HomeMy WebLinkAboutINSP FIRE PROTECTION SYSTEM 6/22/201125- INSPECTION, TES'T'ING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Cover Shee-VNFPA25asamendedbyCCR. Title 19
Property Information: P4 VCF -%
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1
Name: l f Clg r 1 O A Occupancy /Use: 4AEFbl L/4-(_
Address: /cw /T Construction Type:
City: l'J'IGC fJ No. Stories:
ZIP: 3 Year Constructed:
Contact: ( 1' G t C COA, 7— COrAIVI I On t
Telephone
Contractor Information:
Name:
NTH `
N clCS.
Address: J pQ S ( IGr%4y,
City:
n /
State: l
Telephone: (61)
CA License# s D
Job #
Performed by: ) -& %,0b
Print)
Note: Contractor information may be pre - printed
I Number of System Risers
Copy sent to:
Owner Date
uQ_
it N
C
r'
Fire AHJ Date _
dContractor Date 7i
NOTES:
1) For specific inspection, testing, and
maintenance requirements and information,
see NFPA 25, 2002 Edition as amended by
California Code of Regulations, Title 19, §901
to §906.
2) Inspection Items may be performed by the
Owner in accordance with California Code of
Reaulations Title 19 6904.1(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
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:
Frequency
Property Information: .
CAI n(AZ&
Type petystern:
Q Wet Pie
f c." A4 , . p1Name:
Address:
T C
Dry Pipe
Preaction
co •a,C,
IN
1
Deluge,
12.4.3.1
RE MPQ
City:
1.2 1
Main Drain Test Results:
Initial Static Pressure: 70 (psi)
Residual Pressure: 52 (psi)
I / Restored Static Pressure: lD: (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
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 Sprinklers 5.2.1 1
1.9 1 Quarterly Spare Sprinklers 5.2.1.3
1.10 1 Quarterly Fire Department Connections 12.7.1
1.11 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1
1.12 1 Quarterly Preaction /Deluge Valves — Exterior Inspection 12.4.3.1.6
1.13 1 Quarterly Pressure Reducing Valves 12.5.1.1
1.14 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4
1.15 1 Quarterly Backflow Preventers 12.6.1
1.16 1 Annually Pipe and Fittings 5.2.2
1.17 I Annually Buildings 5.2.5
State Fire Marshal AES 2 June 17, 2008
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25 Chapter 5 as amended by CCR Title 19
Page 2 of 4
Frequency Description NFPA 25
Reference
Date of Inspection, Testing, Maintenance: -,7 System Riser ID:
Pass
Property Information:
Name: (I Z 1
s' j / Address: -/ L "'
Type 9,&ystem:
Cpl Wet Pipe
Dry Pipe
Preaction
of CAS/ 11 tt. Q 0p
n
cry
Hangers
Deluge
J
1.19
City.
Annually Seismic Braces
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
spaces) 5.2.3.3
1.22 1 5 Years Pipe and Fittings (Accessible concealed
spaces) 5.2.2.3
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 Inspection 12.4.3.1.7
1.28 1 5 Years Preaction /Deluge Valves - Strainers, filters,
orifices 12.4.3.1.8
1.29 I 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
2.2 T Annually Main Drain Test (Enter data on Page 1)
12.2.6
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
State Fire Marshal AES 2 June 17, 2008
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25 Chapter 5 as amended by CCR Title 19
Page 3 of 4
Date of Inspection, Testing, Maintenance: Z L / System Riser ID:
NFPA 25
Reference
Property Information:
I . 1a.,
Name: i'C lV[N I c-
Type o System: oq< %
o
2.9
Wet Pipe ti
Address: j
Dry Pipe
Preaction
2.10 T
Deluge,' P
City: -fJl iL.
Wi.
u
AREMPS
2.11 T
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2
2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1
2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6
2.12 T Annually Dry 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
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
corrosive water 5.3.1.1.2
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 —
Replace 5.3.1.1.1.1
3.1 M Annually Control Valves 12.3.4
3.2 M Annually Preaction /Deluge Valves 12.4.3.3.2
3.3 M Annually Dry Pipe Valves /Quick- Opening Devices 12.4.4.3.2
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 June 17, 2008
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25 Chapter 5 as amended by CCR, Title 19
Page 4 of 4
Date of Inspection, Testing, Maintenance: (P Z11 System Riser ID:
Property Information:
Name: 1/' c /`' 1 c'-
Type o ystem: of a,,ot1 -G'`'
Address: 5
Wet Pipe
Dry Pipe
Preaction
iZY
iyoDeluge Qy
City: n
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activity listed above:
5-- f?- .
See Continuation Page(s) _ (In ca num of continuation pages)
P SS
FAIL
Signature Date
State Fire Marshal AES 2 June 17, 2008