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HomeMy WebLinkAbout2420 CAMINO VIDA ROBLE; ; FA140009; Permit10/20/21 3:45 PM FA140009 Permit Data City of Carlsbad Fire Alarm Permit Permit No: FA140009 2420 CAMINO VIDA Job Address Status: APPROVED ROBLE Permit Type: FALARM Applied 3/12/2014 Parcel No: 2131101600 Approved: 3/22/2014 Lot #: 0 Reference No.: Issued: 3/22/2014 PC #: Inspector: Project Title: CARLSBAD KINGDOM HALL NEW CONSTRUCTION Applicant: PIONEER ELECTRIC 12250 AVENUE NATIONAL CITY, CA 91950 619-618-8521 Owner: PALOMAR CONGREGATION OF JEHOVAHS WITNESSES VISTA ATTN: GARY HULBERT PO BOX I3O84S CARLSBAD CA Fees ($) Add'I Fees ($) Total ($) Balance ($) 364 0 ' 364 0 We 1/1 Carlsbad Kingdom Hall of Jehovah's Witnesses Fire Alarm System 2420 Camino Vida Roble Carlsbad, CA 92009 Fire Alarm Panel 5700 7788F 7794 Initiating Devices SD505-APS SD500-PS SD505-DUCTR SD505-DTSK Modules SD500-M I M Notification Devices PC2W SCw Fire Alarm Control Panel Wireless Fire Alarm Communicator Digital Dialer Interface for 7788F Addressable Smoke Detector Fire Alarm Manual Pull Box Addressable Duct Detector with Remote Test Station Addressable Monitor Module Multi-Candela Ceiling Mounted Horn Strobe Multi-Candela Ceiling Mounted Strobe CITY OF CARLSBAD FIRE DEPARTMENT APPROVED Subject to field inspection and required tests, notations hereon, conditions in correspondence and conformance with applicable regulations. The stamping of these ns II not be held to permit or ape eatiofl of any law. VV Revision 1 March 18, 2014 FA140009 CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. 7165-0559:0144 Page 1 of 2 CATEGORY: 7165 - FIRE ALARM CONTROL UNIT (COMMERCIAL) LISTEE: SILENT KNIGHT SECURITY7550 Meridian Circle, Maple Grove, MN 55369-4927 Contact: Michael Mclsaac (763) 493-6400 Fax (763) 391-5464 Email: mike.mcisaac@honeywell.com DESIGN: Models *IFP.50 and Fire Alarm Control Units. Power limited, automatic, manual, local, remote station, central station, waterfiow, water releasing and sprinkler supervisory service. Refer to listee's data sheet for additional detailed product description and operational considerations. System components: IFP-50, 5700 Control Units 7628 EOL Resistor 5860/5860R1RA-1000 Annunciator 5897 Power Supply 5496 *Notification Power Expander 5824 Serial/Parallel Interface 5865-3/5965-4 LED Annunciator 5880 LED 10 Module 5883 Relay Interface Board SD500-LIM Line Isolation Module 5D505-61 B Isolation Base RA-100 Remote Annunciator 3158 Reverse Polarity Module 5220 Direct Connect Module RATING: 120 VAC Primary, 24 VDC Secondary INSTALLATION: In accordance with listee's printed installation instructions, applicable codes and ordinances and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model number, electrical rating, and UL label. APPROVAL: Listed as control units for use in high-rise structures when used in conjunction with Model SKE-360 Voice-Tone Evacuation Unit (CSFM Listing No. 6912-0559:122); EVAX Audio Adjunct System Models EVAX-25 (CSFM Listing No. 06911-1446:100), EVAX-50 or EVAX-50E (CSFM Listing No. 06911-1446:102); EVX-2ZA or EVX-4Z Zone Splitters (CSFM Listing No. 06912-1446:101); HMX-MP or HMX-DP Voice Evacuation System (CSFM Listing No. 06911-1446:103), two-way firefighter telephone and separately listed electrically and functionally compatible initiating and indicating devices. Also suitable for non-high rise applications where the voice evacuation and two-way firefighter telephone are not required. Refer to listee's Installation Instruction Manual for details. Rev 10-3-08MA This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires June 30, 2014) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division Listing No. 7165-0559:0144 Page 2 of 2 NOTE: For Fire Alarm Verification Feature (delay of fire alarm signal), the maximum Retard/Reset/Restart period shall not exceed 30 seconds. Rev 10-3-08MA This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires June 30, 2014 Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. 7300-1516:0108 Page 1 of 1 CATEGORY: 7300— FIRE ALARM CONTROL UNITACCESSORIES/MISC. DEVICES LISTEE: AES CORPORATION285 NEWBURY ST, PEABODY, MA 01960 Contact: Thomas Kenty (978) 535-7310 Fax (978) 535-7313 Email: tkentyaes-intelIinet.com DESIGN: *Modelj7)Subscriber Unit, RF transceiver. Unit is intended for use with listee's separately listed Model InteIliNet 7705i system (7300-1516:104) and 7170-EM IPLinks, Remote Transcievers (7300-1516:105). Refer to listee's data sheet for additional detailed product description and operational considerations. RATING: 120 VAC, 16.5 VAC 40VA Secondary, 12 VDC nominal INSTALLATION: In accordance with listee's printed installation instructions, applicable codes and ordinances and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model designation, and UL label. APPROVAL: Listed as a two-way transceiver unit for use with separately listed compatible fire alarm control units. * 07-12-2013 bh This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires June 30, 2014) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION Talb OFFICE OF THE STATE FIRE MARSHAL ' FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. (1300-1516:0109) Page 1 of 1 CATEGORY: 7300— FIRE ALARM CONTROL UNITACCESSORIES/MISC. DEVICES LISTEE: AES CORPORATION285 NEWBURY ST, PEABODY, MA 01960 Contact: Thomas Kenty (978) 535-7310 Fax (978) 535-7313 Email: tkenty@aes-intetlinet.com DESIGN: ModeI(FirePro) Digital Dialer Interface. Model is intended for use with 7744F and 7788F subscriber unit and as a supplemental use. It takes industry standard communication formats provided by the FACP units DACT and transfers the data to the subscriber unit where it is transmitted to the AES MultiNet Receiver System. Refer to listee's data sheet for additional detailed product description and operational considerations. RATING: 12V dc INSTALLATION: In accordance with listee's printed installation instructions, applicable codes and ordinances, and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model number, electrical rating, and UL label. APPROVAL: Listed as miscellaneous devices for use with separately listed manufacturers Model 7744F and 7788F subscriber unit. Refer to listee's Installation Instruction Manual for details. 07-07-11 mt This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires c30, 2014) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE ("s "" LISTING No. 7272-0559:0129 Page 1 of I CATEGORY: 7272 - SMOKE DETECTOR-SYSTEM TYPE-PHOTOELECTRIC LISTEE: SILENT KNIGHT SECURITY7550 Meridian Circle, Maple Grove, MN 55369-4927 Contact: Michael Mclsaac (763) 493-6400 Fax (763) 391-5464 Email: mike.mcisaac@honeywell.com DESIGN: Model analog addressable photoelectric type smoke detector with model 50505-4AB and SD505-6AB bases. Unit consists of resistors, capacitors, diodes, transistors, LED, photo diode, mounted on a printed wiring board inside an enclosure. Refer to listee's data sheet for additional detailed product description and operational considerations. RATING: 39.5 VDC INSTALLATION: In accordance with listee's printed installation instructions, applicable codes & ordinances and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model designation, electrical rating and UL label. APPROVAL: Listed as photoelectric smoke detector for use with listee's separately listed compatible fire alarm control units. Refer to listee's Installation Instruction Manual for details. XLF: 7272-0410:0149 *Rev. 06-13-06 This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires (June 30, 2014) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. 7150-0559:0136 Page 1 of I CATEGORY: 7150 — FIRE ALARM PULL BOXES LISTEE: SILENT KNIGHT SECURITY7550 Meridian Circle, Maple Grove, MN 55369-4927 Contact: Michael Mclsaac (763) 493-6400 Fax (763) 391-5464 Email: mike.mcisaac@honeywell.com DESIGN: Model PS-SKSA andSD500-PSJflre alarm pull boxes. Refer to listee's data sheet for additional detailed product description and operational considerations. RATING: 30VDC INSTALLATION: In accordance with listee's printed installation instructions, applicable codes & ordinances and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model number, electrical rating and UL label. APPROVAL: Listed as fire alarm pull station use with separately listed compatible fire alarm control units. For indoor use only. * These manual pull boxes meet the requirements of UL Standard 38, 1999 Edition and California amendments. *Updated 08-29-2011 mt This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires (,une 30, 2014) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. 3240-0559:0163 Page 1 of 1 CATEGORY: 3240 - DUCT SMOKE DETECTOR HOUSING/BASE LISTEE: SILENT KNIGHT SECURITY7550 Meridian Circle, Maple Grove, MN 55369-4927 Contact: Michael Mclsaac (763) 493-6400 Fax (763) 391-5464 Email: mike.mcisaac@honeywell.com DESIGN: Models SD505-DUCT and(50505-DUCTR)duct smoke detector units, remote test switch. Each unit consists of a smoke detector head, plastic enclosure, plastic cover, relays, electrical components, and sampling and exhaust tubes. The smoke detector heads are not suitable for use as open area detection. Refer to listee's data sheet for additional, detailed product description and operational considerations. RATING: 120 VAC, 230 VAC, 24 VAC and 24 VDC INSTALLATION: In accordance with listee's printed installation instructions, applicable codes & ordinances and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model designation, electrical rating and UL label. APPROVAL: Listed as duct smoke detector units for use with separately listed compatible fire alarm control units to detect an abnormal amount of smoke density in the return air ducts of air conditioning and ventilating system. The air velocity in the duct shall be between 300-4000 fpm. NOTE: For duct application only. Not suitable for open area protection. XLF: 3240-0410:0155 07-15-09 fm R. • This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct v' operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires (June 30, 44) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. 