HomeMy WebLinkAboutALL DOCS - 12-00173 - 488 S 2nd E - BYUI Biddulph Hall Remodeli,"
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Please ComrpEte the Entire Application!
lf the question does not apply fill in NA for non applicable
COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION
35 N 1" E,, REXBURG, ID 83440
208-372-2326
PARCEL NUMBER:( We will provide this fot you)
SUBDIVISION:UNIT# BLOCK# LOT#
inE is based on the infotmation - must accutate
CONTACT PHONE #
PROPE,RTY ADDRESS:
PHONE #: Home ( )
O\X/NER MAILING ADDRESS :
Work
APPLICANT (If other than owner)
(Applicant if other than ownet, a statement authorizing applicant to act as agent for ovmer must accompany this application.)
APPI,ICANT INFORMATION: ADDRE,SS CITY:
STATE;-ZIP-
PHONE #: Home ( )-Work( ) Cell(
MATLTNG ADDRESS' a['fuO k\" saOO S . crry
PHoNE: ceu# (54 -t o tB t=l
AHO REGISTRATION # & EXP. DA
Did you recently purchase this
Is this a lot split? NO \T,S
PROPOSED USE,:
How many buildings are ted on this property?
property?XQYes (If yes,list previous owner's name)
(Please bring copy of new legal description of properry)
(i.e., Single Family Residence, I\{ulti Family, Apartments, Remodel, Garage, Commercial, Addition, Etc.) - CIRCLE ONE
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenaltyof p.'j,,ry,Iherebycertif,thatl
have read this application and state that the infomation herein is correct and I swear that any infomation which may hereafter be given by me in hearings before the
Plaming md Zoning Commis;Qn or the City Comcil for the City of Rexburg shall be truthfi:l and correcl I agree to comply with all City regulations md State laws relating
to the subject mtter of and hereby authodzed representatives of the City to enter upon the above-mentioned property for inspections purposes. NOTE:
The building offi ciil may,issued under the provisions of the 2003 Intemational Code in cases of any false statement or misrepresentation of fact
in the application or rrrtrt wasbased. Permitvoidifnotstartedwithinl80davs. Permitvoidifworkstopsforl80davs
5,/7 / /t
DATE /Signature of Owner/Applica
Do you prefer to be contacted by fax, email ot phone? Circle One
WARNING - BUII.DING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and arc paid in full at the time of application beginning.kyryJ,2l$,
City of Rexburg's Acceptance of the plan review fee does not constitute plan appmval
HBuilding Pemit Fees are due at time of application** sBuilding Pemits are void if your check does not cleat'**
Nelson Electric
Iilfllmtz 16:28 CiB of RexO(mD 3se-3022
208-745-9282
cAAB 3se 3ozz
p.'1
P.001io01
ctTr o l
35 N- le E., Rerburg, td 834,t0
Phone - t208)359-3020 / Hodi:nc - (?f'A]37Z-23,44 / Fu - (209,)359_3OZz
OVNER'S NAME
PROPERTYADDRESS
SUBDTVISION
PHASE LOT BLOCK
Building Sofefi Deportrnenl
City ol Rexburg
Pcr:rrit#
BEIB*:BQ
..lorziori &oil1 Corurrrr ity
Requircd!!!ELECTRICAL
Etectrica:Contractor'sx^ . h..€f lV1(ff-, erl"ne"rN^ " l,/?/[n/ €/e:ffr?tf
Addr"r, ( o '.. 6ox t4o J crv--&ez4a-sat --e)-ap-EE!s{
cell Phone (7t8, ,at - no - =* ** uusiness phone (zag) -t sLI - ? s s?
Fax(M -?clS - 9 P> e-a. Srcge neKan-ete
(COMMERCIAL/INDISTRIAL) Total cost of electrical system (contrac*cd Amouot) S t/ t tro .to
(rckda; tk cott q na*riah iutaltd ngadlus of thc pn;J tqpfing;t Tkfcu tittd aadcr ilnt ;ur4ct;on tpc iloll apfu to ory *i at ,t ara-t h*llationsnot tpcfcaQ mntioaed cLenbm oa tbisfom).
