Report 6 &Q 2ev7- ckso 5F�
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected property: (1/N Ve11f1/11 TI
it f L -L
Address: // 571 e V. • �� •"A ✓� �i • �laP �1�
Representative of protected property (name /phone): 3 �s
Authority having jurisdiction: L, die % r.ei
Address /telephone number:
Organization name /phone Representative name /phone
Installer /, ✓E y ,, u - ' •
Supplier /. — ` .:v
Service organization '
Location of record (as- built) drawings: i `j2-
Location of operation and maintenance manuals: Qirf/'Tr
Location of test reports: Qnrj'T!
•
A contract for test and inspection in accordance with NFPA standard(s)
Contract No(s): �,/VV < ✓9 Effective date: Expiration date:
System Software
(a) Operating system (executive) software revision level(s): Io
(b) Site - specific software revision date: •
(c) Revision completed by: _ —
(name) ', (firm)
•
1. Type(s) of System or Service
NFPA 72, Chapter 6 — Local
If alarm is transmitted to location(s) off premises, list where received:
NFPA 72, Chapter 8 — Remote Station
Telephone numbers of the organization receiving alarm: 1�
Alarm: 4M/AL/t' 7rI / fpiA SD? �r�
Supervisory: 1' f / / /
Trouble: / [ (1 / /
If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone
numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 8 — Proprietary •
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory.
Trouble:
If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone
numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 8 — Central Station
Prime contractor:
Central station location:
•
•
(NFPA 72, 1 of 4)
FIGURE 4.5.2.1 Record of Completion.
2002 Edition
1
72 -32 NATIONAL FIRE ALARM CODE
- -a
Means of transmission of signals from t he protected premises to the central station:
Multiplex One -way radio
McCulloh Others
Digital alarm communicator Two -way radio
Means of transmission of alarms to the public fire service communications center:
(a)
(b)
System location:
NFPA 72, Chapter 9 — Auxiliary Shunt Parallel telephone
Indicate type of connection: Local energy
Location of telephone number for receipt of signals: •
2. Record of System Installation
(Fill out after installation is complete and wiring is checked for opens, shorts, ground faults, and improper branching,
but prior to conducting operational acceptan tests.)
T ' system has been installed in accordance with the NFPA s�nd,a���� own below, was inspected by the devices shown
jydo/ /7 yr/Jl r/f on 6 ``
in 5 l and 6, and has been in service since 7 141----- •
X NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply)
)( NFPA 70, National Electrical Code, Article 760
X Manufacturer's instructions
_Other (specify):
g f 4 Date: ( p /1Dke
Si ned: � / ,, ' ,�
n: ( ✓`�' / 7 Tell/
Organization: y
3. Record of System Operation
Documentation in accordance with Inspection Testing Form, Figure 10 .2.3, is attached date �o !/DIG�
All operational features and functions of this system were tested by /G/ / '
trrn
and found to be operating properly in accordance with the requirements of:
NFPA 72, Chapters 1 2 3 4 15 6 7 8 9 10 11 (circle all that apply)
NFPA 70, National Electrical Code, ( Article 760
Manufacturer's instructions
Other (specify):
' Date. to //841- Signed: i vim � i•�, ��/
Organization: (e /eve' Tech .
4. Signaling Line Circuits
Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
Quantity:
Style: Class:
�� ---- y
(NFPA 72, 2 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 -
4
5. Alarm Initiating Devices and Circuits
Quantity and class of initiating device circuits (see NFPA 72, Table 6.5):
Quantity: Style: Class:
MANUAL
(a) Manual stations Noncoded Transmitters Coded Addressable
(b) Combination manual fire alarm and guard's tour coded stations
•
AUTOMATIC
Coverage: Complete Partial
Selective _ Nonrequired
(a) Smoke detectors 7 Ion Photo Addressable
(b) Duct detectors o2 Ion Photo Addressable
(c) Heat detectors FT RR FT/RR RC Addressable
(d) Sprinkler waterflow indicators: Transmitters Noncoded Coded Addressable /
(e) The alarm verification feature is disabled or enabled , changed from seconds to seconds.
(f) Other (list): •
6. Supervisory Signal Initiating Devices and Circuits (use blanks to indicate quantity of devices)
GUARD'S TOUR
(a) Coded stations
(b) Noncoded stations
(c) Compulsory guard's tour system comprised of transmitter stations and intermediate stations
Note: Combination devices are recorded under 5(b), Manual, and 6(a), Guard's Tour.
SPRINKLER SYSTEM
Check if provided
(a) Valve supervisory switches
(b) Building temperature points
(c) Site water temperature points
(d) Site water supply level points
Electric fire pump:
(e) Fire pump power
(f) Fire pump running
(g) Phase reversal
Engine- driven fire pump:
(h) Selector in auto position
(i) Engine or control panel trouble
•
(j) Fire pump running
ENGINE - DRIVEN GENERATOR:
(a) Selector in auto position
•
(b) Control panel trouble
(c) Transfer switches
(d) Engine running
Other supervisory function(s) (specify):
•
(NFPA 72, 3 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
72 -34 NATIONAL FIRE ALARM CODE
7. Annunciator(s)
Number: Type: Location:
8. Alarm Notification Appliances and Circuits_
NFPA 72, Chapter 6 — Emergency Voice /Al Service
Quantity of voice /alarm channels: Single: Multiple:
Quantity of speakers installed: Y • Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
Quantity and the class of notification appliance circuits connected to system (see NFPA 72, Table 6.7):
Quantity: / Style: Class:
•
Types and quantities of notification appliances installed:
(a) Bells With Visible
(b) Speakers With Visible y
(c) Horns With Visible
(d) Chimes With Visible
(e) Other: With Visible y
(f) Visible appliances without audible:
9. System Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: !:1 Current rating: 4;2(2
L
Overcurrent protection: Type: Q4'/',- Current rating: o
Location: & ,°I. L- lljT A/
(b) Secondary (standby): is
Storage battery: a Amp-hour rating:
Calculated capacity to drive system, in hours: r y
Engine- driven generator dedicated to fire alarm system:
Location of fuel storage:
i
(c) Emergency system used as backup to p rimary power supply:
Emergency system described in NFPA 70, Article 700:
10. Comments
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s):
System deviations from the referenced NFPA standard(s) are:
• (signe for installation t ractor /supplier (title) (date)
(signed) t. alarm service company -- (title) (date)
(sig d) '.r central station (title) (date)
U,.o / pletion of the :. (s) sate actory test(s) witnessed (if required by the authority having jurisdi :on):
Co l it, i`
ed) represen of the aut on y having jurisdiction (title) (date)
(NFPA 72, 4 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition