HomeMy WebLinkAboutINSP FIRE PROTECTION SYSTEM 9/16/201125 -78 INSPECTION, TESTING, ANI AINTENANCE OF WATER -BASED FIRE PROTE TION SYSTEMS
Inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR. Title 19
Property InformatiQG
Name: Mi;hi"CAIt Occupancy /Use: /14E®1dAL—
Address: onstruction Type:
City: rl;` — D No. Stories: iT
ZIP: 933/3 Year Constructed:
Contact: GC_ t'
pC
D% r(/IE Cj/9L
Telephone: KQ
Contractor Information:
Name: MA &LIZ d CSC
Address: c • l (
n ^
City: CGd/
State: (L'
Telephone: ("61
CA License#
Job #
Performed by: '
Print)
Note: Contractor information may be pre -pr
I- Number of System Risers
Copy sent to:
Owner Date
Fire AHJ Date
Aontractor Date
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)
F s included with this report NFPA 25
Chapter Number of Forms N/A FAIL* PASS
efAutomatic 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 Iby CCR Title 19
Page 1 of 4
Date of Inspection, Testing, Maintenance: %% / System Riser ID:
Initial Static Pressure: 7!E (psi)
Property Informatjpw ,-
i
L
Type of o..' Cad %1t1
Name: l W /
Address:
et Pipe
Dry Pipe
Preaction
r,` 011, v
MI = Per Manufacturer's Instructions
Deluge
Item Activity Frequency
City:
NFPA 25 Fail
Main Drain Test Results: Abbreviation Key:
I = Inspection
Initial Static Pressure: 7!E (psi) T = Test
M = Maintenance
Residual Pressure: (psi) A -.0 = After Operation
MI = Per Manufacturer's Instructions
Restored Static Pressure: (psi)
Item Activity Frequency Description NFPA 25 Fail N/A PassReference
1.1 1 Daily Preaction /Deluge Valves — Enclosure 12.4.3.1Weeklytemperature
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
1.9 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 1 Annually Buildings 5.2.5
State Fire Marshal AES 2 June 17, 2008
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25, Ch ter 5 as amended i by CCR, Title 19
Page 2 of 4
Date of Inspection, Testing, Maintenance: 1(O System Riser ID:
NFPA 25
Reference
Property Information:
Name: At Zy-
Address:
Type c FYstem:
L1 Wet Pipe
D PieDryp'
Preaction
of cat,t1t
1.18
Deluge
Annually
City:C'i -t!•
5.2.3
1.19
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 I 5 Years Seismic Braces (Accessible concealed
spaces) 5.2.3.3
1.22 1 5 Years Pipe and Fittings (Accessible concealed
spaces) 52.2.3
1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4
1.24 I 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 I 5 Years Preaction /Deluge Valves - Strainers filters,
orificesori
12.4.3.1.8
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
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 Cha ter 5 as amended by CCR Title 19
Page 3 of 4
Date of Inspection, Testing, Maintenance:
Description
System Riser ID:
Fail
Property nfor ation:
Pass
2.9 T
Name: /
Address:
Preaction Valve — Full Flow Trip Test
ype of Ystem:
8" Wet Pipe
Dry Pipe
Preaction
of PACi, .l`.
0
Deluge
City:'I !!
Dry Pipe Valve — Priming Water 12.4.4.2.1
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 Dgvice 12.4.42.4
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 I 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 ' r
corrosive water 5.3.1.1.2 l
2.21 T 10 Years Sprinklers - Dry I 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 manufactu4ed prior to 1920
Replace 5.3.1.1.1.1
3.1 M Annually Control Valves 12.3.4 r
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 Ch ter 5 as amended by CCR Title 19
Page 4 of 4
Date of Inspection, Testing, Maintenance: 4t- I
System Riser ID:
l
Property Infor ation:,
n
V
Type gf System: o cA <"
Name: 'C.
Address: 7
w
Z Wet Pipe
Dry Pipe
Preaction
i
I
i
Deluge
A
City:
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activity listed above:
V
l
i
i
I
i
CC
i
I
I
i
Se Continuation Page(s) _ (Indica t e umber f continuation pages)
Ass q FAIL
Signature DGte
State Fire Marshal AES 2 June 17, 2008