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. 1ibNDAMa TALS OP.FIREALM• '.SY5 t'EMS / /23113
• 7235
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• • 'FIRE•.ALARM;SYSTEM RECORD'OF'COMPLETION'•
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To be completed by the ayatem•lnefellatlon confreotor et the time•of system accepts.nce and approval.
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•'1.•PROTECTEb•PROPERTY INFORMATION • . •
•Name of property: r Z-l"; .p 3 (-.S/WEST Ct,
• Address; 7 `. •F
• Descrlption.of•property;. �G4�-1ir"� �.
Occupancy.type: T •
. Name of property;representative: /�1/f� •
. Address: 7-7----- I , —— —
Phorie: 503-9I /d 7 Fax: I
Authority having Juriedictlon•over this property: G— E•mell:
Phone: 523• b39:e ,4__/_7_/ •Fax•_
• •.'E•mall;
• 2. FIRE•ALARM•SYSTEM INSTALLATION,SERVICE,AND TES4a INFORMATION •
. • Installation contractor for this equipment• crg%CA+1/ S�c��R1 T •
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Address: SW/ SE M Lo 4 Ht,N aLUD,
Po . 7z OR '9'2 to Z. -
Phone: 5b3~ 151' 0303 Fax:' 533= 2. 0-/c3: .
• E:mSekvicc-q. �i-s�tc�'raMS,co•rl
. Service o•ganization for this equipment: i 6R/CAcV '.• EGitp/T1
Address: -1- // 'SE M CL /!LjA 6L vD; paIartka.p), 4,2 c7720 -
Phone: 533'.2-31- 0303 Fax 3•:•230—. tom
y ':::•L•nt all:;e,¢vrcG @*'►q,_grc11s,cord
Location of as-built•drawings: •O
—_ M :••SIT .
Location of historical test reports:Oiu•S1T�
Location of system operation and maintenance manuals: OP it S/T�.
A contract for.test and inspection in accordance•wlth Nl:'PA•atandef de is.in effect•as of • •
Contracted testing company:__ 1• • .
. Address:
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Phone: ' ' -
Fax: I E-mail:
Contract.expires: Contract number: i Frequency of routine inspect: fir__—__
3. TYPE OF FIRE ALARM SYSTEM.OR:SEFIVICh ' ' '
,• NFP.A 72 Chapter Reference.of System Type; ••!COP : .6 8 •
Name of organization receiving alarni'eighale Ith phone numbers(1tappllcable): •
Alat`m: C/75 CnetriCONJ) • • • Phone: / c d0-
`1(8Z —,7800
. Supervisory: // I /"
�� Phone:
Trouble: Phone: i/
Entity to which alarms are retransmitted: . 1I2 •'17El°7'e:
.Phone;'
•. Method of retransmission of alarms to that organization or lace Ion:` '/ -GEP, aJ�� •
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•. C 2007 Nallonal Flre Protection Asaoclation •
' NFPA 72(p.1 cl 6)
•ITGLTAE4.5.2.1 .Record of Completion. •
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. 2007 Edition CFI
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72—M :NATIONAL FIREACARM:0006. •
3: TYPE OF FIRE ALARM SYSTEM OR$ERYICE(eondnued): • •
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If Chapter B,note the miens'of transmission from.the protected premises to the central station:
)(Digital alarm communicator 0 McCulloh .❑.Multiplex ❑'2-way radio ❑ 1-way radio 0 N/A
• •If Chapter 9,note the type Of connection:.•0 Locs1 energy. ❑..Shunt ❑ N/A
3.1 System Software • - '
Operating system(executive)software revision level: od
Site-specific software revision date:_ /�/�
Revision completed by;
. 4; SIGNALING LINE CIRCUITS ..
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• Characteristics of signaling line circuits connected to this system(se'e NFPA 72,Table 6,611):.• •
'Quantity: I 'Style: D'ate' Class: • ,
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• 6.:ALARM INITIATING DEVICES AND:C,IROUITS
• . • Characteristics of initiating device circuits coiirleotcd to this lyst'em(see NFPA,72;Table 0,5):
. Quantity: eri) Style: Yq • Class:•
5,1:Manual•InItlatIng DbvIces
5,1.1 Manual Pull Stations • I; Number of manual pull stations: 6 '
Type of devices: Addressable. Cr Conventional ❑ Coded 0 Transmitter 0 N/A
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5.2 Automatic Initiating Devices .
6,2.1 Area Smoke Detectors. Number of smoke detectors; • I I .
