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HomeMy WebLinkAboutFAI20-0005 CF Alarm Test 2020 72-48 NATIONALFIREALARM AND SIGNALING CODE • SYSTEM RECORD OF INSPECTION AND TESTING This form is to be completed by the system inspection and testing contractor at the time of a system test. 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. Attach additional sheets,data,or calculations as necessary to provide a complete record. Inspection/Test Start Date/Time:06/18/2020 I 13:45 Inspection/Test Completion Date/Time: 06/18/2020 I 16:00 Supplemental Form(s)Attached:NO (yes/no) 1. PROPERTY INFORMATION Name of property: HAZEL HOTEL Address: 880 HAZEL GRIDLEY CA 95948 Description of property: Name of property representative: Address: Phone: Fax: E-mail: 2. TESTING AND MONITORING INFORMATION Testing organization:VYANET OPERATING GROUP Address: 410 SW COLUMBIA SUITE 120 BEND OR 97701 Phone:541-241-1800 Fax: E-mail: Monitoring organization: TMS Address: 2440 GLENDALE LANE SACRAMENTO CA 95825 Phone:888-610-4377 Fax: E-mail: Account number:821-1994 Phone line 1:530-846-6013 Phone line 2: 530-846-6014 Means oftransmission: POTS Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION Onsite location of the required record documents and site-specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer:SILENT KNIGHT Model number:5820XL 4.2 Software Firmware Firmware revision number: • 4.3 System Power 4.3.1 Primary(Main)Power Nominal voltage: 120 Amps: Location: HOUSE PANEL Overcurrent protection type: CIRCUIT Amps: Disconnecting means location: BREAKER ©2012 National Fire Protection Association NFPA 72(p.1 of 4) FIGURE 7.8.2(g) System Record of Inspection and Testing.(SIG-TMS) 2013 Edition ' DOCUMENTATION 72-49 SYSTEM RECORD OF INSPECTION AND TESTING (continued) 4. DESCRIPTION OF SYSTEM OR SERVICE(continued) 4.3.2 Secondary Power Type:SLA Location:PANEL Battery type(if applicable): DURACELL 12 VOLT 8 AH (2) Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): . 5. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact:TMS Time: 13:45 Building management Contact: ON SITE Time: 13:45 Building occupants Contact: Time: Authority having jurisdiction Contact:GRIDLEY FIRE Time: 13:45 Other,if required Contact: Time: 6. TESTING RESULTS • 6.1 Control Unit and Related Equipment ' Visual Functional • Description I Inspec ion I Test I Comments Control unit Y V, Lamps/LEDs/LCDs V Fuses 0 , ❑ N/A Trouble signals V V Disconnect switches 0 0 N/A Ground-fault monitoring 0 0 N/A • Supervision V '1, Local annunciator V V • Remote annunciators 0 0 N/A Remote powerpanels 0 0 N/A 0 0 6.2 Secondary Power Visual Functional Description I Inspec31on Test I Comments Battery condition vo ltage oltage Load Discharge test i— V I— Z( J !— Charger test I - _ I _ ' I Remote panel batteries I U I 0 ©2012 National Fire Protection Association NFPA 72(p.2 of 4) FIGURE 7.8.2(g) Continued 2013 Edition iv7 72-50 NATIONALFIREALARMAND SIGNALING CODE SYSTEM RECORD OF INSPECTION AND TESTING (continued) 6. TESTING RESULTS (continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices. 6.4 Notification Appliances Attach supplementary appliance test sheets for all notification appliances. 6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface/Signaling Line Circuit Interface/Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes, No Time Comments Alarm signal 0 1 14:26:39 Alarm restoration 0 114:49:38 Trouble signal I 0 114:01:02 Trouble restoration M I 0 114:04:00 Supervisory signal � I 0 I 15:24:58 Supervisory restoration I 0 115:25:04 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal Alarm restoration 0 SY( Trouble signal 0 V"j Trouble restoration Supervisory signal I _ 0 I ' • , I Supervisory restoration I 0 I I I ©2012 National Fire Protection Association NFPA 72(p.3 of 4) FIGURE 7.8.2(g) Continued `:.� 2013 Edition DOCUMENTATION 72-51 SYSTEM RECORD OF INSPECTION AND TESTING (continued) 7. NOTIFICATIONS THAT TESTING IS COMPLETE 16:00 Monitoring organization Contact:TMS Time: 16:00 Building management Contact: ON SITE Time: Building occupants Contact: Time: Authority having jurisdiction Contact: GRIDLEY FIRE Time: 16:00 Other,ifrequired Contact: Time: 8. SYSTEM RESTORED TO NORMAL OPERATION Date:6-30-2020 Time: 1200 • 9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72,2013 edition,Chapter 14. Signed: eJZ '4' Pai6PP Printed name: Connor Dalton Date: 6-30-2020 Organization: Eagle Security Systems Title: Technician Phone: 530-345-6395 Qualifications(refer to 10.5.3): 10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING,OR MAINTENANCE UNABL{�6-TEo i u • • 10.1 Acceptance by Owner or Owner's Representative: The undersigned acc pted the testst report for the system as specified herein: ( r',�,( (3oj2° PrintednamJ &._() Ii1( `+ ( Date: Organization: ski)/ l l( Title: t lit Phone:TN(D,Z OO ®2012 National Fire Protection Association NFPA72(p.4 of 4) FIGURE 7.8.2(g) Continued 2013 Edition ::� 72-52 NATIONALFIREALARM AND SIGNALING CODE NOTIFICATION APPLIANCE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. It includes a notification appliance test record. This form is to be completed by the system inspection and testing contractor at the time of the inspection and/or test. 