HomeMy WebLinkAboutFA COMPLETION - 22-00797 - Madison Station Apartments - Bldg 3FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time or ystem acceptance and approval.
/t shall be permined to modify this farm 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
1. PROPERTY INFORMATION
Name of property: Madison station building 3
Address: 577 train Rexburg Idaho
Description Ofpropmly: Aparh m Building
Occupancytype: GROUP
Name of property representative: Aston Oman,
Address:
Phone: Fax: E-mail:
Authority having jurisdiction over this property: Rexburg FIRE MARSHAL
Phone: Fax: E-mail:
2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION
Installation contractor for this equipment: 4Sight Security, L.L.C.
Address: 6944 Big Bend, Idaho Falls, ID 83406
License or certification number: Contractor: # RCE-37051; ID ELE-SC-021298
Phone: 208-403-1434 F. E-mail: Thes,1041iiihmectartyar,
Service organization for this equipment: 4Sight Security, L.L.C.
Address: 6944 Big Bend, Idaho Falls, ID 834W
License or certification number: Contractor :#RCE-37051; ID ELE-SC-021298
Phone: 208403-1434 To: E-mail:
A contract for test and inspection in accordance with NFPAstaMards is in effect as of:
Contracted testing company: 4Sight Security, L.L.C.
Address: 6944 Big Bend, Idaho Falls, ID 83406
Phone: 20840&1434 Fax: E-mail:
Contract expires: RENEW Contract number: N/A Frequency of routine inspections: ANNUAL
3. DESCRIPTION OF SYSTEM OR SERVICE
Fire alarm system (nonvoiae)
Fire alarm with in -building fun 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 communication system
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Other (specify):
3. DESCRIPTION OF SYSTEM OR SERVICE (comet ecq
NFPA 72 edition: 2017 Additional description ofsystem(s):
3.1 Control Unit
Manuf a mrer. Potter Model number: AFC 1000
3.2
MNS ass Notification System This system does not incorporate an
3.2.1 System Type:
In -building MNS—combination
In -building MNS—smod-alone Wide -area MNS Distributed recipient MNS
Other (specify):
3.2.2 System Features:
Combination fire alarm/NINS MNS autonomous control unit Wide -area MNS to regional national
alerting interface
Local operating console (LOC) Direct recipient MNS (DRMNS) Wide -area MNS to DRMNS interface
Wide -area MNS to high -power speaker array (HPSA) interface In -building MNS to wide -area MNS interface
Other (specify):
3.3System Documentation
An owners manual, a copy of the manufacturer's instructions, a
written sequence of operation, and a copy of
the numbered record drawings are stored on site. Location:
FACP
3ASystem Software
This system does not have alterable site -specific
software.
Operating system (executive) software revision level:
Site -specific software revision date:
Revision completed by: Trevor BLACKSURN
A copy of the site -specific software is stored on site. Location:
3.5Off-Premises Signal Transmission
transmission.
Name of organization receiving amrm signals with phone numbers:
Almon: AVANT GUARD MONITORING
Supervisory: AVANT GUARD MONITORING
Trouble: AVANT GUARD MONITORING
Entity m which alarms are re -transmitted: Idaho Falls Fire
Method ofre- DIGITAL VIA Stadink Radio
transmission:
This system does not have off -premises
Phone:
877-2W9141
Phone:
877-206-9141
Phone:
877-206-9141
Phone:
If Chapter 26, specify the means of transmission from the protected premises to the supervising station:
If Chapter 27, specify the type of auxiliary alarm system: Local energy Shunt W red Wheless
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4. CIRCUITS AND PATHWAYS
4.1 Signaling Line Pathways
4.1.1 Pathways Class Designations and Survivability
Pathways class: N/A Survivability level: Quantity:
(See NFPA 72, Sections 12.3 and 12.4)
4.12 Pathways Utilizing Two or More Media
Quantity: 0 Description: N/A
4.1.3 Device Power Pathways
No separate power pathways from the signaling line pathway
Power pathways are separate but of the same pathway classification as the signaling line pathway
Power pathways are separate and different classification from the signaling line pathway
4.1A Isolation Modules
Quantity: 0
4.2Alam Initiating Device Pathways
41.1 Pathways Class Designations and Survivability
Pathways class: C Survivability level: I Quantity: I
(See NFPA 72, Sections 12.3 and 12.4)
422 Pathways Utilizing Twoor More Media
Quality: I Description: ALARM INITIATING AND NAC'S RUN TOGETHER
4.2.3 Device Power Pathways
No separate power pathways from the initiating device pathway
Power pathways are separate but ofthe same pathway classification as the initiating device pathway
Power pathways are separate and different classification from the initiating device pathway
43 Noa-Voice Audible System Pathways
43.1 Pathways Class Designations and Survivability
Pathways class: B Survivability level: I Quantity: 12
(See NFPA 72, Sections 12.3 and I2,4)
432 Pathways Utilizing Two or More Media
Quantity' 12 Description: ALARM INITIATING AND NAC'S RUN TOGETHER
4.3.3 Appliance Power Pathways
No separate power pathways from the notification appliance pathway
Power pathways are separate but of the same pathway classification m the notification appliance pathway
Power pathways are separate and different classification from the notification appliance pathway
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S. ALARM INITIATING DEVICES
5.1 Manual Initiating Devices
5.1.1 Manual Fire Alarm Boxes
This system does not have manual fire alarm boxes.
