2010 - 00380 - fire alarm system

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FIRE ALARM RECORD OF COMPLETION FORM • +r �..=r r� : Ort• Date: 5 . O Customer# ; “Job#: 0 Primary System# ..� f f i K i;+ Secondary Sys'.em#:}. f+ r '.F.;;;•;; Customer Name: V\ rb 44.4r-45 Aficesry Address(City/State/Zip): 2-35V W Weziairt Blvd; ss 3, Representative of Protected Property(Name/Phone): \h 0\42.4a.:‘`�`l/J R SR— LI-1 3.— 5 Authority Having Jurisdiction: 3prmE. ore [ LL- + Telephone Number: ' 5 _ 77&1 X /0 Location of As-Built Drawings: P}-qT" Location of Operation and Maintenance Manuals: A4Dr a- x� Mv2. Location of Inspection&Testing Reports: 'P' net Location of Control Panel: gar i tec Rgpp Primary Telephone Number: q 5-2-1115--a?..57 Secondary Telephone Number: Does ADT have a contract for testing and inspection in accordance with NFPA standard(s)? $!Yes ❑ No If no,who?: Inspection Start Date: 5 )231 /0 Inspection Frequency: ❑ pAnnually 0 Semiannually El Quarterly ❑ Bimonthly [I Monthly [I Weekly System Software (a)Operating system(executive)software revision level(s): (b)Site-specific software revision date: (c)Revision completed by: (Name) (Company) (Date) 1.Type(s) of System or Service NFPA 72,Chapter 8—ADT Central Monitoring Center Means of transmitting signals from the premises to the central station:(Check all that apply) g. Digital Alarm Communicator El McCulloh El Multiplex ❑ One-way Radio ❑ Two-way Radio ❑ Other: Means of transmission of alarms to the public fire service communications center: System locations: NFPA 72,Chapter 6-Local If alarm is transmitted to location(s)off premises,list where received: ❑ NFPA 72,Chapter 8-Remote Station Telephone numbers of the organization receiving alarms: ❑ NFPA 72,Chapter 8-Proprietary Telephone numbers of the organization receiving alarm: ❑ NFPA 72,Chapter 9-Auxiliary Check type of connection: ❑ Local Energy ❑ Shunt ❑ Parallel Telephone Telephone numbers of the organization receiving alarm: g gg— Z'3$- p.(-, G(P If alarms are retransmitted to a public fire service communications center or other,indicate name and telephone numbers of the organization receiving alarm: Indicate how alarm is retransmitted: Di 91 F‘ rnM404,1 c .{m2 2. Record of System Installation (Complete this section after installation is complete and wiring checked for opens,shorts,ground faults,and improper branching,but prior to conducting operational acceptance tests.)This system has been installed in accordance with the NFPA standards as shown below,was inspected by arta^ on S)Z.7' ,includes the devices shown in sections 4&5,and has been in service since This system has been installed in accordance with the standards as shown below: (�NFPA 72,Chapters 2 3 4 5 6 Circle all that apply) [NFPA 70,National Electrical Code,Article 760 Ic Manufacturer's Instructions ❑ AHJ or Source: Signed: Date: Organization: L L F/C— icsa p Reprinted with permission from NFPA 718 2002,National Fire Alarm Code®,Copyright©2002,National Fire Protection I IIIIII VIII VIII VIII VIII"III I'I'I VIII VIII VIII 11111 VIII VIII VIII VIII VIII IIII I'll Association,Quincy,MA 02169. This reprinted material is not the complete and official position of the NFPA on the referenced 0 1 1 0 0 0 5 0 3 0 0 1 0 5 0 8 subject,which is represented only by the standard in its entirety. '30-01 AHJ (p.1 of 3)