HomeMy WebLinkAbout7000 AUBURN STREET25 -78 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR, Title 19
Property Information:
Name: ` Occupancy /Use:
oF C,q
0
9a
Address: r)
p Construction Type: co
City: No. Stories:
ZIP: Year Constructed:
ARE to
Contact:
Telephone:
Contractor Information: Number of System Risers
Jorgensen Company
Copy sent to:
2345 S. Fruutvale Ave.,1#1
3 owner Date
Bakersfield
Fire AHJ Dater
CA 93308 r.
Contractor Date
661-327-4362
NOTES:
1) For specific inspection, testing, and252995iQ/ /1 /
S[J.yCJC7 maintenance requirements and information,
see NFPA 25, 2002 Edition as amended by
Job # California Code of Regulations, Title 19, §901
to §906.
2) Inspection Items may be performed by the
Performed b
Print)
Owner in accordance with California Code of
Regulations Title 19 §904.1(a)
Forms included with this report NFPA 25
Chapter Number of Forms N/A FAIL* PASS
Automatic Sprinkler System 5
Standpipe and Hose Systems 6
Private Water Supply System 7
Fire Pump 8
Water Storage Tank 9
Water Spray System 10
Foam Water Sprinkler System 11
See "Deficiencies and Comments" section at end of each respective form.
State Fire Marshal AES 1 March 21, 2006
ANNEX B 1_ ,n
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25, Chapter 5 as amended by CCR, Title I9
Page 'I of 4
Date of Inspection, Testing, Maintenance: 1 , System Riser ID:
Property Information*
r- Type of System:F Cq, v jName: '/ 11
CJU%
Wet Pipe
Dry Pipe
Q ~' °9?
Address: / Preaction
Daily
Weekly
Preaction /Deluge Valves — Enclosure
temperature
Deluge y. F E MPQ'
City: l /<ef. %E %bF
1.2
Main Drain Test Results:
Initial Static Pressure: S.S (psi)
Residual Pressure: (psi)
Restored Static Pressure: SS" (psi)
Abbreviation Key:
I = Inspection
T = Test
M = Maintenance
A -O = After Operation
MI = Per Manufacturer's Instructions
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.1 1 Daily
Weekly
Preaction /Deluge Valves — Enclosure
temperature 12.4.3.1
1.2 1 Daily
Weekly
Dry Pipe Valves — Enclosure
temperature 12.4.4.1.1
1.3 1 Quarterly Gauges (Dry, Preaction, Deluge
Systems)
5.2.4.2
5.2.4.3 X
1.4 1 Quarterly Control Valves 12.3.2.1
1.5 1 Quarterly Alarm Devices 5.2.6
1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1
1.7 1 Quarterly Hydraulic nameplate 5.2.7
1.8 1 Quarterly Pipe and Fittings 5.2.2
1.9 1 Quarterly Sprinklers 5.2.1
1.10 1 Quarterly Spare Sprinklers 5.2.1.3
1.11 1 Quarterly Fire Department Connections 12.7.1
1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1
1.13 1 Quarter{ Quarterly
Preaction /Deluge Valves — Exterior
Inspection 12.4.3.1.6
1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1
1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4
1.16 1 Quarterly Backflow Preventers 12.6.1
1.17 1 Annually Buildings 5.2.5
State Fire Marshal AES 2 March 21, 2006
2540 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4
NFPA 25, Chapter 5 aslamended by CCR, Title 19
Date of Inspection, Testing, Maintenance:! System Riser ID: C7
Property information:
Name: u iJ /C> /J-
Type of System: o < opt?
7o Co W --5r.
Wet Pipe ,-Q; 9
Dry Pipe ` CAddress: Preaction
Deluge
City:
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.18 1 Annually Hangers 5.2.3
1.19 1 Annually Seismic Braces 5.2.3
1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3
1.21 1 5 Years Seismic Braces (Accessible concealed 5.2.3.3spaces)
1.22 1 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3spaces)
1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4
1.24 1 5 Years Alarm Valves — Interior Inspection 12.4.1.2
1.25 1 5 Years Alarm Valves - Strainers, filters, orifices 12.4.1.2
1.26 1 5 Years Check Valves — Interior Inspection 12.4.2.1 Ix
1.27 1 5 Years Preaction/Deluge Valves — Interior 12.4.3.1.7Inspection
1.28 1 5 Years Preaction/Deluge Valves - Strainers, 12.4.3.1.8filters, orifices
1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5
1.30 1 5 Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6
21 T Annually Alarm Devices (90 Sec) 5.3.3
12.2.7
12.2.6
22 T Annually Main Drain Test (Enterdata on Page 1) 12.2.6.1
12.3.3.4
2.3 T Annually Antifreeze Test 5.3.4
2.4 T Annually Control Valve - Position 12.3.3.1
2.5 T Annually Control Valve — Operation 12.3.3.1
2.6 T Annually Supervisory 12.3.3.5
2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1
2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10
2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2
State Fire Marshal AES 2 March 21, 2006
ANNEX B 9c_sz1
Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4
NFPA 25, Chapter 6 as amended bv CCR, Title 19
Date of Inspection, Testing, Maintenance: Riser ID: /''
Property Information:
Name: n4up'ly G f---y-4 -Z—.- Type of System: o_ ti
n / rAddress: 44 A bok tj
Wet Pipe .
