Report •
o13-- 6 o/ ?
FUNDAMENTALS OF FIRE ALARM SYSTEMS
72-31
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected property L )e s ,
Address: , �- • r
Representative of protected property(name,phone):
Authority having jurisdiction: C l
Address/telephone number: 6`— '-5 -247 c-MD3l
Organization name/phone 1 Representative name/phone
Installer. v (
Supplier. ' n
Service organization:
Location of record(as-built)drawings: Q
Location of operation and maintenance manuals: 1(
Location of test reports: e
1rG�L. o .
A contract for test and Inspection In accordance with NFPA standard(s):
Contract no(s): Effective Date
Expiration date:
System Software
(a)Operating system(executive software revision level(s):
(b)Site-specific software revision date:
(c)Revision completed by.
(name)
(firm)
1. Type(s) of System or Service
NFPA 72,Chapter 6-Local
If alarm Is transmitted to Iocation(s)off premises,list where received:
NFPA 72,Chapter 8-Remote Station
Telephone numbers of the organtzation receMng alarm
Alan
Supervisory.
Trouble:
If alarms are retransmitted to public fire service communication center or others,Indicate location and telephone numbers of the
organization receMng alarm:
Indicate how alarm is retransmitted:
NFPA 72,Chapter 8-Proprietary
Telephone numbers of the organization receMng alarm:
Alarm:
Supervisory.
Trouble:
If alarms are retransmitted to public fire service communication center or others,Indicate location and telephone numbers of the
organization receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72,Chapter 8-Central Station
Prime Contractor.
Central Station Location:
— ' Q,o liar a
=JGURE 4.6.2.1 Record of Completion (NFPA 72,1 of 4)
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72-32 NATIONAL FIRE ALARM CODE
Means of transmission of signals from the protected premises to the central station:
McCulioh Mutiplex
Digital alarm communicator One-way radio
Two-way radio Others
Means Knsmission of alarms to the public fire service communications center.
(a)
(b)
System Location:
NFPA 72, Chapter 9•Arndllary
Indicate type of connection: Local energy Shunt
Location of telephone number for receipt of signals: Parallel Telephone
2. Record of System Installation
(FM out after instaaabon Is complete and wiring Is checked for opens,shorts,ground faults,and Improper branching
but prlor to conducting operational acceptance tests.)
This system has been Installed In accordance with the NFPA standards as shown below,was Inspected by
on ,Includes the devices shown
In 5 and 6,and has been in service since
NFPA 72, Chapters pea an the.ppm Kt 1 �3 tI 0 7 [3 �9 b.0 ❑11
NFPA 70,National Electrical Code, Article 760 �l "'� ` `''� LJ�
Manufacturer's Instructions
Other(specify)
Signed:
Organization: l Date: '11)4 3
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3. Record of System Operation
Doaanentffiion In accordance with Inspection Testing Form,Figure 10.62.3,Is attached
All operational features and functions of this system were tested by.
and found to be properly Date: •
operating p pery in accordance with the requirements of:
NFPA 72,Chapter
ationalElec►.JJe apply). .i %2. Ig. 1t"I 5Ng6 )K7 ❑8 ❑g �(0 11
NFPA 70,National Electrical Code, Article 760 ("l" J'x 1"� 1�:
/ Manufacturer's Instructions
Other(specify)
Signed: `�
Date: F--F-11-__
Organization: PZ ci K r
4.Signaling Line Circuits
Quantity and class of signaling line circuits connected to system(see PA 72 table 6.6.1):
Quay Style: t Class: S Y
(NFPA 72,2 of 4)
FIGURE 4.6.2.1 Continued
FUNDAMENTALS OF FIRE ALARM SYSTEM 72-33
5. Alarm-Initiating Devices and Circuits
Quantity and class of in', . n.,;-vi..• circuits(see NFPA 72, Table 6.5)
Quantity: , Style:
Class:
MANUAL
(a)Manual
stations Noncoded Transmitters Coded Addressable
(b)Combination manual fire alarm and guard's tour coded stations:
AUTOMATIC
Coverage: Complete Partial
Selective Nonrequired
(a)Smoke Detectors Ion
(b)Duct Detectors Photo Addressable
ion Photo Addressable
(c)Heat Detectors FT RR FT/RR RC Addressable
(d)Sprinkler Waterfiow Indicators: Transmitters Noncoded Coded Addressable
(e)The alarm verification feature Is disabled or enabled_ .changed from seconds to
(f)Other(list): seconds.
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6. Supervisory Signal-Initiating De ices and Circuits(use blanks to indicate quantity of devices)
GUARD'S TOUR
(a) Coded stations
(b) Noncoded stations
(c) Compulsory guard's tour system comprised of transmitter stations and Intermediate stations
Nate: Combination devices are recorded under 5(b),Manual,and 6(a),Guard's Tour
SPRINKLER SYSTEM
Check if Provided
(a) Valve supervisory switches ❑
(b) Building temperature points ❑
(c) Site water temperature points ❑
(d) Site water supply level points ❑
Electric Fire Pump:
(e) Fire pump power ❑
(f) Fire pump running ❑
(g) Phase reversal ❑
Engine-driven Fire pump:
(h) Selector In auto position ❑
0) Engine or control panel trouble ❑
Q) Fire pump mining ❑
ENGINE-DRIVEN GENERATOR
(a) Selector in auto position ❑
(b) Control panel trouble ❑
(c) Transfer switches ❑
(d) Engine running ❑
Other supervisory function(s)(specify):
FIGURE 4.6.2.1 Continued
(NFPA 72,3 of 4)
0
72-34 NATIONAL FIRE ALARM CODE
7.Annunciator(s)
Number: Type: Location:
8.Alarm Notification Appliances and Circuits
NFPA 72,Chapter 6-Emergency Voice/Alarm Service
Quantity of voice/alarm channels: Single:
Quantity of speakers Installed: Multiple:
Quantity of speaker zones:
Quantity of telephones or telephone jacks Included in system:
Quantity and the class of notification appliance circuits connected to system(see NFPA 72,Table 6.7):
Quantity. Style:
Class:
Types and quantities of notification appliances Installed:
(a)Bells With Visible
(b)Speakers With Visible
(c)Horns With Visible l
(d)Chimes
(e) � With Visible
Othe
With Visible
(f)Visible appliances without audible:
9. System Power Supplies
(a)Fire Alarm Control Panel: R Nominal Voltage: a.v Current rating:
Overcurrent protection: 1 .� Type: Current rpting:
Location: q IA. a R1 # 3 `�
(b) Secondary(standby): V/
Storage Battery: � 2 pour rating:
Calculated capacity to drive system,in hours:
Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
(c) Emergency system used as backup to primary power supply
.Emergency system described In NFPA 70,Article 700:
10.Comments
Frequency of routine tests and Inspections,If other than In accordance with the referenced NFPA standard(s);
System deviations from the referenced NFPA standard(s)are:
(sign for Installation ractor/supplier (fie) (date)
(
(signed)for alarm service company I
(title) (date)
(signed)for central station
(title) (date)
Upon completion of the system(s)satisfactory test(s)witnessed(if required by the authority having Jurisdiction):
(signed)representative of the authority having Jurisdiction (title) I
(date)
FIGURE 4.6.2.1 Continued
(NFPA 72,4 of 4)