HomeMy WebLinkAbout85 Nutmeg Road - Life Safety System Test 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 streets,data,or calculations as necessary to provide a complete record.
I. PROPERTY INFORMATION
Name of party:ro 85 Nutmeg South LLC
property:
Address: 85 Nutmeg Road South South Windsor CT.06074
Description of property: Multi tenant space
Occupancy type: Mixed use. Business,storage,office,
Name of property representative: Constantinos Constintineau
Address: 64 Amana Way Tolland, CT 06084
Phone: 240-375-1717 Fax: CELL 913-450-4038 E-mail:
Authority having jurisdiction over this property: South Winsor FMO
Phone: Fax: E-mail:
2. INSTALLATION,SERVICE,AND TESTING CONTRACTOR INFORMATION
Installation contractor for this equipment: Westbrook Electric
Address: 3 Oli,ac Annex Stafford Springs,CT
License or certification number: E-1 108878
Phone: Fax: E-mail:
Service organization for this equipment: FBN Security Co LLC
Address: 425 Windsor Avenue Windsor CT 06095
License or certification number: L-5 106132
Phone: 860-246-0001 Fax: 860-246-9070 E-mail: info@fbnsecurity.net
A contract for test and inspection in accordance with NFPA standards is in effect as of. 2010
Contracted testing company: FBN Security Co LLC
Address: SAME AS SERVICE ORGANIZATION
Phone: Fax:
E-mail:
Contract expires: 8/1/2016 Contract number: Frequency of routine inspections: Annual
3. DESCRIPTION OF SYSTEM OR SERVICE
®Fire alarm system(nonvoice)
❑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 ❑MNS
❑Two-way,in-building,emergency communication system
❑Other(specify):
NFPA 72, Fig. 10.1821.1 (p. 1 of 12)
CoPyright®2009 National Fire Protection Association.This form may be 00pied for individual use other than for resale.It may riot be copied for corranercial sale or distribution.
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3. DESCRIPTION OF SYSTEM OR SERVICE(continued)
NFPA 72 edition: 2010 Addit
ional description of system(s):
3.1 Control Unit
Manufacturer: FiRELITE Model number: 9050UD
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):
3.2.2 System Features:
❑Combination fire alarm/MNS MNS autonomous control unit ❑Wide-area MNS to regional national
alerting interface
❑Local operating console C) ❑Direct recipient MNS(DRMNS) ❑Wide-area MNS to DRMNS interface
❑Wide-area MNS to gh-power speaker array(HPSA)interface ❑In-building AINS to wide-area MNS interface
❑Other(speci
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 numbered record drawings are stored on site. Location: Right side of panel in document cabinet
3.4 System Software ®This system does not have alterable site-specific software.
Operating system(executive)software revision level:
Site-specific software revision date: Revision completed by:
❑A copy of the site-specific software is stored on site. Location:
3.5 Off-Premises Signal Transmission ❑This system does not have off-premises transmission.
Name of organization receiving alarm signals with phone numbers:
Alarm: USA Central Station of Port Chester NY and Milford,CT Phone: 1-800-354-7710
Supervisory: SAME AS ABOVE Phone:
Trouble: SAME AS ABOVE Phone:
Entity to which alarms are retransmitted: South Windsor Fire Department Phone:
Method of retransmission: Pots line
If Chapter 26,specify the means of transmission from the protected premises to the supervising station:
2 Standarp POTS lines as require.(Both dedicated)
If Chapter 27,specify the type of auxiliary alarm system: ❑Local energy ❑Shunt ❑Wired
❑Wireless
NFPA 72, Fig. 10.18.2A.1 (p. 2 of-12)
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.
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4. CIRCUITS AND PATHWAYS
4.1 Signaling Line Pathways
4.1.1 Pathways Class Designations and Survivability
Pathways class: NAC Class B Survivability level:
(See NFP-4 72,Sections 12.3 and 12.4) Quantity: 4
4.1.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.13 Device Power Pathways
❑No separate power pathways from the signaling line pathway
®Power pathways are separate but of the same pathway classification as the signaling line pathway
❑Power pathways are separate and different classification from the signaling line pathway
4.1.4 Isolation Modules
Quantity: NONE
4.2 Alarm Initiating Device Pathways
4.2.1 Pathways Class Designations and Survivability
Pathways class: Multiplex Survivability level: Supervision OSG Quantity: 1 Star topology
(See NFR4 72,Sections 12.3 and 12.4)
4.2.2 Pathways Utilizing Two or More Media
Quantity: Description:
4.23 Device Power Pathways
®No separate power pathways from the initiating device pathway
❑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
43.1 Pathways Class Designations and Survivability
Pathways class: B Survivability level: Superviced/B/ Quantity: 4
(See NFPA 72,Sections 12.3 and 12.4)
4.3.2 Pathways Utilizing Two or More Media
Quantity: Description:
43.3 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
❑Power pathways are separate and different classification from the notification appliance pathway
NFPA 72, Figg. 10.18.2.1.1 (p. 3 of 12)
CoPYdWd®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 cistrilwtion.
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: 8 Conventional: Coded: Transmitter:
Other(specify):
5.1.2 Other Alarm Boxes ([�I7tis system does not have other alarm boxes.
Description: 1�
\3� Type and number of devices: Addressable: Conventional: Coded: Transmitter:
Other(specify):
5.2 Automatic Initiating Devices
5.2.1 Smoke Detectors ❑This system does not have smoke detectors.
Type and number of devices: Addressable: 1 Conventional:
Other(specify): Protection of the alarm panel
Type of coverage: ❑Complete area ®Partial area p Nonrequired partial area
Other(specify):
Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Multicriteria ❑Aspirating ❑Beam
Other(specify):
5.2.2 Duct Smoke Detectors ®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: ❑Ionization ❑Photoelectric ❑Aspirating ❑Beam
5.23 Radiant Energy(Flame)Detectors ®This system does not have radiant energy detectors.
Type and number of devices: Addressable: Conventional:
Other(specify):
Type of coverage:
5.2A Gas Detectors ®This system does not have gas detectors.
Type of detector(s):
Number of devices: Addressable: Conventional:
Type of coverage:
5.25 Heat Detectors ®This system does not have heat detectors.
Type and number of devices: Addressable: Conventional:
Type of coverage: ❑Complete area ❑Partial area ❑Nonrequired partial area ❑Linear ❑Spot
Type of heat detector sensing technology: ❑Fixed temperature ❑Rate-of-rise ❑Rate compensated
NFPA 72. Fig. 10.18.2.1.1 (p.4 of 12)
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.
6. ALARM INITIATING DEVICES(continued)
5.2.6 Addressable Monitoring Modules ❑This system does not have monitoring modules.
Number of devices: 2
5.2.7 Waterflow Alarm Devices ❑This system does not have waterflow alarm devices.
Type and number of devices: Aorembl 1 Conventional: Coded: Transmitter:
3a5 C.c, � '
5.2.8 Alarm Verification ®This system does not incorporate alarm verification.
Number of devices subject to alarm verification: Alarm verification set for seconds
t 5.2.9 Presignal ®This system does not incorporate pre-signal.
�1,, Number of devices subject to presignal:
Describe presignal functions:
5.2.10 Positive Alarm Sequence(PAS) ®This system does not incorporate PAS.
Describe PAS:
5.2.11 Other Initiating Devices ®This system does not have other initiating devices.
Describe:
6. SUPERVISORY SIGNAL-INITIATING DEVICES
6.1 Sprinkler System Supervisory Devices ❑This system does not have sprinkler supervisory devices.
Type and number of devices: Addressable: 1 Conventional: Coded: Transmitter:
Other(specify): Gate valve supervision
6.2 Fire Pump Description and Supervisory Devic ®This system does not have a fire pump.
Type fire pump: ❑Electric pump ❑En ' e
Type and number of devices: Addressable: Conventional: Coded: Transmitter:
ttt Other(specify):
6.2.1 Fire Pump Functions Supervise
❑Power ❑Running ❑Phase rev ❑Selector switch not in auto ❑Engine or control panel trouble [I Low fuel
Other(specify):
63 Duct Smoke Detectors s) ®This system does not have DSDs causing supervisory signals.
Type and number of devic : Addressable: Conventional:
Other(specify):
Type of coverage:
Type of smok detector sensing technology: ❑Ionization ❑Photoelectric ❑Aspirating ❑Beam
6.4 Othe upervisory Devices ❑This system does not have other supervisory devices.
Desc ' e:
NFPA 72, Fig. 1 t1.18.2.1.1 (p. b of 12)
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.
