Report I Zo1Z —ooc7( a
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 -31
FIRE ALARM SYSTEM
. ( � RECORD OF COMPLETION
Name of protected property:
(T , �/
Address: C
. I - S L� ,)
Representative of protected property (name, p one): Y / a l�
Authority having jurisdiction: \ i e /t-c ) . /
Address/ telephone number. 1"...2"1/ • f r ' ! ( 1) rihi (( , (,'V) F7j i - jre' :.;{ < F-1
r Organization name / phone, Representative name / phone
Installer: \ L._- (.�1(A/t„k.a.A. IA..0. t...1 — y�.
Supplier: 'VZC._ /.G Al_ (.-C LiA r, Arr. --
Service organization: >� ? .r.6:,-.1.4_‘44_,-(.4,,,c0--t-r.,.. ---s Location of record (as -built) drawings: i-i
Location of operation and maintenance manuals: p
Location of test reports:
A contract for test and inspection in accordance with NFPA standard(s): u
Contract no(s): f i ;.O i Cr � Effective Date '� l / Z Expiration date:
System Software 1
(a) Operating system (executive software revision level(s):
(b) Site - specific software revision date:
(c) Revision completed by:
(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
Telephone numbers of the organization receiving alarm:
Alarm
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communication center or others, indicate location and telephone numbers of the
organization receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72 , Chapter 8 - Proprietary
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory:
Trouble:
If alarms are retransmitted to public fire service communication center or others, indicate location and telephone numbers of the
organization receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 8 - Central Station t
Prime Contractor: Z L ^6, 1
Central Station Location: _S (- ((( i (). ? z y . /A c `'3 6 C
(NFPA 72 , 1 of 4)
FIGURE 4.5.2.1 Record of Completion
72.32 NATIONAL FIRE ALARM CODE
Means of transmission of signals from the protected premises to the central station:
McCulloh Mutiplex One -way radio
Digital alarm communicator Two-way radio Others
Mea s transmission of alarms to the public fire service communications center.
(a)
(b)
System Location: k V•'
NFPA 72, Chapter 9 - Auxiliary
Indicate type of connection: Local energy Shunt Parallel Telephone
Location of telephone number for receipt 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 h been install in icc oidance wit the NFPA standards as shown below, was inspected by
61 " a c, ,,) on ( j_ ( 5•• (1 „includes the devices shown
in 5 and 6, and has been in service since .
NFPA 72, Chapters (check ell that appyf '153.2 �[ 3 �4 ❑ 5 ❑ 6 7 89 1=1 10 ❑ 11 tgt NFPA 70, National Electrical Code, Article 76 7 �
Manufacturer's instructio.
Other (specify)
Signed: / Date: -- , — i < . ' `-
Organization: 1 ' (, / ,. < I--, s, ��
3. Record of System Operation
Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached
All operational features and functions of this system were tested by: Date:
and found to be operating properly in accordance with the requirements of:
NFPA 72, Chapter(rhect aq mat apply) 1 V1-3 �4 12 5 Li 6 Li 7 Li a ❑ 9 10 1.1
NFPA 70, National Electrical Code, Article 0
Manufacturer's instructions
/
Other (specify)
Signed: , ` _ Date: ! / f —
Organization: �j �' 1.,..0, c 1..$7.e w �s
4. Signaling Line Circuits
Quantity and class of si • ' e circuits connected to system (see NFPA 72 table 6.6.1):
Quantity: Style: Class:
(NFPA 72, 2 of 4)
FIGURE 4.5.2.1 Continued
FUNDAMENTALS OF FIRE ALARM SYSTEM 72-33
5. Alarm- Initiating Devices and Circuits
Quantity and class of init g device circuits (see NFPA 7 Table 6.5)
Quantity: Style: -) Class:
MANUAL
(a) Manual
stations Noncoded Transmitters Coded Addressable
(b) Combination manual fire alarm an guard's tour coded stations:
AUTOMATIC
Coverage: Complete Partial
Selective y No _ uir
(a) Smoke Detectors 1 Ion Photo Addressable
(b) Duct Detectors Ion Photo Addressable
(c) Heat Detectors FT RR FT /PR RC Addressable
(d) Sprinkler Waterflow indicators: Transmit rs Noncoded X, Coded Addressable
(e) The alarm verification feature is disable 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):
FIGURE 4.5.2.1 Continued (NFPA 72, 3 of 4)
72 -34 NATIONAL FIRE ALARM CODE
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 the class of notification appliance circuits connected to system (see NFPA 72, Table 6.7):
Quantity: Style: Class:
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: jeZal Current rating:
Location: Y tex 'ic- 1 « `1/
(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:
L t✓ E �� t�� >f � ! ?"2-
(sig for installation contractor /supplier title) (date)
(signed) for alarm service company (title) (date)
(signed) for central station (title) (date)
Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction):
(signed) representative of the authority having jurisdiction (title) (date)
FIGURE 4.5.2.1 Continued (NFPA 72, 4 of 4)