HomeMy WebLinkAboutFIRE ALARM REPORT - 07-00207 - Rolling Hills - New LDS Chapel06/20/2008 11:20 208-542-1525 SIMPLEXGRINNELL 482 PAGE 02/03
SimpleXGr';nnell LP
tqCU 1279 Nest 2240 South, Ste A
HARM & DETECTION EQUIFWNT Salt Lake City, Utah 84119
& Tel e: 801-262-9406
Fire
Fire !tY TEST REPORT Fax: 162-9423
PAGE t OF 2
%iexaj wn9# Contract No.
Test Report No.
'� Contact WC Q
Property NameW -
t6s �
Street Phone No.
city & State
NAME PHONE NO.
1. Before Test Notify Proper Authorities
A. owner or Owner's Rep.
B. Fire Dept.
C. Central Station
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Tl
2. Control Panel Status Before Te$t
A. Is the Panel connected to the Fire Dept. Master Box
Lease Line
B. Is the Power tight On?
C, Does the Panel indicate Normal Conditions?
D. Are all Indicating Lamp Bulbs in Operating Order?
E. Does the Trouble Light Operate?
F. Does the Silence Switch Operate?
G. Does the Panel have Active Zones? No....�—
H. Does the Panel have Inactive Zones? No.
I. Does the panel have Battery Backup?
J. Do the Batteries indicate they are Properly Charged?
K. Have Fire Dept. and/or Lease Lines been disconnected before
continuing tests?
Comments:
3. Extinguishing Systems
A. Are Halon Systems installed on Property? No.
Is Halon at Recommended Pressure?
B. Are CO2 System$ installed on Property? No.
IS CO2 at recommended pressure?
C. Are any other Type Systems installed on Property? No.
� ,r
Comments;
Test Verification Name
sontum
(By owner or Title 4 t I-%,-
owner's rep.)
Inspector
Phone Number
YES I N.A. I NO
pdnled
Datto — Ste— �.—
Date 6 ~- kg $
cc* Owner (Name),.LIDS' r-��a In - Address
Insurance Co. —1VA — Address
Fire Marshall '',, C1k^5-4- Address --
ISO -'0; 10 - Address cr.fnn� f M7A@
06/20/2008 11:20
208-542-1525
SIMPLEXGRINNELL 482
PAGE 03/03
tyco
Fire &
Security
slmplexaoinnell
ALARM & DETECTION EQUIPMENT
TEST REPORT
Total me. Tested
Equipment
Number Prey, Rwrts
4.
Remote Annunciators
S.
Zones
6.
Manual Stations Pull)
A. Coded
B. NonCoded
>gc-
7.
Detectors See # 13
A. Photoelectric
B. Ionization
C. Thermal
D. Flame
E, Duct (See # 14)�
S.
Audible Alarms
(Remote & at base)
A. Bell
B. Siren
C. Horn
D. Horn and light
A
9.
Video Alarms
(Remote & at base)
10.
Automatic Door Release
/t--
11.
Water Flow Switches
Simp lexGrinnell LP
1272 West 2240 South, Ste A
Safi Lake City. Utah 84119
Tele: 801-262-9406
Fax, 262.9422
PAGE 2 4F 2
No. Tested O erstlon+ai
This Report yes
A. Paddle f
B. Pressure
12. Temper Switches _
13. Were Tested Detectors Cleaned? No.r...
If "no" answer, explain under comments
14. Were Tested Detectors Calibrated? No...
If "no" answer, explain under comments _
15. Did test of Duct Detectors shut down air handling units?
16. Did the monitoring center (Fire Dept. Central Station,
LeaseUne) receive signal?
17. is system reset for normal conditions?
i 8. Is system restored to operational service?
19. Have proper authorities (See # 1) been notified system
is back in service?
20. Indicate % of equip. tested this report 25 50 75 C100
21. Indicate % of equip. tested YTD 25 50 75
Comments for any "No" answers or explanations:
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so inm-i 02/03