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HomeMy WebLinkAboutFA INSPECTION FORM - 22-00795 - Madison Station Apartments - Bldg 1FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND To be completed by the system impector or tester at the time of the inspection or test It shall be permitted to modify thisform as needed to provide a more complete and/or clear Insert N/A in all unused lines. Attach additional sheets, data, or calculations as necessary to provide a complete reco, Date of this inspection or test: 1. PROPERTY INFORMATION Time of inspection or test: Name of property: Madison Station Apartments Building 1 (tower 1 and 2) Address: 1460 Elk Creek, Idaho Falls, Id 83404 Description of property: Apartment Complex Occupancy type: Name of property representative: Alex Lloyd Address: Phone: Fax: E-mail- Authority having jurisdiction over this property: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Service and/or testing organization for this equipment: 4Sight Security Address: 6944 Big Bend Drive Phone: 2084031434 Fax: E-mail: 4sightsecurity@ Service technician or tester: Trevor Blackburn Qualifications of technician or tester: Idaho Specialty Electrical A contract for test and inspection in accordance with NFPA standards is in effect as of: The contract expires: Auto Renew Contract number: Frequency of tests and Monitoring organization for this equipment: Avant Guard H23160 Address: Phone: Fax: E-mail: Entity to which alarms are retransmitted: Phone: 3. TYPE OF SYSTEM OR SERVICE ® Fire alarm system (nonvoice) ❑ Fire alarm with in -building fire emergency voice alarm communication system (EVACS) ❑ Mass notification system (MNS) ❑ Combination system, with the following components: ❑ Fire alarm ❑ EVACS ❑ MNS ❑ Two-way, in -building, emergency ❑ other (specify): system FORM Annual Copyright ®2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for colpmercial sale or distribution. 3. TYPE OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 3.1 Control Unit Manufacturer: Potter 3.2 Mass Notification System 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Other (specify): Additional description of system(s): Model number: ❑ This system does not ❑ Wide -area MNS ❑ Distributed recipient MNS 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS ACU only ❑ Wide -area MNS to regional national t ❑ Local operating console (LOC) ❑ Direct recipient MNS (DRMNS) ❑ Wide -area MNS to DI ❑ Wide -area MNS to high -power speaker array (HPSA) interface ❑ In -building MNS to wide -area MI ❑ Other (specify): AFC-1000 an MNS. xting interface ANS interface i interface 3.3 System Documentation ❑ An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a -opy of the record record drawings are stored on site. Location: 3.4 System Software ❑ This system does not have alterable s e-specific software. Software revision number: SF0815 Software last updated on: ❑ A copy of the site -specific software is stored on site. Location: 4. SYSTEM POWER 4.1 Control Unit 4.1.1 Primary Power Input voltage of control panel: 120VAC Control panel amps: 20 4.1.2 Engine -Driven Generator ® This system does lot have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.1.3 Uninterruptible Power System ® This system es not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for w meraal sale or distribution. 4. SYSTEM POWER (continued) 4.1.4 Batteries Location: In panel Type: LEAD ACID Nominal voltage; 18VDC X2 Amp/hol Calculated capacity of batteries to drive the system: In standby mode (hours): 824 In alarm mode (minutes): 8 ® Batteries are marked with date of manufacture. 4.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification Systen ® This system does not have an EVACS or MNS. 4.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: 4.2.2 Engine -Driven Generator ® This system does Location of generator: Location of fuel storage: Type of fuel: -ating: 12 have a generator. 