page

Home My WebLink AboutFAI20-0020 010-250-006 CF FA 7-12-24 Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19 t Vul a ^.H '�kmr y"" ,Mill ' Mrr • Property In a a �. u,ll �u i' r IP . lfi l" TT. iw"I hu. ,, i+ - J111 III 1 . _ .v,. Name: Orchard Hospital Occupancy/Use: 240 Spruce St F 1A Address: ID Construction Type: 1 /�Q�O'� C'�0I1 City: Gridley No.Stories: y�j 95948 ZIP: Year Constructed: /t/.? ��i�� 1� j � Mike Newton '\,;inE Mp>' Contact: �� Telephone: 701-7681 Name: Voltage Specialists Copy sent to: Address: 370 Apple Lane L Owner Date: 07/12/24 Paradise ❑Fire AHJ Date: City: State: California CIContractor Date: (530)6244514 NOTES: Telephone: 1)For specific inspection,testing,and maintenance 880862 requirements and information,see NFPA 25,2011 CA License#: Edition as amended by California Code of Regulations, Title 19,§901 to§906. Job#: 2)Inspection items may be performed by the owner in Performed by: Wyatt C. accordance with California Code of Regulations,Title 19, §904.1(a) Check box for each system inspected and enter the number of forms used for inspectio f d.GIIIIBIY � Checku boxes(Fail or Pass)to Indicate status of inspected system at end of inspecto° g Forms Included with this Report NFPA 25 Number of Forms N/A Fail* Pass Chapter El Automatic Sprinkler System 5 0 ❑ ❑ ✓❑ ❑ Standpipe and Hose System 6 I 0 I ❑ ❑ ❑ ❑ Private Water Supply System 7 I 0 I ❑ El ❑ ❑ Fire Pump 8 I 0 I ❑ ❑ ❑ ❑ Water Storage Tank 9 I 0 I El ❑ ❑ ❑ Water Spray System 10 I 0 I ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 I 0 I ❑ ❑ ❑ ❑ Water Mist System 12 I 0 I ❑ ❑ ❑ ❑ Concerns that are not deficiencies(i.e. Non-Sprinklered Areas) ❑Yes 0 No *See"Deficiencies and Comments"section at end of each respective form, s; l_'. AES 1 September 3,2013 k Wet Pipe California Code of Regulations-Title 19 Quarterly and 1 of 3 Fire Sprinkler System Inspection, Testing, and Maintenance Annual Report Property Information �� 9oF Contractor or Licensed Owner Information co 2 'Building Name Orchard Hospital v Name Voltage Specialists (Address 240 Spruce St v, �� Q Address 370 Apple Lane Pi _RE Mg"' City Paradise St. CA Zip 95969 City Gridley License# 880862 1Phone 530-362-2609 Contact Person I ❑ SFM IJob#I-432 Mike Newton I ✓Q CSLB 'Misc. Riser Information Main Drain Test (Annual) Rset Riser aisDranI l Static Residual Final Static P,F ,N/ANo• Diameter Diameter Pressure Pressure Pressure k 1 Outside Kitchen 4" I 2" I 60 45 60 P I i I I II I I I I I I I I I I I I I I I I JDThis building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached r---1 Quarterly Inspections •Inspection T a Test M a Maintenance P=Pass F=Fail N/A=Not Applicable u d' INFPA 25 CA ed.I Date Data, . s•r Dat F t, Reference T01/09/24 I , 03/13/24 -07/12'24 Ii 1.1 I Control Valves—Identification Sign I 13.3.1 I P P P 1.2 I Control Valves—Inspection I 13.3.2 I P I P P 1.3 I Waterflow Alarm Devices I 5.2.5 I P P P 1.4 I Supervisory Devices I 5.2.5 I P I P P Ir 1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 I P I P P 1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psil 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 P P 1 9 I Hydraulic Design Information Sign 5 2 6 P P P (for hydraulically designed systems) 1.10 I General Information Sign (not required for system prior to 2007 edition of NFPA 13) 5.2.8 P P P 1.11 I Heat Tape 5.2.7 N/A N/A N/A 1.12 I Spare Sprinklers 5.2.1.4 P P P 1.13 I Fire Department Connections 13.7 P P P 1.14 I Alarm Valves—Exterior Inspection 13.4.1 P P P 1.15 I Pressure Reducing Valves 13.5.1.1 N/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 I N/A N/A IN/A 13.5.5.1 1.18 I IPRV—Fire Sprinkler Systems 13.5.1.1 N/A N/A I N/A I *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 2.1 Sept.3,2013 i Wet Pipe California Code of Regulations-Title 19 Quarterly and 2 of 3 Fire Sprinkler System Inspection,Testing, and Maintenance Annual Report 'pF CA�� Property Information J�� p4� Contractor or Licensed Owner Information fxQ 9Z4# Building Name Orchard Hospital i I'.1 Name Voltage Specialists Address ��11; ,i�� Job#I-432 City Gridley � �"7Re thP:- ANNUAL INSPECTION, TESTING,AND