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17C-220 (3) ServiceNietllll Integrated Human Services 1 1 11 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. DEVICE TEST RESULTS (Attach additional sheets if required) Device Type Address/Zone Location Test Results P/F PES LOCAL ROOM 8 2ND FLOOR SMOKE PASS HDT 5 ROOM 8 2ND FLOOR HEAT PASS HST 5 2ND FLOOR BATHROOM FRONT PASS HDT 5 2ND FLOOR BATHROOM REAR _ PASS HDT 5 2ND FLOOR BATHROOM FRONT PASS HDT 5 2ND FLOOR BATHROOM REAR PASS PES 3 1ST FLOOR COMMERCIAL _T— PASS PES 3 1ST FLOOR OFFICE.COMMERCIAL SPACE PASS PES 3 COMMERCIAL SPACE REAR SMOKE PASS PES 3 SMALL COMMERCIAL SPACE PASS HDT 3 LAUNDRY ROOM HEAT 1`T FLOOR PASS HDT 3 1ST FLOOR BATHROOM HEAT PASS HDT 3 COMMERCIAL SPACE BATHROOM _ PASS PES LOCAL ROOM 1 1ST FLOOR PASS MPS 3 ROOM 1 1ST FLOOR PULL PASS HDT 3 KITCHEN 1ST FLOOR PASS HST NAC ROOM 1 1ST FLOOR PASS HDT 3 1ST COMMON LIVING ROOM PASS PES–Photo-Elec Smoke MPS–Manual Pull Station HDT–Heat Detector SFS–Sprinkler Flow Switch STS–Sprinkler Tamper Switch SSS–Sprinkler Supervisory Switch HSS–Hood Suppression Switch CO–Carbon Monoxide Detector HST–Horn/Strobe STB–Strobe EXB–External Beacon SPST–Speaker/Strobe SPKR–Speaker EBEL–Electro-Mechanical Bell Sery i9 ceNet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. gds "cy DEVICE TEST RESULTS (Attach additional sheets if required) Device Type Address/Zone location Test Results (P/F) MPS 8 BOTTOM BASEMENT STAIR PASS HDT 8 BASEMENT STORAGE ROOM PASS HST 8 BASEMENT STORAGE ROOM PASS MPS 8 REAR BASEMENT _ PASS HDT 8 REAR HALL BASEMENT, PASS HDT 8 REAR STORAGE BASEMENT PASS HST 8 MIDDLE BASEMENT PASS HST 8 FRONT BASEMENT PASS HDT 8 SIDE STORAGE BASEMENT PASS HST NAC BASEMENTFRONT PASS HST NAC BASEMENT MIDDLE PASS HST NAC BASEMENT REAR PASS _ HDT 8 NORTH BASEMENT HEAT PASS HST 8 FRONT STORAGE HEAT BASE PASS HST 8 BOILER AREA H AT PASS MPS 3 FRONT DOOR PULL PASS PES 3 FOYER SMOKE 1s'FLOOR _ PASS PES 3 SMOKE 1 sT FLOOR EY FESTROOM PASS PES 3 REAR HALL SMOKE 1sT'FLOGR PASS MPS 3 REAR DOOR PULL PASS MPS 5 2ND FLOOR REAR PULL_ PASS PES 5 2ND FLOOR HALL S!v1OKE PASS PES 5 2ND FLOOR BY ROOM 7^ -- _ PASS PES 5 l 2ND FLOOR HALLVVAY PASS MPS 6 3RD FLOOR PULL _ PASS PES 6 3RD FLOOR SMOKE — T PASS PES ROOM 10 SMOKE - _ PASS HDT 6 ROOM 10 HEAT -- PASS PES—Photo-Elec Smoke MPS—b4aaual Pull S'ation HDT—Heat Detector SFS—Sprinkler Flow Switch STS--Sprinklet l'rrnper Switch SSS—Sprinkler Supervisory Switch HSS—Hood Suppression Switch CO—Carbon Monoxide Detector HST—Horn/Strobe STB—Strobe EXB—External Beacon SPST—Speaker/Strobe SPKR—Speaker EBEL—Electro-Mechanical Bell ServiceNet Integrated Human Services 1111 129 King Street • Northampton,MA 01060 - 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. DEVICE TEST RESULTS (Attach additionf_l sheets,i6 requieed) Device Type Address/Zone Location Test Results P/F HDT 6 ROOM 11 HEAT 3RD FLOOR PASS PES LOCAL ROOM 11 SMOKE 3R'FLOOR PASS HDT ROOM 13 HEAT 3RD FLOOR PASS PES LOCAL ROOM 13 SMOKE 3RD FLOOR PASS HDT 6 ROOM 12 HEAT 3RD FLOOR PASS PES LOCAL ROOM 12 3"FLOOR SMOKE PASS HST ROOM 133RD FLOOR PASS HDT 6 BATHROOM HEAT 3"'FLOOR PASS HST NAC FRONT 3R0 FLOOR PASS HST NAC REAR 3RD FLOOR PASS HST NAC FRONT 2"D FLOOR PASS HST NAC REAR 2ND FLOOR PASS PES LOCAL ROOM 14 3RD FLOOR SMOKE PASS HDT 6 ROOM 14 3RD FLOOR HEAT PASS HDT 5 ROOM 2 2"D FLOOR HEAT --__ PASS PES LOCAL ROOM 2 2"D FLOOR SMOKE PASS HST 5 ROOM 3 2"D FLOOR HEAT PASS PES LOCAL ROOM 3 2"D FLOOR SMOKE PASS HDT 5 ROOM 4 2"D FLOOR HEAT PASS PES LOCAL ROOM 4 2"D FLOCR SM,,OKE PASS PES 5 ROOM 5 2"D FLOOR SMOKE PASS HDT 5 KITCHEN 2ND FLOOR HEAT PASS PES LOCAL ROOM 7 2"D FLOOR SMOKE PASS HDT 5 ROOM 7 2"D FLOOR HEAT PASS PES LOCAL ROOM 6 2"D FLOOR SMOKE — PASS HDT 5 ROOM 6 2"D FLOOR BEAT PASS PES LOCAL ROOM 9 2"D FLOOR SMOKE PASS HST 5 ROOM 9 2"D FLOOR HEAT PASS PES–Photo-Elec Smoke MPS–Manual Pull Station H:i F–Heat Detector SFS–Sprinkler Flow Switch STS–Sprinkler'Camper Switch SSS–Sprinkler Supervisory Switch HSS–Hood Suppression Switch CO–Carbon Monoxide Detector HST–Horn/Strobe STB Strobe EXB–External Beacon SPST–Speaker/Strobe SPKR–Speaker EBEL–Electro-Mechanical Bell Sery ie ceNet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. $. NOTIFICATIONS THAT TESTING IS COMPLFTF ?