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PSZ�a�- Dot to FuNI)AVENTALS OF FIRE ALARM SYSTEMS i2 - aa FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. • 1, PROTECTED PROPERTY INFORMATION Name of property: ` /�1 (n L,E Address:/ 3 2 - 2 4 5 I-) L s' P lC-ij Description of property: Orr{-, Occupancy type: Name of property representative: Address: Phone: Fax: _ E -mail: Authority having jurisdiction over this property: Phone: Fax: E-mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION installation contractor for this equipment: / 4 - Address: M 54-.) Phone: 5 .- 22.21 . Fax: Sb3 - y61 E-mail: — Service organization for this equipment: Address: Phone: Fax: E -mail: Location of as -built drawings: 1 Location of historical test reports: Location of system operation and maintenance manuals: 7 - A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: E - mail: Contract expires: Contract. number: Frequency of routine inspections: 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE / l NFPA 72 Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers Of upplicablo: Alarm: / 43 / " o `er 1 Phone: - -5 L Supervisory: c$ se' 6 Phone: Trouble: Phone: Entity to which alarms are retransmitted: . Phone: Method of retransmission of alarms to that organization or location: © 2007 National Fire Protection Association NFPA 72 (p. 1 of 5) FIGURE 4.5.2.1 Record of Completion. 2007 Edition 0 72 -34 NATIONAL FIRE ALARM CODE 3. TYPE OF FiRE ALARM SYSTEM OR SERVICE (continued) e 1-7 If Chapter 8, note the means of transmission from the protected premises to the central station: Digital alarm communicator J McCulloh J Multiplex J 2 -way radio J 1 -way radio J N/A If Chapter 9, note the type of connection: J Local energy J Shunt N/A 3.1 System Software Operating system (executive) software revision level: GXr S '� Site specific software revision date: Revision completed by: 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits connected to this system (see NFPA 72, Table 6_6.1): Quantity: Style: Class: 2 5. ALARM - INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 5): Quantity: 1 Style: / Class: 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: �- x'..5 Type of devices: J Addressable J Conventional J Coded J Transmitter J N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: J Complete area ;Partial area J Nonrequired partial area J N/A f - Type of devices: Addressable J Conventional J Coded ❑ Transmitter J N/A Type of smoke detector sensing technology: J Ionization J Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: t S Type of coverage: Type of devices: .J Addressable J Conventional J Coded J Transmitter J N/A Type of smoke detector sensing technology: 'J Ionization 'Ji Photoelectric 5.2.3 Heat Detectors Number of heat detectors: ' t > Type of coverage: ' t Complete area 1 Partial area J Nonrequired partial area .J N/A Type of devices: C! Addressable J Conventional J Coded J Transmitter CI N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: FA. ..$) Type of devices J Addressable J Conventional J Coded ;J Transmitter Li N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: 1,-)/ Alarm verification on this system is: U Enabled J Disabled J Set for seconds © 2007 National Fire Protection Association NFPA 72 (p. 2 of 5) FIGURE 4.5.2.1 Continued Fri 2007 Edition FCN1A \1EN 1'ALS OF FIRE x1.A1:\1 SYSTEMS 72 — :∎3 6. SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: P � ' Type of devices: J Addressable J Conventional J Coded J Transmitter J N/A 6.2 Fire Pump Type of fire pump: J Electric J Diesel Type of fire pump supervisory devices: J Addressable J Conventional J Coded J Transmitter J N/A Fire Pump Functions Supervised J Fire pump power J Fire pump running J Fire pump phase reversal J Selector switch not in auto J Engine or control panel trouble "_1 Low fuel Other: 6.3 Engine•Driven Generator Type of generator supervisory devices: U Addressable J Conventional D Coded J Transmitter D N/A J Engine or c•ont rol panel trouble J Generator running i Selector switch not in auto J Low fuel