Up to $10,000 (fo1&sst sf.rJ6lsp x 0.02) + (fr = $
X **.^::_9!,001- S100,000 ( (roral cost of systcm _ 10.b00) x 0.01) f g260 = g-o Over 5100,001 ( (total cost of systgn i:1@.OdJ x o.o'oS) + g1,160 = g
Small Works (Contractors ONLY): $10 fec for work nor exceedia!$20o ircost and norinvolving a change inseryice connecdons- Does NOT reguire ipspectron.
RESIDENTIAL
Ncv: Single Family Dwelling, including zII buildings with widag being conseucted oo a& prcpetgr- (*Bescd on Eving spzce,sec defiaition below)
o' Up to 1,500 sq ft - 9130 o 1,501 to 2,500 sq ft - $19So 2,501 to 3,500 sq ft - [260 . o f,SOt to +,SOO "q ft _ g3Z5ct over 4,500 sq tt $325 P-lus E65 for cach additional 1,000 sq ft. or portion ttrcreor i$:zs + ($os x # 9f additional1.00Q sq. ft or oordon {:,ereo0).Itfev: Multi-Funily -Dwelling (Cooaectori Oa]y)
D Duplex Apatroent 9260
o Three or more multj-family units: $130 per buiidinq elus $65 per unie ($130 x # of buildings) + ($65 x # of uaj$)oExistingResidence,Modular,Marruiactutedori4obilefi|omes,"oao.@p..
btaoch citorit, up to the maximum of the_cdcesrylg3g sg. fu-of thc uuitding ($65+ (sro x # branctr circut+o Central Heating/C,ooliag Systems: $65 wtren NoT-part of aew residenriilt rwnC n"t*i, u,r., ", .aaltjonalWiring
spar, l{ot Tub-s, and svirnrringpoors: g6s fee for each tip to inspcctPumps-Water, Inigztion, &wzge (each notit)
, D $65 up to 2.5HP og95 - 26 to 200Hp o$130 over 200 Hp
MISCELI-ANEOUS
B Temporary Consruction Services ONLY: 200 arap or less, one locatioo (for a period oot to *cecd I year) - $65D Temponry Arnusement $65. fee prus $ro per d.de, concession o! geo€lato!
o Irrigadon Machine: $65 for center pivor plus $10 pcr tower of ddve moror
B TechnicalSenrice: $65perhour
D PIan Checki: $65 pcr hout
o Reguested fnepe,ction: g65
rli'ing Space - sPtce \oithin a du'elling udt ioteoded for humac habitatioo whicb rnay-reasooably be utilired for sleepic* erting, cooLing,beddng)tp' recreatiorr' and sanitation purposes. An ua6nished bascanenr is -nsa"rJ p*.ro" u"-g spnce
_ 38 r)ry 5--tl-lI
Dateof Licensed Cootacto!Iicensc nusrber &
12 00173
BYU-I Biddulph Hall Remodel
04l19l12
Routing: Copy 3
Done
r-l/ 1---.1
NA
f Don Allen(Please review by Friday, April 20)
Please complete the following:
Done NA
tr I Review Plans
., I Enter Notes for the applicant under Submittals
-E I Update status in the Approvals tab
-E* I Return building plan to Amanda Saurey
Notes:
12 00173
BYU-I Biddulph Hall Remodel
04l13l12
Routing: Office Copy
Bret Stoddard (Please review by Friday, April 13)
Please complete the following:
NA
I Review Plans
I Enter Notes for the applicant under Submiuals
X Update status in the Approvals tab
n Return building plan to Amanda Saurey
Notes:
Doy'e
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Done NA/_x ll
na12 0utn
BYU-I BiddutPh Hall Remodel
0412012012
Routing: Fire Review
Jon Berry (Please review by Friday, April 20)
Please complete the following:
Review Plans
E
n
T
Enter Notes for the applicant under Submittals
Update status in the APProvals tab
Return building plans and this checklist to Amanda saurey
Dogy' NA
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{ Red Line Notes? (Transfer notes to both job site copy & office copy)E
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FIRE ALARiI AND EiIERGENCY COTTUNICATION SYSTEITI RECORD OF GOIf,PLETIOI{
To be cornpleled by the systen iwtallation contractor st the time ofsystern acceptane and apprwal.L slull be permitted to nodifu thisform as needed to provide a more complete and/or clear iecord^
lnsert N/A in oll unused lines.
