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:, FIRE ALARM INSPECTION AND TESTING FORM `
<br /> Alarm Specialist Corp. Date: a m CjCC.Lt ._ t 0 Time 1 0, 5
<br /> SERVICE ORGANIZATION PROPERTY NAME (USER) . r-- Name: EMG ALARM SPECIALISTS . Name: _�0) n -- m r ) Ct rt1 E 11 f er Prt5 ,e_
<br /> Address: 1375 EAST AVENUE N., SARASOTA, FL 34237 Address: 5-Q ::, C . 1 1 Njim, . 7 _ e p; y r j, i (16 Y/ ' :
<br /> Representative: A) Cf e- !tl kit is f Contact: /VI 61 j c
<br /> License No.: EF- 0000096 Telephone: a� - 5 - 6.4 r (
<br /> Monitoring Entity Approving Agency
<br /> Contact: }" C, Contact:
<br /> Telephone: (941) 366 -9130 Telephone:
<br /> Monitoring Account Ref. No.: A S -- 7 q e e7 Ticket #: Customer #:
<br /> TYPE TRANSMISSION SERVICE F.A.C.P.. r D.A.C.T.
<br /> Multiplex ❑ Monthly Panel Manufacturer: S , f ri t j 1 Le AA. e
<br /> (D/Digital ❑ Quarterly Model No.: 6 d (3 c1
<br /> D Other (Specify) 1mi Annually Circuit Styles:
<br /> An nually No. of Circuits: LI
<br /> Signaling Line Circuits 0 Other (Specify) List Dates System ad any service performed:
<br /> Qty: 'v( Style:
<br /> ALARM INITIATING DEVICES AND CIRCUIT INFORMATION
<br /> QTY OF CIRCUIT STYLE QTY OF CIRCUIT STYLE
<br /> A j p Manual Stations Heat Detectors
<br /> Ion Detectors Waterflow Switches
<br /> 1 a Photo Detectors I Supervisory Switches
<br /> g Duct Detectors Other: (Specify)
<br /> ALARM INDICATING APPLIANCES AND CIRCUIT- INFORMATION
<br /> QTY OF CIRCUIT STYLE QTY OF CIRCUIT STYLE
<br /> Bells Strobes
<br /> 7 P--) Horns /3t(Ob . Other: (Specify)
<br /> Chimes � �
<br /> No. of Alarm indicating circuits: �,�, Are circuits supervised? itiYes ❑ No
<br /> SYSTEM POWER SUPPLIES
<br /> a. PRIMARY (Main): Normal Voltage 1 a. ( J , Amps: / 3 b. SECONDARY (Standby)
<br /> Overcurrent Protection: Type: 6i4 -,,t , Amps: 7' C � I D (J - f" Storage Battery: Amp -Hr Rating: " 7 /1 N,
<br /> Location (Panel Number): 4. Calculated capacity to operate system, in hours y 24 60
<br /> Disconnecting Means Location: c ( c . 4 . ' r` o .,.v Engine - driven generator dedicated to fir alarm system:
<br /> Location of fuel storage:
<br /> PRIOR TO ANY TESTING
<br /> NOTIFICATIONS ARE MADE: Y�E ' NO WHO TIME
<br /> MONITORING ENTITY lq ❑
<br /> BUILDING OCCUPANTS 0 - M�, S
<br /> BUILDING MANAGEMENT (1Ac f Sa,
<br /> OTHER (Specify) ❑ ❑ `
<br /> AHJ NOTIFIED OF ANY IMPAIRMENTS ❑ 0 ly
<br /> SYSTEM TESTS AND INSPECTIONS
<br /> TYPE VISUAL FUNCTIONAL COMMENTS TYPE VISUAL FUNCTIONAL COMMENTS
<br /> Control Panel GY ( j Transient Suppressors ❑ El
<br /> Interface Equip. Y . Er Remote Annunciators ❑ ❑
<br /> Lamps /LEDs Id C� / ) / ) G
<br /> Fuses tom' Y IT Notification of Appliances: � Ci L F---
<br /> Primary Power Supply C Audible C t �
<br /> Trouble Signals
<br /> 0 // � � Visual E 11/ Disconnect Switches Gd Id / Speakers Ir
<br /> Ground Fault Monitoring ,r v r y .
<br /> DEVICE SIMU �
<br /> INTERFACE EQUIPMENT: VISUAL OPERATION OPER �� , .. , �'
<br /> (SPECIFY) HVAC ❑ ❑ • ice' ° , tt,�
<br /> (SPECIFY) Elevator Recall 0 13 0 i,3 ,'� � ,f - s ' .
<br /> (SPECIFY) ❑ Li D t , ' /2 /i � „' z . ' � ' - ` Z c s ' "i'
<br /> EMERGENCY COMMUNICATIONS EQUIPMENT: ' " 4 " ' a "% '1 t , ` "S"
<br /> VISUAL FUNCTIONAL fi lls - -d� 41,',0t.,}- .,
<br /> 0 Phone Jacks ❑ ❑ x e t y ' ilk , ,� }�� `,.
<br /> ❑ Amplifiers 0 ❑ a �� �' : } a ' :
<br /> ❑ System Performance 0 ❑ 0 , ' r sP � '' 4 k
<br /> ON /OFF PREMISES MONITORING: 1,1 , t "�`' ;tit : ' "4 }> n
<br /> ii�� 3�, drf� : ff i k X � ',,,,t z ��, 9
<br /> YES NO TIME COMMENTS ”' ' `^`. k , k ,, , F k ', � ,, 1 TIME L
<br /> Alarm Signal 0 jot(�5 1 ',.*,71,;: i i , ? . , "I /� �
<br /> £a
<br /> Alarm Restoral , C� ❑ 4 ,, k � ' t i l
<br /> Trouble Signal lfl' /O - - nom , , ' Ill
<br /> Supervisory Signal O �� .
<br /> Supervisory Restoral (0 � ' . . . ' ' - r a s s z "
<br /> ; .
<br /> THE FOLLOWING DID NOT OPERATE CORRECTLY: - '`` ` f ,2
<br /> SYSTEM RESTORED TO NORMAL OPERATION DATE: TIME:
<br /> THIS TESTING WA ERFORMED N ACCORpANCE WITH APPLICABLE NFPA STANDARDS.
<br /> Name of Inspector: c fi t� f i 4 "" Name of Owner or Representative: ) �]
<br /> 7g /t. y � /
<br /> Date: 2- yl • _ . — Time: Date: , - ,if , Q im- / .' :its
<br /> Signature: L/ _ * ` Signature: [ f a , , e v -
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