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Report f g-0 i 0 e90.0 g-5 FUNDAMENTAI_S OF 111Z F A 1..ARNi sysTEms 72-33 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:. 11kii 11.1 ntiErrE. .- Km A L... Address: 1 7096 5Lo (2 - Description of property: eAML- - Lce . Occupancy type: 1 Name of property representative: C--Ifte Address: Phone°3 i 92,jg Fax: E-mail: Authority having jurisdiction over this property: 4:31 aff. "It elAR...0 Phone: Fax: E-mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION ---- e Installation contractor for this equipment: ....-TO=Aii.-6(..1_ C..C)/1.i0CRAfeir .-cA.,t4R-rr SOU On5 Address: 15 5,5 5,a1,A01..Pl 00 Prt-0 M- A_ Phone: 5 Fax: E-mail: Service organization for this equipment: _A n 0 . e..C.. S • ( -7 .,, „ Address: i 64 9-5: ...1 4 -I _.., . 101 PS ' .. - ' Phone: 5D3-9(pc25-?)5cr) Fax: b V: ,s E-mail: Location of as-built drawings: 0 eorcre-oL'TekeiCAltocation of historical test reports: Location of system operation and maintenance manualsC/ 12- W\.,- A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: 'A Conu• Sec-•6 _....- Address: 19_95 1,A). - uPt PVtoD PrLD . (3K 2fr Phone: 5 .33 Fax:5- ?l E-mail: . Contract expires: Contract. number: Frequency of routine inspections: 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE NFPA. 72 Chapter Reference of System Type: CAA - t j Z- 5 ,G ilo u n - • P A Mir.70741 •- Jr la Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: 6 Phone: e---• 5 Supervisory: Phone: Trouble: IS_.- C&S Phone: Entity to which alarms are retransmitted:V-.MCRY1 -Nei C61 Phone:ft Method of retransmission of alarms to that organization or location(f4e0 Urt,4 - 17tcp - AL, Careon, (,,!') 2007 National Fire Protection Association NFPA 72 (p. 1 of 5) FIGURE 4.5.2.1 Record of Completion. 2007 Edition 0; r 72 - -34 NATIONAL 11 ',ARM CODE 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE (continued) If Chapter 8, note the means of transmission from the protected Pr emises to the central station. fil 1)igitaialarmcommunicator U McCu`loh U Multiplex a 2 -way radio O I -way radio ❑ N/A If Chapter 9, note the type of connection: U Local energy rJ Shunt. a N/A 3.1 System Software Operating system (executive) software revision level: ° Site - specific software revision date: revision completed by: 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits con., ected to this system (see NFPA 72, Table 6.6.1): Quantity: L_ Q Style: 4 910 Class: a 5. ALARM - INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system. (see NFPA 72, Table 6.5): Quantity: 3 Style: .� Class: .1 R 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: U Addressable /Conventional D Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: L I - Type of coverage: U Complete area ikartial area U Nonrequired partial area ❑ N/A Type of devices: U Addressable ;onventional U Coded U Transmitter U N /A. Type of smoke detector sensing technology: D Ionization r ' hotoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: Ti Addressable U Conventional ID Coded U Transmitter U N/A Type of smoke detector sensing technology: U ionization U Photoelectric 5.2.3 Heat Detectors Number of heat detectors: 1 Type of coverage: [3 Complete area ❑ Partial area i 'Nonrequired partial area U N/A Type of devices: U Addressable [sl/(ionventional J Coded U Transmitter U N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices O Addressable iSConventional :J Coded G Transmitter U N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: U Enabled U Disabled D Set for seconds 2007 National Fire Protection Association NFPA 72 (p. 2 of 5) FIGURE 4.5.2.1 Continued 0 2007 Edition _S l')KE ALARM SysTEms 6. SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: /- Type of devices: Li Addressable Con venti,)rmi Coded Li Transmitter Li N/A 6.2 Fire Pump Type of fire pump: D Electric D l)iesci Type of fire pump supervisory devices: D Address.11110 D Conventional D Coded D Transmitter D N/A Fire Pump Functions Supervised Fire p power U Fire pump running U Fire pump phase reversal Li Selector switch not in auto ngine or control panel trouble Li Low fuel Other: 6.3 Engine-Driven Generator Type of generator supervisory devices: ID Addressable L.1 Conventional Li Coded Li Transmitter Li N/A ID gine or control panel trouble 'D Generator running Li