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HomeMy WebLinkAboutNFPA ROC OROVILLE 72-42 NATIONAL FIRE ALARM AND SIGNALING CODE SYSTEM RECORD OF COMPLETION 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. Attach additional sheets,data,or calculations as necessary to provide a complete record. Form Completion Date: Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Oroville Heights Address: 1409 Oro Dam Blvd. West Description of property: Multifamily Name of property representative: Rubik Built _ Address: 1004 Reno Ave Modesto CA 95351 Phone: 209 408 0626 Fax: E-mail: 2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: HCI Systems Address: 1168 W National Dr Suite 70, Sacramento, CA 95834 Phone: (916)419-6900 Fax: (916)419-6903 E-mail: Service organization: HCI Systems Address: 1168 W National Dr Suite 70, Sacramento, CA 95834 Phone: (916)419-6900 Fax: (916)419-6903 E-mail: Testing organization: HCl Systems Address: 1168 W National Dr Suite 70, Sacramento, CA 95834 Phone: (916)419-6900 Fax: (916)419-6903 E-mail: Effective date for test and inspection contract: Monitoring organization: Advanced Monitoring Address: 3566 Investment Blvd Hayward, CA 94545 Phone: 1 855 857-4888 Fax: E-mail: support@advancedmonitoringi Account number: HCIG8318 Phone line 1: Phone line 2: Means of transmission: Cellular Dialer Entity to which alarms are retransmitted: UL Listed Monitoring Station Phone: 18558574888 3. DOCUMENTATION On-site location of the required record documents and site-specific software: Document can near FACP 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: O New system 0 Modification to existing system Permit number: NFPA 72 edition: 2019 4.1 Control Unit Manufacturer: Edwards Signaling Model number: io-64 4.2 Software and Firmware Firmware revision number: 3.7 4.3 Alarm Verification La This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds 02018 National Fire Protection Association NFPA 72(p.1 of 3) A FIGURE 7.8.2(a) System Record of Completion. (SIG-FUN) 2019 Edition Shaded text=Revisions. A=Text deletions and figure.'table revisions, •=Section deletions. N=New material. r.. ....... .. .. .. . y,. ....... ,. .,...r,,............ r,,....,u...,,. .,.,............y,"..r...,..y. DOCUMENTATION 72-43 SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120 Control panel amps: 20 Overcurrent protection: Type: Breaker Amps: 20 _ Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power:_$_ealed.lead acid batteries_ . Location,if remote from the plant: N/A Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 5.2 Control Unit O This system does not have power extender panels O Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Dual Media Separate Survivability Pathway Type Pathway Pathway Class Level Signaling Line X B 0 Device Power X _ _B 0 Initiating Device X B 0 Notification Appliance X B 0 Other(specify): 7. REMOTE ANNUNCIATORS Type Location N/A 8. INITIATING DEVICES Addressable or Alarm or Sensing Type Quantity Conventional Supervisory Technology Manual Pull Stations 1 Addressable Alarm Mechanical Smoke Detectors 1 Addressable Alarm Photoelectric Duct Smoke Detectors 0 Conventional Supervisory Photoelectric Heat Detectors 0 Addressable Alarm Mechanical Gas Detectors 0 Addressable Supervisory Photoelectric Carbon Monoxide Detectors 0 Addressable Supervisory Photoelectric Waterflow Switches 3 Conventional Alarm Mechanical Tamper Switches .8 Conventional Supervisory Mechanical ©2018 National Fire Protection Association NFPA 72(p.2 of 3) A FIGURE 7.8.2(a) Continued Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-44 NATIONAL FIRE ALARM AND SIGNALING CODE SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible 0 Horn Visual 0 Strobe Combination Audible and Visual 1 Horn/Strobe 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices 0 HVAC Shutdown 0 Fire/Smoke Dampers 0 Door Unlocking 0 Elevator Recall 0 Elevator Shunt Trip 0 11. INTERCONNECTED SYSTEMS 0 This system does not have interconnected systems. O 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: Printed name: Reginald Washingi Date: Organization: HCI Systems Title: Field Supervisor Phone: 9165974468 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed:_ Printed name: Reginald Washingl Date: Organization: HCI Systems Title: Field Supervisor Phone: 9165974468 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Reginald Washington Testing contractor representative: Reginald Washington Property representative: AHJ representative: ©2018 National Fire Protection Association NFPA 72(p.3 of 3) A FIGURE 7.8.2(a) Continued 2019 Edition Shaded text=Revisions. 