HomeMy WebLinkAboutFIRE ALARM REPORT - 21-00403 - Teton River Flats Community Housing - 4 Plex - C4SYSTEM 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 modify this form as needed to provide a more complete and/or clear record
Insert MIA in all unused lines.
Attach additional sheets, data, or calculations as necessary to provide a complete record.
Form Completion Date: 6/30/22 Supplemental Pages Attached: 2
1. PROPERTY INFORMATION
Name of property: Teton River Flats buildings 20 & 21.
Address: 280 E Lorene st, Rexburg , ID
Description of property: Apartment buildings
Name of property representative:
Address:
Phone: Fax: E-mail:
2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION
Installation contractor: Fire Services of Idaho
Address: 610 Mallard, Chubbuck, ID 83202
Phone: 208.232-3640 Fax: 208-232-0449 E-mail:
Service organization:
Address:
Phone: Fax: E-mail:
Testing organization: Fire Services of Idaho
Address: 610 Mallard, Chubbuck, ID 83202
Phone: 208-232-3640 In: 208-232-0449 E-mail:
Effective date for test and inspection contract:
Monitoring organization:
Address:
Phone: Fax: E-mail:
Account number: Phone line l: 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: IQ New system ❑ Modification to existing system Permit number:
NFPA 72 edition: 2n 1 R
4.1 Control Unit
Manufacturer:
4.2 Software and Firmware
Firmware revision number.
Notifier
01.003.0006
Model number: NFW-50X
4.3 Alarm Verification ® This system does not incorporate alarm verification.
Number of devices subject to alarm verification: Alarm verification set for seconds
Copyright 02012 National Fine Protection Assouation. This foram maybe copied for indhAdual use other than for resale. It may not be copied for commercial sale or dstr@utton.
(p. 1 of 3)
SYSTEM RECORD OF COMPLETION (continued)
5. SYSTEM POWER
5.1 Control Unit
5.1.1 Primary Power
Input voltage of control panel: 110 AC Control panel amps: 6 amps
Overcurrem protection:, Type:
Branch circuit disconnecting means location: Electrical Room
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):
5.2 Control Unit
Amps:
Number:
In alarm mode (minutes):
❑ This system does not have power extender panels
The system has one power extender in
® Power extender panels are listed on supplementary sheet A
building 21.
U. GIKGUII5ANUNAIKWAY5
Pathway Type
Dual Media Pathway
Separate Pathway
Class
Survivability Level
Signaling Line
2
B
Device Power
NA
Initiating Device
NA
Notification Appliance
6
B
Other (specify):
NA
8. INITIATING DEVICES
Type
Quantity
Addressable or
Conventional
Alarm or Supervisory
Sensing Technology
Manual Pull Stations
1
Addressable
Alarm
Smoke Detectors
2
Addressable
Alarm
Photo
Duct Smoke Detectors
NA
Heat Detectors
NA
Gas Detectors
NA
Waterflow Switches
2
Addressable
Alarm
Paddle
Tamper Switches
4
Addressable
Supervisory
Copyright ®2012 National Fire Protection Association. This form may be espied for IrMiMdual use other than for resale. It may not be copied for commercial sale or o1sfribution.
(p. 2 of 3)
SYSTEM RECORD OF COMPLETION (continued)
9. NOTIFICATION APPLIANCES
Type
Quantity
Description
Audible
26
Horn
Visible
NA
Combination Audible and Visible
2
Horn/Strobe
10. SYSTEM CONTROL FUNCTIONS
Type
Quantity
Hold -Open Door Releasing Devices
NA
f VAC Shutdown
NA
Fire/Smoke Dampers
NA
Door Unlocking
NA
Elevator Recall
NA
Elevator Shunt Trip
NA
11. INTERCONNECTED SYSTEMS
ID 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 time: Richard Harris Date: 6/30/22
Organization: Fire Services of Idaho Title: Fire Technician Phone:
12.2 System Operational Test
This system as specified herein has tested according to all NFPA standards cited herein.
Signed: �— Printed name: Richard Harris Date: 6/30/22
Organization: Fire Services of Idaho Title: Fire Technician Phone:
12.3 Acceptance Test
Date and time of acceptance test:
Installing contractor representalb
6/30/22
Richard Harris
Testing contractor representative: Richard Harris
Property representative:
AHJrepresentative: _ Alex Owens
Copyright 02012 National Fire Protection Association. This form may be wpied for IndiWdual use other than for resale. It may not be copied for wnn enoial sale or distribution.
(p. 3 of 3)