Dry PipejPreaction
Deluge '4
cc•.__ 'S'rc
F/RE MPS
City:
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1
2.11 T Annuallyy ry Pipe Valve — Low Air Pressure 12.4.4.2.6Alarm
2.12 T AnnuallyY ry Pipe Valve — Quick- Opening 12.4.4.2.4Device
2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2
2.14 T Annually Backflow Preventer Assemblies 12.6.2
2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2
2.16 T 5 Years Gauges 5.3.2
2.17 T 5 Years Pressure Reducing Valve 12.5.1.2
2.18 T 5 Years Fire Department Connection Backflush 12.7.4
2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3
2.20 T 5 Years Sprinklers — Corrosive environment or 5.3.1.1.2
corrosive water
2.21 T 10 Years Sprinklers - Dry 5.3.1.1.1.5
2.22 T 20 Years Sprinklers - Fast Response 5.3.1.1.1.2
2.23 T 50 Years Sprinklers 5.3.1.1.1
2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4
2.25 T Sprinklers manufactured prior to 1920 5.3.1.1.1.1Replace
3.1 M Annually Control Valves 12.3.4
3.2 M Annually Preaction /Deluge Valves 12.4.3.3.2
3.3 M Annuallyy ry Pipe Valves /Quick- Opening 12.4.4.3.2Devices
3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3
3.5 M 5 Years Obstruction Investigation Chapter 13
State Fire Marshal AES 2 March 21, 2006
25 -82 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4
NFPA 26, Chapter 6 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: System Riser ID:
Property Information:
Name: /6r' /yPis Type of System: cQ 'Za, O'(JIJU /T
bZ ZS U U
Wet Pipe
Dry Pipe
z./ Z"- Z
a jAddress: Preactioncn,,;
Deluge
city:
item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the .Activity listed above:
See Continuation Page(s) fIndicate t e number of continuation pages)
ASS
FAIL
Signature Date
State Fire Marshal AES 2 March 21, 2006
25 -78 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR, Title 19
Property Information
Name: U koOccupancy /Use: rF
Address: Construction Type:
City: 18A No. Stories:
ZIP: 3,3 Year Constructed:
Contact: r96rA
Telephone: 2 --
Contractor Information: Number of System Risers
Jorgensen Company
Copy sent to:
2345 S. Fruitvale Ave., #1
Owner Date
Bakersfield '= Q 1rFireAHJDate
CA 93305
Contractor Date
551- 327 -4352
NOTES:
252995 1) For specific inspection, testing, and
maintenance requirements and information,
see NFPA 25, 2002 Edition as amended by
Job # L California Code of Regulations, Title 19, §901
to §906. Q n
Performed by: V , /VY yC,
2) Inspection Items may be performed by thePrint)
Owner in accordance with California Code of
Regulations Title 19 §904.1(a)
Forms included with this report NFPA 25
Chapter Number of Forms N/A FAIL.* PASS
APutomatic Sprinkler System 5
Standpipe and Hose Systems 6
Private Water Supply System 7
Fire Pump 8
Water Storage Tank 9
Water Spray System 10
Foam Water Sprinkler System 11
See "Deficiencies and Comments" section at end of each respective form.
