Report 140'CZ.0..)/ 511.4 13E u(Ca t1Wt A r C i-41 '4.•.`-1 3—e-)C
} FUNDAMI[Nt'ALSOF FIRE ALARM SYSTEMS 72-S3
I
•
FIRE ALARM SYSTEM RECORD OF COMPLETION
To be completed by the system lnefelfetion contractor at the time of system acceptance and approval.
1. PROTECTED PROPERTY INFORMATIO N 627,--6.41-. ,
Name of prop property:_____ILLL O W J)'`�Q�f,t��-y..- Af,, C�iv�L- /dt!L{
Address: /fl° _�
/ / <'
Description of property: _
C�JZL� t vt,�
C-M7"'�l1E-1Zt_ J
Occupancy type: i
• 4
Name of property repress'tativa: 6 0 ' / �r% rr� "7-z-5 « h
Address: I � �
Phone: Fax:
ail:
Authority having jurisdiction over this property: /
Phone: SZ'3 7/Z 2g59 Fax:
E-mall.
2, FIRE ALARM SYSTEM INSTALLATION,SERVICE,AND TESTING INFORMATION
Installation contractor for this equipment: /1/14- 14.44/ SECt[RIT'/
Address: 5-41// SE C/C4.0uFrlt/N &t)./), PonTZ D CA 97 202.
Phone: 6?).3 - 2.31— 0303 Fax: 533- 23n-/04y E-mail:gg,v!cG- f4•5,4thnMS,Cot'J
Service organization for this equipment: 6ietett / fEGue,Tf
Address: -r'//l s E flL'dt'Pllav DL VD, PdtZT 4-e iD • a2 "72-0 2
Phone: 5'33. 7-31- 6)303 Fax: .03 230— fogy E•mal1;Si`,e✓t0a-Go A-S Co
• Location of as-built drawings:_ O.l�- $tT Location of historical test reports: a"-SITS
Location of system operation and maintenance manuals: ON- c17-L
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 inepectione:
3. TYPE OF FIRE ALARM SYSTEM OR SERVICE
NFPA 72 Chapter Reference of System Type: C,V4P7 S 6 8
Name of organization receiving alarm signals with phone numbers(if applicable):
Alarm: ,Srrt` ri-f
/ Phone:
Supervisory:
�� Phone:
Trouble: r/
Phone:
Entity to which alarms are retransmitted: Fr g-E (? -,
Method of retransmission of alarms to that organization or location: Phone:
�GE P310'1/4re
0 2007 Nallonal Flre Prolecllon Assoclallon
f1FPA 72(p.1 015)
FIGURE 4.6.2.1 Record of Completion.
2007 Edltlon t•Zl
•
•
•
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 0 Multiplex ❑ 2-way radio Cl 1-way radio ❑ N/A
If Chapter 8,note the type of connection: ❑ Local energy 0 Shunt 0 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 line circuits connected to this system(see NFPA 72, Table 6,6,1):
Quantity: 0 Style: a 5 Class:
6. ALARM-INITIATING DEVICES AND CIRCUITS
Characteristics of initiating device circuits connected to this system(see NFPA 72,Table 6.5):
Quantity: Style: 4 Class: 5
5.1 Manual Initiating Devices
6.1.1 Manual Pull Stations Number of manual pull stations:
Type of devices; ❑ Addressable XConventional 0 Coded ❑ Transmitter ❑ N/A
5.2 Automatic Initiating Devices
5,2.1 Area Smoke Detectors Number of smoke detectors:
Type of coverage: ❑ Complete area :Partial area 0-Nonrequired partial area ❑ N/A
• Type of devices: ❑ Addressable onventional ❑ Coded U 'Transmitter ❑ N/A
Type of smoke detector sensing technology: • ❑ Ionizationotoelectric
5.2.2 Duct Smoke Detectors l Number ofduct smoke detectors:
Type of coverage;
Type of devices: ❑ Addressable ❑ Conventional ❑ Coded 0 Transmitter ❑ N/A
Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric
5.2.3 Heat Detectors Number of heat detectors:
Type of coverage: . fl Complete area ❑ Partial area 0 Nonrequlred partial area ❑ N/A
Type of devices: ❑ Addressable ❑ Conventional 0 Coded 0 Transmitter 0 N/A.
