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I'Xu 11-0161
2920 mewp,04 WvZ
SYSTEM RECORD OF COMPLETION
This form is to be completed by the system installation contractor at the time of system acceptance and approval
It shall be permitted to modem this form as needed to provide a more complete and/or clear record.
Insert N/A in all unused lines.
Attach additional sheets, data, or calculations as necessary to provide a complete record.
Form Completion Date: 06111/2019 SappicincllalPages Attached:
1. PROPERTY INFORMATION
Name of pr
Address:
Description of property: restaraunt
Name of property representative:
Address:
Phone: Fax: E-mail:
2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION
-I ertallatioueontractor SCN SECURITY COMUNICATION NETWORK INC.
Address: 1530 CONSUMER CIRCLE STE. 102, CORONA, CA 92880
Phone: 951-549.8200 Fax: 951-549.8211 E-mail:
Service organization: SCN SECURITY COMMUNICATION NETWORK INC.
Address: 1530 CONSUMER CIRCLE STE. 102, CORONA, CA 92880
Phone: 951-549-8200 Fax: 951-549-8211 E-mail:
Testing organization: SCN SECURITY COMUNICATION NETWORK INC.
Address: 1530 CONSUMER CIRCLE STE. 102, CORONA, CA 92880
Phone: 951-549.8200 Fax: 951-549-8211 E-mail:
Effective date for test and inspection conftaet: 12/0812018
Monitoring organization: RAPID RESPONSE MONITORING SERVICES INC.
Address: 400 E RINCON, CORONA, CA 92879
Phone: 800.647-2758 Fax: E-mail:
Account number: Phone line 1: N/A Phone line 2: N/A
Means of transmission: CELLULAR
Entity to which alarms we retransmitted: FONTANA FIRE DEPARTMENT Phone:
3. DOCUMENTATION
On-site location of the required record documents and site-specific software: @FACP
4. -DESCRIPTION OF SYSTEM OR SERVICE
This is a: ® New system ❑ Modification to existing system Permit number:
NFPA 72 edition: 2016
4.1 Control Unit
-Manufacturer..- DMP - Model•number.- XR150
4.2 Software and Firmware
Firmware revision number: N/A
4.3 Alarm Verification
Number of devices subject to alarm verification:
® This system does not incorporate alarm verification,
Alarm verification set for
seconds
Copyright® 2012 National Fire Protectlon Association. This form maybe copied for individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 1 of 3)
SYSTEM RECORD OF COMPLETION (continued)
5. SYSTEM POWER
5.1 Control Unit
5.1.1 Primary Power
Input voltage of control panel: 120VAC Control panel amps: 20
Overcurrem protection: Type: BREAKER Amps: 20
Branch circuit disconnecting means location: Number:
5.1.2 Secondary Power
Type of secondary power: _BATTERIES
Location, if remote from the plant:
Calculated capacity of secondary power to drive the system:
In standby mode.{hones}: 24 In alarm nwd«(mmutcs) 5
5.2 Control Unit
® This system does not have power extender panels
❑ Power extender panels are listed on supplementary sheet A
5. GIHGU115 AND PATHWAYS
Addressable or
quantity Conventional
Pathway Type
Dust Media ?athway
S"WetePattKNay cuss SurvivatbhityLevel
Signaling Line
Smoke Detectors
B 1
Device Power
Duct Smoke Detectors
Initiating Device
Heat Detectors
B 1
Notification Appliance
Gas Detectors
Other{speeify):
Waterfiow Switches
Type
Addressable or
quantity Conventional
Alarm or Supervisory Sensing Technology
Manual Pull Stations
3 CONVENTIONAL
ALARM
Smoke Detectors
CONVENTIONAL
ALARM PHOTOELECTRIC
Duct Smoke Detectors
Heat Detectors
194 DEGREE ROR
ALARM
Gas Detectors
Waterfiow Switches
Copyright 02012 National Fre Protestion Assoclafion. This form may be copied for Individual use other than for resale. It may not be copied for commercial sale or distribution.
(p. 2 of 3)
SYSTEM RECORD OF COMPLETION (confined)
vtstnte STROBE
Combination Audible and visible —7 SPEAKER/STROBE
11. INTERCONNECTED SYSTEMS
® This system does not have interconnected systems.
❑ Interconnected systems are listed on supplementary sheet
12. CERTIFICATION AND APPROVALS
12.1 System Installation Contractor
This syste 4 specific h rein has
,t.(�een metalled according to all NFPA standards c`it@1d herein. /' p
Signed: �I lt.rl Printed name: &c\"/Date:
Organization: Title: Us ' � ���_ Phone: (51 — G'�(%•`�ta 'Ir,
12.2 System Operational Test
This syst s speci i h r in has tes ed according to all NFPA standards cited It r in.
Signed: (_,i Printed name:
��!' Date: �"'( ���`
Organization: .43a \� Title: /" Phone:' 9q7-69dj
12.3 Acceptance Test `
Date and time of acceptance test:
Installing contractor representative:
Testing contractor representative:
Property representative:
ATU representative:
Copydght02Ol2 Naawel Fre Protection Awaclaflon. This form maybe copied for individual use other than for male. It may not be wpied for commercial sale or distribution.
(p. 3 of 3)