Type and number of devices: Addressable:
I Conventional: Coded: Transmitter:
Other (specify):
5.12 Other Alarm Boxes
This system does not have other alarm boxes.
Description:
Type and number of devices: Addressable:
Conventional: Coded: Transmitter:
Other (specify):
5.2 Automatic Initiating Devices
5.2.1 Smoke Detectors
This system does not have smoke detectors.
Type and number of devices: Addressable:
2 Conventional:
Other(specify):
Type of coverage: Complete area Partial
area Norman red partial area
Other(specify):
Type of smoke detector sensing technology:
Ionization Photoelectric Multicriteria Aspirating Beam
Other(specify):
&22 Duct Smoke Detectors
% This system does not have alarm -causing duct smoke detectors.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Type of coverage:
Type of smoke detector sensing technology:
Ionization Photoelectric Aspirating Beam
523 Radiant Energy (Flame) Detectors
This system does not have radiant energy detectors.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Type of coverage:
5.2A Gas Detectors
This system does not have gas detectors.
Type ofdetectons):
Number of devices: Addressable:
Conventional:
Type of coverage:
525 Heat Detectors
This system does not have heat detectors.
Type and number of devices: Addressable:
Conventional:
Type of coverage: Complete area Partial area Nonrequired partial area Linear Spot
Type of heat detector sensing technology:
Fixed temperature Rate -of -rise Rate compensated
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5. ALARM INITIATING DEVICES (continued)
52.6 Addressable Monitoring Modules
Number of devices:
5.2.7 Watertlow Alarm Devices
devices.
Type and number of devices: Addressable: 1 Conventional:
5.2.8 Alarm Verification
alarm verification.
Number of devices subject w alarm verification: l
53.9 Presignal
Number of devices subject to povditnal:
Describe presignal functions:
5.2.10 Positive Alarm Sequence(PAS)
Describe PAS:
6.211 Other Initiating Devices
Describe:
This system does not have monitoring modules.
This system does have water6ow alarm
Coded: Transmitter:
This system does have incorporate
Alarm verification set for seconds
This system does not incorporate pre -signal.
This system does not incorporate PAS.
This system does not have other initiating devices.
6. SUPERVISORY SIGNAL -INITIATING DEVICES
61 Sprinkler System Supervisory Devices This system does not have sprinkler supervisory devices
Type and number of devices:Addressable: 2 Conventional: Coded: Transmitter:
Other (specify):
63 Fire Pump Descriptlon and Supervisory Devices This system does not have afire pump.
Type fire pump: Electric pump Engine
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other(specify):
6.2.1 Fire Pump Functions Supervised
Power Running Phase reversal Selector switch not in auto Engine or control panel trouble Low fuel
Other (specify):
S3 Duct Smoke Detectors (DSDs) This system does not have DSOs causing supervisory signals.
Type and number of devices:Addressable: 0 Conventional:
Other (specify):
Type of coverage:
Type of smoke detector sensing technology: Ionization Photoelectric Aspirating Beam
6A Other Supervisory Devices This system does not have other supervisory devices.
