Report -'S 24FIRE ALARM SYSTEM
(pc __ OF COMPLETION
Name ofprotected property:
roperty Address: e57:;"S
Representative of ,A,J0D "•
protected '�
Authority �' D,� "
uty havi g jurisdiction:
urisdictio property(Warne/phone); rct s
n
T ..
number:
'-
Address/telephone1. Type(s)of S ro� ... '' 4'o c,`.)�,
System or /5�3_
� NFPA 72 Service
s",..7—_-; ,0
If al ,Chapter 3_Local
arm is transmitted to location(s)offpremises,list w
NFPA 72,Chapter 3_ here received;
Quantity,Chapteala Emergency Voice/Ala
Quantity rm channels: Voice/Alarm Service
Y of speakers installed; Sin
Quantity of tele Single:
NFPA 72, phones or tele Multi
Chapter g_ Phone jacks Quantity of s Multiple:
Indic Auxiliary
Wcluded in speaker zones:
Indicate type ofsystem;
connection:
�Local energy
Location of telephone Shunt
number for receipt of signals Parallel phone
— NFPA 72 tele
Alarm; 'Chapter 5_Remote Station
Supervisory:
NFPA 72
If ala ,Chapter 5_Proprietary
nns are retransmitted to Public
telephone n
umbers of the organization receiving alafire service rm:
centers
Indicate hog, �: or others,indica
NFPA 72 alarm is retransmitted: location and
Cha ansmitted;
Ater 5_Central Station
Prime contractor: ► -r
Central station location:ation;
of transmission of signals from the protected
McCulloh
P tected premises
Digital alarm co to the central station;
of transmission o f Multiplex
(a) alarms to the public fire Two-waycommon One-way radio
(b) service mu Others
System communications center:
m location: 1;
(NFPA Record of Completion 1 of 4)
Organization name/phone Representative name/phone
Installer 9,0;r--w}d,,1+;,� 03- ,"-ota6 :0
Supplier Sc.-,c
Service organization 3c _ ----e
Location of record(as-built)drawings: w fr --1';
Location of owners manuals: Li)--. ,,-- ,--,,),-,,-,.,._
Location of test reports: '''' k :fl
A contract,dated
for test and inspection in accordance with NFPA standard(s)
No(s). ,dated ,is in effect.
2. Record of System Installation
(Fill out after installation is complete and wiring 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
on 6 1"3 ,includes the devices shown below,and has been in service
since
l NFPA 72,Chapters ' 1 ____72—____3 4 5 _6 7 (circle all that apply)
,/NFPA 70,National Electrical Code,Article 760
_✓'Manufacturer's instructions
Other(specify):
Signed: - V----Y Date: O&`1(531(
(
Organization: R. -)1--- m61;6- 6 T
3. Record of System Operation 9
All operational features and functions of this system were tested by ‘ -r on -" -)"? C"
and found to be operating properly in accordance with the requirements of: '
V NFPA 72,Chapters 2 3 4 5 6 7>circle all that apply)
`NFPA 70,National Electrical Code,Article 760
Manufacturer's instructions
Other(specify):
Signed: �'-- ---`z-e-- Date: Is Wil: /C
Organization: P ,A--- ,^10,-/--c,- r()
4. Alarm-Initiating Devices and Circuits wA
Quantity and class of initiating device circuits(see NFPA 72, Table 3-5) Quantity: Style: Class:
MANUAL
(a) Manual stations Noncoded,activating Transmitters Coded
(b) Combination manual fire alarm and guard's tour coded stations
AUTOMATIC
Coverage: Complete: Partial:
(a) Smoke detectors Ion Photo
(b) Duct detectors Ion Photo
(c) Heat detectors FT RR FT/RR RC
(NFPA Record of Completion 2 of 4)
(d) Sprinkler waterflow switches: Transmitters Noncoded,activating Coded
(e) Other(list):
5. Supervisory Signal-Initiating Devices and Circuits(use blanks to indicate quantity of devices)
GUARD'S TOUR tilP,
(a) Coded stations
(b) Noncoded stations,activating transmitters
(c) Compulsory guard tour system comprised of transmitter stations and
intermediate stations
Note: Combination devices are recorded under 4(b)and 5(a).
SPRINKLER SYSTEM
(a) Coded valve supervisory signaling attachments
Value supervisory switches,activating transmitters
(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:
(k) Selector in auto position
(1) Control panel trouble
(m) Transfer switches
(n) Engine running
Other supervisory function(s)(specify):
6. Alarm Notification Appliances and Circuits
Quantity and class(see NFPA 72,Table 3-7)of notification appliance circuits connected to the system:
Types and quantities of notification appliances installed: Quantity: 3 Style: 'l Class:
(a) Bells Inch
(b) Speakers
(c) Horns
(d) Chimes
(e) Other:
(NFPA Record of Completion 3 of 4)
A
(f) Visual signals Type: 1-^-1-1e-e.!,a
with audible w/o audible
(g) Local annunciator
7. Signaling Line Circuits
Quantity and class(see NFPA 72, Table 3-6)of signaling line circuits connected to system:
Quantity: Style: Class:
8. System Power Supplies
(a)Primary(main): 2-0 Nominal voltage: 2-0 Current rating:
Overcurrent protection: Type: <r.'." Current rating:
Location:
(b)Secondary(standby):
Storage battery: Amp-hour rating: 3 5 a
Calculated capacity to drive system,in hours: 24 60
Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
(c)Emergency or standby system used as backup to primary power supply,instead of using a secondary
power supply:
Emergency system described in NFPA 70,Article 700
Legally required standby system 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
9. System Software
(a)Operating system software revision level(s):
(b)Application software revision level(s):
(c)Revision completed by:
(name) (firm)
10. Comments:
(signed)for central station or alarm service company or installation contractor/supplier (title)
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:
(signed)for central station or alarm service company or installation contractor/supplier (title)
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)
(NFPA Record of Completion 4 of 4)