�ul t Cdr t}'�a a„�tftlm M<Jn .......... 1❑;;1:'. +'"�_ _.... 33tu11..t,n:e s,.r.'Iau.ei �.°.enta t� y � i-nc. -� �`� �1�✓1 �j1I.A ri,. ��.-i:.11P2mis CB' J 9. SYSTEM RESTORED TO NORMAL OPERA-, J 10. CERTIFICATION iC1.7 ln��rcctrir`f_;ertil�tcstiirr+; 51>.rcu: � u��'✓� ,.�rnt �_'; 4f�?�._7�'ti�t�',�'s. .�.r'-;:.... ".,:,�'.'"�- f�... _. .... JU.: -�trrlatMnce Ly C)H�Itcrnr(Swncr's kr.hres.ur3�..i•:r. 'l'C`fl`9fI..,JI:�CZ h..i L:a:v..C:.@Iliss�l •r(rlr;r jl 1.S.r ?:Ltre.r Si n 1 ServiceNet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. 7. TESTING RESULTS (continued) 7.11 Auxiliary Functions T Visual Functional Description Inspection Test ! Comments Door-releasing devices ❑ ❑ Fan shutdown ❑ Smoke management/smoke control ❑ I _Smoke damper dam er o eration ❑ ❑ Smoke shutter release ❑ _ ❑_ Door unlocking 1 ❑ Elevator recall ❑ ❑ ` i Elevator shunt tri ❑ _❑ MNS override of FA signals ❑ Other(specify) ❑ 7.12 Alarm Initiating Device ® Device test results sheet attached listing all devices tested and the results of the testing 7.13 Supervisory Alarm Initiating Device ® Device test results sheet attached listing all devices tested and.the results of the testing 7.14 Alarm Notification Appliances ® Appliance test results sheet attached listing all applianc,s tested and the results of the testing 7.15 Supervisory Station Monitoring Visual { Functional Description Inspect on Test 'rime I Comments Alarm signal ❑ ❑ _ Alarm restoration ❑ [ � Trouble signal ❑ [_] Trouble restoration ❑ ❑ Supervisory signal Supervisory restoration ❑ I ❑ S erviceNet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. Partner ft—Y 7. TESTING RESULTS (continued) 7.7 Combination Systems ®N/A Visual Functional Description Inspection Test Comments Fire extinguishing monitoring ❑ ❑ devices/system Carbon monoxide detector/system ❑ ❑ Combination fire/security system ❑ ❑ Other(specify) ❑ ❑ 7.8 Special Hazard Systems Z N/A Visual FLi letional Description(specify) Inspection Test Comments ❑ ❑ ❑ LI 7.9 Emergency Communications System Fj -N/A ❑ Visual ❑ Functional ❑ Simulated operation ❑ Ensure predischarge notification appliances of special hazard sysierns are not overridden by the MNS. See NFPA 72,24.4.1.7.1. 7.10 Monitored Systems Visual Functional Description s eci ) Inspection Test I Comments En ine-driven generator Fire pump Special suppression systems ❑ Other(specify) ❑ I___�_�� ServiceNiet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. 7. TESTING RESULTS(continued) 7.5 Mass Notification Equipment(continued) Visual Functional Description Inspection Test Comments MNS to direct recipient MNS 1 ❑ ❑ Sound pressure levels ❑ ❑ Occupied ❑Yes [:]No Ambient dBA Alarm dBA (attach report with locations,values, and weather conditions) System intelligibility ❑CSI ❑STI I (attach report with locations,values, and weather conditions) Other(specify) ❑ ❑ 7.6 Two-Way Communications Equipment Z N/A Visual Functional Description Inspection Test Comments Phone handsets ❑ ❑ Phone'acks ❑, ❑ Off-hook indicator ❑ ❑ Call-in signal ❑ ❑ System performance ❑ System audibility ❑ {{ ❑� System intelligibility ❑ I ❑ Radio communications ❑ enhancements stem Area of refuge communication ❑ ❑ system - — Elevator emergency ❑ ❑ communications system Other(specify) ❑ _ ❑ 1 J C r ServiceNet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. 