1568_001.pdfFUNDAMENTALS OF FIRE ALARM SYSTEMS
72-31
Name of protected riper _
Address: - }h W
Representative of protected pi
Authority having jurisdiction:
Address/telephone number: _
FIRE ALARM SYSTEM
RECORD OF COMPLETION
CIM045 . C i ,A Hal)
1 Organization name/phone / Represenlative name/phone
Installer ,fOc�ai�rh ROOT ��Q(o- ��� -��i 5 N� l,at, C iledrIC
Supplier Agiyz6
Service organization ADT
Location of record (as -built) drawings:
Location of operation and maintenance manuals: A we EA 2
Location of test reports: Ilh 1�t�e�i.r t 41 S a�J[cK5
A contract for test and inspection in accordance with NFPA standard(s)
Contract No(s): Effective date: Expiration date:
System Software q
(a) Operating system (executive) software revision level(s): �k 6 o�/ 0U
(b) Site -specific software revision date:
(c) Revision completed by: 7n, Q,
(name) (firm)
1. Type(s) of System or Service
NFPA 72, Chapter 6 — Local
If alarm is tr nsmitted to location(s) off p�tremises, list where received:
I Sl PCUli- .S064)Qk6
y NFPA 72, Chapter 8 —Remote Station
Telephone numbers of the organization receiving alarm:
Alarm: 711 -3, IS 17 —) 9 09
Supervisory: Sc+N1 t✓
Trouble: Sam P_
If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone
numbers of the organization receiving alarm: Br'ct ec /. n I 877 - 313%- 1 go$
Indicate how alarm is retransmitted: C 1 1'
NFPA 72, Chapter 8 — Proprietary
Telephone numbers of the organization receiving alarm:
Alarm:
Supervisory:
Trouble:
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:
NFPA 72, Chapter 8 — Central Station
Prime contractor:
Central station location:
FIGURE 4.5.2.1 Record of Completion.
(NFPA 72, 1 of 4)
2002 Edition
72-32
NATIONAL FIRE ALARM CODE
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex 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 72, Chapter 9 — Auxillaiy
Indicate type of connection: Local energy
Location of telephone number for receipt of signals: _
2. Record of System Installation
Shunt Parallel telephone
(Fill out after installation is complete and wiring is checked for opens, shorts, ground faults, and improper branching,
but prior to conducting operational acceptance tests.)
This system has been installed in accordance with the NFPA standards as shown below, was inspected by
C✓h r r, e w+ on ) ' rj__ ? Q 19 includes the devices shown
in 5 and 6, and has been in service since '907.019
✓ NFPA 72, Chapters Q dD Z 4' d' c111 C dD 100 UT (circle all that apply)
NFPA 70, National Electrical Code, Article 760
Manufacturer's instructions
Other (specify):
*S, igned: /�%Date:
Organization:
3. Record of System Operation
Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached
All operational features and functions of this system were tested by C hrl5 RJyr+ date 1 r 2� —2¢ f 9
and found to be operating properly in accordance with the requirements of:
NFPA 72, Chapters Q (1) 4D ® W 6> <D 0 ® ® ® (circle all that apply)
1 NFPA 70, National Electrical Code, Article 760
Manufacturer's instructions
Other (specify):
-Signed:
Organization:
Date:
4. Signaling Line Circuits
Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
Quantity: _ Style: Class: C 64c 5 B
(NFPA 72,2 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition
FUNDAMENTALS OF FIRE ALARM SYSTEMS
72-33
5. Alarm -Initiating Devices and Circuits
Quantity and class of initiating device circuits (see NFPA 72, Table 6.5):
Quantity: L010 Style: { e,6"A4- Class:
MANUAL
(a) Manual stations Noncoded Transmitters Coded Addressable
(b) Combination manual fire alarm and guard's Lour coded stations _
AUTOMATIC /
Coverage: Complete V Partial
Selective Nonrequired
(a) Smoke detectors�Ion Photo Addressable V
(b) Duct detectors Ion Photo Addressable /
(c) Heat detectors FT RR FT/RR RC Addressable �(
(d) Sprinkler waterilow indicators: Transmitters Noncoded — Coded — Addressable
(e) The alarm verification feature is disabled or enabled changed from _ seconds to seconds.
(f) Other (list): _
6. Supervisory Signal -initiating Devices 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
Note: 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
(i) Engine or control panel trouble
0) Fire pump running
ENGINE -DRIVEN GENERATOR:
(a) Selector in auto position
(b) Control panel trouble
(c) Transfer switches
(d)Engine running
Other supervisory function(s) (specify):
FIGURE 4.5.2.1 Continued
(NFPA 72, 3 of 4)
2002 Edition
72-34
NATIONAL FIRE ALARM CODE
7. Annunciator(s) Number: Type: 1"6! UWC91) 6" Location: Wal E►
L-060
:-�`
8. Alarm Notification Appliances and Circuits
NFPA 72, Chapter 6 — Emergency Voice) larm 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:
Quantity and the class of notification appliance circuits connected to system (seeNFPA 72, Table 6.7):
Quantity:_2, Style: Er-d of hA r' Class: C (0.45
A
Types and quantities of notification appliances installed:
(a) Bells 1 _ With Visible
(b) Speakers _ With Visible 19
(c) Horns _ With Visible 20
(d) Chimes With Visible �7
(e) Other: With Visible
(f) Visible appliances without audible: / D
9. System Power Supplies
) 2 VAc
(a) Fire Alarm Control Panel: Nominal voltage: t0
Current rating:
Overcurrent protection: Type:
Current rating:
Location: l;s`It' Ennr EI"c0.
Rw�.
(b) Secondary (standby):
Storage battery: l- 12y Amp -hour rating: 7A14
Calculated capacity to drive system, in hours: 2 i �nJ
Engine -driven generator dedicated to fire alarm system:
Location of fuel storage: UA
(c) Emergency system used as backup to primary power supply:
to
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:
(signed) for installation contractor/tupplier (title)
(date)
(signed) for alarm service company (title)
(date)
(signed) for central station (title)
(date)
Upon co leti of the system(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction):
(s represent of the authority having jurisdiction (title)
(date)
(NFPA 72, 4 of 4)
FIGURE 4.5.2.1 Continued
2002 Edition