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Report (39) ri aorS - co /c, 3 INSPECTION,TESTING,AND MAINTENANCE 72-101 INSPECTION AND TESTING FORM DATE: /—02-4/-40-/ TIME: /O.•Gte, SERVICE ORGANIZATION PROPERTY NAME(USER) Name: 7ff/L�/ 01-10OOA//Ci.S Name: --V1/Yr '�• Address:_ �f`J_/_ (AZ ? �!� /�!/L�.�_ Address: Representative: AfA77-7deK/ Owner Contact: W� License No,: ''7'd,/te7 L,e-At- Telephone: Telephone: ;3-2�^�i.SOBff MONITORING ENTITY APPROVING AGENCY Contact: 1444PS "E-1--"e- IJ I GS Contact: a./Ty 77a-gici''r> _ Telephone: Monitoring Account Ref.No.: /V9 74, TYPE TRANSMISSION SERVICE LI McCulloh LI Weekly LI Multiplex U Monthly )igital LI Quarterly LI Reverse Priority LI Semiannually LI RF Ikr-4nn.ually LI Other(Specify) LI Other(Specify) Control Unit Manufacturer: 5'I t-E ht F•' CN Ie.1rr- Model No.: Si©y$ Circuit Styles: a.A.4.0..s $ Number of Circuits: S.- Software Software Rev.: A/E?/ Last Date System Had Any Service Performed: VAN/' Last Date that Any Software or Configuration Was Revised: A/er.!'✓ ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION Quantity Circuit Style / G+ sg 25 Manual Fire Alarm Boxes Ion Detectors / G`1AS5 }3 Photo Detectors Duct Detectors Heat Detectors .1L,R{5,g $ Waterflow Switches eli45e ' $ Supervisory Switches Other(Specify): Alarm verification feature is disabled jtC� enabled (NFPA Inspection arid Testing,1 of 4) FIGURE 10.6.2.3 Example of an Inspection and.Testing Form. 2002 Edition 72-102 NATIONAL FIRE ALARM CODE ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity Circuit Style / GSL, SS Bells Horns Chimes Strobes __---- _-- Speakers Other(Specify): No.of alarm notification appliance circuits: Are circuits monitored for integrity? tlf.s.Yes U 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 Engine Running Other: SIGNALING LINE CIRCUITS Quantity and style of signaling line circuits connected to system(see NFI'A 72, Table 6.6.1): Quantity Style(s) SYSTEM POWER SUPPLIES (a)Primary(Main): Nominal Voltage /?HVAC_ Amps 20464- Overcurrent Protection: Type Amps Location(of Primary Supply Panelboard): ' - OI•. Disconnecting Means Location: Lim—/ GAY ZS (h)Secondary(Standby): /ZV,t�G Storage Battery:Amp-Hr.Rating G.4 Calculated capacity to operate system,in hours: 7C_ 24 60 Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY 13 Dry Cell LI Nickel-Cadmium 5ealed Lead-Acid D Lead-Acid 0 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 NEPA 70,Article 700 Legally required standby described in NEPA 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) FIGURE 10.6.2.3 Continued 2002 Edition INSPECTION,TESTING,AND MAINTENANCE 72-103 PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Yes No Who Time Monitoring Entity U11.1,7' <f5 Building Occupants - U -� Building Management U 0401.flt}rR.. Other(Specify) U U AHJ Notified of Any Impairments U U SYSTEM TESTS AND INSPECTIONS TYPE Visual Functional Comments Control Unit Interface Equipment U U Lamps/LEDS ,`R NC _ ___..___ Fuses „ Primary Power Supply -, Trouble Signals Disconnect Switches K. _.._.______.._........__........__ _ Ground-Fault Monitoring tjd-- . SECONDARY POWER TYPE Visual Functional Comments Battery Condition Load Voltage Discharge Test Charger Test U Specific Gravity U TRANSIENT SUPPRESSORS U REMOTE ANNUNCIATORS U ::1 NOTIFICATION APPLIANCES Audible ........___.__.__.... -- __.... Visible U U Speakers U U Voice Clarity U INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS Device Visual Functional Factory Measured Loc.&S/N Type Check Test Setting Setting Pass Fail 77-0s.ER— ti' rE tow ) XL U ,vs-Mt.... tGrr_ADZ U ss� - -rra-a_ 7 . U U U U, U Comments: (NFPA Inspection arid Testing,3 of 4) FIGURE 10.6.2.3 Continued 2002 Edition 72-104 NATIONAL FIRE ALARM CODE EMERGENCY COMMUNICATIONS EQUIPMENT Visual Functional Comments Phone Set Phone Jacks Off-Hook Indicator ❑ Q Amplifier(s) Q Q — Tone Generators) Q ❑ Call-in Signal ❑ ;] System Performance - Device Simulated Visual Operation Operation INTERFACE EQUIPMENT (Specify) Q O Q (Specify) Q Q Q (Specify) ❑ ❑ Q SPECIAL HAZARD SYSTEMS (Specify) ❑ ❑ Q (Specify) ❑ Q Q (Specify) Q ;] ❑ Special Procedures: Comments: SUPERVISING STATION MONITORING Yes No Time Comments Alarm Signal Q ¢'175- Alarm mssAlarm Restoration UI Trouble Signal XX- ❑ Supervisory Signal ❑ Supervisory Restoration ❑ 1:.+10 NOTIFICATIONS 1 - NOTIFICATIONS THAT TESTING IS COMPLETE Yes No Who Time Building Management ❑ V'4J) .1S . /p ..F� Monitoring Agency 74. ❑ pia./.r7.f Building Occupants Q Sy 60%•e Z— Other(Specify) LI Q The following did not operate correctly: System restored to normal operation: Date: A.-Z414--A51 Time: /42-' THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS. Name of inspector: Date: Time: Signature: Name of Owner or Representative: 1710-7712524/ i /AE K Date: /-Z.9-//+ Time: /O'3j� �G�iQSignature: �/�— V (NFPA Inspection and Testing,4 of 4) FIGURE 10.6.2.3 Continued 2002 Edition