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HomeMy WebLinkAboutAlarm Initiating Devices 01-02-2019 ALARM INITIATING DEVICES GLYNN electric = 11 Resnik Road Plymouth, MA 02360 (508)732-8933 (508)732-8934 Fax TESTED BY: MELVIN AVILES-HERNANDEZ DATE: 1/2/19 TRIPS LANLORD FACP MONITORED BY LANDORD LOCATION: PLANET FITNESS FACP AHOLD ACCT#5113 17 LONG POND DRIVE #1-877-893-5393 SOUTH YARMOUTH,MA 02664 Number Number Number Device Type Description Total Tested Failed Not Tested PULL PULL STATIONS 3 3 0 0 SD SMOKE DETECTORS 3 3 0 0 DS DUCT SMOKE DETECTORS 5 5 0 0 MM MONITOR MODULES 1 1 0 0 _ TS SPRINKLER SYSTEM TAMPER 0 0 0 0 FS SPRINKLER SYSTEM WATERFLOW 1 1 0 0 RM RELAY MODULES 8 8 0 0 H/S GENTEX HORN/STROBES 10 10 0 0 SR GENTEX STROBE 10 10 0 0 BEACON OUTSIDE BEACON 1 1 0 0 Detail of Test Results Device Type Description Zone Pass Fail Comments FACP NOTIFIER AFP-100 X BY FRONT ENTRANCE BATTERIES (2)X 12V 12AH X AT FACP BOOSTER HONEYWELL HPFFB X BELOW FACP BATTERIES (2)X 12V 7AH X AT FCPS KEMUIt ILSI SWI ILHUY DS RTU#1 DUCT-SMOKE L1 D01 X FACP KEMU I t I Lb I SWI I CM BY DS RTU#2 DUCT-SMOKE L1D02 X FACP Num IE ILbI SWI ILH HY DS RTU#3DUCT-SMOKE L1D03 X FACP KEMUIt ILSI SWI Il.H13Y DS RTU#4 DUCT-SMOKE L1 D04 X FACP KLMUIt ILbI SWIICH BY DS RTU#5 DUCT-SMOKE LIDOS X FACP SD ABOVE FACP L1D06 X SD REAR MAIN ELECTRIC ROOM LID07 X SD FRONT ELECTRIC ROOM LIDOS X BY MANAGERS OFFICE PULL MAIN ENTRANCE L1M01 X PULL CARDIO AREA L1M03 X PULL REAR LEFT EXIT L1 M04 X RM RTU#1 SHUTDOWN LIMOS X RM RTU#2 SHUTDOWN L1 M06 X RM RTU#3 SHUTDOWN L1M07 X RM RTU#4 SHUTDOWN L1M08 X RM RTU#5 SHUTDOWN L1M09 X FS MAIN WATERFLOW RISER#1 &2 L1M10 X RM LAND LORD FACP TRIP L1 M11 X RM MUSIC SHUTDOWN L1M12 FUTURE USE RM TANNING SHUTDOWN L1M13 FUTURE USE 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 sheets,data, or calculations as necessary to provide a complete record 1. PROPERTY INFORMATION Name of property: PLANET FITNESS Address: 17 LONG POND DRIVE SOUTH YARMOUTH,MA 02664 Description of property: GYM Occupancy type: COMMERCIAL Name of property representative: LEIBO BROTHERS MANAGEMENT Address: 39 NEW HAVEN RD SEYMOUR,CT 06483 Phone: 203-4564465 Fax: 203-832-6782 E-mail: INFO@LEIBOBROTHERS.NET Authority having jurisdiction over this property: TAUNTON FIRE DEPARTMENT Phone: 508-821-1452 Fax: E-mail: 2. INSTALLATION, SERVICE,AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: GLYNN ELECTRIC 8 DONOVAN ELECTRIC Address: 70 INDUSTRIAL PARK RD PLYMOUTH,MA 02360/ License or certification number: A14492 Phone: 508-732-8933 Fax: 508-732-8934 E-mail: SERVICE@GLYNNELECTRIC.COM Service organization for this equipment: Address: License or certification number: Phone: Fax: E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of ............. Contracted testing company: Address: Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. DESCRIPTION OF SYSTEM OR SERVICE o 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 0 MNS 0 Two-way,in-building,emergency communication system ❑Other(specify). NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright©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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2013 Additional description of system(s): ADDRESSABLE SYSTEM 3.1 Control Unit Manufacturer: NOTIFIER Model number: AFP-100 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 0 Wide-area MNS 0 Distributed recipient MNS ❑Other(specify): 3.2.2 System Features: ❑Combination fire alarm/MNS ❑MNS autonomous control unit 0 Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) - 0 Direct recipient MNS(DAMNS) 0 Wide-area MNS to DRMNS interface ❑Wide-area MNS to high-power speaker array(IIPSA)interface 0 In-building MNS to wide-area MNS interface ❑Other(specify): .._... - 3.3 System Documentation 0 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 ®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 0 This system does not have off-premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: AHOLD Phone: 1-877-893-5393 Supervisory: Phone: Trouble: Phone: Entity to which alarms are retransmitted: 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 ®Wired 0 Wireless NFPA 72, Fig. 10.18.2.1.1 (p.2 of 12) copyright©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 a distribution. • 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: A Survivability level: 1 Quantity: 1 (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 ®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: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: A Survivability level: 1 Quantity: 1 -.