INSPECTION AND TESTING FORM FIRE ALARM.pdfBRED HAWK
Fire & Security
INSPECTION AND TESTING FORM
DATE: 3/29/19
TIME:
TESTING ORGANIZATION
PROPERTY NAME (USER)
Name: Red Hawk Fire & Security
Name: 85c Bakery Cafe
Address: 21312 30t" Drive SE
Address: 22611 76th Avenue W,
Space 100
Bothell, WA 98021
Edmonds, WA 98026
Representative: Red Hawk Fire & Security
Owner Contact:
License No.: REDHAHF882NH
Telephone:
Telephone: (425) 486-2600
MONITORING ENTITY
APPROVING AGENCY
Contact: Alarm Center
Contact:
Telephone: 1-866-402-3673
Telephone:
Monitoring
Account AES-6009
Ref No.:
TYPE TRANSMISSION
SERVICE
• McCulloh
0 Weekly
• Multiplex
0 Monthly
• Digital
0 Quarterly
• Reverse Priority
0 Semiannually
x RF (Radio)
0 Annually
0 Other (Specify):
0 N/A
Control Unit: Notifier
Model No.: NFW-10OX
Circuit Styles: 4, Class B
No. of Circuits: 1
Software Rev.: 9.
Last Date System Had Any Service Performed:
3/29/19
Last Date That Any Software or Configuration Was
Revised: 3/29/19
ALARM INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity of
Devices Installed
Circuit Style
Quantity of Devices
Tested
7
Style 4
7
Manual Fire Alarm Boxes
N/A
N/A
N/A
Ion Detectors
1
Style 4
1
Photo Detectors
N/A
N/A
N/A
Duct Detectors
28
Style 4
28
Heat Detectors
N/A
N/A
N/A
Waterflow Switches
N/A
N/A
N/A
Supervisory
2
Style 4
2
Monitor Only Kitchen Hood
Alarm verification feature is X enabled 0 disabled.
Revised 06/20/2007 by JML. I
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION
Quantity of
Appliances Installed
Circuit Style
Quantity of
Appliances Tested
N/A
N/A
N/A
Bells
N/A
N/A
N/A
Horns
10
Style 4
10
Visuals
12
Style 4
12
Horns W/ Visuals
N/A
N/A
N/A
Speakers
N/A
N/A
N/A
Speaker W/ Strobes
No. of alarm notification appliance circuits:
Are circuits monitored for integrity? f) Yes 0 No
SUPERVISORY SIGNAL -INITIATING DEVICES AND CIRCUIT INFORMATION
Quantity of
Devices Installed
Circuit Style
Quantity of
Devices Tested
N/A
N/A
N/A
Building Temp.
N/A
N/A
N/A
Site Water Temp.
N/A
N/A
N/A
Site Water Level
N/A
N/A
N/A
Fire Pump Power
N/A
N/A
N/A
Fire Pump Running
N/A
N/A
N/A
Fire Pump Auto Position
N/A
N/A
N/A
Fire Pump or Pump Controller Trouble
N/A
N/A
N/A
Fire Pump Running
N/A
N/A
N/A
Generator in Auto Position
N/A
N/A
N/A
Switch Transfer
N/A
N/A
N/A
Generator Engine Running
Other:
SIGNALING LINE CIRCUITS
Quantity and style of signaling line circuits connected to system.
Quantity: 2 Style(s): Style 4
SYSTEM POWER SUPPLIES
(a) Primary (Main): Nominal Voltage 120V Amps
Overcurrent Protection: Type Breaker Amps 20
Location (of Primary Supply Panelboard): By back door in kitchen
Disconnecting Means Location: By back door in kitchen
(b) Secondary (Standby): Storage Battery: Amp-Hr Rating 12AMP-hr
Calculated capacity in 24 AMP-Hrs to operate system for 4 Hours.
Engine -driven generator dedicated to fire alarm system: N/A
Location of fuel storage: N/A
TYPE BATTERY
• Dry Cell (c) Emergency or standby system used as a backup to primary power
• Nickel -Cadmium supply, instead of using a secondary power supply:
x Sealed Lead -Acid x Emergency system described in NFPA 70, Article 700
0 Lead -Acid x Legally required standby described in NFPA 70, Article 701
0 Other (Specify): x Optional standby system described in NFPA 70 Article
NOTIFICATIONS ARE MADE
Monitoring Entity
Building Occupants
Building Management
Other (Specify)
AHJ Notified of Any Impairments
702, which also meets the performance requirements of
Article 700 or 701
PRIOR TO ANY TESTING
YES NO
x i)
x i)
x f)
x i)
Revised 06/20/2007 by JML.
PRE -TEST
SYSTEM TESTS
TYPE
Visual
Functional Comments
Control Unit
x
x
Interface Equipment
x
x
Lamps/LEDs
x
x
Fuses
x
x
Primary Power Supply
x
x
Trouble Signals
x
x
Disconnect Switches
x
x
Ground -Fault Monitoring
x
x
SECONDARY POWER
TYPE
Visual
Functional Comments
Battery Condition
x
x
Load Voltage
x
x
Discharge Test
x
x
Charger Test
x
x
Specific Gravity
x
x
TRANSIENT SUPPRESSORS
x
x
REMOTE ANNUNCIATORS
x
x Located in Bakery by back door
NOTIFICATION APPLIAMCES
x
x
EMERGENCY COMMUNICATIONS EQUIPMENT
Visual
Functional
Comments
Phone Set
N/A
Phone Jacks
N/A
Off -Hooks Indicator
N/A
Amplifier(s)
N/A
Tone Generator(s)
N/A
System Performance
N/A
Device
Simulated
COMBINATION SYSTEMS
Visual
Operation
Operation
Fire Extinguisher Monitoring Device/System
Carbon Monoxide Device/System
t>
()
t>
(Specify): N/A
0
(?
0
INTERFACE EQUIPMENT
(Specify): N/A
(?
(?
f?
(Specify): N/A
0
0
0
(Specify): N/A
0
0
0
System restored to normal operation: Date: 3/29/19 Time: AM
THIS TESTING PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS.
Name of Inspector: Dave Rasmussen Date: 3/29/19 Time: AM
Signature:
Name of Owner or Representative: Date: Time:
Signature:
Revised 06/20/2007 by JML. 3