Attach additional sheets, dala, or calculations as necestar)t to praide a complete record.
1. PROPERTY INFORJTNANOil
Nameofproperty, @
Address: Byu-ldaho, Rexburg tdaho
Description of prop€rty; Biddulph Hall Officp Building
Occupancy type: B
Name of property represeirtativc: Thomas Mooro
Address:
Phone:Fax:E-mait:
Authority having jurisdiction over this property City of Rexburg Fke Marshal
Phone:Fax:E-mail:
2. INSTALLATION, SERVICE, AND TESNNG CONTRACTOR INFORMATION
Installation contractor for this equipm€nt; Nelson Electric
Address;
License or certification nurnber:
Phone: Fax:
Service organization for this equipment: Nelson Fire Sptems
Address: 1481 South Major Street SLC, UT 841 15
License or certi{ication number:
Phone: 801466-8300 For: 801468-8305
E-mail:
E-mail: office@nelsonfire.com
E-mail:
Frequcncy of routine inspections:
A contract for test and inspection in accordurcc with NFPA standards is in effect as of
Controcted lcsting company:
Address:
Phone:
Contract expires:
Fax:
3. DESCRIPTION OF SYSTEI' OR SERVIGE
ff! Fire alarm system (nonvoice)
El Fire alarm with in-buildingfire emergency voice alarm comilunicalion system (EVACS)
E Mass notification system (MNS)
0 Combination syste4 with thc following components:
E Fire alarm E] EVACS El tvfNs fl Two-way, in-building emergency oonrmunication systcm
[J other (specify):
Copytigftt e 20Gt tldhnd Fir. Prol.dim &3oddiil" Thi3 totfi lmy b. oopisd fd irdividEl e other thg| |or l€rd.. I 'YBy not b. 6piod tbr dnmrcial !6b d .nrfibtdm.
3.DESCRfPTIOI{ OF SYSTEil OR SERVICE (contlnued)
NF\A 72 edition: 2O'lO Additional dascription of system(s):
3.1 Control Unit
Manufacturer: GamewelFF0l
3.2 Mrss Notitication Systcm
3.2.1 Syrtem Type:
I ln-building MNS--+ombination
E In-buildingMN$-stand-alone E Widc-area MNS
E Other (speciff):
3.2.2 Systcm Features:
E Distributed rccipient MNS
D Combination fire alarm/IvtNS tr MNS autonomous control unit E Wide-area MNS to rcgional national
alerting interface
E Locat operating console (LOC) [ Direct recipient MNS (DRMNS) E Wide-area MNS to DRMNS interface
n Wide-area MNS to high-powcr speaker array (HPSA) interfacc E ln-building MNS to wide-area MNS intcrface
fl Other (speci!):
3.3 System I)ocumentation
I An owner's manual, a copy of the manufacturer's instructiong a writtcn sequence of operation, and a copy of
the numbercd record drawings arc storpd on site. Location:
3.4 System Softrvare
Operating systcm (executivc) software rwision level:
Site-specific software revision date: 2113113
El A copy ofthe site-specific software is stored on site. Location:
3.5 Olf-Promises Signal Tranrmlssion
Name of organization rccciving alarm signals with phone numbcrs:
Alarm: BYU'ldaho Public SafetY
SuPewisorY: sam€
Trouble: same
Entity to which alarms are retraosmitted:
Melhod of retransmission :
Model number: E3 Series
E This system does not incorporatc on MNS
E] This systom does not have alterable site-specific software.
Version 2.30.10
Revision completed bY: David Burns
Main FACU
I This qystem does not have off-premiscs transmission.
Phone: 208'496-3000
Phone:
Phone:
Phone:
lf Chapter 26, speciff the means of transmission from the protected premises to thc supervising station:
If Chapter 2?, speci! the type of auxiliary alarm system: EJ Local energy B Shunt E Wired El Wireless
''r ;',/i ;':r !:rtr.r ji.i lil ,) 1 i l) 'j tt\ 1,tl.t
Coflri0ht O 20@ Naltsoal Fr. Probcrion tu ocialftrr. TlSr tm o|ay bo oopiod for Indrvi&al U3. oul6f thd bt faldo. lt may not b€ copicd br C!('mtrciC 8.b a didtiMhn
4 CIRCUITS AND PATHWAYS
4.1 Slgnaling Line Prthweys
4.1.1 Pathways Class Designations and Survivability
Pathways class: B Survivability level: I
(See NFPA 72, Sections 12.3 and 12.4)
4.12 Pathways Utilizing Two or More Medir
Quantity:Description:
4.1.3 Device Power Pathways
fl No separate power pathways from the signaling line pathway
! Power pathways are separate but ofthe same pathway classification as the signaling line pathway
I Powsf palhways ar€ sepafate and difrerent classificalion from the signaling line palhway
4.1.4 Isolation Modules
Quantity:
4.2 Alarm Initiating Device Pathways
4.2.1 Pathways Class Designations and Survivability
Pathways clms:Survivability level:Quantity:
(See NFPA 72, Sections I2.j and | 2'4)
4.2.2 Pathways Utilizing Two or More Media
Quantity:Description:
4.23 Device Power Pathwryg
E No separate power pathways tom the initiating device pathway
I Power pathways are scparate but of the same pathway classification 8s the initialing device pathway
D Power pathways are separate and different classification from the initiating device pathway
4.3 Non-Voice Audible System Pathweys
4.3.1 Pathways Class Derignations and Survivability
Palhways class: B Survivability level: 1
(See NFPA 72, Sections 12.3 and 12.4)
4.3.2 Pathways Utilizing Two or Morc Media
Quantity: 13
Quantity:Descriptionl
4.33 Dcvice Power PathwaYs
E No separate power palhways from the notification apptiance pathway
Et power pathways are separate but ofthe same pathway classificatioil as the notiftcstion appliance pathway
S Power pathways are separate and ditrerent classification from the notification appliance pathway
,.,,-rt\',':: ;io lC.13 2 1 : i) i ni 'l2i
Copyright 6 2OOO Ndidtel Fife Pml€ction Assoclalhn. This form rEy bs copisd fo. iJdhidud u€e other than 'of rcat3. la may ool bs coftad ttr m€rdal sle d dk{tibuibn'
Quantity:2 ( Existing )
Other (specifr):
Type ofcoverage: S Complete area E Partial area El Nonrequired partial area
Other (specifr):
5. ALARM INITIATING DEVICES
5.1 Manual Initlating Deviccs
5.1.1 Manual tr'ire Alarm Boxes
Type and number of devices: Addrcssable:
Other (sPecif,): 15 ( Existing )
5.1.2 Other Alarm Boxes
Description:
Type and number ofdevices: Addressable:
Other (sPeci$):
5.2 Automatic Initiating Devices
5.2.1 Smoke Detectors
Type and number ofdevices: Addressablc:
Type ofsmoke detector sensing technology:
Other (speciff):
5.2.2 Duct Smoke Detectors
Type and number of devices: Addressablel
Other (speci$):
'Iype ofcoverage:
Type of smoke detector sensing technolory:
5.23 Radiant Energy (Ftane) Detectors
Type and number ofdevices: Addressable:
Other (sPecifY):
Type ofcoverage:
5.2.4 Gas Detectors
Type ofdetecto(s):
Number of devices: Addressable:
Type ofcoveragel
5.2.5 Heat Detectors
Type and number of devices: Addressable:
fl This system does not have smoke det€ctors'
39 Conventional:
E Ionization El Photoelectric El Multicriteria E Aspirating fl Searn
fi This system does Dot have alarm'causing duct smokc detectorc'
Conventional:
E lonization E Photoelectric EI Aspirating E Beam
[t This system does not have radiant energy det€ctors'
Conventionall
El This system does not have gas detectors'
