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Home My WebLink About12-13521 CITY OF ZEPHYRHILLS � . 5335-8TH STREET (sis)�so-oo20 13521 FIRE ALARM SYSTEM PERMIT Permit Number: 13521 Address: 7350 DAIRY RD Permit Type: FIRE ALARM SYSTEM ZEPHYRHILLS, FL. Class of Work: FIRE ALARM SYSTEM Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: CITY OF ZEPHYRHILLS Est. Value: Parcel Number: 35-25-21-0010-06900-0020 Improv. Cost: 1,691.00 Date Issued: 10/26I2012 Name: ADVENTIST HEALTH SYSTEMS Total Fees: 150.00 Address: 7340 DAIRY RD Amount Paid: 150.00 ZEPHYRHILLS, FL. 33542 Date Paid: 10/26/2012 Phone: (813)788-4300 Work Desc: FIRE ALARM INSTALLATION FIRE INSPECTION FEES 50.00 /� ��L ( l�"�" � � ina FIRE ELEVATOR RECALL Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay for the costs of fire prevention and protection related activities such as inspections, plan review,administrative fees,and other costs related to the aforementioned. Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All work shall be performed in accordance with City Codes and Ordinances. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO BTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN O BEFORE ECORDING YOUR NOTICE OF COMM O CTOR SIGNATURE PERMIT OFFICER PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION -8 HOURS NOTICE REQUIRED ZEPHYRHILLS FIRE RESCUE DEPT-813-780-0041 s�3aso-oo2o City of Zephyrhills Fire Fax-813-780-0021 Permit Application Date Received , " Phone Contact for Permit }��3 a(o s g�— Owner's Name �'evL i �,,, �J S Erw� �✓,,�6Q� Owner's Phone Number �/3 �� D� Owner's Address Fee Simple Titleholder Name Titlehoider Phone Number � � � Fee Simple Titleholder Address JobAddress �.3.�C� ,.. �Q� ZE � �`�t� ��s Lot# � Sub Division Parcel# �.�—��sZ) ��0 '�(cs�0 O"'��O � Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent � Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL � Controlled Burn � Hood Installation � Emergency Generator<30 kw � LP/Natural Gas-Installation � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � � Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL 1 (C �„'T�L try em� �n t er � � 1�� O .L{j��F�" - e(((,,,,,,��S�.�.,�� Sprinkler � ❑ ❑ ❑ � Recreationai Burn �� Fire Alarm � ❑ ❑ ❑ � � Sparklers Hood Cleaning � ❑ ❑ ❑ � � Sprinkier System Installations � �3,j�'� l Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) � Fire Alarm Installation � Torch Roofing/Tar Kettle � Fire Pumps � Waste Tire Storage ANNUAL � Fire Works � Flammable Application-ANNUAL °ti Valuation of Project � Fuel Tanks 0 Other: Contractor Company Signature Registered Y/N Fee Current Y/N Address License# ELECTRICIAN Company Signature Registered Y/N Fee Current Y/N Address License# PLUMBER Company Signature Registered Y/N FeE Current Y/N Address License# MECHANICAL Company Signature Registered Y/N Fee Current Y/N Address License# OTHER Company � Signature Registered Y Fee Current Y/N Address S�� ,. " License# � �"'� Directions: Fill out application completely Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$5000) Suppiy two(2)sets of drawings with appiicable documentation Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) •NOTICE OF DEED RESTRICTIONS� The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES. If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847- 8009 Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended)� If valuation of work is $2,500.00 or more, I certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs If the applicant is someone other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the"owner" prior to commencement. - CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety(90) consecutive days, the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. FLORIDA JURAT(F S. 117 03) L� OWNER OR AGENT CONTRACTOR �—� Subscribed and sworn to(or affirmed)before me this Subscribed and swo r affirmed�4 ore me is by bY�.