HomeMy WebLinkAboutFA RECORD OF COMPLIANCE - 22-00804 - Madison Station Apartments - Bldg 10FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION
To be completed by the system Installation contractor at the fime ofsystem acceptance and approval.
It shall be permitted 0 mod)ry this form as needed 0 provide a more complete and/or gear record.
Insert N/A m all anasedlines.
Attach additional ,heeds, data, or calcalmions as necessary laproride a romp/ere record.
1. PROPERTY INFORMATION
Name ofproperty: Madison Station Apartments Building 10
Address: 577 Train St Building 10 Rexburg Idaho 834ID
Desaipcm ofp-pwy: Apartment Building
Oampanry type: GROUP R2
Name ofproptM representative:
Address:
Phone: Fax: E-mail:
Authority haviogjunsdictbn over dus property: Idaho Falls FIRE MARSHAL
Phone: Fax: E-mail:
2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION
Installation contractor far this equipment *Sight Security, L.L.C.
Address: 6944 Big Bend, Idaho Falls, ID S3406
License or ceohnstiw number: 1on1ac1r:#RCE-37051;ID ELE-SC-021298
Phone: 208-403-1434 Fax: &mail: Trevorno4anhtse.unVom
Service organisation far this equipmwt *Sight Security, L.L.C.
Address: 6944 Big Bend, Idaho Falls, ID 834M
License or certification number: contractor#RCE-37051; ID ELE-SC-021298
Phone: 208-4031434 Fax: gam(:
A contrast for test wad Inspection In accordance with NFPA standard. is in effect as of.
Contracted testing company: 4Sight Security, L.L.C.
Address: 6944 Big Bend, to she Falls, ID 83406
Phone: 208-403-1434 Pax: E.mail:
Contract expires: AUTO- Contract number: NIA Frequency of routine inspections: ANNUAL
RENEW
3. DESCRIPTION OF SYSTEM ORSERVICE
Fire dome system (nervoi s)
Fite alarm with in -budding the emergency voice slams communication system (EVACS)
Mass notification system (MNS)
Combination system, with the following com>ponenie:
Fhealami EVACS MINIS Two-way, m-budding, enargecy, commwiedon system
nay*ivno vm xaw Flre FlJalim am.rem. Trm e.m mry e. mqm n im.ae ux xrr tlg, b rd. x mmm e. mqm a. wnnxrtW We uaiebmm.
Other (specify);
I DESCRIPTION OF SYSTEM OR SERVICE (continued)
NTPA 71 Mition: 2019 Additional description ofsystem(s):
3.1 Control Unit
Manufacturer: Poser Modelnumber: AFC 1000
3.2 Mass Nullification System This system does not incorporate an
MNS
3,21 System Type:
In -building MNS,ombimation
In -building MNS—stand-alone Wide -area MNS Distributed recipient MNS
Other (specify):
3.2.2 System Features:
Combination fas almn✓MNS MNS autonomous control unit Wide -area MNS to regional national
alerting interface
Local operating console (LAC) Direct recipient MNS (DAMNS) Wide -area MNS to DAMNS interface
Wide -area MNS to high -power speaker army (HPSA) interface In-bufld'ng MNS m widoarea MNS interface
Other (specify):
3.3 System Documentation
An owner's 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
3.4 System Software This system does not have alterable site -specific
software.
Operating system (.—five) software revision level:
Site-speofic software revision date: Revision complete! by. Trevor BLACKBURN
A copy of the site -specific software is stored on site. Location:
3. 5 Off -Premises Signal Transmission This system does not have off-premuess
transmission.
