Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
31B-282 Fire Alarm Completion 2012-05-15
RM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION completed by the system installation contractor at the time of system accep1lJnce and approval. If be permitted to modifY this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. ttach additi01l0.1 sheets, data. or calculations as necessary 10 provide a complele record. Name of property: NORTHAMPTON POLICE STATION Address: 29 CENTER STREETNORfHAMPTON. MA. 01060 Description of property: ______ . __ ._; __ .. _. _________ . ____ . _____ .. __ ~_ .. _._ .. _._ ... _._ .. _____ .. , '-_._._., __ ._._._." >ri." ... ,,''''',,' "," , ... _ .... "" .... ,,_, , ... "",.,,_ ......... " .... ____ ."" .... " ... __ Occupancy type: ... _ .. _~ .. "._ ......... .. Name of property representative: ____ -;-._._. ______ . ____ . __ " __ . __ ..... ,"""' _______ . __ .. __ ... _,._ .. ", " .. _ ....... _"-_ .... ".-._.--..... _ .. , ... --_._-_._ ... ,_.-."" ............ ,.,."., ........ " .... ,,"_ ...... ,,_, ... , Address: Phone: Fax: E-mail: Authority baving Jurisdiction over this property: NHFD Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: ... ~·,~,: .. ~~~~~ El.:~~~~~"~~_ .............. ,.,, ... , ........ __ ........ " .......... ~ ____ ._. ___ ...... _. ____ ,,_ .... __ .... _ Address: .. _!1~!:!9..r:!:I~~.!3.~22~ .. ~<?~I?.Ii'?..l~I~!9.~~ .. ~:._9.~,!·~~~,1,<1_,9,!._ ....... ___ . ____ .... _._" ___ ... _______ ., ........ _ ... _",, License or certification number: Phone: Fax: E-mail: Service organization for this equipment: Address: License or certification number; Phone: Fax: E-mail: A contract for test and inspection in accordance with NFP A standards is in effect as of: Contracted testing company: ., " ..... _ .. _ ... , ........ ~ Address: Fax: Contract expires: Contract number: ............. Frequency of routine inspections: 3. DESCRIPTION OF SYSTEM OR SERVICE 181 Fire alarm system (nonvoice) o Fire alarm with in-building fire emergency voice alarm communication system (EV ACS) o Mass notification (MNS) o Combination system. with the following components: o Fire alarm BY ACS 0 MNS 0 Two-way, in-building, emergency communication system Other (specify): , .................. _....., ...... _.. , .... , .. , .. NFPA 72, 10.18.2.1-1 1 of 12) Copyright I\li 2009 National Flro Pl'Otedlori Association: This fQl'lll may be copled for indMdual use other than fQr resale. II may nol be copied lor commerCial sale or dlstributiGf1. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 3.1 Control Unit Manufacturer: NOTIFIER 3.2 Mass Notification System 3.2.1 System Type: DIn-building MNS-combination Additional description ofsystem(s): Model nwnber: NFW 2-100 {8J Th.is system does not incorporate an MNS DIn-building MNS-stand-alone 0 Wide-areaMNS 0 Distributed recipient MNS o Other ( specifY): ................................. """". '"'''''''' """" .................... " .. _. __ ._ ....... __ .. ,. __ ......... _ .. _ .... ,"', ... _ .. __ .. _._. ___ ._ ... ___ ._ .. _ .. _ ". ___ ._ ... _. __ .... _ .... __ .... __ . ____ ." ... " 3.2.2 System Features: o Combination fire alarm/MNS o MNS autonomous control unit 0 Wide-area MNS to regional national alerting interface (8J Local operating console (LOC) o Direct recipient MNS (DRMNS) 0 Wide-area MNS to DRMNS interface D Wide-area MNS to high-power speaker array (HPSA) interface 0 In-building MNS to wide-areaMNS interface D Other (specifY): ." " .... " _"""" .. " .... " __ ....... " .. """.,,"" ._" ....... " ... " .... __ . ____ " ________________ .. _______ ... ___________ .. __ ._ ........ __ .... _. ________ . ________ . 3.3 System Documentation 181 An 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 Operating system (executive) software revision level: o Th.is system does not have alterable site-specific software. 5.085 Site-specific software revision date: ._ .... __ ............ ___ ... _ .... _._ .... "._ ... Revision completed by: ........ " ........ _ ................... , .. _ ...... _ ......... "" .. ". o A copy of the site-specific software is stored on site. Location: _____ .. _ ....................... _. ____ ............ _" .. __ ...... , .. _ .. ___ ...... _ ....... _,, __ .................... _ .. _ .. 3.5 Off-Premises Signal Transmission o This system does not have off-premises transmission .. Name. of organization receiving alarm signals with phone numbers: Alarm: Phone: Supervisory: ................. . Phone: Trouble: Phone: Entity to which alarms are tetransmitted: Phone: Method of retransmission: If Chapter 26, specifY the 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 o Wired l'8I Wireles..