ROC Aldercrest.pdf1) 0 CL I M L N ]'A TI ON
SYSTEM RECORD OF COMPLETION
'this farm is to be completed by the system installation contractor at the erne of system acceptance and approval,
It shall be permitted to modify this form as needed to provide a more complete and/or clear record.
Insert NIA in all unused lines.
Alkle't) addihoruN �shvvfs; dow, 00, (Wiloudiihons as herr es arr to proWde a (wenplefe mcord
Form Wv Paqes Atlachwt
ptvlon J_t �' .__
1. PROPERTY INFORMATION
0
Name of
>
ko�
Addirer
Dese,rl nflon of nronertv:
Name
Addof'rpAt
y P
.. ........ ..e
Phone. 4z�� 2L4
2. INSTALLATION, SERVI CEJESTING, AND MONITORING INFORMATION
Ingtallation contraclon _�A __hlt . _
YI N.
Addrpsq
Phone: Fax -
F -mail-
. ............ . .....
Phone- E -Nnaflr . . . . . . .........
Testing urgani,,Phnw. . . . .........
Addre�,_
Phone: Fav E-mail
Effixtive date for vem, and ins.)pection conf-racIt',....
fvloudt,nOng organization:
Address: -- — ------ .. ..... ...
Phone: Fax .. . ... ....... E-mafl:
Accouni. nwhirnber, nPhone fine 1� Phunp.hne2�
L) ➢0� .......... . . . . ... .....
....... .....
Entity to which 91aringnre retranmitte& �,tt ..............
3. DOCUMENTATION _5N C) CzTtAjt C-0 YJAMLW CA'n .0 CgWtnl
'N ,
Ori-ite kwation of flie requireid record documentsand site ...9 ped Re rqot1;,,VaNA 1
re_- i4ll
72-37
4, DESCRIPTION OF SYSTEM OR SERVICE
Thn,� w, a: �j Nesv ��Vstpm 1A1, ex�sfing,;ygtem Far tit suuxnber:_
.......... .
NFFIA 72 erfition:
4.1 Control Unit
Manufacturer: ....................... ......... .. ..... Model aiurnbp
4.2 Software and Firmware
,
Firmware revision nunkbei-7
4.3 AWmVeirification 12/Tdiissystern doeu not kxr)rpnrateafiirm verifica6an..
'Nminher uf'dLvirxs.'_;tjjjjedL t1j ,9U, Vi veri.11catiom bv¢xmdg
,95 2012 Neuonal Fire Prota6on Associsfor
. . .......... . . . . . .
FIGURE'7,8,2(a) System Record of'Completion.. (SIG - FUN)
72-38
6TJj
NA F110NAL RRE ALAILvi ANT) SIGNALING GODF
s. SYSTEM POWER
Addrevuable or
5.1 Control Unit
conventional
t , Primary Power
hlpwjt volt,l-Ige, of mintrol pinot
Control panrAl arnpH
79
,e
Branch
N . . ....
5.1.2 Secondary Power
Liv -
2
Type of secondary powen
,
Location, if rasrnote from the Plaint:.— il,
Calculated capacity of sewndsry pnwer-to drive the Bytitenli'
In standby mode (hour In
alarm mode minutes)!
5.2,Control Unit
JThis syistcm doer, oast have power extender panels
U Power extender panels are hqted on.9upplernentary sheet A
6. CIRCUITS AND PATHWAYS
pathway'rype
Dual Mediu
Pathway
Separate
Pathww. ay
Survivability
Level
siguabling Link,
Device Btmer
Initiating Deviqx-
Notific ation Appliance
7. REMOTE ANNUNCIATORS
Type
LVM.
Manual Pkffl Stations
Smoke Ontectors
Duct Smoke Dewetors
Heat Detectoro
. ..............
Gas Detecktfl'S
water-flov" Switches
ramper Switch"
Qj 2012 Nalonot Five Protedinfi AsSadWion
i FIGUIU., 7.8.2(a) Cmifinued
2010 EaRion
A16
72 p oi 31
Addrevuable or
Quantity
conventional
Qj 2012 Nalonot Five Protedinfi AsSadWion
i FIGUIU., 7.8.2(a) Cmifinued
2010 EaRion
A16
72 p oi 31
- ---------
SYSTEM RECORD OF COMPLETION (continued)
9. NOTIFICATION APPLIANCES
Type
Audible
Visible
Cipronhlginhon AurflHp and Visible
10. SYSTEM CONTROL FUNCTIONS
"'ype
72-39
11. INTERCO NNECTEDSYSTEMS
iK'rhis svAeLa does miol, have inLerevariveted sysrerw
-) InLereonnecLed ii;ystexn6 are hated un akjpplenientar�v ahect
12. CERTIFICATION AND APPROVALS
111 aystent Installation Contractor OA'1".11wNt (UNk-)
Th' I "W1111 %(ficd herein hos been installed according to all NFPA standnr&, efted hercinL
Signe& naniv:
Organ phnnv�
..... --------- - - -
14 i�
12.2 System Operational Test
Nyxt('1v1 I SI)CIPIfied hFTern Jim teqted according to all NFPA standa�rards cited herein,
ab�iroroPrinted iv
Organization: Title: Phone,�
12.3 Acceptance Test 71
Date and time of acceptarice. teat;
T as Lai ling contractor rejarwri I a Li vv�
..................... . .. .................... .. . ....... .
To-
46rig contractor represental.ive.:
Property reprowntatiw
AHJ rei)resenuaiwSJ
- — _�11-11c"I", 1kj � 0
fo 20 G2 National Fira Protection kwdaton
MF 7 &2(a) '( P t din ued
FIA 72 (3, 3 of 3)