Report (33) Cps 090-?
! INSPECTION AND TESTING FORM
DATE: // —/2 — ZO lsf
TIME: 1 4/72
SERVICE ORGANIZATION PROPERTY NAME(USER)/
Name: CSC-,.^ f I /,4 14/f1C/7A/ Name: G[`'D/l% /0/ (11///1 377,y
Address: 47//9 .✓�,/i 47eIh,Cl/Q 4 / uC�'l." ,4 e -- Address:"a 7 13 SW 6g741 ,f' ode
S' Afr(/ ^/0 //�Q7 Owner Contact: �{ ^.( -(' forest, /
Representative: -_(�P /��' ?�, ���
License No.:�JSC y 3 9 7.3 S Telephone: 5 5 5 9 a.6
Telephone: 5 3 %f 7 7'.O 2.,
MONITORING ENTITY APPROVING AGENCY
Contact: L 'Y q Contact: trl",,4 (UC'/I/y .a.pd . 7
Telephone: 6-1)43 G' .S� -�� L1 Telephone: ��03 Sc)O /3--c-r ?
Monitoring Account Ref.No.: 3 ' v q� CH(/ of / ! Cj cCl 5O 7/8 V.
TYPE TRANSMISSION SERVICE
• McCulloh 3 Weekly
3 Multiplex 3 Monthly
Digital D Quarterly
J Reverse Priority 3 Semiannually
J RF 3 Annually // /
3 Other(Specify) 3 Other(Specify) kW/75-M/ TS (44-
-74r, f
Control Unit Manufacturer: 5i/f'4 f nn//I/1 / Model No.:5-Q X/ <5//.C/
Circuit Styles: (j 4_9/Cl s5 C (�CL�
Number of Circuits: c5/_Lt(2,) //4 e(9) Ore 7P ( 47)
( �Y�
Software Rev.:
Last Date System Had Any Service Perfomied: /.1 '02 �S
Last Date that Any Software or Configuration Was Revised: /7/ ' - /S
ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity Circuit Style
(p �� - CUSS y Manual Fire Alarm Boxes
Ion Detectors
S LC_-P'l()fA(t'SS040-- Photo Detectors
Duct Detectors
Heat Detectors
Waterfow Switches
SLR _� �!/Z°SS� �- Supervisory Switches (e4f1 '
Other(Specify):
(NFPA Inspection and Testing 1 of 4)
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION
Quantity Circuit Style
Bells
Horns
Chimes
Strobes
I / Speakers
y Neu) /3 ( 5 a old) Other(Specify): /74a4/1//5-7-60X6----;_c
No.of alarm notification appliance circuits: `7
Are circuits monitored for integrity? ,Yes ❑ No
SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity Circuit Style
Building Temp.
Site Water Temp.
Site Water Level
Fire Pump Power
Fire Pump Running
Fire Pump Auto Position
Fire Pump or Pump Controller Trouble
Fire Pump Running
Generator In Auto Position
Generator or Controller Trouble
Switch Transfer
( Generator En One Running
Other: c2 C h Id C-iie.iu t .
• - , G h •
SIGNALING LINE CIRCUITS
Quantity and style(See NFPA 72,Table 3-6)of signaling line circuits connected to system:
Quantity 7- SLC Style(s)
SYSTEM POWER SUPPLIES
a. Primary(Main): Nominal Volta e 42-0 ��'� ,Amps
Overcurrent Protection: Type S e Gl K P r ,Amps_2 i2
Location(of Primary Supply Panelboard): 2�' ' �L��� L� n/I
Disconnecting Means Location:
b. Secondary(Standby):
`/Y"r( Storage Battery: Amp-Hr.Rating
Calculated capacity to operate system,in hours: /0 A9. Nt cti✓1 24 4 N /04—(,60
Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
TYPE BATTERY
D Dry Cell
D Nickel-Cadmium
..— Sealed Lead-Acid
• Lead-Acid
• Other(Specify):
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.
(NFPA Inspection and Testing 2 of 4)
•
d PRIOR TO ANY TESTING 10(a 1 —d Ef ec-4'orS
NOTIFICATIONS ARE MADE Yes No Who Time _
Monitoring Entity 0 C‘ � /
S 7700 / 4,
Building Occupants 0 ,j'-(I-P i)P A1j c,i 4'
Building Management 0 0 ..5-on-v1/4_,L '
Other(Specify) 0 0
Alit(Notified)of Any Impairments ❑ 0
SYSTEM TESTS AND INSPECTIONS r//e? ^ v-7$l'as
TYPE Visible Functional Comments
Control Unit 0
Interface Eq.
Lamps/LEDS _
Fuses
Primary Power Supply
Trouble Signals
Disconnect Switches
Ground-Fault Monitoring
SECONDARY POWER
TYPE Visible Functional Comments
Battery Condition 0 1 . -f 1 jJ ao4 e ,,J.74.4
Load Voltage 0 V
Discharge Test 0 / (U C I . ArtNNW-
Charger Test 0 / / ,,,,''
Specific Gravity '0 0 y� Ar J
•
TRANSIENT SUPPRESSORS 0 _
REMOTE ANNUNCIATORS ,2._-' —' a
NOTIFICATION APPLIANCES S / *.2.
Audible -- ti---*ti---* KI idjarrA9.4
Visual ---- 0----
Speakers 0 0 /�i%;-
Voice Clarity 0 /t//e}-
INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS
Device Visual Functional Factory Meas.
Loc.&S/N Type Check Test Setting Setting Pass Fail
O 0 0 0
❑ ❑ ❑ 0
❑ ❑ 0 J
❑ 0 ❑ 0
O ❑ 3 0
Comments:
(NFPA Inspection and Testing 3 of 4)
d
■
EMERGENCY COMMUNICATIONS EQUIPMENT Visual Functional Comments
Phone Set ❑ ❑
Phone Jacks ❑ ❑
Off-Hook Indicator ❑ ❑
Amplifier(s) ❑ ❑
Tone Generator(s) ❑ `❑�
Call-in Signal /x -0 " ilL >1 ' he
System Performance ❑ ❑
Device Simulated
Visual Operation Operation
INTERFACE EQUIPMENT
(Specify) ❑ ❑ 0
(Specify) 0 0 ❑
(Specify) ❑ > D
SPECIAL HAZARD SYSTEMS
(Specify) ❑ 0 0
(Specify) ❑ ❑ 0
(Specify) 0 ❑ 0
Special Procedures:
,
Comments:
SUPERVISING STATION MONITORING Yes No Time Comments
Alarm Signal ❑ ❑
Alarm Restoration ❑ ❑
Trouble Signal ❑ ❑
• Supervisory Signal ❑ ❑
Supervisory Restoration ❑ 0
NOTIFICATIONS THAT TESTING IS COMPLETE Yes No Who Time
Building Management �' 0 /2'.'9/..c Monitoring Agency ❑ ( S/zi
Building Occupants ❑ 0
Other(Specify) ❑ ❑
The following did not operate correctly:
System restored o nori ah I open n: D. �. / Time: c� ti /243 4,..---
THIS TESTING WAS PERFORMED J ' ••RDA t'I— APPLICABLE N A'S A DA DS. �(
Name of Inspector: _ , . `i —•��n r 0__-P Date:/1—t�$ ' Time:
Signature: !' �/4is./
Name of Owner or Representative: atr la ea r c
Date: Time:
Signature:
(NFPA Inspection and Testing 4 of 4)