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SPECIALTY ELECTRONIC S Y S T E M S y INC. Means of transmission of signals from the protected premises to the central station: 3791 9 HEATHER PLAZA • DADE CITY, FLORIDA 33525 McCulloh Multiplex One-way radio 352-567-5996- • 352-52 1 -GOBS p y OF C SYSTEM Digital alarm communicator Two-way radio Others DECOR®OF C FIRE Means of transmission of alarms to the public fire service communications center: ,. _ r (a) Name of protected property: Address: :7 _ `, 2_ Z-C'r•.,,;, 1 i (b) Representative of protected property(name/phone): System location: Authority having jurisdiction: r'Address/telephone number: NFPA 72,Chapter 9—Auxillary Organization n¢me/phone Representative name/phone Indicate type of connection: Local energy Shunt Parallel telephone Installer Specialty Electronic Systems 352-567-5996 Location of telephone number for receipt of signals: Supplier '�;:;^ �� ' '.i a_`-;• : ,-e.,, _� , , .. i Service organization Specialty Electronic Systems 2.Record of System Installation Location of record(as-built)drawings: '-*\• (Fill out after installation is complete and wiring is checked for opens,shorts,ground faults,and improper branching, Location of operation and maintenance manuals: '�`+" but prior to conducting operational acceptance tests.) Location of test reports: �"'V' "� This system has been installed in accordance with the NFPA standards as shown below,was inspected by A contract for test and inspection in accordance with NFPA standard(s) t on ,includes the devices shown Contract No(s): Effective date: Expiration date: in 5 and 6,and has been in service since System Software i� NFPA 72,Chapters-- 1- '2 -3 4 ,5_,.6- .7--8--9 -10---11---(circle-all that apply) (a)Operating system(executive)software revision level(s): (b)Site-specific software revision date: ','NFPA 70,National Electrical Code,Article 760 (c)Revision completed by: r' (name) (firm) /fManufacturer's instructions 1.Type(s)of System or Service _Other(specify): V�NFPA 72,Chapter 6—Local If alarm is transmitted to location(s)off premises,list where received: Signed: Date: Organization: Specialty Electronic Systems NFPA 72,Chapter 8—Remote Station Telephone numbers of the organization receiving alarm: 3.Record of System Operation Alarm: Documentation in accordance with Inspection Testing Form,Figure 10.6.2.3,is attached Supervisory: All operational features and functions of this system were tested by date Trouble: and found to be operating properly in accordance with the requirements of: If alarms are retransmitted to public fire service communications centers or others,indicate location and telephone numbers of the organization receiving alarm: �%NFPA 72,Chapters 1..._2 =3•$4 '5""6 7 8_ _9_ 10_ .1 _.(dircle all that apply) Indicate how alarm is retransmitted: ='NFPA 70,National Electrical Code,Article 760 NFPA 72,Chapter 8—Proprietary �1Vlanufacturer's instructions Telephone numbers of the organization receiving alarm: Alarm: _Other(specify): Supervisory: Trouble: Signed: Date: If alarms are retransmitted to public fire service communications centers or others,indicate location and telephone Specialty ty Electronic Systems ystems numbers of the organization receiving alarm: Organization: _ Indicate how alarm is retransmitted: 4.Signaling Line Circuits NFPA 72,Chapter 8—Central Station Quantity and class of signaling line circuits connected to system(see NFPA 72,Table 6.6.V: Prime contractor: V Central station location: Quantity: Style: Class: ;-`% (NFPA 72,1 of 4) (NFPA 72,2 of 4)