HomeMy WebLinkAboutBuilding Permit 07-0968 (Wireless Depot)
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
(/-(}~
ADDRESS
,'G 73( Nw-..r (J
OWNER
CONTR.
PHONE NO.
PERMIT NO.
'7- Cfc;r--
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
"
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
f/~(
(f)
S'-0r1
11>
r t' s 1- re1zJ)1/lj
o WORK SATISFACTORY, PROCEED
.lCORRECT ACTION AND PROCEED
~ CORRECT WO . CA F REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNon
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please
ADDRESS
Date Rec' d
q-J- /- O?
I White
Pink
Yellow
I PERMIT NO. 07, o9tP~1
File
City
Applicant
I1N S'53?'Z-
ZONING (office use)
Gt-,
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) WireleSS
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
p,,'cy L~ n/'J
(Phone) q:S3...22k~ S/8b
12..
(Phone)
(Phone)
TYPE OF WORK ~New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level FinIsh 0 Fireplace
'OAdditlOn OAlteration o Utility Connection
CODE: DI.R.C. ~I.B.C.
Type of Constmction:
Occupancy Group: A (!y
Division:
I
E
I~ 6i> ~V
I 2 3
V
M
4
o Misc.
A@
R S U
5
PROJECT COST /V ALUE
(excluding land)
$
/0zJlJ ~
I hereby certity that I have hlrnlshed Information on this applicatllln whIch IS to the best of my knowledge true and mITecl I also certify that I am the owner or authol!zed agent ftlr the
above-mentlllned property and tbat all Clmstrucl10n Will cOnftllm to all eXIStIng state and local laws and WIll proceed In accordance with submItted plans 1 am aware that the bUlldmg
nftkial can revoke thiS permit for Just cause Furthermore, I hereby agree that the CIty official O[ a deSignee may enter upon the prope11y to pcrt{)rm needed inspectIOns
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee I $
Gas Fireplace Permtt Fee $
Becomes Your Building Permit When Approved
q-2f'-n
Date
Contractor's License No.
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
,
Pressure Reducer $
Sewer/Water ConnectlOn Fee # $
,
Water Tower Fee # $
Builder's Deposit I $
Other $ L
TOTAL DUE $ (g 8:' SJJ
Paid
Date
1ofzr:7
i ~~C1,NO
r
t;;ilf?? Cj
ThiS IS to certify that the request m the above applicatIOn and accompanY1l1g documents is in accordance with the City Zoning Ordinance and may proceed as requested ThiS document
when signed by the City Planner constltutes a temporary Certificate of Zonmg complIance and allows construction tLJ commence. Before occupancy, a Certlticate uf Occupancy mllst be
i."iSLled
/1)- / - {/ 7 SyJ~"",It ~d1.m 1u.1, G/~..JYr'Ui I, E:;~ ~"'~1V'1
Date Spec~ Conditions, if any~ r;;>, r-r+s I
24 hour notice for all inspectious (952) 447-91150. fax (952) 447-4245 , ~""" .II .1 d
4646 Dakota Street Prior Lake, MN 55372 ' ,rYe..,. .
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
tA/fV1: /1'5'; 0-(//(./ +
q-L-I~ (]f
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
1~7]/ J/'{ n s V;,r,;v M4-,;41., ST37L
Accepted With Corrections
~
Accepted
Denied
~;Jt-
Date:
q -L(,- Of
Reviewed By:
Comments:
(1) /4-0/1'1. sfrvhc
51?).~
a IcvvVI
1//\
JIl1 t{ , i-1
vu,/,.f--- of
GJ
Q)
S-rCj v'\ +0
S<p....r6t i-c
s ?'O '1./
IoL U h-l./vr
Sr5v'1
(?-</o/Vl.I+ .
/
r~
s; vfJfl-< ~ IU"'I
P-< /' (A/1 vb
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,A.J.vr It' _' ~
/) 'J I
I (', / '. .
cr./.-: (rj
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ 0 7 ] / / !Vlh/ J ~ .5 p. . // /a{( ,ll'1 ~:- j ) L
(
Accepted With Corrections
.--'
~
Accepted
Denied
/1(
.
'7r/
"/l
/,!~-
I
Date:
,} . L (: .' I
Reviewed By:
Comments:
liThe issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
.....