Type of coverage: ❑•Complete area •XPartiai.area • •O.Nonrequlred partial area 0.N/A
Type of devices: . 0 Addressable ,C'Conventional 0 Coded. ❑ Transmitter ❑ N/A
Type of smoke detector sensing technology: •0 Ionization' 0 Photoelectric .•
5,2.2 Duct•Smoke Detectors ••••�: Number of:duet smoke detectors: 3
. Type.of coverage:. . '
• . .Type of devices: ✓✓✓✓ Addreseable 0 Conventional 0 Coded ❑ Transmitter ❑ N/A
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Type of smoke det e0000tdr sensing technology:. 0•Ionization. 0 Photoelectric •
5.2.9 Heat Detectors Numiier of heat detectors:. U
• Type of coverage: . Q Complete area .13 Partial area 0 Nonrequired partial area ❑ N/A
Type of devices:. ❑ Addressable 0 Conventional. .0 Coded ❑ Tran'sniitter 0 N/A.
5.2.4 Sprinkler Wat rflowDeteotore Number of waterflow detectors: it
Type of devices / Addressable d Conventional 0 Coded • .0 Transmitter ❑ N/A
5.2,6 Alarm Verification • . - Number of devices subject to•alarm verification:
. Alarm verification on this system is: ' 0 Enabled Disabled 0 Set for seconds
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0 2007 National Fire Protection Association • NFPA 7.2(p.2 of 5)
. FIGURE 4.5.2.1 Continued . •.• •
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• .� 2007 Edition _„ •
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—— NBA�1OITAI30FFIREALARM SYSTEMS —--- --
. 72-35
•6■ SUPERVISORY•SIGNAL•INITIAtINGDEVICES.AND CIRCUITS
.6.1.5prinkier.System
•• Number of valve supervisory switches:
Type of devices: KAddreasable : ❑ Conventional 0 Coded ❑ Transmitter 0 N/A
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6.2 Fire Pump /l/
Type.of fire pump:• 0•Electric• '0 Diesel • '
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Type of fire pump supervisory devicesi• 0 Addressable ❑ Conventional ❑.Coded •❑ Transmitter 0 N/A
Fire Pump Functions Supervised ,/J/4- •
• ❑ Fire pump power ❑ Fire pump.running . 0 Fire pump phase reversal ❑ Selector switch not in auto
❑ Engine or control panel trouble 0.2ow itiel
• • Other:
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d.3.Engine•Driveri Generator ! : 4
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' Type of generator supervisory devices; :0 Addressable. .0 Conventional. 0 Coded 0•Transmitter 0 N/A •
❑ Engine or control panel trouble•' ❑.Generator runnidg ❑•Selectar•awitch not in auto 0 Low fuel
Other:
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• 7, ANNUNCIATORS ` ` .
' 7,1 Annunciator 1 ID Local. .0 Remote
• Type: Addressable ❑•Directory 0 Graphic 0 N/A Location: sr Do N.-
7.2 Annunciator 2 ❑ Local ❑ Remote • . .
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. Type: ,0 Addressable 0 Directory 0 Graphic ' ❑ NIA . Location:.
• . 7.3 Annunciator 3 ❑ Local .❑ Remote .
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Type: ❑ Addressable ❑ Directory . 0'Graphic ❑ N/A Location:
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• •8,..AL;ARM NOTIFICATION DEVICES:WO •
, _______
8.1 Emergency Voice Alarm Service •
Number of single voice alarm channels: • Ntimber of multiple voice alarm channels:
Number of speakers: .. Number•of speaker zones:
8,2 Telephone•Jacks . ,
•. Number of telephone f acks installed: Number of telephone handaets•stored on site:
• Type of telephone system installed: 0 Electrically_powered ❑.Sound powered ❑ N/A
8.3 Nonvolce Audible System . .
Characteristics of nol1 catlori deulce clrcuggs connected•tq this system(see NFPA 72,Table 6.5):
Quantity: IOC Style: •%//(/ • B
• Class:
C 2007 National Flre Prolecllon Aesoelaeon
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NFPA 72(p.3 of 5)
FIGURE.4.5.2.1 Continued •
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I 2007 Edlllon .„
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72-3fi'
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--- ' NATIONAL!+! FA ARKCODE
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8. ALARM NOTIFICATION DEVICES AND CIRCUITS(contl ri
a;a Types er>q quhntlties ot:Nonvoice NpttfEeatlon A n ed) •
Bells:___________• With visual device: ppllancse Installed
Bells: �� Horne: c....2—
�_ With'visual device:_ �— With visual device: 2�_
Visual devices without audible devices: Bells:
Q —.�_ With visual device;
9.•EMERQENCY CONTROL FUNaT 0 Other(descrIbe):
O Hold=opari door releasing ' N ACTIVATEp
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Q. Door Unlocking
ng devlgee 0 Smoke management or smoke control
XElevator recall
10. SYSTEM POWER SUPPLY Other.
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• 10:1 Primary PQWer
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Nominal voltage Zp✓�L
Overcuirent.pratectlon:• 'j�.pe 6l2GU /
/eS Am-
mps.....k?
