Report F76 PO- Od frir
FLrNUA11 N ALS OF FIRE MARIA SYS'I'ENI.S 72 -31
FIRE ALARM SYSTEM
CORD { OF COMPLETION
Name of protected property: r, a r "r iL k ��r 1
Address: 1 SD- 1 5 ... : . L. • ._.
Representative of protected property (name /phone):
Authority having jurisdiction:
Address/telephone number:
Urganizalton name 1p!rurte Rr)rmxea(aliur nonce /phuru
Installer �ci C � � tt4-v o � j ��/ ( -3 t'V "�� _� t Pr c,•, _._3.�U..._y ) ,2. - 1 /`. ( / L 1
Supplier ' t - r.l AtiG1r4 ' 6(4%11
1
service organisation /
Locution of record (inn- built./ drawings: S.i L _, —._.- .... ....
Location or operation and �ma manuals, s i 4 L —
Location of text reports: - + ._]C►'t
A contract for teat and inspection in accordance with NFPA stundurd(s )
Contract Nu(s): - ._..__. Effective date: Expiration date:
System Software
a) Operating f3yritcn (exec.ot, ve) Rnftware reviRion level(s):
(b) Site - specific software revision date: _._.___......
lc) Revision completed by:
(Nolo) (firm)
1.Type(s) of System or Service
NFPA 72, Chapter 6 — Local
If alarm is transmitted Lo location(s) ofi' premises, list where received:
.
NhY'A 72, Chapter 8 — Remote Station
Telephone numbers of the organization receiving ularmL
Alarm:
Supervisory:
'l'roublc:
IF alarms ore retransmitted to public fire service communications centers or other, indicate location and telephone
numbers of the organization receiving alarm:
Indicate how alarm iR retransmitted:
NFPA 7 Chapter 8 Proprietary
Telephone numbers of the organization receiving alarm:
Alarm:
Trouble:
if alurins 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 n ^ — Central Station
Prime contractor: A fon `?ern
Central station locution: c.�.k( �e ft
(NFPA 72, 1 of 4)
FIGURE 4.5.2.1 Record of Completion.
2002 Edition
72 - ,s� s NAiiONALFIIREALAKM (.a)I)IC
Means of trunarniasion of signals from the. protected premises to the central station:
McCulluh ..__ Multiplex One -way radio
. -.._ Digital alarm communicator .. —_.. -_Two-way radio Others
Means of transmission of alarms to the public fire service communications center:
la) --
System location: .....- - --
NFPA 72, Chapter 9 — Auxil
indicate type of connection: Local energy Shunt Parallel telephone
Location of telephone numher for receipt of signals:
2. Record of System Installation
( Fill out, after installation is complete and wiring is checked for open(:, shorts, ground faults, and improper branching,
hut prior to conducting operational acceptance tests.)
• '1'hi3 '!,y,,steln has Aeen installed in accordance with the NP'1'A standards as shown below, was inspected by
f _ i 14t .S .__. on . 1/ .1 / - /O , includes the devices shown
in 5 and 6, and has been in service since i/ • i/O
5 6 - NFPA 72, Chapters 1 2 6 (i i 8 9 10 11 (circle all that apply)
lj��. NFPA 70, National Electrical Cnde�, Article 760
..1` _ Manufacturer's instructions
Other (specify): _
� n
Organizatiunr A C `<L M �( 1.r, tOie J -.. ....... ._....__._._.._,.
3. Record of System Operation
`-
I
Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, ' at child •
All operational lecturer; and functions of this system were tcstod by , � f " M S date Jl • / �o
and found to be operating properly in accordance with the requirements of:
NFPA 72. Chapters 1 2 3 4 5 6 7 8 9 0 1 1 Jcircle all that apply)
NFPA 70, Notional Electrical Ccxle, Article 760
y , Manufacturer's instructions
_Other (specify): —._... -.
Signed: �[�� c � Date: /A /2 /o
I I�
Organization: `J � I-C!_ t rb a cw G
t _.- _ .......... ........