7. MONITORED SYSTEMS
7.1 Engine-Driven Generator ®This system does not have a generator.
7.1.1 Generator Functions Supervised
❑Engine or control panel trouble ❑Generator running ❑Selector switch not in auto ❑Low fuel
❑Other(specify):
7.2 Special Hazard Suppression Systems
❑This system does not monitor special hazard systems.
Description of special hazard system(s):
7.3 Other Monitoring Systems ❑This system does not monitor other systems.
Description of special hazard system(s):
S. ANNUNCIATORS ®This system does not have annunciators.
8.1 Location and Description of Annunciators
Location 1:
Location 2:
Location 3:
9. 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 1:
Location 2:
Location 3:
9.2 Nonvoice Notification Appliances ❑This system does not have nonvoice notification appliances.
Horns: 27 With visible: 26 Bells: With visible:
Chimes: With visible:
Visible only: 4 Other(describe):
93 Notification Appliance Power Extender Panels ❑This system does not have power extender panels.
Quantity: 1
Locations: Next to the alarm panel
NPPA 72, Fig. -10.18.2.1.1 (p.6 of 12)
Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other Ulan for resale.It may not be copied for commercial sale or distribution.
10. MASS NOTIFICATION CONTROLS,APPLIANCES,AND CIRCUITS ®This system does not have an MNS.
10.1. MNS Local Operating Consoles
Location is
Location 2:
Location 3:
10.2 High-Power Speaker Arrays
Number of HPSA speaker initiation zones:
Location 1:
Location 2:
Location 3:
103 Mass Notification Devices
Combination fire alarm/MNS visible appliances: MNS-onl isible appliances:
Textual signs: Other(describe):
Supervision class:
103.1 Special Hazard Notification
❑This system does not have special suppression predischarge no' cation.
❑MNS systems DO NOT override notification appliances r fired to provide special suppression
predischarge notification. I
11. TWO-WAY EMERGENCY COMMUNICA�N SYSTEMS
11.1 Telephone System ®This system does not have a two-way telephone system.
Number of telephone jacks installed: Number of warden stations installed:
Number of telephone handsets stored o site:
Type of telephone system installed- ❑Electrically powered ❑Sound powered
11.2 Two-Way Radio Com nications Enhancement System
❑This system does not h e a two-way radio communications enhancement system.
Percentage of area co red by two-way radio service: Critical areas: % General building areas: %
Amplification co onent locations:
Inbound sign ngth: dBm Outbound signal strength: dBm
Donor an a isolation is: dB above the signal booster gain
Radio equencies covered:
io system monitor panel location:
t+fFPA 72, Fig. 10.18.2,1.1 (p. 7 of i 2)
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.
11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS(continued)
113 Area of Refuge(Area of Rescue Assistance)Emergency Communications Systems
❑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
❑This system does not have an elevator emergency communications system.
Number of elevators with stations: Location of central control t:
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 trot fuctions:
❑Hold-open door releasing d ces ❑Smoke management ❑HVAC shutdown ❑F/S dampers
❑Door unlocking levator recall ❑Fuel source shutdown ❑Extinguishing agent release
❑Elevator shunt ❑Mass notification system override of fire alarm notification appliances
Other(specify
12.1 Ad essable Control Modules ®This system does not have control modules.
Nu er of devices:
ther(specify):
13. SYSTEM POWER
13.1 Control Unit
13.1.1 Primary Power
Input voltage of control panel: 115 VAC Control panel amps: 3
Overcurrent protection: Type: Circuit Breaker Amps: 20
Location(of primary supply panel board): Loading dock
Disconne/gene :
uo
Panel 10 Ckt 41 Labeled
13.1.2 Eator ®This system does not have a generator.
Location Location Type of fuel:
NFPA 72, Fig. 10.18.2.1.1 (p.8 of 12)
copyright 0 2009 National Fire Protection Association.This forth 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 ®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):
13.1.4 Batteries
Location: Type: Nominal voltage: /hour rating:
Calculated capacity of batteries to drive the system:
In standby mode(hours): In alarm mode(minutes):
❑Batteries are marked with date of manufacture ❑Battery calculations are hed
13.2 In-Building Fire Emergency Voice Alarm Communication System or ss Notification System
❑This system does not have an EVACS or MNS system.