<; NFPA 72, Fig. 10.18.2.1:1 {po 2 of 12} Copyright @2oo9 National Fire Protection AssociatiCln. This form may be copied lor Individual use other lhan lor resale. It may not be copied for commeroial sele or distribution. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Liue Pathways 4.1.1 Patbways 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 o No separate power pathways from the signaling line pathway o Power pathways are separate but of the same pathway classification as the signaling line pathway o Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: . ___ ............. _ ..... ___ ..... _ ........ " ............................................ _ ..................... _ .. _ .......................... _._ ..... __ .. ___ ..... _ .. _. __ .. _ ................... _._ ..................... __ .. _ ....... . 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: Survivability level: (See NFP A 72, S~ctions . .... ............... Quantity: 4.2.2 Pathways Utilizing Two or More Media Quantity: Description: 4.2.3 Device Power Pathways o No separate power pathways from the initiating device pathway o Power pathways are separate but of the same pathway classification as the initiating device pathway o Power pathways are separate and different classification from the initiating device pathway 4.3 Non-Voice Audible System Pathways 4.3.1 Pathways Class DesignatioBs and Survivability Pathways class: Survivability levei: (See NFPA 72. seciionsTi.'3'''ii;;ii2.4j·~ Quantity: 4.3.2 Pathways Utilizing Two or More Media Quantity: ~ ___ .. _.~ ....... " ..................... ".".... Description: 4.3.3 Appliance Power Pathways o No separate power pathways from the notification appliance pathway o Power pathways are separate but of the same pathway classification as the notification appliance pathway o Power pathways are separate and difterent classification'from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 {p.3{)f12} Copyright 1;ll200s National Fire ProIaclion Asooclation. This form may be copied lor Individual use other than lor resale. It may not 00 copied fur commercial Bale or diSllibulion. S. ALARM INITIATING DEVICES 5.1 Manllallnitiating Devices 5.1.1 Manual Fire Alarm Boxes o This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 11 Conventiorull: Coded: Transmitter: Other (specify): ''_.''_'' __ '''' ___ .'"" 5.1.2 Other Alarm Boxes Description: " Type and number of devices: Addressable: Conventional: Other (specify): __ .... "' .. " ... __ " __ ,,_"',,""" __ ,,,,"_,,~,, __ . __ _ 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors Type and number of devices: Addressable: 19 Conventional: Other (specify): o This system does not have other alarm boxes, Coded: Transmitter: o This system does not have smoke detectors. Type of coverage: 0 Complete area 0 Partial area 0 Nonrequired partial area Other (specify): "''''''''''"._ .. ,''' ______ " ___ .. _"_"_''''''_,,',,._,,_'',,,.,,,,'' , Type of smoke detector sensing technology: 0 Ionization !81 Photoelectric 0 Multicriteria 0 Aspirating 0 Beam Other (specify): """,_",.,._."_", .. ,_" __ ,_,_ ... :""",,,,,_,,,,_,,,,,,,,,,, '''"."., """""--,--""'''"''---,,-,,._,,_ .. ''----''''-_ .... ,,'''''''''''' ''',''''"''''"_.,, ..... , .. ,'','','',,'',, .... ,''_ .... , .. " .. " .. _, "" .. , '"'' 5.1.1 Duet Smoke Detectors o TIlis system does not have alarm-causing duct smoke detectors. Type and number of devices: Addressable: 12 Con'llentionai: Other ( specify): ", __ "",,,., ..... _,., ...... _'., ... _"",."_._." .. ,. __ ""."."_,,._,, ...... "._ "" .. " .. "." "" '" '"'''' " ... " ... ".""""."."'"''' ___ '''' __ ",,._, .... ,,. ___ ,_,, __ .... ___ ....... ,,'''''.""" ... "" .. ,." .. ", ...... " __ ,, Type of covel"age: Type of smoke detector sensing technology: 0 Ionization 181 Photoelectric 0 Aspirating 0 Beam 5.2.3 Radiant Energy (Flame) Detectors 181 This system does not have radiant energy detectors. Conventional: "---,---_.,, Type and number of devices: Addressable: Other (specify): ,.-~."' ... --"''' ... -.. ''''' .. ,,-.-.,''.... ."""". ". "" ... """." .. """ ... "--,,.--.-.""'''''''~~~.-... -, .. '''''.''' ... ''''., """-"".",.,,,,,---_."" .""".".""