�c�.'_/!/ . L— Who is/are personally known to me or has/have produced Who is/are personally known to me or has/have produced as identification. as identification. Notary Public �� Notary Public � Commission No. C �missio o .•A�%'��"''••. .: :.� Comrnission#EE 040520 �:::, �a: . Name of Notary typed,printed or stamped Name of Notary�}y 'EB;; te�be� .P, ��adi�eaoaes�o�s ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Fire Chief Keith Williams Bus (813)780-0041 Fax ;813)780-0044 FIRE SERVICE USER FEES Occupancy No.: ' /��_ n [� Plan No.: Contractor: �YY1 P `e-X l.t��n ne �� "mr�d`S Business Name: �� , S Billing Address: Business Address: � �r Business Phone No.: 3- (�g-� Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE BSitePlan N/C Annual N/C Sprinkler $50 1stAlarm N/C Multi-Family/Commercial .06 st 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C (Minimum Charge$25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C � Plan Revisions DBL 3rd Re-inspection $250 Hoods $50 4th Alarm $700 4th Re-Inspection $500 Fire Alarm $50 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200 0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150 26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- Pertank $50 STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100 � Per Riser $50 Hydrostatic Test $65 per system Fire Works $500 FIRE PUMP Acceptance Test $45 per system Camp Fire $25 � Per Pump $100 Hydrant Flow $75 Controlled Burn $100 IRE ALARM SYSTEM Hood/Duct $50 b-25 Devices $50 „ FIRE ALARM SYSTEM Place of Assembly $50 Mnual 26 plus Devices $100 System Acceptance $50 Fire Protection $25 SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 nnnuai Wet $50 OTHER Waste Tire Storage $50 Annual Dry $50 Fire waulSmoke Wall $15 per wall Generator<KW $100 CO2 $50 LP Gas $25 per tank Generator>30 KW 150 Other $50 Natural Gas $25 persystem Bio-Hazard Waste $100 Annual KITCHEN EXHAUST Fumigation Tenting $50 � Hood/Ducts $50 Tent 10'x10'or greater $15 per�em Torch PoUApplied $50 OTHER Fire Pump $45 Haz.Materials $100 Annual LP Installation per tank $50 Fire Suppression $30 Fuel Tank Installation $50 System Acceptance (Per Tank) $50 Exhaust Hood/Duct $30 �Natural Gas Installation $50 Re-inspection DBL (Per System) (other than annual) � Spray Booth $50 � Inspection scheduled DBL B and cancelled less than 24 hours Construction Insp. N/C Emergency Vehicle A� $50 FALSE ALARM PLANS TOTAL�(�, INSPECTION TOTAL;�� PERMIT TOTAL�C� TOTAL� I� GRAND TOTAL Comments: Date: Inspector: lllh City of Zephyrhills BUILDING PLAN REVIEW COMMENTS > Contractor/Homeowner: /1'). i/i'/e C�l'yiC{J' Date Received: � " 9—�� Site: � �JL� �/r ,� Permit Type: h�'� �/G{,�� r�-tS'�� Approved w/no comments� Approved w/the below comments: ❑ Denied w/the below comments: ❑ . � This comment sheet shall be kept with the pemut and/or plans. )��tt,. � ��, Bi 1 Burges Building Official Date Contractor andlor Homeowner (Required when comments are present) Simp/exGri�nne// j� �. .: p.t- : � ATyco lnte�national Company ZEPHYRHILLS HEALTH AND REHAB MONITOR PRESSURE SWITCH FIRE ALARM SYSTEM EQUIPMENT SUBMITTAL October 9, 2012 TYPE OF PROJECT(ADDITION) ZEPHYRHILLS HEALTH AND REHAB 7350 DAIRY ROAD ZEPHYRHILLS, FL. ARCHITECT ARCH NAME ARCH ADDRESS CITY,STATE, ZIP ENGINEER ENG NAME ENG ADDRESS CITY,STATE, ZIP GENERAL CONTRACTOR GC NAME GC ADDRESS CITY,STATE,ZIP ELECTRICAL CONTRACTOR EC NAM E EC NAME CITY,STATE,ZIP FIRE ALARM SYSTEM INSTALLATION/SUPPORT SIMPLEXGRINNELL 4701 OAK FAIR BLVD TAMPA, FL 33610 PHONE: 813 626 5482 FAX: 813 664 1731 CONTACT: JOE HIXON,CONSTRUCTION MANAGER SALES: DAVID FUTRAL, ELECTRONIC SYSTEMS SALES REPRESENTATIVE Simp/ex�Grinne// r f� ° .f.