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HomeMy WebLinkAboutB24-2419 010-180-035 CF FA 2024 NFPA 72 (p. 1 of 3) SYSTEM RECORD OF COMPLETION Form Completion Date: Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: Description of property: Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Address: Phone: Fax: E-mail: Service organization: Address: Phone: Fax: E-mail: Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: 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 On-site location of the required record documents and site-specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: New system Modification to existing system Permit number: NFPA 72 edition: 4.1 Control Unit Manufacturer: Model number: 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds © 2016 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. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquiries or to report unauthorized use, contact licensing@nfpa.org. NFPA 72 (p. 2 of 3) SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: Control panel amps: Overcurrent protection: Type: Amps: Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: Location, if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode (hours): In alarm mode (minutes): 5.2 Control Unit This system does not have power extender panels Power extender panels are listed on supplementary sheet A Addressable or ConventionalType Quantity Alarm or Supervisory Sensing Technology Manual Pull Stations SK-Smoke Detectors Duct Smoke Detectors Heat Detectors Kitchen Hood SK-Minimon SK-Relay 8. INITIATING DEVICES Dual Media PathwayPathway Type Survivability Level Separate Pathway Class Signaling Line Device Power Initiating Device Notification Appliance Other (specify): 6. CIRCUITS AND PATHWAYS Type Location 7. REMOTE ANNUNCIATORS © 2016 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. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquiries or to report unauthorized use, contact licensing@nfpa.org. NFPA 72 (p. 3 of 3) SYSTEM RECORD OF COMPLETION (continued) 11. INTERCONNECTED SYSTEMS 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:Printed name: Date: Organization:Title:Phone: 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed:Printed name: Date: Organization:Title:Phone: 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers Firefly Elevator Recall Elevator Shunt Trip Audible Visible Combination Audible and Visible 10. SYSTEM CONTROL FUNCTIONS Type Quantity Description 9. NOTIFICATION APPLIANCES © 2016 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. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquiries or to report unauthorized use, contact licensing@nfpa.org. NFPA 72 NOTIFICATION APPLIANCE POWER PANEL SUPPLEMENTARY RECORD OF COMPLETION Form Completion Date:Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. NOTIFICATION APPLIANCE POWER EXTENDER PANELS Make and Model Location Area Served Power Source See Main System Record of Completion for additional information, certifications, and approvals. © 2016 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. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquiries or to report unauthorized use, contact licensing@nfpa.org.