State Fire Marshal AES 1 . March 21, 2006
F-1wh"JOW.W. 7
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25, Chapter 5 as amended by CCR, Title 19
Page 1 of 4
ap
Date of Inspection, Testing, Maintenance: —Z3— t' System Riser ID: 11Y7
Property Information:
Name: t, ) 1 ? Type of System:
Fail N/A
Wet Pipe f_
1.1
joAddress: t U pry Pape i
12.4.3.1
Deluge
1.2
FRE MPS
City:2
Dry Pipe Valves — Enclosure
temperature 12.4.4.1.1
Main Drain Test Results:
Initial Static Pressure: 15Z (psi)
Residual Pressure: (psi)
7
Restored Static Pressure: c. / (psi)
Abbreviation Key:
I = Inspection
T = Test
M = Maintenance
A -O = After Operation
MI = Per Manufacturer's Instructions
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.1 Daily
Weekly
Preaction /Deluge Valves — Enclosure
temperature 12.4.3.1
1.2 1 Daily
Weekly
Dry Pipe Valves — Enclosure
temperature 12.4.4.1.1
1.3 1 Quarterly Gauges (Dry, Preaction, Deluge
Systems)
5.2.4.2
5.2.4.3
1.4 1 Quarterly Control Valves 12.3.2.1
1.5 1 Quarterly Alarm Devices 5.2.6
1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1
1.7 I Quarterly Hydraulic nameplate 5.2.7
1.8 1 Quarterly Pipe and Fittings 5.2.2
1.9 1 Quarterly Sprinklers 5.2.1
1.10 1 Quarterly Spare Sprinklers 5.2.1.3
1.11 1 Quarterly Fire Department Connections 12.7.1
1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1
1.13 1 Quarter) Quarterly Preaction /Deluge Valves — Exterior
Inspection 12.4.3.1.6
1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1
1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4
1.16 1 Quarterly Backflow Preventers 12.6.1
1.17 1 Annually Buildings 5.2.5
State Fire Marshal AES 2 March 21, 2006
25 -80 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4
NFPA 25, Chapteer26 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: System Riser ID:
Property Information,_
A ^ 1 f // macUYd" /( Type of System: of oa<
Name: bG l7 ( Wet Pipe
Address: 7rno Buhup-iJ Dry Pipe ID
Preaction
Deluge
City:!
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.18 1 Annually Hangers 5.2.3
1.19 1 Annually Seismic Braces 5.2.3
1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3
1.21 1 5 Years Seismic Braces (Accessible concealed 5.2.3.3spaces)
1.22 I 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3spaces)
1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4
1.24 1 5 Years Alarm Valves — Interior Inspection 12.4.1.2
1.25 1 5 Years Alarm Valves - Strainers, filters, orifices 12.4.1.2
1.26 1 5 Years Check Valves - Interior Inspection 12.4.2.1
1.27 1 5 Years Preaction/Deluge Valves — Interior 12.4.3.1.7Inspection
1.28 1 5 Years Preaction/Deluge Valves - Strainers, 12,4.3.1.8filtersorifices
1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5
1.30 1 5 Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6
2.1. T Annually Alarm Devices (90 Sec) 5.3.3
12.2.7
12.2.6
2.2 T Annually Main Drain Test (Enterdata on Page 1) 12.2.6.1
12.3.3.4
2.3 T Annually Antifreeze Test 5.3.4
2.4 T Annually Control Valve - Position 12.3.3.1
2.5 T Annually Control Valve — Operation 12.3.3.1
2.6 T Annually Supervisory 12.3.3.5
2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1
2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10
2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.12
State Fire Marshal AES 2 March 21, 2006
ANNEX B 25 -81
Inspection, 'Testing, and Maintenance Fire Sprinkler System Page 3 of 4
NFPA 25, Chanter 5 as alrnended b CCR, Title 19
Date of Inspection, Testing, Maintenance: 7 ` System Riser ID:v /
Property Information:
IeI J G Type of System: OF CA//,
Name: / I Wet Pipe
Address: / Ay bU Dry Pipe
Preaction`:C' `''
Deluge , 9 5 F/RE tNPP
City: ElELb
Z
745E2,5--
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1
2.11 T Annually Dry Pipe Valve — Low Air Pressure 12.4.4.2.6Alarm
2.12 T AnnuallyY ry Pipe Valve — Quick - Opening 12.4.4.2.4Device
2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2
2.14 T Annually Backflow Preventer Assemblies 12.6.2
2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2
2.16 T 5 Years Gauges 5.3.2
2.17 T 5 Years Pressure Reducing Valve 12.5.1.2
2.18 T 5 Years Fire Department Connection Backflush 12.7.4
2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3
2.20 T 5 Years Sprinklers — Corrosive environment or 5.3.1.1.2corrosivewater
2.21 T 10 Years Sprinklers - Dry 5.3.1.1.1.5
2.22 T 20 Years Sprinklers - Fast Response 5.3.1.1.1.2
2.23 T 50 Years Sprinklers 5.3.1.1.1
2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4
2.25 T Sprinklers manufactured prior to 1920 5.3.1.1.1.1Replace
3.1 M Annually Control Valves 12.3.4
3.2 M Annually Preaction /Deluge Valves 12.4.3.3.2
3.3 M Annuallyy ry Pipe Valves /Quick- Opening 12.4.4.3.2Devices
3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3
3.5 M 5 Years Obstruction Investigation Chapter 13
State Fire Marshal AES 2 March 21, 2006
25 -82 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25, Chapter 55 as amended by CCR, Title 19
Page 4 of 4
Date of Inspection, Testing, Maintenance: ;lam ! System Riser ID: 1 r
Property Informatioon_:,,
Name: l l [& Type of System: o
Address: c.t_Y l C
4f_INet Pipe
C3 Dry Pipe
z'l
ry j
El Preaction
Deluge
city:
t
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activity listed above:
AkI6
See Continuation Page(s) Indicate the number of continuation pages)
ASS _
I FAIL Cy 23 L
signature Date
State Fire Marshal AES 2 March 21, 2006
25 -78 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR, Title 19
Property Information:
rV
oName: i1% // Occupancy /Use:
Address: Construction Type:
f' T Z
i r Iv
City: No. Stories: 0 , .
ZIP: Q( Year Constructed:
E M Q'
Contact: i4' Al e-V
Telephone:
Contractor Information: of System Risers
Jorgensen Company
Number
Copy sent to:
2345 S. FIruitvale Ave., 1 Owner Date
Bakersfield L.. Fire AHJ Date
CA 93306 :, :.,
Contractor Date
661-327-4352
NOTES:
262995 1) For specific inspection, testing, and
maintenance requirements and 'information,
see NFPA 25, 2002 Edition as amended by
Job # California Code of Regulations, Title 19, §901
to §906.
Performed by:
2) Inspection Items may be performed by thePrint)
Owner in accordance with California Code of
Regulations Title 19 §904.1(a)
Forms included with this report NFPA 25
Chapter Number of Forms NIA FAIL* PASS
Automatic Sprinkler System 5
Standpipe and Hose Systems 6
Private Water Supply System 7
Fire Pump 8
Water Storage Tank 9
Water Spray System 10
Foam Water Sprinkler System 11
See "Deficiencies and Comments" section at end of each respective form.
State Fire Marshal AES 1 March 21, 2006
25 -79
Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4
NFPA 25, Chapter 5 as amended b CCR, Title 'i9
Date of Inspection, Testing, Maintenance: 2j'!/ System Riser ID: 9(-06- -%-
Property Information:
Type of System: chi , Name:iJ 4.'! oF
o ? N'Wet Pipe ,tee,
Address: / t%
y
t/11i
D Pipe
Peacon
Pass
Deluge T
RE MPQ'
City:,`idl /G/
Daily
Weekly
Main Drain Test Results:
Initial Static Pressure: J (psi)
Residual Pressure: 44 (psi)
Restored Static Pressure: (psi)
Abbreviation Key:
I = Inspection
T = Test
M = Maintenance
A -0 = After Operation
MI = Per Manufacturer's Instructions
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.1 I Daily
Weekly
Preaction /Deluge Valves - Enclosure
temperature 12.4.3.1
1.2 1 Daily
Weekly
Dry Pipe Valves - Enclosure
temperature 12.4.4.1.1
1.3 1 Quarterly Gauges (Dry, Preaction, Deluge
Systems)
5.2.4.2
5.2.4.3
1.4 1 Quarterly Control Valves 12.3.2.1
1.5 1 Quarterly Alarm Devices 5.2.6
1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1
1.7 1 Quarterly Hydraulic nameplate 5.2.7
1.8 1 Quarterly Pipe and Fittings 5.2.2
1.9 1 Quarterly Sprinklers 5.2.1
1.10 1 Quarterly Spare Sprinklers . 5.2.1.3
1.11 1 Quarterly Fire Department Connections 12.7.1
1.12 1 Quarterly Alarm Valves - Exterior Inspection 12.4.1.1
1.13 I Quarter) Quarterly Preaction /Deluge Valves - Exterior
Ins ection 12.4.3.1.6
1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1
1.15 1 Quarterly Dry Pipe Valves - Exterior Inspection 12.4.4.1.4
1.16 1 Quarterly Backflow Preventers 12.6.1
1.17 1 Annually Buildings 5.2.5
State Fire Marshal AES 2 March 21, 2006
25 -80 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4
NFPA 26, Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance:
r / System Riser ID: /J —
Property Information:.
