Report 6up Pic -
ALARM INSPECTION AND TESTING REPORT page I!3 t✓" j
DATED i C TIME STARTED ''
PROPERTY TENANT , M 0
NAME pi-i'� {, 9a (d ' %c,'ct ( fc(
ADDRESS i I ': Or ,..,' :`:.'x " , ' L r if,. ‘ PROPERTY OWNER SAFETY b FIRE, INC
• CITY,STATE ZIP 71 ccr .+ /c,/ / . (.%;,<: NAME Fuu SERVICE ruts PROTECTION-
PHONE T, r i 6 - ;.: 7 ADDRESS
CONTACT /74-4 i c. !;: /c- /S CITY,STZIP
MONITORING ENTITY 'tr. APPROVING AGENCY
CONTACT: CONTACT:
PHONE: PHONE:
ACCT #:
TRANSMIT ION TYPE SERVICE PERFORMED
. [) McCULLOH [ ] WEEKLY
[ ) MULTIPLEX [ ] MONTHLY
[ac] DIGITAL [ ] QUARTERLY
[ I REVERSE PRIORTY [ ] SEMI-ANNUAL
[ ] RF FI ANNUAL
[ ] OTHER (SPECIFY) [ ] OTHER (SPECIFY)
PANEL MANUFACTURER: C, : L , -,5 MODEL NO.: , -''':
CURCUIT STYLES: -/L
NO. OF CIRCUITS: Z.
SOFTWARE REV.: I O, Z Z.
LAST DATE SYSTEM HAD ANY SERVICE PERFORMED: k j •//
LAST DATE ANY SOFTWARE OR CONFIGURATION WAS REVISED: ' y/i this"
ALARM- INITIATION DEVICES AND CIRCUIT INFORMATION
: ZONE NO. ZONE DESCRIPTION CIRCUIT STYLE ZONE NO. ZONE DESCRIPTION CIRCUIT STYLE
[ 1. -_. 1 1______1 1 1
U 1 —._. lJ 1 1
U 1 - - -- - -1 -.1 1 1
1 1 l l _.... -- ... 1 1
1 1 1 1 -- T` _ 1
1 1 1_1 1 .... _______...., 1
NO. OF ALARM INDICATING CIRCUITS SUPERVISED? [ -YES [ ] NO
SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUIT INFORMATION
QTY CIRC STYLE DESCRIPTION QTY CRC STYLE DESCRIPTION •
- - --__ ,_.,._ BUILDING TEMP. FIRE PUMP OR CONTROLLER TROUBLE
STIE'WAT11tTEMP. GENERATOR IN AUTO POS ON
SITE WATER LEVEL ' - - GENERATOR OR CONTR TRBLE
FIRE PUMP POWER _ SWITCH 1RANSFIR
FIRE PUMP RUNNING GENERATOR-E NGU E RUNNING
FIRE PUMP AUTO POSITION OTHER (SPECIFY
SIGNALING LINE CIRCUITS
QUANTITY AND STYLE OF SIGNALING LINE CIRCUITS CONNECTED TO SYSTEM
SYSTEM POWER SUPPLIES
a. PRIMARY (MAIN): NOMINAL VOLTAGE: + 1 Z. ,AMPS::.
OVERCURRENT PROTECTION: TYPE: 1 ; «.kti r ,AMPS: ? G
LOCATION (PANEL NO.) j i.?" e k1$} I
DISCONNECTING MEANS LOCATION: j,.:.ti, �.
ALARM INSPECTION AND TESTING REPORT page V3
Date Customer
= ....._F-.
b. SECONDARY (STANDBY): z://:. ,..
STORAGE BATTERY: ,AMP -HR RATIN
CALCULATED CAPACITY TO OPERATE SYSTEM, IN HOURS: ; 24' , ,60
ENGINE- DRIVEN GENERATOR DEDICATED TO FIRE ALARM SYSTEM: [ 1 YES[ 1 NO
METRO
LOCATION OF FUEL STORAGE: SAFETY & FIRE, INC
•FULL SERVICE FIRE PROTECTION.