."" ..... ,, .... ,,",,"",," ... _---,,''''-- Type of coverage: 5.2.4 Gas Detectors This system does not have gas detectors. Type of detector(s): C 0 DETECTORS Numbc( of devices; Addressable: 5 Conventional: Type of coverage: 5.1.5 Heat Detectors o This system does not have heat detectors. Type and number of devices: Addressable: Conventional: Type of coverage: 0 Complete area 0 Partial area 0 Nonrequi(ed partial area 0 Linear 0 Spot Type of heat detector sensing technology: ~ Fixed temperature 0 Rate-of-rise 0 Rate compensated NFPA 72, 10.18.2.1.1 (p, -4 of 12) Copynght C 2009 National Fire Protection Association. This farm may be copied for IndivldlJal use other 111M for l'e5a1e. It lIISy nol be copied for oommerclal sale Qf dislrtbution. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: o This system does not have monitoring modules. 5.2.7 Waterflow Alarm Devices 0 This system does not have waterflow alarm devices. Type and number of devices: Addressable: "."5.~ __ .. ".",, ... Conventional: Coded: Transmitter: 5.2.8 Alarm Verification C8l This system does not incorporate alarm verification. N umber of devices subject to alarm verification: Alarm verification set for seconds 5.2.9 Presignal C8l This system does not incorporate pre-signal. Number of devices subject to presignal: Describe presignal functions: .... _ ... "" __ ." .... _."._ .. "."._ ... "._""." ........ "."".""" .. ".... . ... ".......... .... . .. ' ...... "._" ... " .. ".""."." " .... """" ...... _ .. _----_ ....... ".,," ...... ,, ......... " .......... "".""._"". 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: 6. SUPERVISORY SIGNAL-INITIATING DEVICES I8J This system does not incorporate PAS. [g] This system does not have other initiating devices. 6.1 Sprinkler System Supervisory Devices Type and numher of devices: Addressable: 8 Other (speci'fY): o This system does not have sprinkler supervisory devices. Conventional: Coded: Transmitter: 6.2 Fire Pump DescriptioD aod Supervisory Devices [g] This system does not have a tire pump. Type fire pump: 0 Electric pump Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specifY): . ........... ......."' .... '" .... _ ........... "." .. ~".'" ... _"".,,_~_ .. __ .""._ ... """''''"' .. 6.2.1 Fire Pump Functions Supervised o Power 0 Running 0 Phase reversal 0 Selector switch not in auto 0 Engine or contr01 panel trouble 0 Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ~ This system does not have DSDs causing supervisory signals. Typeaod number of devices: Addressable: "'".""' ___ .. ,," .. Conventional: Other (specify): ....... "."."'"" ........ "_""_ .. " .. ""._,,,,""_"""" ..... " ........... , .. Type of coverage: " .... " .... " ... " ..... " .... " .......................... " ......... " ... " .. _~_ .. _ .. "._ ...... __ " .. ___ .............. "'''' .. " ........ . Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 0 Aspirating 0 Beam 6.4 Otber Supervisory Devites Describe: o This system does not have other supervisory devices. NFPA 72, Fig .. 10.18.2.1..1 (p .. 5nT 12) Copyright 1/;12009 National Fire Protection Association. This form may be copied for individtlalllStl other than for resal .... h may not be copied for commercial sale or dislribulion. 7. MONITORED SYSTEMS 7.1 Engine--Driven Generator I2Sl This system does not have a generator. 7.1.1 Generator Functions Supervised o or control panel trouble Generator running o Selector switcb not in auto o Low fuel 7.2 Special Hazard Snppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Descriptioo of specialllazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location I; Location 2: Location 3: 9. AL.ARM NOTIFICATION APPLIANCES o This system does not monitor special hazard systems. o This system does not monitor other systems. t8J This system docs not have annunciators. 9.1 In-Building Fire Emergency Voice Alarm Communication System o This system does not have an EV ACS. Number of single voice alarm channels: Number of speakers: 36 Location of amplification and sound-processing equipment: Location ofpllging microphone stations: Location 1: FRONT MAlN ENTRY Location 2: Location 3: 9.2 Nonvoice Notification Appliances Horns; With visible: Chimes: With visible: 9.3 NotificatioD Appliance Power Extender Panels Quantity; Locations: 1 Number of multiple voice alarm channels: Number of speaker circuits: FRONT MAIN ENTRY o This system does not have nonvoice llQtitication appliances. Bel1s: Witb visible: o This system does lfot bave power extender panels. NFPA 10.18.2.1.1 Bof 12) Copyright@ 2009 Natit.:>nal Fin; Proteclio!1 A$!lOcia\Ion, This form may be copied for individual use other \han for re!!ale. It may no! be copil!