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HomeMy WebLinkAboutFA REPORT - 21-00119 - Adams Elementary Addition - AdditonSYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify 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. 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) Form Completion Date: Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: Description of property: Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Address: Phone: Fax: E-mail: Service organization: Address: Phone: Fax: E-mail: Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Address: Phone: Fax: E-mail: Account number: Phone line 1: Phone line 2: Means of transmission: 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 Modification to existing system Permit number: NFPA 72 edition: 4.1 Control Unit Manufacturer: Model number: 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds Adams Elementary Fire services of idaho 2087451020 6.0.02 Fire Services of Idaho 3880 E 200N, Rigby ID 83442 AE-01-0258 Avantgard 8006622512 Omni Above panel 8008663640 6820 EVS 110 N 2nd E 510 Mallard, chubbuck ID, 83202 Mountain valley electric 3905 E 200 N, Rigby,ID 83442 Cellular Silent knight Madison school district 60W main st, rexburg idaho 2082280775 8008663640 Elementary school 520 mallard st, chubbuck idaho, 83202 12/22/21 2016 SYSTEM RECORD OF COMPLETION (continued) 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. 2 of 3) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: Control panel amps: Overcurrent protection: Type: Amps: Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: Location, if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode (hours): In alarm mode (minutes): 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 Pathway Separate Pathway Class Survivability Level Signaling Line Device Power Initiating Device Notification Appliance Other (specify): 7. REMOTE ANNUNCIATORS Type Location 8. INITIATING DEVICES Type Quantity Addressable or Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations Smoke Detectors Duct Smoke Detectors Heat Detectors Gas Detectors Waterflow Switches Tamper Switches Supervisory Alarm Addressable Addressable Alarm Silent knight 20 Front door 10 6 26 Switch Circuit breaker 2 Smoke photo Addressable 524 Panel A Batteries 7 Circuit breaker Smoke photo B 120 AC SYSTEM RECORD OF COMPLETION (continued) 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) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible Combination Audible and Visible 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers Door Unlocking Elevator Recall Elevator Shunt Trip 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 specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: 2082349055Fire alarm tech Spencer Jessee Horn strobe 12/22/2021 Fire alarm tech Fire services of idaho 2082349055 Spencer Jessee Spencer jessee 12-22-21 Not present 2 5 Fire Services of Idaho 28 12/22/21 1:30 pm Spencer Jessee 2 Brett Stoddard Strobe