7300-0559:0132 Page 1 of 1 CATEGORY: 7300— FIRE ALARM CONTROL UNITACCESSORIES/MISC. DEVICES LISTEE: SILENT KNIGHT SECURITY7550 Meridian Circle, Maple Grove, MN 55369-4927 Contact: Michael Mclsaac (763) 493-6400 Fax (763) 391-5464 Email: mike.mcisaac@honeywell.com DESIGN: Model 50500-ARM Relay Module and SD500-AIM,(SD5O0-MlMAddressable Input Modules*. Models SD500-ARM provides inputs for a control unit communication circuit and have two sets of dry relay contacts. Models S0500-AIM and -MIM provide additional input circuits. Refer to listee's data sheet for additional detailed product description and operational considerations. RATING: 5D500-ARM: 120 VAC, 30 VDC INSTALLATION: In accordance with listee's printed installation instructions, applicable codes & ordinances and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model number, electrical rating and UL label. APPROVAL: Listed as control unit accessories for use with listee's separately listed compatible fire alarm control units. Refer to listee's Installation Instruction Manual for details. *Rev. 03-11-10 fm This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires (June 30, 2014) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. 7125-1653:0188 Page 1 of 1 CATEGORY: 7125 - FIRE ALARM DEVICES FOR THE HEARING IMPAIRED LISTEE: System Sensor, Unincorporated Div of Honeywell Intl Inc.3825 Ohio Ave, St. Charles, IL 60174 Contact: Trish Linhart (630) 377-6580 Fax (630) 377-7245 Email: tnsh.linhart@systemsensor.com DESIGN: Models CHSR and CHSW Chime/Strobes. Models P2R, P2W,_P2RH and P2WH Horn/Strobes two-wire type, rectangular enclosure. Models PC2R,(C2W) PC2RH and PC2WH Horn/Strobes two-wire type, round enclosure Models P4R, P4W, P4RH and P4WH Horn/Strobes four-wire type, rectangular enclosure. Models PC4R, PC4W, PC4RH and PC4WH Horn/Strobes* four-wire type, round enclosure. All models are intended for indoor use only unless other wise indicated. Models may be followed by the suffix "K" indicating indoor or outdoor use, or may be followed by suffix UP" for plain housing with no lettering. "K" suffix models are suitable for outdoor applications at temperatures from -40°F to +151°F (-40°C to +66°C) and are rated NEMA 4X when used with the System Sensor weather proof back boxes models SA-WBB (Wall), SA-WBBW (Wall), SA-WBBC (Ceiling) and "SA-WBBCW (Ceiling). Refer to listee's data sheet for additional detailed product description and operational considerations. RATING: Standard Horn/Strobes and Chime/Strobes 8 - 17.5 or 16-33 VDC/FWR Hi CD Horn/Strobes 16-33 VDC/FWR INSTALLATION: In accordance with listee's printed installation instructions, applicable codes and ordinances, and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model number, electrical rating, and UL label. APPROVAL: Listed as *hom/strobes or chime/strobes suitable for signaling appliances and equipment for the hearing impaired applications when used with separately listed compatible fire alarm control units. Horn/strobes with -K suffix are suitable for indoor or outdoor use, ceiling or wall mount. Chime section is suitable for private mode and indoor use only. Horn/Strobes or chimelstrobes* can generate the distinctive three-pulse audible Temporal Pattern Fire Alarm Evacuation Signal (for total evacuation) in accordance with NFPA 72, 2010 Edition. Refer to listee's Installation Instruction Manual for details. *Corrected 12-15-11 bh 0 This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires(June 30, 204) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division CALIFORNIA DEPARTMENT OF FORESTRY & FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING - BUILDING MATERIALS LISTING PROGRAM LISTING SERVICE LISTING No. 7125-1653:0186 Page 1 of 1 CATEGORY: 7125 - FIRE ALARM DEVICES FOR THE HEARING IMPAIRED LISTEE: System Sensor, Unincorporated Div of Honeywell Intl lnc.3825 Ohio Ave, St. Charles, IL 60174 Contact: Trish Linhart (630) 377-6580 Fax (630) 377-7245 Email: trish.linhart@systemsensor.com DESIGN: Synchronous type strobe lights, Models SR, SRH, SW, SW-CLR-ALERT, SWH, SCR, SCRH, SCW-CLR-ALERT and SCWH followed by the suffix -P, -SP, -PG, or none. Intended for indoor use mounted on the wall or the ceiling. Refer to listee's data sheet for additional detailed product description and operational considerations. RATING: 8-17.5 or 16-33 VDC/FWR Candela: 15,15f75, 30, 75, 95, 110, 115, *135 *150 *177 185cd INSTALLATION: In accordance with listee's printed installation instructions, applicable codes and ordinances, and in a manner acceptable to the authority having jurisdiction. MARKING: Listee's name, model number, electrical rating and UL label. APPROVAL: Listed as strobe lights suitable for hearing impaired application when used with separately listed compatible fire alarm control units. Suitable for indoor use, wall or ceiling mounted. Refer to listee's Installation Instruction Manual for details. *Rev. 03-11-10fm I4 This listing is based upon technical data submitted by the applicant. CSFM Fire Engineering staff has reviewed the test results and/or other data but does not make an independent verification of any claims. This listing is not an endorsement or recommendation of the item listed. This listing should not be used to verify correct operational requirements or installation criteria. Refer to listee's data sheet, installation instructions and/or other Date Issued: July 01, 2013 Listing Expires @une30, 2014) Authorized By: JAMES PARSEGIAN, Program Coordinator Fire Engineering Division a f=A 14o600l FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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 PROPERTY INFORMATION Name of property: Cc 'r Address: ..... Description of property: - ......... Occupancy type: - . .. Name of property representative: cx.,rPst r\ Address: Phone: Fax: - E-mail: - - Authority having jurisdiction over this property: c'._ Phone: . Fax: E-mail: - . -- INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: Address: . License or certification number: C_- 0 )Ot\ ZTZ..... . . . . -. . Phone: Fax: E-mail- Service organization for this equipment: - ilt, Address: L1ç Vd' QA. License or certification number: Phone: C PA 7çLj Fax: - ..........- E-mail: - A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: - Address: . . . Phone: ,., Fax: E-mail: Contract expires: - Contract number: Frequency of routine inspections: DESCRIPTION OF SYSTEM OR SERVICE 94 ire alarm system (nonvoice) E] Fire alarm with in-building fire emergency voice alarm communication system (EVACS) 0 Mass notification system (MNS) o Combination system, with the following components: 0 Fire alarm 0 EVACS 0 MNS 0 Two-way, in-building, emergency communication system El Other (specify): NFPA 72, Fig. 10.18.2.1.1 (p.1 of 12) Copyright © 2009 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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continUed) NFPA 72 edition: 2c: Additional description of system(s): 3.1 Control Unit Manufacturer: 3.2 Mass Notification System 3.2.1 Systeni...T C] In-building M1 E] In-building MI' o Other (si Model number: 0 This system does not incorporate an MNS 0 Wide-area MNS 0 Distributed recipient MNS 3.2.2 System Features: - . - El Combination fire alarm/MNS 0 S autonomous control it 0 Wide area MNS to regional national alerting interface El Wide-area S to high-power speaker array A)iface0ln-building MNS to wide-area-MNS interface O Locaboperating console (LOC) 0 Direct re ient S (DRMNS) 0 Wide-area MNS to DRMNS interface El Other (specify): 3.3 System Documentation owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: 3.4 System Software Phis system does not have alterable site-specific software. Operating system (executive) software revision level: Site-specific software revision date: Revision completed by: El A copy of the site-specific software is stored on site. Location: 3.5 Off-Premises Signal Transmission 0 This system does not have off-premises transmission. Name of organization receiving alarm signals wit phone numbers: Alarm: Phone: C,G( 2C(-7 T5 Supervisory: _.... . ._ Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission: If Chapter 26, specify te means of transmission from the protected premises to the supervising station: If Chapter 27, specify the type of auxiliary alarm system: 0 Local energy 0 Shunt 0 Wired 0 Wireless NFPA 72, Fig. 10.18.2.1.1 (p.2of12) Copyright © 2009 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: Survivability level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: Description: 4.1.3 Device/Power Pathways separate power pathways from the signaling line pathway O Power pathways are separate but of the same pathway classifiôation as the signaling line pathway Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Mot _K_ Quantity: \.. 