<:! for commereial sale or disltibullon. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS i8l This system does not have an MNS. 10.1 MNS Local Operating Consoles Location I: Location 2: Location 3: 10.2 High.Power Speaker Arrays Number ofHPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination tire afarmlMNS visible appliances: Textual signs: _ ...... , .. _., ... , ...... ',. ___ Other (descnbe): Supervision class: "............., .. ""., .. ,""", .. , ... " ..... ,,' .,," " 10.3.1 Spedal Hazard Notification MNS-only visible appliances: o This system does not have special suppression predischarge notification. o MNS sy~ems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO·WAY EMERG:ENCY COMMUNICATION SYSTEMS 11.1 Telephone System This does not have a two-way telepbone 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 11..2 Two-Way Radio Commonications Enhancement System 181 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 strengtll: 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. 7 0112) Copyrlght@20Q9 NaUan!!1 Flro PrOledlOl'l Assodalion. This form may be copIed for individual use oIher lhan for resale, It may'not be copied for CO!IImerciai sale Of distribution, 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems .[81 This 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 181 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: 12. CONTROL FUNCTIONS This system activates the following control fuctions: o Hold-open door releasing devices 0 Smoke management [81 HV AC shutdown 0 F/S dampers o Door unlocking 181 Elevator recall 0 Fuel source shutdown 0 Extinguishing agent release o Elevator shunt trip 0 Mass notification system override offire alarm notification appliances Other (sp ec if)t ) : " .. _, ....... ' ..... , .. . .. ' .. ~ ... ~_ .. ___ N ____ ._. ___ ,, __ . .. ..... _., ____ , ___ ._,.,." ______ •.. ______ •.• ____ .•• , ____ . ___ , __ ",_ .•. N ... __ . ... ••••••.•••••• •• ~, ,,', ...... , •. N ............... " .,' .N.... • ••••• ~.~~ •. ~ .• ~.~.~.~.~ •. ~.~ .•. ~ .•.• ~~.~.~~ .• ~.~.~. 12.1 Addressable Control Modules o This system does not have control modules. Number of devices: 21 Other (specitY): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120 Control panel amps: Overcurrent protection: Type: BRAKER Amps: .... 3.~ ...... __ ............. _ ........... _ ...... _ ......... _._ ............................................ . Location (of primary supply panel board): Disconnecting means location: __ .......... _ .... _ ........ _ ......................................... . 13.1.2 Engine-Driven Generator 181 This system does not have a generator. Location of generator: ._.~.~ __ . __ ~~.~ .. ~~.~.~~.~ .. ~ ... ~.~.~ ... ~.~.~ .... ~~ .. ~~ .. ~ .. __ .. _ .. _ ......................... _ ... __ .. ~_._~_. ___ ._ .. __ . __ .~_~._ .. _. __ . __ ._._~_. ___ . ____ . __ .. ~_~._._ .. ___ . ____ .~~~.~._. __ ... __ . __ ._. __ .. _._ .. _ .... . Location of fuel storage: Type of fuel: NFPA 72, Fig.10.1B.2.U (p. 8 of 12) Copyright © 2009 National Fire Protection Association. TIlls form may be copied for individual use other than for resale. It may not be copied for commercial sale or dlslribution. 13. SYSTEM POWER (continued) 13.1.3 Uninterruptible Power System' Equipment powered by a UPS system: o This system does not have a UPS. Location of UPS system: ,' ____ .'._, .. , __ .,. _____ ,_,_., _____ .,'"""," '" ,,"'_, __ , , ...... "', .. __ ,, __ "" __ """, .. _.,, ". Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): "n."" •• _ In alarm mode (minutes): 13.1.4 Batteries Location: GEUCElL Nominal voltage: 12 Calculated capacity of batteries to drive the system: In standby mode (hours): 18'1 Batteries are marked with date of manufacture In alarm mode (minutes): [81 Battery calculations are attached Amplhour rating: 13.2 In-Building Fire Emergency Voice Alarm Communication System or Mass NotifJeaiion System r8J This system does not have an BV ACS or MNS system. 13.:2.1 Primary Power 24 Input voltage of BV ACS or MNS panel: .. ~"", ... ",. __________ ,._____ EY ACS or MNS panel amps: ______ , ______ " .. ___ , .. Overcurrent protection: Type: " Amps: Location (of primary supply panel board): Disconnecting means location: 13.2.2 Engine-Driven Generator [81 This system does not have a generator. U>cation of generator: , _____ , .. ,,_,_,_,_, Location of fuel storage: Type offue1: 13.2.3 Unioterruptible Power System Equipment powered by a UPS system: 1&1 This system does not have a UPS. 