�� . A7yco Mtemationa!Company ZEPHYRHILLS HEALTH AND REHAB MONITOR PRESSURE SWITCH FIRE ALARM SYSTEM EQUIPMENT SUBMITTAL October 9, 2012 Item Manufacturer PID Description INDEX TABLE OF CONTENTS A SCOPE OF WORK B DEVICE MOUNTING HEIGHTS C TECHNICAL INSTALLATION SERVICES D SIMPLEXGRINNELL HARDWARE WARRANTY E WIR DISTANCE GUIDELINES F SIEMEN TRI S MONITOR MODULE ADDRESSABLE ,Simp/�ex6�inn�e// f f �.;�. ,� . ATyco lnternational Company SCOPE OF WORK �__.__ _. ____._______---- _.__.___---___�____ ____ ______.._______. � i iProvide and install required addressable modules and program changes to the fire alarm � ; system to monitor the new low air pressure switches on the 2 fire sprinkler risers.This !, i proposal is for 2 riser locations only. ; I ; ; � � i � � , � � , � � ; II i � � , � ; ' , � I � Simp/+ex��in�e// .. _� ,s- �. � . A7yco lntarnational Company ! THESimplexGrinnellWARRAN7'Y—HARDWARE � �� SIMPLEXGRINNELLWARANTYSTATEMENT• ; SimplexGrinnell warrants to the purchaser of new SimplexGrinnell building systems product(s)that during the effective , period of the warranty such product(s)shall be free of defects in workmanship and materiaL � I WARRANTY PERIOD: ' The warranty period will terminate immediately following the earliest occurrence of either of the following• I 18 months have elapsed following shipment of any system or subsystem from SimplexGrinnell to the customer site,or ; 12 months have elapsed following the final connection operation and beneficial use of all or any part of the system. SIMPLEXGRINNELL OBLIGATION UNDER THE TERMS OF THE WARRANTY. , SimplexGrinnell sole responsibility shall be to repair,adjust or replace at its option any SimplexGrinnell product which ; fails during this period,provided purchaser has promptly reported such failure to SimplexGrinnell in � writing. Replacement parts provided under warranty of products may contain used parts which are equivalent to new ; parts when used. Replacement parts will be warranted only for the balance of the equipment warranty. SimplexGrinnell agrees to continue to honor all of the unexpired express warranties specified above on defective equipment after transfer of the equipment to purchaser's customer,provided purchaser's customer assumes the ; purchaser's obligations specified below. ; Exceptforthe express warranties stated herein SimplexGrinnell disciaims all warranties on products furnished i hereunder,including without limitation,all implied warranties of inerchantability and fitness for a particular purpose, j and the stated warranties are in lieu of all obligations or liabilities on the part of SimplexGrinnell arising out of or in connection with the performance of the products. The seller shall not be liable for a direct,incidental of consequential iloss or damage to the purchaser or user of the equipment arising out of the failure of the equipment to operate in � excess of the purchase price of said equipment. SimplexGrinnell make no warranty and now warranty shall be deemed to exist,that purchaser holds the goods free of claim of any third person by way of patent infringement for the like. i j PURCHASER'S OBLIGATION UNDER THE TERMS OF THE WARRANTY: This warranty is contingent upon the proper installation and use of the product(s).Such warranty shall not apply if the � product failure is the result of accident,unusual physical,electrical or electromechanical stress,neglect,misuse,user �, programming errors,failure of electrical power,air conditioning or humidity control,construction dust,damage foreign substances,transportation or causes other than manufacturing defect.Purchaser agrees to provide full and free access ! to authorized