Type
Name: Gn/xx
of System:
Is3-Wet Pipe 9Z
Address: U l t//f/t J Dry Pipe 1a
Preaction dDeluge
City: e"r'/°l L•t%
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.18 1 Annually Hangers 5.2.3
1.19 1 Annually Seismic Braces 5.2.3
1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3
1.21 1 5 Years Seismic Braces (Accessible concealed 5.2.3.3spaces
1.22 1 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3
spaces)
1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4
1.24 1 5 Years Alarm Valves — Interior Inspection 12.4.1.2
1.25 1 5 Years Alarm Valves - Strainers, filters, orifices 12.4.1.2
1.26 1 5 Years Check Valves— Interior Inspection 12.4.2.1
1.27 1 5 Years Preaction /Deluge Valves — Interior 124.3.1.7Inspection
1.28 1 5 Years Preaction/Deluge Valves - Strainers, 12.4.3.1.8filters, orifices
1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5
1.30 1 5 Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6
2.1 T Annually Alarm Devices (90 Sec) 5.3.3
12.2.7
12.2.6
2.2 T Annually Main Drain Test (Enterdata on Page 1) 12.2.6.1
12.3.3.4
2.3 T Annually Antifreeze Test 5.3.4
2.4 T Annually Control Valve - Position 12.3.3.1 g--
2.5 T Annually ControlValve — Operation 12.3.3.1
2.6 T Annually Supervisory 12:3.3.5
2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1
2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10
2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2
State Fire Marshal AES 2 March 21, 2006
ANNEX B 25 -81
Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4
NFPA 25, Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: -2 —/ _ System Riser ID:
Property Information:
t /T CName: 13Jpe
Type of System: oF ?
R-Wet
Dry PipeAddress: f'tv(
Preaction
T Deluge ' F..,
CZP
ARE MPS
City: eLegD
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1
M
2.11 T Annuallyy ry Pipe Valve — Low Air Pressure 12.4.4.2.6Alarm
2.12 T Annuallyy ry Pipe Valve — Quick - Opening 12.4.4.2.4Device
2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2
2.14 T Annually Backflow Preventer Assemblies 12.6.2
2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2
2.16 T 5 Years Gauges 5.3.2
2.17 T 5 Years Pressure Reducing Valve 12.5.1.2
2.18 T 5 Years Fire Department Connection Backflush 12.7.4
2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3
2.20 T 5 Years Sprinklers — Corrosive environment or 5.3.1.1.2
corrosive water
2.21 T 10 Years Sprinklers - Dry 5.3.1.1.1.5
2.22 T 20 Years Sprinklers - Fast Response 5.3.1.1.1.2
2.23 T 50 Years Sprinklers 5.3.1.1.1
2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4
2.25 T Sprinklers manufactured prior to 1920 5.3.1.1.1.1Replace
3.1 M Annually Control Valves 12.3.4
3.2 M Annually Preaction /Deluge Valves 12.4.3.3.2
3.3 M Annuallyy ry Pipe Valves /Quick- Opening 12.4.4.3.2Devices
3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3
3.5 M 5 Years Obstruction Investigation Chapter 13
State Fire Marshal AES 2 March 21, 2006
25 -82 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 4. of 4
NFPA 26, Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: Z7-11 System Riser ID: [fib
Property Information:
Type
Name: /qua/ v I 1 -r of System: 04A-Wet Pipe
Dry PipeAddress: 76W% l9yWjJ Preaction +
Deluge
t
City:"S lC7
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activity listed above:
See Continuation Page(s) D (Indicate the number of continuation pages)
PASS /
FAII '' %
toSignatureDate
010
State Fire Marshal AES 2 March 21, 2006
25 -78 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR, Title 19
Property Information:
Name: (J UI 1 1CJ' Occupancy /Use: or- Cq4
Address: Construction Type: In
City: No. Stories:
ZIP: 70 Year Constructed:
Contact: Ja jvF, -yam
Telephone: 72- - %t(
Contractor Information: P Number of System Risers
Jorgensen Company
Copy sent to:
2345 S. F ruitvale Ave.,, #1 owner Date
BakersfWd 1
s i Fire AHJ Date - 07-11
CA 93306
Contractor Date
661-327-4352
NOTES:
262995 1) For specific inspection, testing, andz— maintenance requirements and information,
see NFPA 25, 2002 Edition as amended by
Job # California Code of Regulations, Title 19, §901
to §906.
Performed by: G r
2) Inspection Items may be performed by thePrint)
Owner in accordance with California Code of
Regulations Title 19 §904.1(a)
Forms included with this report NFPA 25
Chapter Number of Forms N/A FAIL* PASS
A'Automatic Sprinkler System 5
Standpipe and Hose Systems 6
Private Water Supply System 7
Fire Pump g
Water Storage Tank g
Water Spray System 10
Foam Water Sprinkler System 11
See "Deficiencies and Comments" section at end of each respective form.