Describe:
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7. MONITORED SYSTEMS
71 Engine -Driven Generator
7.1.1 Generator Functions Supervised
Engine or control panel trouble Generator running
Other (specify):
72 Special Hazard Suppression Systems
Description of special hazard system(s):
73 Other Monitoring Systems
Description of special hazard system(s):
8. ANNUNCIATORS
&1 Location and Description of Annunciators
Location I:
Location 2:
Location 3:
This system does not have agenerator.
Selector switch not in auto Low fuel
This system does not monitor special hazard systems,
This system does not monitor other systems.
This system does not have annunciators.
S. ALARM NOTIFICATION APPLIANCES
9.1 In -Building Fire Emergency Voice Alarm Court munication
System This system does not have an EVACS.
Number of single voice about channels:
Number of multiple voice alarm channels:
Number of speakers:
Number of speaker circuits:
Location of amplification and sound -processing equipment:
Location of paging microphone stations:
Location I:
Location 2:
Location 3:
92 Nnnvoee Notification Appllances
Homy: 36 With visible: 48
Hells: With visible;
Chimes: With visible:
Visible only: Other (describe):
93 NotNkation Appliance PowerEmender Panels
This system does have power maunder panels,
Quantity: t
Locations: flier room
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10. MASS NOTIFICATION CONTROLS, APPLIANCES,AND CIRCUITS This system does not have an MNS.
10.1 MNS Local Operating Consoles
Location 1:
Location 2:
Location 3:
10.2 High -Power Speaker Arrays
Number of HPSA speaker initiation zones:
Location 1:
Location 2:
Location 3:
103 Mass Notification Devices
Combination fire alarm/MNS visible appliances: MNS-only visible appliances:
Textual signs: Other (describe):
Supervision class:
10.3.1 Special Hazard Notification
This system does not have special suppression predischarge notification.
MNS systems DO NOT override notification appliances required m provide special suppression
predischarge notification.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS
ILI Telephone System
Number of telephone jacks installed:
Number of telephone handsets stored on site:
Type of telephone system installed: Electrically powered
This system does not have a two-way telephone system.
Number of warden stations installed:
Sound powered
III Two -Way, Radio Communications Enhancement System
This system does not have a two-way radio communications enhancement system.
Percentage of area covered by two-way radio service: Criticalarem: % General building areas: %
Amplification component locations:
Inbound signal strength: dB. Outbound signal strength: dBm
Donor antenna isolation is: dB above the signal booster gain
Radio frequencies covered:
Radio system monimr panel location:
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If TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued)
113 Area of Refuge of Rescue Assistance) Emergency Communications Systems
This system does not have an area of refuge (area of rescue assistance) emergency communications system.
Number of stations: Location of central control point
Days and hours when central control point is attended:
Location of alternate control point:
Days and boors when altemate control point is attended:
I14 Elevator Emergency Communications Systems
This System does not have an elevator emergency communications system.
Number of elevators with stations: Location of central control point
Days and hours when central control point is attended:
Location of alternate control point:
Days and hours when alternate control point is attended:
115 Other Two -Way Communication Systems
Describe:
12. CONTROL FUNCTIONS
This system activates the following control functions:
Hold -open door releasing devices Smoke management HVAC shutdown FIS dampers
Door unlocking Elevator recall Fuel source shutdown Extinguishing agent release
Elevator shunt Nip Mass notification system override of foe alarm notification appliances
Other (specify):
12.1 Addressable Control Module. This system does not have control modules.
Number of devices:
Other (specify):
13. SYSTEM POWER
13.1 Control Unit
13.1.1 Primary Power
Input voltage of control panel: 120 VAC Control panel amps: 20
Overcuuent protection: Type: BREAKER Amps: 20
Location(ofprimmy supply panel board): Front riser room
Disconnecting means location: ELECTRICAL PANEL, MARKED ON PANELS
13.12 Eagine-Driven Generator This system does not have agenemon.
Location ofgenemtor:
Location of fuel storage: Type of fuel:
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13. SYSTEM POWER (continued)
13.13 Uninterruptible Power System This system does 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):
13.IA Batteries
Location: IN PANEL Type: LEADACID Nominal voltage: 12 Amp/bour rating: 18
VDC X
2
Calculated capacity of batteries to drive the system:
In standby mode (hours): 24 In alarm mode (minutes): 5
Batteries are marked with date of manufacture Battery calculations are attached
131 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System
This system does not have an EVACS or MEVS system.
