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FPc'it- Copyright 2008 by National Fire Protection Association (NFPA). Licensed, by agreement, for individual use and single download on February 1, 2008 to BARBARA DERKACHT of FOCUSMICRO INC. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing @nfpa.org. 72 - 111) N.ATIONAI. FIRE ALARM( CODE '.r4 5 f / 7oS Sw �cxf� H INSPECTION AND TESTING FORM • DATE: — TIME: J.. SERVICE ORGANIZATION PROPERTY NAME (USER) Name: fUC_S / 1 40 Name: /SG 7 5/40 P■ w 4-1 S 2 . 3 Address: L/ 6 CI J Ci v,i i. S V� ` Ju3 Address: if-7(24-r; Representative: It !� KSIl Owner Contact: License No.: 7 L F- / A- Telephone: Telephone: Ll l S S 4 1 MONITORING ENTITY APPROVING AGENCY Contact: ✓ M Co �,/ Contact: Telephone: SCri p > ' / 0 V - 'IS (7 ( Telephone: 9 Monitoring Account Ref. No.: L + “G / TYPE TRANSMISSION SERVICE C I McCulloh U Weekly ❑ Multiplex ❑ Monthly If Digital U Quarterly Li Reverse Priority Li Semiannually ❑ RF U Annually ❑ Other (Specify) Other (Specify) //lSl�'l,l Control Unit Manufacturer: Si £ ,'ii K t c Model No.: .5 7 U Circuit Styles: ULp cos C. 5 A Number of Circuits: Li Software Rev.: cc, Last Date System Had Any Service Performed: 8- t a 1 I Last Date That Any Software or Configuration Was Revised: " I O 41 ALARM - INITIATING DEVICES AND CIRCUIT INFORMATION Quantity of Quantity of Devices Installed Circuit Style Devices Tested 3 CLM 6 3 Manual Fire Alarm Boxes fg �� Ion Detectors / 9 Ct.o D / e Photo Detectors $ Cf Duct Detectors Heat Detectors 4; Waterflow Switches Supervisory Switches 11/A- Other (Specify): Alarm verification feature is disabled enabled © 2007 National Fire Protection Association NFPA 72 (p. 1 of 4) FIGURE 10.6.2.3 Example of an Inspection and Testing Form. 0 2007 Edition • Copyright 2008 by National Fire Protection Association (NFPA). Licensed, by agreement, for individual use and single download on February 1, 2008 to BARBARA DERKACHT of FOCUSMICRO INC. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use. contact licensing @nfpa.org. INSI'F:C:'fION. "I1:S[INC..\ND MAINTENANCE 72 • ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity of Quantity of Appliances Installed Circuit Style Appliances Tested Bells 7 —__ .- Horns %��! Chimes Strobes Speakers —_ Other (Specify): No. of alarm notification appliance circuits: I f -- Are circuits monitored for integrity'? Yes IJ No SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUIT INFORMATION Quantity of Quantity of Devices Installed Circuit Style Devices Tested _ Building Temp. Site Water Temp. Site Water Level Fire Pump Power Fire Pump Running Fire Pump Auto Position Fire Pump or Pump Controller Trouble Fir, Pump Running Generator in Auto Position Generator or Controller Trouble Switch Transfer Generator Engine Running Other: SIGNALING LINE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity �t� Style(s) L.40 ( L,,44 S SYSTEM POWER SUPPLIES (a) Primary (Main): Nominal Voltage / 2.0 Amps 2 O Overcurrent Protection: Type $•sTwi- Amps _ Location (of Primary Supply Panelboard ): 3 2 Disconnecting Means Location: ISM.lil +f1- Pla'y1rk /&y lC/ - f' (b) Secondary (Standby): ,i,� 2 /2. velt. = 2 v O Storage Battery: Amp -Hr Rating 7 ft i /'�R S Calculated capacity in j Amp -Hrs to operate