HomeMy WebLinkAboutPermit - Replacement of Fire Alarm Panel - 2 Harvest Drive - Permits - 11/15/2019 T
w
'r# Application for Standard Permit
FP-006 return completed application to:
(Rev,1.1.201 )
Permit plumber: DIG SAFE NUMBER
City or Town:
Start Date:
Date: � -----
kJ
1n accordance with the provisions of M.G.L.Chapter 148,as provided in Section application is heroby made
by cvioz_�� .__1z1_. A; SW
(Full Nar6 of P Ord, irrn or Corporatio (Phone Number)
%nu� NIA olaeao--o
(Address:Street or P.O.Box,City or Jovn,21p Code)
for permission to state clearly purpose for which permit is requested)
4--
* .
'�L
(( el 10�t
i
irne of Competent perato if pl oble � ert, o
Date Issued-rejected By
feature fApplicant)
Date of expiration Fee Amount Paid
F P-00
(Rev.1.1. 01 ) PERMIT
City or Town: r'A
DIG SAFE NUMBER
Date:
Start Date:
Permit lumber(if applicable):
In ac o dance With the provisions of 1. .L.Chapter 148,as provided in this permit is granted
to 69 �t* q4.
(Full flame of Person, irrn or Corporation)
or
?-eOL, 1� `
_ S : (�
Restrictions:
5
ti
(street a or D cribe Location for Adequate ld ntif cation)
Fee Paid " 's p it will expire on
Signature of Official Granting Permit: Title r/1
;� This Permit MUSt be conspicuously posted upon the premises
*loop""
Fire Alarm Panel
IF
Hel co Electric Int,
ICAL CONTRACTORS SINCE19C4
Inspection Report
ZER0 CENTENNIAL DRIVE,,PEABODY,MA01960-7902 (978)532-71,1�M/FAX(978)532-2,524I
PROPERTY i i INSPECTION DATE SYSTEM TYPE
Oakrdge Vllage 4Y
ADDRESS, TEST TYPE
QTR
2100 Harvest Drive Bui lding 2 F] ANNUAL QUARTERLY OTHER
CITY STATE INSPECTOR(S) LICENSE
Y
North Andover MA
CONTROL PANEL FUNCTIONS DEFECTS ORNIALF NI' CTIONSFOUND IN CONTROL PANEL DURING TESTING: YES NO
MANUFACTURER MODEL#
PANEL TYPE CONNECTED ZONES,I: CON'NECTED NACS
41111
ADDRESSABLE CONVENTIONAL
> tc
- I I
Ll
ACTIVATION EACH ZONE TESTED PROPER zdNE ACTIVATIO PROPER PiA.C.P,ACTIVATION, PRO PERANN UN I TI N PROPER ZONE RESTORE
'YES NO NO
FILINt"ITIONIS YES NO E S N 0 NO YES
'Y YES
B SUPERVISORY "
ZONE'TROUBLE SIGNALTROUBLE A/C LbS RY F
s ATTEAIL URE TRAN"MISSION TROUBLE
FUNCTIONS PASSE] FAIL PASSE] FAIL PASSE] PAIL PA F] FAIL F FAIL
IF L PASS, N/A
IF
SIGNALLING ALL SOUND SIGNALLING HO,RN/STROB,E E ORN 1:1 STROBE EJ SPEAKER/STROBE
TYPE , -1 SPEAKER
SELECTIVE MEANS HOIRN/LIGHT BELL I OUTDOOR BEACON
NOTIFICATION OUTPUT TYPE INTERNAL COMMUNWATION SYSTEM
CONSTANT E CODE 3(T-3), E] MARCH TIME H I LO OTH E R N/A 0 P E]ASS FAIL
ll FI I,
N/A RADIO/MA RBO STEIX
MONITORING COMPANY ACCIAI'01,41A(A
MUNICIPAL,
NOTIFICATION INN PASS FAIL N YES Ej NO YES NO
# 317
C8 LOCATION LABELLED IN FACP DEDICATED C.B. BREAKER LOCK QTY MODEL#
VOLT W/A.C. VOLT W/LOAD
POWER BAr7ERIES
YES NO 01'YES NO YES NO
make note of date
OA
AUXILARY FUNCTIONS () ,rd /0
N/A
DOOR HOLDERS N/A QTY VOLT HVAC SHUTDOWN AUTO RESTART
PASS [:] FAIL, NOT TESTED PASS FAIL YES N 0
SMOKE EXHAUSTSYSTEM N/A SYSTEM IN ELEVATOR RECALL DATE TESTED
NOT TESTED F1 PASS [:] FAIL Ej PASS 0 FAIL
ANNUNC IATOR,PANELYrJa, LOCATION/TYPE MODEL#
BOOSTE R PA NCI E L 0 P ERATIO N I,-R-N/A LOCATION($
PASS 0 FAIL CITY:
PASS FAI L East Lobby/Full
DETECT,ION/1NDICATION EQUIPMENT DEFECTS OR MALFUNCTIONS FOUND IN DEVICES TESTED". YES NO
SMOKE DETECTORS MODEL H QTY MODEL,N QTY
MODEL OTY# MO DEL# QTY
1
Sign, PS
HEAT DETECTORS MODEL# QTY w MODEL# QTY MODEL#/QTY MODEL# QTY
F
q
NI
MANUALSTATIONSI MODEL,ft/QTy MODEL# QTY MODEL#/QTY MODEL,#/QTY
Sin 278
INDICATING DEVICES MODEL# QTY i MO DEL# QTY MODEL# QTY MODEL#/QTY
A111
('71
J
multi CQ
NOTATIONS/IRECOMMEDATIONS EMERGENCY LIGHTS'Ti YES NO,
2 . .....