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: f-) level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: Description: 4.2.3 Device Power Pathways \No separate power pathways from the initiating device pathway El Power pathways are separate but of the same pathway classification as the initiating device pathway Power pathways are separate and different classification from the initiating device pathway 4.3 Non-Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: Survivability level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: Description: 4.3.3 Appliance Power Pathways \No separate power pathways from the notification appliance pathway Power pathways are separate but of the same pathway classification as the notification appliance pathway 0 Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p.3o112) Copyright 0 2009 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. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes This system does not have manual fire alarm boxes. Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.1.2 Other Alarm Boxes 0 This system does not have other alarm boxes. Description: V ofices: Type and nu Addressable: - Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors 0 This system does not have smoke detectors. Type and number of devices: Addressable: 'IJW Conventional: Other (specify): Type of coverage: 0 Complete area partial area 0 Nonrequired partial area Other (specify): Type of smoke detector sensing technology: 0 Ionization 4p, hotoelectric 0 Multicriteria 0 Aspirating 0 Beam Other (specify): 5.2.2 Duct Smoke Detectors 0 This system does not have alarm-causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 0 Aspirating 0 Beam 5.2.3 Radiant Energy (Flame) Detectors $.his system does not have radiant energy detectors. Type and number of devices: Addressable: - Conventional: Other (specify): Type of coverage: 5.2.4 Gas Detectors s system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: - 5.2.5 Heat Detectors his system does not have heat detectors. Type and number of devices: Addressable: Conventional: Type of coverage: 0 Complete area 0 Partial area 0 Nonrequired partial area 0 Linear 0 Spot Type of heat detector sensing technology: 0 Fixed temperature 0 Rate-of-rise 0 Rate compensated NEPA 72, Fig. 10.18.2.1.1 (p.4of12) Copyright @ 2009 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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: 5.2.7 Waterfiow Alarm Devices Type and number of devices: Addressable: - 5.2.8 Alarm Verificaf n Number of devices subj c to alarm verification: 5.2.9 Presignal Number of devices ject to presignal: Describe presigna funct ns: 5.2.10 Positive Alarm Sçqknce (PAS) Describe PAS: 5.2.11 Other Initiati , ,ices Describe: *This system does not have monitoring modules. 0 This system does not have waterfiow alarm devices. Conventional: Coded: Transmitter: is system does not incorporate alarm verification. Alarm verification set for seconds i-This system does not incorporate pre-signal. his system does not incorporate PAS. is system does not have other initiating devices. 6. SUPERVISORY SIGNAL-INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices 0 This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: Conventional Coded: Transmitter: Other (specify): 6.2 Fire Pump Descripti a Supervisory Devices this system does not have a fire pump. Type fire pump: 0 Ele ic pump 0 Engine Type and number of devic s: A dressable: Conventional: Coded: Transmitter: Other (specify): - 6.2.1 Fire Pump FunctioqSuvised o Power 0 Running 0 eversal 0 Selector switch not in auto 0 Engine or control panel trouble 0 Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) 0 This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: 0 Ionization Photoelectric 0 Aspirating 0 Beam 6.4 Other Supervis ry evices 0 This system does not have other supervisory devices Describe: NFPA 72, Fig. 10.18.2.1.1 (p.50f 12) 'Copyright © 2009 National Fire Protection Association, This form may be copied for individual use other than for resale. It may not be copied for commercial sate or distribution. MONITORED SYSTEMS 7.1 Engine-Driven Generator 41 his system does not have a generator. 7.1.1 Generator Functions Supervised D Engine or control panel trouble 0 Generator running 0 Selector switch not in auto 0 Low fuel 0 Other (specify): 7.2 Special Hazard Suppression Systems system does not monitor special hazard systems. Description of special hazard system(s): 7.3 Other Monitoring Systems 'js system does not monitor other systems. Description of special hazard system(s): ANNUNCIATORS AThis system does not have annunciators. 8.1 Location and rofAnnunciators Location l -sj-ç--. Location 2: Location 3: ALARM NOTIFICATION APPLIANCES 9.1 In-Building Fire Emergency Voice Alarm Communication System *This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound-processing equipment: Location of paging microphone stations: Location I: Location 2: Location 3: 9.2 Nonvoice Notification Appliances 0 This system does not have nonvoice notification appliances. Horns: With visible: Bells: With visible: Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels *This system does not have power extender panels Quantity: Locations: NFPA 72, Fig. 10.18.2.1.1 (p.60f12) Copyright © 2009 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. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS I's system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High-Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification E] This system does not have special suppression predischarge notification. El MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System This system does not have a two-way telephone system. Number of telephone jacks installed: N'nber of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: 0 Electrically powered 0 Sound powered 11.2 Two-Way Radio Communications Enhancement System *This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: . % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p.70f12) Copyright 0 2009 National Fire Protection Association. This torn, may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems .Tlhis system does not have an area of refuge (area of rescue assistance) emergency communications system. 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: 11.4 Elevator Emergency Communications Systems *This system does not have an elevator emergency communications system. 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: 11.5 Other Two-Way Communication Systems Describe: CONTROL FUNCTIONS This system activates th ollowi g control fuctions: El Hold-open door re leas in d vices 0 Smoke management 0 HVAC shutdown 0 F/S dampers 0 Door unlocking 0 ator recall 0 Fuel source shutdown 0 Extinguishing agent release El Elevator shunt trip 0 M notification system override of fire alarm notification appliances Other (specify): 12.1 Address y1eCotrol Modules Numberofde Other (specify 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: - Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: Ct.lc -e_&Jc 13.1.2 Engine-Driven Generator Location of generator: Location of fuel storage: ,his system does not have control modules. Control panel amps: #zs system does not have a generator. Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p.80112) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.1.3 Uninterruptible Power System Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): This system does not have a UPS. 13.1.4 Batteries Location: Type: ô Qminal voltage: _12. V Amp/hour rating: 77,10 Calculated capacity of batteries to ive the system: In standby mode (hours): 72._ _________________ In alarm mode (minutes): El Batteries are marked with date of manufacture 0 Battery calculations are attached 13.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System This system does not have an EVACS or MNS system. 13.2.1 Primary PowerK n:: Input voltage of EVACS o EVACS or MNS panel amps: Overcurrent protection: Amps: Location (of primary supp ) Disconnecting means locat 13.2.2 Engine-Driven Ge èrator 0 This system does not have a generator. Location of gene or: Location of fuel stor Type of fuel: 13.2.3 Uninterruptible Pow(System 0 This system does not have a UPS. Equipment power d by a U system: Location of UPS syst Calculated capacity of batteries to drive the system components connected to it: In standby mod (h' ): - - In alarm mode (minutes): 13.2.4 Batteries Location: Type: Nominal voltage: Calculated capacity of eries to drive the system: In standby mode (h rs): In alarm mode (minutes): 0 Batteries are marked with date of manufacture 0 Battery calculations are attached Amp/hour rating: NFPA 72, Fig. 10.18.2.1.1 (p.90f12) Copyright © 2009 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 POWER (continued) 13.3 Notification Appliance Power Extender Panels )~This system does not have power extender panels. 13.3.1 Primary Power Input voltage of power extender panel(s): Power extender panel amps: Overcurrent protection: Type: Amps: Location (of primary supply panel board): Disconnecting means location: - 13.3.2 Engine-Driven Generator is system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 Uninterruptible Power System This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 13.3.4 Batteries Location: Type: - - Nominal voltage: Calculated capacity of batteries to drive the system: In standby mode (hours): - In alarm mode (minutes): 0 Batteries are marked with date of manufacture 0 Battery calculations are attached Amp/hour rating: -- RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: 1 w system 0 Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) El NFPA 72, Edition: E] NFPA 70, National Electrical Code, Article 760, Edition: 20 - janufacturer's published instructions Other (specify): - . . .. ... ... . - . - System deviations from referenced NFPA standards: Signed: - Printed name: 1') c L\C'J2_Date: Organization: ,LL4..LIitle: CS PhoneP7—LtcOO NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright © 2009 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. It