- (See NFPA 72,Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: Description: 4.23 Device Power Pathways 0 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 4.3.1 Pathways Class Designations and Survivability Pathways class: A Survivability level: 1 _ Quantity: 3 (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 0 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, Fig. 10.18.2.1.1 (p.3 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 sate or distribution. 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: 3 Conventional: Coded: Transmitter: Other(specify): . . _. 5.1.2 Other Alarm Boxes ®This system does not have other alarm boxes. Description: . _. __.. ... .. .. . _... . Type and number of devices: Addressable: Conventional: Coded: ,. . . Transmitter: Other(specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors 0 This system does not have smoke detectors. • Type and number of devices: Addressable: 3 Conventional: _ Other(specify) _. ... . . . .. _-_. Type of coverage: ❑Complete area ®Partial area ❑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: 5 Conventional: Other(specify): Type of coverage: _ ... . Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Aspirating ❑Beam 5.2.3 Radiant Energy(Flame)Detectors ®This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other(specify) _ .... . ___ .._ ... Type of coverage ...... 5.2.4 Gas Detectors ®This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: 5.2.5 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©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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules ❑This system does not have monitoring modules. Number of devices: 1 5.2.7 Waterflow Alarm Devices ❑This system does not have waterfow alarm devices. Type and number of devices: Addressable: 1 Conventional: Coded: Transmitter: 5.2.8 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds 5.2.9 Presignal ®This system does not incorporate pre-signal. 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: Conventional: Coded: Transmitter: _ Other(specify): 6.2 Fire Pump Description and Supervisory Devices ®This system does not have a fire pump. Type fire pump: ❑Electric pump ❑Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other(specify): 6.2.1 Fire Pump Functions Supervised ❑Power ❑Running ❑Phase reversal ❑Selector switch not in auto ❑Engine or control panel trouble ❑Low fuel Other(specify): 6.3 Duct Smoke Detectors(DSDs) ®This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: _... Other(specify): Type of coverage. .. Type of smoke detector sensing technology: ❑Ionization ❑Photoelectric ❑Aspirating ❑Beam 6.4 Other Supervisory Devices ❑This system does not have other supervisory devices. Describe: NFPA 72, Fig. 10.18.2.1.1 (p.5 of 12) Copyright C 2009 National Fire Protection Association.This tom,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 0 Generator running 0 Selector switch not in auto 0 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): 8. 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 0 This system does not have nonvoice notification appliances. Homs: 10 With visible: X Bells: With visible: Chimes: With visible: Visible only: 10 Other(describe): 9.3 Notification Appliance Power Extender Panels 0 This system does not have power extender panels. Quantity: 1 Locations: BELOW FACP BY FRONT ENTRANCE • NFPA 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 than for resale.It may not be copied for commercial sale or distribution. 10. MASS NOTIFICATION CONTROLS,APPLIANCES,AND CIRCUITS 0 This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High-Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other(describe): Supervision class: 10.3.1 Special Hazard Notification ®This system does not have special suppression predischarge notification. ®MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System 0 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 on site: Type of telephone system installed: 0 Electrically powered 0 Sound powered 11.2 Two-Way Radio Communications Enhancement System ®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 signal strength: _ 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 of 12) Copyright 02009 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 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: ❑Hold-open door releasing devices 0 Smoke management ®HVAC shutdown 0 F/S dampers ❑Door unlocking 0 Elevator recall 0 Fuel source shutdown 0 Extinguishing agent release ❑Elevator shunt trip 0 Mass notification system override of fire alarm notification appliances Other(specify): TANNING BED&MUSIC _ 12.1 Addressable Control Modules ®This system does not have