67,7 1�
v
-00AFM
Helco Electric Inc. FIRE ALARM, EQUIPMENT
ELECTRICAL,CONTRACTORS SINCE 1964 INSPECTION SUMMARY
ZERO CENTENNIAL DRIVE,PEABODY,MA019W7902 (978)532-7500 FAX(978)532-2524
�..........--ow 0��
PROPERTY INSPECTOR j INSPECTION DATE ........
t/11
............
'4�
OaRrIdge Village 4-, 16"I"I'll"If"
CA
NN
,ADDRESS LICENSE 4 PAGE
200 Harvest Drivel North Andover OF
SD-SMOKE DETECTOR FT-FIXED TEMP HEAT H-HORN HS-HORN STROBE BK-BEACON
DS-DUCT SMOKE DETECTOR RR-RATE,OF RISE HEAT TROBE SIBS-SPEAK,E R STROBE D,H-DOOR HOLDER
BD-BEAM:DETECTOR, PS-PULL STATION' B-BELL SP-SPEAKER RA-DEVICE ANNUNCIATOR.
z Proper
Type Model# Floor Location Address operation Note
SCE Si g,a PS 1 by FACP 1-002
PIS Sip 278 1 by EACH'
SD Siga PS 1 West Entranice, Lobby 1-003
.................
SD Siga PS 1 by stairway
........... ............
�SD Si ga PS, 1 West St a i rwel I I
SD Sig PS, 1 West Stairway by Storage 1-006
PIS Sli West Stairwell by Exit Door 1-127
SD �siga PS, 1 ha llw ay by 103/105
--��-�-� .--I'll �- .-'- ............
SD SIP PS 1 hallway by 1,06/107'
1 Storage B
SD Sip PS 1 Water/Fire Room 1-010,
SD Siga PS I hallway by,1107/108 1-012
SD Siga PS 1 halllway by 109/11�O 1-013
SD Sip PS 1 hallway by East Stairway 1-0,17'
SD Sip PS 1, East Interior Lobby 1-018
�SD Siga PS, 1 East Vestibule
PS Sig,a 278 1 East Vestibule 1-128
SD Sip PS 1 East Stairway by Commion HaIll 1-0,14
SD Siga PS 1 East Stairway by Exit Door
.® .
............
ps Sip 278 1 East Stairway 1-129
............ 11"1 1.1.".�1.� -1.1-1-1----, ". - "I 1 11,, I-,---,,,"1 11 1 1 1 11 11 1 1 1,,,,, ,,,�..............................- -
S D Sign PS 1 Electrical Room 1-016,
SD Sip PS 2 East,Stairway 2nd Floor
P S Sip 278 2 hallway by East Staway ir
.......................................... ...... ............... ..................
S D Sigahallway by 2,13/212 1-030
-1-1.1--.1 1 1-1-1-11 -I.�,-��I-',- -1-11111 1 '1'11.-1 1���l" ............................................................
2 Storiage, Room E
SD Sip PS 2 hallway by#211 1-0219
.............. ...............
