Specifications eg(i/ 7- 0053 3
t,^ (Ref: NFPA 72 [2006 Ed])
SimplexGrinnell BE SAFE. FIRE ALARM SYSTEM RECORD OF COMPLETION
Name of protected property:
Address: (eC70 Su....) )c6 - "_ t l C, c l l R — ( 7�`� �
Representative of protected property (name /phone):
Authority having jurisdiction:
Address /telephone number:
Installer: A '\ULSaXY - Q._ - 2 - %.0 ,, ®® r c
Supplier: l Vk�1 IJ /'(tW< S AVG' 6283 ' ! Y()l`�
Service organization: �tK� c �1.�1. . t)1L,( OLSD J `Cflc� J . 960I
Organization name /phone Representative e /phone
Location of record (as- built) drawings:
Location of operation and maintenance manuals:
Location of test reports:
A contract for test and inspection in accordance with NFPA standard(s)
Contract No(s): Effective date: Expiration date:
System Software
(a) Operating system (executive) software revision level(s): St KV 6L
(b) Site - specific software rexisi date:
(c) Revision completed by: A.A.) Cµ -VLVL AM0 A..
(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 ® 46 ‘S
Ac. ---14 '
-T 2d - 5
Telephone numbers of the organization receiving alarm: . J 9P��
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: 1 \›�
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:
MC24 -2 -014
0806
Copyright NFPA AHJ - White; Owner - Canary; District - Pink; Site Copy - Goldenrod (NFPA 72, 1 of 4)
NFPA 72, Chapter 8 — Central Station
Prime contractor:
Central station location:
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One -way radio
Digital alarm communicator Two -way radio Others
Means of transmission of alarms to the public fire service communications center:
(a)
(b)
System location:
NFPA 72, Chapter 9 — Auxiliary
Indicate type of connection: Local energy Shunt Parallel telephone
Location of telephone number for recipient 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 acceptance tests.)
This system has been installed in accordance with the NFPA standards as shown below, was inspected by
on , includes the devices
shown in 5 and 6, and has ben in service since
NFPA 72, Chapters « 3 ® ®- 5 D (circle all that apply)
NFPA 70, National electrical Code, Article 760 •
6 G. Manufacturers instructions
Othe pe " ):
Signed: / Date:
Organiz-
3. Record of System Operation
Documentation in accordance with Inspection testing Form, Figure 6.2.3, is attache ( r .00
®
All operational features and functions of this system were tested by -I— � date
and found to be operating properly in accordance with the requirements of:
NFPA 72, Chapters ®® 3 ID ®C3) (circle all that apply)
NFPA 70, National electrical Code, Article 760
�• Manufacturer s instructions
sp ify :
Signed: Date:
Organization:
4. Signaling Line Circuits
Quantity and class of signaling line circuits connected to system (see NFPA 72 •le 6.6.1):
Quantity: Style: Class: •�
Quantity: Style: Class:
Quantity: Style: Class:
MC24 -2 -014
0806
Copynght NFPA AHJ - White; Owner - Canary; District - Pink; Site Copy - Goldenrod (NFPA 72, 2 of 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 Ion Photo K. Addressable
(b) Duct detectors 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):
b1C24 -2 -014
0806
Copyright NFPA AHJ - White; Owner - Canary; District - Pink; Site Copy - Goldenrod (NFPA 72, 3 of 4)
•
7. Annunciator(s)
Number: Type: Location:
8. Alarm Notification Appliances and Circuits
NFPA 72, Chapter 6 — Emergency Voice /Alarm Service
Quantity of voice /alarm channels: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
Quantity and class of notification appliance circuits connected to system (see NFPA 72, table 6.7):
Quantity: I, Style: Class: PA
Types and quantities of notification appliances installed:
(a) Bells With Visible
(b) Speakers With Visible
(c) Horns With Visible
(d) Chimes With Visible
(e) Other With Visible
(f) Visible appliances without audible:
9. System Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: Current rating:
Overcurrent protection: Type: Current rating:
Location:
(b) Secondary (standby):
Storage battery: Amp -hour rating:
Calculated capacity to drive system, in hours:
Engine- driven generator dedicated to fire alarm system:
Location of fuel storage:
(c) Emergency system used as backup to primary 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• or 'tallation contractor /supplier (title) (date)
• -- - fit-( 3.14 og
(signed) for alarm service company (title) (date)
(signed) for central station (title) (date)
Upo completion of e system(s isfactory te-, (s) witnessed (if required by the authority having jurisdiction):
_2 lilt O y
signed) repres- tative of the u hority having jurisdiction (title) (date)
MC24 -2 -014
0606
Copyright NFPA AHJ - White; Owner - Canary; District - Pink; Site Copy - Goldenrod (NFPA 72, 4 of 4)
i
t CO1F/re & r � .
Simp /exGrihne // FIRE ALARM TEST /INSTALLATION
•
Security °• - ACKNOWLEDGEMENT CONTINUATION SHEET
1- 800-746 -7539
NAME r & • BOOK # CALL#
// _ 11111 111111 •
C 7O , -).k` ,VID ' ��G�'Y' J Vim ! / 2 Z(I PG OF
. PERIPHERAL FUNCTION TEST
DEVICE DEVICE LOCATION A • T n S NOTE ANNUN. ZONE ALARM ZONE DEVICE DEVICE LOCATION A T S NOTE ANNUN. ZONE ALARM ZONE
TYPE L A U EN NO. OR OR TYPE L A O EN NO. OR OR
S TELEPHONE SIGNAL TELEPHONE SIGNAL
R
R M BL I T e ZONE ZONE M LE T ZONE ZONE
Alm
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PSD .= Photoelectric Smk Det PS = Manual Pull Station B = Bell Only TS = Tamper Switch
• ISO = Ionization Smk Det CPS = Coded Pull Station H = Horn Only WF = Water Flow Sw
• PDD = Photo. Duct Smk Det RR = Rate of Rise Ht Det C = Chime Only DH = Door Holder
IDD = Ion. Duct Smk Det • HT = Fixed Temp Heat Det S = Spkr Only FP = Fire Phone
DHS = Door Hldr & Sink.Det MD = Mercoid Heat Det ANr. =•Aud o.Vj ual PJ = Phone Jack
SSD Smk Det FD =Flame De V� V'sual Only NCS = Nurse Call Sta.
BD =Be Beam Det. Det. — —
FAILURES AND SYSTEM DEVIATIONS FROM NFPA DADS: None • II As Follows (describe fully),
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Ac.cr 203 Q
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AUTHORITY HAVING JURISDICTION MC24 -2 -005