control modules. Number of devices: Other(specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120V Control panel amps: 20A Overcurrent protection: Type: BREAKER Amps: 5.2A Location(of primary supply panel board): REAR MAIN ELECTRIC ROOM Disconnecting means location: PANEL PP-CIR#19 • 13.1.2 Engine-Driven Generator 0 This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p.8 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.II 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: AT FACP Type: SLA Nominal voltage: _12V Amp/hour rating: _12AH Calculated capacity of batteries to drive the system: In standby mode(hours): _ In alarm mode(minutes): ❑Batteries are marked with date of manufacture 0 Battery calculations are attached 13.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System • ®This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: Overcurrentprotection: 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 0 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): 13.2.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): _ ®Batteries are marked with date of manufacture 0 Battery calculations are attached NFPA 72, Fig. 10.18.2.1.1 (p.9 of 12) Copyright®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. 13. SYSTEM POWER(continued) 13.3 Notification Appliance Power Extender Panels 0 This system does not have power extender panels. 13.3.1 Primary Power Input voltage of power extender panel(s): 120V Power extender panel amps: 5.2 A Overcurrent protection: Type: BREAKER Amps: 20A Location(of primary supply panel board): REAR MAIN ELECTRIC ROOM Disconnecting means location: PANEL PP-CIR#19 13.3.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: IN FCPS Type: SLA Nominal voltage: 12V Amp/hour rating: 7AH Calculated capacity of batteries to drive the system: In standby mode(hours): 24HRS In alarm mode(minutes): 5MINS ®Batteries are marked with date of manufacture 0 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 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.) ®NFPA 72,Edition: 2013 ®NFPA 70,National Electrical Code, Article 760,Edition: 2017 ®Manufacturer's published instructions Other(specify): System deviations from referenced NFPA standards: Signed: Printed name: GLYNN ELECTRIC& Date: 01-02-19 DONOVAN ELECTRIC Organization: Title: _. _ Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright©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. 15. 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 modified operational features and functions of the 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 the following: ®NFPA 72, Edition: 2013 0 NFPA 70,National Electrical Code,Article 760,Edition: 2017 ®Manufacturer's published instructions Other(specify): ❑Individual device testing documentation[Inspection and Testing Form(Figure 14.6.2.4)is attached] GLYNN ELECTRIC 8 Signed: _ Printed name: DONOVAN ELECTRIC Date: 01-02-19 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: MELVIN AVILES- Date: 01-02-18 HERNADEZ Organization: GLYNN ELECTRIC Title: JOURNEYMAN ELECTRICIAN Phone: 508-732-8933 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: Date: Organization: Title: Phone: 16.3 Supervising Station: This system,as specified herein,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®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. 16. CERTIFICATIONS AND APPROVALS(continued) 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 C 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. FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND TESTING FORM To be completed by the system inspector or tester at the time of the inspection or test. 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 sheets,data, or calculations as necessary to provide a complete record. Date of this inspection or test: 01-02-19 Time of inspection or test: 7:00AM 1. PROPERTY INFORMATION Name of property: PLANET FITNESS Address: 17 LONG POND DRIVE SOUTH YARMOUTH,MA 02664 Description of property: GYM Occupancy type: COMMERCIAL Name of property representative: LEIBO BROTHERS MANAGEMENT Address: 39 NEW HAVEN RD SEYMOUR,CT 06483 Phone: 203-456-4465 Fax: 203-832-6782 E-mail: INFO@LEIBOBROTHERS.NET Authority having jurisdiction over this property: TAUNTON FIRE DEPARTMENT Phone: 508-821-1452 Fax: E-mail: 2. INSTALLATION, SERVICE,AND TESTING CONTRACTOR INFORMATION Service and/or testing organization for this equipment: GLYNN ELECTRIC Address: 70 INDUSTRIALPARK RD PLYMOUTH,MA 02360 Phone: 508-732-8933 Fax: 508-732-8934 E-mail: SERVICE@GLYNNELCETRIC.COM Service technician or tester: MELVIN AVILES-HERNANDZEZ Qualifications of technician or tester: JOURNEYMAN ELECTRICIAN/FIRE ALARM TECH A contract for test and inspection in accordance with NFPA standards is in effect as of: The contract expires: Contract number: Frequency of tests and inspections: Monitoring organization for this equipment: Address: Phone: Fax: E-mail: Entity to which alarms are retransmitted: __. Phone: 3. TYPE 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: 0 Fire alarm 0 EVACS ❑MNS 0 Two-way,in-building,emergency communication system ❑Other(specify): NFPA 72, Fig. 14.6.2.4(p. 1 of 11) Copyright®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. 