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HomeMy WebLinkAboutFA RECORD OF COMPLETION - 22-00803 - Madison Station Apartments - Bldg 9FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify thisform 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. ' s 1. PROPERTY INFORMATION Name of property: Madison Station Apartments Building 9 Address: 577 Trejo St Building 10 Rexburg Idaho 83440 Description of property: Apartment Building Occupancy type: GROUPl Name of property representative: Address: Phone: Fax: E-mail: Authority having jurisdiction over -this property: Idaho Falls 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 Fax: E-mail: TrevoraC.4sightsecurity.org Service organization 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 Fax: E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: 4Sighf.$ecurity, L.L.C. z Address: 6944 Big Bend, Idaho Falls, ID 83406 Phone: 208-403-1434 Fax: E-mail: Contract expires: AUTO- Contract number: N/A Frequency of routine inspections: ANNUAL RENEW 3. DESCRIPTION OF SYSTEM OR SERVICP,M' Fire alarm system (tionvoice) 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 communication system NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) 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 commercial sale or distribution. S ' M Other (specifv): • 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) Nh'PA 72 edition: 2019 Additional description ofsystem(s): " . 3.1 Control Unit Manufacturer: Potter Model number: AFC 1000 3.2 Mass Notificatior!'Systeml This system does not incorporate an 'MNS 3.2.1.System Type: In -building MNS—combination ` In=building MNS—stancL-alone, Wide -area MNS Distributed recipient MNS Other (specify): • 3.2.2 System Features: Combination fire alarm/MNS 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 (spec ify): 3.3 System Documentation 0 A•n owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of ;the numbered record draOings are stored on site. Location: FACP 3.4S stem Software Y This system does not have alterable site -specific software. Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: Trevor BLACKBURN A copy of the site-specificsottware is stored on site. Location: 3.50ff-Premises Signal Transmission This system does not have off -premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: AVANT GUARD MONITORI,C Phone: 877-206-9141 Supervisory: AVANT GUARD MONITORING Phone: 877-206-9141 trouble: AVANT GUARD MONITORING Phone: 877-206-9141 Nntity to which alarms arc re -transmitted: Idaho Falls Fire Phone: Method orre- DIGITAL VIA Starlink Radio transmission: If Chapter 26. specify the means oftfansmission from the protected premises to the supervising station: If Chapter 27, specify the type of•auxiliary alarm system: Local energy Shunt Wired Wireless NFPA 72, Fig. 10.18.2.1.1 (p 2 of 12) Copyright© 2009 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line'Pathways r 4.1.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: Quantity: (Sea NFPA 72, Sections 12.3 and 72.4) 4.1.2 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 4.1.4 Isolation Modules Quantity: 0 4.2Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: C Survivability level: 1 Quantity: 1 (See NFPA 72, Actions 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: 1 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 s, 4.3 Non -Voice Audible System Pathways 4 4.3.1 Pathways Class Designations and Survivability y Pathways class: B Survivability level: 1 (See NFPA 72, Sections 12.3 and 12.4) Quantity: 12 4.3.2 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 as the notification appliance pathway Dower pathways are separate and different classificationlfrom the notification appliance pathway :: NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) 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 commercial sale or distribution. 5. ALAFM INITIATING DEVICES • ' 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Bozes This system doesaet-have manual fire alarm boxes. Type and number of devices: Addressable: 1 Conventional: Coded: Transmitter: Other,(specify): 5,1.2 Other Alarm Boxes t• This system does not have other alarm boxes. Deserjption: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): , 5.2 Automatic Initiating, Devices 5.2.1 Smoke Detectors This system does m4 have smoke detectors. Type and number of devices: Addressable: 2 t Conventional: Qther (specify): Type of coverage: Complete area Partial area Nonrequired partial area Otlier (specify): Type of smoke detector sensing technology: Ionization Photoelectric Multicriteria Aspirating Beam Other (specify): • 5.2.2 Duct Smoke Detectors X This system does not have alarm -causing duct smoke detectors. • Type and number of devices: 'Addressable: Conventional: Other (specify): +� 'A Type of coverage: Type of smoke detector sensing technology: Ionization Photoelectric Aspirating Beam 5.2.3 Radiant Energy (Flame) Detectors This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): ' Type of coverage: 5.2.4 Gas Detectors This system does a#have gas detectors. Type of detector(s): COJ.. Number of devices: Addressable: 1 Conventional: Type of coverage: 5.2.5 Fleet6etectors . t 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 r NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright b 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. r , M 5. ALARM INITIATING DEVICES �ontinued) ,. 5.2.6 Addressable Monitoring Modules . This system does whave monitoring modules. Number of -devices: 5.2.7 Waterflow Alarm Devices This system does have waterflow alarm devices.. "type and number of devices: Addressable: Conventional: Coded: Transmitter: I 5.2.8 . Alarm Verification This system does have incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds 5.2.9 Presignal This system does not incorporate pre -signal. Number of devices subject to presignal: 1 Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) ,� This system does not incorporate PAS. Describe PAS: i 5.2.11 Other Initiating Devices This system does not have other initiating devices. Describe: 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices This system does+leili have sprinkler supervisory devices. ' Type and number of devices: Addressable: 2 Conventional: Coded: Ti ansmitter: Other (spec ify)•: 62 Fire Pump Description and Supervisory Devices This system does not have a fire 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 s4l)itch not in auto Engine or control panel trouble Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) This system does not have DSDs 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 6.4 Other Supervisory Devices This system does not have other supervisory devices. Describe: NFPA 72, Fig_ 10 18.2 1 A (p 5 of 12) Copyright© 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 7. MONITORED SYSTEMS , • 7.1 Engine -Driven Generator This system does not have agenerator. 7.1;1 Generator Functions Supervised Engine or control panel trouble Generator running Selector switch not in auto Low fuel Other (Specify): 72 Special Hazard Suppression Systems This system does not monitor special hazard systems. Description of special hazard system(s): 7.3 Other Monitoring Systems This system does not monitor other systems. Description of special hazard system(s): F 8. ANNUNCIATORS This system does not have annunciators. &I Location and Description of Annunciators Location 1: Location 2: +i Location 3: 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System This system does not have an EVACS. . Number of single void alarm channels: Number of multiple voice alarm channels: Number of speakers: •• Number of speaker circuits: ).ocation ofamplification and solipd-processing equipment: Location of paging microphone stations: Location l: Location 2: ' Location 3: 92 Nonvoice Notification Appliances, •, horns: 84 With visible: Bells: With visible: Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels This system does have power extender panels. .ti Quantity: . 1 Locations: RiST room i. I NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. • r 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS This system does not have an MNS. 10.1 MNS Local Operating Consoles Location l: Location 2: Location 3: 102 High -Power Speaker Arrays' Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification.19 vices Combination fire alarrfl/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 to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System This system does not have a two-way telephone system. Number of telephone • jacks ins't cd: .s Number of warden stations installed: Number oftelephone handsets sTored on ,site: Type of telephone system installed: Electrically powered Sound powered 11.2 Two -Way Radio Communications Enhancement System This system does not have a two-way radio communications enhancement system. • Percentage of area coveted by two-way radio -Service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: lr NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. i 11.. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 113. Area of Refuge (Area 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 of4entral control point: _ Days and hours when central control point is attended:". Location of alternate control point: Days and hoots when a3ternate control point is attended: 11.4 Elevator Emergency Communications Systems This system does not have an elevatoifemergency 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 poi'j is attended 113 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 F/S dampers Door unlocking Elevator recall .'Fuel source shutdown Extinguishing agent release Elevator shunt trip Mass notification jstem override of fire alarm notification appliances .4 Other (speci fy): 12.1 Addressable Control Modules This system does not have control modules. Number of devices: Other (specify): 13. SYSTEM POWER 13.1 Control 1)nit . 