Conventional:
I This system does not have heat detectors'
Conventional:
I This system does not have manual fire alarm boxes'
Coded: Transmitterl
E This system does not have other alarm boxes'
Coded: Transmitter:
ILinear flSPot
I Rate comPensated
Conventional:
Conventional:
Type ofcoverage: E Complcte area n Partial area E Nonrequired partial area
Typeofheatdetectorsensingt€chnologl:EFixedtemperatureERate-of-rise
,\i /)"/i ir'-t. 1l-l i8 il i i rt;
copyfuht @ 2@9 Narionar Fl! protsction Asrocia[on- This form ftay be copisd lor individlal u86 olls lhm fd r$6le lt may not be ooPisd ior comme*d ssle or dslriition
5.ALARM IN|TIATING DEVICES (continued)
5.2.6 Addrcsseble Monitoring Modulcs
Number ofdevices:
5.2.? Waterflow Alarm Devices
Type and number of devices: Addrcssable:
5.2.8 Alarm Verification
Number ofdevices subject to alarm veriftcation:
5.2,9 Presignal
Number ofdevices subject to presignal:
Describe presignal functions:
5.2.10 Positive Alarm Sequence (PAS)
Describe PAS:
5.2.11 Other Initiating Devices
Desuibe:
fi This system does nothave monitoring modules'
S This system does not have waterflow alatm devices'
Conventional:Coded: Transmitter:
E This system does not incorporate alarm verification'
Alarm verification setfor: seconds
[t This system does not incorporate pre-signal'
I This system does not incorporate PAS'
[! This system does not have olher initiating devices'
E This system does not have a fire pump.
Coded: Transmitter:
[t This system does not have DSDs causing supervisory signals'
Conventional:
6. SUPERVISORY SIGNAL.INITIATING DEVICES
6.1 sprinkler system supervisory Dcvices fi This system does not have sprinkler supervisory devices'
Typeandnumberofdevices: Addressable: Conventional: Coded: Transmitter:
Othet (speciff):
6.2 Fire Pump Deecription rnd Supervisory Devices
Type fire pump: E Electric pump E Engine
Type and number ofdevices: Addressable: Conventional:
Other (specify):
6.2.1 Firo Pump Functions Superviscd
f]PowerIRunningEPhasereversa|Eselectorswitchnotinauto
Other (speciff):
E Engine or control panel Eouble fl Low fuel
6.3 Duct Smoke Detectors @SDs)
Type and number ofdevices: Addressable:
Other (speci$):
Type ofcoverage:
Type of smoke detector sensing technology: F lonization 0 Photoelectric E Aspirating E Beam
6.4 Other SupervisorY Devices
Describe:
El This systom does not have other supervisory devices'
:.,!:r:!t 7't ,:rs tl lll.! 1 1 lr: i-. of 121
copynqht o 2oo9 Nstiond F € protsdiEt AsEciation. Thts lom may bo @pird br individal 6E other tlffi ior resalg' lt may ml bo opied ftr mm€rciEl sd6 s ttltdlajtim
7.ITIONITORED SYSTEMS
7.t Engine-DrlYen Generator
?.1.1 Gencrator Functiong Supervircd
fl Engine or coottol pangl trouble El Generator running
E Other (specify):
7.2 Spectal Hrzard Supprcseion Systcms
Description of special hozard system(s):
?3 Other Monitoring SYrtoms
Description of special hazard system(s):
ANNUNCIATORS
8.1 tocrtion and llccription of Annunciators
Location l:
Location 2:
Location 3:
Number of single voice alarm channels:
Numbcr of speakers:
Location of amplification and sound-processing equipment:
Location of paging microphone stations:
Location l:
Location 2:
Location 3:
9.2 Nonvoice Notllication Applirnce
El This system does not have a generator
ff Selectot switch not in Buto fl Low fuel
E This system do€s not monitor special hazard systcms'
$ This system does not monitor other systems.
fit This system does not have annunciators'
Number of multiple voice alarm channels:
Number of sPeaker circuits:
fl This system does not have nonvoice notification applianccs'
Bclls:With visible:
E.