4. Signaling Line Circuits 4
Quantity and class of signaling Zinc Circuits connected t0 systerrl (Nee NFPA 72, Ta61e G.G. I):
Quantity: Style: Class:
(NFPA 72. 2 of 4)
FIGURE 4.5.2.1 Gutttinlicd
2002 Edition
FUNDAMENTAL-5 OF Mk; ALARM wy'I'I..M} 72 -
5. Alarm - Initiating Devices and Circuits
Quantity and class of initiating device circuity (set' NFPA 72, Table 6,5):
Quantity: .,,. Style; _._._. Class:
•
MANUAL
(a) Manual stutions Noncnded. Tranamittera Coded Addressable,..._.,
(b) Combination manual fire alarm and guard's tour coded stations
AUTOMATIC
Coverage: Complete Partial
Selective Nunrcquired
(al Smoke detector's ion Photo , Addressable
(h) Duct detectors ion Photo Addressable
(c) pent detectors F'f RR . FT/RR RC Addressable
(d) Sprinkler waterflow indicators: Transmitters Noncnded Coded Addressable
lei The alarm vel'iticution feature iH disabled or enabled , changed from seconds to seconds.
(F) Other (li
6. Supervisory Signal- Initiating Devices and Circuits (use blanks to indicate quantity of devices)
GUARD'S TOUR
{u) Coded stations
lb) Noncnded dt,ntions
(c) Compulsory guard's tour system comprised of transmitter stations and intermediate stations
Note: Combination devices are recorded under 6(h), Manual, and 6(a), Guard's Tour.
SPRINKLER SYSTEM
Check if provided
(a) ......Valve supervisory switches
(h) Building temperature point.a
lc) Site water temperature paints
(d) Site water supply level points
Electric fire pump:
(e) Fire pump power
(f) Fire pump running
(g) Phase reversal
Engine- driven tare pump;
(hi Selector in auto position
(i 1 Engine or control panel trouble
(j) Fire pump running
ENGINE- DRIVEN GENERATOR:
(u) Selector in auto position
(b) Control panel trouble
(c) Transfer awlLchos
(d) Engine running
Other supervisory function(s) (specify):
(NFPA 72, 3 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
NATIU AM. FIREAl ARM f]f1111:
7. Annunciator(s)
Number: Type: .._ Locution: - ..
8. Alarm Notification Appliances and Circuits
NPPA 72, Chapter 6 — Emergency Voice /Alarm Service
Quantity of voice/alarm channels: Single:. _ — Multiply
Quantity of speakers installed :... .. Quantity of speaker zones:
Quantity of telephones ur telephone jacks included in system:
Quantity and the class of notification appliance circuits connected to system (See NFPA 72, Table 6,71:
Quantity: Style
Class:
l l y 7 r--
—
Types and quantities of notification appliances installed:
(u) Bells _ -. ._ With Visible ._ _
(h) Speakers _ .._ With Visible
(c) }lorns__,.,, With Visible
Id) Chimes _ With Visible
e) Other: With Visible
II) Visible appliances without audible:
9. System Power Supplies
(a) Fire Alarm Control Pane]: N�minal l Current rating: S
O vercurrent prntectinn: Type: [Sf c.. tr, _ - - _ �} ..... Current rating: .,.._... - -- _ - -. - --
Vocation: - (") . r.- r /L
(b) Secondary (standby):
Storage battery: 2 ✓ Amp -hour rating:
Calculated capacity to drive system, in hour
Engine- driven generator dedicated to lire alarm system; --
1.ncation of' fuel storage:
(c) Eme.rgency system used as backup to primary power supply:
Emergency system described in NFPA 70, Article 700:
10. Comments
Frequency of routine testy and inspections, rr other than in accordance with the referenced NFPA stundard(s):
Syatom deviations from the referenced NFPA standard(s) are:.,_._- ,_,___
T .� _ //J2-/
/ �
(signed) for installation contractor /supplier (Title) (date)
(si})oUdl ror aINm sorvice company (title) (dale)
for central tenon (lillU) (date)
Upun curt„ &flan u the system(s) aatrelactery tcsL(s)) witnes Ecd (if roquired by the authority having jurisdiction):
• � v` O
(signed) representative of tae authority having ill risdicrinn (one) (dale)
(NFPA 72, 4 of 4)
FIGURE:, 1.5.2.1 Confirmed
2002 edition