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Location(of primary supply panelboard): Am•e.
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----Disconnecting means.location:.
10.2 Secondary ps er
Location: !
Number of standby batteries: ape' "Nominal voltage;.
Location Of erne+ enc Current rating:
g y generator; ;N Amp hour rating; 7
Location of fuel storage: /
• Calculated capacity of second power to drive the system
In standby mode:: //CVOS.•
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11. RECORD OF SYSTEM INSTALLATION. In alarm mode: .T M/.�l6tS
Fill out after all.installation is complete and Wiringhas.been checked for opens,'shorle,ground faults and
branching,but before conducting operational acceptance tests.
The system has been installed in accordance with•the follbwing.NFPA standards;(Note any or alllthat appy.)
ArNFPA 72•
�Manufncturer's published inetru tlo s 0NFBA 70,National.Electrical Code Article 760 ppl
0 ❑ Other(please specity);
System devi ions A•om eferenced l FPA standards:
Signed: Lam ;}
�iy��/G N Prinfadname: /G(6 �f/� -
Organization: 4/ry „� Date; -?�,
Title; ,�d3.23/-6301•.3
12. RECORD OF SYSTEM'OPERATION' Phone:
•All operational features•and tUfctinne.of this system:were.teSted by.or in.the presence of the signer show
the date shown below;and were found to be operating properly in accordance with the requirements of:
NFPA 72 n below,on
pi Manufacturer's published ins tructions J> NFPA 70,National Electrical Code,Article 760'
❑•Other(please specify):
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❑ Documentati in a cord nce Inspection and''eating Form figure 10.6:24 is attached
SlgneS: ,ri'
AN1P�P.0 Printedaame: �e-4 � ad-e Date:
Organization: / S_7_ +��
Title: Sa3'231-03173
Phone:
®2007 Nallonal Fire Proleclion Association
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FIGURE 4.5.2.1 Continued NFPA 72(p,q of 5)
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.e 2007 Edlllon
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' FUNDAMENTALS OF FIRE ALARM SYSTEMS
72-97
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13. CERTIFICATIONS AND APPROVALS-- --------- - • •
13.1 System Installation Contractor •
• This system a aypectfIed•herein has been installed and tasted according to all NFPA standards cited herein. •
Signed: 4-2 /�16G+./-/i/
' � ,Printed name; Date; 0/ f("4:3
Organization: •/1/15R•/e4-4/ -52:4•4 . Title: Tl C-6
Phone; SG3•Z3/-d 303
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13.2 System Service Contractor -
This system a spelled herein has been installed.and•tested•kccording.to•all NFPA standards cited herein.
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• Signed: `;•'r • Printed name: ./ fridis ,/-�/--
Organization: ./�'ISR/ Date:
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Cs;'. _:.SEC6l/2r'7./ Title: . • ,ra.44 Phone: s- " 231-'630j
• 13.3 Central Station
This system :: spa ed.here(: Il.ba monitored according to all NFPA standards cited herein.
Signed: r. :� --
Printed name: i G ' Date: /` ; --- --
Organization: ��9fi�/Cf... _ C4 ffy Title: LC
P $(}3 -Z3/'0 3
hone:
13.4 Property Hepresentative • •
--- I accept this system as having been installed and tested tolts specifications and all NFPA standards cited herein.
• Signed: • ..
Printed name: Date:
Organization: - Title:
Phone:
13.5 Authority Having Jurisdiction
I have witnessed a satisfactory acceptance test of this system and find it.to be installed and operating properly
in accordance with its approved plans and epet ificattons,its approved sequence of operations,and with all NFPA
standards cited herein:
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Signed: Printed name:
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Date:
• Organization: Title:
Phone: ---------------
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®2007 National Fire Protection Association ' NFPA 72(p:5 of 5)
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. FIGURE 4.5.2.1 Continued ,' •
• . 2007 Edition wn
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