3. TYPE OF SYSTEM OR SERVICE(continued) NFPA 72 edition: 2013 Additional description of system(s): ADDRESSABLE SYSTEM 3.1 Control Unit Manufacturer: NOITIFIER Model number: AFP-100 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 0 Wide-area MNS 0 Distributed recipient MNS ❑Other(specify): 3.2.2 System Features: ❑Combination fire alarm/MNS 0 MNS ACU only ❑Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) 0 Direct recipient MNS(DRMNS) ❑Wide-area MNS to DRMNS interface • ❑Wide-area MNS to high-power speaker array(HPSA)interface 0 In-building MNS to wide-area MNS interface ❑Other(specify): 3.3 System Documentation 0 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: 120V Control panel amps: 5.2A_. 4.1.2 Engine-Driven Generator 0 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): NFPA 72, Fig. 14.6.2.4(p.2 of 11) Copyright®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. 4. SYSTEM POWER(continued) 4.1.4 Batteries Location: AT FACP Type: SLA Nominal voltage: 12V Amp/hour rating: 16AH Calculated capacity of batteries to drive the system: In standby mode(hours): 24HRS In alarm mode(minutes): RAINS ®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 ®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): 4.2.4 Batteries Location: Type: Nominal voltage: _ Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ,. ®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): 120V Power extender panel amps: 5.2A 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 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): NFPA 72, Fig. 14.6.2.4(p. 3 of 11) 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. 4. SYSTEM POWER(continued) 4.3.4 Batteries Location: IN FCPS Type: SLA Nominal voltage: 12V Amp/hour rating: 7AH Calculated capacity of batteries to drive the system: In standby mode(hours): 24HRS In alarm mode(minutes): 5MINS ®Batteries are marked with date of manufacture. 5. ANNUNCIATORS ®This system does not have annunciators. 5.1 Location and Description of Annunciators Annunciator 1: Annunciator 2: Annunciator 3: 6. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: YES Time: 7:00AM Building management Contact: YES Time: 7:00AM. Building occupants Contact: YES Time: 7:OOAM Authority having jurisdiction Contact: YES Time: 7:00AM Other,if required Contact: Time: 7. TESTING RESULTS 7.1 Control Unit and Related Equipment Visual Functional Description Inspection Test Comments Control unit 0 El Lamps/LEDs/LCDs 0 Fuses 0 Trouble signals ❑ ® _._. _. .. _ _. Disconnect switches 0 Ground-fault monitoring 0 Supervision 0 Local annunciator 0 Remote annunciators 0 0 Power extender panels 0 ® Isolation modules 0 0 Other(specify) 0 0 NFPA 72, Fig. 14.6.2.4(p.4 of 11) Copyright C 2009 National Fire Protection Association.This form may be copied for Individual use other than for resale.II may not be copied for commercial sale or distribution. 7. TESTING RESULTS (continued) 7.2 Control Unit Power Supplies Visual Functional Description Inspection Test Comments 120-volt power 0 Generator or UPS 0 0 • Battery condition 0 • Load voltage 0 Discharge test 0• Charger test 0 Other(specify) 0 0 7.3 In-Building Fire Emergency Voice Alarm Communications Equipment Visual Functional Description Inspection Test Comments Control unit 0 0 THIS SECTION NOT APPLICABLE Lamps/LEDs/LCDs 0 0 Fuses 0 0 Primary power supply 0 0 Secondary power supply 0 0 Trouble signals 0 0 Disconnect switches 0 0 Ground-fault monitoring 0 0 Panel supervision 0 0 System performance 0 0 _ _.. . Sound pressure levels 0 0 Occupied ❑Yes ❑No Ambient N/A dBA • Alarm N/A dBA (attach report with locations,values, and weather conditions) System intelligibility 0 0 ❑CSI ❑STI (attach report with locations,values, and weather conditions) Other(specify) 0 0 NFPA 72, Fig. 14.6.2.4(p. 5 of 11) • Copyright®2009 National Fire Protedion Associates.This form may be copied for individual use other than for resale.It may not be copied for commercial sale a distribution. 7. TESTING RESULTS(continued) 7.4 Notification Appliance Power Extender Panels Visual Functional Description Inspection Test Comments Lamps/LEDs/LCDs 0 Fuses ❑ Primary power supply 0 ® _ Secondary power supply 0 Trouble signals 0 Ground-fault monitoring 0 Panel supervision 0 Other(specify) 0 0 7.5 Mass Notification Equipment Visual Functional Description Inspection Test Comments Functional test ❑ 0 THIS SECTION NOT APPLICABLE Reset/power down test 0 0 Fuses 0 0 Primary power supply ❑ 0 UPS power test ❑ 0 Trouble signals 0 ❑ Disconnect switches ❑ 0 Ground-fault monitoring 0 0 CCU security mechanism 0 0 Prerecorded message content 0 0 Prerecorded message activation 0 ❑ Software backup performed 0 0 Test backup software 0 0 Fire alarm to MNS interface 0 0 MNS to fire alarm interface 0 0 In-building MNS to wide-area 0 0 MNS NFPA 72, Fig. 14.6.2.4(p.6 of 11) Copyright©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. TESTING RESULTS(continued) 7.5 Mass Notification Equipment(continued) Visual Functional Description Inspection Test Comments MNS to direct recipient MNS 0 0 THIS SECTION NOT APPLICABLE Sound pressure levels 0 0 Occupied 0 Yes 0 No Ambient dBA Alarm dBA (attach report with locations,values, and weather conditions) System intelligibility 0 0 ❑CSI ❑STI • (attach report with locations,values, and weather conditions) Other(specify) ❑ 0 7.6 Two-Way Communications Equipment Visual Functional Description Inspection Test Comments Phone handsets 0 0 THIS SECTION NOT APPLICABLE Phone jacks 0 0 Off-hook indicator 0 0 Call-in signal 0 0 System performance 0 0 System audibility 0 0 System intelligibility 0 0 Radio communications 0 0 _ enhancement system Area of refuge communication 0 0 system Elevator emergency 0 0 communications system Other(specify) 0 0 NFPA 72, Fig. 14.6.2.4(p. 7 of 11) Copyright®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. TESTING RESULTS(continued) 7.7 Combination Systems • Visual Functional Description Inspection Test Comments Fire extinguishing monitoring ❑ ❑ THIS SECTION NOT APPLICABLE devices/system Carbon monoxide detector/system 0 0 Combination fire/security system 0 ❑ Other(specify) 0 ❑ 7.8 Special Hazard Systems Visual Functional Description(specify) Inspection Test Comments O 0 THIS SECTION NOT APPLICABLE ❑ 0 7.9 Emergency Communications System ® Visual O Functional O Simulated operation ❑ Ensure predischarge notification appliances of special hazard systems are not overridden by the MNS. See NFPA 72,24.4.1.7.1. 7.10 Monitored Systems Visual Functional Description(specify) Inspection Test Comments Engine-driven generator 0 ❑ Fire pump 0 ❑ __ _ _ Special suppression systems ❑ ❑ Other(specify) ❑ 0 TESTED WITH SPRIKLER TECH 01-03-08 NFPA 72, Fig. 14.6.2.4(p.8 of 11) Copyright 02009 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. TESTING RESULTS (continued) 7.11 Auxiliary Functions Visual Functional Description Inspection Test Comments Door-releasing devices 0 0 Fan shutdown ❑ 0 Smoke management/smoke control 0 ❑ Smoke damper operation 0 0 Smoke shutter release 0 0 Door unlocking 0 0 Elevator recall 0 0 Elevator shunt trip 0 0 MNS override of FA signals 0 0 Other(specify) ® 0 TANNING BEDS&MUSIC SHUTDOWN RELAYS 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 appliances tested and the results of the testing 7.15 Supervisory Station Monitoring Description Yes No Time Comments Alarm signal ® 0 Alarm restoration ® 0 Trouble signal 0 0 Trouble restoration 0 0 Supervisory signal 0 0 Supervisory restoration i 0 0 • NFPA 72, Fig. 14.6.2.4(p. 9 of 11) Copyright @ 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. 8. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: YES Time: 12:00PM Building management Contact: YES Time: 12:00PM Building occupants Contact: YES Time: 12:00PM Authority having jurisdiction Contact: YES.. . Time: _ 12:00PM Other,if required Contact: Time: 9. SYSTEM RESTORED TO NORMAL OPERATION Date: 01-02-19 Time: 12:00PM 10. CERTIFICATION 10.1 Inspector Certification: This system,as specified herein,has been inspected and tested according to all NFPA standards cited herein. Signed: Printed name: MELVINAVILES- Date: 01-02-19 HERNANDEZ Organization: GLYNN ELECTRIC Title: JOURNEYMAN Phone: 508-732-8933 ELECTRICICAN 10.2 Acceptance by Owner or Owner's Representative: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date:_ Organization: Title: ..._....._..___.Phone: NFPA 72,Fig. 14.6.2.4 (p. 10 of 11) Copyright 02009 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. DEVICE TEST RESULTS (Attach additional sheets if required) Device Type Address Location Test Results • NFPA 72,Fig. 14.6.2.4(p. 11 of 11) 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.