Report FA s a o i o -- 0 76
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: AAA.
Address: , J "t q5 31 /x) 7 07 Vl
Description of property:
Occupancy type: (3
Name of property representative: 1-17- 1,4-4"—) S, U..i n��.Lt1"-
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: EC ... LC
Address: 212- _._ N 1N T h totrt tdl � ire cs✓+ ` `
Phone: 5a3_ ZZ+ 351 I - ... Fax: E -mail:
Service organization for this equipment:
Address:
Phone: Fax: E -mail:
Location of as -built drawings: - -5 ; t 1 _ i _ ation of Historical Test Reports:
Location of system operation and maintenance manuals: FM '
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
NFPA 72!, Chapter Reference of System Type:
Name of organization receiving alarm signals with phone numbers (:f applicable):
Alarm: 5 01-+ .. . -_ Phone:
Supervisory: _ _ Phone:
Trouble: Phone:
Entity to which alarms are retransmitted: Phone:
Method of retransmission of alarms to that organization or location:
NFPA 72, Fig. 4.5.2.1 (p. 1 of 5)
Copyright ® 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
If Chapter 8, note the means of transmission from the protected premises to the central station:
1E1 Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2 -way radio ❑ 1 -way radio ❑ N/A
If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ 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 connected to this system (see NFPA 72® Table 6.6.1):
Quantity: Style: I Class: . ............ ..
5. Alarm - Initiating Devices and Circuits
Characteristics of initiating device circuits connected to this system (see NFPA 72® Table 6.5):
Quantity: _ Style: 9 Class:
5.1 Manual Initiating Devices
5.1.1 Manual Pull Stations Number of manual pull stations:
Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A
5.2 Automatic Initiating Devices
5.2.1 Area Smoke Detectors Number of smoke detectors:
Type of coverage: ❑ Complete area 120 Partial area ❑ Nonrequired partial area 0 N/A
Type of devices: 13 Addressable ❑ Conventional ❑ Coded ❑ Transmitter O N/A
Type of smoke detector sensing technology: ❑ Ionization ki Photoelectric
5.2.2 Duct Smoke Detectors Number of duct smoke detectors:
Type of coverage:
Type of devices: ( Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A
Type of smoke detector sensing technology: ❑ Ionization ,$ Photoelectric
5.2.3 Heat Detectors Number of heat detectors:
Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A
Type of devices: 131 Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A
5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors:
Type of devices: ❑ Addressable IN Conventional ❑ Coded ❑ Transmitter ❑ N/A
5.2.5 Alarm Verification Number of devices subject to alarm verification:
Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds
6. Supervisory Signal - Initiating Devices and Circuits
6.1 Sprinkler System Number of valve supervisory switches:
Type of devices: ❑ Addressable 12) Conventional ❑ Coded ❑ Transmitter ❑ N/A
NFPA 72, Fig. 4.5.2.1 (p. 2 of 5)
Copyright ® 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
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6.2 Fire Pump Nib
Type of fire pump: ❑ Electric ❑ Diesel
Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A
Fire Pump Functions Supervised
❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto
❑ Engine or control panel trouble ❑ Low fuel
Other:
6.3 Engine - Driven Generator
Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A
❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel
Other:
7. Annunciators
7.1 Annunciator l g Local ❑ Remote
Type: ELAddressable ❑ Directory ❑ Graphic ❑ N/A Location:
7.2 Annunciator 2 ❑ Local i_ Remote
Type: ra Addressable ❑ Directory ❑ Graphic ❑ N/A Location:
7.3 Annunciator 3 ❑ Local ❑ Remote
Type: O Addressable ❑ Directory ❑ Graphic ❑ N/A Location: ... _ ._ . _ - - - . . . . . . . . . . .....
8. Alarm Notification Devices and Circuits
8.1 Emergency Voice Alarm Service f
Number of single voice alarm channels: - N J - _ - _ . _ - _ Number of multiple voice alarm channels:
Number of speakers: _ /4/ fir Number of speaker zones:
8.2 Telephone Jacks n
Number of telephone jacks installed: 2 Number of telephone handsets stored on site:
Type of telephone system installed: ti j Electrically powered ❑ Sound powered ❑ N/A
8.3 Nonvoice Audible System
Characteristics of notification device circuits connected to this system (see NFPA 72 Table 6.5):
Quantity: 7 Style: - - - - Class: QQ
8.4 Types and Quantities of Nonvoice Notification Appliances Installed
C�
Bells: With visual device: Horns: With visual device: s: _ . 3__�. .-
Chimes: With visual device: Bells: With visual device:
Visual devices without audible devices: 3 2.. - _ - Other (describe):
NFPA 72. Fig. 4.5.2.1 (p. 3 of 5)
Copyright ® 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. tt may not be copied for commercial sale or distribution.
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9. Emergency Control Functions Activated
11 Hold -open door releasing devices 53 Smoke management or smoke control
❑ Door unlocking fp Elevator recall ❑ Other
10. System Power Supply
10.1 Primary Power
Nominal voltage: ) 2. 0 v 2- v Fq
- - - - - - - - - _ Amps : Overcurrent protection: Type: - .)::)r- (...41,c1..-e - - - - - - Amps: Z .
Location (of primary supply panelboard): F £&P SZ . .t -
Disconnecting means location: F tA -pi r ir - _ - 5-e �•" 1 2
t� r
PS Z- .. j_ - - . 1. „ 1,-- - _ ..S 1- . - .2 `'"
_- -- - --- -_....
10.2 Secondary Power p
Location: _FAL .._ _ _ Type: 60, -2 - Nominal voltage: 1 vdc Current rating:
/�/
Number of standby batteries: J _ .. Amp hour rating: 3 3 _ _ 6 , . 1 „ , _ _ _ _ _ . . _ . . . . _ _ _ . _ . . . _ . .
Location of emergency generator. W .Q S± . - pt,,,,,, k LU
Location of f u e l storage: t . Sfi 0 . . . . 1 - < - 1 1 - 1 1 1 j - l b t`
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, ground faults, and improper
branching, but before conducting operational acceptance tests.
The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.)
129 NFPA 72 ® [s NFPA 70 Article 760
(1l Manufacturer's published instructions ❑ Other (please specify):
System deviations from referenced NFPA standards:
Signed: Aol.,1 Printed name: C- tZ c QC- ' -- Date: I ^ 2.--g `� I0
Organization: ' L- Title: . Ei c _ .z,r, .; Sw -_.. Phone: 3 - 22- '`'t `.35/
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.
❑ NFPA 72 ❑ NFPA 70 Article 760
❑ Manufactur • s pullished instructions ❑ Other (please specify): _
❑ Documenta r on in ccordance with Inspection and Testing Form fi �e ch / `
(Figure 10.6.2.3 of NFPA 72 is attached
Signed: . ' Printed name: •N u ' ”
'i Date: I Z Y c?
% Organization: + ,^ e: �� Q.. Phone: � l 4 Z Zy
NFPA 72, Fig. 4.5.2.1 (p. 4 of 5)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
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13. Certifications and Approvals
13.1 System Installation Contractor
This system as specified herein has been installed and tested according to all NFPA standards cited herein.
Signed: w 1( J Printed name: e t " Date: 0 5
r j .�--�— Phone: SU 3 - 22 ... I /
Organization: �- t. Title: f ` 'c Pk .54-1, 3
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 will be monitored according to all NFPA standards cited herein.
Signed: Printed name: Date:
.,
Organization: Title: Phone:
13.4 Pr r • • r Representative
I accept is syste i having been installed and tested to its specifications and all NFPA standards cited herein.
Signed _ , Printed name: c1,... -0 c '�• ...- Date: '' U
Title: Phone: ,503" -S l iv -( , g '
Organization: t [ u
13.5 Authority Having Jurisdiction 0
I have witnessed a ' factory acceptance test of this system and find it to be installed and operating properly in accordance
with its approved I s and specifications, its approved sequenc pera ens, and wi all NFPA standards cited herein.
Printed name: .. -_ - -- ....
Signed: - _. ��... %��' Da 9 _�.. . . .
Organization. " �� itle: V. � ...34).5 Phone: 7 . --Z.• Z. -
NFPA 72. Fig. 4.5.2.1 (p. 5 of 5)
Copyright ® 2009 National Pre Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.