SimplexGrinnell employees. � WARRANTYSERVICEHOURS: ' Services provided under this warranty will be performed during 8:00 a.m.to 5:00 p.m.Monday through Friday, ; excluding locally observed SimplexGrinnell holidays. Off-hours response is available as an extra cost service option. I , WARRANTY EXCLUSIONS. ; Labor,travel and mileage for: � Service outside of SimplexGrinnell normal business hours. � Programs and/or label changes ' Failures due to external caused(lightning surges,construction dust,etc.)other that manufacturing defect. i Electrical work external to the equipment supplied by SimplexGrinnell or maintenance of accessories,alterations, i attachments or other devices not furnished by SimplexGrinnell. � Batteries ' Coverage of equipment classed as a water flow monitoring/control devices installed in or on water piping. � � 1 SI EM ENS �;r� �� TRI Series Intelligent Initiating Devices Interface Modules for MXL Fire Detection Panels TRI-S,TRI-D,TRI-R E��I�EE� �(�C� �I��I��T �t'E�I�I+��TI�hJ� • Interfaces and Supervises Normally Open Contacts • Integral SPDT Relay (up to 4 amps) onTRl-R Model • Dual Input onTRl-D Model • Multi-color L.E D. indicates status (green, amber, red) ° � ' � , • Easy front access to programming port and wiring terminals • Mounts in 4 inch square 2'/a deep box, or double gang box • Dynamic Supervision �� ",` �_,�� • Comes with 5x5 inch faceplate ' �' �R�'�'r`:`.;t�=�, , � , la;Y'��:�.i��. • Two wire operation , , ' � ��;,� "" • Model DPU or FPI-32 Programs and Verifies --�..,,,,� " ' Device's Address and Tests Device's functionality �+'-,.Ey� , • Electronic Address Programming is Easy and Dependable 'Z REV�EW DAT�: � � i�-y Z'� • �� UL Listed, ULC Listed CITY OF ZEPHYRHI � . CFSM, FM, NYMEA Approved BUiLD1NG O�'Fi�C1A�L ��' � Introduction module reports the contact's status to the control TheTFil Series Intelligent interface modules are panel TheTRI-S model can only monitor and report the designed to provide the means of interfacing direct status of the contact, while theTRl-R incorporates an shorting devices to the MXL system's ALD loop addressable Form C relay TheTRI-R relay and contact circuit device input are controlled at the same address. For the MXL system, the relay and input contact can be The TRI Series Intelligent interface modules provide controlled as a separate function The relay is typically the market's most advanced method of address used where control or shunting of external equipment programming and supervision, combined with sophis- is required. ticated control panel communication Each TRI Series interface module incorporates a microcomputer chip. TheTRI-D is a dual input module and is designed to TheTRI Series microcomputer chip technology and its supervise and monitor two sets of dry contacts.This sophisticated bi-directional communication capabilities interface module requires two address settings The with the control panel, achieve the state of an "Intelli- TRI-D is ideal for monitoring a v�✓aterflow switch and its gent Device" respective valve tamper switch TheTRI has a multi-color Light Emitting Diode that Description flashes green when operating normally, amber if unit The TRI Series Intelligent interface modules are avail- able in three models. TheTRI-S andTRl-R are designed to monitor a normally open dry contact. The interface CATALOG NUMBER 6179 ' is in trouble condition, and red to indicate a change of Mounting Data state. The TRI-D f�ashes twice, once for each address, Addressable interface Model TRI-S,TRI-D,TRI-R theTRl-R red L.E D. indicates a change of state in mounts directly into a 4 inch square 2'/a deep box the relay or a double gang box (user supplied) A 5 inch square The device's microcomputer chip has the capacity of off-white faceplate is included with each TRI storing, in memory, identification information as well as important operating status information p,,�,��i�,�-r��,`;�,;;t_,�-�, =i7,a:Itd:N Siemens Buiiding Technologies, Fire Safety Division �:,,,+,,��i-:�;i;,�;,, innovative technology allows all TRI Series intelligent �� _ interface modules to be programmed by using the ,.--;. ;�'--- -- - ---'`�-�,:�� --,, mode) DPU or FPI-32 Programmer/Tester The Pro- � ��rf ��;�� , �� ;;� � grammer/Tester is a compact, portable, menu driven - �- � _ accessory that makes programming and testing an ��, � `, - I _- i-r,,-,�r-:�,-� interface device faster, easier and more dependable _ :�' ,��.y, ""��, � � �„�;�.i_,�;�i than previous methods. _:� j; ' = � � The DPU or FPI-32 eliminates the need for mechanical ; r �� ,`��t,r��t.<+ir-a.a addressin mechanisms, such as ro ram um ers, - � F'�-'� `�`��'-�� 9 p g 1 p r;=-, :. DIP switches or rotary dials, because the Programmer/ �� .',�''T�-'�;��!`�'�� Tester electronically sets the TRI interface's address �- into the interface's microcomputer chip nonvolatile t-, �� r_f' �._� '�I memory Vibration, corrosion and other conditions that � 'R.`�� '� �-` j� , deteriorate mechanical addressing mechanisms are no � �� longer a cause for concern ��. , `;d;`rll}�;TI��U":' (!'�'_ TheTRI Series is fitted with screw terminals for �r_7:;i,�y�,�L'+_L�;��°��,� connection to an addressable circuit �,�1�-rc4��,.�,<, The TRI Series is fully compatible on the same MXL Figure A circuit with all intelligent FP IL and ID-60 Series Mounting the TRI-S/-R/-D detectors, MSI Series addressable manual stations or any other addressable intelligent modules, such as the CZM or ICP. Electrical Ratings All TRI Series intelligent interface modules are Current Draw (Active or Standby) 1.5mA UL listed Environmental operating conditions for all TRI Series TRI-R Relay Ratings Resistive. 4A, 125 VAC modules are 32°F (°C) to 120°F (49°C) with a relative 4A, 30 VDC humidity of not greater than 93% non-condensating. Inductive 3 5A, 120 VAC (0 6P.F:) Ordering Information s oA, 30 VDC (0 6PF) 2.OA, 120 VAC (0 4P.F=) Shipping Wt. 2.OA, 120 VAC (0 35PF.) Model Description Lb. Kg. 2 OA, 30 VDC (0.35P1=) TRI-S Single Input 7 oZ, ,Z TRI-R Single Inputw/Relay 7 oz. .2 TRI-D Dual Input 7 oZ. ,p Fire Safety Fire Safety 8 Fernwood Road 2 Kenview Boulevard Florham Park, NJ 07932 5/06 Brampton, Ontario Siemens Building Technologies Tel: (973) 593-2600 5M Canada L6T 5E4 FAX. (973) 593-6670 SFS-IG Tel: (905) 799-<)937 May2006 Fire Safety Website: www.sbt.siemens.com/fis Printed in U S.A. FAX. (905)799-9858 Supersedes sheet dated 7/03 FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of sysfem accepfance and approval. 1. PROTECTED PROPERTY INFORMATION Name of property: � � �' , �; �A /�j,F,�d dL P`jti,s Address: ��'✓�C� /�//' �r �2 �r I`F,� � -A Description of property: Occupancy type: Name of property representative. Address: Phone: Fax: E-mail: Authonty having jurisdiction over this property: Phone Fax: E-mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION Installation contractor for this equipment: Address: Phone. Fax: E-mail: Service organization for this equipment: Address: Phone. Fax: E-mail: Location of as-built drawings: Location of historical test reports. Location of system operation and maintenance manuals. A contract for test and inspection in accordance wrth NFPA standards is in effect as of Contracted testing company: Address. Phone: Fax. E-mail: Contract expires: Contract number• Frequency of routine inspections• 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE NFPA 72 Chapter Reference of System Type: Name of organ�zation receivmg alarm signals with phone numbers (if applicable)• Alarm: Phone: Supervisory: Phone Trouble Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location Reprinted with permission from NFPA 72,National Fire Alarm CodeOO,Copyright�02002,National Fire Protection Association,Quincy,MA 02169.This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. �O 2007 National Fire Protection Association SCa24-2-014 Rev (10/07)(p.1 of 5) NATIONAL FIRE ALARM CODE 3.TYPE OF FIRE ALARM SYSTEM OR SERVICE (continued) If Chapter 8,note the means of transmission from the protected premises to the central station: ❑ Digital alarm communicator ❑McCulloh ❑ Multiplex ❑ 2-way radio ❑ 1-way radio ❑ N/A If Chapter 9, note the type of connection. ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: Site-specific software revision date. Revision completed by:_ 4. SIGNALiNG LINE CIRCUITS Characteristics of signali�tg line circuits connected to this system (see NFPA 72, Table 6.6.1): Quantity: Style Class 5.ALARM-INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system(see NFPA 72, Table 6 5): Quanrity• Style Class• 5.1 Manual initiating devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ❑Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors. Type of coverage ❑ Complete area ❑Partial area ❑ Nonrequired partial area ❑ N/A Type of devices. ❑ Addressable ❑ Conventwnal ❑ Coded ❑Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors• Type of coverage: Type of devices ❑ Addressable ❑ Convent�onal ❑ Coded 0 Transmitter ❑ N/A Type of smoke detectar sensing technology: ❑ Iomzation ❑ Photoelectric 5.2.3 Heat Detectors Number of heat decectors• Type of coverage ❑ Complete area 7 Partial area ❑ Nonrequired partial area ❑ N/A Type of dev�ces ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of dev�ces. ❑ Addressable ❑ Conventional ❑ Coded ❑Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification. Alarm veritication on this system is. ❑ Enabled ❑ Disabled ❑ Set for seconds Reprinted with permission from NFPA 72,National Fire Alarm CodeO,Copyright 02002,National Fire Protection Association,Quincy,MA 02169 This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. O 2007 National Fire Protection Association SCa24-2-014 Rev (10/07)(p.2 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 6. SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUITS ` LjL 6.1 Sprinkler Sy tem Number of valve supervisory switches: Type of devices dressable ❑ Conventional ❑ Coded ❑ Transmitter ❑N/A 6.2 Fire Pump Type of fire pump: ❑ Electrical ❑Diesel Type of pump supervisory devices: ❑ Addressable ❑ Convent�onal ❑Coded ❑ Transn�itter ❑ N/A Fire Pump Functions Supervised ❑ Fire pump power ❑Fire pump runnmg ❑ Fire pump phase reversal ❑ Selector switch riot in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine-Driven Generator Type of generator supervisory dev�ces: ❑ Addressable ❑ Conventional ❑ Coded ❑Tra.nsmitter ❑ N/A ❑ Engme or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑Low fuel Other: 7. ANNUNCIATORS 7.1 Annunciator 1 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Locahon. 8. ALARM NOTIFICATION DEVICES AND CIRCUITS 8.1 Emergency Voice Alarm Service Number of single voice alarm channels Number of multiple voice alarm channels: Number of speakers. Number of speaker zones: 8.2 Telephone Jacks Number of telephone�acks installed. Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notificatinn device circuits con�tected to this systern (see NFPA 72, Table 6.5): Quantity• Style• Class: Reprinted with permission from NFPA 72,National Fire Alarm CodeO,Copyright 02002,National Fire Protection Association,Quincy,NIA 02169.This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. OO 2007 National Fire Protection Association S(a24-2-014 Rev (10/07)(p.3 of 5) NATIONAL FIRE ALARM CODE 8.ALARM NOTIFICATION DEVICES AND CIRCUtTS (continued) 8.4 Types and �uantities of Nonvoice Notification Appliances Installed Bells. With visual device Horns: With visual device: Chimes. With visual device Bells: With visual device. Visual devices without audible devices. Other(describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED ❑ Hold-open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑Elevator recall ❑ Other 0. SYSTEM POWER SUPPLY 10.1 Primary Power � g ��`J 'I��C pmps ,Z� '� Nominal volta e Overcunent protection: Tvpe US-C Amps 6 '� Location (of primary supply panelboard). D�sconnecting means location• 10.2 Secondary Power Location: Type Nominal voltage: _ Current rating: Number of standby batteries: Amp hour rating: Location of emergency generator: Location of fuel storage• Calculated capacity of secondary power to drive the system In standby mode. In alarm mode: 1. RECORD OF SYSTEM INSTALLATION Fill out ufter ull instullutioft is contplete nnd wiring has been d�ecked,for opens, shorts, ground faults and improper branc{iin�q, hut/i�fore cn�tducting operntiortal acceptance test.r The system has been installed in accordance with the following NFPA standards: (Note any or all thac apply) ❑NFPA 72 ❑ NFPA 70,National Electrical Code, Article 760 ❑Manufacturer's published instructions ❑ Other(please specify). System deviahons from referenced NFPA standards Signed: Prmted name• Date. Organiz.ation: Title. Phone. 2. RECORD OF SYSTEM OPERATION 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 oF. ❑NFPA 72 ❑ NFPA 70,National Electrical Code, Artiele 760 ❑ Manufacturer's published instructions ❑ Other(please specify). ❑ Documentat�on in accordance with Inspection and Testing Form (Figure 10 6.2.3) is attached Signed: Printed name• Date: Organization. Title. Phone: Reprinted with permission from NFPA 72,National Fire Alarm CodeC�,Copyright�02002,National Fire Protection Association,Quincy,NIA 02169.This reprinted material is not the compiete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. �O 2007 National Fire Protection Association Sc324-2-014 Rev (10/07)(p.4 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 3. CERTIFICATIONS AND APPROVALS 13.1 System Instailation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herem. Signed. Printed name Date Organization Title. Phone 13.2 System Service Con ractor This system a, specitied herei �s been installed and tested accord' to all NF A standards cited here�n. Signed ��-�_�y` Print d name: c-� �( /Z Date Or�anization� �j '; ti� Title /^J� � Phone �J�/�G�- 3-- ?�� 13.3 Central Station This system as tipec�fied here�n w�ll be momtored according to all NFPA standards cited herein. Signed• Printed name. Date: Orgamzation. Title• Phone 13.4 Property Representative I accept this system as having been installed and tested to �ts specifications and all NFPA standards cited herein. Signed Printed name Date Organ�zation: Title� Phone 13.5 Authority Having Jurisdiction I have w�tnessed a sat�sfactory acceptance test of this system and find it to be installed and operat�ng properly in accordance i its approved plans and spec�fications, rts approved sequence of operations, and w�th all NFPA standar s cit d h i � � - � � Signed Printed name:W � t�� ` ��'2��Ye. �j � 2`��2-- Organization. � U�f Title:�� 17)R� �,� �Phone•�� C' `� �ZJ �s�11.�1-� � �,, �� s � � o,� � �r ��5�� ,-r _ C � 5 ��, �C�J o.� s��.� �c�l�r— ,� Y s ,� e �`7 � Reprinted with permission from NFPA 72,National Fire Alarm CodeOO,Copyright �02002,National Fire Protection Association,Quincy,N1A 02169 This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced sub�ect which is represented only by the standard in its entirety. �O 2007 National Fire Protection Association S(a24-2-014 Rev (10/07)(p.5 of 5)