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U5 Dover- Dr
SYSTEM 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 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: 8/27/19 Supplemental Pages Attached:
1. PROPERTY INFORMATION
Name ofproperty: Enviromental Nature Center School
Address: 745 Dover Dr. NewportBeach
Description of property: Presch001 School
Name of property representative:
Address:
Phone: Fax: E-mail:
2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION
Installation contractor: West Coast Fire & Integration
-
Address: 3199-D Airport Loop Drive, Costa Mesa, CA. 92626
Phone: (714) 957.5750 Fax: (714) 957-5749 E-mail:
Service organization: West Coast Fire & Integration
Address: 3199-D Airport Loop Drive, Costa Mesa, CA. 92626
Phone: (714) 957-5750 Fax; (714) 957-5749 E-mail:
Testing organization: WEST COAST FIRE INC
Address: SAME
Phone: Fax: E-mail:
Effective date for test and inspection contract:
Monitoring organization: LBUSD
Address:
Phone: Fax: E-mail:
Account number: Phone line 1:
Phone line 2:
Means of transmission:
Entity to which alarms are retransmitted: CONTACT ID
Phone:
3. DOCUMENTATION
On-site location of the required record documents and site-specific software: FCRM
- RECORD DOC BOX
4. DESCRIPTION OF SYSTEM OR SERVICE
This is a: ® New system ❑ Modification to existing system Permit number:
NSA
NFPA 72 edition: 2016
4.1 Control Unit
Manufacturer: Notifier Model number: NFW -50X
4.2 Software and Firmware
Firmware revision number:
4.3 Alarm Verification
Number of devices subject to alarm verification: NSA
❑ This system does not incorporate alarm verification.
Alarm verification set for seconds
Copyright 02012 National Fire Protection Association. This form may be copied for ftelMdual use other then for resale. It may not be copled for commercial sale or distribution.
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SYSTEM RECORD OF COMPLETION (continued)
S. SYSTEM POWER
5.1 Control Unit
5.1.1 Primary Power
Input voltage of control panel: 120V
overcurrent protection: Type: Breaker
Branch circuit disconnecting means location: Electric Room
5.1.2 Secondary Power
Type of secondary power: Battery
Location, if remote from the plant:
Calculated capacity of secondary power to drive the system
In standby mode (hours): 24
5.2 Control Unit
❑ This system does not have power extender panels
❑ Power extender panels are listed on supplementary sheet A
Control panel amps: 2_20
Amps: 20
Number:
In alarm mode (minutes): i0
e wITIwT1 kl^ nG1I1nCQ
Type
Quantity
.Addressable or
Conventional
Alarm or Supervisory
Sensing Technology
Manual Pull Stations
2
A
A
Smoke Detectors
1
A
A
Duct Smoke Detectors
A
A
Heat Detectors
3
A
A
Gas Detectors
-
Waterflow Switches
t
Tanner Switches
2
Copyright ®2012 National Fire Protection Association. This toren may be copied for individual use amar than for rewia. It may not be copied for commercial sale or distribution.
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SYSTEM RECORD OF COMPLETION (continued)
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 a;4pecifie�.l�orein, has been installed according to all NPP�A standards •t herein.
Signed: , C/lis^ C\�' Printed nam; f,5 Y� �' z.. Date: 8/27/19
organization: 'yyk r o4as7 147;-, Title: FOREMEN Phone: 00'% yiA- 65-/L
12.2 System Operational Test
This system s specifi ie n has tested according to all NFPA standar cited he�eyt.l�6—
Signed: Printed name: i _ Date: 8/27/19
Organization: )rlcs%Cdsa5'r F,;4� Title: FOREMEN Phone: Zol-yyy-661/
12.3 Acceptance Test
Date and time of acceptance test:
Installing contractor representative
Testing contractor representative:
Propertyrepresentat
AHJ representative:
Copyright ®2012 NeHonal Fire Protection Assoclaaon. This form maybe copied for indWidual use other than for resale. a may not be copied for commercial sale or distdbulion.
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