system for 24 hours Engine - driven generator dedicated to fire alarm system: /L..nrtlt- Location of fuel storage: TYPE BATTERY ❑ Dry Cell D Lead -Acid J Nickel - Cadmium U Other (Specify): Sealed Lead -Acid (c) Emergency or standby system used as a backup to primary power supply, instead of using a secondary power supply: Emergency system described in NFPA 70, Article 700 Legally required standby described in NFPA 70, Article 701 Optional standby system described in NFPA 70, Article 702, which also meets the performance requirements of Article 700 or 701 © 2007 National Fire Protection Association NFPA 72 (p. 2 of 4) FIGURE 10.6.2.3 Continued 2007 Edition D Copyright 2008 by National Fire Protection Association (NFPA). Licensed, by agreement, for individual use and single download on February 1, 2008 to BARBARA DERKACHT of FOCUSMICRO INC. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing @nfpa.org. 72 -112 NATIONAL FIRE ALARM CODE PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Yes No Who Time Monitoring Entity r U _ Building Occupants (j)..- U ea-3-- Building Management ly Ii Other (Specify) U U AHJ Notified ofAny Impairments ►Y U SYSTEM TESTS AND INSPECTIONS TYPE Visual Functional Comments Control Unit 0/ I Interface Equipment to- rjy Lamps/LEDs V ur Fuses GI' r' Primary Power Supply G✓ iy Trouble Signals rtY V Disconnect Switches GY fe Ground -Fault Monitoring UY ul" SECONDARY POWER TYPE Visual Functional Comments Battery Condition films Load Voltage :1t' Discharge Test II Charger Test iV Specific Gravity U g4 ` 15.1s TRANSIENT SUPPRESSORS U A...■ REMOTE ANNUNCIATORS ij NOTIFICATION APPLIANCES Audible Ili- re' Visible fg' fA Speakers U U M. //4- Voice Clarity U ilf/ AND SUPERVISORY DEVICE TESTS AND INSPECTIONS Device Visual Functional Factory Measured Loc. & S/N Type Check Test Setting Setting Pass Fail Lahc L jtalr 4..14 5....x/42- i.1--- Z.1 AIA- AIA" il- ry tJ✓' i. s.w. - 4- ..1--- t ( t r per 1j /n/. !2, 5 .,41...r4 rA— tl ( f f t U Rt »- eCt,,,r pt., C-t.. rtJ— r Y Cd• U MA, Sihre.z $nr•,ry . rvi ✓ Ir it IQ. U fot_ _r f .� G■ i— r AL--- N. e ti O''' U Comments: © 2007 National Fire Protection Association NFPA 72 (p. 3 of 4) FIGURE 10.6.2.3 Continued 0 2007 Edition 1 1 i 1 i I Mi : ha el Koffler , F • : Laura A [lariasemgaecurity.com] _ Se . Friday, August 19, 2)11 11:50 AM l To: 1 i • Michael KoEler Cc: Mimi Safieddine; Pa.rI Drebes FW• L566971 Sporting Coo , OR =`; Ta T , i • zorle list for bia 5 tigiard re alam.xlxc L5: g Bi: •porti g . oo i s 233 Fire 11 • W Pac i f1 ghway II! III OR 97 i - - 1 'KEDETECT R/ FA N ' RM. SMOKE • • 8/ FA � ' i 'E RM SMOKE I 44 , �. •11111111 SMOKE OKE 0 ECTO! 8/%1 10:47 8 FA We RM SMOKE DETEC OR 8 9 .01 10:48 A R 0' •NUAL 'ULL S AT_ON 8-/19/2: 9—: FA-4— N/W SALES FLR • 8/19/2011 10 2 r RESTORE j Ii 8/ 9/201 1% '3 RESTORE 1 •/ % RE TOE III 9/ -01 % :49 6 RE'T•'E 8/ 9/-%1 %:49 9 RE'T.'E 8/ 9/ •.49 4 RE 'E ' 8/ 9/..%1 % :49' 11 FA WEST SALES FLR • E 8/ 9/.%1 ::50 5 FA REAR CR MANUAL ' L STAT_ON 112 . FA WE$T E)(I� R LR •UA (PULL T r231:0111 5 RE'TO'E 1 1 fl II : :j NH 8/ ME rTZ'Rt1 O11 1 % 13 FA GUN DISPLAY ARE S • E . , is FA S/W PLtS FLR 4 17 FA FRONT S nR AMJAI DI1 F , 8/ 1131E54 16 FA REGISTER JMOKE 'ET CTOR 8/ 5- 7 RE Tv'E -' . 12 RE T.'E 8/ 9/.01 1 %:54 13 RE TIE 8/19/201 1 %: . 