MAINTENANCE Include ALL Quarterly Inspections =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable '� NFPA 25 CA ed. •' Item' �Descriptionamiii- I Reference I Date l ; Comments Only " P,F, A' 1.19 I Sprinklers I 5.2.1 107/12/24 I P 1.20 I 'Buildings(Freeze Protection) I 4.1.1.1 I I Owner's Responsibility N/A 1.21 I (Pipe and Fittings I 5.2.2 107/12/24 I I P 1.22 I 'Hangers I 5.2.3 107/12/24 I I P 1.23 I 'Seismic Braces I 5.2.3 107/12/24 I I P 2.1 T Field Service Test Required 5.3.1 If REQUIRED, Enter'F'until N/A 'Field Report to Fire Code Official) I I (results are returned from Lab I 2.2 T 'Recalled Sprinklers I Title 19 ' 07/12/24 I P If not present=Pass; If present=Fail 904.1(c) 2.3 T 'Water Flow Alarm Devices ' 5.3.3 107/12/24 127 sec. I P 90 sec.maximum - (Enter Time) 13.2.6 2 4 T 'Main Drain Test I 13.2.5 '07/12/24 I P (Enter data on Page 1 of this form) 13.3.3.4 2.5 T 'Control Valve-Position I 13.3.3.2 107/12/24 I I P 2.6 I T 'Control Valve-Operation I 13.3.3.1 107/12/24 I P 2.7 T 'Supervisory Devices I 13.3.3.5 107/12/24 I I P 2.8 T IBackflow Preventer Assemblies I 13.6.2 I I N/A 2.9 T 'Small Hose Connections* I 13.5.2.3 I I N/A w/PRV Hose Valves-Partial Flow Test 13.5.3.3 2.10 T IPRV-Fire Sprinkler Systems I 13.5.1.3 I I N/A 3.1 M 'Control Valves I 13.3.4 107/12/24 I I P 3.2 M 'Small Hose Connections* I 13.5.6.3 I I I N/A Obstruction Investigation required 3.3 M (If"Yes",see Deficiencies and Comments Section I 14.3 107/12/24 IB YNos P for Results.) EYeS3.4 MSystem Returned to Service I 4.5.3 I07/12/24 I P Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II,or Ill standpipe systems. D=Deficiency C=Comment Indicate type) M 4 te t Q`` t a t r4 llitl� M Ikpl� �7dili ml enC and Comments .. ,. y i � ,:p i 4 in u + �1" 6. ��ti t , ea a were repaired or replaced I J I Ri I 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 Property Information is�cDF Contractor or Licensed Owner Information h 5.1 'Building Name Orchard Hospital i i v Name Voltage Specialists Address Job# 1-432 ICity Gridley ‘N fiiE MP -' D=Deficienc C=Comment Indicate t .e Item Date Riser D C Deficiencies and Comments (cont.) Indicate all equipment,devices and parts that were repaired or replaced 1111111 I-- 1 I I F.-4 0I :1 I y 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 Completed in the Indicated Quarter QuarterDate �01/09/24�-�---.... � _..�03/13/24 � � Q 1st Annual 2nd Annu.:" 07/12/24 I Print Name Mat Machado Wyatt C. I Wyatt C. ,/7,, I Signature ��/ r, YYY��\ `it III Form AES 2.1 Sept.3,2013 ta.� VOLTAG e4„1oo, 4l PECIALISTs t AI, "4' .- .. 370 Apple Lane, Paradise, CA 95969 Phone 530-624-4514 www.VoltageSpecialists.com 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: 7/12/24 Inspector: Wyatt C. Location: Orchard Hospital Address: 240 Spruce Street, Gridley Riser Time for W/F to Location # Device Type Report to Panel Pass Fail Notes Outside Medical Records WF-1 Water Flow 29 sec. X On Riser Outside Kitchen TS-1 Tamper Switch 1.5 Turns X Comments/Notes 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 7/12/24 CUSTOMER SIGNATURE DATE TECH SIGNATURE m PECIALISTs• VOAG 370 Apple Lane, Paradise, CA 95969 Phone 530-624-4514 www.VoltageSpecialists.com 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 5 QUARTERLY ALARM VERIFICATION TEST Orchard Hospital 7/12/24 Customer Test Date Orchard Hospital CSM Site Monitoring Company 240 Spruce Street, Gridley 40-3704 Address Account Number Silent Knight 5280 9:17:25 9:33:46 Panel Type Panel Time Time Alarm Transmitted Pull Station 9:18:04 9:33:59 Device Tested Monitoring Co. Time Time Alarm Rec'd 13 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) INSPECTOR SIGNATURE CUSTOMER SIGNATURE TEST DATE: 17/12/24 VOLTAGA$PECIALISTS 370 Apple Lane, Paradise, CA 95969 www.VoltageSpecialists.com EP 10 - Quarterly Fire Department Inspections Date: 7/12/24 Inspector: Wyatt C. Location: Orchard Hospital Address: 240 Spruce Street, Gridley FDC Riser Location # Pass Fail Note# Cause of Failure 1 Outside Kitchen X Comments/Notes 1 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 • 7/12/24 CUSTOMER SIGNATURE DATE TECH SIGNATURE