S D Sip PS 2 hallway by#207 1-0,28
SD Si ga PS 2 Storage, Room by Elevator 1-02�7
SD Si ;a PS, 2 Storage Room D
1-1.1-11111-111 11 1-1 11-11-11- 111111111111-1111 � 111-
SD Siga PS hallway by 2051/20,6 1-024 2
A.Pff Helco Electric Inc. FIRE ALARM EQUIPMENT
ELECTRICAL CONTRACTORS - SINCE 1964 INSPECTION SUMMARY
ZERO CENTENNAL DRIVE,PEABODY,MA019W.7902 (978)532-75W FAX(978),532-2524
PROPERTY INSPECTOR INSPECTION DATE ��� n m.w..� ���
2,
O akri dge'Vill age
ADDRESS LICENSE #
, e i
PAGE
OF
200 Harvst Drve, North Andover
SD-SMOKE DETECTOR FIT-FIXED TEMP HEAT HI-HORN HS,-HORN STROBE BK,-BEACON
DS-DUCT SMOKE DETECTOR RR-'RATE OF RISE HEAT S-STROBE BPS-SPEAKER, STROBE DH-DOOR HOLDER
BD-BEAM DETECTOR PS-PULL STATION B-BELL SP-SPEAKER RA-DEVICE ANNUNCIATOR
zone P,rope�r
Type Model# Floor Location Note
Address Operation
7
SD Sip PS 2 haltway by#2031
PS Sip 278 2 hallway by,West Stairway 1-145
SD Sip PS 2 hallway by West Stairway
SI) Su PIS 2 'West Stairway
.......... ...........
�SD Si ga RS 3 West Stairway
SD Siga PS 3 hallway by West Stairway
P S Si ga 278 3 hallway by West Stairway
SD Siga P'S 3 Storage Room, F
............ ....... ..........
SID Siga PS �3 hallway by#303
SD Siiga PS 3 hallway by 305/
-111111-11 --,�,- -,- 1----1-1, .................
SID Siga PS 3 Maintenance Room
..............
SD Siga PS, 1-037 3, Roof Access
SD Si ga PIS 3 hallway by 307/308 1-040,
SD Slip PIS 3 hallway by#31019 1-041
�1".��,".,-,- �"...,,,,,,-� ....................... .......
SD Sign PS 3 Storage Room G
............. ....................................................................................................
Sl) Siga PIS, 3, hal lw East Stairs ay by 101,46
...........I--..................
P 1 IS Sig,a 2,78 3 hallway by East Stairs -146
................
SID Sip PS 3 East Stairway 1-047 ...........
.................... .......... ............ ........ .......
E]
........................................................................................................... ...........................................................................
H lti 'Is,t Floor Qty(8)S Mu CD I
HS, Multi CD 2 2nd Floor Qty(5)
HS Multi CD 3 3rd Floor Qty('5)
BK OS Outside Beacon(west end facing 1114)
..........
El
FIRE,ALARM AND EMERGENCY COMMUNICATION SYSTEM REC10RD OF COMPLETION
To be conipleteel by the systein installatioti contractor at the ffine qj'syslem acceptance and approval.
It shl a,l'l be permittedlo nwdify thisfib),-in as needed to,pi-ovide a mom,coniplete,andloi-clear recoi(L
hisert NIA In all unused fines.
A'ttach additional sheets,data,or calculations as,necessaty to pmi-4de a coniplete recont
1. PROPERTY INFORMATION
Naine of pr,operty: Oakridge Village
Address:1 2 Harvest Drive,North An dover,MA 01845
Description of property: condominlurn Building
Occupancy type,- Residential
Name of property rpresentatilve: Property Managerrnent of,Andover
Address,: 439 SOUth Union St,Lawrenc,e,MA,01,843
Phone: ('978)683-4101 Fax-,, (978)686,4664 E-mall-. eitaier@pniaridover.,coiii
Authority havingjunisdilict'lion over this property: North Andover(Fire!Department
Phon,e- (978)6,88-9590 Fax- (978)68,89594 E-mail:
2. INSTALLATION,SERVICE,AND TESTING CONTRACTOR INFORMATION
Installation conti-actor for this equipi'lient: Fielco Uectric Inc
Address-, Zero Centennial IDr,Peabody,MA 0196�O
License or certification number- Master Electrical License A62,38
P (978)532-7500 (978)532-2524 seivic�edept@helcoeIllec,l"ric corn
1,1011,e* Fax: Eniail:
Service or P
ganization for this equipnient: IRB Allen CO
Address: 131 Lafayette Rd, Nw1h Haniptun,Wi 03,862'
License or,certification,nuinber- 2901 D
Phone: (800),258-72"64, Fax: E-mail: rbaHen@rballen.com
A cmitract for test and ire sI)ection in accordance with NFPA standards is in effect as
Contir-aictcd testing company: Same as installation contraictor
Address:
Phone: Fax: E-rnail:
Contract expires: Cotitract imi'liber: Frequency of routine inspections: Avinual
inspection
3. DESCRIPTION OF SYSTEM OR SERVICE
Fire alarm systcni('11onvolce)
El Fire alarni with in-buil.din re emergency voice,alarm communication systcm(EVACS)
®i Mass ii,otificatin system(MNS)
0 Combination systeui,,,with the following coniponents*
0
11, -building,emergency cornmunicat" sysm Fire alarm EVACS [I MNS El Two-way in 1011 te
NFPA 7'2, Fig. 110.18.2.1.1 Q). 1, of 12)
Copyright Q 2009 National Fire Protection Assodation.This f6rm may&e copied for indMdual use other then for resale.it may not be copied for commerciat sate or distribution.
