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ltUNDAMENTALS OF FIRE ALARM SYSTEMS :* - /9'1 13 72-33 i
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FIRE ALARM SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time of system acceptance and approval,
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1. P Address:
TE73 -0 5.14" A)2(1.- -tz-' / 7O T E D p n o p g rir y INFORMATION .4. i .1 - r•flt",
Name of property: /21° effIX")"°ffAkPC t C // I-
//t, -70P 73 'O 1.36-A)69
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• Description of property: - - ,5411.t..-S-C Zi-N-Ite>e - 2 s"rmey 77 2 2----3
Occupancy type:
Nitta of*.roperty representative: _AV A/161-74194C "X/A./...C,W 6121/41s7221"(-6 Vail 1
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Address:
Phone: "30.5 92 cfdY7 Fax: E-mail:
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Authority having jurisdiction over this property: & ij a 7 126-471-1-1
Phone: -573•L 39- aii 71 Fax: E-mail: „
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2. FIRE ALARM SYSTEM INSTALLATION,SERVICE,AND TESTING INFORMATION
Installation contractor for this equipment: kib-X/t/i1V SkettRiTy
Address: 54'f/ 5... /lc LenACtit/AIi31-121), poreil.I.JD
Phone: 5A3- 131— 0303 Fax: 533- 210-/0 q Li E-mail:Seg.titeq)Assmifa pis,cori
Service organization for this equipment: XliORie,44/ receiga-y
Address: 591/ Ye /161:1 i GIG/i Lltsi BLVD,) Pd ter LA-n..0 ie 5 g 912.02-
Phone: 633' 2-3 I- o 30 3 Fax: -5'..a3 - 2'5'3- 143 LI Y • speoc8 GC)AS 41-4V4 441 S'C°1 ' I
Location of as-built drawings: OW" 5-ITE Location of historical test reports:6"-S ITE.• i
Location of system operation and maintenance manuals: 0 NI- S'ill.-
A contract for test and inspection in accordanCe with NFPA standards is in effect as of
Contracted testing company:
Adress:
hone: Fax: E-mail:•
Contract expires: Contract number: Frequency of routine inspections:
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3. TYPE OF FIRE ALARM SYSTEM OR SERVICE 4
NFPA 72 Chapter Reference of System Type: eiY4P7r12-5 6 8 • ;
Name of organization receiving alarm signals with phone numbers(if appl(cable):
Alafm: e/15" (Cie IT/C 0 Al) Phone: A'gei°—4716 Z — ?Sd°
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Supervisory: Phone:
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Trouble: Phone: '
Entity to which alarms are retransmitted: A/2-e - Phone:
..... .,_ . .
Method of retransmission of alarms to that organization or location: / 1-*.6'al/a"c '':
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D 2007 National Fire Protection Association trap.1 of 5)
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FIGURE 4.5.2.1 Record of Completion.