State Fire Marshal AES 1 March 21, 2006
ANNEX B 25 -79
Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4
NFP/A 25, Chapter 5' as amended b CCR, Title '19
Date of Inspection, Testing, Maintenance: — System Riser ID:
Property Information:
Type of System: c
Name: F 0l,'Wet Pie
pAddress: C7 i Ji1,P U8eI Dry Pipe 'coil
Preaction
CY jv
A -O = After Operation
Deluge
MI =Per Manufacturer's Instructions
Item
City:'liS.°3 r/c7--- t 2
Frequency
Main Drain Test Results: Abbreviation Key:
I = Inspection
Initial Static Pressure: (psi) T =Test
M = Maintenance
Residual Pressure: —S-0 (psi) A -O = After Operation
Restored Static Pressure: &J— (psi)
MI =Per Manufacturer's Instructions
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.1 I Daily Preaction /Deluge Valves — Enclosure 12.4.3.1Weeklytemperature
1.2 1 Daily Dry Pipe Valves — Enclosure 12.4.4.1.1Weeklytemperature
1.3 1 Quarterly Gauges (Dry, Preaction, Deluge 5.2.4.2
Systems) 5.2.4.3
1.4 1 Quarterly Control Valves 12.3.2.1
1.5 1 Quarterly Alarm Devices 5.2.6-
1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1
1.7 1 Quarterly Hydraulic nameplate 5.2.7-
1.8 1 Quarterly Pipe and Fittings 5.2.2
IN-
1.9 1 Quarterly Sprinklers 5.2.1
1.1.0 1 Quarterly Spare Sprinklers 5.2.1.3
1.11 1 Quarterly Fire Department Connections 12.7.1
1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 r-
1.13 1 QuarterlyQuarter) Preaction /Deluge Valves — Exterior 12.4.3.1.6Inspection
1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1
1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 x
1.16 1 Quarterly Backflow Preventers 12.6.1
1.17 1 Annually Buildings 5.2.5
State f=ire Marshal AES 2 March 21, 2006
25 -80 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4
NFPA 25, Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: / "l System Riser ID: 0&190 'G
Property Information:
Type E
r Name: AllA"7JAV
of System:
Wet Pipe ,erg% ;
ooh
c
Address: !cam" 1 s
Dry Pipe IPPreaction
Deluge 45.ZQ'
M
city: /3 F /CZ-e2
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.18 1 Annually Hangers 5.2.3
1.19 1 Annually Seismic Braces 5.2.3x-
1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3
1.21 1 5 Years Seismic Braces (Accessible concealed 5.2.3.3spaces
1.22 1 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3
s a
1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4
1.24 1 5 Years Alarm Valves— Interior Inspection 12.4.1.2
1.25 1 5 Years Alarm Valves - Strainers, filters, orifices 12.4.1.2
1.26 1 5 Years Check Valves — Interior Inspection 12.4.2.1
1.27 1 5 Years Preaction /Deluge Valves — Interior 12.4.3.1.7Inspection
1.28 1 5 Years Preaction/Deluge Valves - Strainers, 12.4.3.1.8filters, orifices
1.29 1 5 Years Dry Pipe Valves _ Interior Inspection 12.4.4.1.5
1.30 1 5 Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6
2.1 T Annually Alarm Devices (90 Sec) 5.3.3
12.2.7
12.2.6
2.2 T Annually Main Drain Test (Enterdata on Page 1) 12.2.6.1
12.3.3.4
2.3 T Annually Antifreeze Test 5.3.4
2.4 T Annually Control Valve - Position 12.3.3.1 p
2.5 T Annually Control Valve — Operation 12.3.3.1
2.6 T Annually Supervisory 12.3.3.5
2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1
2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10
2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2
State Fire Marshal AES 2 March 21, 2006
ANNEX B 7S_R1
Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4
NFPA 25, Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: ~ " — System Riser ID: — L
Property Information:
Type of System:
Name: i z t l'7e - .i —"t—
moo__. t
Wet Pipe 0Q,
E3 Dry PipeAddress: a ,%y Preaction
Deluge
RE MPQ'
City:yF /E /1
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1
2.11 T Annuallyy ry Pipe Valve — Low Air Pressure 12.4.4.2.6Alarm
2.12 T Annuallyy ry Pipe Valve — Quick - Opening 12.4.4.2.4Device
2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2
2.14 T Annually Backflow Preventer Assemblies 12.6.2
2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2
2.16 T 5 Years Gauges 5.3.2
2.17 T 5 Years Pressure Reducing Valve 12.5.1.2
2.18 T 5 Years Fire Department Connection Backflush 12.7.4 x
2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3
2.20 j T 5 Years Sprinklers — Corrosive environment or 5.3.1.1.2
corrosive water
2.21 T 10 Years Sprinklers - Dry 5.3.1.1.1.5
2.22 T 20 Years Sprinklers - Fast Response 5.3.1.1.1.2
2.23 T 50 Years Sprinklers 5.3.1.1.1
2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 x
2.25 T Sprinklers manufactured prior to 1920 5.3.1.1.1.1Replace
3.1 M Annually Control Valves 12.3.4
3.2 M Annually Preaction /Deluge Valves 12.4.3.3.2
3.3 M Annuallyy ry Pipe Valves /Quick- Opening 12.4.4.3.2Devices
3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3
3.5 M 5 Years Obstruction Investigation Chapter 13
State Fire Marshal AES 2 March 21, 2006
25 -82 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4
NFPA 25, Chapter 6 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: l System Riser ID: rov- L
Property Information:_
Type
Name: -
of System: do -
Wet Pipe 9YJ
Address: 2 Vz) 4u gu eev Dry Pipe
Preaction,',
Deluge
City :f C/
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activity listed above:
it /` iiS ICA,
See Continuation Page(s) _ 0 (Indi to the number of continuation pages)
5Y PASS 7
FAIL - `
Si ure Date
State Fire Marshal AES 2 March 21, 2006
25 -78 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR, Title 19
Property Information:
Name: Occupancy /Use:
Address: 7- fZ j9(isu)2w Construction Type: CO !v
City: W - -p -, No. Stories:
ARE
ZIP: Year Constructed:
TdIPF`
Contact: -,-
Telephone:
Contractor Information: of System Risers
Jorgensen Company
Number
Copy sent to:
2346 S. Fruitvale Ave., I in Owner Date
Bakersfield
Fire AHJ Date
CA 933 08 '
o Contractor Date
661-327-4352
NOTES:
262996 1) For specific inspection, testing, and
maintenance requirements and information,
see NFPA 25, 2002 Edition as amended by
Job # California Code of Regulations, Title 19, §901
to §906.
2) Inspection Items may be performed by the
Performed by:
Print)
Owner in accordance with California Code of
Regulations Title 19 §904.1(x)
Forms included with this report NFPA 25
Chapter Number of Forms NIA FAIL* PASS
I Automatic Sprinkler System 5
Standpipe and Hose Systems 6
Private Water Supply System 7
Fire Pump 8
Water Storage Tank 9
Water Spray System 10
Foam Water Sprinkler System 11
See "Deficiencies and Comments" section at end of each respective form.
State Fire Marshal AES 1 March 21, 2006
ANNEX B 25 -79
Main Drain Test Results:
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25, Chapter 5'as amended by CCR, Title 19
Page 1 of 4
Date of Inspection, Testing, Maintenance. System Riser ID: tY"
Property Information:
Type of System:
Name: UL iJl 1a1; X-Wet Pipe Q. ^x.09?
Address: 7oao tAisu glZ) D. pOn
Frequency Description NFPA 25
Reference Fail N/A Pass
1.1
Deluge
Daily
City:
12.4.3.1
Main Drain Test Results: Abbreviation Key:
I = Inspection
Initial Static Pressure: (psi) T = Test
M = Maintenance
Residual Pressure: (psi) A -O = After Operation
12 MI = Per Manufacturer's Instructions
Restored Static Pressure: (psi)
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.1 I Daily Preaction /Deluge Valves — Enclosure 12.4.3.1Weeklytemperature
1.2 1 Daily Dry Pipe Valves — Enclosure 12.4.4.1.1Weeklytemperature
1.3 I Quarterly Gauges (Dry, Preaction, Deluge 5.2.4.2
Systems) 5.2.4.3
1.4 1 Quarterly Control Valves 12.3.2.1
1.5 1 Quarterly Alarm Devices 5.2.6
1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1
1.7 1 Quarterly Hydraulic nameplate 5.2.7-
1.8 1 Quarterly Pipe and Fittings 5.2.2
1.9 1 Quarterly Sprinklers 5.2.1
1.10 1 Quarterly Spare Sprinklers 5.2.1.3
1.11 1 Quarterly Fire Department Connections 12.7.1
1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1
1.13 1 Quarter) Quarterly
Preaction /Deluge Valves — Exterior 12.4.3.1.6Inspection
1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1
