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CJ 0 o ( FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. • 1. PROTECTED PROPERTY INFORMATION Name of property: F C % ^ cc1,1 Cc n4t Address: / Lc'? Sid Green \:),,r r62 a leor.11•Anl 02. 4 3722 3 Description of property: h'<« RI Occupancy type: R - ELN: s Name of property representative: lior erN34t. /1 ( ec►1 \ Ser�tCcS Address: 10 Z- .S()Ce- c c., 1 i,,r) c � for 4 Ca. 57 Phone: Fax: E -mail: Authority having jurisdiction over this property: Phone: Fax: E -mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION Installation contractor for this equipment: C1r► J - Actson. f lac r •c Address: 5 Ccic>" ieo. ,I Q. 5 1-2 O, Phone: Fax: E -mail: Service organization for this equipment: S ex Ge • r1 1\ Address: G3° Stt! 1—Ake 6swc„ C' Phone: 4b3— CV3'9a0C) Fax: S? 7 ' Cq-s 6_512 l E -mail: Location of as -built drawings: 'Ac . 1' c. s aEr• G¢— Location of historical test reports: 14 t ioei 4,1 - Location of system operation and maintenance manuals: oi < \; \:e3 e V A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: St ^'► pt^eXG r. i1At 0 . Address: l g h c G1S 14 •-c._ Phone: . Fax: E -mail: Contract expires: Contract number: Frequency of routine inspections: 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE NFPA 72 Chapter Reference of System Type: C-ePtdri l - 4 "'1 Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: Phone: Supervisory: Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.1 of 5) 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: cif-Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2 -way radio ❑ 1 -way radio ❑ N/A If Chapter 9, note the type of connection: 0 Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: 6. b.3": U Site - specific software revision date: 51• I 0 Revision completed by: 5y2 e . t \ 1 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits connected to this system (see NFPA 72, Table 6.6.1): Quantity: Style: Class: 5. ALARM - INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: Style: Class: 5.1 Manual initiating devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: • Type of coverage: 0 Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: 0 Complete area 0 Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Waterfow Detectors Number of waterflow detectors: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. ©2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.2 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 6. SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 6.2 Fire Pump Type of fire pump: ❑ Electrical ❑ Diesel Type of pump supervisory devices: ❑ Addressable D Conventional ❑ Coded ❑ Transmitter ❑ N/A Fire Pump Functions Supervised D Fire pump power 0 Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto 0 Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded 0 Transmitter ❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. ANNUNCIATORS 7.1 Annunciator 1 ❑ Local D Remote Type: ❑ Addressable D Directory ❑ Graphic ❑ N/A Location: 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ 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 ❑ Sound powered D N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: 1 Style: Y Class: b Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.3 of 5) • • NATIONAL FIRE ALARM CODE 8. ALARM NOTIFICATION DEVICES AND CIRCUITS .(continued) 8.4 Types and Quantities of Nonvoice Notification Appliances Installed r� Bells: With visual device Horns: With visual device: 2 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 0 Door unlocking , 0 Elevator recall 0 Other 10. SYSTEM POWER SUPPLY 10.1 Primary Power Nominal voltage (2e) v A,. • Amps b 1 1 ev7 r Overcurrent protection: Type 13 re (Cr ■ Amps 2' .4 ../.., • Location (of primary supply panelboard): 'Disconnecting means location: 10.2 Secondary Power • Location: Type: Nominal voltage: 2 °tC Current rating: 1 / 1 " 4 v Number of standby batteries: Amp hour rating: I S q �y. Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 2'4 6.......,- In alarm mode: 11 '!'" 1 - ,1 11. RECORD OF SYSTEM INSTALLATION Fill out after all installation 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.) . 0 NFPA 72 - 0 NFPA 70, National Electrical Code, Article 760 0 Manufacturer's published instructions 0 Other (please specify): - • . System dev' . m referenced NFPA standards: Signed: T - / Printed name: 61z3cr j S, Ke Hn Date: I 1 / I / 7 Organization: C., rt - kfzK Sa tv t=kS) t L T1KTitle: S•eik t1; C_r T cJ c Phone: co3 /•9 -.S3o 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: 0 NFPA 72 0 NFPA 70, National Electrical Code, Article 760 0 Manufacturer's published instructions 0 Other (please specify): 0 Docume j' io in accordance with Inspection and Testing Form (Figure 10.6.2.3) is attached‘ c, Signed: L d i.,, 41 Printed name: a,a (�� ri/ac� t L(/? ate: F''' � /' Date: ° Organi .tion: c 'n-� _ �, nt I I Title: 1- k Pe Phone: •S`v3 -G � 3-5C446 Reprinted with permission from NTFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. 02007 National Fire Protection Association . SG24 -2 -014 Rev. (10/07) (p.4 of 5) • FUNDAMENTALS OF FIRE ALARM SYSTEMS 13. CERTIFICATIONS AND APPROVALS 13.1 System Installation Contractor This system cified herein has been installed and tested according to all NFPA standards cited herein. Signed: s t Printed name: 6/ oyo� tCe,+� j D 1' fil-.t j // o Organization: Ckit 1 i Tevt S ° v. EL,�. (-i tr .. ) Title: S�� 1 -4 N''-,n L Phone: ,c ?3/ /' 13.2 System Service Contractor This system .: p; cified herei s been installed and tested according to all NFPA standards cited herein. Signed: Printed name: �" Date: �''� O Organization: S' I C+'G - . n c I Title: Tee //L Phone: 5 "G 11- 3 - 1c.JC%G 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accorda e w'th its approved plans and specifications, its approved sequence of operations, and with all NFPA standard • ci - 1,4,4 Signed /l�� _ Printed name: I4644:r $4 -Ie.i /( 1( Date: c Z C, • / 0 Organization: 7 i _V. 4R.. Title: a O-fiiglte:, F7J gj W Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright 02002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. ® 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.5 of 5)