Report 14 L s 97 l VE_.
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/C���/,�q�� Roadie CAL CONTRACTORS, INC.
- Jl' 4403 S.E. Roee Road
V Milweukie, Oregon 97267
( (503) 659 -2212 FAX (503) 6594944
FIRE ALARM INSPECTION AND TESTING FORM
M
— 1 CCB #1532
Site: / !RCN ( i t `'� 1 S c ti ut 1 Date of Testing: l a / 1
Address: Contact: rn /9 ern s S r
Address: -- 17 arc) t 2,2g t- / Phone: 663 c' (
Fax: 6 3 6 S4 V? c-/‹./
INSPECTION PERFORMED
Quarterly Semi- Annual Annual Other r(
MONITORING ENTITY
Name: �:
T( -lam Type of Dialer: _ C T
Phone: 7 S 3 -q c2 e/ Make: F,/ K 1�
Account #: F = 3 ( tVf 30 2.- i1 Model #: $ ("( P C
FIRE PANEL
Manufacturer r = C AL Model # 7Zn D
Circuit Styles g # of initiating circuits or zones:
# of signaling circuits:
Primary Power: Nominal Voltage: /0 Amps: O r
Over Current Protection: Type: St, D Amps: et
Power Location (Panel Number):
Secondary / Standby: Battery Voltage* Q 2 Lit/ Amp -Hr Rating: 7,0 A
Date Battery Installed: ) / ) '(i T,y Battery Condition: _6
Fire Alarm Inspection and Testing
Page 1 of 3
PANEL CONDITION
Good Bad Comments
Lamps /LEDs I
Fuses
Trouble Signal 1 _
Disconnect Switches ✓
Ground -Fault Sup.
Remote Annun. _
Additional Comments:
ALARM INITIATING DEVICES AND CIRCUIT INFORMATION
Device Quantity # Tested Pass Fail
Manual Station 3 3
Ion Detector _ — - .
Photo Detector / 1 I `{ `/
Duct Detector I I './
Heat Detector ✓
Watertlow Switch _ 1
Supervisory Switch I I - '/
Other
Other
Other
Fire Alarm Inspection and Testing .
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t
ALARM INDICATING DEVICES
Device Quantity # Tested Pass Fail
Horn /Strobe J5
Strobe 6 —
Speaker —6)
Speaker /Strobe -e
Heat Detector
Comments:
ON / OFF PREMISES MONITORING
Signal Sent Yes No Comments
Alarm Signal ✓
Alarm Restore
Trouble Signal ✓ _
Trouble Restore V
Supervisory Signal
Supervisory Restore
SPECIAL PROCEDURES:
SYSTEM DEFICIENCIES / NOTES:
Did system return to normal operation ? Yes K No
Comments:
This test was performed in accordance with NFPA standards -
Name of inspector: eclic�, rc� A • H (0(' n S j S� /
Signature of inspector: roe/i Date. (�- 67�' ? /
Name of owner or contact p9 -- FI r'c I C' e
Signature. Date:
Fire Alarm Inspection and Testing
Page 3 of 3
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