HomeMy WebLinkAboutFA RECORD - 17-00362 - DL Evans Bank - Tenant FinishR-Ou' .
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 modem this form as needed to provide a more complete and/or clear record.
Insert N/A in all unused lines.
Attach additional sheets, data, or calculations as necessary to provide a complete record.
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Name of property: DL EV ANS BANK
Address: 125 VALLEY RIVER DR, REXBURG, ID 83440
Description of property: BUSINESS
Occupancy type: B
Name of property representative:
Address: 125 VALLEY RIVER DR, REXBURG, ID 83440
Phone: Fax:
Authority having jurisdiction over this property:
Phone: Fax:
E-mail:
E-mail:
2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION
Installation contractor for this equipment: Pinnacle Technologies, L.L.0
Address: 560 Main Ave South, Twin Falls, ID 83301
License or certification number: Public Works: 012998-D-4; Contractor: 009285; ID ELE 25206; NICET 11 129957
Phone: 208-595-2372 Fax: 208-733-3750 E-mail: jasonp@pinn-tech.net
Service organization for this equipment: Pinnacle Technologies
Address: 560 Main Ave South, Twin Falls, ID 83301
License or certification number: Public Works: 012991 Contractor: 009285; ID ELE 25206; NICET 11 129957
Phone: 208-595-2372 Fax: 208-733-3750 E-mail:
A contract for test and inspection in accordance with NFPA standards is in effect as of:
Contracted testing company: Pinnacle Technologies, L.L.C.
Address: 560 Main Ave South, Twin Falls, ID 83301
Phone: 208-595-2372 Fax: 208-733-3750 E-mail:
Contract expires: AUTO- Contract number: N/A Frequency of routine inspections: ANNUAL
RENEW___ _
3. DESCRIPTION OF SYSTEM OR SERVICE
Fire alarm system (nonvoice)
Fire alarm with in -building fire emergency voice alarm communication system (EVACS)
Mass notification system (MNS)
Combination system, with the following components:
Fire alarm EVACS MNS Two-way, in -building, emergency communication system
NFPA72, Fig. 10.18.2.1.1 (p. 1 of 12)
Copyright 0 21119 National Fire Protection Association. This forth may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
a
Other (specify):
3. DESCRIPTION OF SYSTEM OR SERVICE (continued)
NFPA 72 edition: 2010 Additional description of system(s):
3.1 Control Unit
Manufacturer: POTTER
3.2 Mass Notification System
MNS
3.2.1 System Type:
In -building MNS—combination
In -building MNS—stand-alone
Other (specify):
3.2.2 System Features:
Wide -area MNS
Model number: PFC-6030
This system does not incorporate an
Distributed recipient MNS
Combination fire alarm/MNS MNS autonomous control unit Wide -area MNS to regional national
alerting interface
Local operating console (LOC) Direct recipient MNS (DRMNS) Wide -area MNS to DRMNS interface
Wide -area MNS to high-power speaker array (HPSA) interface In -building MNS to wide -area MNS interface
Other (specify):
3.3System Documentation
An 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:
3ASystem Software
Operating system (executive) software revision level: ___
Site-specific software revision date: _9-19-2017 Revision completed by HOMER CREUTZ
A copy of the site-specific software is stored on site. Location: IN FACP
3.5011 -Premises Signal Transmission This system does not have off -premises
transmission.
Name of organization receiving alarm signals with phone numbers:
Alarm: AVANT GUARD MONITORING _ Phone: 877-206-9141
Supervisory: AVANT GUARD MONITORING Phone: 877-206-9141
Trouble: AVANT GUARD MONITORING Phone: 877-206-9141
Entity to which alarms are re -transmitted: REXBURG DISPATCH Phone:
Method of re- DIGITALVIA CELLULAR
transmission:
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:
Local energy Shunt Wired Wireless
NFPA 72, Fig. 10.18.2.1.1 (p. 2 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.