PRIOR LAKE
INSPECTION RECORD
DEPf"RTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS S
NATURE OF WORK a/c.,-" t.~""",
USE OF BUILDING D. Qc.,c,...p.~o/
PERMIT NO. e 0%6 DATE ISSUED
CONTRACTOR J!1 (J.;c! l"tItJ.-I PHONEC - ~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I. r..J8 I
I, ...._.J{r.I_.I.... · fLU) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
C{ - j, k1f7
FRAMING
ELECTRICAL
~
HEATING (if required)
,- 't-frY)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
)
l/r(J
BUILDING
ELECTRICAL
---
HEATING
fir I J
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
:spri 5v~"-j, ~ Pn*-c:lt"'~
~1a,t:-. C~p c /~~
WK ~ Co.~ ~rV\i1:<-
8' ld fJ't't'J Lo",- ,5+-.
[)~~
~ lr?-- '578- 7793
tel 2. - 3~-4hfS
o~
cJ)f
r[-=:.r. (r' '\>'-:'.. !r~"J /,.-----....
I _.. i:" '. ,'> <'. . ,..:.:! r-'\)
Lr0-:j(f~'-;1l W,
CAP ELECTRIC, INC.
13497 Fenway Blvd. Circle N. . Suite 200 . Hugo, MN 55038
telephone 651.426.4600 . fax 651.426.6100
J..
~L.fIv
September 13, 2007
David Chute
Bluebird Construction LLC
3433 Broadway Street NE Suite 215
Minneapolis, MN 55413
RE: SOUTH LAKE VILLAGE SUITE 104
Dear David I
Cap Electric, Inc. proposes to furnish and install labor and material for the above
referenced project. A brief description of the work included follows:
SCOPE OF WORK:
. Install (15) 2x4 prismatic lay-in fixtures. (Labor = $75.00; materials = $75.00 fixture &
wiring).
. Install (6) duplex receptacles. (Labor = $90.00; materials = $60.00)
. Remove (2) temporary lights above ceiling. (Labor = $125.00)
LABOR & MATERIALS = $3,275.00
Add to install exit/emergency light = $250.00 (Labor = $120.00; materials = $130.DO-fixture &
wiring).
Add to install exterior sign circuit = $300.00 (Labor = $175.00; materials = $125.00)
If you have any questions or comments please feel free to contact me at 651.426.4600.
Sincerely,
~~~
Brian Wilke
CAP ELECTRIC, INC.
OA'lfD CHUTE PROPOSAL 2001-246 - FAX: 612.677.3636 - 9/1412007
~'d
00 ~9'9ZV' ~99
8NI 81Cl18313 dV8
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-
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'S3INl111'f 1\/ 31\S NO 135 N'Vld 51 Hi d33)\
'Me!M~l S!4l U! pelOU Alle:1l}pads ~OU SW<'H\ 6u;pn\OIJ! SluaWGJIPO
-91 apCY.> 6U!U01'/2 6u!pl!nq a\qeondde lie \.ll\M aoue!ldUJO::l \iO! UI
9UOP aq \\el\S )\JOM \\\1 'uor~eUlJO!U! lOOf. lO} ale SW8WWOO asa41
1\V\I9nS'3Cl ~ 1~3BBO::>-031d3JJV 101'1 0
0310N S'V SNOI1::>3BBO::> HliM 031d3:)J'V' II
Q3U\V\ISnS Sv' 031d3:}:)'if C1
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-
F-RONT
11/08/2007 11:12 FAX 7835884474
LIFE SAFETY ~ROUP
141001/008
LIS
Lilil.s~:I' IpllIIIIl
--COVER PAGE--
DATE 11/8/07
TO Mike Peterson
CO. City of Prior Lake
DEPT. Building / Inspections
FAX# 952-447-4263
FROM Paul Klein
FAX#(7 63 )566-44 7 4
TEL#(763)560-2048
8 # OF PAGES TO FOLLOW
COMMENTS
Wireless Depot @ South Lake Village
(1) Horn/strobe installation - Close-out docwnentation
Contact me with any questions! ! !
-If
3700 74th Avenue Nolth Brooklyn Pa"'. MN 55443 7G3 - 560.2048 Fax: 763 - 586 - 4474
11/08/2007 11:15 FAX 7835884474
LIFE SAFETV GROUP
. J
72-104
NATIONAL FlREAl...ARM CODE
EMERGENCY COMMUNICAT~ONS EQUIPMENT
Phone ~
Phone ,Jacka
OfT.Hook [ndicator
Amplifier(s)
Tone Gcnerator(a)
Call-in Signal
Sy~l.cm Pllrforml\nCa
Vi8ual Functional
Q Q
Q Cl
Q Q
0 U
a Q
0 Q
Q Q
~vic;:e
Visual Operlltion
Q a
Q 0
Q u
Q 1:1
1:1 0
Q 0
INTERFACE EQUIPMENT
(Specify) -
(SpecifY)
(Specify)
SPECIAL HAZARD SYSTEMS
(StJeeify) ,....