Name oforganisation receiving alarm signals with phone members:
Alarm: AVANTGUARDMONITORM Phone: 877-206-9141
SnPervisory: AVANTGUARO MONITORING Phone: 877-2069141
Trouble: AVANT GUARD MONITORING Phone: 877-20F9141
Entity to which alarms are re-Cmsmitted: Idaho Falls Fire Phone:
Method ofe, DIGITALVIAStadlnk Radio
transmission:
IfChaptur 26, specify the nwaes of traonrsission from the protected premises 0 the supervising station:
If Chapter 27,specifythe type ofauxiliary alarm system: Local energyShunt Wired Wireless
CtgrigMO AN-.. 1ire1.. Psgyyim.um Mmmry Is gplW N'rMnlOa' W M.N. 11 mNrr=M �m 4..a,,u mUwiotm
4. CIRCUITS AND PATHWAYS
4.1 Signaling Line Pathways
4.1.1 Pathways Class Designations and Survivability
Pathways class: NIA Survivability level: Quantity:
(See NFPA 72. Sections 12.3 and 12.4)
4.1.2 Pathways Utilizing Two or More Media
Quantity: 0 Dwmption: NIA
4A.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 seism^•, and different classification from the signaling lime pathway
4.1.4 tested. Modules
Quantity: a
4.2Alarm Initiating Device Pathways
4.2.1 Pathways Class Designations and Survivability
Pathways class: C Survivability level: 1 Quantity: 1
(See NFPA 72, Sections 12.3 sad 12.4)
4.2.2 Pathways UdH a Two or More Media
Quantity: 1 Description: ALARM INITIATING AND NACSS 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 Non -Yoke Audible System Pathways
4.3.1 Pathways Class Designations and Sunhr bglity
Pathways class: B Survivability level: i Quantity: 12
(See NFPA 72, Sextons 12.3 and 12.4)
4.3.2 Pathways Utilizing Two or More Media
Quantity: 12 Description: ALARM INITIATING AND NACS RUN TOGETHER
4.3.3 Appliance Power Pathways
No separate power pathways from the notification applimce pathway,
Power pathways are separate but of the same pathway classification a the notification appliance pathway,
Power pathways we separate and different classification from the notification appliance pathway
W 14.200eN.. nreRNctim Heo[rarm Ru trm mry Mcape]hrntlrvlGa' ue. aa, fo r®the.amry MMwpaf fu cwnm_,e setawP..I..
5. ALARM INITIATING DEVICES
5.1 Manual Initiating Devices
5.1.1 Manual FireAlarm Boxes
Thia system does not have manual the alarm boxes.
Type and number of devices: Addressable:
1 Conventional: Coded: Transmiher:
Other (specify):
5.11 Other Alarm Boxes
This system does not have other alarm boxes.
Description:
Type and number of devices: Addressable:
Conventional: Ceded: 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 Non req ui red partial area
Other (specify):
Type of smoke detector sensing technology:
Ionization Photoelectric Multiaiamic Aspirating Beam
OW.hilmcify):
521 Duct Smoke Detectors
g Th is system does in or h ave alarm-causl ng d uct smoke it electors.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Type of coverage:
Type of smoke detector sensing technology:
Ionization Photoelectric Aspirating Beam
5.2.2 Radiant Energy (Flame) Detectors
This system does not have radiant energy de cemm.
Type and number of devices: Addressable:
Conventional:
Other (specify):
Type of coverage:
5.2A Gas Detectors
This system does not have gas detectors.
Type ofdetector(s): CO2
Number of devices: Addressable: )
CanveneoneI
Typeof..ge
5.2.5 Rat Detectors
This system does not have hear detenars.
Type and member of devices: Addrasabic:
Conventional:
Type of coverage: Complete area Partial area Nonraquired partial area Linear Spot
Type of hat decector sensing technology:
Fixed companies, Raznof-rise Race compensated
c.m*ivno an xmar siar+a uui yam reu am ma m wpm mr�m.wa i.. w�. aei a ww ft... e. "M ce wmmeaa r. eawroao.
5. ALARM INITIATING DEVICES (condnueciQ
5.2.6 Addressable Monitoring Modulo
This system does not have monitoring modules.
Nutnberofdevices:
5.2.7 Walerflow Alarm Devices
This system does have waterflow alarm
devices.
Type and number ofdevicea: Addressoble: Conventional:
Coded: Transmitter: 1
5.2.8 Alarm Verification
This system does have incorporate
alarm verification.
Number of devices subject to alsmt verification:
5.2.9 Pristine]
Number of devices subject to presignal:
Desmbe pradignal functions:
52.16 Positive Alarm Sequence (PAS)
Desenbe PAS:
52.11 Other Initiating Devices
Describe:
6. SUPERVISORY SIGNAL -INITIATING DEVICES
Alarm verification set for seconds
This system does not incorporate pre -signal.
This system does not in corpo onto PAS.
This system does not have other lensing devices.
6J Sprinkler System SupervisoryDevla This system does not have sprinkler supervisory devices.
Type and number of devices: Addressable: 2 Conventional: Coded: Trausmitter:
Other (specify):
62 Fire Pump Description and Supervisory Devices Th is system does n of have a fire pump.
Type fire pump: Electric pump Engine
Type and number of devices: Addressable: Conventional Coded: Transmitter:
Odur(sPecify):
6.2.1 Fire Pump Functions Supervised
Power Running Phase reversal Selector switch not in auto Engine or conned panel unable Low fuel
Other, (specify):
63 Duct Smoke Detectors(DSDs) This system does not have DSDs causing supervisory signals.
Type and number ofdevices: Addressable: 0 Conventional:
Other (specify):
Type oFcoverag.:
Type of smoke delemr sensing technology: lonvztion Photoelectric Aspirating Beam
6A Other Supervisory Devices This system does not have other supervisory devices.
Descnbe:
e yneno axe nicer ro-anm.wi weaao. In. ern raw ire was er im. w our . c, r.ea a raw eu sec wm er —mama era. aeon.
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 hinged system(s):
71 Other Monitoring Systems
Description of special hazard system(s):
8. ANNUNCIATORS
81 Location and Description of Annunciators
Location i.
Location 2:
Location 3:
9. ALARM NOTIFICATION APPLIANCES
This system does not have agenaator.
Selector switch not be auto Low fuel
This system does not monitor special hazard systems.
This system do" not monitor other systems.
This system does not have annunciators.
91 In-Bugdvg Fire Emergency Voice Alarm Communication System This system does not have an EVACS.
Number ofsingle voice storm channels: Number of multiple voice slam channeu:
Numberof speakers: Number of speaker circuits:
Location ofamplification andsound-pmcessingequipment
Location of paging microphone stations:
Lemdon 1:
Location 2:
Location 3:
92 Nonvolce Notification Appliances
Home: 84 With vuble: Bells:
Chimes: With visible:
Visible only: Other (describe):
92 Notification Appliance Power Extender Panels
Quantity: i
Locations: Mar room
With visible:
This system does have power extender panels.
cwt,erso toner ouma rim wmoum n..w.o ,arm tow sets. we art. ran emue. a tom. n.wmw n—mmun men, e.mnam.
10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS This system does not have an MINIS.
101 MASS Local Operating Cm axles
Location 1:
Location 2:
Local. 3:
102 High -Power Speaker Arrays
Number ofHPSA speaker initiation ones:
Location 1:
Location 2:
Location 3:
103 Mass Notification Devices
Combination fare alarmrMP1$ visible appliances: MNS-only viibkappliances:
Textual signs: Other (describe):
Supervision class:
10.3.1 Special Haaard Notification
This system does not have special suppresswa predischarge aotifastion.
MNS systand DO NOT override notification appliances required to provide special suppression
predischarge notification.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS
1L1 Telephone System This system does not have a two-way telephone system.
Number of telephom jacks installed: Number of ward® stations installed:
Number of u lephone handset stored made:
Type oftelephone system installed:Dectrically powered Soundpowered
ILI Two -Way Radio Communications Enhancement System
This system dues not have a two-way radio corammrications enhancement system,
Percentage of area mvered by two-way radio service: Critical areas: % General building arem: %
Amplification component locations:
Inboard signal strength: dB. Outbound signal strength: 113m
Donor anteme isolation is: dB above the signal booster gain
Radio frequencies covered:
Radio system monitor panel location:
cwr*eno are now ro-.nmmo� weou>oo. mi:roan tan eaovm wiry Asa w w. ma. w � n taw m m yam w �mo��g we o a.o-�an�m.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued)
IU Area of Refuge (Am of Rescue Assistance) Emergency Communications Systems
This system does not have an area of refuge (area of rescue assistant) emergency mmmunicafiow system.