7. TESTING RESULTS(continued) 7.4 Notification Appliance Power Extender Panels ❑N/A ii Visual Functional Description Descri tion Ins ection I 'Test Comments Lam s/LEDs/LCDs Fuses Primary power supply Secondary power supply ®- Trouble signals Ground-fault monitoring Panel supervision ® (� Other(specify) ❑ ❑ 7.5 Mass Notification Equipment Z N/A Visual Functional Description Ins ection Test Comments Functional test ❑ ❑ Reset/power down test ❑ 1 ❑ Fuses ❑ ❑ Primary power supply ❑ i _ L] UPS power test ❑ i❑ Trouble signals ❑ El Disconnect switches ❑ Ground-fault monitoring El ❑ CCU security mechanism ❑ ❑ Prerecorded message content ❑ ❑ Prerecorded message activation ❑ ❑ Software backup erformed ❑ ❑ Test backup software ❑ [] Fire alarm to MNS interface ❑ ❑ MNS to fire alarm interface ❑ In-building MNS to wide-area ❑ ❑ MNS ServiceNietllll Integrated Human Services l i l l 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.0. 7. TESTING RESULTS(continued) 7.2 Control Unit Power Supplies Visual Functional Description Inspection Tes4 Comments 120-volt power ® Z Generator or UPS ❑ I ❑ N/A Battery condition I Load voltage ❑ ❑ Discharge test Charger test ❑ _I Other(specify) ❑ f__ ❑ 7.3 In-Building Fire Emergency Voice Alarm C--ommu-nic—anion—s Equipment ®N/A Visual functional Description Inspection _'test __ Comments I Control unit ❑ t _ I _w - Lam s/LEDs/LCDs ❑ _,_� __ Fuses ❑ -❑—��- Primary power supply ❑ ❑ __ Secondary power supply ❑ ._ ❑ ❑ Trouble signals ❑ y Disconnect switches ❑ _�_�� Ground-fault monitoring 1 ❑ ❑ Panel supervision System performance ❑ �_��~ ! I Sound pressure levels ❑ -� I Occupied ❑Yes ❑No Ambient dBA I Alarm dBA (attach report with locations,values, and weather conditions) - System intelligibility ❑ { _ I ❑CSI ❑STI i (attach report with locations,values, i and weather conditions) 1 Other(specify) ❑ W _❑ I___ ServiceNet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. Parma Agency 4. SYSTEM POWER(CONTINUED) 4.3.4 Batteries Location: IN PANEL Type: SLA Nominal voltage: 27.4 Amp/hour rating: 7AH(X2) Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ❑Batteries are marked with date of manufacture. 5. ANNUNCIATORS ❑This system does not have annunciators. 5.1 Location and Description of Annunciators Annunciator l: FOYER ENTRANCE IsT FLOOR Annunciator 2: Annunciator 3: 6. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: Y Time: 12:00 PM Building management Contact: . Y Time: 12:00 PM Building occupants Contact; . Y _ Tinge: 12:00 PM Authority having jurisdiction Contact: Time: Other,if required Contact: Time: 7. TESTING RESULTS 7.1 Control Unit and Related Equipment Visual Functional Description Inspection Test _ Comments Control unit Lam s/LEDs/LCDs Fuses ❑' n N/A Trouble signals Disconnect switches ® I_ Ground-fault monitoring Supervision ® �' Local annunciator t Remote annunciators Power extender panels ® L� i Isolation modules ❑ ❑ Other(specify) ❑ ❑ _ / -7 C ' ServiceNet Integrated Human Services 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • www.servicenet.org • Susan L. Stubbs, C.E.O. 4. SYSTEM POWER(continued) 4.1.4 Batteries Location: FACP Type: SLA Nominal voltage: 26.8 Amp/hour rating: 7.OAH Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ®Batteries are marked with date of manufacture. 4.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System ®This system does not have an EVACS or MNS. 4.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: 4.2.2 Engine-Driven Generator ❑This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.2.3 Uninterruptible Power System Z 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 oonnected to it: In standby mode(hours): In alarm mode(minutes): 4.2.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): !n alarm mode(minutes): ❑Batteries are marked with date of manufacture. 