Property Information: Name: ___________________________________ Address: _________________________________ City: _____________________________________ Zip: ______________________________________ Contact: __________________________________ Phone: ___________________________________ Contractor Information: Name: ___________________________________ Address: _________________________________ City: _____________________________________ Zip: ______________________________________ Contact: __________________________________ Phone: ___________________________________ Main Drain Test Results: System Riser ID: __________ Initial Static Pressure: ____________________ (psi) Residual Static Pressure: ____________________ (psi) Restored Static Pressure: ____________________ (psi) Type of System: Wet Pipe Dry Pipe Preaction Deluge Abbreviation Key: I = Inspection T = Test M = Maintenance A-O = After Operation MI = Per Manufacturer’s Instructions CA Licence #: ________________________________________ Job#: _______________________________________________ Performed By: ________________________________________ Occupancy Use: ______________________ Construction Type: ____________________ No. Stories: __________________________ Year Constructed: ____________________ Date of Inspection, Testing, Maintenance: _________________ Number of System Risers: _____ Copy Sent To: Owner Date: ___________ Fire AHJ: Date: ___________ Contractor Date: ___________ Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Page 1 1) For specific inspection, testing and maintenance requirements and information, see NFPA 25, 2002 Edition as amended by California Code of Regulations, Title19, §901 to §906. 2) Inspection Items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). NOTES: Forms included with this report Automatic Sprinkler System Standpipe and Hose Systems Private Water Supply System Fire Pump Water Storage Tank Water Spray System Foam Water Sprinkler System * See “Deficiencies and Comments” section at the end of each respective form. NFPA 25 Chapter Number of Forms N/A FAIL* PASS Item 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 I I I I I I I I I I I I I I I I I Daily / Weekly Daily / Weekly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Annually Preaction/Deluge Valves - Enclosure Temp. Dry Pip Valves - Enclosure Temp. Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 / 5.2.4.3 Control Valves Alarm Devices Gauges (Wet Pipe Systems) Hydraulic Nameplate Pipe and Fittings Sprinklers Spare Sprinklers Fire Department Connections Alarm Valves - Exterior Inspection Preaction/Deluge Valves - Exterior Inspection Pressure Reducing Valves Dry Pipe Valves - Exterior Inspection Backflow Preventers Buildings 12.4.3.1 12.4.4.1.1 12.3.2.1 5.2.6 5.2.4.1 5.2.7 5.2.2 5.2.1 5.2.1.3 12.7.1 12.4.1.1 12.4.3.1.6 12.5.1.1 12.4.4.1.4 12.6.1 5.2.5 Activity Frequency Description PASS FAIL N/A NFPA 25 Reference
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Performed By: ________________________________________
Occupancy Use: ______________________
Construction Type: ____________________
No. Stories: __________________________
Year Constructed: ____________________
Date of Inspection, Testing, Maintenance: _________________
Number of System Risers: _____
Copy Sent To:
Owner Date: ___________ Fire AHJ: Date: ___________Contractor Date: ___________
Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Page 1
1) For specific inspection, testing and maintenance requirements and information, see NFPA 25, 2002 Edition as amended by California Code of Regulations, Title19, §901 to §906.
2) Inspection Items may be performed by the Owner in accordance with CaliforniaCode of Regulations Title 19 §904.1(a).
NOTES:
Forms included with this reportAutomatic Sprinkler System
Standpipe and Hose SystemsPrivate Water Supply System
Fire PumpWater Storage TankWater Spray System
Foam Water Sprinkler System
* See “Deficiencies and Comments” section at the end of each respective form.