620 GLEN STWo
SNOI
Y
D
Fire Alarm Checklist
7
Name of Building or complex Date
Address (,,� Permit numberNZ:2�j,,14,71i
--'-q Fire alarm system complete anlq�l Fire alarm system pre -testing complete
Building occupants (if applicable) notified of fire alarm testing
System is in test mode 44 SnoCorn has been notified Tj Knox'Nox kWQbeen provided
Remote annunciator is properly located, accessible, not obstructed and conforms to approved
plans
K Fire alarm control panel is properly located, accessible, and not obstructed and conform to
approved plans.
C�kApproved signage-has been provided. This includes signage to specific locations and specific
features. ( ie. Dry Standpipe and FDC)
U Provide the alarm monitoring company's name and 24 hr number on the control
panel. Monitoring company's name JI.RS:
-WC,A�
Provide a manual pull station reset key(s) as needed for the Knox box.��Is,\,,
System loss of ac power, verify operation standby power
VA [ ] AES check list completed (on reverse side)
P.J Fire alarm control panel circuit breaker shall be labeled FACP, painted
red, and locked in the ON position.
DI Fire alarm panel shall indicate what circuit breaker supplies power and the
location of the panel where that circuit is located.
Check a random selection of initiating devices (minimum of 25%)
&I-\ ce4
Activation of audible, visual and audible / visual devices. Verify visual synchronization
Outside horn / strobe activation and location
Verify alarm, supervisory, and trouble retransmission signals to monitoring station
Require Certificate of completion from installer
Signature of Fire Official:7>�6-�)(, 0, �
12425 Meridian Avenue S / Everett WA 98208 / 425-551-1200 www.firedistrlctl.org
SNOHOMISH CO.
FIRE
DISTR T
Wireless Mesh Network (AES) Installation Inspection Checklist
All AES radio transmitters shall be installed and inspected according to NFPA 70, NFPA 72, WAC, manufacturer
requirements/recommendations.
o The AES Radio is mounted near the FACP in a temperature controlled environment. If it is mounted on the
interior side of an exterior metal, concrete, or block wall it is mounted on an insulating board to prevent direct
contact with moisture or temperature extremes. Alternate locations, if approved by the fire marshal may require
the AES Radio to be located inside a lockable NEMA 4X enclosure with smoke detector and thermostatically
controlled heater.
• AES routing table shows a minimum of two (2) "good" paths with a net -con of 0-5 prior to connecting to FACP.
• AES is protected by a smoke detector.
• A/C transformer to AES is protected inside a secured transformer enclosure.
• The A/C transformer is one of the following 3 models; AMSECO model XF1640, Elk Products model TRG1640, or
MG Electronics model MGT1640.
• Wires from A/C transformer enclosure to AES enclosure are in conduit.
• AES is powered via dedicated A/C circuit or shared with a dedicated circuit to FACP.
• A/C breaker to AES circuit is labeled and provided with a lock -on device.
• All exposed wiring below seven feet (7� AFF is protected in conduit.
• Coaxial cable outside the AES enclosure is installed in conduit.
• Exterior antennas are protected by a lightening arrester. Arrester is located a minimum 6'from AES radio and
grounded to earth with a minimum 6 AWG copper wire.
• All bends in the coaxial cable outside of the AES enclosure (if applicable) have a minimum six inch (6'� radius.
• AES AND IntelliPro Fire or FireTap (if installed) is locally supervised at the protected premises (both audibly and
visibly) in an approved manner for antenna cut, low battery, communication troubles, and charger fault as a
separate zone or address on the FACP. (14 outputs)
• General alarm (zone 1), general trouble (zone 2), and supervisory (zone 3) outputs from the FACP are connected
to supervised input zones on the AES.
• All zones, signals, or addresses capable of being transmitted by the FACP are transmitted to the central station.
This may require an IntelliPro Fire or FireTap.
• A current Routing Table showing the NetCon, Link Layer, and Signal Strength (minimum 2 "Good" paths with a
minimum NetCon of 5 or less) is to be provided to the Fire Inspector at time of final inspection.