4.3 Notification Appliance Power Extender Panels ❑This system does not have power extender panels. 4.3.1 Primary Power Input voltage of power extender panel(s): 110 VAC Power extender panel amps: 4.3.2 Engine-Driven Generator This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.3.3 Uninterruptible Power System This system does riot 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 erode(minutes): ti=. ServiceNet Integrated Human Services 1 1 1 1 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • wwwservicenet.org • Susan L. Stubbs, C.E.O. Partner Agency 3.2 Mass Notification System ®This system does not incorporate an MNS 3.2.1 System Type: ❑In-building MNS—combination ❑In-building MNS—stand-alone ❑Wide-area MNS ❑Distributed recipient MNS ❑Other(specify): 9' 3:2.2 System Features: ❑Combination fire alarm/MNS ❑MNS ACU only ❑Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) ❑Direct recipient MNS(DRMNS) ❑Wide-area MNS to DRMNS interface ❑Wide-area MNS to high-power speaker array(HPSA)interface ❑In-building MNS to wide-area MNS interface ❑Other(specify): 3.3 System Documentation ❑An owner's manual,a copy of the manufacturer's instructions,a written sequence of operation,and a copy of the record record drawings are stored on site. Location: 3.4 System Software This system does not have alterable site-specific software. Software revision number: Software last updated on: ❑A copy of the site-specific software is stored on site. Location: 4. SYSTEM POWER 4.1 Control Unit 4.1.1 Primary Power Input voltage of control panel: 120Vac _ Control panel amps: 4.1.2 Engine-Driven Generator ®This system does not have a generator Location of generator: Location of fuel storage: Type of fuel: 4.1.3 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): a�� ServiceNiet Integrated Human Services 1111 129 King Street • Northampton, MA 01060 • 413.585.1300 • Fax 413.582.4252 • wwwservicenet.org • Susan L. Stubbs, CE.0. -7 .. a o FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND TESTING FORM Date of this inspection or test: 7/24/14 Time,of inspection or test: 1,2:00 PM 1. PROPERTY INFORMATION Name of property: FLORENCE INN Address: 15-17 NORTH MAPLE STREET, FLORENCE,MA Description of property: Occupancy type: Name of property representative: SERVICENET Address: Phone: Fax: _ E-mail: Authority having jurisdiction over this property: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE,AND TESTING CONTRACTOR INFORMATION Service and/or testing organization for this equipment: Citizen Se,:urity Corporation Address: 87 Center St Ludlow,MA 01056 Phone: 413-547-6512 _ Fax: 413-509-0961 nail: Seniice.department @citizen-secudty.com Service technician or tester: BOB BELANGER Qualifications of technician or tester: A contract for test and inspection in accordance with NF?F,standards is ir.effect as of: The contract expires: Contract number: Frequency oftests and inspections: YRLY Monitoring organization for this equipment: Citizen Security Corpor&tion A contract for test and inspection in accordance with NFPA standards is in eff;,ct,as of` _ Address: 87 Center St Ludlow, MA 01 U58 Phone: 413-547-6512 _ Fax: 4_3_`89-096_ - E jr:aij: Sarvicc-.department @citizen-security.com Entity to which alarms are retransmitted: Phone: 3. TYPE OF SYSTEM OR SERVICE ®Fire alarm system(nonvoiee) ❑Fire alarm with in-building fire emergency voice alarm communication system(EVACS) ❑Mass notification system(MNS) ❑Combination system,with the following components: ❑Fire alarm ❑EVACS f7!MNS ❑TN' o-way.,in-but}ding,emergency communication system ❑Other(specify): ATPA 72 edition: Check W/Tom _ Additiona;description of-system(s): 3.1 Control Unit Manufacturer: BOSCH ^_`� _ __�_� Mod--I number: 7024