Other(sl)ccif�):
3. DESCRIPTION OFSYSTEM OR SERVICE (continued)
NFrPA 72 cditjoil., Addition,al descriptlion of system(s).-,
3.1 Control Unit
Manufacturer: Edwards Model number: 10,1000 RD
3.2 Mass Notiffication System This system does not incorporate an MNS
12.1 System Type,*,
In-build'Ing MNS—combination,
In-building MNS—stand-atone Wide-area MNS El DistTib art ed recipient MNS
Other(Specify):
3.2.2 System Features to
Colubination fire alanm/MNS El MNS auto,nonious control unit El Wide-ai-ea MNS to reglional.national
aleilin interface I g I
El Local operatthig con BLOC) Direct recipient MNS(DR MNS) El Wide-area MNS to DRMNS int rfAce
W,i,dc-area MNS to high-power speaker array( ,SSA)interface Z In-building MNS to old area MNS,interface
Other(spcciif�),
33 System Documentation
An owner's manual,a copy of the inanufactiner's instructi''ons,a written sequence of operation,and a copy of'
the numbered record drawings are stored on s4e. Location: selpar'ate b1fldt ig-Clubhouse in centeir,of property
3.4 Systeni Software El This system does not have alterable site-specific software.,
Operafin, ystcni(executiv tware revision level;
Site-specific software revision,date.-, 11/25/119 Revision completed by: RB Affe `ecNiic ar
El A copy of the site-specific software is stor ed.on site. Locatioll'.
15 Off-Premises Signal Transimission This system does tint lave off pmnuses tratisim Is i ►n.,
Name of organization receiving alarm signals with phone numbers:
Alarin: Nort1h Andover Fire Diepart ment, Phone- (1978)688-9590
Supervisory: to be added in 2020 Phojw-
Trouble-. to be added N,,i 2020 Plione*
Entity to,which alarms are retransmitted: Phone.-
Method of retransMISS1,011: Radio box ill ClUbl"mUse
If Chapter 26,specify t1le ineans of transmission from the protected premises to,the superviisin; staflotV
If Chapter 27,spec i fy the type of au iliac atatin systein- El Local eater gyy [I Shunt El Wired, ED Wireless
NFI-11A 72, Fig. 101.18.2.1 1 (p. 2 of 12)
Copyright Q 200,91 National Fire Protection Association.This form may be copield for individual use other than for resale.It,may not be copied;for comimercial sale or distribution.
