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Home My WebLink About750 Deming Street - Life Safety System T (3) 72-111 INSPECTION TESTING AND MAINTENANCE INSPECTION AND TESTING FORM WO#: 1102 DATE: SERVICE ORGANIZATION PROPERTY NAME(USER) NAME: Dynamark Security NAME: Churchofthe Living God* ADDRESS: P.O. Box 1170 Tolland,CT 06084-1170 ADDRESS: 199 Deming Street Manchester,CT 06042-1731 REPRESENTATIVE: Michael G.Casieri(8600))872-4050 TELEPHONE: (860)648-0520 TELEPHONE: ( LICENSE NO.: 8 CONTACT: Jody Tiffany CHECK HERE 1F MAILING ADDRESS IS DIFFERENT❑ MONITORING ENTITY APPROVING AGENCY CONTACT: CMS CONTACT: South Windsor Fire Marshal TELEPHONE: 1-800432-1429 ADDRESS: 1540 Sullivan Avenue South Windsor,CT 06074 MONITORING ACCOUNT#: FL5001196 TELEPHONE: (860)644-2511 ext.217 TYPE TRANSMISSION SERVICE ❑-McCulloh ❑-Weekly ❑-Mult plex El-Monthly ❑-Quarterly ®-Digital Reverse Priority FT Reverse Semi-Annually ®-Annually ❑-R F ❑-Other(Specify) ❑-Other(Specify) PANEL MANUFACTURER: Silent Knight MODEL NO.: SK 5208 DATE INSTALLED: 8/14/08 CIRCUIT STYLES: B NO.OF CIRCUITS:20 SOFTWARE REV.:N/A LAST DATE SYSTEM HAD ANY SERVICE PERFORMED: Fire Test 8/31/09 ALARM INITIATING DEVICES AND CIRCUIT INFORMATION TY CKT.WSUPERVISORY 7 STATIONS CTORS I ETECTORS TECTORS I TECTORS 2 LOW SWITCHES 6 SORY SWITCHES OTHER: (SPECIFY) E7i6URITY *Quality MEMO CENTERS Alarm Systems TM Since 1985 P.O. Box 1170 "Notionolly Known, Locally Owned" Tolland, CT 06084-1170 LIC 4181641 Tel. (860) 872-4050 Fax (860) 875-0493 Church of the Living God* DynamarkCT@comcast.net 199 Deming Street 19 Manchester, CT 06042-1731 Date: 3/11/2011 RE: ANNUAL FIRE ALARM TEST Attached is a copy of the "INSPECTION AND TESTING FORM". This form was completed upon testing the fire system in your building, as required annually. A copy must be kept in a file on the property for a minimum of three [3] years and available if asked for by a building official or fire marshal SEE NOTES ON PAGE 72-115 Michael G Casieri CC: Fire Marshal WO# 1102 Ofessed 6e the Lord my roc( my refuge and my fortress, my stronghold, my deliverer, my shield in whom I trust. PSALM 144 0 72-115 INSPECTION.TESTING.AND MAINTENANCE SPECIAL PROCEDURES/COMMENTS: Note:8/14/08-Two main water shut-off valves are not supervised. There may be 2 more shut-off valves(I on the main floor &l on the 2 d floor). -r,�I ppol&J,-. Lk rb Access Ze ry g U-AL✓� I l -it,to jA t9'-0rr-- ever li'�104k- ON/OFF PREMISES MONITORING YES NO TIME COMMENTS ALARM SIGNAL ❑ '2 -3 0 ALARM RESTORAL ❑ TROUBLE SIGNAL ❑ ❑ SUPERVISORY SIGNAL ❑ ❑ SUPERVISORY RESTORAL ❑ ❑ NOTIFICATION THAT THIS YES NO WHO TIME TESTING IS COMPLETE: BUILDINGMANAGEMENT ❑ �-3z'7 MONITORING AGENCY El '� BUILDING OCCUPANTS ❑ ❑ OTHER(SPECIFY) ❑ ❑ THE FOLLOWING DID NOT OPERATE CORRECTLY: SYSTEM RESTORED TO NORMAL OPERATION:: DATE �� l f ( i / TIME 2--30' THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS. NAME OF INSPECTOR: It7 DATE: 311I l it SIGNATURE: NAME OF OWNER OR REPRESENTATIVE: DATE: SIGNATURE: NATIONAL FIRE ALARM CODE 72 1 14 TYPE VISUAL FUNCTIONAL COMMENTS TRANSIENT SUPPRESSIONS ❑ REMOTE ANNUNCIATORS ❑ ❑ NOTIFICATION APPLIANCES AUDIBLE ❑ VISUAL ❑ SPEAKERS ❑ ❑ VOICE CLARITY ❑ INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS LOCATION DEVICE VISUAL FUNCTION FACTORY MEAS. PASS FAIL TYPE CHEC TES - SETTING SETTING Basement Electrical Room Smoke Detector ❑ Basement Left Exit Door Pull Station ❑ Basement Exit Door Pull Station ❑ Basement Door to Stairway Pull Station t ❑ Main Level Kitchen Heat Detector ❑ Main Level Front Door Pull Station El ull Main Level Door to Stairway P Station ❑ Office Level Rear Exit Pull Station [yU/ ❑ Office Level Door to Stairway Pull Station v ElSPRINKLER SYSTEM: ❑ ❑❑ ❑ ❑ ❑ Zone 1 Flow Valve-Wet Zone 1 ❑ ❑❑ 11 EJ Zone 2 Pressure Switch-Dry Zone 2 / E Li Shut Off-Wet Zone 3 Q Li Shut Off-Dry Zone 4 [� ❑ Trouble-Dry Law Pressure Zone 5 Tamper-Elevator Shaft-Attic Zone 6 ❑ Tamper-Valve-Elec. Room Rear Zone 7 ❑ Tamper-Valve-Elec.Room Over El11 ❑❑ Panel Zone 8 ❑ ❑ � ❑ ❑ COMMENTS: ❑ ❑ VISUAL DEVICE SIMULATED OPERATION INTERFACE EQUIPMENT OPERATION (SPECIFY) (SPECIFY) El ❑ ❑ El El(SPECIFY) ❑ El ElSPECIAL HAZARD SYSTEMS ❑ (SPECIFY) (SPECIFY) El El El ❑ (SPECIFY) ❑ ❑ EJ ❑ 72-113 INSPECTION TEST ING AND MAINTENANCE I (Main):Nominal Volta e 120v AC Am s: 15 rent Protection T e Breaker Am s:20 n(Panel Number): Basement LP-2 ecting Means Location: Circuit#39 b. Secondary(Standby): Storage Battery#I: Amp-Hr.Rating: "7.0 VDC: ' -2y AH: '! �{- Installed: 8/08 VDC: AH: -La-p Installed: Storage Batte 42: Amp-Hr.Rating: '/-O � S 6-0Calculated capacity to operate system,in hours: 24 Engine-driven generator-dedicated to fire alarm system: TYPE BATTERY ❑Dry Cell []Nickel Cadmium ®Sealed Lead-Acid ❑Lead-Acid []other(Specify) c. Emergency or standby system used as a backup to primary power supply,instead of using a secondary power supply: []Emergency system described in NFPA 70,Article 700 ❑Legally required standby described in NFPA 70,Article 701 ❑Optional standby system described in NFPA 70,Article 702,which also meets the performance requirements of Article 700 or 701. PRIOR TO ANY TESTING VMO TIME NOTIFICATIONS ARE MADE. YES NO MONITORING ENTITY ❑ �� BUILDING OCCUPANTS ❑ El MANAGEMENT ❑ ❑ OTHER(SPECIFY) AHJ(NOTIFIED OF ANY IMPAIRMENTS ❑ ❑ SYSTEM TESTS AND INSPECTIONS VISU FUNCTIONAL COMMENTS TYPE ❑ CONTROLPANEL ❑ INTERFACE EQ. ❑ LAMPS/LEDS ❑ ❑ FUSES ❑ PRIMARY POWER SUPPLY ElTROUBLE SIGNALS El DISCONNECT SWITCHES ❑ ❑ GROUND FAULT MONITORING ❑ SECONDARY POWER COMMENTS TYPE VISU FUNCTIONAL BATTERY CONDITION LOAD VOLTAGE ❑ DISCHARGE TEST ❑ CHARGER TEST ❑ SPECIFIC GRAVITY NATIONAL FIRE ALARM CODE 72-112 ALARM INDICATING APPLIANCES AND CIRCUIT INFORMATION TV CKT.STYLE TYPE LOCATION V[SU FUNCTIONAL I B Strobe/Horn Basement 1 B Strobe/Hom Basement 1 B Strobe/Horn Basement ❑ I B Strobe/Horn Basement 1 B Strobe/Li ht Basement I B Strobe Li t Basement I B Strobe/Li t Basement I B Strobe Hom Main Level Lobb I B Strobe/Hom Main Level Church I B Strobe/Horn Main Level Church I B Strobe/Li t Main Level Restroom 1 B Strobe/Li lit Main Level Restroom I B Strobe/Horn Office Level Hallwa 1 B Strobe/Horn Office Level Hallway 1 B Strobe t Office Level Bathroom 1 B Strobe/Li lit Office Level Bathroom ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NO.OF ALARM INDICATING CIRCUITS:4 ❑ ❑ ARE CIRCUITS SUPERVISED? ®YES ❑NO SUPERVISORY SIGNAL INITIATING DEVICES AND CIRCUIT INFORMATION QTY CKT.STYLE BUILDING TEMP. SITE WATER TEMP. SITE WATER LEVEL FIRE PUMP POWER FIRE PUMP RUNNING FIRE PUMP AUTO POSITION FIRE PUMP OR PUMP CONTROLLER TROUBLE GENERATOR IN AUTO POSITION GENERATOR OR CONTROLLER TROUBLE SWITCH TRANSFER GENERATOR ENGINE RUNNING OTHER: SIGNALING LINE CIRCUITS Quantity and style(See NFPA 72,Table 3-6.1)of signaling line circuits connected to system: Quantity Style(s)