12425 Meridian Avenue S / Everett WA 98208 / 425-551-1200 www.firedistrict1.org
All Events Report
Report for period: 8/17/2017 12:00:00AMto811712017 8:30:OOAM
Glen Street Condo's 88,3395
620 Glen St
Edmonds
Snohomish
Washington
98026
8/17120117
5:58:55AM Record Edited
8/17/2017
5:58:55AM Details Opened for Viewing (Eng) Jake Lyons
MOB
8/17/2017
7:18:03AM Record Edited
8/17/2017
7:18:03AM Details Opened for Viewing (Eng) Jake Lyons
MOB
8/17/2017
7:18:03AM Customer Taken Out of Service
Customer
8/17/2017
7:18:03AM Customer temp out : Aug 17, 07:18 to Aug 17, 10:18 (Eng) Jake Lyons
MOB
Thu
811712017 7:23:28AM 12 Gate Valve Sensor
Site on Test
Thu
811712017 7:23:34AM 12 Restore
Site on Test
Thu
811712017 7:25:20AM 11 Waterflow
Site on Test
Thu
811712017 7:31:11AM 15 Fire Alarm
Site on Test
Thu
811712017 7.-35:29AM 14 Fire Alarm
Site on Test
Thu
811712017 7.-38:49AM 3 Pull Station
Site on Test
8/17/2017
7:58:41AM Record Edited
8/17/2017 7:58:41AM Details Opened for Viewing (Eng) Jake Lyons
MOB
Thu
811712017 8:03:18AM 4000 Equipment Fail Restore
Site on Test
Thu
811712017 8:04:13AM 4000 System Reset
Site on Test
Thu
811712017 8:04:16AM 3 Restore
Site on Test
Thu
811712017 8:04:19AM 11 Water Alarm Restore
Site on Test
Thu
811712017 8:04:27AM 14 Fire Restore
Site on Test
Thu
811712017 8:04:27AM 15 Fire Restore
Site on Test
Thu
811712017 8:04:30AM Unex Fire Test (1)
Site on Test
Thu
811712017 8:06:25AM 4000 System Reset
Site on Test
Thu
811712017 8:06:29AM Unex Fire Test
Site on Test
8117/2017
8:16:35AM Record Edited
8/17/2017 8:16:35AM Details Opened for Editing (Opr) Marka Clark
MLC
Actions P = Police, K = Keyholder Group, S = Site, A = Special Action, N = Information Page,
Legend., F = Fire, G = Gen Agency, I = Installer, M = Medical, C - Command, R = Report
Alarm Center Inc. 1-800-752-2490
Snohomish County Multi -jurisdictional
STATEMENT OF FIRE PROTECTION SYSTEM COMPLIANCE
dy 'or inspection at the time the
y submitted may result in cancellation of the
The purpose of this form is to ensure that projects are proper y functioning and rea
inspection is scheduled. Compliance statements faiselyorprematurel
inspection and an automatic re -inspection fee or other financial penalties by the local jurisdiction.
INSTRU TIONS: This com liance statement must be comple�ted and sublmitte�d
It t!
I g.
to the AHJ prior to scheduling accepta:nc�etesting.
In accordance with 901.2.1 of the International Fire Code, I hereby affirm the
following, indicated by my initials and signature:
NITIAL A LsTATEMEN rn noted below has been properly and completely
The fire protection syste
I
s with approved plans.
installed in accordance
A pprov pla immediately available for review on site at the time of
7pproved plans will be
inspection.
64�—Permits have been paid for and will be immediately available for review on site
at the time of inspection.
The indicated fire protection system has been tested in accordance with the
manufacturer's specifications and the appropriate installation standard.
Deviations from the design standards (check one):
No deviations from design standards:
proval of deviations):
Deviations are as follows (attach ap
per permit number
Fire Alarm
C] Underground C1 Household
bd Commercial
0 NFPA 13-D
NW NFPA 13-R
'nQ NFPA 13
,C-
[KlqTAI I ATION A1J1JKt:z,,),
qr PRItN
) 22 T �E:n N �AE
�tLLL�IG CONT �CTG�� S�GN��T�1!!
Other
U Standpipe
C3 Hood Suppression
El Other_--.
;t
z
LICENSE #
0 4,
Daily Inspection List
121 5th Ave, Edmonds Washington - Phone: (425) 771-0220
Calendar:
Fire Inspections
Inspection Date: 08/17/2017
+'BLD20161292
620 GLEN ST, EDMONDS
I -ANY
30 - Fire Sprinkler
RErrENMIER - GLEN ST LLC 620
1930
F-Fire Sprinkler Acceptanc
Contact: MICHEL, ROB
Phone: 2069302445
Comment., Requesting an AM Inspection.0730
Thank you.
4A BLD20161494
620 GLEN ST, EDMONDS
I -ANY
79 - Fire Alarm
G LEN ST LLC 620
1935
F-Fire Aharm'svitem, Acceptanc
Contact: MICHEL, ROB
Phone: 2069302445
Comment: Requesting an AM inspection. 0730
1950
F-Fire Safety and Evacuation Plan
Contact: MICHEL, ROB
Phone: 2069302445
Comment: Requesting an AMinspection.0730
Thank you
'BLD20170880
9601 220TH ST SW, EDMONDS
i-ANY
79 - Fire Alarm
-
WESTGATE ELEMENTARY PORTABLE -SCHOOL DIST 15 EDMONDS
1935
F-Firemarm syst�m_Aiceatance
Contact: Derrick
Phone: 206-743-7676
Comment: Red Hawk Katie 206-771-4328
FA Inspection: Exits, Extinguisher, Snocom, Monitor Co Report
1:OOPM Derrick 206-743-7676
IDFM16
I
Ou,
�:31:28 PM Page 1 of 1
(DL-W)Q FSA rj-3;?A 11%
sc',) Q.,
4 'FA Lz(,4k.�,A
C,,,7)e t�4er;orf-,�
k
FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time ofsystem acceptance and approval.
It shall be permitted to modify thisform as needed to provide a more complete andlor clear record
Insert NIA in all unused lines.
Attach additional sheets, data, or calculations as necessary to provide a complete record.
1. PROPERTY INFORMATION
Name of property:
Address: eF,11 &_
1 6 c26. al (s T
Description of property, 4 Ohl r & ftvto
Occupancy type: ?ff la5'41 4 /
Name of property representative: xa"" /I/ c/v-,,,/
Address: -7 o J?t40(41_1tAV,' le -
Phone: o2O6 -U-AWr Fax:
Authority having jurisdiction over this property:
Phone: 'V�1r7Lr0_,5_'?6J_ Fax-
E-mail:
P444W&int
E-mail:
2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION
Installation contractor for this equipment: Pt're ?rCXVe_'_-V1 cw-,
Address: 5 0 C__
A
License or certification number:
Phone: I-SCO-(,oV - V11S Fax: E-mail:
1p -T
Service organization for this equipment: _nc
nr
Address: 'ON C�_
License or certification number:
Phone: Fax: E-mail:
A contract for test and inspection in accordance with NFPA standards is in effect as of.
Contracted testing company: 71ne-.)
VL4
Address: A-1-60 &'kySCX'\ it V'VCe-4 ii
Phone: Fax: E-mail:
Contract expires: Contract number: Frequency of routine inspections:
3. DESCRIPTION OF SYSTEM OR SERVICE
50ire alarm system (nonvoice)
[:] Fire alarm with in -building fire emergency voice alarm communication system (EVACS)
C1 Mass notification system (MNS)
C1 Combination system, with the following components:
[] Fire alarm [I EVACS El MNS Two-way, in -building, emergency communication system
F-1 other (specify):
NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
3. DESCRIPTION OF SYSTEM OR SERVICE (continued)
NFPA 72 edition: S011A Additional description of system(s):
3.1 Control Unit
Manufacturer: Model number: 0
3.2 Mass Notification System
3.2.1 System Type:
E] In -building MNS---combination
El In -building MNS—stand-alone
El Other (specify):
3.2.2 System Features:
El This system does not incorporate an MNS
E] Wide -area MNS [-] Distributed recipient MNS
D Combination fire alarm/MNS El MNS autonomous control unit El Wide -area NINS to regional national
alerting interface
El Local operating console (LOC) Direct recipient MNS (DRNTNS) E] Wide -area MNS to DRMNS interface
E] Wide -area MNS to high -power speaker array (HPSA) interface [I In -building MNS to wide -area MNS interface
Other (specify):
3.3 System Documentation
XAn owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of
the numbered record drawings are stored on site. Location:
3.4 System Software DR�rhis systern does not have alterable site -specific software.
Operating system (executive) software revision level:
Site -specific software revision date: Revision completed by:
A copy of the site -specific software is stored on site. Location:
3.5 Off -Premises Signal Transmission This system does not have off -premises transmission.
Name of organization receiving alarm signals with phone numbers:
Alarm: rcl� C_V � CV\ -I,, Phone: 0000— 612A — "'Ib
Supervisory: ? rovp_c,-�ion Mnc- Phone:
Trouble: r 0A - R_ C, OT y - \ r— Phone: CbM 6<bl t 75
Entity to which alarms are retransmitted: Phone:
Method of retransmission:
If Chapter 26, specify the means of transmission from the protected premises to the supervising station:
If Chapter 27, specify the type of auxiliary alarm system: [I Local energy El Shunt 0 Wired El Wireless
NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12)
Copyright @ 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
4. CIRCUITS AND PATHWAYS
4.1 Signaling Line Pathways
4.1.1 Pathways Class Designations and Survivability
Pathways class: - ?—> Survivability level: Quantity:
(See NFPA 72, Sections 12.3 and 12.4)
4.1.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.1.3 Device Power Pathways
D&No separate power pathways from the signaling line pathway
0 Power pathways are separate but of the same pathway classification as the signaling line pathway
El Power pathways are separate and different classification from the signaling line pathway
4.1.4 Isolation Modules
Quantity:
4.2 Alarm Initiating Device Pathways
4.2.1 Pathways Class Designations and Survivability
Pathways class: - ' ?5 -_ '* . Survivability level:
(See NFPA 72, Sections 12.3 and 12.4)
1-61,
Quantity: C_
4.2.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.2.3 Device Power Pathways
JKNo separate power pathways from the initiating device pathway
El Power pathways are separate but of the same pathway classification as the initiating device pathway
El Power pathways are separate and different classification from the initiating device pathway
4.3 Non -Voice Audible System Pathways
4.3.1 Pathways Class Designations and Survivability
Pathways class: Survivability level: Quantity:
(See NFPA 72, Sections 12.3 and 12.4)
4.3.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.3.3 Appliance Power Pathways
151,No separate power pathways from the notification appliance pathway
[I Power pathways are separate but of the same pathway classification as the notification appliance pathway
El Power pathways are separate and different classification from the notification appliance pathway
NFPA 72, Fig, 10,18.21.1 (p� 3 of 12)
copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
5. ALARM INITIATING DEVICES
5.1 Manual Initiating Devices
5.1.1 Manual Fire Alarm Boxes This system does not have manual fire alarm boxes.
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other (specify):
5.1.2 Other Alarm Boxes This system does not have other alarm boxes.
Description:
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other (specify):
5.2 Automatic Initiating Devices
5.2.1 Smoke Detectors El This system does not have smoke detectors.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Typeofcoverage: ElCompletearea OPartialarea [3Nonrequired partial area
Other (specify):
Type of smoke detector sensing technology:
El Ionization 2(Photoelectric El Multicriteria El Aspirating F1 Beam
Other (specify):
5.2.2 Duct Smoke Detectors
XThis system does not have alarm -causing duct smoke detectors.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Type of coverage:
Type of smoke detector sensing technology:
Ionization E] Photoelectric El Aspirating El Beam
5.2.3 Radiant Energy (Flame) Detectors
JgThis system does not have radiant energy detectors.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Type of coverage:
5.2.4 Gas Detectors
CgThis system does not have gas detectors.
Type of detector(s):
Number of devices: Addressable:
Conventional:
Type of coverage:
5.2.5 Heat Detectors
OKThis system does not have heat detectors.
Type and number of devices: Addressable:
Conventional:
Type of coverage: El Complete area M
Partial area E] Nonrequired partial area E] Linear El Spot
Type of heat detector sensing technology:
El Fixed temperature E] Rate -of -rise E] Rate compensated
NFPA 72, Fig. 10. 1 &2� 1. 1 (p. 4 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. it may not be copied for commercial sale or distnbution.
5. ALARM INITIATING DEVICES (continued)
5.2.6 Addressable Monitoring Modules This system does not have monitoring modules.
Number of devices:
5.2.7 Waterflow Alarm Devices El This system does not have waterflow alarm devices.
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
5.2.8 Alarm Verification [I This system does not incorporate alarm verification.
Number of devices subject to alarm verification: Alarm verification set for seconds
5.2.9 Presignal gThis system does not incorporate pre -signal.
Number of devices subject to presignal:
Describe presignal functions:
5.2.10 Positive Alarm Sequence (PAS) CR�This system does not incorporate PAS.
Describe PAS:
5.2.11 Other Initiating Devices KThis system does not have other initiating devices.
Describe:
6. SUPERVISORY SIGNAL -INITIATING DEVICES
6.1 Sprinkler System Supervisory Devices El This system does not have sprinkler supervisory devices.
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other (specify):
6.2 Fire Pump Description and Supervisory Devices 3�This system does not have a fire pump.
Type fire pump: El Electric pump Engine
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other (specify):
6.2.1 Fire Pump Functions Supervised
E] Power F] Running E] Phase reversal Selector switch not in auto Engine or control panel trouble E] Low fuel
Other (specify):
6.3 Duct Smoke Detectors (DSDs) &This system does not have DSDs causing supervisory signals.
Type and number of devices: Addressable: Conventional:
Other (specify):
Type of coverage:
Type of smoke detector sensing technology: E] Ionization E] Photoelectric El Aspirating [I Beam
6.4 Other Supervisory Devices EMis system does not have other supervisory devices.
Describe:
NFPA 72, Fig. 10, 18,21 .1 (p. 5 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
7. MONITORED SYSTEMS
7.1 Engine -Driven Generator
7.1.1 Generator Functions Supervised
[I Engine or control panel trouble E] Generator running
El Other (specify):
7.2 Special Hazard Suppression Systems
Description of special hazard system(s):
7.3 Other Monitoring Systems
Description of special hazard system(s):
8. ANNUNCIATORS
8.1 Location and Description of Annunciators
Location 1:
Location 2:
Location 3:
Whis system does not have a generator.
D Selector switch not in auto El Low fuel
XThis system does not monitor special hazard systems.
X'This system does not monitor other systems.
Xr'This system does not have annunciators.
9. ALARM NOTIFICATION APPLIANCES
9.1 In -Building Fire Emergency Voice Alarm Communication System 3KThis system does not have an EVACS.
Number of single voice alarm channels: Number of multiple voice alarm channels:
Number of speakers: Number of speaker circuits:
Location of amplification and sound -processing equipment:
Location of paging microphone stations:
Location 1:
Location 2:
Location 3:
9.2 Nonvoice Notification Appliances This system does not have nonvoice notification appliances.
Horns: With visible: Bells: With visible:
Chimes: With visible:
Visible only: Other (describe):
9.3 Notification Appliance Power Extender Panels IXThis system does not have power extender panels.
Quantity:
Locations:
NFPA 72, Fig 10 18 2 1 1 (p. 6 of 12)
Copyright C 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS t$jhis system does not have an N4NS.
10.1 MNS Local Operating Consoles
Location 1:
Location 2:
Location 3:
10.2 High -Power Speaker Arrays
Number of HPSA speaker initiation zones:
Location 1:
Location 2:
Location 3:
10.3 Mass Notification Devices
Combination fire alarm/MNS visible appliances: MNS-only visible appliances:
Textual signs: Other (describe):
Supervision class:
10.3.1 Special Hazard Notification
NJhis system does not have special suppression predischarge notification.
MNS systems DO NOT override notification appliances required to provide special suppression
predischarge notification.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS
11.1 Telephone System ;6jhis system does not have a two-way telephone system.
Number of telephone jacks installed: Number of warden stations installed:
... .. .....
Number of telephone handsets stored on site:
Type of telephone system installed: El Electrically powered [] Sound powered
11.2 Two -Way Rad io Communications Enhancement System
J&This system does not have a two-way radio communications enhancement system.
Percentage of area covered by two-way radio service: Critical areas: % General building areas: %
Amplification component locations:
Inbound signal strength: dBm Outbound signal strength: dBm
Donor antenna isolation is: dB above the signal booster gain
Radio frequencies covered:
Radio system monitor panel location:
NFPA 72, Fig� 10,18,21.1 (p. 7 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued)
11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems
[�_This system does not have an area of refuge (area of rescue assistance) emergency communications system.
Number of stations: Location of central control point:
Days and hours when central control point is attended:
Location of alternate control point:
Days and hours when alternate control point is attended:
11.4 Elevator Emergency Communications Systems
WThis system does not have an elevator emergency communications system.
Number of elevators with stations: Location of central control point:
Days and hours when central control point is attended:
Location of alternate control point:
Days and hours when alternate control point is attended:
11.5 Other Two -Way Communication Systems
Describe:
12. CONTROL FUNCTIONS
This system activates the following control fuctions:
E] Hold -open door. releasing devices 0 Smoke management El HVAC shutdown C3 F/S dampers
E] Door unlocking Wlevator recall E] Fuel source shutdown El Extinguishing agent release
El Elevator shunt trip C] Mass notification system override of fire alarm notification appliances
Other (specify):
12.1 Addressable Control Modules This system does not have control modules.
Number of devices:
Other (specify):
13. SYSTEM POWER
13.1 Control Unit
13.1.1 Primary Power
Input voltage of control panel: I z 0 Q Ac-
Overcurrent protection: Type: br-eo_'<e_,c-
Location (of primary supply panel b oard): ?N -1 co P_ r
Disconnecting means location: 1p��ber ?-�rn
13.1.2 Engine -Driven Generator
Location of generator:
Location of fuel storage:
Control panel amps:
Amps: '2-
corn
IN This system does not have a generator.
Type of fuel:
NFPA 72, Fig. 10,18.2.1.1 (p. 8 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
13. SYSTEM POWER (continued)
13.1.3 Uninterruptible Power System I&This system does not have a UPS.
Equipment powered by a UPS system:
Location of UPS system:
Calculated capacity of UPS batteries to drive the system components connected to it:
In standby mode (hours): In alarm mode (minutes):
13.1.4 Batteries
Location: V-1 r-9- 90-TQA _. Type: SkAQWWLNominal voltage: I 'I Amp/hour rating:
Calculated capacity of batteries to drive the system:
In standby mode (hours): _'Z A 'n -OAr-, In alarm mode (minutes): S
Matteries are marked with date of manufacture 2KBattery calculations are attached
13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System
XThis system does not have an EVACS or MNS system.
13.2.1 Primary Power
Input voltage of EVACS or MNS panel: EVACS or MNS panel amps:
Overcurrent protection: Type: Amps:
Location (of primary supply panel board):
Disconnecting means location:
13.2.2 Engine -Driven Generator 9KThis system does not have a generator.
Location of generator:
Location of fuel storage: Type of fuel:
13.2.3 Uninterruptible Power System 2<fhis system does not have a UPS.
Equipment powered by a UPS system:
Location of UPS system:
Calculated capacity of UPS batteries to drive the system components connected to it:
In standby mode (hours): In alarm mode (minutes):
13.2.4 Batteries
Location: Type:
Cal culated capacity of batteries to drive the system:
In standby mode (hours):
El Batteries are marked with date of manufacture
Nominal voltage: Amp/hour rating:
In alarm mode (minutes):
El Battery calculations are attached
NFPA 72, Fig. 10.18.21.1 (p, 9 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
13. SYSTEM POWER (continued)
13.3 Notification Appliance Power Extender Panels
13.3.1 Primary Power
Input voltage of power extender panel(s):
Overcurrent protection: Type:
Location (of primary supply panel board):
Disconnecting means location:
t&This system does not have power extender panels.
Power extender panel amps:
Amps:
13.3.2 Engine -Driven Generator '�LThis system does not have a generator.
Location of generator:
Location of fuel storage: Type of fuel:
13.3.3 Uninterruptible Power System 1�4,This system does not have a UPS.
Equipment powered by a UPS system:
Location of UPS system:
Calculated capacity of UPS batteries to drive the system components connected to it:
In standby mode (hours): In alarm mode (minutes):
13.3.4 Batteries
Location: . Type:
Calculated capacity of batteries to drive the system:
In standby mode (hours):
0 Batteries are marked with date of manufacture
14. RECORD OF SYSTEM INSTALLATION
Nominal voltage:
In alarm mode (minutes):
Battery calculations are attached
Amp/hour rating:
Fill out after all installation is complete and wiring has been checkedfor opens, shorts, groundfaults, and improper
branching, but before conducting operational acceptance tests.
This is a: ONew system El Modification to an existing system Permit number:
The system has been installed in accordance with the following requirements: (Note any or all that apply.)
2FNFPA 72, Edition: 7-0173
CEKNFPA 70, National Electrical Code, Article 760, Edition: 110 14
El Manufacturer's published instructions
Other (specify):
System deviations from referenced NFPA standards:
Signed: Printed name: 5jCtJV_e_ Lydw� Date:
j
Organization: Title: QC4 Phone:
NFPA 72, Fig. 10. 18.2, 1A (p. 10 of 12)
copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST
gNew system
All operationalfeatures andfunctions of this system were tested by, or in the presence of the signer shown
below, on the date shown below, and werefound to be operating properly in accordance with the requirements
for thefollowing:
El Modifications to an existing system
All newly modified operationalfeatures andjunctions of the system were tested by, or in the presence of the
signer shown below, on the date shown below, and werefound to be operating properly in accordance with the
requirements of thefollowing:
El NFPA 72, Edition:
E] NFPA 70, National Electrical Code, Article 760, Edition:
Manufacturer's published instructions
Other (specify):
E] Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached]
Signed: Printed name: 7�, Date:
. , -� Ly
OrganizatiO4-rr-Lv- Title: Phone:
16. CERTIFICATIONS AND APPROVALS
16.1 System Installation Contractor:
This system, as specified herein, has been installed and tested according to all NFPA standards cited herein.
Signed: Printed name: Date:
Organ zation: Title: Phone:
16.2 System Service Contractor:
The undersigned has a service contract for this system in effect as of the date shown below.
Signed: Printed name: Uy 6 V"I Date:
Organization: Title: Phone:
16.3 Supervising Station:
This system, as s ecified herein, will be monitored according to all NFPA standards cited herein.
Signed: Printed name: -3,v—p— Lo,,,s Date:
Organizat4ion: Title: Phone:
NFPA 72, Fig, 10.18.2.1.1 (p. 11 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
16. CERTIFICATIONS AND APPROVALS (continued)
16.4 Property or Owner 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:
16.5 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, with its approved sequence of operations, and with all
NFPA standards cited herein.
Signed: Printed name: Date:
Organization: Title: Phone:
NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.