9. ALART ilONFEATION APPLIANCES
g.1 ln-Building Firc Emcrgcncy voicc Alrrm communlcetion systcm [t This system does not have an EVACS'
Horns: 77
Chimes:
Visible only:
With visibler 77
With visible:
Other (describe):
9.3 Notif,crtion Applirnce Powcr Extetrdcr Patrel3
Quantity: 4
Loca$ons: Janitor Cloeet on each floor, main FACP
I This system do€s not have Powcr extsnd€r panel$'
,\ilrii'4
copyfigfit o 2oo9 N.tbnal Fka prot.clbn A!&detlon thb form m6y bs capiod tuf mdividual ura ooFr tlrgr tof resh ll m8y mt bo coPkd fot oomm€'dd rdt o' didtiMion'
10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS I This svst€m does not bave an MNS'
f0.f MNS Local OPerating Consoles
Location l: .
Location 2:
Location 3:
102 High-Power SPeaker Arr&Ys
Number of HPSA speaker initiation zones:
Location l;
Location 2:
Location 3:
103 Mass Notilicatlon Devices
Combination fire alarmMNS visible appliances:
Textual sigrs: Other (describe):
Supervision class:
103.1 Special Hezrrd Notification
MNS-only visible aPPliances:
El This system does not have special suppression predischarge notification'
nMNssystemsDoNoToverridenotiflcationappliancesrequiredtoprovidespecialsuppressionpredischarge notification.
11. TWO.WAY EMERGENGY COMMUNICATION SYSTEMS
11.1 TelePhoneSYstem
Number of telephone jacks installed:
Number oftelephone handsets stored on site:
Type oftelephone system installed: fl Elecnically powercd B Sound powered
ll.2 Two-Wry Radio Communications Enhancement System
DThissystemdoesnothaveatwo.wayradiocommunicationsenhancementsystem'
Percentage ofarea covoed by two'way radio service: Critical areas: o/o
Amplification component locations:
Et This system does not havo a two'way telephone system'
Number of warden stations installed:
General building areas: o/o
Inbound signal strength:
Donor antenna isolation is:
Radio fi equencies covered:
Radio system monitor panel location:
dBm Outbound signal strength:
dB above the signal booster gain
coo/n4ft o 2oog Natonal Firs protocnim lssoqigtion. This fqm may bs coptsd b. indivi&al use ohaf lhan fof res€lE ll m6y mt bo @lgd fo' @mm€fcid sda s dirttlbilion'
1 1. TWO-WAY EMERGET,ICY COMiIUNICATION SYSTEI$S (continued)
It.3 Area of Refuge (Areo of Re'scuc Assistence) Emergency Communicetions Systcms
El This system does not have an area ofrefuge (area ofrescue assistance) emergency communications system'
Number of stations:Location ofcenffal control Point:
Days and hours when central control point is attended:
Location of altematc control point:
Days and hours when altemate conlrol point is attended:
11.4 Elevator Emergency Communications Systems
El This system does not have an elevatof cmergency communications system'
Number of etevators wilh stations: Location of ccntral control point:
Days and hours when central control point is attended:
Location of alternate control point:
Days and hours when altemate control point is aftended:
ll.5 Other Two-Way Communicrtion Systems
Describe:
12. GONTROL FUNCTIONS
This system activates the following control fuctions:
EHold.opendoorreleasingdevicesflsmokemarragementEHVACshutdownDF/Sdampers
fl Door untocking n Elevator rcaall tr Fuel soulte shutdown fl Extinguishing sgent release
E Elevator shunttrip E Mass notiftcation system overide offire alarm notification appliances
Other (sPecif,):
l2.l Addressablc Control Module
Number of devices:
Other (sPeci$):
13. SYSTEM POWER
13.1 Control Unit
l3.l.l PrimarY Power
Inputvoltagsofcontrolpanel: 120 VAC
Ov€rcurent protection: Type: Cicuit Breaker