0=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-45 EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion.It includes systems and components specific to emergency communications systems. 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: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. DESCRIPTION OF SYSTEM OR SERVICE 0 Fire alarm with in-building fire emergency voice alarm communication system(EVAC) 0 Mass notification system 0 Combination system,with the following components: 0 Fire alarm 0 EVACS 0 MNS 0 Two-way,in-building,emergency communications system 0 Other{specify): NFPA 72 edition: Additional description of system(s): 2.1 In-Building Fire Emergency Voice Alarm Communications System Manufacturer: _ Model number: Number of single voice alarm channels: Number of multiple voice alarm channels: Number of loudspeakers: Number of loudspeaker circuits: Location of amplification and sound processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 2.2 Mass Notification System 2.2.1 System Type: 0 In-building MNS—combination O In-building MNS 0 Wide-area MNS 0 Distributed recipient MNS 0 Other(specify): ©2018 National Fire Protection Association NFPA 72(p.1 of 3) ©FIGURE 7.8.2(b) Emergency Communications System Supplementary Record of Completion. (SIG-FUN) Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-46 NATIONAL FIRE ALARM AND SIGNALING CODE EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF COMPLETION (continued) 2. DESCRIPTION OF SYSTEM OR SERVICE (continued) 2.2.2 System Features: 0 Combination fire alarm/MNS 0 MNS autonomous control unit 0 Wide-area MNS to regional national alerting interface 0 Local operating console(LOC) 0 Distributed-recipient MNS(DRMNS) 0 Wide-area MNS to DRMNS interface 0 Wide-area MNS to high power loudspeaker array(HPLA)interface 0 In-building MNS to wide-area MNS interface 0 Other(specify): 2.2.3 MNS Local Operating Consoles Location 1: Location 2: Location 3: 2.2.4 High Power Loudspeaker Arrays Number of HPLA loudspeaker initiation zones: Location 1: Location 2: Location 3: 2.2.5 Mass Notification Devices Combination fire alarm/MNS visual devices: MNS-only visual devices: Textual signs: Other(describe): Supervision class: 2.2.6 Special Hazard Notification 0 This system does not have special suppression predischarge notification. 0 MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 3. TWO-WAY EMERGENCY COMMUNICATIONS SYSTEMS 3.1 Telephone System Number of telephone jacks installed: Number of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: 0 Electrically powered 0 Sound powered 3.2 Area of Refuge(Area of Rescue Assistance)Emergency Communications Systems Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: ©2018 National Fire Protection Association NEPA 72(p.2 of 3) A.FIGURE 7.8.2(b) Continued 2019 Edition Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N w New material. ... '. . ............... . ._,.... y .....r.....��r��.... .r N.....�........w rt....... ... v...,. .,.......r..y.. r..... a`„Yr...y. DOCUMENTATION 7247 EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF COMPLETION (continued) 3. TWO-WAY EMERGENCY COMMUNICATIONS SYSTEMS (continued) 3.3 Elevator Emergency Communications Systems Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 3.4 Other Two-Way Communications System Describe: 4. CONTROL FUNCTIONS This system activates the following control functions specific to emergency communications systems: Type Quantity Mass Notification Override of Alarm Signaling Systems or Appliances See Main System Record of Completion for additional information,certifications,and approvals. ©2018 National Fire Protection Association NFPA 72(p.3 of 3) 0 FIGURE 7.8.2(b) Continued Shaded text=Revisions. .