4.2.3 Uni nruptible Power System ® Thissystemd as not have a UPS. Equipment powered by UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 4.2.4 Batteries Location: Type: Nominal voltage: Amp/hou rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): .flatteries are marked with date of manufacture. 4.3 Notification Appliance Power Extender Panels ❑ This system does not have pov er extender panels. 4.3.1 Primary Power Input voltage of power extender panel(s): Power extender nel amps: 4.3.2 Engine -Driven Generator s system does r or have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.3.3 Uninterruptible Power System ❑ This system s not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): _. copyright ® 2009 National Fire Protection AssocWtion. This form may be copied for individual use other than for resale. It may not be copied for com ercial sale or distribution. 4. SYSTEM POWER (continued) 4.3.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture. 5. ANNUNCIATORS 5.1 Location and Description of Annunciators Annunciator I: Annunciator 2: Annunciator 3: 6. NOTIFICATIONS MADE PRIOR TO TESTING Nominal voltage: In alarm mode (minutes): Monitoring organization Contact: AvantGuard Building management Contact: Front Receptionist Building occupants Contact: Authority havingiurisdiction Contact: Other, if required Contact: 7. TESTING RESULTS 7.1 Control Unit and Related Equipment Visual I Functional Other (specify) OK OK OK OK OK OK OK OK OK OK OK 0 This system does not Time: Time: Time: Time: Time: rating: annunciators. Copynght ®2008 National Fire Protection Association. TNs form maybe copied for Individual use other than for resale. a may not be copied for c mr nemial sale or distribution. 7. TESTING RESULTS (continued) 7.2 Control Unit Power Supplies Visual I Functional condition OK NA OK OK OK OK —Other (specify) 1 ❑ 1 ❑ 1 7.3 In -Building Fire Emergency Voice Alarm Communications Equipment Visual Functional Control unit ❑ ❑ NA Lam s/LEDs/LCDs ® ® OK Fuses ® ® OK Primary power supply ® ® OK Secondary power supply ® ® OK Trouble signals ® ® OK Disconnect switches ® ® OK Ground -fault monitoring ® ® OK Panel supervision ® ® OK System performance ® ® OK Sound pressure levels Occupied ❑ Yes ❑ No Ambient dBA Alarm dBA ® ® OK (attach report with locations, values System intelligibility ❑ I ❑ OK ❑ CSI ❑ STI (attach report with locations, values, Other (specify) Copyright ® 2009 National Fire protection Association. This form may be copied for individual use oNer than for resale. It may not be copied for co,lmercial sale or o stribution. 7. TESTING RESULTS (continued) 7.4 Notification Appliance Power Extender Panels Visual Functional Description inspection Test Lam s/LEDs/LCDs ❑ ❑ Fuses ❑ ❑ Primary power supply ❑ ❑ around -fault monitoring ❑ ❑ Panel supervision Q Q Other (specify) 7.5 Mass Notification Equipment NA NA NA NA NA NA NA Description Visual Inspection Functional Test Functional test ❑ ❑ N/A -Reset/power down test ❑ ❑ NA Fuses ❑ ❑ NA -Primary power supply ❑ ❑ NA UPS power test ❑ ❑ NA Trouble signals ❑ ❑ NA Disconnect switches ❑ ❑ NA Ground -fault monitoring ❑ ❑ NA CCU security mechanism ❑ ❑ NA Prerecorded message content ❑ ❑ NA Prerecorded message activation ❑ ❑ NA Software backup performed ❑ ❑ NA Test backup software ❑ ❑ NA Fire alarm to MNS interface ❑ ❑ NA MNS to fire alarm interface ❑ ❑ NA In -building MNS to wide -area ❑ ❑ NA Copyright 020M National Fire Protection Association. This torte maybe copied for Individual use dher than for resale. It may not be copied for comemial sale or distribution. 