4. CIRCUITS AND PATHWAYS
4A Si'gnaling Line Pathways
4.1.1 Pathways,Class,Designatioliis and Survivability
Pathways class: Class A Survivability level: 0 Quanfity: 2
(See NFPA 72,1 Sections.12.3 on 12.4)
4.1.2 Pathways Utilizing Two or More Media
Quantity*. Description:
4.1.3 Device Power Pathways
I@ No,separate power pathways from the signaling line pathway
Power pathways are separ atebut of the sanie pathway classification as the signaling line pathway
Power pathways are separate and d,I'ffcrcnt classification from the signaling line pathway
4.1.4 Isolation Modules
Quantity:
4.2 Alarm lit itiating'Device Pathways
4.2.1 Pathways Class Designations and,Survivability
Pathways alas: Survivability level: Quantity:
(See,NFPA 72,Sections 12.,3 and'12.4),
4.21 Pathways Utilizing Two or MoreMedlia
Quantity: Descript'10111.1
4.23 Device Power Pathways
0 No,separate power pathways froin the initiating dcv,ice pathway
[]Power,pathways are separate but of the same) thw classification as the initiating device pathway
El.Power patliways arc separate and different classification from the initiating device pathway
4.3 Non-Voice Audible System Pathways
4.3.1 Pathways Class Designations and Survivability
Pathways class: Class A, Survivability level: rntity: 2(panel)
(Sep NFf PA' 72,Sections 12'.3 and 12.4)
4.1.2 Patill.ways'Utillizing Two or More Media
Quandty: Description:
4.3.3 Appliance Power Pathways
[I No separate power pathways ffoin,the notification appliance pathway
[j Power pathways are separate but of the same pat'liway classification as the notification appliance pathway
El Power Pathways,are separate and different classification froni the notification appliance pathway
Nr-PA 721 Hlg,w 10.181.2.1.1 (p.3 of'12)
Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resel .It may not be coded for commercial sale or distribution.
F
. ALARMINITIATIN DEVICES
5.1 Manual Initiating Devices
.1.1 Manual Fire Alarm Boxes ❑This system does not have manual fire alarm boxes.
Type and number of devices: Addressable: 8 Conventional: Coded: Transmitter:
Other(specify):
. .2 Other Alarm Boxes 0 This system does not have other alann boxes.
lescriptioll:
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other(specify):
5.2 Automatic Initiating Devices
5.2.1 Smoke Detectors ❑This system does not have smoke detectors.
Type and number of devices: Addressable: 38 Conventional-
Other(specify:
Type of coverage: ED Complete area ❑Partial area ❑Nonrequired partial area
Other(specify):
Type of smoke detector sensing technology: ❑lonization O Photoelectric ❑lulticriteria ❑Aspirating ❑Beau
Other(specify):
5.2.2 Duct Smoke Detectors This system does not have alarm-causing duct smoke detectors.
Type and number of devices: Addressable: Conventional:
Other(specify):
Type of coverage:
Type of sinoke detector sensing technology: ❑Ionization ❑Photoelectric ❑Aspirating ❑Beam
.2.3 Radiant Energy( lain )Detectors ®This system does not have radiant energy detectors.
Type and number of devices: Addressable: Conventional:
Caber(specify):
Type of coverage:
.2.4 Gas Detectors This system does not have gas detectors.
Type of detectors):
Number of devices: Addressable: Conventional:
Type of coverage:
5. .5 Heat Detectors ❑This system does not have heat detectors.
Type and number of devices: Addressable: Conventional:
Type of coverage: ❑Complete area ❑Partial area ❑I onrequired partial are ❑Linear ®Spot
Type of heat detector sensing technology: El Fixed temperature ❑Rate-of rise ❑bate compensated
NFPA 72, Fig. 10.18, ,1.1 p.4 of 1 )
Copyright�0 2009 National Fire Protection Association.This form Fn ay be copied for Indiv1duat use other than for resale.It stay not be Copied for commercial sale or distribution.
4
. ALARM INITIATING DEVICES(continued)
5.2.6 Addressuble.Monitoring Modules E]This system does not have monitoring modules.
Number of devices:
h
. .'7 Waterllow Alarm Devices E]This system does not have waterflow alarm devices.
Type and number of devices: Addressable: 6 Conventional: Coded: Transmitter:
5.2.8 Alarin Verification This system does not incorporate alarm verification.
Number-of devices subject to alarm verification: Alarm verification set for seconds
5.2.9 Presi nal This system does not incolrpor'ate pre-signal.
Number of devices subject to presignal:
Describe presignal functions:
. .10 Positive Alarm Sequence(PAS) ED This system does not incorporate PAS.
Describe PAS:
. .11 Other Initiating Devices This system does not have other initiating devices.
Describe:
6. SUPERVISORY I NA .-INITI TIN DEVICES
.1 Sprinkler System Supervisory Devices E]This system does not have sprinkler supervisory devices.
Type and number of devices: Addressable: 6 Conventional: Coded: Transmitter:
Other(specify):
6.2 Fire Pump Description and Supervisory Devices 10 This systein sloes not have a fire pump.
Type fire pump: El Electric pump (3 Engine
Type and number-of devices: Addressable: Conventional: Coded: Transmitter:
Other(specify):
. .1 Fire Pump Functions Supervised
El Power 0 Running [:1 Phase reversal El Selector switch not in auto ]Engine or control parcel trouble ❑Low fuel
Other(specify):
.3 Duct Smoke Detectors DSDs This system does not have DSDs causing Supervisory signals.