=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72.48 NATIONAL FIRE ALARM AND SIGNALING CODE POWER SYSTEMS SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion.It includes systems and components specific to power systems that incorporate generators, ESS systems,remote battery systems, or other complex power systems. 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: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. SYSTEM POWER 2.1 Control Unit 2.1.1 Primary Power Input voltage of control panel: Control panel amps: Overcurrent protection: Type: Amps: Location(of primary supply panelboard): Disconnecting means location: 2.1.2 Engine-Driven Generator Location of generator: Location of fuel storage: Type of fuel: 2.1.3 Energy Storage Systems Equipment powered by ESS system: Location of ESS system: Calculated capacity of ESS batteries to drive the system components connected to it: In standby mode(hours): _ In alarm mode(minutes): 2.1.4 Batteries Location: Type: Nominal voltage: Anipfhour rating: _ Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): 2.2 In-Building Fire Emergency Voice Alarm Communications System or Mass Notification System 2.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: Overcurrent protection: Type: Amps: Location(of primary supply panelboard): Disconnecting means location: O 2018 National Fire Protection Association NFPA 72(p.I of 3) A FIGURE 7.8.2(c) Power Systems Supplementary Record of Completion. (SIG-FUN) 2019 Edition Shaded text-Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-49 POWER SYSTEMS SUPPLEMENTARY RECORD OF COMPLETION (continued) 2. SYSTEM POWER (continued) . 2.2.2 Engine-Driven Generator Location of generator: Location of fuel storage: Type of fuel: 2.2.3 Energy Storage Systems Equipment powered by ESS system: Location of ESS system: Calculated capacity of ESS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 2.2.4 Batteries Location: Type: Nominal voltage: _ Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): - In alarm mode(minutes): 2.3 Notification Appliance Power Extender Panels ❑ This system does not have power extender panels. 2.3.1 Primary Power Input voltage of power extender panel(s): Power extender panel amps: Overcurrent protection: Type: Amps: Location(of primary supply panelboard): Disconnecting means location: 2.3.2 Engine Driven Generator Location of generator: Location of fuel storage: _ Type of fuel: 2.3.3 Energy Storage Systems Equipment powered by ESS system: Location of ESS system: Calculated capacity of ESS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 2.3.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ©2018 National Fire Protection Association NFPA 72(p.2 of 3) A.FIGURE 7.8.2(c) Continued Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-50 NATIONAL FIRE ALARM AND SIGNALING CODE POWER SYSTEMS SUPPLEMENTARY RECORD OF COMPLETION (continued) 2. SYSTEM POWER (continued) 2.4 Supervising Station Transmission Equipment ❑ This system does not use transmission equipment within the building powered by any other source than the alarm system control unit. 2.4.1 Primary Power Input voltage of shared transmission equipment: Shared transmission equipment panel amps: Overcurrent protection: Type: Amps: Location(of primary supply panelboard): Disconnecting means location: 2.4.2 Engine Driven Generator Location of generator: Location of fuel storage: Type of fuel: 2.4.3 Energy Storage Systems Equipment powered by ESS system: Calculated capacity of ESS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 2.4.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): See Main System Record of Completion for additional information,certifications,and approvals. O 2018 National Fire Protection Association NFPA 72(p.3 of 3) 0 FIGURE 7.8.2(c) Continued 2019 Edition Shaded text=Revisions. 0=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 12-51 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 fo provide a more complete and/or clear record. Insert N/A in all unused lines. Form Completion Date: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Guad's Tacos and Beer Address: 231 3rd St. Davis. CA 95616 2. NOTIFICATION APPLIANCE POWER EXTENDER PANELS Make and Model Location Area Served Power Source EST 1ST FL Riser Rm EST 2nd Fl EST 3rd FL EST 4th FL See Main System Record of Completion for additional information,certifications,and approvals. ©2018 National Fire Protection Association NFPA 72 0 FIGURE 7.8.2(d) Notification Appliance Power Panel Supplementary Record of Completion. (SIC-FUN) Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 21319 Edition 72-52 NATIONAL FIRE ALARM AND SIGNALING CODE INTERCONNECTED SYSTEMS SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion.It includes a list of types and locations of systems that are interconnected to the main system. 