HomeMy WebLinkAbout14-15218 . CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 15 18
FIRE ALARM SYSTEM PERMIT
Permit Number: 15218 Address: 38508 A AVE
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: 14-26-21-0010-01700-0010
Improv. Cost: 90,000.00
Date Issued: 5/01/2014 Name: GTE FLORIDA INC
Total Fees: 230.00 Address: PO BOX 152206
Amount Paid: 230.00 IRVING TX 75015-2206
Date Paid: 5/01/2014 Phone:
Work Desc: INSTALLATION FIRE ALARM SYSTEM W/VESDA
1 . 5 .
FIRE INSPECTION FEES 50.00 CONTRACTOR CERTIFICATE 30.00
I
, ' ../ �
�
: n
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$100.00, whichever is greater. All
work shall be pertormed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
! _.._ r �� ' � �
{-c�. /%�. '� '�., ;; ;;
�,:,;�.�-�� t_ , I��,x-�y_,
CONTRACTOR SIGNA URE PERMIT OFFICEF��`�---
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
i iiiiii iiiii iiiii�iiii�iii�iiiii iii�i ii�ii ii�ii iiiii i�i��i��
' 2014022884
NOTICE OF COMMENCEMENT Rept:1581782 Rec: 10.00
Permit No.
DS: 0.00 IT: 0.00
Prope;rtyIdentificationNo �a-2�2�-oo�aoi�oo.00io 02�13/14 5. Shultz, Dpty Clerk
THE UNDERSIGNED he by gives notice that improvements witl be made to certain real property,and in accordance with Section
713.13 of the Florida Sta es,the following informarion is provided in the NOTICE OF COMMENCEMEN'I'.
I. I)escription of prope (legal descriplion.� �OREB FIRST ADDRION TO CITV OF 2EPMRMILL$PB t PG 57 LC1TS 1 THRU 5 INCLUSNE d LOT3 12 THRU 181NCLUSNE OLOCK 17
a) Sh'Cet AlIdTBSS: 519 A AVE 2EPHYRHILLB FL 33542
2. C;eneraf description o improvements R��CE OLD FIRE ALARM SYSTEM WITH NEW FIRE ALARM SYSTEM. REMOVE HAION 1301 FIE SUSPRESSION SYSTEM.
3. C>wner Information
a) Nalt10 8t►d d��l'eS : C,TE FLORIDA INC TAX OEPT PO BOX 152206 IRVING TX 75015-22p8
b) Name and addres of fee simp(e titleholder(if other than owner)
c) lnterestin prope
4. C'ontractor Informatio
a) Ndt17C 81](I ad(JIeS : UNITED FIRE PROTECTION INC.,12001 31 ST COURT NORTH,ST PETERSBURG,FLORIDA 33718
b) Telephone No.: > >-47+-0aso Fvc No.(Opt.) �2�•a�i-oae�
5. Surety Information
a1 Name and addres :
b) AmountofBond: Pau�a s.o'NEIL,Ph.D.PqSCO CLERK & COMPTROLLER
ci TelephoneNo.: 02/13/14 �9�4 1 of�l��
6. Lender OR BK pG
aj Name and addres : __ _ +7�7
7. Tclentity of person wit 'n the State ofFlorida designated by owner upon whom notices or other documents may be served;
a) Name and address
bl Telephone No.: Fax No.(Opt.)
_ 8. In addition to himself, vmer designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b),Florida tatutes:
a) Name and address
b} Telephone No.: Fax No.(Opt.)
_ 9. Expiration date of Not' e of Commencement(the expiration date is one year from the date of recording unless a different date is
specified):
WARIVING TO OW1vF.R ANY PAYM�NTS MADE BY THE OWNF,R AP"/'ER TAE EXPIRATION OF THE NOTICE OF
COMI4IENCEMF,NT,�R CONSIDERED IMPROPER PAYMENTS UNDER CPAPTER 713,PART l,SECTION 713.13,
FI,OR:IDA STATU'TES CAN RESULT IN YOUR PAYING TWICE FOR IPROVEMENTS TO YOUR PROPER7'Y.A
NO'I'1�GF,OF COMMEN EMENT MUST RE RECORDED AND POSTED ON THE,TOB STTE BETORE THE FIRST
INSPECTION.IF YOU t TEND TO OBTAIN FINANC[lYG,CONSULT YOUR LENDER OR AN ATTORNEY BEFO.RE
COMl4IENCWG WORK R RECORDING YOU NOTICE OF COMMENCEMENT.
STATE Q�FLORIDA ^
COUN7'Y Oi'PASCO �J �
Sigaature OF Owner or Owner's A rized OfficedDirector/1'artnedMenager
_�FAn1 � �l�la-D
Prinf Name
7'he forr,going instrument was cknowled d before m this�hday of --�E,'��'"'.�'t' 20 �`�"'� hy i�P��r7 � �--r�,�'j
as �
.�(��7��_� ( f authority,e.g,officer,trustee,attorney in fact) or
(name of party on behalf of whom in rumen executed).
Personally Known�OR p duced identification� ,•
Notary Signature -��'
Type of ldentification Produce C..� r`(��"j-,a �^, ' ' �� , �
� �(t-i Name(print} � ?=�. 1. �
Veritication pwsusnt to Sectio 92.525,Florida Statutes.Under pennitles of perjury,I declare that 1 have read-t�'/�;fore�oirig an t facts`stated
2, ,.
in it are true to the best of my k owledge and belief. ///��� ��., `,����.
t�OltMti'NOC.rvsd2007 / ' ...':V; {� • — .
NOTAR PUBLIGSTATE OF FLORIDA � � iC'J- ` �s-n' ' w ;' '
"'I��� Toni Raefisher Cannon Signeture uf Natural Person Signing Above - ' � .,
�' M " �
=Commission#�EE114837 , . �,��;;t,�t ''�;�
�, Expires: JULY 26�2015 ••.�S.' . •',,*
Baewsu o n'n.nrnTc aormura ca,nra, ' �r 9��.�..,. �•�.{:,•
qi• \
:n,,,:� . �
ZE�EfYR�ILL� FIi�E DEE�/�E�Tl�E[�T
, 6907 Dairy Road, Zephyrhills, FL 33542
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: Contractor:
Business Name:_ �t�_c,,-� Billing Address:
Business Address:
Business Phone No.: Billing Phone No.:
Business Fax No.: Billing Fax No.`.
Contact: Contact:
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM p�E
8 Site Plan WC Mnual � N/C Sprinkler �50 1st Alarm WC
MuMi-FamilylCommerr,ial .06 sf 1st R�inspection WC StandP�P� S50 2nd Alarm WC
(Minimum Charge 325.00 2nd Re-inspection 5100 Fire Pump �50 3ad Alarm N/C
�Pla�Revisio�s DBL 3rd Re-inspecXion 5250 Hoods �50 4th qlartn a100
dth Re-Inspecfion 5500 e Alarm a50 5th Alartn $150
SPRINKLER SYSTEMIS (Business qosed until �p� asp sy�q�� �
0-25 Heads S50 violafJons coRec�ed) Nahxal Gas S50 r��uwce 5150
26 plus Heads $100 SPRINKLfR SYSTEIIAS Fuel Tanks- Perwrrc $Sp
STANDPIPE SYSTEM Hyrlro Undergrounds a45 Sparklers $100
� Per Riser S50 Hydrostatic Test �65 per sysum Fire Works $500
FIRE PUMP Acceptance Test $45 persys�em Camp Fire S25
�Per Pump a100 Hydrant Flow $75 Controlled Bum b100
FIRE ALARM SYSTEM Hood/Duct $50
25 Devioes $50 FlRE qL,ARM SYSTEM Place of Assembly $50 �
36 plus Devioes 5100 System Acceptance $50 Flre Protection a25
�UPPRESSION SYSTEMS Recall Acxeptance �50 ��ppr,�� agp �
Wet �50 OTHER
� Waste Tire Storage S50 �„nud
�fY S50 Firc WaM/Smoke Waq �15 perwau Generator<KW 5100
CO2 S50 LP Gas $25 per mMc Generator>30 KW 150
Other S50 Naturai Gas . S25 xrsrscan Bio-HazarcJ Waste 5100 kxwa�
KITCHEN DCHAUST Fumigation Tenting �50
❑H��� S50 Tent 10k10'or gr�eater a15 per� Torch PoUApplied a5p
OTNER Fke Pump a45 Haz.Materials $100 Nx,um
�'��^Pa��k S50 Fire Suppression �3p
Fuel Tank Inshallation S5p Syy�� q��ce
(Per Tank) �50 {1 Fad►s,ust Hood/Duct S30
❑N�'�����oion S5o L�Re-inspection DBL
(Per System) (oth�than annuat)
❑SPraY Booth S50 �Inspection sdieduled DBL
a�d cancelled less fhan 8
24 hours
r a��� 8 Construc6on Insp. N/C
� Emerc��cy Vehlde A, �50 FALSE ALAR�A
-----�f'b4i�IS'`TOT�1i flEC'�10N-fi@Tili —i��fiM1�=F0 —i'9fii�-----
--—
— __....._.._.
;_ . --
GRANO TOTAL
Comments•
Date. S? �t� �0��
Inspector:
nm
��'�t ZO+v ��h�,�{�r�1/S Bufiding Department
�� YY�ONiL
Date Received __ ,�;� `. �L!
Phone Contact for Permittin (�4' _ �`9G� .
,.�— �'
Owner's Name f � ��7 2�'p�A ����� Owner Phone Number
Owner's Addresa Owner Phone Number � —1
Fee simple Titleholder Name Owner Phons Number
Fee 3lmple Titleholder Address
JOB ADDRE33 �g Z /,2 h� S L. 3 3 S LOT# C�
SUBDIVISION IKGc' _�5 /ST . PARCEL ID# �4-�`�-O� �O •-Q i `7 0 0 -� C3f) 1 O
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROP03ED NEW CONSTR ADD/ALT Q SIGN [� Q DEMOLISH
INSTALL 8 REPAIR
PROPOSED USE Q SFR Q COMM C� OTHER
TYPE OF CON3TRUCTION Q BLOCK [� FRAME �� STEEL �] (--"""'----�
DE3CRIPTION OF WORK ..�.��R 1 1 'h:rz.e.A IA2r+^ S ST M W � S
eUILDINf3 SIZE � 8Q FOOTA(iE� HEI(iHT �
BUILDING VALUATION OF TOTAL CONSTRUCTION
$ �0; e�e c�t��
.. [�ELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY [� W.R.E.C.
y QPLUMBING $ �� � (L,
�I �C/
OMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
��
OGAS � ROOFING Q SPECIALTY C� OTHER
FINISHED FLOOR ELEVATiONS �� FLOOD ZONE AREA QYES NO
BUtLDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# r�
ELECTRICIAN COMPANY
31GNATURE REGISTERED Y/ N FE8 CURRE� Y/N
Addresa License# �— —�
PLUMBER COMPANY
SIGNATURE REOISTERED Y/ N FEE CURREA Y/N
Address License# �
MECHANICAL COMPANY
31GNATURE REGISTEREO Y/ N fEE CUl�RE� Y/N
Address License# ��
UTHER COMPANY �
31GNATURE t fZp`fii.c�C'CG�rJ j�J ��j
REOISTERE�F � Y/ N FEE CURRE� Y/N �
Address 3 S cT STP ` 3�,iig �Q� i�5-- LlcenBe# �OC�io o�, . 1 ;�D p
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R.O-W Permit for new constructlon,
Minimum ten(10)v►norking days after submittal date. Requlred onsite,Co�struct(on Plans,Stormwater Plans w/Silt Fence Installed,
Sanitary Facllides 8 1 dumpster;Site Work Permit for subdivis(ons/large projects
COMMERCIAL Attach(3)wmplete sets of Buflding Pians pius a Life�sfiety Page;(1)set of Energy Forms.R-Q-W Permit for new constra�cUon.
Minimum te�(10)working days after submittal date. Requlred ons(te,Constructlon Plans,Stormwater Plans w/Slit Fence installed,
San(tary Facflities 8�1 dumpster.Site Work Permit for all new proJects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Ertglneered Plans.
"`"PROPERTY SURVEY required for all NEW.consfrucdon.
)ireCtions:
FIII out application completely.
Owner&Contractor sign back of appNcatlon,notarfzed
If over E2S00,a Notice of Commencement Is required. (A/C upgrades over 57500)
' Agent(for the contractor)or Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
)VER THE COUNTER PERMiTTING (Front of Applicatlon Oniy)
!eroofs if shingles Sewers Service Upgrades A/C Fences{PIoUSurvey/Footage)
Dr(veways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTtONS: The undersig�ed understands that�his permit may be subJect to"deed"restrictions"
which may be more restrlctive than County regulations. The undersigned assumes responsibility for compUance 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 iocal regulations. If the
contractor Is not Iicensed as �equired by law, both the owner and contractor may ba citad for a misdemeano� violation
under state law. If the owner or intended cont�acto� are uncerta(n as to what licensing requirements may apply for the
intended work, they are advised to contact the Pascv County Building Inspection Diviston—Licensing Sectlon 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 applicatfon for which they will be responslble. 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 p�ivileges in Pasco
County.
TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEE3: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specifled in Pasco County Ordfnance number 89-07 and
90-07, as amended. The undersfgned also understands, that such fees, as may be due, will be Identified at the time of
permitting. It is further understood that Transpo�tation Impact Fees and Resource Recovery Fees must be paid prlor to
�eceiving a "certificate of occupancy" or flnai power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pascv County ordinances.
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 Lfen Law—Homeowner's
Protection Guide" prepared by the Florida Depa�tment 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 descr(bed document and promise in good faith to
deliver it to the"owner"prior to commencement.
CONTRACTOR'S/OWNER'3 AFFIDAVIT: I certify that all the information in this application is accurate and that all work-
will be done fn compliance with all applicable laws regulating construction, zoning and land development. Applicatfon is -
hereby made to obtain a permit to do work and installation as indicated. I certffy that no work or instaliation has
commenced prior to issuance of a permit and that all work wfll be performed to meet standards of all laws regulating
construction, County and City codes, zoning �egulations, and land development regulations in the Jurisdiction. I also -
ce�tify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibiliry to identify what actions I must take to be in compNance. Such agenctes include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engl�eers-Seawalls, Docks, Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
- US Envi�onmentat Protectfon Agency-Asbestos abatement.
Federal Aviation Autho�ity-Runways.
I understand that the foilowing restrictions apply to the use of flll:
- Use of flll is not allowed in Flood Zone"V"unless expressly permitted.
If the flli material is to be used In Fiood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at tfine of permitting which is p�epared by a professional engineer
licensed by the State of Flor(da.
If the flll material is to be used in Fiood Zone "A" in connection with a permitted building usfng stem wall
const�uction, I certify that flll will be used only to flll the area wlthin the stem wali.
- If fill material Is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect ad)acent properties, the owner may be cited for vfolating
the conditions of the building permit issued under the attached permit application, for iots less than one (1)
acre which are elevated by flll, an engineered drainage plan is requfred.
If I am the AGENT FOR THE OWNER, I promise (n good faith to inform the owner of the perm(tting conditions set forth in
this affidavit prior to commencing canstructfon. I understand that a separate permit may be requ(red for electrical work,
plumbing, signs, welis, pools, air conditioning, gas, or other installations n�t specifically included in the appifcation. A
permit issued shall be construed to be a license to proceed with the wo�k 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 Buiiding Official from thereafter
requiring a correction of errors in plans, construction or vfolatfons 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 ff work authorized by
the permit (s suspended or abandoned for a perfod of six(6) months after the time the work is commenced. An extension
may be requested, in writing, from the Buiiding 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 RECO�A.D A �O?lC�E �J� COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINENCNT, CONSULT
WITH YOUR LENDFR OR AN ATTORNEY BEFORE RECORDING Y
FLORIDA JURAT(F.S.'11 . ) ,.
OWNER OR A(iENT CONTRACTOR
Subscribed and s to{or afflrmed)before me thls Subscribed and bwom to(or aiflrmed)before me this
Wh ersonally k to me.or has/have produced Who Is/are personally knovm to me o�hes/have produced
as Identlflcatlon. as tdentlflcation.
�
,.,,�"•, B�GE � Notary Publ(c
� C ry ubUc
" J
i '` ��� m er 1y.2(!14 Commisslon No.
Co m lon No :; �f,r,,,,�u�
�I�f��
�E
Name of Notary typed,printed or stamped Name of Notery typed,printed or stamped
:�ba �
iel, ,l,ao. .
. .. . ,._r............. . �swr2��'�a�s:xF.,.'.. ti,. .. . �.°tRSe,. s'�,?: �i.. rt . . . ' � � '��
,.,._.■ .,. .
PROVIDING WORLD CLASS SERVICE
Tampa •Ortando• Ft. Lauderdale•Atlanta
gg8-822-5544•www.united-fire.com
FIRE ALARM SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time of system acceptance and approval.
1. PROTECTED PROPERTY INFORMATION
Name of property: _
Address:
Description of property:
Occupancy type:_
Name of property representative:
Address: E-mail:
Phone: _ Fax:--
Authority having jurisdiction over this property:
Phone: —
Fax: E-mail:
2. FIRE ALARM SYSTEM INSTALLATION,SERVICE ANDTESTING INFORMATION
lnstallation contractor for this equipment:
A�!dress:__ —
Phone:---. — —
Fax: E-mail:
Service organization for this equipment:
Address:_ __ — --
Y Fax: E-mail: —
Phone:___�—. ---
Location of as-built drawings _ Location of historical testing reports:
' Location of system operation and maintenance manuals:_ —
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. TYPE OF FIRE ALARM SYSTEM OR SERVICE
,NFPA 72 Chapter Reference of System Type:
Name of organization receiving alarm signals with phone numbers(if applicable):
Phone:
Alarm:__ _
Phone:
Supervisory:
Phone:
Trouble: --
Phone:
Entity to which alarms are transmitted:
Method of retransinission of alarms to that organization ar location:
If Chapter 8,note the means of transmission from the protected premises to the central station:
_7 Digital alarm communicator ❑McCulloh ❑Multiplex ❑2-way radio � 1-way radio �N/A
lf Chapter 9,note the type of connection: 7 Local energy �7 Shunt �N/A
3.1 System Software
Operation system(executive)software revision level: _ r �
Site-specific software revision date:_ —
Revsion completed by:
4.SIGNALING LINE CIRCUITS
Churcicterrstics qj�signaling line cirez�its connected to this sy.i�tem(see NFRA 72, Table 6.6.1):
Quantity:_
Style: Class:
5.ALARM-INITIATING DEVICES AND CIRCUITS
Churacter�islics qj�rrtitiatirlg dei�ice circ�its connected to this system(see,'VFRA 72, Table 6.5):
Quantity: Style:__ Class:
5.1 Manual Initiating Devices
5.1.1 Manual Pull Station _ Number of manual pull stations:
Type of devices: ��Addressable ❑Conventional ❑Coded ❑Transmitter �N/A
5.2 Automatic Initiating Devices
5.2.1 Area Smolze Detectors Number of smoke detectors:
Type of coverage: �Complete area ��Partial area �Nonrequired partial area ❑N/A
.--� �a
Type of devices: �Addressable �Conventional 7 Coded �Transmitter ❑N/A �
Type of smoke detector sensing technology: ]Ionization 3'�hotoelectric
5.2.2 Duct Smoke Detectors Number of duct smoke detectors:
Type of coverage: —
Type of devices: )Addressable ❑Conventional ❑Coded ❑Transmitter ❑N/A
Type of duct smoke detector sensing technology: ❑Ionization ❑�Photoelectric
5.2.3 Heat Detectors
Number of heat detectors:
Type of coverage: J Coinplete area U Partial area ❑Nonrequired partial area ❑N/A
Type of devices: �'Addressable ❑Conventional �Coded ❑Transmitter �N�A pa�e t of3
a; . _� . ... . :;
: . . ,:. :� 4; � . �., . .�
5.2 Automatic Initiating Devices (conrinued)
5.2.4 Sprinkler Waterflow Detectors Number of waterRow detectors:
Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter C1�'I�1�A
5.2.5 Alarm Verification Number of devices subject to alattn verification:
Alarm verification on this system is: ❑Enebled �Disabled ❑Set for seconds
6.SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUITS
6.1 Sprinkler System Number of valve supervisory switches:
Type of devices: �Addressable ❑Conventional ❑Coded ❑Transmitter ¢'�`1�A
6.2 Fire Pump
Type of fire pump: ❑Electric ❑Diese] �-�
Type of fire pump supervisory devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter �'N�A
Fire Pump Functions Supervised
