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HomeMy WebLinkAboutF2018-0538 - MiscX2018.0539 kilo Mangold Ave FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem acceptance and approval. It shall be permitted to modify 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. `M:J-1ilk 4:4 ►7l I[;[*] ZI JJ F-Ai[a]:I Name of roe Fire Station 5 & Branch Address: 410 Marigold AVE Newport Beach Description of property: Fire Station Occupancy type: A3BR2S2 _...... _.... _.._ .__. _.. Name of property representative: City Of Newport Beach Address: 100 Civic Center Newport Beach CA 92660 Phone: Fax: E-mail: Authority having jurisdiction over this property: City of Newport Beach Phone: 949-644-3101 Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: R.M. Systems Inc. Address: 330 E. Orangethorpe Ave. Unit # F, Placentia, CA, 92870 License or certification number: C7/C10 #835143 Phone: (714) 984-1206 Fax: (714) 984-1209 E-mail: admin@rmsystemsinc.net Service organization for this equipment: Same, as above ( 1,YEAR WARRANTY) Address: License or certification number: Phone: Fax: E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: N.A. Contracted testing company: Address: Phone: Fax: E-mail: Contract expires: _.. Contract number: _ Frequency of routine inspections: 3. DESCRIPTION OF SYSTEM OR SERVICE ® Fire alarm system (nonvoice) ❑ Fire alarm with in -building fire emergency voice alarm communication system (EVACS) ❑ Mass notification system (MNS) ❑ Combination system, with the following components: ❑ Fire alarm ❑ EVACS ❑ MNS ❑ Two-way, in -building, emergency communication system ❑ other (specify) ......... ....... _. ...... _. __.. ..... ____.. NFPA 72, Fig. 10.18.2.9.1 (p. 1 of 12) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. it may not be copied for commercial sale or distribution. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2013 Additional description of systems 3.1 Control Unit Manufacturer: Silent Knight Model number: IFP 2000 3.2 Mass Notification System ® This system does not incorporate an MNS 3.2.1 System Type: ❑ In -building MNS�ombination ❑ In -building MINS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ Wide-areaMNSto regional national alerting interface ❑ Local operating console (LOC) ❑ Direct recipient MNS (DRMNS) ❑ Wide -area MNS to DRMNS interface ❑ Wide -area MNS to high-power speaker array (HPSA) interface ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: On Site F A C P. 3.4 System Software ❑ This system does not have alterable site-specific software. Operating system (executive) software revision level: S.K.S S 5.0.1.0 Site-specific software revision date: 2.11 15 _ _ _ Revision completed by: Cesar Rodriguez CIA copy of the site-specific software is stored on site. Location: 3.5 Off -Premises Signal Transmission ❑ This system does not have off -premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: Phone: Supervisory __. _... __ _... ........ Phone: _._ ..... .... Trouble: Phone: Entity to which alarms are retransmitted: Fire. Department _. _.. Phone: _... _.,. Method of retransmission: Central station operator calls 911 after receiving signal If Chapter 26, specify the means of transmission from the protected premises to the supervising station: If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NEPA 72, Fig. 10.1112.1.1 (p. 2 of 12) Copyright to 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: N/A Description: 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 1 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 0 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: N/A _._.._.. Description: 4.2.3 Device Power Pathways ❑ No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: e Survivability level: 0 Quantity: 4 (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: N/A Description: 4.3.3 Device Power Pathways ® No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 90.18.2.1.1 (p. 3 of 12) Copyright ® 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑ This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 1 Conventional: _. _.._ Coded: Transmitter: „ Other (specify): 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: Type and number of devices: Addressable: _. _ Conventional: Coded. _.._ Transmitter: Other (specify): _. ..... _...... _... _....... ........ ..... 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 15_ _ Conventional: _.. _.. Other (specify): Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): _.. ._.... __._ _... ..... .. ..... _.. ._..._. Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): ..__.. __._.. _. ._._ ....... _...... ._._.. 5.2.2 Duct Smoke Detectors ❑ This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: _ Conventional: 2._ _._. Other (specify): ..... ...... __ _._ _._ _. _. Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): _._ .... _. __ .... .... _. ... ........ Type of coverage: __. _ _.. _. ...... _.. _._ ..... ...... 5.2.4 Gas Detectors ® This system does not have gas detectors. Type ofdetector(s): _._ ... __ _._ ...... _. __ ........ _.. Number of devices: Addressable: Conventional: Type of coverage: _.. ... _ ._..._ .._ . .._.. _ _._. 5.2.5 Heat Detectors ® This system does not have heat detectors. Type and number of devices: Addressable: _. Conventional: _.._ _.. Type of coverage: ❑ Complete area ❑ Partial area ❑ Not required partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ❑ Rate -of -rise ❑ Rate compensated NPPA 72, Fig. 1 D.18.2.1.1 (p. 4 of 12) Copyright ® 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. S. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: 7 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: _..1.._ 5.2.5 Alarm Verification Number of devices subject to alar verification: _ 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: Knox Box ❑ This system does not have monitoring modules. ❑ This system does not have watertlow alarm devices. Conventional: Coded: Transmitter: ® This system does not incorporate alarm verification. Alarm verification set for: seconds E This system does not incorporate pre -signal. E This system does not incorporate PAS. ❑ This system does not have other initiating devices. 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: _. _.._ Conventional: 1 _.._ Coded: Transmitter: i Other (specify): 6.2 Fire Pump Description and Supervisory Devices E This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: _._ Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): ._....... _.... _.. _. 6.3 Duct Smoke Detectors (DSDs) E This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): _.. __. _. _... _._ _. ....... Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices Describe: E This system does not have other supervisory devices. NFPA 72. Fig. 10.18.2.1.1 (p. 5 of 12) Copyright m 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution, 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): _. ._. ..... _... 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): Gas Shut off 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: Station Lobby Location 2: Location 3: ® This system does not have a generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special hazard systems. ❑ This system does not monitor other systems. ® This system does not have annunciators. 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: _ _ Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances ❑ This system does not have nonvoice notification appliances. Horns: 14 With visible: 14 Bells: N/A With visible: N/A Chimes: N/A With visible: N/A Visible only: 14 Other (describe): 9.3 Notification Appliance Power Extender Panels ® This system does not have power extender panels. Quantity _.. _.._................... Locations: NEPA 72, Fig, 10.18.2.1.1 (p. 6 of 12) Copyright ® 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be cooled for commercial sale or distribution. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: „. _ MNS-only visible appliances: Textual signs: _ _.._ Other (describe): Supervision class: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ® This system does not have a two-way telephone system. Number of telephone jacks installed: Number of warden stations installed: _ Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ® This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: _..._.. % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.9.1 (p. 7 of 12) Copyright 0 2009 National Fire Protection Association. This farm may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended. _.. _.. _.. _.. 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ❑ Hold -open door releasing devices ❑ Smoke management ® HVAC shutdown ® F/S dampers ❑ Door unlocking ❑ Elevator recall ® Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): _._ _._ ..... _.. _. ........ 12.1 Addressable Control Modules Number of devices: 6 Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power ❑ This system does not have control modules. Input voltage of control panel: 120 VAC _. _. Control panel amps: 5.0 _._.... Overcurrent protection: Type: CIRCUIT BREAKER Amps: 20 Location (of primary supply panel board): ELECTRIC ROOM Disconnecting means location: PANEL BREAKER _.. _.._._ 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: Type of fuel: ® This system does not have a generator. NFPA 72, Fig. 10,182.1.1 (p. 8 of 12) Copyright © 2009 National Fire protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 13. SYSTEM POWER (continued) 13.1.3 Uninterruptible Power System ® This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 13.1.4 Batteries Location: MAIN FACP Type: ,GEL Calculated capacity of batteries to drive the system: In standby mode (hours): 24 _.. _. ❑ Batteries are marked with date of manufacture Nominal voltage: 24VDC Amp/hour rating: _18 In alarm mode (minutes): 5 ❑ Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel. Overcurrent protection: Type: Location (of primary supply panel board). _.._ Disconnecting means location: 13.2.2 Engine -Driven Generator Location of generator: ................... Location of fuel storage: „...,.,..,_, EVACS or MNS panel amps: Amps: M This system does not have a generator. Type of fuel: 13.2.3 Uninterruptible Power System ® This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 13.2.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ® Batteries are marked with date of manufacture Nominal voltage: In alar mode (minutes): ❑ Battery calculations are attached Amp/hour rating: NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. it may not be copied for commercial sale or distribution. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender par l(s): Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: 13.3.2 Engine -Driven Generator Location of generator: Location of fuel storage: E This system does not have power extender panels. Power extender panel amps: Amps: E This system does not have a generator. Type of fuel: 13.3.3 Uninterruptible Power System ® This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: _ _. _._ _. ....... Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): __. _.. _.. In alarm mode (minutes): _. 13.3.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): E Batteries are marked with date of manufacture 14. RECORD OF SYSTEM INSTALLATION Nominal voltage: __.._.._.. In alarm mode (minutes): „ ❑ Battery calculations are attached Amp/hour rating: Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before confucting operational acceptance tests. This is a: E New system ❑ Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) E NFPA 72, Edition: 2103 E NFPA 70, National Electrical Code, Article 760, Edition: 2013 E Manufacturer's published instructions Other (specify) _. _...... _. System deviations from referenced NFPA standards: NONE _... ,, _....... Signed: _. Printed time: 0-e14/1 ;t.c .�,,S� Dater Organization: l W!t � _ � _ Title: Pure ki yi _,. _. Phone: ��1Y� IVFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 16. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ❑ New system 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 for the following: [D Modifications to an existing system All newly modified operational features and functions ofthe 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 ofthefollowing: E] NFPA 72, Edition: 2013 ® NFPA 70, National Electrical Code, Article 760, Edition: 2013 ® Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: _._ Printed name: _. _.. ... Date: Organization: Title: Phone: 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. ��pp Signed: _ r Printed time: (;-( 41'� Organization: _.. Title: 'Poll, "-"7It4-\ J _. Phone: I (.�-// �,`sj/'%6 WYO 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: N/A _._. _._ Printed name: _.. Date: Organization: Title: Phone: 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: _ N/A _,.. ., Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 10,18.2.1.1 (p. 11 of 12) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: _...... _. Title: _.._. ...._. _ _._.. Phone: _...._. _.. 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name Date: Organization: Title: _ Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution.