HomeMy WebLinkAboutSystem Record of Inspection and Testing Oct 2026SYSTEM RECORD OF INSPECTION AND TESTING
This foin is to be @mpteted by ttp system insFction aN teslit]4 contractu at tbe lime ol a systom test
It shall be Frmitted to modily this tom as Dee&d to ptovile a morc complete ao ot clear @cotd.
losed I'I/A in all unused lr,€s.
Atteh *titboal sheets, data. q cahulalions as ne@ssary lo p@y,tb a cor,plete rccord.
lnspectidrT esr Start Date/Time: 10/1412026 9:00 AM Inspeclion/test Compl€tion Date/limc: 1U14l2025 9:30 AM
Supplcmcntrl Fotm(s) Attscled: Yes (yeJno)
I. PROPERTY INFORMATION
Ns.mc of proFrty:Larsen Residence
Address: 45 Seth Lsne South Ysrmouth, MA 02664
Description of property :Residence
Name of prop<ty rcpesaorxive:
Address:
Ray Hall
Phone: 504-221-2il4
2. TESTING AND MONITORING INFORMATION
E-mail:ray@ ricottareahstats.com
Tcsting organization:SeaskJe Alarms. lnc
Address: 1265 Route 28 S Yarmouth, MA 02664 Lic. 1317-C
Fax: 50&760-2630 E-mail: brran@seasidealarms.com
MonitorinB organization:Centra-Larm, lnc
Address: 99l Candia Road Manchester, NH 03109
Phone: 88&22-8808 Fax:
Account number: SSA# 08806-001 Phone lirrc I
Means oftrarsmission: Cellular Radio CS# 61307858
E-mail
l'hone lhe 2
Entity to \ahich darms aI! retra[smittcd Yarmouth Fire Department
3. DOCU ENTATIOT{
On-sitc locatiofl ofth€ rcquir€d tccord docurncnls and site-specific softwarc:
4. DESCRIPTION OF SYSTEM OR SERVICE
4.1 Cotrt ol Unit
Manufadur€r: Napco
Phonc: 508-39&2211
Behind Panel
Modelnumbcr: i664
4: Softwarc rod Firmw.re
Fi r\ are rEvision number: N/A
4.3 Systco Po*er
,1.3.1 Primrry (Mrin) PoBGr
Nominal voltage:lrcation:
Overc{nent proteclioo typc:Disconnecting mee$ loc{tiooi
Amps:
Amps:
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Fax:
Phonc: 50&394-0599
SYSTEi, RECORD OF INSPECTION AND TESTING (conrhled)
4. DESCRIPTION oF SYSTEM OR SERvlcE (continued)
4.3.2 S.cordrry Pow.r
Type:Ba(ery Location: ln FACP
Battery type (if 6pplicable):
Calculsred capqcity ofbatteries to &ive thc systcm
ID standby nod€ (hours):
5. NOTIFICATIONS XIADE PRIOR TO TESTING
Mooitoring orgaizalion Cmtaar:
Building management Contact:
Buildiog occupants Conoa:
Authority havingjurisdiction Cootact:
Other, if Cont d:
required
6. TESTING RESULTS
6.1 Cootrol Utria rod Rclrt d EquipEett
In alarm mode (minutes):5
9100 AM
Ray l-lall 9:00 AM
Desc Comments
Control unit
Ds
Fuses
Trouble
Disconnect switches
Ground-fault
l-ocalannunriator
Remote annunciators
Remote els
6.2 S.cond.ry Powcr
Commenls
condition
Load
test
test
Remote batteries
Central Station Tim€:
Time:
Time:
Time :
Ti,rle:
Visual
lnspection
Functional
Test
Ea
a
!tr
Ea
tr tr
a E
tr E
tr !
tr tr
D !
n n
Visual
lnspsc0on
Fuoctional
Test
E E
IZ::l
Elv
tr
tr D
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24
SYSTEi, RECORD OF INSPECTION AND TESTING (continued)
6. TESTING RESULTS (cordased)
6.3 Alrrm rnd Sop.rvilory AhrE lliairting Irwic.
Attach supplementary device test sheets for all initiating devices.
6.4 Notifi crtion Appliuccs
Attach supplementary appliance test she€E for allnotification applianc€s.
65 Intcrfrcc f,quipocDt
Attach supplementary interhce compoDent test sheets for all interface componenG.
Cit.uit Interface / Siqhaling Une Circuit lnterface / Fire Alann Control Intnfoce
6.6 Srp.rvbiDg Strtion Monitoritrg
Oescri Comments
Alarm
restoration
Trouble
Trouble rcstoration
Su
restoration
6.7 Public Em.rgcncy Al..m R.portirg Syitcrn
Comments
AIarm
Alarm resto€tion
Trouble
Troubie restoratson
restoration NiA
Yes No Time
n
trE
!a
a D
tr tr
tr n
Yes No Time
!n
!!
tr tr
tr tr
n !
trtr
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SYSTEii RECORD OF INSPECTION AND TESTIIIG (continued)
7. NOTIFICATIONS THAT TESTING IS COMPLETE
Monitoring oBanization
Buildirg manaSement
Building occlrpants
Autlority having iurisdictior
0ther, if
required
Contacl: Ray Hall
Contrd:
CoDtaal:
Conta(t:
Time:
Timc:
Time:
Tirne:
Time:
930AM
930AM
8. SYSTEM RESTORED TO NORMAL OPERANON
Date: 1011412026 Time 9:30 AM
9. CERTIFICATIOT
This system as specined herein has and tesM according to NFPA 72,2013 edition, Chapt€r 14-
Printednane: Aaron Gianakis Dat: 10f2112O26Signed:
Organization:S€aside Alanns, Inc.Title: Technician Phonc: 508-394-0539
Qualifications (refer b l0-5.3):Seaside Alarms License 1317-C
10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION,
TESTING, OR MAINTENANCE
l0.l Acceptlnca by owrcr or ownar's Raprrscntttivc:
The undersigned accepted the tqst report for the system as specified herein:
Printed name:Signed
Org'an ization:I itle:
Date:
Phonc:
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Conta* CentralSlatjon
NOTIFICATION APPLIANCE
SUPPLEilIENTARY RECORD OF INSPECTION AND TESTI'{G
This fotm is a su$bmert to t e System Recqrd of lns,fcliotl and Testing.
It inclu&s a ooblEatbt appliat@ test r*qd.
Ihis lotm is to b @fitp/€I€d by the syslem inso€cliofi atd teding coihactot st the line of the ihs,E,ctin andot tesl.
ll shal be Fmitted to mdily this torm as neede'd to pmv*le a /,,o'? compbte etd,/ot clear rwod.
lnseft IUA in al! unusod lir,€.s.
lnspectionfiest Start Dale/Tirne:10/14/2026 9:00 AM lnspedior/Iest Cornpletion Daley'Timc: 10/1412026 9:30 AM
Numbcr ofsupplcrDcrtal Pag6 A$adlcd: 1
2, PROPERTY INFORMATION
Name ofproperry:Larsen Re3rdence
Addess: 45 Seth Lane South Yarmouth, MA 026&
2. NOTIFICATION APPLIANCE TEST RESULTS
Appliance Type Location/ldentirier Test Results
Speaker 1st Floor Hall Pass
Speaker Lower L€vel at Stairs Pass
Ser mritl Sys&h Record oflnspcction rnd Tcsting for rdditioorl ilfo.mrtion, c.rtiricttioN, .nd spprovili.
C.prr{ailo 2012 l..lirol Fis PrueIEo Ar*anjm Thb io.o na, be c.pifi,lq ar,h,nud ulo otE or'l tu tEb. tt Er.or b. cqi*t ir tenffi:il{ !.b s didrtiion
INITIATING DEVICE
SUPPLEMENTARY RECORD OF INSPECTION AND TESTING
This fotm is a su$ement to t ,e q/slaD Reoord ot lns@ction aod Tesfng.
It inctu&s 8n ioifating (i,-vifr te& rc@rd.
This lorm is to b com*tod by the system insryclon and testing contractq at the tde ol tE inslE{.tin aod/o, test.
tt shat be Nnitted to m* "," 7#"f;ffi#,hm;{"* *reb arf,l$ cbar rcd)(d.
tnspection/Test Stan Daleffin,c' 10114nO26 9:00 AM Inspecrion/T€sl Completion Datc/Time: 10/1412026 9i30 AliI
Nuobcr of Supplemertal Pages Attadr.d:
2. PROPERTY INFORMATION
Name of property
Address: 45 Seth Lane South Yarmouth. tIA 02664
2. INITIATING DEVICE TEST RESULTS
Device TyDe Address Location Test Resultg
Smoke Detector Living Room Pass
Smoke Detector Sunroom Pass
Smoke Detector 2nd Floor Let B€droom (Old)Pass
Smoke Detector 2nd Floor Right Bed.oom (Old)Pass
Smoke/CO Combo 2nd Floor Hall (Old)Pass
Smoke Detector 2nd Floor Left Bedroom (Ne$/)Pass
Smoke Detector 2nd Floor Right Bedroom (Netv)Pass
Smoke/CO Combo 2nd Floor Hall (New)Pass
Smoke Detector 1st Floor Hall Pass
Smoke Detector Master Bedroom Pass
Smoke Detector New Basement at Stairs Pass
Smoke Detector Lower Level LNing Room Pass
Smoke Detector Lower Lev6l 8€droom Pass
Smoke/CO Combo Lowe. Level al Stairs Pass
Smoke,/Co Combo Master Bedroom Hall Pass
Heat Oetedor Garage Heat Leff Pass
Heal Oeteclor Garaqe Heat Rrqhl Pass
Heat Deteclor Single Bay Pass
Sec m.in Sys!.m Record oflospection .nd Tcsting for rddition.l inform.tion, c.rtilic.tions,.nd .pprovrls.
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Larsen Residence