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Home My WebLink Aboutfire alarm installation/tests Simplex FIRE ALARM TEST/INSTALLATION Simplex Time Recorder Co. ACKNOWLEDGEMENT CONTINUATION SHEET Gardner, MA 01441-0001 U.S.A. NAMEy fi. _ - BOOK# CALL# PG OF PERIPHERAL FUNCTION TEST DEVICE DEVICE LOCATION A T NOTE NO. ANNUN.ZONE ALARM ZONE DEVICE DEVICE LOCATION A T NOTE NO. ANNUN.ZONE ALARM ZONE TYPE L OR OR TYPE L OR OR R TELEPHONE SIGNAL R TELEPHONE SIGNAL M ZONE ZONE M 'E ZONE ZONE S S, ilk �S ,C t L' S t v v r PSD =Photoelectric Sink Det PS =Manual Pull Station B =Bell Only TS =Tamper Switch ISD =Ionization Sank Det CPS =Coded Pull Station H =Horn Only WE =Water Flow Sw PDD =Photo.Duct Sink Det RR =Rate of Rise Ht Det C =Chime Only DH =Door Holder IDD =Ion.Duct Sink Det HT =Fixed Temp Heat Det S =Spkr Only FP =Fire Phone DHS =Door Hldr&Sink Det MD =Mercoid Heat Det A/V=Audio Visual RI =Phone Jack SSD =Sgl Station Sink Det FD =Flame Det V =Visual Only NCS =Nurse Call Sta. BD =Beam Det. STANDARDS:FAILURES AND SYSTEM DEVIATIONS FROM NFPA • • • (describe 1 ��+�+e!}7,rra�•`>is�^{%a'.':y�arr;r•t.rr,�+r+rrg4*r ,.a�. , ,,rye=k-,• . +�,�.�.��`-. - . ADV-0352 a-ez AUTHORITY HAVING JURISDICTION rti tri arra tra( aoaa cse aara♦a..i:51A _�_i_i9 Yv��lriRr FIRE ALARM TEST/INSTALLATION Simplex Simplex Time Recorder ACKNOWLEDGEMENT Gardner,Massachusetts 0144144 1 U.S.A. BRANCH SERVICE AT CUSTOMER NUMBER J� �ARRW� ATE ( TR COMP.DATE BILLABLE I NON-BILL NSP.DATE PROJECT NO. IP.CODE SERV.CODE INSTAL. ❑MTHLY ❑SEMI-AN ❑ORTLY ❑ANNUAL ADDRESS(OR ATTR OF) CUSTOMER PURCHASE ORDER AND/OR CUSTOMER CONTACT NAME(PRINT) FINAL all I ADDRESS iw LABOR HRS TRAVEL HRS MILES TR TERR. M.A. CwfSTATE ZIP LABOR HRSI TRAVEL HRS TM.3 LABOR HRS TRAVEL HRS :;ONTROL MA A TUREF{"- MODEL NO.�!�/ SE IO. WI NG DUAG.NO. SEQUENCE NO. (� THRU TYPE OF SIGNALING POWER CIR.BRKR.LOCATION NO. LOCKED CIR.BRKR DEDICATED CIR. ❑GENERAL ALARM ❑SELECTIVE SIGNALS ❑CODED ❑ PRE-SIGNAL SOURCE ❑Y ❑N ❑Y ❑ N VOLTAGE WITH CHARGER El [I�� ❑NORM TROUBLE RESPONSE TO: ZONE TROUBLE SIGNAL TROUBLE AC/OP POWER LOSS EARTH GROUND BATTERIES VOLT WITHOUT CHARGER [IN/A : CONDITIONS ❑ El NORM El NOTE# NOJJM ❑ NOTE# ❑Now 11 NOTE# 1-1 NORM ❑ NOTE# CUSTOMER OPERATING INSTRUCTIONS PROVIDED TO: STR TR 1 SIGNATURE GUSTO R SI 'R FIRE ALARM LICEPtSE NO.-STATE CERTIFICATIO NO. SEE NOTAT O. THE SIM LEX-SUPPLIED EQUIPMENT FOR THIS SYSTEM WAS TESTED AND FOUND OPERATIONAL. SIGNALS WERE NOT SOUNDED PER CUSTOMER REQUEST THE WARRANTY BEGINS ON MONTH DAv YR, ❑Y ❑N 4UXILIARY FUNCTIONS MFGR. SERIAL DOOR DOOR RELEASE DEVICES,INCLUDING CLOSERS AND LATCHES ANNUNCIATOR HOLDERS ❑NORM ❑ QTY. ❑ NOTE# N/A MODEL WIRING DIAGRAM ELEVATOR RECALL TO PRIMARY FLOOR FIRE RECALL ❑NORM ❑ NOTE# N/A [I NCAND. El GRAPHIC [I CRT VOLTAGE NO.OF ZONES UNUSED PTS. RECALL TO ALTERNATE FLOOR TYPE ELEVATORS RESTART LED DROP FROM FIRE VC. ElLEDEl NORM E] NOTE# /A AUTOMATICALLY ❑Y ❑N ADDITIONAL NOTES: AIR HANDLER SHUTDOWN AUX El LAMP TEST El REMOTE RESET HVAC AIRHANDLER(S) FUNCTIONS ❑DRILL SW ❑REMOTE A K SHUTDOWN RESTART FROM ❑ NORM ❑NOTE# ❑ QTY. SHUTDOWN AUTOMATICALLY ❑v ❑N UNIQUESPECIAL LIST ANY • CONSIDERATIONS TO BE AWARE OF •' CITY CRY RESPONSE TO ALARM OFFICIAL CONTACTED 1 CONNECTION OR ❑NORM ❑NOTE# Yt r CENTRAL MONITORING CITY RESPONSE TO TROUBLE TIME OF DAY X STATION ❑NORM ❑NOTE# OUT OF SERVICE IN SERVICE LOCAL FIRE DEPT./CENTRAL STATION FD.BUS.PHONE NO./CENTRAL STATION 3 MPX/TPR CHECK LIST PERIPHERAL/PARTS USED THE NUMBER OF MODEL No. THE FOLLOWING ! • TRANSPONDERS MODEL/ID/PART NO. CHARGE ITEM TOTAL NO No. ✓okay FAILED THE TEST (X) CODE QTY. UNIT PRICE OF DEVICES Tested XSee below NO.OF XPNDRS TESTED LOCATION NOTE# i 1 1 STATIONS `""r POWER SUPPLY VOLTAGE NOTE# LOCATION NOTE# HEAT UETECTORS — - ❑NORM 2 SMOKE DETECTORS CHARGER VOLTAGE NOTE#LOCATION NOTE# 3 d ANNUNCIATORS ❑NORM GROUND FAULT NOTE 4 LOCATION NOTE# DUCT DETECTOR ❑Y ❑N 4 HORNS G-- BATTERIES VOLTAGE NOTE# LOCATION NOTE# 5 BELLS ❑NORM CHIMES POINTS TESTED NOTE# LOCATION NOTE# ❑NORM 6 SPRINKLER SYST OTHER NOTE# LOCATION NOTE* 7 NURSE CALL PRINTERS NOTE# CRT'S NOTE# OTHER NOTE# TYP —SL Ely [IN Ely ❑N $ L� NOTATIONS • DA • ENCOUNTERED DURING TEST M552-1FV 3-91 IF DETAILED TESTING IS REQUIRED-USE CONTINUATION SHEET ADV-0352 9-88 AUTHORITY HAVING JURISDICTION -