13.1.1 Primary Power input voltage of control panel: 120 VAC Control panel amps: 20 Overcurrerit protection: Type: BREAKER Amps: 20 • Location (o primary supply panel boards Side of Building s� • Disconnect ie� means location: ELECTRICAL PANEL, MARKED ON PANELS y 13.1.2 Engine -Driven Generator This system does not have agenerator. Location of generator: Location of fuel storage: Type of fuel: V NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. . V 13. SYSTEM POWER (continued) 13.1.3 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): 43.1.4 Batteries ' Location: IN PANEL Type: LEAD ACID Nominal voltage: 12 VDC X Amp/hour rating: 18 'Calculated capacity of batteries to drive the system: {n standby mode -(hours): 24 In alarm mode (minutes): 5 Batteries are marked with date of manufacture Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System Tffis system does not have an EVACS or MNS system. 13.2.1 Primary Poker Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: ' ©vercurrent protection: Type: ' ' Amps: Location (of primary supply panel board): Disconnecting means location: A.2,.2 Engfne-Driven Generator • Of. This system does not have agenerator. Location of generator: Location of fuel storage: t Type of fuel: 13.2.3 Uninterruptible Power System This system does not have a UPS. Equipment powered by a UPS system: ocatron of UPS system: _ - 4 Calculatedcapacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 13.2.4 Batteries Location: j -Type: Nominal voltage: '" •• g _ Amp/hour rating: Calculated 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 w ,M NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) i� 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 commercial sale or distribution. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels This system does not have power extender panels. 13.3.1 Primary Power ' • Input voltage of power extender panel(s): 120 VAC ,1W Power extender panel amps: 6 Overcurrent protection:." Type: BREAKER ? Amps: 20 Location (of primary supply panel board): Fire Front Rlsr ROOM Disconnecting medns location: ELECTRICAL PANEL, MARKED ON FIRE PANELS 13.3.2 Engine-DrW6 Generator ' This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 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): 13.3.4 Batteries t Location: IN PANEL `x Type: LEAD ACID Nominal voltage: 12 Amp/hour rating: 18 VDC X 2 Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 5 w 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 faults, and improper branching, but befoee conducting operational acceptance tests. This is a: New system Modification to an existing system 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, National Electrical Code, Artic le 760, Edition: 2019 Manufacturer's published instructions Other (specify): System deviations from referenced NF1PA standards: NONE Signed: Printed name: Trevor Blackburn 4Sight Security LLC Date: Organization: Title: JOURNEYMAN TECHNICIAN • Phone: 208-881-3510 ` NFPA 72, Fig. 10-18.2.1.1 (p. 10 of 12) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. t 15: RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ' New system A11 operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operatingproperly in accordance with the requirements for the following: Modifications to an existing system All newly modified•operational featuures andfunctions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: NFPA 72, Edition: = 2017 v NFPA 70, National Electrical Code, Article 760, Edition: 2017 Manufacturer's publishlginstructions - Other(specify): Ipdividual 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: 208-881-3510 16. CERTJFICATIONS AND APPROVALS 16.1 System Installation Contractor: Thy s} t`em, 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: Title:. JOURNEYMAN TECHNICIAN Phone: 208-881-3510 16.2 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 Date: 4Sight Security LLC Organization: _ "Title: JOURNEYMAN TECHNICIAN Phone: 208-881-3510 w 16.3 Supervising Station: This systeml spegified herein, will be monitored according to all NFPA standards cited herein. Signed:Printed name: JASONPERRON Date: 4Sight Security LLC --- - _.- - Organization: Title: JOURNEYMAN TECHNICIAN Phone: 208-881-3510 NFPA 72, Fig. 10,18.2.1.1 (p. 11 of 12) copyright 0 2009 National Fire Protection Association. This forts may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. M • 16. CERTIFICATIONS AND PPROVAL;S (continued) 16.4 Property or Owner Relvesentativ ' I accept this sys as havi g en ins 1 d and tested to its specifications and all NFPA standards cited herein. Signed: Printed e: Trevor Blackburr Date: 12-30-25 Organizatio 4Sight S rity fitle: Fire Alarm Technician Phone: 208-881-3510 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: Printed name: �'C� Date: Organization: � •�r df 'j_ � Title: ��• � I � .LPhone: ' , Y Y, 1y a • NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) w �• Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.