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HomeMy WebLinkAboutF2023-0304 - MiscSYSTEM RECORD OF COMPLETION This form is 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 Form Completion Date: Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: The Landing Address: 3101-3121 Newport & 3130-3142 Balboa Newport Beach, CA 92663 Description of property: Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: VFS Fire & Security Services Address: 501 West Southern Avenue Phone: (714) 778-6070 Fax: E-mail: Service organization: VFS Fire & Security Services Add ess: 501 West Southern Avenue Phone: (714) 778-6070 Fax E-mail: Testing organization: VFS Fire & Security Services Address: 501 West Southern Avenue Phone: (714) 778-6070 Fax: E-mail: Effective date for test and inspection contract: VFS Fire & Security Services Monitoring organization: NMC Add... 25341 Commercentre Dr. Lake Forest, CA 92630 Phone: 866-440-0311 Fax: E-mail: Account number: Phone line 1: NIA Phone line 2: NIA Means of transmission: One way private radio alarm system - Wireless communicator (7707P-88-ULP-M) Entity to which alarms are retransmitted: Central station Phone: 866-440-0311 3. DOCUMENTATION On -site location of the required record documents and site -specific software: Document Cabinet next to FACP 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: [ u .New system lomodification to existing system Permit number: F2023-0304 NFPA 72 edition: 4.1 Control Unit ` , l 1 !-� Manufacturer: s1 u-' NT t't�1 \ Fi fA T Model number: � 1y 0 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification J2-This system does not incorporate alarm verification. Number of devices subject to alarm verification: Y" Alarm verification set for seconds Copyright ® 2012 National Fire Protection Amodation. This form may be copied for individual use other than for resale. It may not be copied for mmmen ial sale or distribution. 1p. 1 of 3) (6 jo , CO 'uopnquslp Jo ales le!avawwm jol paldoo aq jou hew ll'apsou io+uegl iaglo asn IenplAtW I )o; peldoo aq Aew uuo) slgl'uopepossy uop oloid enj IeuDWN ZLOZ 0IgBuAdop -TI RI sogojjmS mdnml vt (q sagallmS moula"m N Slopolacl wo l-/ SlmaalaQ luaH k9 sloloap(j 331omS lonU M (y Slolaa12G axows (N SuollmS Ilnd lunmw 46010ugoel6ulsueS AIosimednS jo wjelV leuolluanuoO jo algessalppV Algueno edAl SdJ1AdU JNIlVIlINI H SNOlVIONnNNV 31OW3U 'L :(I;pads)1a po 0 (V aoumlddy uogeognolq 0 9 %1 ! (✓ ODIAaQ 5mleglu1 N, lamod 33000I 0 g QUIZ dulluu is Ianej AAI!genwnS sselo Aemg;ed aleledsg Aemgled elpapy Ien❑ edAl Aemgled SAVMH1Vd UNV SllI UMID -9 V hags fMuomalddns uo pa1Sg ale slaved lapualxo lamod ❑ slaved lapualxo lamod anuq lou soap malsAs slgl 12' 1luI11o1InoO Vs :(salnmm) apom mlele m � :(smoq) apom ,fgpuels ul �% I :molds agl anup of lamod If puoaas )o ,il}audua palelnale0 :luejd agl UIoy alomali `uolleaoZ :lamod ,Uupuoaas;o od j Jaeod 6Uupu033S Z'T'S pk�M 17�moilmol sneam dmloanaoaslp lmona gouelg :sdmV ��7—�}�±r��� )�l n1 3j1:adll :uopoaloldmalm3lan0 :sdme hued lo.puoD �>�j (1 �� :loped loRuoa;o OSETIOA lndm © b Jamod fJuwlld T'I'S 1!u11 Io.quo0 1'9 H3MOd W31SAS 'S (ponur;uoo) NOLL3ldW00 d0 MJOOA2] W31SAS SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible /s/ 1A Visible N Strobe Combination Audible and Visible iF Horn/Strobe 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold -Open Door Releasing Devices /wj HVAC Shutdown Fire/Smoke Dampers (q Door Unlocking TJ 1A Elevator Recall i Elevator Shunt Trip a 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 system as specified € di ras installed according to all NFP/1A standards cited herein. JJ _ Signed: Printed name: /{ ;c ca . cr �� �a�{'2+'i�te: 2 Organization: �� �C F t Title: 'c(t`V NcAE. T-CC�F} Phone: 714 LlUy [a q2 7 12.2 System Operational Test This system as specifre rere'trttttste ed according to all NFPA standards cited herein. J) r Signed: Printed name: A w ('tcrl -c 'JC 10 Date: Organization: Title: SCAR-V iJ1C_I;4 Phone: ''j l y q( (o4 -7 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: <— \� CopynghtC 2012 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied for rommercial sale or dishlbuBoa (p. 3 of 3)