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HomeMy WebLinkAbout66 Glendale Road - Life Safety System Te MONTAGNO Letter of Transmittal lace RELATIONSHIPS BUILT ON TRUST 75 PROGRESS LANE WATERBURY,CT 06705 PHONE(203)597-9014 FAX(203)573-0517 To: Walter Summers Transmittal#: 64 Town of South Windsor Date: 4/23/2013 1540 Sullivan Avenue Job: 212-603 Preferred Display South Windsor, CT 06074 Ph: (860)644-2511 x217 Fax: (860)644-7280 Subject: Inspection and Testing Form WE ARE SENDING YOU r Attached Via US Mail r Under separate cover r Shop drawings r- Prints r Plans r, Samples r Copy of Letter r- Change order r- Specifications r- Other Document Type Copies Date No. Description Other 1 4/17/13 Inspection and Testing Form THESE ARE TRANSMITTED as checked below: 177 For approval Approved as submitted r Resubmit_copies for review r- For your use I""A` Approved as noted r Submit_copies for distribution r As requested r- Returned for corrections I Return corrected prints i" For review and comment 177 For your records I- For Bids Due r PRINTS RETURNED AFTER LOAN TO US Remarks: Enclosed please find the"Inspection and Testing Form(1)" dated 4/17/13 and provided by DuBaldo Security Systems, Inc. Please keep this for your records. Thank you and have a nice day. Copy To: File (Montagno Construction, Inc.) From: Valerie Busa(Montagno Construction, Inc.) Signature: If enclosures are not as noted,kindly notify us at once. Page 1 of'I An Equal Opportunity Employer DuBaldo Security Systems Inc. Burglar, Fire,& Camera Systems D Sales - Service- Installation S S 24 - Hour U.L. Monitoring 110 Tracy Drive - Manchester, CT 06042 CT Lie.#ELC 185503-L5 (860) 645-6500 - Fax (860) 643-5591 - Toll Free (877) DUBALDO - www.DUBALDO.com Inspection and Testin Form (1) Date: Property Name: /� Name: AfG/',rGJ Address: G� /�,�,4,�,/G Address: ,�? �i���� 4L�D7y Owner/Contact: t/4�7� �L/``D'g�P Telephone:, 1-13 -D3lZ Service Orzanization: Name: DuBaldo Security Systems, Inc. Representative: Address: 110 Tracy Drive License No.: 118550033 7 Address: Manchester, CT 06042 Telephone: (860) 645-6500 Select 1110111110 Monitored System Local System Monitorinz Entity: Approving A. ency: Account#: = - f:&:at Contact: Telephone J^j:;Gd-F,73-G-f f-g Telephone: Contact: Type Transmission: Service: Panel Mfg.: No. Manual Stations: Model No: - �V52�%4,V No. Ion Detectors: Circuit Style: SG. No. Photo Detectors: 2 No. of Circuits: f No. Duct Detectors: Software Rev: No. Heat Detectors: Last Service: �/� S� No. Water Flow Sw: Last Software Rev: No. Supervisory Sw: Others: White Copy:Fire Marshal Yellow Copy: Customer Pink Copy:DuBaldo Security D uBaldo Security Systems Inc. Burglar, Fire, & Camera Systems D Sales- Service- Installation S S 24 -Hour U.L. Monitoring 110 Tracy Drive - Manchester, CT 06042 CT Lie.#ELC 185503-L5 (860) 645-6500 - Fax (860) 643-5591 - Toll Free (877) DUBALDO - www.DUBALDO.com Ins ection and Testing Form (2) Date: < Alarm Notification Appliances & Circuit Notification Indicating Circuits: &f Circuit Supervision: (lei SianalinQ Line Circuits Bells: Quantity: Horns: Style: Strobes: Chimes: Speakers: Others: Supervisory Sienal-Initiatinz Devices & Circuit Information System Power Supplies Primary Secondary Nominal Voltage: 4-7gr yA-G Battery Type: , Amps: ;;�o A Amp/Hour Rating: ;7e!LAo AAo— Overcurrent Protection: G-6 Calculated Capacity: -;zy 4, Overcurrent Amps: .70,q- Generator: Panel Location: Fuel Fuel Storage: Disconnect Location: C Ar- W© Disconnect Location: I Comments: White Copy.Fire Marshal Yellow Copy.Customer Pink Copy:DuBaldo Security D uBaldo Security Systems Inc. Burglar, Fire,& Camera Systems D Sales- Service- Installation S S 24 - Hour U.L.Monitoring 110 Tracy Drive - Manchester, CT 06042 CT Lie.#ELC 185503-L5 (860) 645-6500 - Fax (860) 643-5591 - Toll Free (877) DUBALDO - www.DUBALDO.com Inspection and Testin Form (3) Date: /f Prior To Testing Notification Circle Name Time Monitoring Entity: NO , Mee Building Occupants: NO Building Management: NO Others: YES NO System Test and Inspection System Circle Comments Control Panel: (:Ki;;� uncti Interface Eq. Visual Lamps/LEDS: Visual nett Fuses: is Functional Primary Power Supply: Visual ne Trouble Signals: Visual Disconnect Switches: Visual < unctio 1 Ground Fault: Visual unc Secondary Power Battery Condition: Visual unctio Load Voltage: Visual <1unc i Discharge Test: Visual unction Charger Test: Visual Functional Specific Gravity: Visual Functional Notification Appliances Audible: Visual nc ion Visual: Visual ncti Speakers: Visual Functional Voice Clarity: Visual Functional Transient Suppressors: Visual Functional Remote Annunciators: Visual Functional White Copy.Fire Marshal Yellow Copy.Customer Pink Copy.DuBaldo Security D uBaldo Security Systems Inc. Burglar, Fire,& Camera Systems D Sales- Service- Installation S S 24 - Hour U.L.Monitoring 110 Tracy Drive - Manchester, CT 06042 CT Lie.# ELC 185503-L5 (860) 645-6500 - Fax (860)643-5591 - Toll Free (877) DUBALDO - www.DUBALDO.com Inspection and Testing Form (4) Date: / Initiating and Supervisory Device Test & Inspection Device Type,Location & SIN Circle Setting Pass/Fail G Visual unc Pas Fall .,_7_ Visual unct _ ass Fail ;,6e- T/' Visual un Pas Fail A.fT �eeTr �k Visual (IRU Pa Fail S ,',kA Visual un Pass Fail Visual une Fail Visual Funct Pass Fail Visual Funct Pass Fail Visual Funct Pass Fail Visual Funct Pass Fail Visual Funct Pass Fail Visual Funct Pass Fail Visual Funct Pass Fail Visual Funct Pass Fail Comments: Emergency Communications Equipment Phone Set: Visual Funct Pass Fail Phone Jacks: Visual Funct Pass Fail Off-Hook Indicator: Visual Funct Pass Fail Amplifiers: Visual Funct Pass Fail Tone Generators: Visual Funct Pass Fail Call-in Signal: Visual Funct Pass Fail System Performance: Visual Funct Pass Fail Interface Equipment: Special Hazard Systems: Special Procedures: Comments: White Copy:Fire Marshal Yellow Copy: Customer Pink Copy:DuBaldo Security D uBaldo Security Systems Inc. Burglar, Fire,& Camera Systems Sales- Service- Installation A 24 - Hour U.L. Monitoring 110 Tracy Drive - Manchester, CT 06042 CT Lie.#ELC 185503-L5 (860) 645-6500 - Fax (860) 643-5591 - Toll Free (877) DUBALDO - www.DUBALDO.com Inspection and Testing Form (5) Date: On/Off Premise Monitoring Circle Time & Comments Alarm Signal: NO _ Alarm Restore: NO Trouble Signal: NO Supervisory Signal: NO Supervisory Restore: YE NO Notification of Test Completion Notification Circle Name Time Building Management: (E]�5 NO Monitoring Agency: <JD� NO Building Occupants: YE NO Others: YES NO Comments: System Restored to Normal Operation Time: This test was done in accordance with applicable NFPA standards Inspector(Print): Signature: Date: Owner/Rep(Print): L47" �FtJk'7� Signature: Date: White Copy:Fire Marshal Yellow Copy: Customer Pink Copy:DuBaldo Security