TYPE BATTERY [ ] DRY CELL [ ] NICKEL- CADMIUM M SEALED LEAD -ACID
[ ] LEAD -ACID [ 1 OTHER (SPECIFY):
c. EMERGENCY OR STANDBY SYSTEM USED AS BACKUP TO PRIMARY POWER SUPPLY, INSTEAD OF USING A
SECONDARY POWER SUPPLY: (SPECIFY):
SYSTEM TESTS AND INSPECTIONS
TYPE VISUAL FUNCTIONAL COMMENTS
CONTROL PANEL 1 1 f 1 1
INTERFACE EQ. 1 1 1 •,' 1. 1
LAMPS/LEDS 1, 1 f 1 1
FUSES 1 1 f 1 1
PRIMARY POWER SUPPLY [ ] 1 ;< 1 1
TROUBLE SIGNALS 1 1 1 1 1
DISCONNECT SWITCHES [ J [ .I 1 1
GROUND FAULT MONITORING f 1 [ ._ ' 1 1
SECONDARY POWER
TYPE VISUAL FUNCTIONAL COMMENTS
BATTERY CONDITION [ 1 [ -X. 1 1
LOAD VOLTAGE Z: 7 , / ? 1 t: 1 1
DISCHARGE TEST 2. i . 1 1 1
CHARGER TEST 1 ;< 1 1
SPECIFIC GRAVITY 1 1 1
TRANSIENT SUPPRESSORS 1 . 1 1
REMOTE ANNUNCIATORS f 1 f 1 1
NOTIFICATION APPLIANCES
AUDIBLE 1 11/4 - 1 f x 1 1
VISUAL . 1 K. 1 [ x. ] 1
SPEAKERS [ 1 1 1 1
VOICE CLARITY [ 1 1
- INITIATION AND SUPERVISORY DEVICE TESTS AND INSPECTIONS
LOCATION/ DEVICE VISUAL FUNC FACTORY MEAS.
SERIAL; NO- __ TYPE PE CHECK TION SETTING SETTING PASS/FAIL
1 ` `__ ---- -- -L_._. L[ 1 1 1 1 1
1 f 11 1 11 1
J 1 11 1 -'_` 1 11 1
•
J 1 11 1 - -[---. f 1
i
SEE ATTACHED SUPPLEMENTAL PAGE IF CHECKED HERE-
ALARM INSPECTION AND TESTING REPORT page 3/3
Date Customer
EMERGENCY COMMUNICATIONS EQUIPMENT
VISUAL FUNCTIONAL COMMENTS
METRO
PHONE JACKS — —_ [ 1 [ 1 SAFETY & FIRE, INC
OFF -HOOK INDICATOR [ ] •FULL SERVICE FIRE PROTECTION.
AMPLIFIER(S)
TONE GENERATOR(S) [ 1 [
CALL -IN SIGNAL
SYSTEM PERFORMANCE [ J [ ]
SPECIAL PROCEDURES: -
f f r• 1 } i c r c., o !% , 5
COMMENTS: - LL . f " ur ci vw v �r 1-1„ 1 , r i I- 1 ( b\ 0p„ c . c�' C l /9,1 < d
6, / ,,s to t( fil
PRIOR TO ANY TESTING
NOTIFICATIONS ARE MADE: YES NO WHO TIME
MONITORING ENTITY [ [
BUILDING OCCUPANTS [ [
BUILDING MANAGEMENT t1 [
OTHER (SPECIFY) [ ] [
AHJ (NOTIFIED) OF ANY IMPAIRMENTS [ J [ ]
SPECIAL INSTRUCTIONS:
THIS SERVICE WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS BY AN ALARM
TECHNICIAN REPRESENTING YOUR SERVICE COMPANY, METRO SAFETY & FIRE INC. 7055 NE GLISAN ST,
PORTLAND OR 97213 IF YOU HAVE ANY QUESTIONS ABOUT THE SERVICE PERFORMED OR COMMENTS
MADE IN THIS REPORT PLEASE CALL 503)231 -2999
NAME OF TECHNICIAN
SIGNATURE:) I r __: ? . �� _ �_- Date L/ f: // G Time (-`
NAME OF OWNER OR REPRESENTATIVE THAT THIS REPORT SHOULD BE FORWARDED TO:
) 7 ti L= 1 Date
SIGNATURE OF CLIENT REPRESENTATIVE RECEIVING SERVICE