Selector switch not in auto Li Low fuel Other: 7. ANNUNCIATORS 7.1 Annunciator 1 /Local Li Remote Type: D Addressable Li Directory LT.! Graphic Li N/A Location: 7.2 Annunciator 2 Li Local Li Remote Type: D Addressable D Directory D Graphic D N/A Location: 7.3 Annunciator 3 Li Local Li Remote Type: rj Addressable Li Directory 1 3 Graphic Li 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 Number of telephone jacks installed: Number of telephone handsets stored on site Type of telephone system installed: Li Electrically powered Li Sound powered D N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: Style: Class: © 2007 National Fire Protection Association NEPA 72 (p. 3 of 5) FIGURE 4.5.2.1 Continued 2007 Edition 0 �., 72-36 x/n0 \A/. r — ---- — ---- --'---------------- --- 8. ALARM NOTIFICATION DEVICES AND CiRCUITS (continued) | ( 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: ................. With visual device: Horns: With visual device: Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: O t h e r /dovmib:: S. EMERGENCY CONTROL FUNCTIONS ACTIVATED D Hold-open door releasing devices rj Smoke management or smoke control D Door unlocking Li Elevator recall ID Other 10. SYSTEM POWER SUPPLY 10.1 Primary Power Nominal voltage 1gOV Amps Overcurrent protection: Type - '__ Location (of primary supply ^ co "Rin -___________-____��_-_�'_____�__ Disconnecting means location: 64mC 10.2 Seconder Power l �U1/�` Lo^ntivo�� � o ~ � ?yType: ° * , PO L§ -L21) _- Current rating: ___ Number of standby batteries: 2 - Amp hour rating: 14 Location of emergency generator: Location vf 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 cwnplete and wiring has been checked fbr opens, shorts, ground faults, rind improper branching, hut before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) 1�))4 72 ai(P670, National Electrical Code, Article 7V0 meclsuu(artu,a,`npuNiabmdinstructions 0 Other (please enooify): ____-__-.________-�'__'_--_-___� -' System d lVPD\ntuodmUe: Signe '^ - �� � ' li. � � - ' d uu��� / � �2-� 7 l�/{k�� Da `7~��)/{� � 71 /��� ^�,� "�. � ' oOrganization: �x ��u�"'. ~�� ',�cY Title: 1�m� Phone: 606r9u053300 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 opera ing properly in accordance with the requirements of: [9-",‘PA 72 , .' NFPA 70, National Electrical Code, Article 760 1 4.i--it<nifacturer's published instructions :_.1 Other (please specify): D Dnvuo^n`tuiovivarporJuuov~ithI^^portiuoaod?oatiugForm(xlgzrelO.8.2.3)ioxuoohrd �n/ ' �,�� �° �4�'l—�/�/C� Signed: 0uu�,�m,1 ~°�-�__ vt"duom � �^«�\ ^~— Organization: /w`� ' nur� L � [— � rbvoc D . 5 -. ?(^3 - ~ © 2007 National Fire Protection Association wppwro (p.*ms) aGoRF 4s.2.1 Continued [l �� 2007 Edition .., . ' NPA: NT. \ L:') OF IIRF ALARM SyS \ IS 72-i7 ...._.. 13. CERTIFICATIONS AND APPROVALS 13.1 System Installation Contractor • This system as specified li.ein lins bone insiiiiied and tested according to ad NFPA standards cited herein. „„,_ .. „ Signed: WAN? Mr' ' Printed narne:WeRha:i, Li Date: Organization: - 1 . 1 c lnie._ COAL), ...„9,, Sof . title: — <rik%Uiter Phone: 13.2 System Service Contractor This system as s ecified herein has been installed and tested according to all NFPA standards cited herein. . Signe itidirtrielltll Printed name: +06ser L • eita-- 5- 4. -,/ -i - 20 Organization-5W n t0 , --. e_or Se,C )61. Title7:101jalar Phone: 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: , / Printed name: Ske.-5V-e_ KP It-- le: c:' — ° Organization: Title: or I A-1, ..,,e, r Phone:5-6 13.4 Property Representative I accept this system as having been installed and tested to its specificatio s anAall. NFPA standards cited herein. r " A 1 Signed: Zlit/ .,..„ 4.,..i Printed name: Date: fi 4...// /.., , 1 )• Organization: / te di 4. ft q 4.1 Title : 7 Of 1 Phone: 5 fir9/ 13.5 Authority , - ng 'Jurisdiction I have wit/les:id a satisfa tory acceptance test of this system and find it to be installed and operating properly in accordance with its ap ,roved plans and specifications, its approved sequence of operations, and with all NFPA standar.:. at: d herein. Signed: 11110 . rinted nam ' e / R - Date: o Organization: ' 1 0 5.' - -----Vs'S Q- PhonTii: 1 ‘.. ! I © 2007 National Fire Protection Association NFPA 72 (P. 5 of 5 ) 1 i I FIGURE 4.5.2.1 Continued 2007 Edition 0,