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: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. INTERCONNECTED SYSTEMS Description Location Purpose See Main System Record of Completion for additional information,certifications,and approvals. 2018 National Fire Protection Association NFPA 72 A FIGURE 7.8.2(e) Interconnected Systems Supplementary Record of Completion. (SIG-FUN) 2019 Edition Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-53 DEVIATIONS FROM ADOPTED CODES AND STANDARDS SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion.it enables the designer and/or installer to document and justify deviations from accepted codes or standards. 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: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. DEVIATIONS FROM ADOPTED CODES OR STANDARDS Description Purpose See Main System Record of Completion for additional information,certifications,and approvals. ©2018 National Fire Protection Association NFPA 72 0 FIGURE 7.8.2(f) Deviations from Adopted Codes and Standards Supplementary Record of Completion. (SIG-FUN) Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition .. ,M.............. .. .. ..,„w.. ....r... ,. .,. _r„.....,,,...,, �.... 72-54 NATIONAL FIRE ALARM 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: Inspection/Test Completion Date/Time: Supplemental Form(s)Attached: select.. (yes/no) 1. PROPERTY INFORMATION Name of property: Address: Description of property: Name of property representative: Address: Phone: Fax: E-mail: 2. TESTING AND MONITORING INFORMATION Testing organization: Address: Phone: Fax: E-mail: Monitoring organization: Address: Phone: Fax: E-mail: Account number:_ Phone line 1: Phone line 2: Means of transmission: 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: Model number: 4.2 Software Firmware Firmware revision number: 4.3 System Power 4.3.1 Primary(Main)Power Nominal voltage: Amps: Location: Overcurrent protection type: Amps: Disconnecting means location: Q2018 National Fire Protection Association NFPA 72(p.1 of 4) FIGURE 7.8.2(g) System Record of Inspection and Testing. (SIC-TMS) 2019 Edition Shaded text=Revisions. G1 =Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-55 SYSTEM RECORD OF INSPECTION AND TESTING (continued) 4. DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: Location: Battery type(if applicable): 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: Time: Building management Contact: 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 0 Lamps/LEDs/LCDs 0 0 Fuses 13 0 Trouble signals 0 0 Disconnect switches 0 0 Ground-fault monitoring 0 0 Supervision 0 0 Local annunciator 0 0 Remote annunciators 0 0 Remote power panels 0 0 0 0 6.2 Secondary Power Visual Functional Description Inspection Test Comments Battery condition 0 0 Load voltage 0 0 Discharge test 0 0 Charger test 0 0 Remote panel batteries 0 0 ©2018 National Fire Protection Association NFPA 72(p.2 of 4) A FIGURE 7.8.2(g) Continued Shaded text=Recisions. A=Text deletions and figure/table revisions. •=Section deletions. N-New material. 2019 Edition ....w Y ...uuu u... ..�. ..i w .....u .0 . 0 up..,......... .. ... ,. .....i..... u.iwu w.. ............ ..... u'•M�' M a 72-56 NATIONAL FIRE ALARM AND 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 alI interface components. Circuit Interface I Signaling Line Circuit Interface I Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes No Time Comments Alarm signal ❑ ❑ Alarm restoration ❑ ❑ Trouble signal ❑ ❑ Trouble restoration ❑ p Supervisory signal 0 0 Supervisory restoration 0 ❑ 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal 0 ❑ Alarm restoration ❑ p Trouble signal ❑ 0 Trouble restoration 0 ❑ Supervisory signal 0 ❑ Supervisory restoration ❑ ❑ ©2018 National Fire Protection Association NFPA 72(p.3 of 4) A FIGURE 7.8.2(g) Continued 2019 Edition Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-57 SYSTEM RECORD OF INSPECTION AND TESTING (continued) 7. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Time: Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other,if required Contact: Time: 8. SYSTEM RESTORED TO NORMAL OPERATION Date: Time: 9. CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72, edition,Chapter 14. Signed: Printed name: Date: Organization: Title: Phone: Qualifications(refer to 10.5.3): 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: ©2018 National Fire Protection Association NFPA 72(p.4 of 4) A FIGURE 7.8.2(g) Continued Shaded text=Revisions. A Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-58 NATIONAI.FIRE ALARM 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. Inspection/Test Start Date/Time: Inspection/Test Completion Date/Time: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. NOTIFICATION APPLIANCE TEST RESULTS Appliance Type Location/Identifier Test Results ©2018 National Fire Protection Association NFPA 72(p.1 of 2) 0 FIGURE 7.8.2(h) Notification Appliance Supplementary Record of Inspection and Testing. (SIG-TMS) 2019 Edition Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-59 NOTIFICATION APPLIANCE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 2. NOTIFICATION APPLIANCE TEST RESULTS (continued) Appliance Type Location/Identifier Test Results See main System Record of Inspection and Testing for additional information,certifications,and approvals. ©2018 National Fire Protection Association NFPA 72(p.2 of 2) A FIGURE 7.8.2(h) Continued Shaded text=Revisions. ©=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-60 NATIONAL FIRE ALARM 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 Date/Time: Inspection/Test Completion Date/Time: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. INITIATING DEVICE TEST RESULTS Device Type Address Location Test Results ©2018 National Fire Protection Association NFPA 72(p.1 of 2} A.FIGURE 7.8.2(i) Initiating Device Supplementary Record of Inspection and Testing. (SIG-TMS) 2019 Edition Shaded text=Revisions. A=Text deletions and figure/table revisions. +=Section deletions. N=New material. DOCUMENTATION 72-61 INITIATING DEVICE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 2. INITIATING DEVICE TEST RESULTS (continued) Device Type Address Location Test Results See main System Record of Inspection and Testing for additional information,certifications,and approvals. O 2018 National Fire Protection Association NFPA 72(p.2 of 2) 0 FIGURE 7.8.2(i) Continued Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition .. _.. ,... .. ,y..,,-- ......-.,r........ ...... ..r,......,,.,." vwi.....w.,.wu.ub� .t....uiy. 72-62 NATIONAL FIRE ALARM AND SIGNALING CODE MASS NOTIFICATION SYSTEM SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. It includes a mass notification system test record. This form is to be completed by the system inspection and testing contractor at the time of fhe 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 Date/Time: Inspection/Test Completion Date/Time: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. MASS NOTIFICATION SYSTEM 2.1 System Type 0 In-building MNS—combination 0In-building MNS—stand alone 0 Wide-area MNS O Distributed recipient MNS O Other(specify): 2.2 System Features O Combination fire alarm/MNS 0 MNS ACU only O Wide-area MNS to regional national alerting interface D Local operating console(LOC) C Direct recipient MNS(DRMNS) C Wide-area MNS to DRMNS interface 0 Wide-area MNS to high-power loudspeaker array(HPLA)interface 01n-building MNS to wide-area MNS interface 0 Other(specify): 3. IN-BUILDING MASS NOTIFICATION SYSTEM 3.1 Primary Power Input voltage of MNS panel: MNS panel amps: 3.2 Engine-Driven Generator UThis system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 3.3 Energy Storage Systems C This system does not have an ESS. Equipment powered by an ESS system: Location of ESS system: Calculated capacity of ESS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 3.4 Batteries Location: Type: Nominal voltage:_ Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours):_ In alarm mode(minutes): 0 Batteries are marked with date of manufacture. ©2018 National Fire Protection Association NFPA 72(p.1 of 2} A FIGURE 7.8.2(j) Mass Notification System Supplementary Record of Inspection and Testing. (SIG-TMS) 2019 Edition Shaded text=Revisions. .