131.1 Primary Power
Input voltage of EVACS or NB4S panel: EVACS or MNS panel amps:
Overcurrent protection: Type: Amps:
Location (of primary supply panel board):
Disconnecting means location:
1311 Engine -Driven Generator This system does not have a generator.
Location of generator:
Location of fuel storage: Type of fuel:
131.3 Uninterruptble Power System This system does 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 no it:
In standby mode (hours): In alarm mode (minutes):
131A Batteries
Location: Type: Nominal voltage: Amp/hour rating:
Calculaed capacity of batteries to drive the system:
In standby mode (hours): In alarm mode (minutes):
Batteries are marked with date of manufacture Battery calculations are attached
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13. SYSTEM POWER (continued)
133 Notification Appliance Power Extender Panels This system does not have power extender panels.
133.1 Primary Power
Input voltage of power extender panel(s): 120 VAC Power extender panel amps: 6
Overcurrent protection: Type: BREAKER Amps: 20
Location (of primary supply panel board): Fire Front Rill ROOM
Disconnecting means location: ELECTRICAL PANEL, MARKED ON FIRE PANELS
1332 Engine -Driven Generator This system does not have agenerator.
Location of generator:
Location of fuel storage: Type of fuel:
133.3 Uninterruptible Power System This system does not have, 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):
133.4 Batteries
Location: IN PANEL Type: LEAD ACID Nominal voltage: 12
g Amp/hour rating: 18
VDC X
2
Calculated capacity of batteries to drive the system:
In standby mode (boors): 24 In alarm mode (minutes): 5
Batteries are marked with date of manufacture Battery calculations are attached
14. RECORD OF SYSTEM INSTALLATION
Fill out after all installation is complete and wiring has been checked for opens, shorts, ground fauhs, and improper
branching, but before conducting operational acceptance tests.
This is a: New system Modification to an existingsystem
Permit number:
The system has been installed in accordance with the following requirements: (Note any or all that apply.)
NFPA 72, Edition: 2019
NFPA 70, Nat onol Electrical Code, Artir le 760, Edition: 2017
Manufacturer's published instructions
Other(specify):
System deviations from referenced NFPA standards: NONE
Signed: Printed time: Trevor Blackburn Date:
4Sght Security LLC
Organization: Title: JOURNEYMAN TECHNICIAN
Phone: 208-861-3510
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15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST
Na. system
All operational features and functions of this system were tested by, or m the presence of the signer shown
below, on the date shown below, andwerefound to be operatingproperly in accordance with the requirements
for the following'
Modifications to an existing system
-411 newly modified operational features and functions ofthe system were tested by, or in the presence of the
signer shown below, on the date shown below, and were found to be operanngproperly in accordance with the
requirements ofthe following'
NFPA 72, Edition: 2017
NFPA 70, Nafioml Electrical Code, Antic le 760, Edition: 2017
Manufacturer's published instructions
Other (specify):
Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached]
Signed: Printed name: Trevor Blackburn Date:
4Sight Security LLC
Organization: Title: JOURNEYMAN TECHNICIAN Phone: 208A81-3510
16. CERTIFICATIONS AND APPROVALS
16.1 System Installation Contractor:
This system, as specified herein, has been installed and tested according to all NFPA standards cited herein.
Signed: Printed name: Trevor Blackburn Date:
4Sight Security LLC
Organization: Tile: JOURNEYMAN TECHNICIAN Phone: 208.887J570
16.2 System Service Contramr:
The undersigned has a service contract for this system in effect as of the data show. below.
Signed: Printed name: Trevor Blackburn
4Sight Security LLC
Organization: Title: JOURNEYMAN TECHNICIAN
163 Supervising Station:
This system, as specified herein, will be monitored according to all NFPA standards cited herein.
Signed: 4Sight Security LLC Printed time: JASON PERRON
Organization: Title: JOURNEYMAN TECHNICIAN
Data
Phone: 208-881-3510
Date:
Phone: 208-881-3510
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16. CERTIFICATIONS AND APPROVALS (continued)
16A Property or Owner Representative:
I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein.
Signed: Printed name: Date:
Organiaetion: Title:
Phone:
16.5 Authority Having Jurisdiction:
I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly
in accordance with its approved plans and specifications, with its approved sequence of operations, and with all
NFPA standards cited herein.
Signed: N` ,4 Printed name: 6 4�� 1 Date: 9/J
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Phone:
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