Number ofstations: location rfcentml enrol point
Days and hours when central control point is attended:
Location ofaltemate control free
Days and hours when alternate control point is attended:
IIA Elevator Emergency Communications Systems
This system does not have an elevator emergency communications system
Number of elevators withsttions: Location ofmotral control point:
Days and bows when central control poet is atmrded:
Location ofaltemate controlpoint
Days and hours when alterrut control point is attended:
11.5 Otter Two -Way Commuwmww Systems
Dam -be:
12. CONTROL FUNCTIONS
This system activates the following control functions
Hold -open door releming devices Smoke management HVAC shutdown F/S dampers
Door unlocking Elevator recall Fuel source shutdown Extinguishing agent release
Elevator shunt trip Mess maifcation system override of in alarm notification appliances
Other(specify):
12.1 Addmssable Control Modules This system does not have control modules.
Numberof 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
Overcurrent protection: Type: BREAKER Amps: A
Location (of primary supply panel board): Sideof Building
Disconnecting means location: ELECTRICAL PANEL, MARKED ON PANELS
13.1.2 Engino-Driven Generator This system does art have a ge comor.
Location of generator:
Location of fuel slump: Type of And:
IXp/�ian0 NSB N 4vN FIre Rq tiro Paexl4m Thle lum wry tl qpb N Ilplvind me Wp p� Ica ®ale. II mryM N nytl b mnmgpy sale aElffiih4m.
13. SYSTEM POWER (rontinued)
13.1.3 Uoioterruptlble Power System Ibis 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 (haute): In alarm mode (minks):
13.1.4 Bstteries
Location: IN PANEL Type LEAD ACID Nominal voltage: 12 Amp/hour hiring: 18
VDC X
2
Calcuated capacity ofbaaeries to drive the system:
In standby mode (houa): 24 In alarm mode (minks): 5
Batteries are marked with dateofnrmufacmre Barney, calculations are coached
13.2 In -Building Fire Emergency Voke Alarm Communication System or Mass NotBleatlou System
This syatem does not have m EVACS or MNS system
13.2.1 Primary Power
Input voltage of EVACS or MNS panel: EVACS or MNS panel amps:
Overcument protection: Type: Amps:
Location (of primary supply panel boud):
Disconnecting means location:
13.2.E Eaglne-Driven Generator This system does not have agenerator,
Location ofgenerakr.
Location of fuel storage: Type offueL
13.2.3 Unimtermptible Power System This system does not have a UPS.
Equipment powered by aUPS system:
Location ofUPSsystam:
Calculated capacity of UPS baneriea to drive the system components connected in it:
In standby mode (hours): In alarm made (minutes):
13.2.4 Batteries
Location: Type. Nominal voltage: Amp/hour rating:
Calculated comarity, of batteries to drive the system:
In standby mode (bouts): In alarm mode (minutes):
Batteries are marked with date of manufacture Battery calculations are attached
c Iui®mm waaclmo,.Toat«mmyacam r«mzv�a,aww«ment«r�ao-.arawcam carat«gym«cw
13. SYSTEM POWER (continued)
13.3 Notifiertion Appliance Power Extender Panels This system does not have power extruder panels.
13.3.1 Primary Power
Input voltage of power extender panel(s): 120 VAC Power extends panel amps: 6
Overcerrent proration: Type: BREAKER Amps: 20
Location (of primary supply panel board): Fire Front Rlsr ROOM
Disconnecting romans location: ELECTRICAL PANEL, MARKED ON FIRE PANELS
13.3.E Enpne Driven Generator This system dos not have agencrater.