=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-63 MASS NOTIFICATION SYSTEM SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 4. MASS NOTIFICATION EQUIPMENT TEST RESULTS Visual Functional Description Inspection Test Comments Functional test Reset/power down test Fuses Primary power supply ESS power test Trouble signals Disconnect switches Ground-fault monitoring CCU security mechanism Prerecorded message content Prerecorded message activation Software backup performed Test backup software Fire alarm to MNS interface MNS to fire alarm interface In-building MNS to wide-area MNS MNS to direct recipient MNS Sound pressure levels Occupied U Yes U No Ambient dBA: Alarm dBA: (attach supplementary notification appliance form(s)with locations, values,and weather conditions) System intelligibility Test method: Score: CIS value: (attach supplementary notification appliance form(s)with locations, values,and weather conditions) Other(specify): See main System Record of Inspection and Testing for additional information,certifications,and approvals. 02018 National Fire Protection Association NFPA 72(p.2 of 2) A FIGURE 7.8.20) Continued Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-64 NATIONAL FIRE ALARM AND SIGNALING CODE EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. It includes systems and components specific to emergency communication systems. 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 Date/Time: Inspection/Test Completion Date/Time: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. DESCRIPTION OF SYSTEM OR SERVICE O Fire alarm with in-building fire emergency voice alarm communication system(EVAC) 0 Mass notification system 0 Combination system,with the following components: 0 Fire alarm 0 EVACS 0 MNS 0 Two-way,in-building,emergency communication system 0 Other(specify): Additional description of system(s): 2.1 In-Building Fire Emergency Voice Alarm Communication System Manufacturer: Model number: Number of single voice alarm channels: Number of multiple voice alarm channels: Number of loudspeakers: Number of loudspeaker circuits: Location of amplification and sound processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 2.2 Mass Notification System 2.2.1 System Type: O In-building MNS—combination O In-building MNS O Wide-area MNS 0 Distributed recipient MNS C Other(specify): p 2018 National Fire Protection Association NFPA 72(p.1 of 5) FIGURE 7.8.2(k) Emergency Communications Systems Supplementary Record of Inspection and Testing. (SIG-TMS) 2019 Edition Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-65 EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 2. DESCRIPTION OF SYSTEM OR SERVICE (continued) 2.2.2 System Features: O Combination fire alarm/MNS 0 MNS autonomous control unit 0 Wide-area MNS to regional national alerting interface 0 Local operating console(LOC) 0 Distributed-recipient MNS(DRMNS) 0 Wide-area MNS to DRMNS interface 0 Wide-area MNS to high-power loudspeaker array(HPLA)interface 0 In-building MNS to wide-area MNS interface 0 Other(specify): 2.2.3 MNS Local Operating Consoles Location 1: Location 2: Location 3: 2.2.4 High-Power Loudspeaker Arrays Number of HPLA loudspeaker initiation zones: Location 1: Location 2: Location 3: 2.2.5 Mass Notification Devices Combination fire alarm/MNS visual devices: MNS-only visual devices: Textual signs: Other(describe): Supervision class: 2.2.6 Special Hazard Notification 0 This system does not have special suppression pre-discharge notification O MNS systems DO NOT override notification appliances required to provide special suppression pre-discharge notification 3. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 3.1 Telephone System Number of telephone jacks installed: Number of warden stations installed: _ Number of telephone handsets stored on site: Type of telephone system installed: 0 Electrically powered 0 Sound powered 3.2 Area of Refuge(Area of Rescue Assistance) Emergency Communications Systems Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: OO 2018 National Fire Protection Association NFPA 72(p.2 of 5) 0 FIGURE 7.8.2(k) Continued Shaded text=Revisions. 