2007 Edition gr]
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72-34 :NATIONAL FIRE ALARM.CODE -
3. TYPE OF FIRE ALARM SYSTEM OR SERVICE(continued)
If Chapter 8,note the means of transmission from the protected premises to the central station:
Digital alarm communicator 0 McCulloh 0 Multiplex 0 2-way radio 0 1-way radio 0 N/A
If Chapter 9,note the type of connection: 0 Local energy 0 Shunt 0 N/A
3.1 System Software / / /
Operating system(executive)software revision level: 51G `4���`
Site-specific software revision date: 17/4 Revision completed by: h jam/
4.SIGNALING LINE CIRCUITS
Characteristics of s' ling line circuits connected to this system(see NFPA 72,Table 6.6.1):
Quantity: Style: a S Class: 13
5. ALARM-INITIATING DEVICES AND CIRCUITS
• Characteristics of initiating device circuits connected to this system(see NFPA 72,Table 6.5):ia
Quantity: O Style: 4 Class: 5
5.1 Manual Initiating Devices
5.1.1 Manual Pull Stations Number of manual pull stations: -
Type of devices: ❑ Addressable ,Conventional 0 Coded 0 Transmitter 0 N/A
5.2 Automatic Initiating Devices
5,.2.1 Area Smoke Detectors Number of smoke detectors: .3 2
;
Type of coverage: 0•Complete area •)(Partial.area 0,Nonrequired partial area 0 N/A
Type of devices: 0 Addressable 3eConventional 0 Coded 0 Transmitter 0 N/A
Type of smoke detector sensing technology: • 0 Ionization' X Photoelectric
5.2.2 Duct Smoke Detectors Number of•duct smoke detectors:
Type of coverage:
Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A
Type of smoke detector sensing technology:. 0 Ionization 0 Photoelectric
5.2.3 Heat Detectors Number of heat detectors:
Type of coverage: . Q Complete area >4 Partial area 0 Nonrequired partial area 0 N/A
Type of devices: 0 Addressable A Conventional .0 Coded 0 Transmitter 0 N/A, f
5.2.4 Sprinkler Waterflow.Detectors Number of waterflow detectors: v
Type of devices 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A -
5.2.5 Alarm Verification Numb r of devices subject to alarm verification:
Alarm verification on this system is: Q Enabled Disabled 0 Set for seconds
®2007 National Fire Protection Association NFPA 72(p.2 of 5)
FIGURE 4.5.2.1 Continued •
FUN DAM ENTALS OF FIRE ALARM SYSTEMS 72-35
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6. SUPERVISORY SIGNAL•INITIATING DEVICES AND CIRCUITS
6.1 Sprinkler.System • Number of valve supervisory switches:
Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A
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6.2 Fire Pump A01/1-
Type of fire pump: 0-Electric '❑ Diesel •
Type of fire pump supervisory devices: 0 Addressable 0 Conventional 0 Coded .❑ Transmitter 0 N/A
Fire Pump Functions Supervised •
O Fire pump power 0 Fire pump running 0 Fire pump phase reversal 0 Selector switch not in auto
O Engine or control panel trouble ❑.Low fuel
Other:
6.3 Engine-Driven Generator .A//4-
Type of generator supervisory devices: 0 Addressable ❑ Conventional. 0 Coded ❑ Transmitter 0 N/A
❑ Engine or control panel trouble ❑ Generator running 0 Selectorswitch not in auto 0 Low fuel
Other:
1. .
7. ANNUNCIATORS A1/4—•
7.1 Annunciator 1 0 Local .0 Remote
Type: 0 Addressable 0 Directory 0 Graphic '❑ N/A • Location:
7.2 Annunciator 2 0 Local 0 Remote '
. Type: 0 Addressable 0 Directory 0 Graphic 0 N/A . Location:.
7.3 Annunciator 3 0 Local 0 Remote '
Type: 0 Addressable 0 Directory . 0 Graphic 0 N/A Location: •
8. ALARM NOTIFICATION DEVICES'AND CIRCUITS
8.1 Emergency Voice Alarm Service.
Number of single voice alarm channels: Number of multiple voice alarm channels:
Number of speakers: . Number of speaker zones:
8.2 Telephone Jacks
Number of telephone jacks installed: Number of telephone handsets stored on site:
Type of telephone system installed: ❑ Electrically powered 0 Sound powered 0 N/A
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8.3 Nonvoice Audible System
Characteristics of notification device circuits connected to this system(see NFPA 72,Table 6.5):
Quantity: Style: 'W Class: 3
®2007 National Fire Protection Association NFPA 72(p.3 of 5)
FIGURE 4.5.2.1 Continued
2007 Edition 0
72-36 NATIONAL FIREALARhi CODE
8. ALARM NOTIFICATION DEVICES AND CIRCUITS(continued)
8.4 Types and Quantities of.Nonvoice Notification Appliances Installed
Bells:.._, With visual device: Horns: With visual device:
Chimes: With visual device: • Bells: With visual device:
Visual devices without audible devices: Other(describe):
9. EMERGENCY CONTROL FUNCTIONS ACTIVATED
0 Hold-open door releasing devices. 0 Smoke management or smoke control
❑ Door unlocking 0 Elevator recall 0 Other
10. SYSTEM POWER SUPPLY
10.1 Primary Power •
Nominal voltage /ZD✓AL Amps
Overcurrent protection: Type. G%2G6tr 8/LEfl Amps 1
_
Location(of primary supply panelboard): I Cf0 C_e Sc f 7/3 —r
Disconnecting means location: �„, 7,
10.2 Secondar�Power
Location: Al'' Type: •Nominal voltage:. Current rating:
Number of standby batteries: Amp hour rating: 7
Location of emergency generator: Nf✓-
Location of fuel storage: WM
Calculated capacity of secondary pow�er/to drive the system
In standby mode: c2 41 /V4urzS In alarm mode: 3 M/4/4 7-S.
