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HomeMy WebLinkAboutB19-1758 CF Fire Alarm 2019 Kitchen 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: 7 I♦ 2 PM Inspection/Test Completion Date/Time: 7 t /1 L/pa, Supplemental Form(s)Attached: (yes/no) 1. PROPERTY INFORMATION Name of property: IOW I N e A A L1.,, Address: Description of property: Name of property representative: 140 i N elat41)1I' ^} Address: Phone: Fax: E-mail: 2. TESTING AND MONITORING INFORMATION 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 Monitoring organization: Foothill Fire Alarm& Security, Inc. Address: 170 Erma Ct. Chico, CA. 95928 Phone: 530.826.3013 Fax: E-mail: Account number: ZS-1 uL G1 Phone line 1: iri1 A Phone line 2: eeZ i Means of transmission: Entity to which alarms are retransmitted: /3j./r r"' /C// Phone: 530 - 5 3 7 3 z..2- 3. Z3. DOCUMENTATION On-site location of the required record documents and site-specific software: p`,(i i,--- 4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer: )41I RCO M Model number: F x _ Z-C)0t0 4.2 Software and Firmware Firmware revision number: N6 4.3 System Power JJJ 4.3.1 Primary(Main)Power Nominal voltage: 120 �/ At Amps: 5 Location: tit et{IQ c. TPf Overcurrent protection type: Co Amps: Al:', 15 Disconnecting means location: F^1 L 2 }-3 B Copyright©2012 National Fire Protection Association.This form maybe copied for individual use other than for resale.It may not be copied for commercial sale or distribution. (p. 1 of 4) SYSTEM RECORD OF INSPECTION AND TESTING(continued) 4. DESCRIPTION OF SYSTEM OR SERVICE(continued) 4.3.2 Secondary Power Type: Batteries Location: Panel Battery type(if applicable): Sealed Lead Acid Calculated capacity of batteries to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 5. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: 64-/r9 Time: Building management Contact: Itr5 Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if required Contact: Time: 6. TESTING RESULTS 6.1 Control Unit and Related Equipment Visual Functional Description Inspection Test Comments Control unit 0 Lamps/LEDs/LCDs Er' 0 Fuses ®"" ❑ Trouble signals 0 Disconnect switches [( 0 Ground-fault monitoring 0 0 Supervision 2' 0 Local annunciator fa' 0 Remote annunciators ❑ ❑ n Remote power panels 0 0 N//f rpt. 0 0 / �'! 6.2 Secondary Power Visual Functional Description Inspection Test Comments Battery condition a a- /N ' 7-i-/q Load voltage a a Discharge test ®" Er Charger test ❑' g Remote panel batteries E' la /vAi Copyright @ 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. (p.2 of 4) 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 0 Alarm restoration ❑ 0 Trouble signal 0 0 Trouble restoration 0 ❑ Supervisory signal 0 0 Supervisory restoration ❑ ❑ 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal 0 0 m/!4- Alarm restoration 0 0 Trouble signal 0 ❑ Trouble restoration 0 0 Supervisory signal 0 0 Supervisory restoration 0 0 Copyright©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. (p. 3 of 4) SYSTEM RECORD OF INSPECTION AND TESTING (continued) 7. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Ff Time: Building management Contact: 1/45. Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if required Contact: Time: 8. SYSTEM REST/i ?, D TO NORMAL OPERATION Date: 7// ( Time: 9 //y, 9. CERTIFICATION This system ass ecitied herein has been inspected and tested according to NFPA 72,2011}33�edition,� (( Chapter 14. Signed: ( Printed name: Sha beVQ(.lk Date: 7 f[©1 Z-v1 i Organization: ff17 Title: nGfv?t. cyf4.-- Phone: Sal✓. 3Z •30 I 3 Qualifications(refer to 10.5,3): /C fes/ Y ill 12.--,4, 10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: Printed name: Date: Organization: Title: Phone: Copyright©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. (p.4 of 4)