4. CIRCUITS AND PATHWAYS
4.1 Signaling Line Pathways
4.1.1 Pathways Class Designations and Survivability
Pathways class: N/A Survivability level: Quantity:
(See NFPA 72, Sections 12.3 and 12.4)
4.1.2 Pathways Utilizing Two or More Media
Quantity: _0 Description: N/A _
4.1.3 Device Power Pathways
No separate power pathways from the signaling line pathway
Power pathways are separate but of the same pathway classification as the signaling line pathway
Power pathways are separate and different classification from the signaling line pathway
4.1.4 Isolation Modules
Quantity: 0
4.2Alarm Initiating Device Pathways
4.2.1 Pathways Class Designations and Survivability
Pathways class: C Survivability level: 1 Quantity: 1
(See NFPA 72, Sections 12.3 and 12.4)
4.2.2 Pathways Utilizing Two or More Media
Quantity: 1 Description: ALARM INITIATING AND NAC'S RUN TOGETHER
4.2.3 Device Power Pathways
No separate power pathways from the initiating device pathway
Power pathways are separate but of the same pathway classification as the initiating device pathway
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: B Survivability level:
(See NFPA 72, Sections 12.3 and 12.4)
1
Quantity: 1
4.3.2 Pathways Utilizing Two or More Media
Quantity: 1 _ Description: ALARM INITIATING AND NAC'S RUN TOGETHER
4.3.3 Appliance Power Pathways
No separate power pathways from the notification appliance pathway
Power pathways are separate but of the same pathway classification as the notification appliance pathway
Power pathways are separate and different classification from the notification appliance pathway
NFPA 72, Fig. 10.18.2.1.1 (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
This system does not have smoke detectors.
Type and number of devices: Addressable:
4 Conventional:
Other (specify):
Type of coverage: Complete area
Other (specify):
Type of smoke detector sensing technology:
Ionization Photoelectric Multicriteria Aspirating Beam
Other (specify):
5.2.2 Duct Smoke Detectors
This 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 Photoelectric Aspirating Beam
5.2.3 Radiant Energy (Flame) Detectors
This system does not have radiant energy detectors.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Type of coverage:
5.2.4 Gas Detectors
This system does not have gas detectors.
Type of detector(s):
Number of devices: Addressable:
Conventional:
Type of coverage:
5.2.5 Heat Detectors
This system does not have heat detectors.
Type and number of devices: Addressable:
Conventional:
Type of coverage: Complete area Partial area Nonrequired partial area Linear Spot
Type of heat detector sensing technology:
Fixed temperature Rate -of -rise Rate compensated
NFPA72, Fig. 10.18.2.1.1 (p. 4 of 12)
Copyright ® 2009 National Fire Protection Association. This forth 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
Number of devices:
5.2.7 Waterflow Alarm Devices
This system does not have monitoring modules.
Type and number of devices: Addressable: 1 Conventional: Coded: _ _ Transmitter:
5.2.8 Alarm Verification This system does not incorporate alarm
verification.
Number of devices subject to alarm verification:
5.2.9 Presignal
Number of devices subject to presignal:
Describe presignal functions:
6.2.10 Positive Alarm Sequence (PAS)
Describe PAS:
5.2.11 Other Initiating Devices
Describe:
Alarm verification set for seconds
This system does not incorporate pre -signal.
This system does not incorporate PAS.
This system does not have other initiating devices.
6. SUPERVISORY SIGNAL -INITIATING DEVICES
6.1 Sprinkler System Supervisory Devices 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 This system does not have a fire pump.
Type fire pump: Electric pump Engine
Type and number of devices: Addressable: Conventional: _ Coded: Transmitter:
Other (specify):
6.2.1 Fire Pump Functions Supervised
Power Running Phase reversal Selector switch not in auto Engine or control panel trouble 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 (soecifv):
Type of coverage:
Type of smoke detector sensing technology: Ionization Photoelectric Aspirating Beam
6.4 Other Supervisory Devices This system does not have other supervisory devices.
Describe:
NFPA 72, Fig. 10.18.2.1.1 (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
Engine or control panel trouble Generator running
Other (specify):
7.2 Special Hazard Suppression Systems
Description of special hazard systeni
7.3 Other Monitoring Systems
Description of special hazard systeri
8. ANNUNCIATORS
8.1 Location and Description of Annunciators
Location 1:
Location 2:
Location 3:
This system does not have a generator.
Selector switch not in auto Low fuel
This system does not monitor special hazard systems.
This system does not monitor other systems.
This system does not have annunciators.
9. ALARM NOTIFICATION APPLIANCES
9.1 In -Building Fire Emergency Voice Alarm Communication
System This system does not have an EVACS.
Number of single voice alarm channels: 1
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 l:
Location 2:
Location 3:
9.2 Nonvoice Notification Appliances
This system does not have nonvoice notification appliances
Horns: With visible: 6
Bells: With visible:
Chimes: With visible:
Visible only: Other (describe):
9.3 Notification Appliance Power Extender Panels This system does not have power extender panels.
Quantity:
Locations:
NFRA72, Fig. 10.18.2.1.1 (p. 6 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not the copied for commercial sale or distribution,
10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS This system does not have an MNS.