11. RECORD OF SYSTEM INSTALLATION
Fill out after allinstallation is complete and Wiring has been checked for opens,shorts,ground faults,and improper
branching,but before conducting operational acceptance tests.
The system has been installed in accordance with the following NFPA standards:(Note any or all that apply.)
%NFPA 72 NFPA 70,National Electrical Code,Article 760
i3'Manufacturer's published instructions 0 Other(please specify):
System devia ' ns om re er d NFPA standards:
Signed: � ff' Printed name: i'7 i�4 /�`/tif' Date: Z 3
Organization: k162/C4A/ gC-1t4/'/ Title: rG'L4 Phone: SO- 3/-6303
12. RECORD OF SYSTEM OPERATION
All operational features and functions of this system were tested by.or in the presence of the signer shown below,on
the date shown below,and were found to be operating properly in accordance with the requirements of:
)?1'NFPA 72 AiNFPA 70,National Electrical Code,Article 760.
iiCi Manufacturer's published instructions 0•Other(please specify):
❑ Docume 'on/in ac ce wit1f Inspection and Testing Fo (Figure 10.6.2.3)is attached
Signed: 1 .LI
Printed name: `U4 fl�/ Date: 01-/-Z1/3
Organization: MR/Ci¢// ,rELCA2tTy Title: ` Phone: 503.231-6303
®2007 National Fire Protection Association NFPA 72(p.4 of 5)
FIGURE 4.5.2.1 Continued
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Et 2007 Edition
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FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-57
13. CERTIFICATIONS AND APPROVALS.
13.1 System Installation Contractor
This systema , eci•ed herein has been installed and tested according to all NFPA standards cited herein.
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Signed: Printed, name: Date:
I,i5i'/C9-41 5f-5-4" ./7 Title: ' 7 Phone: 5()3'23J.C36 j
Organization: <` °
13.2 System Service Contractor
This system a eci ed her 'n ' stalled and tested according to all NFPA standards cited herein.
Printed name:Signed:
AL 'i//41 Date: 2/2 7 L3
Organization:
/9/174/C41l'a 5-ectegt / Title: iesCl7 Phone: sa3- Z3/-63 3
13.3 Central Station
This system as specified herein will be monitored according to all NFPA standards cited herein.
Signed: Printed name: Date:
Organization: /9-friOR/C04" 45-6C4117/ Title: Phone: 6-33-z3/.°36-3
13.4 Property Representative
I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein.
Signed• il� r.— Printed name5( Date?J
Organization: Title: Phone:
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13.5 Authorit` Having Jurisdiction
I have witn••fed a satisfactory acceptance test of this system and find it to be installed and operating properly
in accorda .f with its approved pla.. and specifications,its approved sequence of operations,and with all NFPA
standards fted hereip.
Signed: L�•f►- — Printed name: (t1 r eibc)/ Date:
Organization: Title: Phone:
NFPA 72(p:5of5)
®2007 National Fire Protection Association
FIGURE 4.5.2.1 Continued
2007 Edition
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