HomeMy WebLinkAboutSystem Record of Completion - Permits - 9/20/2019 SYSTEM RECORD OF COMPLETION
This form is to be completed by the sjsterpt installation cotaractor at the lone qfs),sleor acceptance and approval.
It shall be permitted to mortify this form as needed toproviele a snore complete anellor clear record.
Insert MIA in all unused lines.
Attach additional sheets,data,or calculations as necessary,to provide a complete record.
9-20-19 0
Form Completion Date: Supplemental Pages Attached:
1. PROPERTY INFORMATION
Name of property: SMOLAK FARMS QRUST[C BARNy
Address: 3 t5 SOUTH BRADFORD rill„NOR 11H ANDOVER,MA 01045
Description ofpropvrty: WORKNO FARM AND SMAt L EVE"N 11 VIE"NUE
Name of property representative: WHAEL SMO�.AK
Address: SAMF
Phone: (918)682 6332 Fax: E-mail:
2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION
Installation contractor: A111-PRO 1.U.011MC f.W
Address: 640 BOXF ORD RD,01RADF OR D MA,G l 835
Phone: 9 78 4 69-0 1001 Fax: E-mail:M I K E 0 I @AIL L P R 0 F 0 T R 6 C,CO
M
Service organization: AL I-P RO IE L EC TMC V,LC
Address: 040 BOXFORD RD,DIRADIFORD MA,W835
Phone: 978 469()t 00 Fax: E-mail:M11K[H@M LPROELECIMC.001V
'resting organization: AV -PRO H F(A'MG 11 1,C
Address: 640 BOO ORD RD,MRADFORD MA,W835
Phone: 978 469 0100 Fax: E-mail:MIKEH§AULFIROD.EG HRIC.COM
Effective date for test and inspection contract:
Monitoring organization: WA
Address:
Phone: Fax Email:
Accountmunbcr: Phone line 1: Phone line 2:
Means of transmission:
Entity to NvInch alarms ore retransmitted:NIA Phone:
3, DOCUMENTATION
On-site location of the required record documents and site-specific software:.
4. DESCRIPTION OF SYSTEM OR SERVICE
This is a: New system Modification to existing system Permit number:
NFPA 72 edition:
4.1 Control Unit
Manufacturer: NOTIHER Model number: MS-2 8
41 Software and Firmware
Firinivare revision number:
4.3 AlarDl Verification 'This system does not incorporate alarm vetification.
Number of devices subject to alarm verification! Alarm verification set for seconds
6. SYSTEM POWER
5.1 Control Unit
5.1.1 Primary Power
Input voltage of control panel: 120 Control panel amps:20
Overcurrent protection: Type: CHRCUH BRILAKER Amps: 20
ADJACE N� TO Ci HE F HE
Branch circuit disconnecting means location:M ARM PAND Number:
5.1.2 Secondary PoNver
7 2AH SLA BAl I LRY
'fype ofsecondary,power.
Location,if remote from the plant: WA
Calculated capacity of secondary power to drive the system:
In standby mode(hours): 24 HRS In ilinn mode(minutes): 30 h1ft It 8
5.2 Control Unit
This system does not have power extender panels
Power extender panels are listed on supplementary sheet A
6. CIRCUITS AND PATHWAYS
Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level
Signaling Line WA
Device Power WA
Initiating Device YES B a
Notification Appliance Y[ls B D
Other(specify):
7. REMOTE ANNUNCIATORS
Type Location
8. INITIATING DEVICES
Addressable or
Type Quantityl Conventional Alarm or Supervisory Sensing Technology
Manual Pull Stations tj GOWEN noNAl ALARM NIA
Smoke Detectors 0
Duct Smoke Detectors 0
Beat Detectors 0
Gas Detectors it
Waterflow Switches 0
Tamper Switches 0
9. NOTIFICATION APPLIANCES
Type Quantity Description
Audible 0
Visible f i'DOEMOR BEACON
Combination Audible and Visible iR HORN/SIROBES
10. SYSTEM CONTROL FUNCTIONS
Type Quantity
Hold-Open Door Releasing Devices 0
11 VAC Shutdown 0
Fire/Smoke Dampers 0
Door Unlocking 0
Elevator Recall 0
Elevator Shunt Trip 0
11. INTERCONNECTED SYSTEMS
This system does not have interconnected systems.
f
Interconnected systems are listed on supplementary sheet..
12, CERTIFICATION AND APPROVALS
12.1 System Installation Contractor
This systernas specified herein has been installed according to all NFPA standards cited herein.
JAJA E S DASI LVA 9 20 19
Signed: printed nanic: Date:
Organization: Ak PRO FLFCIRIC,U C Title: F()RF MAN phone:978-98t 9379
12.2 System Operational Test
This system as specified herein has tested according to all NFPA standards cited herein.
JAM ES DASHMA 9 2019
Signed: Printed name: Date:
Organization: A4 U RRO ELECTRIC 11 @ C Title: ORIMAN Phone:
987 9379
12.3 Acceptance'est
Date and One of acceptance test: 9-20 19
Installing contractor representative: JAMES DASILIVA
Testing contractor representative: JAMES[ SHNA
property representative: MIC HAAfL L 'SlAU AlK
AIIJ representative:
CoWqhlr)20t2National Fire NotestonAsiodabon.Th4s,Form may be copied for individual use other than for resale.ft may not be co*d for mmmecdal sale of dstributim.