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
This 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 This 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: Electrically powered Sound powered
11.2 Two -Way Radio Communications Enhancement System
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. 10.18.2.1.1 (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
This 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 functions:
Hold -open door releasing devices Smoke management HVAC shutdown F/S dampers
Door unlocking Elevator recall Fuel source shutdown Extinguishing agent release
Elevator shunt trip 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: 120 VAC _ - Control panel amps: 20
Overcurrent protection: Type: BREAKER Amps: 20
Location (of primary supply panel board):
Disconnecting means location: ELECTRICAL PANEL, MARKED ON PANELS
13.1.2 Engine -Driven Generator This system does not have a generator.
Location of generator:
Location of fuel storage: _ _ _ - Type of fuel:
NFPA72, Fig. 10.18.2.1.1 (p. 8 of 12)
Copyright 0 2009 National Fire Protection Association. This form may be dopiest 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 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: IN PANEL Type: LEADACID Nominal voltage: 12 Amp/hour rating: 7
VDC X
2
Calculated capacity of batteries to drive the system:
In standby mode (hours): - 24 _ In alarm mode (minutes): 5
Batteries are marked with date of manufacture Battery calculations are attached
13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System
This 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
This system does not have a generator.
Location of generator:
Location of fuel storage: _ -
Type of fuel:
13.2.3 Uninterruptible Power System
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):
13.2.4 Batteries
Location: Type:
Nominal voltage: Amp/hour rating:
Calculated capacity of batteries to drive the system:
In standby mode (hours):
In alarm mode (minutes):
Batteries are marked with date of manufacture
Battery calculations are attached
NFPA 72, Fig. 10.18.2.1.1, (p. 9 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.
13. SYSTEM POWER (continued)
13.3 Notification Appliance Power Extender Panels
This system does not have power extender panels.
13.3.1 Primary Power
Input voltage of power extender panel(s):
Power extender panel amps:
Overcurrent protection: Type:
Amps:
Location (of primary supply panel board):
Location: Type:
Disconnecting means location:
Calculated capacity of batteries to drive the system:
13.3.2 Engine -Driven Generator
This system does not have a generator.
Location of generator:
Batteries are marked with date of manufacture
Location of fuel storage:
Type of fuel:
13.3.3 Uninterruptible Power System
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:
Nominal voltage: Amp/hour rating:
Calculated capacity of batteries to drive the system:
In standby mode (hours):
In alarm mode (minutes):
Batteries are marked with date of manufacture
Battery calculations are attached
14. RECORD OF SYSTEM INSTALLATION
Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper
branching, but before conducting operational acceptance tests.
This is a: New system Modification to an existing system Permit number:
The system has been installed in accordance with the following requirements: (Note any or all that apply.)
NFPA 72, Edition: 2013
NFPA 70, National Electrical Code, Article 760, Edition: 2014
Manufacturer's published instructions
Other (specify):
System deviations fro a re ed "FPA standards: NONE
Signed:
PINNACLE
TECHNOLOGIES LLC
Printed name: _ JASON PERRON
Title: JOURNEYMAN TECHNICIAN
Date: 1-70 1
Phone: 208-595-2372
NFPA 72, Fig. 10.18.2.1.1 (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
New system
All operational features and functions ofthis system were tested by, or in the presence of, the signer shown
below, on the date shown below, and were found to be operating properly in accordance with the requirements
for the following:
Modifications to an existing system
All newly modified operational features and functions 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:
NFPA 72, Edition: 2013 _
NFPA 70, National Electrical Code, Article 760, Edition:
Manufacturer's published instructions
Other (specify): _ _
Individual devi documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached]
PINNACLE
TECHNOLOIGIES LLC
16. CERTIFICATIONS
Printed name: _ JASON PERRON _ Date: ��—Zo — 1-7
Title: JOURNEYMAN TECHNICIAN Phone: 208-595-2372
16.1 System Inst a{6 Contractor:
This system, a ' ted herein, has been installed and tested according to all NFPA standards cited hereiinn..� % �J
Signed, Printed name: JASON PERRON Date: ( ` o ` / /
Ionization: PINNACLE Title: JOURNEYMAN TECHNICIAN Phone: 208-595-2372
TECHNOLOGIES LLC
16.2 System Servi ractor:
The undersigne ervtce contract for this system in effect as of the date shown below.
Signed:
Printed name: JASON PERRON
hg ton: PINNACLE Title: JOURNEYMAN TECHNICIAN
TECHNOLOGIES LLC
16.3 Supervising St
This system, as i ed herein, will be monitored according to all NFPA standards cited herein.
Printed name: JASON PERRON
PINNACLE Title: JOURNEYMAN TECHNICIAN
_TECHNOLOGIES LLC _
Date: �—zo —/ 7
Phone: 208-595-2372
Date:. G o --/ /
Phone: 208-595-2372
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:X Printed name: _ KOL Date:
Y ��t o F� _
Organization: l 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:
Organization: REXBURG FIRE DEPT
�$VMWWIQ
Date:
f ��—
Phone:
NFPA 72, Fig. 10.18.2.1.1 (p. 12 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,