Report 411.7,-;P,.....;-10 (Pc A.= -
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-31
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected property: SOMERSET INVESTMENTS
Address: 10200 SW GRELNAURG RD TIGARD OR 97223
Representative of protected property(name/phone):
Authority having jurisdiction: CITY OF TIGARI)
Address/telephone number:
Organization name/phone Representative name/phone
Installer Safe Technology Group 360-699-2130
Supplier Safe Technology Group 360-699-2130
Service organization Safe Technology Group 360-699-2130
Location of record(as-built)drawings: FACP
Location of operation and maintenance manuals: FACP
Location of test reports: Central Station
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):
(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 communications centers 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 communications centers or others,indicate location and telephone
numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
X NFPA 72, Chapter 8—Central Station
Prime contractor: SIMPLEX
Central station location:
(NFPA 72,1 of 4)
FIGURE 4.5.2.1 Record of Completion.
2002 Edition
72-32 NATIONAL FIRE ALARM CODE
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One-way radio
X 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 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 has been installed in accordance with the NFPA standards as shown below,was inspected by
Safe Technology Group Inc on 11/12/2015 ,includes the devices shown
in 5 and 6,and has been in service since 11/12/2015
NFPA 72, Chapters 1 2 3 4C k fc 7 fe ft 10 11 (circle all that apply)
X NFPA 70,National Electrical Code,Article 760
X Manufacturer's instructions
Other(specify):
Signed: Date: 11/12/2015
Organization: Safe T hnology Group
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 Safe Technology Group Inc date 11/12/2015
and found to be operating properly in accordance with the requirements of:
NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 fm 11 (circle all that apply)
X NFPA 70,National Electrical Code,Article 760
K-Manufacturer's instructions
-Other(specify):
Signed: W Date: 11/12/2015
Organization: Safe Tec ology Group
4.Signaling Line Circuits
Quantity and class of signaling line circuits connected to system(see NFPA 72,Table 6.6.1):
Quantity: NA Style: D Class: B
(NFPA 72,2 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-33
5.Alarm-Initiating Devices and Circuits
Quantity and class of initiating device circuits(see NFPA 72,Table 6.5):
Quantity: NA Style: Class:
MANUAL
(a)Manual stations Noncoded Transmitters Coded Addressable
(b)Combination manual fire alarm and guard's tour coded stations
AUTOMATIC
Coverage: Complete X Partial
Selective Nonrequired
(a)Smoke detectors Ion Photo 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):
(NFPA 72,3 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
72-34 NATIONAL FIRE ALARM CODE
7.Annunciator(s)
Number: NA 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,?able 6.7):
Quantity: I Style: Y Class: B
Types and quantities of notification appliances installed:
(a) Bells With Visible
(b) Speakers With Visible
(c) Horns With Visible 5
(d) Chimes With Visible
(e) Other: With Visible
(f) Visible appliances without audible: 5
9.System Power Supplies
(a) Fire Alarm Control Panel: Nominal voltage: 120VAC Current rating: 5A
Overcurrent protection: Type: Breaker Current rating: 20A
Location: HOUSE PANEL
(b) Secondary(standby):
Storage battery: 2 Amp-hour rating: 7
Calculated capacity to drive system,in hours: 24
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:
A/4' TECHNICIAN 11/12/2015
(signed)for install tor/supplier (title) (date)
(signed)for alarm service company (title) (date)
(signed)for central station (title) (date)
Upon coin leti o n o t e eye (a)satisfactory test(s)witnessed(if required by the authority having jurisdiction):
�o.= t of [ ( j
(signed)rep ;.e give o he aut or ha ng jurisdiction (Ale) ( ate)
(NFPA 72,4 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition