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f2br2 -11?2
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 modify this form as needed to provide amore complete and/or clear record.
Insert N/A in all amused lines.
Attachadditional sheets, data, or calculations as necessary to provide a complete record.
Form Completion Date: Supplemental Pages Attached:
1. PROPERTY INFORMATION
Nameofproperty: AUTONATION PORCHE / LAND ROVER
Address: 445 Pacific Coast HWY Newport Beach, CA 92660
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
Address: 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
Address: 25341 Commercentre Dr, Lake Forest, CA 92630
Phone: 866-440-0311 Fax: E-mail:
Account number: Phone line L N/A Phone line 2: N/A
Means oftransmission: 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: F ew system ❑F_ -Modification to existing system Permit number F2022-0022
NFPA 72 edition:
4.1 Control Unit - -
Manufacturer: - Model number: -
4.2 Software and Firmware
Firmware revision number:
4.3 Alarm Verification ❑ This system does not incorporate alarm verification.
Number of devices subject to alarm verification: Alarm verification set for seconds
Copyright ® 2012 National Fire Protection Assoclatlon. This form may be copied for Individual use other than for resale. it may not be copied for wmmerclal sale or distrlbuton.
(p. 1 of 3)
r
SYSTEM RECORD OF COMPLETION (continued)
5. SYSTEM POWER
5.1 Control Unit
5.1.1 Primary Power
Input voltage of control panel:
Overcurrent protection:. Type:
Branch circuit disconnecting means location:
5.1.2 Secondary Power
Type of secondary power:
Location, if remote from the plant:
Calculated capacity of secondary power to drive the system:
In standby mode (hours):
5.2 Control Unit
❑ This system does not have power extender panels
❑ Power extender panels are listed on supplementary sheet A
6. CIRCUITS AND PATHWAYS
Control panel amps: _
Amps:
Number:
In alarm mode (minutes):
III
Pathway. Type
Dual Media Pathway Separate Pathway. Class Survivability Level
Signaling Line
B 0
Device Power
-
Initiating Device
B 0
Notification Appliance
Duct Smoke Detectors
Other (specify):
8. INITIATING DEVICES
Type Quantity
Addressable or
.Conventional Alarm or Supervisory
Sensing Technology
Manual Pull Stations
Smoke Detectors 1
Duct Smoke Detectors
Heat Detectors
Gas Detectors t
Waterflow Switches
Tamper Switches
Copyright 02012 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 distributor,
(p. 2 of 3)
SYSTEM RECORD OF COMPLETION (continued)
2
Audible
Visible I I Strobe
Combination Audible and Visible 1 2 1 Horn/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 system as 'tag erern has been installed according to all NFPA standards cited herein.
Signed: Printed name:U/j(..)j'G�`iLy'� /�r(XG7i5TC Date:
3-17- Z�-
Organization: uF,5 %/(Zi Title: "jG% .. Phone:
3�-
12.2.System Operational Test
This system ass as tested according to all NFPA standards cited herein.
Signed: Printed name:6(l,r'L.$dk0 Date:
Organization:� ✓ +i/)'-F`i Title: ywc,4 Phone:
12.3 Acceptance Test
q v 7
Date test:
and time of acceptance
Installing contractor representative:
Testing contractor. representative:
Property representative:
_
AHJ representative: ll Ab t ' n -
Copyright 62012 National Fire Protection Association. This form may be copied for individual use ether then for resale. It may not be copied for commercial sale or astnbutlon.
(p. 3 of 3)