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HomeMy WebLinkAboutFA RECORD OF COMPLETION - 19-00649 - Mountain View Clinic - RemodelSYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time ofsystem acceptance and approval. It shall be permitted to nzodi_fv 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. Foran Completion Date: 9/15/2020 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Mountain View Clinic Address: 404 N 2nd E Rexburg, Id 83440 Description of property: Clinic Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Marathon Electric Address: 6646 South Cottonwood St, Murray, Ut 84107 Phone: 801-266-2119 Fax: E-mail: Service organization: Fire Services of Idaho Address: 610 Malard St, Pocatello, Id 83202 Phone: 208-232-3640 Fax: E-mail: Testing organization: Fire Services of Idaho Address: 610 Malard St, Pocatello, Id 83202 Phone: 208-232-3640 Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Avantguard Address: 366 Grand Loop, Rexburg, id 83440 Phone: 866-383-6694 Fax: E-mail: Account number: AE01 0'5578 Phone line 1: Phone line 2: Means of transmission: Cellular dialer Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ® New system 0 Modification to existing system Permit number: NFPA 72 edition: 2016 4.1 Control Unit Manufacturer: Notifier Model number: NFW-1 0OX 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification Number of devices subject to alarm verification: 8 0 This system does not incorporate alarm verification. Alarm verification set for 5 seconds Copyright © 2012 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. (p. 1 of 3) SYSTEM RECORD OF COMPLETION (continued) S. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120 20 Control panel amps: Overcurrentprotection: Type: Clrmlit Breaker 20 Amps: Branch circuit disconnecting means location: ELECTRICAL ROOM Number: Panel LB Beaker #48 5.1.2 Secondary Power Type of secondary power: 1 2V7AH Batteries Location, if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode (hours): 24 5.2 Control Unit ❑ This system does not have power extender panels ❑ Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Pathway Type Dual Media Signaling Line Device Power Initiating Device Notification Appliance Other (specify): 7. REMOTE ANNUNCIATORS LCD In alarm mode (minutes): Location front doors 67 Survivability Level 8. INITIATING DEVICES Type Manual Addressable or Quantity Conventional Alarm or Supervisory Sensing Technology Pull Stations 3 Addressable Alarm Smoke Detectors 4 Addressable Alarm Duct Smoke Detectors Heat Detectors Gas Detectors waterflow switches 1 Addressable Alarm Tamper switches 2 Addressable Supervisory Copyright © 2012 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. SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES ""`y %trobe scriptionAudible 55 visible Combination Audible and Visible 24 Horn strobe 10. SYSTEM CONTROL FUNCTIONS Door Releasing Devices HVAC Shutdown F 11V 3MOKe L)a: Door Unlocking Elevator Recall 11. INTERCONNECTED SYSTEMS ® This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specified herein has been installed according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 12.2 System Operational Test This system as ecif4ed herein has tested according to all NFPA standards cited herein. ..v Signed: I'llPrinted name: -Joe Monsen Date: 9/15/2020 Organization: Fire Servicesoff ldahOTitle: Alarm Technician Phone: 208-589-1498 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: Copyright © 2012 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. (p. 3 of 3)