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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.