13.2.1 Primary Power
Input voltage of EVACS or MNS panel: VACS or MNS panel amps:
Overcurrent protection: Type: Amps:
Location(of primary supply panel board):
Disconnecting means location:
13.2.2 Engine-Driven Generator ❑This system does not have a generator.
Location of generator:
Location of fuel storage: Type of fuel:
13.2.3 Uninterruptible Power System ®This system does not have a UPS.
Equipment powered by a UPS system:
Location of UPS system:
Calculated capacity of UPS ba es to drive the system components connected to it:
In standby mode(hours): In alarm mode(minutes):
13.2.4 Batteries
Location: Type: Nominal voltage: Am /hour rating:
P g
Calculated capac' of batteries to drive the system:
In standby m e(hours): In alarm mode(minutes):
❑1B3 ' are marked with date of manufacture ❑Battery calculations are attached
IVFPA 72, Fig. 10-18.2.1.1 (p. 9 of 12)
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 distribufion-
6 �
13. SYSTEM POWER(continued}
133 Notification Appliance Power Extender Panels
❑This system does not have power extender panels.
133.1 Primary Power
Input voltage of power extender panel(s): 115 VAC Power extender panel amps: 6
Overcurrent protection: Type: Amps:
Location(of primary supply panel board): SAME AS ALARM PANEL
Disconnecting means location: SAME AS ALARM PANEL Panel 10 CKT 41
133.2 Engine-Driven Generator -----
® s system does not have a generator.
Location of generator:
Location of fuel storage: T of fuel:
1333 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 system components connected to it: .
In standby mode(hours): In alarm mode(minutes):
13.3.4 Batteries
Location: Type: Nominal voltage: Amp/hour rating:
Calculated capaci of batteries to drive the system:
In standby de(hours): In alarm mode(minutes):
❑B dies are marked with date of manufacture ❑Battery calculations are attached
14. 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 ®New system ❑Modification to an existing system Permit number.
The system has been installed in accordance with the following requirements:(Note any or all that apply.)
®NFPA 72,Edition: 2008
®NFPA 70,National Electrical Code,Article 760,Edition: 2010
®Manufacturer's published instructions
Other(specify):
System deviations from referenced PA standards:
Signed:�d�� Printed name: Date:
Organization: For es1N tl Electric Title: t ✓ t j� Phone:
NFPA 72, Fig. 10.18.2.1.1 (P. 10 of 12)
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.
I& RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST
®New system
All operational features and functions of this system were tested by,or in the presence of,the signer shown
below,on the date shown below,and were found to be operating properly in accordance with the requirements
for the following.
❑Modifications to an existing system
All newly modtfted operational features andfunctions ofthe system were tested by,or in the presence of,the
signer shown below,on the date shown below,and were found to be operating properly in accordance with the
requirements of thefollowing.
®NFPA 72,Edition: 2010
®NFPA 70,National Electrical Code,Article 760,Edition: 2008
❑Manufacturer's published instructions
Other(specify):
❑Individual device testing documentation[Inspection and Testing Form(Figure 14.6.2.4)is attached]
Signed: Printed name: Date:
Organization: Title: Phone:
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:
V� Organization: Title: Phone:
16.2 System Service Contractor:
The undersigned has a service contract for this system in effect as of the date shown below.
Signed: Printed name: `\ &-A Date:"2`y'—J.�
Organiza n: SL; Z- 't' Title: el� v Phone:g��."Z�/�Gov)
T
163 Supervising Station:
This system,as specified herei will be monitored according to all NFPA standards cited herein.
Signed: Printed name: Date:
Organization: Title:
Phone:
NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12)
Copyright 0 2DO9 National Fire Protection Association.This form may be copied for individual use other that for resale.It may not be copied for commercial sale or distritwtion.
16. CERTIFICATIONS AND APPROVALS(conunuean
16.4 Property or Owner Representative:
I accept this system as having been installed and tested to its specifications and all 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 with all
NFPA standards cited herein.
Signed: Printed name: Date:
Organization: Title: Phone:
NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12)
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 dishibution.