HomeMy WebLinkAboutFA REPORT - 19-00577 - Ollie Manor - New MFRSYSTEM RECORD OF COMPLETION
This form is ro be copleied by the system assonant. coatraota at the No one ofsystem acceptance and approval.
It shall be permitted to modgy this form as needed to➢roride a more complete and/or clear record.
Insert 2V/A in all amused lines.
Attach additional sheers, darn, m' calcalatheas as threw smy to provide a complete record.
Form Completion Date: 9/14/21 Supplemental Pages Attached:
1. PROPERTY INFORMATION
Naawri property: 011ie Manor
Address: _109 N 1st E, Rexburg ID 83440
nmcnpnonofpropettY: Apartment building
Name of property representative: Cy Hepworth
Address: _ 105 N 1 st E Rexburg,ID 83440
Phone: 08- 1 -5958 Fax: &mad athomexentsCgma
2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION
Installation comment, Nephi Electric
Address: 272 N 2000E Rexburg ID 83440
Phone: 208-313-2883 Fax E-mail:
Sarsiceageriaaren: Fire Services of Idaho
Address: 510 Mallard, chubbuck ID, 83202
Phone: 2082323640 Fax &mail:
Testing organizaten: Fire services of idaho
Address: 510 Mallard, ehubt
Phone: 2082323640 Fax,
Effective date for test and inspection contract
Monitoring organization: Fire servi(
Address: 510 Mallard, chubt
Phone 2082323640
F. E.ma l:
Accountramber: 89-7595 Phone line l: PM1one line 2:
Means of transmission: Cellular dialer
Entity to which alarms are retransmitted: Avantgard Phone: 800-662-2512
3. DOCUMENTATION
on-sitemestion Of the requredreeonadocamentsand sitespeeiresoftware: Inside fire alarm panel on usb drive
4. DESCRIPTION OF SYSTEM OR SERVICE
This is a: ® New system ❑ Modification to existing system Permit number: 20-00920
NFPA 72 edition: 2016
4.1 Control Unit
Manufacturer: Notifier
4.2 Software and Firmware
Firmware revision number: 1.1
43 Alarm Verification
Number of devices subject to alarm verification:
Model number: 100X
® This system does not incorporate alarm verification
Alarm verification set for seconds
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SYSTEM RECORD OF COMPLETION (continued)
0 unTl Flrennu e
Type
Quantity
Description
Audible
4E 14
Low frequency horns
vamle
� +
1 Strobes
Combination Audible and Visible
I '�f`a 3
1 Horn strobes
11. INTERCONNECTED SYSTEMS
® This system does not have interconnmted systems.
❑ Interconnected systems are listed on supplementary sheet
12. CERTIFICATION AND APPROVALS
12.1 System Installation Contractor
This system as specified herein hers been installed according m all NFPA standards cited herein.
Signed: printed name: Date: 9/14/21
organization: Fire department Title: Fire marshall phone;
12.2 System Operational Test
This system cified s ein bass tested according to all NFPA standards cited herein.
Signed: V Printed name: Spencer jessee Date: 9/14/21
Organization: Fire sPrvi c of Idaho Title: Fire alarm technician phnne: 2082349055
123 Acceptance Test
Date and time of acceptance test: 9/14/21 12:00pm
Installing contractor representative:
Testing contractor representative: Spencer.iessee
AHJ representative:
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