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Home My WebLink AboutB19-3775 CF Fire Alarm Inspection SYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time ofsystem acceptance and approval. It shall be permitted to modifi,this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data,or calculations as necessary to provide a complete record. Form Completion Date: 4/30/2020 Supplemental Pages Attached: Yes 1. PROPERTY INFORMATION Name of property: Helena Chemical Address: 1566 Nelson Rd. Durham, CA. 95938 Description of property: Warehouse Name of property representative: Helena Chemical Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: Foothill Fire Alarm &Security, Inc. Address: 170 Erma Ct. Chico, CA. 95928 Phone: 530.826.3013 Fax: 530.893.3013 E-mail: alarms@ffprotection.com Service organization: Foothill Fire Alarm&Security, Inc. Address: 170 Erma Ct. Chico, CA. 95928 Phone: 530.826.3013 Fax: 530.893.3013 E-mail: alarms@ffprotection.com Testing organization: Foothill Fire Alarm&Security, Inc. Address: 170 Erma Ct. Chico, CA. 95928 Phone: 530.826.3013 Fax: 530.893.3013 E-mail: alarms@ffprotection.com Effective date for test and inspection contract: Monitoring organization: Foothill Fire Alarm &Security, Inc. Address: 170 Erma Ct. Chico, CA. 95928 Phone: 530.826.3013 Fax: 530.893.3013 E-mail: alarms@ffprotection.com Account number: Z570171 Phone line 1: 530.566.9853 Phone line 2: 530.566.9801 Means of transmission: POTS Entity to which alarms are retransmitted: Butte County Cal Fire Phone: 530.538.7322 3. DOCUMENTATION On-site location of the required record documents and site-specific software: FACP 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system •Modification to existing system Permit number: B19-3775 NFPA 72 edition: 2016 4.1 Control Unit Manufacturer: Silent Knight Model number: 5700 4.2 Software and Firmware Firmware revision number: N/A 4.3 Alarm Verification a This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds Copyright m 2012 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. SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120vac Control panel amps: 3 Overcurrent protection: Type: Circuit Breaker Amps: 20 . Branch circuit disconnecting means location: Elec. Rm. Panel "LAA° Number: 22 5.1.2 Secondary Power Type of secondary power: Batteries • Location,if remote from the plant: FACP Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 15 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 I Dual Media Pathway I Separate Pathway i Class ! Survivability Level Signaling Line I I X B 0 . Device Power I I X I B I 0 Initiating Device I I X I B 0 . Notification Appliance I i X I B I 0 • Other(specify): 7. REMOTE ANNUNCIATORS • Type I Location NONE I • I . 8. INITIATING DEVICES Addressable or Type Quantity I Conventional I Alarm or Supervisory Sensing Technology Manual Pull Stations 12 Conventional with Module I A I N/A Smoke Detectors 1 A I A Photoelectric Duct Smoke Detectors 0 I Heat Detectors 1 Conventional with Module I A Fixed/Rate of Rise Gas Detectors 0 I I Waterflow Switches 3 Conventional with Module I A I Flow Tamper Switches 15 Conventional with Module I S I Switch Copyright 0 2012 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. SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type I Quantity I Description Audible I I Visible I 4 I Strobe Combination Audible and Visible I 14 I Horn Strobe 10. SYSTEM CONTROL FUNCTIONS Type I Quantity Hold-Open Door Releasing Devices I N/A HVAC Shutdown N/A Fire/Smoke Dampers I N/A Door Unlocking I N/A Elevator Recall ! N/A Elevator Shunt Trip N/A 11. INTERCONNECTED SYSTEMS IN This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specified herein has been installed according to all NFPA standards cited herein. � Signed: 5 P0�/ Printed name: Shane DeValera Date: 4/30/2020 organization: Foothill Fire Protection Title: Manager Phone: 530.826.3013 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: c ,yy . Z7d/alg44., Printed name: Shane DeValera Date: 4/30/2020 Organization: Foothill Fire Protection Title: Manager Phone: 530.826.3013 12.3 Acceptance Test Date and time of acceptance test: 4/30/2020 12:00//PM Installing contractor representative: c/// ._/L� Z72YG Testing contractor representative: c5'%2 t4. Z 4.1 Property representative: ., AHJ representative: (/ J L I 30--24 Copyright B 2012 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. NOTIFICATION APPLIANCE POWER PANEL SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion.It includes a list of types and locations of notification appliance power extender panels. This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Form Completion Date: 4/30/2020 Number of Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: Helena Chemical Address: 1566 Nelson Rd. Durham, CA. 95938 2. NOTIFICATION APPLIANCE POWER EXTENDER PANELS Make and Model Location Area Served Power Source PSN-106 AG Chem (North Whse) L1 } I See Main System Record of Completion for additional information,certifications,and approvals. Copyright 0 2012 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.