HomeMy WebLinkAboutFA REPORT - 21-00047 - Madison Memorial Hospital - BHU RemodelJohnson
Controls
SYSTEM RE CORD OF COMPLETION
h is fo m is io be complelecl� th s);Sle t ins to ll(16012 cont) -actor at the tinie ulew acceptance and -oi7al.
Inset AIZ4 in all imused lines.
Attach adcfifionol sheets, data, or calcidations as necessary to pi-ovide a coniplete record.
Form Comelet' n fat : 8,')7'2021
1. PROPERTY INFORMATION
Supplcmental Pages Attached:
Name of pi-ope t : Madison M eni ri l Hospital r-- Behavioral Health Unit T1
Address, 4 �O li. %1-111'n Street Rexberg, Id.. 83440
Description of Property: Hospital
Name of Property Representative: JRW - General Contractor
Address=
Phone: Fa X E-Mal,110
2. INSTALLATION,. SERVICE, TESTING, AND MONITORING INFORMATION
Installation Contractor: ACS Svstems
Address: 2307 E Commercial SL Meridian, E
Phone: ( 208) 331-8554 ax: E-mail:
Service Organization: Johnson Controls Fire Prot ti o n.
Ad dre8783 West Hacka for 1)rive 46 Boise, I
Phone: (208) 376-2111 Pax: (208) 376-2192 E-mail:
414-1. !4101
Testing r�niztion: Johrson C"ontmis
Fire Protection
Address: 878 _3 West Hackamore Drive'l. I
11iou ,: 0 3`76-2 111 Fax () '-31)76-2192 E -m il.
Effective date fior tett and inspection contract'.
`Y-
on i tering Organization-. Johnson Controls fireProtection
Address:
. .. ! I lEI7EEI�ER,�1_!� ! ,*!I\ ElM..7.71 IEE. �-----•••••_._. ... ..
Phone: -746- Fax-. E-mail:
I�E'°F�f�Jri
Account Mimber., 20-2-1 l Phone Lire I Phone Line
Means of Transmission: P h One 1, i n e
Entity to which alarms are transmitted: 911 Fire Dispatch
3. DOCUMENTATION
On-site location of the required record docunients and site-specific software:
4. DESCRIPTION OF SYSTEM OR SERVICE
1'h i s i t New systein Modification to existing system
NFPA 72 Edition: 2016
.1 Control Unit
Inside CACP
Permit number:
Manuftturn S'Implex Model numbed 4
,�1E� IEI1711 II IEEI EEFl VIAE -- - -.."... ��iMrliM�w�
4.2 Software and Firmware
Firmware revision .umber:
4.3 Alarm Verification This systemdoes not incorporate alarm verifleation
Num ber of devices subject to alarm verification: N/A Akeirm verification sed .dor Nl oiid
5. SYSTEM POWER
.1 conti-01 Unit
5.1.1 Primary Po we r
Input voltagc ofcontrcl panel: 120
y r u.rr nt protection types Breaker
r tich circuit disconnecting means lccat 1aq
Control p nel amps: 4
Amps:
anber:
N FPA 72 Page 1 of
SYSTEM RECOIti) OF COMPLETION (condinted)
5. SYSTCNI PO'4VEFt (ewifiiiijeti)
Type of secondary p vei-: Se4i ! ed lead acid batteries
Lot1*onD i F remote from panel: N/
Calcuffed capacity of secondarypower to drive (he system:
In standby mode hour In alarm mode (minutes) -
5.2 Power(minutes)-
Extender Panels
'l'hs system does not have power t n d r panels
CIRCUITS AND PATHWAYS
Pathway Type
Signaling Lire
Device Power
Initiating Device
Notificat-ion Appliance
Other (specify):
Dual Media Pathway
7, REMOTE ANNUNCIATORS
Type
. INITIATING DEVICES
Type
Manual Pail Stations
Smoke- Detectors
Duct Smoke Detectors
Fiat Detectors
Gas Detectors
Waterflow Switches
Teamper Switches
Monitor Modules
Johnson
0)1(1
Controls
Po -% r extender panels are listed on supplenientaiy sheet
Separate Pathway Class i` .i bilil .bevel
M
F
Quantity --Ad-dressabler Coilvenfloiial
Addressable
lAd.dressable
9. T11 I CATION APPLIANCES
Type
Audible
,
Visible
anibin tin Audib1c andVisible
n/a
cl
11/a
n/
10. SYSTEM CONTROL FUNCTIONS
Hold -Open Door Releasing Devicts
FIVAC Shutdown
Fire/Smoke Dam
Door Unlockitig
Elevator Rcca[J
Elevator Shunt Tri
Uhl
Addressable
Quantit
0
Strobemy
w,'16 'C- hime Stroben
Type
A
c
Location
Alarm or Supervisor
Alrn
Fire laN: m
n/a
n
n
Alarm I Supervisory
Descr,iption
Sensing Technology
IT, �1
ii/a
NFPA 72 Page 2 of 5
Johnson
Name of pi-operly Madison erii ri l Hospital Behavioral ea[th Uiiit TI Controls
SYSTEMRECORD OF MI'LETI coWlyw d
If. 1NTERC0NNE1C-"MDSYLSTEMS
'I'llis yt m does not 1j,(jvc i ra r e tine ted systems.
Intei-001111ected systems are listed on uai
lemel tat, slj.%-,%, L
12. CERTIFICATIONS AND APPROVALS
f1 SYstern Int 11ation Contractor
This sYstem as specified herein has been installed according
Signed
ACS Svstems
r n i t*lore
12.2 System Zi t-ation l Test
Jago
Printed am
Title
I'llls sYstem as specified r in has been te-stcd accord-ing to all NFPA
I
r rControls Firc FirProtection.
Organization
12.3 tan Test
Date and tiiiic of acceptancetest+
In t l[in � contractor r t tiVeL
Testing contractor i'F i` . tati '
Property representative,
HJ repi-esentative:
Brandon Hig[,
Printed Name
fire Instal I -1"ech
Title
91112021 AM Itispection
Date
Phone.
Date
{20S} 376-21.11
Phone
NFPA 72 Page 3 of 5
INITIATING DEVICE
SUPPLEMENTARY RECORD OF INSPECTION AND TFqjS"1-'ING
Thi-yficivit is a supplemew to the Syslent Recoi-d of hhiked oij wid Testing.
It includes an hu'liating-device test
7 I'S
'h * foi-in is to be completed by the syslem inspectimi and testi'i'�g cw?hactoj,, at the time ofthe inspectioll and/01.
lnsu't AIIA in (it/ uni(sed lines.
Inspest ionfl"est Start Dat efrime: Ii' sI)ectioll/1'est Completioii Datefflme:
Number Of SLIPPIeMelltal Pages Attaclied:
1. PROPE(RTY INFORMATION
Name of propetty-, Madison Memorial Hospital -- Behavioral Health 'Un TI
Address: 450 E Main Street Rexberg, Id. 83440
2. INITIATING DEVICE TEST RESULTS
Device Type
S III C-) k- e
S111011".'e
Smoke
Smoke
Smoke
Smoke
Smoke
Smoke
Smoke
Snioke
P1111
Pull
Relay.
Monitor Module
Monitoi- Modute
Address
I'd -M5-89
BHU -COITidor
BHU - Coi-ridor
Location
I -M5-88
BHU
I
- Cot-i-idor By Outside Eiitt-y
I:M'5-87
BHU
- CwTidor
B14U - Corridor By Exani Rm
BHU - Corridor By in t"119
Rooni
B'H-U - Corridor
LJ - Corn do._ By Hospital Ent
BHU Security Vestibule
BHU Corridor By Outside Entry
B14U - Nurse Station,
BHU - Fire Alarm R t y To Ace - es_s-Contr0t,Pat1e1
i%4ecb Room 4 isWa
Dry System Ltej.flo�V
Mech Rooi-n 4 - Di -v Systeni Low Ali- Superv*130ty
Test Results
Pass
Pass
Pass
Fess
Pass
Pass
Piss
Pass
P�Ass
Pass
Pass
Pasis
Pass
Pass
AMM
Pass
NFPA 72 Page 4 of 5
r
NOTIFICATION APPLIANCE
SUPPLEMENTARY RrcaRn OF INSPECTION AND TcsTirrG
Thisform is a suppieinont to the Silstein Recoi-d of Inspection and Testing,
It includes a ti t ifieci f io n cil�p1hulve j e si 1,e co ci.
771 is fo i w i is to b e comp leted by thestein itispe ction a? id test"
ing conWactoi4 at 1he lime the ave i��, �� � � ■
test.
s {-t NIA in all wietsed fitie .
lnspeotioiVTest Stant t Tim I ",
Nwiriber of Supplemental Pales Attached:
*'HIq.�H�l •�ITpR�i
Io PROPERTY INFORMATION
Name of property:
Address:
Madison M inoril it -al -- Behavioral Health .Unit TI
450 E Mani Street rcy , 83440
14, INITIATFING DEVICE TEST RESULTS
ppli n cc Type Identifier
Chime/Strobe HY3�
Strobe
Chime/Strobe
ilne/ h-
Chime/Strobe
.Chime/Strobe
Chitne/Strobe,
Strobe
Chime/Strobe
hi /Strobe
Chime/Strobe
Chime/Strobe,
01inic/Strobe
Strobe
Chilifte/strobc.
Strobe
Chnne/Strobe
Strobe
Strobe
h i r ti+
NC : -
NAC20,-V 1
Y-IT!177
C ;V1
N : 1
�7g5'Y7W■■i�
: 1-
4: V4
Location
H - Couidor
HU - Nurse Steation Staff Restroom
-
Corridor
BHU-
Corridor
BHU -
Nurse Station
. -NUI-Se.
e. r Station
BHU -
Reception
B14U-
COIT'Idor By Hospital Entry
Vis itn
BHU a Doctors Office
BH U - Day Room
HU - Corridor By Day Room
or
BHU ..i:
.l H -Therapy iPYSRSii�Hii�Y�BJA-'U - Corridor Bv Therarw
H - Exam Roo in,
}
Plia-miacy Expansion
Ph ion
Pharmacy Expansion
Test Results
Fess
��tM45i'Wi■■�I
P
Pass
Pas
Pass
.
Pass
,s
Pass
Pas
Pass
pfass
"ass
Pass
Pass
Pass
Pass
Pas
Pass
14P■!T■■'1!YlSM■tWiii�l AI1.ef9iiY'�'
Pass
.�.a -YP I�If■
Pass
NFPFA 72 Page 5 of 5