Type and number of devices. Addressable: Conventional:
Other(specify):
Type of coverage:
Type of smoke detector sensing technology: E]Ionization 0 Photoelectric []Aspirating ]Bealn
6.4 Ocher{Supervisory Devices ED This system does not have other-supervisory device:.
Describe:
NFPA 72, Fig. 10.18.2.1.1 p.5 of 1
ppight 6 2009 National Fire Protedon Associarlon.This form may be copied for Individual use other than for resate.It may not be copied for ommercial sale or distribution.
7. MONITORED SYSTEMS
7.1 Engline-Driven Generator ED'Thl's,sy'stein does not have a gencrator.
7.1.1, Generator Functi'ons Supervised
Engine or control panel troub�le Ej Generator runnitig Selectot•switch not in auto El Low fuel
Other(specif�)-
7.2 S�pecia,l lc mrd Suppressioji.Systenis This system does not nionitor special hazard,systerns.
Description of special hazard systun(s):
7.3 Other Honig ring Systenis This system does not nionitor other,systems.,
Descri ption of special hazard systcrn(s):
8., ANNUNCIATORS This system does not have annuncl'ators-,
Location and Description of Annun,cliators
Location, I- Right side d,ow to buHdirig
Location I
Location 3:
9. ALARM NOTIFICATION APPLIANCES
9.1 In-Bul"'Iding,Fire Etnergency Voice Alarm.Cova nitinlic Ott ion System S This system.does,not,have an.EVACS.
Number of'singic voice alarm channels: Number of multi plevoice slam hannels:
Number of speakers-, Nutnber of speaker circuits-
Location of amplificatioti and sound-process,i,ng of ail.
Location of pa,ging inicrophone stations-
Location 1:
Location,2:
Loco fion,3-
9.2 Nonvoice Notification Appliances 0 This systein does not have non voice notification appliances.
Honis.: 18 With visible: 118 Bells: With visible:
Chillies: Witli visible:
Visible only: Other(describe): IExterior,Beacwi(1)
93 Notification Appliance Power Exteiider Panels El This systern,does not have power extender panels.
Quantity: "I
Locations: IL-eft skle reair,exit I way in stor' e iroom
NFPA 72,F ig. 10.18.2.,1.1 (p. f'12)
Copyright 0 2009,National Hire P rot ection,Association.This form may be:copied for individual use other than for resale.IIt.may not be copied for oornmerow sale or di'stribution.
5
1
1 . MASS NOTIFICATION CONTROLS,APPLIANCES,AND CIRCUITS 0 This system does not have an MNS.
10.1 MNS Local Operating Consoles
Location 1:
Location
Location 3:
10.2 High-Power Speaker,grays
Number ofHPSA speaker initiation zones:
Location 1:
Location :
Location 3:
10.3 Mass Notification Devices
Combination fire alann/MNS visible appliances: MNS-only visibleappliances:
Textual sighs: Other(describe):
Supervision class:
10.3.1 Special Haznrd Notification
tion
❑This system does not have special supprmion 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 asks installed- Number of warden stations installed:
Number of telephone 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 covered by two-way radio service: Critical areas: % General building areas: %
Amplification component locations:
Inbound signal strength: dBin Outbound signal strength: dBin
Donor antenna isolation is dB above the signal booster gain
Radio frequencies covered:
Radio systein monitor panel location:
NF-1.VA 7 2, 1`i9. 10,18,2,1 J 1). 7 cal '1 )
copyright 0 2009 NationaI FI€e Protection As odaitoo.Ws form€oay be copied for individual use other than for resale,it mar riot be copied for commercial sale or distribution,
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS(continued)
1,1.3 Area of Refuge(Area of Rescue Assistance)Emergency Communications Systems
[:]I This systern does not have an area of refuge(atea of rescue assistance),eniergiency cotni'liunications system.
Nuinber of statiolls: Location of central.control,point-.
Days and hours when central control point'is attended,
Location of afternate,control point:
Days and,hiours when altcm,ate control point is attended:
1 L4 Elevator Emergency Communications Systems
El This�systein does not have,an elevator cinergency conine unications,system.
Nunibcr of elevators with statiotis', Location of central control point:
Days and,hours when.central control point is attended:
Location of afteniate control point:
Days and hours when allcmate control point is,attended:
1,I. Other Two-Way Conimunication Systems
Describe:
12. CONTROL FUNCTIONS
This system activates the followhig control fuctions:
I[j Hold-open door releasing devices E]Smoke nianagemerout El IIVAC shutdown n F/S dam pers
El Door,unlocking Elevator recall []Fuel source shutdown E]Extinguishing agent release
[I Elevator shunt trip, E]Mass notification systeinoverrule of fire alarm notification appliances
Other(specify):
12.1 Address,able Confrol,Modules This system does niot have control niodules.
Nuniber of devices:. 2
Other(specify):'
13. SYSTEM POWER
III Control Uni't
1.3.1.1, Primary Power
Input voltage of control panel: 120v Control panel atrips: 2.5 amp
Overcurrent protection: Type- QrcuR Breakieiu,' Anips.: ',20 amps
Location of pritnary supply panel,board): Mair i, ,IN ectir-ical Rooi-n-Rigl"A side re w exit
Disconnecting means location: Main eleldrical lupooffii FI,OLJs,e,Oedrical panel
13.1.2 Engine-Driven Generator ED This systetri does not have a gienie rat or,
Location of generator:
Location of fuel storage: Type of fuel:
Nl--'PA 72, Fig. 10.18.2.1.1 ('p.18 of 12)
Copyright C)2009,National Fire Prot e:ction,Association.This form may b opled for,individual urm other than for resale.Iit.may not be copied for oommerccal sale or distribution.
13. SYSTEM POWER(continued)
13.1.3 Uninterruptible Power Systeni This systeni does not have a UPS.
Equipment powered b UPS system:
Location.of UPS systcin:
Calculated cal.)acity of UPS batteries to drive the system coinponents connected,to it:
In standby niode(hours): In alarni niode(minutes):
13.1.4 Batteries
Location: Left side rear exit Type: PS12330 Norninlal voltage: 24 vDC Atnp/bour rating: 33 AH
tiallway iri storage
room
Calculated capac,ity of battcries to drive the system:
In standby niode O'lours): 240 In ala rni mode(minutes): 120
ID Batteries are marked with date of manufacture Battery calculatiions are attached
13.2 In-Building Fire Eniergency Voice Alarm Communication System,or Mass Notification System
[D T[iis system does nott have an EVACS or MNS system.
13.2.1 Primary Power
Input voltage of EVACS or MNS,panel: EVACS or MNS,panel amps:
Overcurrent protection: Type: Ainps:
Location(of primary supply panel board)-,
Disconnecting means locaftoll:
13.2.2 En gin D riven.Generator This s stem does not have a gene rat or.
y
Location of gcncrator:
Location of fuel storage: Type of fuel-
13.2.3 Uninterruptlible"Power S,ysteni OThis system does no�t have a UPS.
Equipnient powered by a,UPS systcni:
Location of UPS system:
Calculated capacity of UPS batteriesto,dnive the systei�n components connected to it:
In standby inode(hout.$): In alarm mode(niinutes):
13.2.4 Batteries
Location: Type: Nonlinal voltage: Ainip/hour rating:
Calculated capacity ofbattcries to dr'lve the system:
In standby mode(liours.): In a,lann mode(minutes):
Batteries are inarked,with date of manufacture Battciy cal culati'ons are attached
NFF>A 721 Fig. 10.18.2.,1.1 (p.9 of 12)
Copyright 0 2009 Nati n:al Fire:Protection AssocAation.This form may be co pled for Indvidual use other than for resale.it may not,be copled for commercial sate or distribution.
13. SYSTEM POWER(continued)
13.3 Notification Appliance Power,Extender Panels T'lil's,system,does not have power extender panels.
13.3.1 Primary over
Input voltage of power extender panel(s): 120 voit Power extender panel amps: 4anip
Overcurrent protection: Type: drcuft breaker Anips, 20,arnp
Location(of pnimary supply panel board): Left slide rear exit hallway inn storage roorn
Disconnecting ineans lu tion IMain electdc;W room use electrical panell
13.3.2 Engline-Driven Generator This systeni does not have a generator.
Location of generator.,
Location of fuel storage: Type of fuel:
133.3 Uidinterruptible over System 0 This systeni does not have a UPS.
Equipment powered by a UPS systeni-
Location of UPS systeliv
Calculated capacity of UPS batteries to drive the,system components conriectcd to it:
li standby mode(hours): In a1ann mode(ininutes):
13.3.4 Batteries,
L
24 v'D1C ag-, 10 Aocation: Inside Booster Panel Type- PS11270 Nominal voltage, Anip/hour,r fin H
Ca1culated capacity of batteries to drive the system:
In standby mode Qiours) 300 In alann,mode(nA nut es),: 150
0 Batteries are niarked with date of manufacture E]Battery calculattions are,attached
14. RECORD,OF SYSTEM INSTALLATION
F ill oitt a et-aH installation is complete and wil-ing has bleen checkedfoi-olmns,shoi-ts,giviin dffiii Its,and finproIxt-
01
branching,bw before conth1cmig, operational acceptance tests.
This is a: [I Ncxv system 01 Modification to an existing system Pennit number:
The system has,becti,installed in accordan with.the following requirements:(Note any or all that apply.),
0,NFPA 72,Edition: 2019
[D NFfPA 70,National Electrical Code, Article 760,Edition: 2017
0 Manufacttirer's,pijblished instritchons
Other if�)ec(s :
p I
Systeindeviations from referenced NFPA standards:,
Signed- Printed name: Date:
Organ ization�: Title: Pholie:
Copyright National,Fire Protection Assoletallon.nits form may be copledfor indiViduat use other than for resale.It may not be copied for commexial sale or disIdbution.
ay
15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST
0 New system
All operationaljea'tw-ev' ndfinctions,ofthis splein wel'e tested by,or in the p-esence of the signet-shmtpn
bek
-ope-1 it -datice tipith the i-equit-einents,w,on the date shown below,and wet-efoun(Ito beopet-'(vingpi i i accm
foi-thefiollowing.-
CD Modifications,to an exi;tMg system
All nen?))i ified,opei-(itioiia itti)-ey andfiviell'01mv of theyyslein were tested by o)-in thepi-esence of,the
signer.,vhown belmy,on the date shown befoul)and weivfound to be qpeiahng pmpei-ly,in accoi-clinice nyith the
i-equit-einents of1hefiolloiving:
[--].NFPA 721,Editioll'.
0 NFPA' 70,Nation i-ical Co*,,article'760,Edition",#
0 Manufacturer's published Itisti-tictions
Other(specify):
[]Individual device testing documentation[Inspection and Testing Fora n(Figure 14.6.2.4)is,attached]
Signed: Printed name: Date:
OrganizatloW, Title:' Phone:
16. CERTIFICATIONS AND APPROVALS
16.1, Sy tern Installation Contractor:
This system,a, specified i in,hasbase installed and tested according to all NFPA,standards cited hereill'.
Date: 11/27119
Signed- Printed mine: Jim McRobbie
Organizatioll e'll lectric Title: Servioe Mmiager Phone- 78)5,327500
1.6.2 System Service Contractov:
The undeisigned has a service contractfor this system,in effect as of the date shown below.
Signed: Printed naine: Date:
Organizatioll: Title: Phone:
16.3 Suptrvising Statioll:
This system,as specified herein,will be monitored according to all.NFPA standards cited Ivereill.
Signed: Printed name: Date:
Organizatioa- Title: Phone:
NFPA 72, 1'-i 10.,18.2.1A (p. 11 of 12)
Gopyright @,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.
16. :CERTiFICATIONS ANO APPROVALS(conflnupd)
0;4 Pvqpv.rt.y 6r Owiter Mpksontative:
I uccep�thi q6ni q§h6vhfg bmi ingallod acid tvocod to its tj�MuOhs and,411 NFPA atkdW�ciftod hdmill,
Ninted hable: 0111c:
0rg01117.Afl0n:
err
r
16.5 Authorlty
I blive-NOwes""M u ball"Auc tory ncecl).I III c 1:00 1 t 11',isys(en'i and find It tit by inm4licd wid opewting pry poly
in two6r(h'ilive,with itg 11ppr-oved plaw.-611d Spec.i I'l pill with its of operotions,and wi.111 aII
NFPA,stond,qrd,&6W budn,
signud: Pfinted nealle: MAV-1
NFPA 72,Fig. 10,1 .1 1 (1) 12 of"I 2)
C.QW01 G.M Nmk"l Ro �j Kj&tjiA,IVA(04-Al may b4 octpO for T*Aduul wt VM then �gja.ft may W d4VW000.