Location (ofprimary supply panel board):
Disconnecting means location: Panel Bteaker
13.1.2 Engin*'Driven Generator
Location ofgenerator:
Location of fuel storage:
Et This system does not have control modules'
Control panel amPs: 4
Amps: 20
[t This system does not have a generator'
Type of tuel:
. 1;:{:! i2 [rci 'li). ii.: il.], t iq. I cf l2i
copy,ron o 2oog Nationd Fio protedion Assietim. Thi! form riay bo @pi€d ld lrdilid8l e olher thsr for t63ale- lt may not bo @€d br €nm€'od tals ot di8ltih'io'l
13. SYSTEM POWER (conttnued)
13.1,3 Unlnterruptible Power Syrtcm 8t This system does not haYc a UPS'
Equipment Powered bY a UPS sYstem:
Location of UPS sYstem:
Calcu|atedcapacltyofUPsbatteriestodrivethesystemcompoflcnts@nnectedtoit:
In standby mode (hours):
13.1.4 Batterlcs
In alarm mode (minutes):
Location: Cabinet by FACP Type: i3,il{"o
Nominal voltage: 24v Amp/hour rating: 7
Calculsted capacity of batteries to drive thc s'stem:
In standby modc (hours): 1 In alarm modc (minutes):
Et Batteries are marked with date of manufacture fl Battery calcutations are attached
13.2 In-Butlding Firc Emcrgcncy volce Alrrm commuolcltion systcm or Mrss Notification System
El This systcm does not have an EVACS or MNS slstcm'
13.2.1 PrinarY Power
Input voltage of EVACS or MNS Panel;
OvercurrcntProtection: TYPe:
Location (ofprimary supply panel board)l
Disconnecting means location :
13.2.2 Enginc-Driven Gcnomtor
Location ofgenerator:
Location of fuel storage:
EVACS or MNS Panel amP's:
Amps:
E This system does not have a generator'
Type of tuel:
13J.3 Unintcrruptiblc Powcr Syrtom Et This system does not have a UPS'
Equipment Powercd bY a UPS sYstem:
Location ofUPS sYstem:
Calculated caPacity ofUPS battcries to drivc the system componsnB connected to it:
In standbY mode (hours):
132.4 Betteries
Location:
Calculated capacity of batteries to drive the system:
In standby mode (hours):
E Batteries are marked with date of manufacture
In alarm mode (minutes):
Type: Nominal voltage:
In alarm mode (minutes):
E Battcry calcrrlations are attached
Amplhour rating:
copyd9hto2oo9NationdFlBPrd.c|ionA${,cis!m.Thi!'omirayb'@pi9db.i'tdiv|d,6|LE.othoflh$br'e'd..ltmEyr'oiboooPbdfo'c!rt|tn6njdsdgad3UiMi
13. SYSTES POWER (colnfrnued)
13.3 Notilicrtlon Appliancc Powcr Ertetrder Prneh
13.3.1 Primary Power
Input voltage ofpower extender panel(s): 120 VAc
Overcurrentprotection: Type: CircuitBreaker
Location (ofprimary supply panel board):
Disconnectingmeanslocation: PanelBreaker
13.3.2 Enginc-Drivcn Gcncretor
Location ofgenerator:
Location of fuel storage:
fl This system does not have power extendcr panels'
Power extenderPanel amPs: 6
Amps: 20
[t This systcm does not have a generator'
Type of tuel;
Datc: 2114t13
Phone:
1333 Uninterruptiblc Power System $ This qystem docs not have a UPS'
Equipmcnt powered bY a IJPS sYstem:
Location of UPS sYstem:
calculated capacity ofuPS batteries to drive thc system comPonents conn€cted to it:
Tvoc Ssaled
Lead Acid
Calculated capaclty of batteries to drive the systcm:
In standby mode (hours): 24 In alarm mode (minutes): 5
Et Batteries are marked with date of manufacturc o Banery calculations are attached
14. REGORD OF SYSTEM INSTALLATIOX
Fig out olter alt lnstallation is complete atdviring has been checkedfor opens, shorts, groundfaults, and improper
branehing, but before confuctittg opemtiotul acceptance tests'
This is a: E New system El Modification to an exieting system Pcrmit number:
The system has been installed in accordance with lhc following requirements: (Note any or all that apply.)
