Report rF5 Z 0 -&-e, s3
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected property: =>`tv CkC Ov^ Q t s •n' J
Address: 1(.e'3 Z S r
Representative of protected property(name/phone):
Authority having jurisdiction:
Address/telephone number.
1. Type(s)of System or Service
✓ NFPA 72,Chapter 3—Local
If alarm is transmitted to location(s)off premises,list where received:
- NFPA 72,Chapter 3—Emergency Voice/Alarm Service
Quantity of voice/alarm channels: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
- NFPA 72,Chapter 6—Auxiliary
Indicate type of connection:
Local energy Shunt Parallel telephone
Location of telephone number for receipt of signals:
- NFPA 72,Chapter 5—Remote Station
Alarm:
Supervisory:
NFPA 72,Chapter 5—Proprietary
If alarms 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:
V NFPA 72,Chapter 5—Central Station
Prime contractor:
Central station location:
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex V One-way radio
Digital alarm communicator Two-way radio Others
Means of transmission of alarms to the public fire service communications center:
(a)
(b)
System location:
(NFPA Record of Completion 1 of 4)
Organization name/ one Representative name/phone
Installer 9l M aw;Ap r Gr p
Supplier 1
Service organization
Location of record(as-built)drawings:
Location of owners manuals: pp
Location of test reports: OScA'Y c� 1?-0O V✓-
A contract,dated ,for test and inspection in accordance with NFPA standard(s)
No(s). ,dated ,is in effect.
2. Record of System installation
(Fill out after installation is complete and wiring checked for opens,shorts,ground faults,and improper
branching,but prior to conducting operational acceptance tests.)
This�has been installed in accordance with the NFPA standards as shown below,was inspected
by(DCVA''Ci! on 'l I ,includes the devices shown below,and has been in service
since
NFPA 72,Chapters g g 6 (> (circle all that apply)
4NFPA 70,National Electrical Code,Article 760
Manufacturer's instructions
Other(sp '
Signed: Date:___D4211.3.._
Organization: n s a k Mpg.\Dr-
3. Record of System Operation 1�
All operational features and functions of this system were tested by on 1 13
andJound to be operating properly in accordance with the requirements of:
NFPA 72,Chapters j9 ® g7 6 (circle all that apply)
NFPA 70,National Electrical Code,Article 760
/Manufacturer's instructions
Other(specify):
Signed: Date: Z
Organization: VOkh
4. Alarm-initiating Devices and Circuits
Quantity and class of initiating device circuits(see NFPA 72,7hble 3-5) Quantity:_ Style: Class:
MANUAL
(a) Manual stations Noncoded,activating Transmitters Coded
(b) Combination manual fire alarm and guard's tour coded stations
AUTOMATIC
Coverage: Complete: Partial:
(a) Smoke detectors Ion Photo
(b) Duct detectors Ion Photo
(c) Heat detectors FT RR FT/RR RC
(NFPA Record of Completion 2 of 4)
(d) Sprinkler waterfiow switches: Transmitters Noncoded,activating Coded
(e) Other(list):
S. Supervisory Signal-Initiating Devices and Circuits(use blanks to indicate quantity of devices)
GUARD'S TOUR
(a) Coded stations
(b) Noncoded stations,activating transmitters
(c) Compulsory guard tour system comprised of transmitter stations and
intermediate stations
Note: Combination devices are recorded under 4(b)and 5(a).
SPRINKLER SYSTEM
(a) Coded valve supervisory signaling attachments
Value supervisory switches,activating transmitters
(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
(i) Engine or control panel trouble
(j) Fire pump running
Engine-driven generator.
(k) Selector in auto position
(1) Control panel trouble
(m) Transfer switches
(n) Engine running
Other supervisory function(s)(specify):
6. Alarm Notification Appliances and Circuits
Quantity and class(see NFPA 72,7hble 3-7)of notification appliance circuits connected to the system:
Types and quantities of notification appliances installed: Quantity: Style: Class:
(a) Bells Inch
(b) Speakers
(c) Horns
(d) Chimes
(e) Other.
(NFPA Record of Completion 3 of 4)
(f) -7 Visual signals Type: Ski s
with audible 3 w/o audible
(g) Local annunciator
7. Signaling Line Circuits
Quantity and class(see NFPA 72,Table 3-6)of signaling line circuits connected to system:
Quantity Style: Y Class: 3
8. System Power Supplies
(a)Primary(main): r-4c O Nominal voltage: 12-fl Current rating:
Overcurrent protection: Type: -C Current rating: `2.0
Location: Flo ckr,'ca\ 12..n - K A 2.-V-..\ -14 39
(b)Secondary(standby):
it Storage battery: Amp-hour rating:
Ci war'3 Calculated capacity to drive system,in hours: 24 60
Engine-driven generator dedicated to fire alarm ystem:
Location of fuel storage:
(c)Emergency or standby system used as backup to primary power supply,instead of using a secondary
power supply
Emergency system deathbed in NFPA 70,Article 700
Legally required standby system described in NFPA 70,Article 701
Optional standby system described in NFPA 70,Article 702,which also meets the performance
requirements of Article 700 or 701
9. System Software
(a)Operating system software revision level(s):
(b)Application software revision level(s):
(c)Revision completed by.
(name) (firm)
10. Comments:
(signed)for central station or alarm service company or installation contractor/supplier (title) (date)
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:
(signed)for central station or alarm service company or installation contractor/supplier (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) (date)
(NFPA Record of Completion 4 of 4)