5.2,4 Sprinkler Waterflow.Detectors Number of waterflow detectors;
Type of devices ❑ Addressable 'Qonventional ❑ Coded 0 Transmitter ❑ N/A
5.2.5 Mann Verification Number of devices subject to alarm verification: 0
Alarm verification on this system is: 0 Enabled 0 Disabled 0 Set for seconds
@ 2007 National Fire Prolecllon Assoclallon
NFPA 72(p.2 0l 5)
FIGURE 4.5.2.1 Continued
FUNDAMENTALS OF FIRE ALARM SYSTEMS
72-35
6, SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUITS
6.1 Sprinkler System Number of valve supervisory switches:
Type of devices: ❑ Addressable .' Conventional ❑ Coded 0 Transmitter ❑.N/A
6.2 Fire Pump "..///9
Type of fire pump: ❑ Electric ❑ Diesel
Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional 0 Coded ❑ Transmitter ❑ N/A
Fire Pump Functions Supervised
❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal 0 Selector switch not in auto
❑ Engine or control panel trouble ❑.Low fuel
Other:
6.3 Engine-Driven Generator
Type of generator supervisory devices; ❑ 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 A.1l11
7.1 Annunciator 1 ❑ Local ❑ Remote
Type: ❑ Addressable 0.Directory Q Graphic Q N/A Location:
7.2 Annunciator 2 0 Local ❑ Remote
. Type: 0 Addressable 0 Directory 0 Graphic ❑ N/A Location:
7.3 Annunciator 3 0 Local ❑ Remote
Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location:
8. ALARM NOTIFICATION DEVICES AND CIRCUITS
8.1 Emergency Voice Alarm Service Ai/A
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 do site:
Type of telephone system installed: ❑ Electrically powered 0 Sound powered ❑ N/A
8.3 Nonvoice Audible System
Character/sties of notification device circuits connected to this system(see NFPA 72, Table 6.5):
Quantity: . $ Style: t4" f3
Class:
C 2007 National Fire Protection Association
NFPA 72(p.3 or 5)
FIGURE 4.5.2.1 Continued
2007 Edlllon Ci;
•
72-53 NATIONAL FIRE ALARM CODE
•
8. ALARM NOTIFICATION DEVICES AND CIRCUITS(continued)
8.4 Types and Quantities of Nonvolee Notlflcntlon Appllancao Installed
Bells: With visual device:
Horns: with visual device: 5-63' �
Chimes: With visual device: Bells:
Visual devices without audible devices:-- /uti�) With visual device:
� Other(describe):
9. EMERGENCY CONTROL FUNCTIONS ACTIVATED
O 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 20 VAL
G/2GCl1 /-E Amps
Overcurrent protection: Type A
Amps ._.
Location(of primary supply panelboard):
•
Disconnecting means location:
10.2 Secondary Power
Location: Type: Nominal voltage: Current rating:
Number of standby batteries: Amp hour rating:
Location of emergency generator:
Location of fuel storage:
Calculated capacity of secondary power to drive the system
In standby mode: 0241 hfOGLf 5 In alarm mode: 5—Al A
11. RECORD OF SYSTEM INSTALLATION
Fill out after all installation is complete and tuiring has been checked for opens,shorts,ground faults, and improper
branching,but before conducting operational acceptance testa.
The system has been installed in accordance with the following NFPA standards:(Note any or all that apply.)
f�NFPA 72 X NFPA 70,National Electrical Code,Article 760
Manufacturer's published Instructions 0 Other(please specify):
System deviatio s from relerrced NFPA standards:
Signed: �i /t'I /��/ /u/ //
Printed name: Date:
Organization: ./1b2/C'M/ $&GCc,2/71/ Title:
Phone: Sa3 23/- 630 3
12. RECORD OF SYSTEM OPERATION
All operational features and functions of this system were tasted by or in the presence of the signer shown below,on
the date shown below,end were found to be operating properly in accordance with the requirements of:
NFPA 72 )SINFPA 70,National Electrical Code,Article 760
Manufacturer's published instructions 0'Other(please specify):
O Documental i 6�agay)r with Inspection and Testing Forni(Figure 10.6.2.3)is attached
/t `� /LJ�!tip
Signed: Printed name: iv/ 3//t
Organization: //M) /e/C'� S�6C4) Date;
Title: 6 , Phone: 503. 231-63v3
02007 National Firs Protection Association
NFPA 72(p.4 of 5)
FIGURE 4.5.2.1 Continued
,`,i# 2007 EdIllon
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-57
13, CERTIFICATIONS AND APPROVALS
13.1 system Installation Contractor
This system asssspeci9ed herein has been installed and tested according to all NFPA standards cited herein.
Signed: � Printed name: Dnte:
Organization: A/114-re/C-12N .52--46( 17-7 R. Title: ` Phone: �3 'Z3/-630..3
13.2 System Service Contractor
This systeI:t her 'n n installed and tested accang to all NFPA standards cited herein.
Signed: � Printed name: �� /4 V Date: /a '3�I
Organization: /7,470.4/C-4-A/ 5-6-644241/ Title: -�.� Phone: - Z31-63 Q5
13.3 Central Station
This system ass cifi herei willonitored according to all NFPA standards cited herein.
/ . �� /�•//�> �i 3//4
Signed: Printed name: Date:
A7fr/010CAA/ .SEGaQiT�
Organization: Title: `�' - Phone: 5-63 '2'3/• 6303
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 it!'approved plans and specifications,its approved sequence of operations,and with all NFPA
standards cited herein.
Signed: Printed name: Date:
Organization: Title: Phone:
CS 2007 National Flre Protection Association NFPA 72(p.5 of 5)
FICURE 4.5.2.1 Continued
2007 Edition h.".f