Other: — 7. ANNUNCIATORS 7.1 Annunciator 1 J Local J Remote Type: J Addressable J Directory J Graphic J N/A Location:' 7.2 Annunciator 2 J Local J Remote Type: J Addressable J Directory D Graphic J N/A Location: 7.3 Annunciator 3 J Local J Remote Type: J Addressable J Directory J Graphic J N/A Location: 8. ALARM NOTIFICATION DEVICES AND CIRCUITS 8.1 Emergency Voice Alarm Service • Number of single voice alarm channels Number of multiple voice alarm channels: Number of speakers: Number of speaker zones: 8.2 Telephone Jacks _ S� Number of telephone jacks installed: _ Number of telephone handsets stored on site: �_. Type of telephone system installed: J Electrically powered J Sound powered ! N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits convected to this system (see NFPA 72, Table 6.5): Quantity: Style: _ Class: © 2007 National Fire Protection Association NFPA 72 (p. 3 of 5) FIGURE 4.5.2.1 Continued 2007 Edition Or 72 -R(i NATIONAL FIRE ALARM CODE 8. ALARM NOTIFICATION DEVICES AND CIRCUITS (continued) 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: \ \'ith visual device: Horns: P -- \ \'ith visual device: " Chimes: With visual device: Bells: \ \tith visual device: Visual devices without audible devices: Other (describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED . - J Hold -open door releasing devices J Smoke management or smo3Ce control J Door unlocking D Elevator recall J Other 10. SYSTEM POWER SUPPLY 10.1 Primary Power Nominal voltage Amps Overcu•rent protection: Type Amps _ Location (of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: _ Type: Nominal voltage: Current rating: Number of standby batteries: _ Amp hour rating: Location of emergency generator: _ Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: _ In alarm mode: 11. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts grouted faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance the following NFPA standards: (Note any or all that apply.) NFPA 72 ; 1I N FPA 70, National Electrical Code, Article 760 Alanufacturer's published instructions J Other (please specify): System deviations from referenced NFPA standards: ' Signed: l` - � Printed name: '✓ : I 'J�r"� Date: t ( i s / � , 12-"-5 / Organization: -tS< L Title: / / /• -� -,- � { -- `^Phone: 5 - t_LL 12. RECORD OF SYSTEM OPERATION All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of: ('∎ 72 ,NFPA 70, National Electrical Code, Article 760 'a- published instructions J Other (please specify): Documentation iin accord nce with Inspection and Testin For (Figure 10.6.2.3) is attached Signed: 6"'- '" � L' Printed name: ,'L1 D n- ✓ Date: 17, Organization: j �S / c_. Title: --7 - lG- 4 ^ rte. < - ? t - - -'e Phone: ° © 2007 National Fire Protection Association NFPA 72 (p. 4 01 5) FIGURE 4,5.2,1 Continued w o r 2007 Edition FUNDAMENTALS LAL.S OF FIRE ALARM SYSTEMS 7247 13. CERTIFICATIONS AND APPROVALS 13.1 System Installation Contractor This system as specified here has been installed and tested according to all NFPA standards cited herein. Signed: Printed L/ name:, 'J✓'�,,r 1 // Date: ! / 3 // d Organization: ' S / 1 Title: 1L .ti -0:. " k 5-2 '-=' 4 1/ - 2-4" e r_ 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.3 Central Station This system as specified herein mill be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.4 Property Representative I accept this ; y t m as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: i I _ Printed name: P 6411 Date: I I l /3 ! /6 Organization: )?4 Title: SL4e 1�N � 6°1) g66 S SL/Pere la' Phone: 13.5 Authority Having Jurisdiction 1 have witnessed a . factory acceptance test of this system and find it to be installed and operating properly in ac.cordat ce with pproved plans and specifications, its approved sequence of operations, and with all NFPA standards c. red he l� /J Signed: i Printed name: `'� �`� �� 1 / l �/ t a te: 'r r-. Organization: .� - 7 \ r,()"' le:5r - _-ems () f Phone:? d 3 ` 7 k d - 2 T Z 1 © 2007 National Fire Protection Association NFPA 72 (p. 5 of 5) FIGURE 4.5.2.1 Continued 2007 Edition `;