HomeMy WebLinkAboutFA REPORT - 21-00766 - Yellowstone Heights Condos - Bldg 1 - 12 PlexSYSTEM 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.
Form Completion Date: 09/08/2023 Supplemental Pages Attached:
1. PROPERTY INFORMATION
Nameofproperty: Yellowstone Heights BLDG D
Address: 238 Ella St. Rexburg, Idaho 83440
Description of property: Apartment BLDG D. (3 floors of 4 apartments).
Name of property representative: Robert Bishop
Address:
Phone: 208-604-1407 Fax: E-mail:
2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION
installation contractor: State Fire Idaho/ Robbins Electrical
Address: 610 Mallard St, Chubbuck, ID
Phone: 208-232-3640 Fax: E-mail:
State Fire Idaho
Address:
Phone: Fax: E-mail:
Te ,; State Fire Idaho
Address:
Phone: Fax: E-mail:
Effective date for test and inspection contract: 09/08/2023
,a..-:«.�.,,......e 4—+;...,. State Fire Idaho/ Avantgard
Address, V 610 Mallard St, Chubbuck, ID
Phone: 877-206-9141 Fax: E-mail:
Accoum number:
897687 Phone line 1: None Phone line 2: None
,,,ree., r „; Starlink Cell Dialer
Entity to which alarms are retransmitted: Avantgard Phone: 877-206-9141
3. DOCUMENTATION
On -site location of the required record documents and site -specific Thumb Drive in panel
software
4. DESCRIPTION OF SYSTEM OR SERVICE
This is a: ® New system ❑ Modification to existing system Permit number: 22-00.306
NFPA 72 edition: 2017
4.1 Control Unit
Manufacturer: Notlfier
4.2 Software and Firmware
Firmware revision number:
Modeinumber: NFW-50X
4.3 Alarm Verification N This system does not incorporate alarm verification.
Number of devices subject to alarm verification: Alarm verification set for seconds
Copyright92012 National Fire Protec0an easodafwn. This form may be espied for individual use otter than for resale. It may not be copied for wmmenial sale or distribution.
P. 1, ^f 3)
SYSTEM RECORD OF COMPLETION (continued)
5. SYSTEM POWER
5.1 Control Unit
5.1.1 Primary Power
Input voltage of control panel: 120vac
Ovemurrent protection: Type: Breaker
Branch circuit disconnecting means location:
HOA Panel
5.1.2 Secondary Power
Type of secondary power: Battery backup
Location, if remote from the plant:
Calculated capacity of secondary power to drive the system:
In standby made (hours): 3.42 hr
Control panel amps:
Amps: 20
Number: 4
15
In alarm mode (minutes): .07hr
5.2 Control Unit
® This system does net have power extender panels (1)Notifler PSE-6 with 18amp batteries
❑ Power extender panels are listed on supplementary sheet A
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v. yr �V V..v.-....�...........�
Pathway Type
Dual Media Pathway
Separate Pathway
Class
Survivability Level
Signaling Line
B
Device Power
B
Initiating Device
B
Notification Appliance
B
Other (specify):
\rlTl wTl\12 McnnPca
Type
ble or
tional
Alarm or Supervisory
Sensing Technology
Manuai Pull Stations
Alarm
Switch
Smoke Detectors
e
W
1 alarm, 12 super
Photo
Duct Smoke Detectors
Heat Detectors
Gas Detectors
al
Supervisory
CO
WatertlowSwitches
1
Conventional
Alarm
Switch
Tamper Switches
12
1 Conventional
Supervisory
Switch
copyright 02012 National Fire Protection Association. This form may be copied for indivldual use other than for resale. It may not be coped for commercial sale w distribution.
p. 2 of]I)
SYSTEM RECORD OF COMPLETION (continued)
Audible 130 System sensor wall low frequency horns
Visible �2 ADA restroom strobes
Combination Audible and visible I I ADA horn/strobe and FDC horn/strobe
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: Primedname: Travis
Organization: Robbins Electric Title:
12.2 System Operational Test
This syste sp cj rein has tested according to all NFPA standards cited herein.
Signed: I Printedname: Michael Beal
Organization: State Fire Idaho Title: Install Technician
12.3 Acceptance Test
Date and time of acceptance test: 09/08/2023
Installing contractor
representative:
Testing contractor representative:
Property representative: /
AHJ representative:
Date:
phone: 208-709-6344
Date: 09/08/2023
Phone: 208-251-9431
Copyright ®2012 National Fire Protection A ociafiam This form may be copied for Iidivdual use other than for resale. It may not be mpled for commercial sale or distribution.