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FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-BS I FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system Installation contractor at the time of system acceptance and approval, 1. PROTECTED PRO • RTY INFORMATIQN • Name of property: 'l of fit° l ("I Q Address: `'. P , Description of property: Occupancy type: Name of property,representative: �`' )Pfr 1 w / 5 Address: q r� • Phone: C C) " ! I Q " L �U D9 Fax: E-mail: Authority having jurisdiction over this property: Phone: Fax: _ E•mai1: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION • Installation contractor for this equipment: / 5kCtairy Address: •54 3E f 23L-VD, p - i. n7D oR 9 - 2 20Z Phone: 5a 3 — 2-31— 0303 Fax: 533- 2-10- /ti q E• mail: gK✓ ice-- qu f}-S t , Co Service organization for this equipment:, A'7ER /C4A/ fecu2/7y Address: ...5 SE MCL'O(tG/IL /N BLVD. ParertA -tJD. 02 912.02- Phone: 563. 7'31- 0303 Fax: , 230— /o yr w E-mail: S8R C� [• i n ,q -t.ky2M S • Co . >`? Location of as -built drawings: 0. t - SITE. Location of historical test reports: 6 k 1 SITE Location of system operation and maintenance manuals: ON - S/T . A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: E-mail: • Contract expires: Contract number: Frequency of routine inspect ' i :' • 1 TYPE OF FIRE ALARM SYSTEM bR SERVICE p NFPA 72 Chapter Reference of System Type: 'C W P7r? -5 b � O Name of organization receiving alarm signals with phone numbers (if applicable): Alafm: C "75 (Cie TT/ C O NJ) Phone: / go° g 2 - ?.8Q0 Supervisory: �� Phone: Trouble: // Phone: • Entity to which alarms are retransmitted: F P7EPr, Phone; Method of retransmission of alarms to that organization or location :_, / � Ar e 02007 NatIonal Flre Protection Association NFPA 72 (p. 1 or 5) FIGURE 4.5.2.1 Record of Completion. 2007 Edition rnl 72 -34 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: Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2 -way radio ❑ 1 -way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N /A 3.1 System Software Operating system (executive) software revision level: Site- specific software revision date: Revision completed by: 4. SIGNALING LINE CIRCUITS Characteristics of signaling fine circuits connected to this system (see NFPA 72, Table 6,6.1): Quantity: , Style: 0' S Class: 1 5. ALARM- INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 6.5): �II Quantity: t Style: >9 Class: 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: 0 Addressable Et Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5,2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: In Complete area 0 Partial area 0 Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable •gl Conventional ❑ Coded ❑ Transmitter 0 N/A Type of smoke detector sensing technology: ❑ Ionization ' ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: ❑ Addressable ditbConventional ❑ Coded 0 Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.9 Heat Detectors Number of heat detectors: Type of coverage: 0 Complete area ❑ Partial area 0 Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional 0 Coded ❑ Transmitter ❑ N /A. 5.2,4 Sprinkler Watertlow.Detectors Number of waterfiow detectors: Type of devices ❑ Addressable Ci Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: 0 Enabled ❑ Disabled ❑ Set for seconds m 2007 National Fire Protection Association NFPA 72 (p. 2 of 5) FIGURE 4.5.2.1 Continued fZl 2007 Edition • • ' FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 - 35 • 6, SUPERVISORY SIQNAL•INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler. System Number of valve supervisory switches: Type of devices: ❑ Addressable 0 Conventional ❑ Coded ❑ Transmitter ❑ N/A • 6.2 Fire Pump • • • . Type of fire pump: • 0 •Electric '0 Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded •❑ Transmitter ❑ N/A Fire Pump Functions Supervised . O Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal 0 Selector switch not in auto ❑ Engine or control panel trouble ❑• Low fuel Other: Engine- Driven Generator • Type of generator supervisory devices; 0 Addressable .0 Conventional . 0 Coded ❑ Transmitter ❑ N/A • ❑ Engine or control panel trouble . ❑ Generator running 0 Selector•switch not in auto ❑ Low fuel Other: • • • 7. ANNUNCIATORS i • 7.1 Annunciator 1 - focal . 0 Remote • Type: 4414ddressabie 0 .Directory ❑ Graphic •0 N/A • 'Location: r 7.2 Annunciator 2 tt Local 0 Remote • • Type: - 0 Addressable- 0 Directory - ❑ Graphic ' 0 N/A . Location: - . 7.3 Annunciator 3 0 Local 0 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: 0 Electrically powered ❑ Sound powered ❑ N/A • 8.3 Nonvoice Audible System 0 Characteristics of notification device circuits connected'to this system (see NFPA 72, Table 6.5): Quantity: Style: Class: f3 • 0 2007 National Fire Protection Association NFPA 72 (p. 3 of 5) FIGURE 4.5.2.1 Continued • 2007 Edition x�i 72 -86 NATIONAL FIREALAW CODE 8. ALARM NOTIFICATION DEVICES AND CIRCUITS (continued) 8.4 Types and Quantities of Nonvoice Notification Appliances (na ailed Bells: With visual device: Horns: With visual device: Chimes: With visual device: —__• Bells: With visual device; Visual devices without audible devices: Other (describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other 10. SYSTEM POWER SUPPLY 10:1 Primary Power • Nominal voltage 20 ✓.A}L Overcurrent protection: T ype G /2Gcc hE� Amps rimer supply IA • Amps primary PP Y Panelbo: ); ILA \ Location (of Disconnecting means location: 10.2 Secondary Power Location: 1 Type: Nominal voltage: Current rating: -- Number of standby batteries: ( g l Z Amp hour rating; Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: c 1/out . 5 In alarm mode: /4.0,4/6 ,(TxS 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.) ,NFPA 72 NFPA 70, National Electrical Code, Article 760 Manufacturer's published instructions 0 Other (please specify): System de l‘ • s f • r= renced NFPA standards: Signed: Printed name: a A N 1 \• �(� 6 4:3 Svc ate: Organization: /166'1 /fiN eGee,'u / 7'' Title: Phone: ✓�5 "Z3 /- 6303 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: NFPA 72 J'NFPA 70, National Electrical Code, Article 760 Manufacturer's published instructions ❑ Other (please specify): O Docume in a o with Inspection and Testi anti (Fi re 10.6:2.9) is attached Signed: C Printed name: `r \ l .mac Organization: $ Date: �M�R / , Title: .. Phone: 673` 231- 030j © 2007 National Fire Protection Association NFPA 72 (p. 4 of 5) FIGURE 4.5.2.I Continued M 2007 Edlllon • • • .FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 -37 • • 13. CERTIFICATIONS AND APPROVALS 13.1 System installation Contractor This system as specified"herein has been installed and tested according to all NFPA standards cited herein. Signed: n .Printed name: Date: Organization: 41fc.-N 5 Title: Phone: 53'23J'6303 • 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: AIM' /C-4 SEcuim/ Title: Phone: 5 23/-633 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: 4 7/ / 04 / 041 A/ '52-C41i / Title: 6-33 -Z3 /• 6303 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 accordance with its approved plans and specifications, its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: • • • ® 2007 National Flre Protection Association NFPA 72 (p: 5 of 5) FIGURE 4.5.2.1 Continued • • 2007 Edition .n