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): 13.2.4 Batteries Location: Type: " ..... ___ ,, ____ ., Nominal voltage: ''' ____________ Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): o Batteries are marked with date of manufacture 0 Battery calculations are attached NFPA 72, -10.18,2,1.1 (p, 9 of 12} Copyright@2!109 Nilliona! Fire Protection ~<>Il, This foon may bEl copied for lndiviauallJsli! other than fO( resale. It may not be OQI.'Ied ''I' commercial sale or disinlll.llon, 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power input voltage of power extender panel(s): _ .. 1~_20,,,, .. ,,.,~,_,,,,,._.,_., .. ,, ........ _ .. ,, .. ,,,,, o This system does not bave power extender panels. Power extender panel amps: 8 Overcurrent protection: Type: BRAKER ... , ...•. " ..... ,~_.. Amps: ,_ .. 2~O_ .. _ .... _ ............. _ .. ,_, .. _ ... _ ... ~ .. _" .. __ ..... _ ..... " ..... _ ..... _,, ___ .. .. Location (of primary supply panel board): ,.. ........ __ .. "_ ...... ",._,. __ ... __ ,_., ________ ... __ ,,...... . .. ".,,_. "'"'' Disconnecting means location: 13.3.2 Engine--Driven Generator f8I This system does not have a generator. Location of generator: Location of fuel storage: 13.3.3 Uninterruptible Power System 181 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: 10 standby mode (hours): . Iii alarm mode (minutes): 13.3.4 Batteries Location: Type: Nominal voltage: ......... ~ .. ,. .. ,. ...... ,. Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): ................... ___ ........ __ ....... ______ .. ___ In alarm mode (minutes); o Batteries are marked with date of manufacture o Battery calculations are attached 14, RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked/or opens, shorts, ground/aullS, and improper branching, but before conducting operational acceptance tests. This is a: 181 New 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.) I8l NFPA 72, Edition: 181 NFP A 70, National Electrical Code. Article 760, Edition: f8I Manufacturer's published instructions Other (specify): Sy&tem deviations from referenced NFP A standards; Signed: Printed name: Date: 4127112 Organization: WJ GRIFFLN ELECTRIC Title: Phone: NFPA 72, Fig. 10.18.2,1.1 (p. 10 of 12} Copyright@2OO9National Fire Protedlon AsSOClia1rorL This form may be copied for Individual use othllr than far resalI1. It matt not be copied for commercial sale or <llSlflbuIlon. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ~Newsystem All operational features and jUnctions of this system were tested by. or in the presence oj. the signer shown belaw, on the date shawn below, and were found to be operating properly in accordance with the requirements for thefollowing: o Modifications to an existing sYStem All newly modified operational features and jUnctions of the system were tested by, or in the presence oj. the signer shol'm below. on the date shown below. and were found to be operating properly in accordance with the requirements of the following: t8J NFPA 72, Edition: ~ NFP A 70. National Electrical Code, Article 760, Edition: t8J Manufacturer's published instructions Other (specify): documentation [[nspe,,'1;ion and Te::.1:ing Form (Figure 14.6.2.4) is attached] Printed name: .M1C::HAe:I"R C.hapin Date: 4/27112 -, ........ , . --''''~." -,~ .... . Title: TECHN ICIAN Phone: 413-543-9090 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as ofthe date shown below. Signed: __ .... ___ .. __ .. _ ....... _ .. __ ... _ ................... __ ._'.'.'.'."._.'."'.' .. _._. Printed name: Date: Organization: Title: Phone; 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFP A standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p.11 of 12) Copyright@ 2009 National F~e Protection Association. This form may be copied for individual use olller than for resale. It may not be copied for commercial sale or dlstrlbullon. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: 1 accept this system as having been installed and tested to its specifications and aU NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and "'ith all NFP A standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig, 10.18.2.1.1 (p, 12 c'f 12) Copyright /fI! 2009 National Rre P.roleotion Association. This fOlm may be copied for Individual use other than for resale. It may not be copied for commercial sale or distribution.