1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4
1.16 1 Quarterly Backflow Preventers 12.6.1
1.17 I Annually Buildings 5.2.5
State Fire Marshal AES 2 March 21, 2006
25 -80 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4
NFPA 25, Chapter 6 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: - 7 System Riser ID:
Property Information:
3 -6Type
a
of System:
Name: Wet Pipe "'Z'
Address: Dry Pipe
Preaction ,lp",,
Deluge 9T
RE M
City:
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
1.18 1 Annually Hangers 5.2.3
1.19 1 Annually Seismic Braces 5.2.3
1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3
1.21 1 5 Years Seismic Braces (Accessible concealed 5.2.3.3spaces)
1.22 1 5 Years Fittings (Accessible concealed 5.2.2.3spaa
1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4
1.24 1 5 Years Alarm Valves - Interior Inspection 12.4.1.2
1.25 1 5 Years Alarm Valves - Strainers, filters, orifices 12.4.1.2
1.26 1 5 Years Check Valves - Interior Inspection 12.4.2.1
1.27 1 5 Years Preaction/Deluge Valves - Interior 12.4.3.1.7Inspection
1.28 1 5 Years Preaction/Deluge Valves - Strainers, 12.4.3.1.8filters, orifices
1.29 1 5 Years Dry Pipe Valves - Interior Inspection 12.4.4.1.5
1.30 1 5 Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6
2.1 T Annually Alarm Devices (90 Sec) 5.3.3
12.2.7
12.2.6
2.2 T Annually Main Drain Test (Enterdata on Page 1) 12.2.6.1
12.3.3.4
2.3 T Annually Antifreeze Test 5.3.4
2.4 T Annually Control Valve - Position 12.3.3.1-
2.5 T Annually Control Valve - Operation 12.3.3.1
2.6 T Annually Supervisory 12.3.3.5
2.7 T Annually Preaction Valve - Priming Water 12.4.3.2.1
2.8 T Annually Preaction Valve - Low Air Pressure Alarm 12.4.3.2.10
2,9 T Annually Preaction Valve - Full Flow Trip Test 12.4.3.2.2
State Fire Marshal AES 2 March 21, 2006
ANNEX B 25 -81
Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4
NFPA 25, Chapter 5 as amended h CCR, Title 19
Date of Inspection, Testing, Maintenance: -77 /f System Riser ID: C. •'""
Property Information:
Type
Name: l dJ rr ,Z^ /7 "rh/
of System: o.
i'Wet Pipe Q•, C `,
Address: ?ay fVat jL.ri/ Dry Pipe
PreactionA`.0
Deluge ' 7"z ;Ze
ARE tVIPp'
City:F /R/%
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
2.10 T Annually Dry Pipe Valve - Priming Water 12.4.4.2.1
2.11 T Annuallyy ry Pipe Valve - Low Air Pressure
Alarm 12.4.4.2.6
2.12 T Annuallyy ry Pipe Valve - Quick - Opening
Device 12.4.4.2.4
2.13 T Annually Dry Pipe Valve - Trip Test 12.4.4.2.2
2.14 T Annually Backflow Preventer Assemblies 12.6.2 c
2.15 T 3 Years Dry Pipe Valve - Full Flow Trip Test 12.4.4.2.2.2
2.16 T 5 Years Gauges 5.3.2
2.17 T 5 Years Pressure Reducing Valve 12.5.1.2
2.18 T 5 Years Fire Department Connection Backflush 12.7.4
2.19 T 5 Years Sprinklers - Extra High Temperature 5.3.1.1.1.3-
2.20 T 5 Years Sprinklers - Corrosive environment or 5.3.1.1.2
corrosive water
2.21 T 10 Years Sprinklers - Dry 5.3.1.1.1.5
2.22 T 20 Years Sprinklers - Fast Response 5.3.1.1.1.2
2.23 T 50 Years Sprinklers 5.3.1.1.1
2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4
2.25 T Sprinklers manufactured prior to 1920 5.3.1.1.1.1Replace
3.1 M Annually Control Valves 12.3.4
3.2 M Annually Preaction /Deluge Valves 12.4.3.3.2
3.3 M Annuallyy ry Pipe Valves /Quick- Opening 12.4.4.3.2Devices
3.4 M Annually Dry Pipe Valve -Low Point Drains 12.4.4.3.3
3.5 M 5 Years Obstruction Investigation Chapter 13
State Fire Marshal AES 2 March 21, 2006
25 -82 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4
NFPA 25, Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: System Riser ID: (C &- t"
Property Information:_
Type System: AIIv J /jName: I`I (jLj
of oF
1 r/Vet Pipe °'v,
Address: le"N CI.V Dry Pipe
Preaction
Deluge
City:II=D
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activity listed above:
0 AJO ilrG
See Continuation Page(s) 21"')— In ' to the number of continuation pages)
PASS
FAIL
signature Date
M
State Fire Marshal AES 2 March 21, 2006