Report (37) NFPA-72 Fire Alarm System Record of Completion
Date: j/ ii/ 19
City of 1 fJ i(CI Information: Permit No. rp5a0!C7s(rO
Name of protected property: Lflh1Lo l 0 Ccv IAC ,� 1
Address of protected property: Lc () 51 j ' G. 1 ), 6w c qi'3
Representative of protected pro ert (name/phone): 1�k fo A Yg (-j --—1 ?CICS
Authority having jurisdiction: (J t9 a F fl a��0
Address/telephone number: 131 ,9)5 lj J ft31 li i WJ 'T(' l qi
1. Type(s)of System or Service
NFPA 72, Chapter 3-- Local
If alarm is transmitted to locations(s) off premises, list where received:
NFPA 72, Chapter 3-- 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:
NFPA 72, Chapter 5--Auxiliary
Indicate type of connection:
Local energy Shunt Parallel telephone
Location of telephone number for receipt of signals:
NFPA 72,
Alarm:
Supervisory:
NFPA 72, Chapter 5-- Proprietary
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 5--Remote Station
Prime contractor:
Central station location:
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One-way radio
Digital alarm communicator Two-way radio Others
Means of transmission of alarms to the public fire service communications center:
(a)
(b)
System location:
Organization name/phone Representative name/Phone
Installer CIA 10 C:
Supplier 064 I V C
Service organization 1) ,
Location of record(as-built)drawings:
Location of owners manuals: (Q. r
Location of test reports:
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 installations 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
by on 51/6/)/ , included the devices shown below, and has been in service
since 7//�
x NFPA 72(2010), Chapters 10 12 14 17 18 21 23 (underline all that apply)
x NFPA 70(2011), National Electrical Code, Article 760
x Manufacturer's instructions
Other(specify):
Signed: // Date: 5 /72_//9
c7
Organization: ().L ) (Vl C. _
3. Record of System Operation
All operational features and functions of this system were tested by c e 1 Tij1n5c'n Le0r01s on 5117//q
and found to be operating properly in accordance with the requirements of:
x NFPA 72(2010), Chapters 10 12 14 17 18 21 23 (underline all that apply)
x NFPA 70(2011), National Electrical Code, Article 760
x Manufacturer's instructions
_Other(specify):
Signed: / Date: 57,2
Organization: 0S , (v a,
4. Alarm-Initiating Devices and Circuits
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
(d) Sprinkler waterflow switches: Transmitters Noncoded, activating
(e) Other(list):
5. Supervisory Signal-Initiating Devices and Circuits
HVAC
(a) Duct detectors Ion Photo
SPRINKLER SYSTEM
(a) Non coded valve supervisory switch at sprinkler riser
(b) Non coded valve supervisory switch at sprinkler vault
(c) Non coded supervisory air pressure switch at sprinkler riser
(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
Q) Fire pump running
Engine-driven generator:
(k) Selector in auto position
(I) Control panel trouble
(m) Transfer switches
(n) Engine running
Other supervisory functions(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: Style Class: B
(a) Bells Inch
(b) Speakers
(c) Horns
(d) Chimes
(e) Other:
(f) Visual signals Type:
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 ( Notification Power Supply NAC 5.1)
(a) Primary(main): Nominal voltage: Current rating:
Overcurrent protection: Type: Current rating:
Location:
(b) Secondary(standby):
Storage battery: Amp-hour rating:
Calculated capacity to drive system, in hours: 24 60
(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): N/A
(b) Application software revision level(s):
(c) Revision completed by: N/A
(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):
This record of completion applies to
Devices installed conform to NFPA standards.
System deviations from the referenced NFPA standard(s) are: NONE
(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)