7. TESTING RESULTS (continued) 7.5 Mass Notification Equipment (continuer) Visual Functional Description Inspection Test MNS to direct recipient MNS ❑ ❑ NA Sound pressure levels ❑ ❑ NA Occupied ❑ Yes ❑ No Ambient dBA Alarm dBA (attach report with locations, values, and weather conditions) System intelligibility ❑ ❑ NA ❑ CSl ❑ STI (attach report with locations, values, and weather conditions —Other (specify) ❑ ❑ 7.6 Two -Way Communications Equipment Visual Functional Description Inspection Test Phone handsets ❑ ❑ NA Phone'acks ❑ ❑ NA —Off-hook indicator ❑ ❑ NA Call -in si nal ❑ ❑ NA —System performance ❑ ❑ NA —System audibility ❑ ❑ NA —System intelligibility ❑ ❑ NA Radio communications ❑ ❑ NA enhancements stem Area of refuge communication ❑ ❑ NA s stem Elevator emergency ❑ ❑ NA. communications system Other (specify) ❑ ❑ Comments Copyright 0 2009 National Fire Protection Association. This forth may be copied for individual use other than for resale. It may not be copied 7. TESTING RESULTS (continued) 7.7 Combination Systems Visual Functional Description Inspection Test Comments Fire extinguishing monitoring ❑ ❑ NSA devices/system Carbon monoxide detector/system ❑ ❑ NA Combination fire/securi s stem ❑ ❑ NA Other (specify) ❑ ❑ 7.8 Special Hazard Systems Visual tion s eci Ins ection Comments nFunctionalDescri ❑❑ 7.9 Emergency Communications System ❑ Visual ❑ Functional ❑ Simulated operation ❑ Ensue predischarge notification appliances of special hazard systems are not overridden by the MN See NFPA 72, 24.4.1.7.1. . 7.10 Monitored Systems Visual Functional Description s eci Inspection Test Comments -Engine-driven generator ❑ ❑ NA NA NA Fire pump ❑ ❑ S ecial suppression systems ❑ ❑ Other (specify) ❑ ❑ Copyn& ®2009 National Fire Proteotien Association This form may ba coped for individual use other than for resale. It may not be copied for commercial sale or di.s button. 7. TESTING RESULTS (continued) 7.11 Auxiliary Functions Description Visual Inspection Functional Test Comments —Door-releasing devices ❑ ❑ NA NA NA NA NA NA NA NA NA Fan shutdown ❑ ❑ Smoke management/smoke control ❑ ❑ Smoke damper operation ❑ ❑ Smoke shutter release ❑ ❑ Door unlocking ❑ ❑ Elevator recalll❑ Elevator shunt trip ❑ MNS override of FA si ❑ Other (specify) ❑ 7.12 Alarm Initiating Device ® Device test results sheet attached listing all devices tested and the results of the testing 7.13 Supervisory Alarm Initiating Device ® Device test results sheet attached listing all devices tested and the results of the testing 7.14 Alarm Notification Appliances I@ Appliance test results sheet attached listing all appliances tested and the results of the testing 7.15 Supervisory Station Monitoring Description No Time Com ents Alarm signalAlarm restorationTrouble si 1Trouble VIOC:31 restorationSu rviso si alSu ervisor restoration ❑ Copyright 0 2009 National Fire Proteelion Association. THIS form may be copied for indvidual use other than for resale. It may not be copied for comlarclat sale or distribution. 8. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Avantouartl Time: Building management Contact. All Present Time: Building occupants Contact: Time: Authority having jurisdiction Contact:' Time: Other, if required Contact: Time: 9. SYSTEM RESTORED TO NORMAL OPERATION Date: 'lime: 10. CERTIFICATION 10.1 Inspector Certification: This system, as specified herein, has been inspected and tested according to all NFPA standards cited Signed: Printed name: Trevor Blackburn Date: Organization: 4Sight Security, Title: Manager LLC Phone: 10.2 Acceptance by Owner or Owner's Representative: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Organization: Printed name: Title. Date: Phone: Copyright C 2009 National Fire Protection Association. This form may be copied for Individual use other than for resale. It may not be copied for ccm,Ircial sale or distribution. DEVICE TEST RESULTS (Attach additional sheets if required) Pull Statiom 2 FACP?RISER Room Photo Smoke 3 FACP/RISER room Flow Imput 4.1 Water Flow Tamper 1 5.1 Tamper/Sprinkler Tamper 5.2 Tamper/Sprinkler Nac MOD 6 unit 1104 ADA room Carbon 7 ADA Room 11 o4 Photo Smoke 8 ADA Room i i o4 Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other then for resale. It may not be copied for ,ommi-ial sale or distribution.