ENFPA T2,Edition:
ENFPA 70, Natiotut Electrical Code, Article 760, Edition:
Et Manufacturer's published instructions
Othcr (sPeci$):
System devialions from referenced NFPA standards: NONE
tn standby mode (houn):
133.4 Batteries
Location: Cabinet bY FACP
Signed:
Organization: NolsonElec'tric
In alarm mode (minutes):
Nominal voltage: ,rL" Amplhour rating: 7
Printcd name:
Title:
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copyrtght o 2ooo Nslimd Fir€ pro{octbn AlEocialicn TN! iorm my b6 copi€d fot individrd u!. dhd ttn for ror€tt n may not b€ csH ror oomm€roid ralo ot dl$iMlon
15. RECORD OF SYSTEIT @ERATIONAL ACCEPTANCE TEST
E New system
All operational featwes and furcfions ol f his system were tesled by, or in the presence of the signer shown
below, on the iate shown beiow, and wire found to be operating properly in accor&nce wilh the reguirements
for thefollowing:
El Modifications to an existing system
All newly modifted operatiomlfeatwes andfunctiorc of the systemwere tested by, or in the presence of' 1le
signer shown 6elow,- on the daie shown beloty, and were found to be operating properly in accordance with the
req uire me nls of the {ol low ing :
ENFPAT2,Ed'ition:
ENFPA 70, National Electrical Code, Article 760' Edition:
fit Manufacturer's published instructions
Other (specif):
E Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached]
16. CERTIFICATIOilS AND APPROVAI.IS
16.1 Systom Inst.llltioD Contractor:
This systenU as spccified herein, h*s been installed and tested according to all NFPA standards citcd herein'
Signed:
Organization: Nelson Fire Systems
Signed:
Organization:
Printed name: David Burns
Title: T€chnician/Projec{Manager
Printed name:
Title;
Printed name:
Title:
Date: 2114t13
Phone: 801-468-8300
Dalc:
Phone:
Date:
Phone:
Signed:
Organizntion: NelgonElectric
16.2 Systcm Service Contractor:
The undenigned has a service contract for this system in effect as ofthe date shown below.
Signed:Printed namel
Organization: Title:
16.3 Supervising Station:
This system, as spocilied herein, witt be monitored according to all NFPA standards cited herein-
Date:
Phone:
t!|I1rt -1 r:(r 'ii). lli :l i i ig; 1i r:r ,,:1
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16. GERTfFICATIONS AND APPROVALS (contlnued)
16.4 Property or Owner Representative:
This system, as specified herein, will be monitored according to aU NFPA standards cited herein'
I have witnessect a satisfactory acceptance test ofthis systen and find it to be installed and operating properly.-
in accordance with its approv'Jpirir *O specification+ with its approved sequence of operations, and with all
NFPA standards cited herein.
Signed:
Organization:
165 Authority Having Jurisdiction:
Signed:
Organization:
Printed name:
Title:
Printed name:
Title:
Date:
Phone:
Date:
Phone:
NFiaA ;2 l--rq. .10 13 2. 1, .1 & 12 cI 1''
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tnspction Reguest: Recd By ., (- Date Z{a-/Z-Req. By , phone No.
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lNsPEcrED trEMs coNronrrl ro epF6TES-0ffi flY Ox Or{/AINSPECTOR'S.ACTION
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ACflON REQUTRED:
Xpress Bill Pay - Payment frysine Page 1 of1
City of Rexburg
35 Northlst East
Rexburg, lD 83440
208-359-3020
4o Col, Frinter i-l I
{ r 1.1 (! l,
REXBURG
q\l
.1 a.lr 'iilj lr!drir,l , n.^,rfrtJrrrfr
Lre,elqil-__S?aono1
Transaction taken by: amanda
ietinfr 1 floose_l
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I Transaction detail for payment to City of Rexburg.DaE:0511612012 - 2:59:57 PM
Transaction Number: 15369220PT
Visa - XXXX-XXXX-XXXX-3563
Status: Successful
Description Reference #Amt per ltem # ltems Total Amt
BP PLAN CHECK FEE 't2 00173 $65.00 1 s6s.00
BUILDING PERMIT 12 00173 $6s.00 1 s6s.00
BUILDING PERMIT DEPOSIT 12 00173 $-100.00 I S-too.oo
ELECTRICAL PERMIT 12 00173 $560.00 1 s56A.00
MECHANICAL PERMIT 12 00173 $80.00 1 s80.00
PLUMBING PERMIT 12 00173 $110.00 1 st 10.00
Billing Information
David L Beck
,83440
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Receipt Number: 12{191 .;--,.,.
83440
) 359-3022
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