❑Fire pump power ❑Fire pump running ❑Fire pump phase reversal ❑Selector switch not in auto
❑Engine or control panel trouble ❑Low fuel
Other:
6.3 Engine-Driven Generator
Type of generator supervisory devices: ��Addressable �]Conventional ❑Coded ❑Transmitter ❑N/A
❑Engine or control panel trouble ❑Generator running ❑Selector switch not in auto ❑Low fuel
Other:
7. AAINUNCIATORS
7.1 Annuneiator 1 �Local ❑Remote
Type: ❑Addressable �Directory �Graphic D�N/A Location:
� 7.2 Annuneiator 2 �Local ❑Remote
Type: J Addressable ❑Directory O Graphic �N/A Location:
7.3 Annunciator 3 ❑Local ❑Remote
Type: �Addressable �Directory �Graphic OlN/A Location:
8. ALARM NOTIFICATION DEVICES ANR CIRCUITS
8.1 Emergancy 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
Nuinber of telephone jacks installed: number of telephone handsets stored on site:_
Type of telephone system installed: ❑Electrically powered ❑Sound powered ❑N/A
8.3 Nonvoice Audible Systems
Characteristics of notification device circuits connected to this s,vstem(see NFRA 72, Table 6.5):
Quantity: Style: Class:
8.4Types and Gluantities 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 U Elevator recall ❑Other
10.SYSTEM POWER SUPPLY
10.1 Primary Power
Nominal voltage Amps
Overcurrent protection: Type Amps �
Location(of primary supply panelboard): � ; �
Disconnecting means location:
10.2 Seconday Power
Location: Type: Nominal voltage: Current rating:
Number of standby batteries: Amp hour mode:
Location of emergancy generator:
Location of fuel starage:
Calculated capacity of secondary power to drive the system
In standby mode: _ ln alarm mode:
Page 2 of 3
. �«�r e..
_ ..._ �._,,.�.....w�.;::: ,wa ri.e�ur:a�'�a . .,
11.RECORD OF SYSTEM INSTALLATION
Fr//nut af(er all rn.�'lcallarion i�complete arad K�iring llas been checked�or opens,shorts,ground,faults, and improper
b��c�nchin�, but hefore co��dz�cting operaf�onal accep�nnce teets.
The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.)
J�'FPA 7Z 0 NFPA 70,National Electrical Code,Article 760 �
O Manufacturer's published instructions �Other(please specify):
System deviations from referenced NFPA standards -
Printed name:
� � Date: �
Signed:
Title: Phone:
Organization:
12.RECORD OF SYSTEM OPERATION
All operational features and functions of this system were�ested by or in the presence of the signer shown below,on the date shown below,
and werc found to be operating properly in accordance with the requirements of:
�NFPA 7? ❑NFPA 70,Natio��al Electrical Code, Article 760
�Manufacturer's published instructions
❑Other(please specify):
❑Documentation in accordance with Inspection and Testing Form(Figure 10.6.2.3)is attached
Printed name: –
Date:
Signed:
Title: _ Phone:
Organization: -- —
13.CERTIFICATION AND APPROVALS
' 13.1 System Installation Contractor
. This system as specificd herein has been installed and tested according to all NFPA standards cited herein.
Signed:_
Printed name: _ Date:
Organization:_ _ — �—
Title: _ Phone:
13.2 System Service Contractor
This system as specified herein has been installed and tested according to all NFPA standards cited herein.
Signed:_ --
Printed name: � � Date:
� Title: � _ Phone: �
Organization: — —
13.3 Central Station
This system as specified herein will be monitored according to all NFPA standards cited herein.
Signed: ---
Printed name: _ Date:
Organization: —
Title: _ Phone: _
13.4 Property 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:
13.5 Authority Having Jurisdiction
I have witnessed a satisfactory aeceptance test of this system and find it to be installed and operating properly in aceordance with its approved plans
and specifications,its approved sequence of operations.and with all NFPA standards cited herein.
Signed:
Printed name: � � _ Date: �
j
% - Title: Phone:
Organiz_ation: r � —
Page 3 of 3