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. InspectionfTest Start Date/Time:06/18/2020 13:45 Inspection/Test Completion Date/Time:06/18/2020 116:00 6-30-2020 1200 Number of Supplemental Pages Attached: 1 OF 4 1. PROPERTY INFORMATION Name ofproperty: HAZEL HOTEL Address: 880 HAZEL GRIDLEY CA 95948 2. NOTIFICATION APPLIANCE TEST RESULTS Appliance Type Location/Identifier Test Results HORN APT 1 BEDROOM PASS HORN APT 1 PASS HORN APT 3 PASS HORN APT 3 PASS HORN APT 4 PASS HORN STROBE APT 4 PASS HORN APT 5 PASS HORN STROBE APT 5 PASS HORN STROBE APT 2 PASS HORN APT 6 PASS HORN APT 6 PASS HORN STROBE APT 7 PASS HORNSTROBE APT 7 PASS HORN APT 7 PASS HORN STROBE I APT 8 I PASS HORN I APT 9 I PASS HORN STROBE I APT 9 I PASS HORN I APT 13 I PASS HORN APT 13 PASS HORN APT 12 PASS ©2012 National Fire Protection Association NFPA 72(p.1 of 2) FIGURE7.8.2(h)Notification Appliance Supplementary Record of Inspection and Testing.(SIG-TMS) 2013 Edition DOCUMENTATION 72-53 NOTIFICATION APPLIANCE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 20F4 2. NOTIFICATION APPLIANCE TEST RESULTS (continued) Appliance Type Location/Identifier Test Results HORN STROBE I APT 11 I PASS HORN I APT 11 I PASS HORN APT 10 PASS HORN STROBE APT 10 PASS STROBE MENS RESTROOM I PASS STROBE WOMENS RESTROOM I PASS HORN STROBE RESTROOM HALLWAY _ I PASS STROBE RESTROOM HALL I PASS HORN STROBE C2 RESTROOM PASS WATERFLOW BELL EXTERIOR PASS HORN STROBE FACP I PASS I I See main System Record of Inspection and Testing for additional Information,certifications,and approvals. ®2012 National Fire Protection Association NFPA 72(p.2 of 2) FIGURE 7.8.2(h) Continued 2013 Edition n 72-54 NATIONALFIREALARM AND SIGNALING CODE INITIATING DEVICE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. It includes an initiating device test record. This form is to be completed by the system inspection and testing contractor at the time of the inspection and/or test. 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. Inspection/Test Start DatefTime:06/18/2020 13:45 Inspection/Test Completion Date/Time: 06/18/2020 116:00 6-30-2020 1200 Number of Supplemental Pages Attached: 30F4 1. PROPERTY INFORMATION Name of property: HAZEL HOTEL • Address: 880 HAZEL GRIDLEY CA 95948 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results PULL 57 LOBBY PASS SMOKE 41 FACP PASS SMOKE 42 1ST FLOOR ELEVATOR PASS SMOKE 37 ELEVATOR CONTROL ROOM PASS HEAT 04 ELEVATOR CONTROL ROOM PASS SMOKE 46 SPACE B PASS SMOKE 47 SPACE A PASS SMOKE 48 SPACE A PASS SMOKE 49 SPACE C I PASS SMOKE 50 SPACE C RESTROOM I PASS SMOKE 51 SPACE C WORK ROOM PASS SMOKE 52 SPACE D2 Pass SMOKE 53 SPACE D1 Pass SMOKE 27 APT 10 PASS SMOKE 26 APT 10 PASS WATERFLOW 45 EXTERIOR CORNER PASS SMOKE 29 APT 11 PASS SMOKE 30 APT 11 PASS SMOKE 32 APT 12 PASS SMOKE 34 APT 13 PASS • ©2012 National Fire Protection Association NFPA 72(p.1 of 2) FIGURE7.8.2(i)Initiating Device Supplementary Record of InspectionandTesting.(SIG-TMS) iii tow? 2013 Edition DOCUMENTATION 72-55 INITIATING DEVICE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 4OF4 2. INITIATING DEVICE TEST RESULTS (continued) Device Type Address Location Test Results SMOKE 35 APT 13 PASS SMOKE 55 MENS RESTROOM PASS SMOKE 54 WOMENS RESTROOM PASS SMOKE 01 APT 1 PASS SMOKE 02 APT 1 PASS SMOKE 04 APT 2 PASS SMOKE 06 APT 3 PASS SMOKE 07 APT 3 PASS SMOKE 43 ELEVATOR 2ND FLOOR PASS SMOKE 09 APT 4 PASS SMOKE 10 APT 4 PASS SMOKE 13 APT 5 PASS SMOKE 12 APT 5 PASS SMOKE 16 APT 6 PASS SMOKE 15 APT6 PASS SMOKE 18 APT 7 PASS SMOKE 19 APT 7 PASS SMOKE 21 APT 8 PASS SMOKE 23 APT 9 PASS SMOKE I24 IAPT 9 PASS SMOKE 38 ELEVATOR SHAFT PASS HEAT 04 ELEVATOR SHAFT PASS SUPERVISORY 144 I BUTTERFLY I PASS I I I 1 I I I I I I I See main System Record of Inspection and Testing for additional information,certifications,and approvals. ©2012 National Fire Protection Association NFPA 72(p.2 of 2) FIGURE 7.8.2(i) Continued 2013 Edition 1101