15 RE TI'E 8 1 %: 1G AIC T. C 8/19/ 01 1 %:5. 17 RE TI'E 8/19/.01 1 %: ' 18 FA SOUTH SALES FLR SMOKE '20 FA N/E LCS FLR SMOKE 8/19/.01 1 %:58 21 FA NOf1TH SALES FLR SMOKE 8/19/101 1 %:5• 18 RE TO ;E is /IN /1191 i , : 3 : 20 RE TO E R/• 9/ :A1 ; 1 :�5• 71 RE TOFE 8/19/ 11:2% 22 FA NORTH CTF SALES FLI SMOKE 8 /-9 /0191 11:z% 22' Mt TUI L 8/1Q/181 11: ' _11_ RE TORF 8/:9/101' 11:3% 14 FA OFFICE SMOKE DETECTOR 8/ =9/101 11:3 - 1 FA GUI MT SMOKE DETECTOR I I 3 ■ — t r L L ■■■■■■•■■.■■• ■■■.■.■■■■■■--li ■1FEMBEI11■■/ME17111111111111111111■.■■■■■■--III .KEELIMI■. , ■..■■■•11111 _II EMS Arias -T 11 ■■■■1■■■■■■ ■EM Entry SuerZ� .■ 11111 MIN _� ■iczz alle . '278 III ill ■■■■ 14� -8 :8, Ext• ■S (774) 14) S 545 -035 1�■ ■■ —■ ■■ - ■E= 7MGSecuri I t ! ■B■ ■UM P„ r. - . . . .ur r alarms s on , n,..i i r:liil�■■■ ■nn , iesirm # is 1°- 886 - 469 -3009. ..... 11111■■■■■■■■ ■■■■■ ■UU■•.000il ■111111■111 —, • U con ai to:m 0 - ocusm cr .cam 111111111111111 �I tiftg eddine; ^ e ocus L EM.. / ' ■1112211/Gillinalliiii 6 ■. ■.■ I'EF INIMI this s tore with la -1s We will be doi n plimErrte 111111111111•111111111111 ....III ••......•. 11111111111MMI UEMMQ22000 MEM= U_U.....• IMO= MIIIIiii.;11MiiiiiMiii • gale .. "ear *cam ■■■■■ IIIIIMANUAGNIIIII ■■■■■ ■i11111111111111111111111 EMU. ail izismag,7 & Secorda y would be 88051 28897 ■■■■■ ■1111MEZIi■ MINIM UU2= :2EINLI NMI■ ■•�I■ ■■■■■ Em a r ass! U.N.. ■,en : ognat 2011 10 17 AM U..■■ i o ff : SSaa — igna e • es; Laura Arias ■I■■■ 10111111111111111111/ 11111111.• 11110,111111111111111•111 MINI■ -- - - - - -- Copyright 2008 by National Fire Protection Association (NFPA). Licensed, by agreement, for individual use and single download on February t, 2008 to BARBARA DERKACHT of FOCUSMICRO INC. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing @nfpa.org. I Waal ON, 1LSfINC, AND MAINTENANCE 72 -113 I EMERGENCY COMMUNICATIONS EQUIPMENT Visual Functional Comments Phone Set J J 4-/a Phone Jacks J J Off -Hook Indicator J J ^ /� A Amplifier(s) J J - - f 4 Tone Generator(s) J J / u Call -in Signal J J System Performance 'J J Device Simulated Visual Operation Operation OMBINATION SYSTEMS e Extinguisher Monitoring Device %Syste1 J J Carho Monoxide Detector /System I - J (Specify) J J - J INTERFACE EQUIPME (Specify) J J J (Specify) _ \ m - J J (Specify) __ J J I \ SPECIAL HAZARD SYSTEMS --___ (Specify) I I I (Specify) J J J (Specify) I J U Special Procedures: Comments: SUPERVISING STATION MONITORING Yes No Time Comments Alarm Signal 'ty- ❑ • S NO 5X 4, 1 r Alarm Restoration riir I t t t t Trouble Signal C I l t t Trouble Signal Restoration tir U t t l Supervisory Signal UJ 1 r ( • Supervisory Restoration i� J L. `' NOTIFICATIONS THAT TESTING IS COMPLETE Yes No Who Time Building Management I Monitoring Agency IV 'J Building Occupants 4- Other (Specify) 1 y' `J The following did not operate correctly: System restored to normal operation: Date: . Time: / /CJ /I/ / /'5 Av THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS. Name of Inspector: Date: Time: Signature: Name of Owner or Representative: .ii /tom / _ _ iii✓ Date: Cr) ZZ -17 -f' Time: II , sb Signature: !/ ^ / © 2007 National Fire Protection Association NFPA 72 (p. 4 of 4) FIGURE 10.6.2.3 Continued 2007 Edition 0