Location ofSeamen:
Location of fuel storage: Type of fuel:
13.3.3 Uninterrupti Power System This system does not have a UPS.
Equipment powered by aUPS system:
Location ofUPSsymam:
Calculated capacity of UPS batteries induce the system components connected wit:
In swdby mode (hours): In alarm mode (minutes):
13.3.4 Batteries
Location: IN PANEL Type: LEAD ACID Nominal voltage: 12 Amp/hourmtivg: 18
VDC x
2
Calculated capacity ofbancries to drive thesystem:
In standby mode (hours): 24 In alarm erode (rninumn): 5
Batteries aremarked with date of manufacture Battery calculations are ateachd
14. RECORD OF SYSTEM INSTALLATION
Fill out after all instalhrtion is complete andwbing has been chnoted for opens, shorb, greandfrulb, and unproper
branching, but before conducting operchanal acceptance tests.
This is a: New system Modification to an existing system Permit numbs:
The system hen been installed in accordance with the following requirements: (Note any or all that apply)
NFPA 72, Edition: 2019
NFPA 70, National Elearkod Code, Artie In 760, Edition: 2019
Manufacturer's pubinhd instructions
Other(specify):
System devistiava from referenced NFPA standards: NONE
Signed: Printed nerve: Trevor Blackburn Date:
4Sight Security LLC
Orgevvstion: Title: JOURNEYMAN TECHNICIAN Phone: 208-881-3510
cmniano moo uesar nrengecom n.m.ure. me wire revue vm ai„anm Wm.,n�ar.ar xrerun a. w.samrre.m.a. ae�.o-�ma.
15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST
New system
All operational f efty at andfanedoni ofthis system were boomed by, ar in the presence of, thesigner shown
below, on the dote shown below, and were fund to be aperadngproperly in accordance with the re adrements
far the following:
Modifications m an existing system
All newly modified operational features andfancerms ofthe system were tested by, or in the Presence of the
signer shaven below on the date shown below, and were found to be operating properly in accordance with the
requirements ofthefollowing:
NFPA 72, Edition: 2017
NFPA 70, National Elseliml Code, Antic Is 760, Edition: 2017
Manufacturer's published hiswctions
Other (specify):
Individual device testing documentation [Inspection end Testing Form (Figure 14.624) is mtachd)
Signed: Printed name: Trevor Blackburn Dete:
4Sight Security LLC
Orgaaa�ion. Tide: JOURNEYMAN TECHNICIAN Phone: 20&881-3510
16. CERTIFICATIONS AND APPROVAL$
16.1 System Installation Contractor.
This system as specified herein, has been noodled and tested according to all NFPA standards cited herein.
Signed: Printed name: Trevor Elackbum Date:
4Spht Security LLC
Organvntion: Title: JOURNEYMAN TECHNICIAN Phone: 208-881-3510
163 System Service Contractor:
The undersigned has a service contract for this system in effect as of the date shown below.
Signed: Printed name: Trevor Blackburn
4SightSecurity LLC
OrgenvAtion: Title: JOURNEYMAN TECHNICIAN
163 Supervising Station:
This system, as specified herein, will be monitored according mall NFPA standards cited herein.
Signed: Printed mem; JASON PERRON
4Sight Security LLC
Organisation: Tina JOURNEYMAN TECHNICIAN
Dme:
Phone: 21 &881-3510
Dale.
Phone: 208-881-3510
crorrvsnmcone ua«w rlrerru tin w.«IA«. col. Mmcon ee wan nrro, vw.,svw,eme.nmumm«vmwcdnm.tl9 ae«eico-iartvn.
16. CERTIFICATIONS AND APPROVALS (mndnued)
16A Property or Owner Representativ
I accept this s as hav g en in and tested to its specifications and all NFPA standards cited herein.
Signed: Prin : Trevor Blackburn Date: 12-30-25
Organization: or
itv Title: Fie Alarm Technician Phone:208-881-3510
165 AuthorityRaving Jurisdiction:
I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly
in nccordmce with its approved plans and specifications, with its approved sequence of operations, and withal]
NFPA standarda/cited �herei�n.
Signed: 4iQ4A I Printed.: RICK azoiJ Daze: jL/31IL5-
Organbadon: Title: Phone:
cm+�eree an xmor virewarcom oaesitnm m .".w. wI.a," i... — - oww x... to apm s...—Imaaa.naom