0=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-66 NATIONAL FIRE ALARM AND SIGNALING CODE EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 3. TWO-WAY EMERGENCY COMMUNICATIONS SYSTEMS (continued) 3.3 Elevator Emergency Communications Systems Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 3.4 Other Two-Way Communication System Describe: 4. TESTING RESULTS 4.1 Control Unit and Related Equipment Visual Functional Description Inspection Test Comments Control unit CI Lamps/LEDs/LCDs ❑ ❑ Fuses CI ❑ Trouble signals 0 0 Disconnect switches 0 Ground fault monitoring 0 ❑ Supervision ❑ 0 Local annunciator 0 ❑ Remote annunciators 0 0 Remote power panels 0 0 Other: 0 ❑ 4.2 Secondary Power Visual Functional Description Inspection Test Comments Battery condition 0 0 Load voltage 0 0 Discharge test 0 0 Charger test ❑ 0 Remote panel batteries 0 O Q 2018 National Fire Protection Association NFPA 72(p.3 of 5) FIGURE 7.8.2(k) Continued 2019 Edition Shaded text=Revisions. A.=Text deletions and figure/table revisions. •=Section deletions. N=New material. DOCUMENTATION 72-67 EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 4. TESTING RESULTS (continued) 4.3 Emergency Communications Equipment Visual Functional Description Inspection Test Comments Control unit ❑ 0 Lamps/LEDs/LCDs 0 0 Fuses 0 ❑ Secondary power supply ❑ ❑ Trouble signals 0 ❑ Disconnect switches 0 0 Ground fault monitoring 0 ❑ Panel supervision ❑ 0 System performance ❑ 0 System audibility ❑ 0 System intelligibility 0 0 Other: 0 0 4.4 Mass Notification Equipment Visual Functional Description Inspection Test Comments Functional test 0 0 Reset/Power down test 0 ❑ Fuses ❑ I] Primary power supply 0 0 ESS power test 0 0 Trouble signals 0 0 Disconnect switches 0 ❑ Ground fault monitoring ❑ 0 CCU security mechanism 0 0 Prerecorded message content 0 ❑ Prerecorded message activation 0 0 Software backup performed 0 ❑ Test backup software 0 ❑ Fire alarm to MNS Interface ❑ 0 MNS to fire alarm interface 0 ❑ In-building MNS to wide-area MNS ❑ 0 MNS to direct recipient MNS 0 0 ©2018 National Fire Protection Association NFPA 72(p.4 of 5) A FIGURE 7.8.2(k) Continued Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition 72-68 NATIONAL FIRE ALARM AND SIGNALING CODE EMERGENCY COMMUNICATIONS SYSTEMS SUPPLEMENTARY RECORD OF INSPECTION AND TESTING (continued) 4. TESTING RESULTS (continued) 4.4 Mass Notification Equipment (continued) Visual Functional Description Inspection Test Comments Sound pressure levels 0 0 (attach report with locations, values,and weather conditions) System intelligibility ❑ 0 ❑CSI ❑STI (attach report with locations, values,and weather conditions) Other: 0 0 4.5 Two-Way Communication Equipment Visual Functional Description Inspection Test Comments Phone handsets 0 0 Phone jacks 0 ❑ Off-hook indicator 0 ❑ Call-in signal ❑ 0 System performance ❑ ❑ System audibility 0 ❑ System intelligibility 0 ❑ Other: ❑ ❑ See main System Record of Inspection and Testing for additional information,certifications,and approvals. CG 2018 National Fire Protection Association NFPA 72(p.5 of 5} A FIGURE 7.8.2(k) Continued 2019 Edition Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. " ..................,.. .....�. y ..,,.,�.u......,..,..,„,..,N.,...,..,........ rr.n„..,w..v,..,,.......,.«. ,.,,...,...,.......,aye..r......y. DOCUMENTATION 72-69 INTERFACE COMPONENT SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. it includes an interface component test record for circuit interfaces,signaling line circuit interfaces,and fire alarm control interfaces. 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 Date/Time: _ _ inspection/Test Completion Date/Time: Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. INTERFACE COMPONENT TEST RESULTS Interface Component Type Address Location Test Results ©2018 National Fire Protection Association NFPA 72(p.1 of 2) ,A FIGURE 7.8.2(1) Interface Component Supplementary Record of Inspection and Testing. (SIG-TMS) Shaded text=Revisions. A=Text deletions and figure/table revisions. •=Section deletions. N=New material. 2019 Edition