(Speeify) _ ...
(Specif.y) -
Special ProcCldurell: 11 , ...
Comml!nt~: ,vI Pr
III 008/008
~
-
Comments
--~~
Sim\llaied
Operation
o
Q
CJ
1:1
Q
Q
SUPERVISING STATION MONITORING YfN No Time Comments
Alarm Signal Q p-
Alarm Restorlltir;m U wr
Trol.lble Signal a- Q
Supervisory Signal r:J er
Superviaory Restoration Q I2r""
NOTIFICATIONS "..AT TESTING IS COMPLETE Yea No Who Time
Building M!ll1agement I,J fa-
Monitoring Agency j;r""' Q ALC.. 1R.- '.10
Building Oct;Upanta Q .rr
Other (Specify) Q JiY
The following did not operate C(lrrectly: _r-! I ~
__...-.-........._ ~w............
System re~tored to normlll operll.tion~ Date: ~ 1" "1 - Time:-.10 ]6
S ~FOFlMED IN ACCORDANCe WITH APPLICABLE NFPA STANDARDS.
._ " c~L~s.~ Date: tl..., .0....
THIS TESTIN
Name ofInsp
Sign8t\lTe;
Name of Owner or ReproHentativv: .__.
Date: Time:
Sigllll.tul'e: __.
FIGURE 10.6.2.3 Continued
llOO:Z Edlllon
Time: t ~ '30
(NFPA Inspecdon and Teellnu, 4 of 4)
11/08/2007 11:15 FAX 7835884474
LIFE SAFETY GROUP
~ 008/008
INSI:'F,CllON, TESTINC. AND NWNTENANCF.
72-103
PRIOR TO ANY TESTING
NOTIFICATIONS ARE MADE Yel!l No Who Time
Monitoring Entity d'" Q ~---- _...~.,._.-
Building Occmpants 0 Iiir
BuiJdinp; Mann/tllmont Q /ir --,_._----
Other (Specify) Q 2!" --
AHJ Notified of Any [mpllirment8 Q r .---..-.........- .....-
SYSTEM TESTS AND INSPECTIONS
TYPE Visual Funetional CDmm.ents
Control Unit 0 Cl ,.,/4--
Interface Equipment Cl Q
- , ,-..
Lamps/LEDS u 0
~-
Fuses Q a ---.
........-----.. ..-
Primary Power Supply a u
Truuble Signals Cl 0 ._,_....~ -
Disconnect Switches a a
Ground-Fault Monitoring r.J Cl -
---..-
SECONDARY POWER
TYPE Vi,u.l Funetlonal Comments
Battery Cond.ition a t-J.fA
Load Voltage .-.- . -
U
Di!lchargc Test Cl I
Charger Teet a -.... f --
Specific Gl'avity 0 ,-
TRANSIENT SUPPRESSORS iJ .~
FlEMOTE ANNUNCIATORS Cl U -
NOTIFICATION APPLIANCES
Audibl{! ~ 'ir ~tc:..
- -~
Vitiiblo lOr'" r-'
SpeI:lker6 C"l 0 .
Voice Clnrity ~
Cl
.,,-
INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS
Device VISUBI Functional Fuctory Moa!lurod
Loc. & SIN 'lYPe Chock Test Setting Setting Pass Fail
1::1 U 0 Cl
--,.--
Cl a 0 0
-~
l:;l W U 0
-,-~-
Q Cl Cl IJ
-----.. -- ,.
~ a [J tl U
.- Q
0 a a
-...---- .__.,..
Comm~ts: -4l( K"
..-
-' ,- ---.
--.-, ---- r.-
- _....-....- -.-
(NFPA In8pactlon and TOIUna. 3 ot 4)
FIGURE 10.6.2_3 Continued
2002 EdlllOl't
LIFE SAFE TV BROUP
I4i 007/008
11/08/2007 11: 14 FAX 7835884474
'72-102
. -..., - ..~
NATIONAL mucAl...AltM (:mw,
Quantity
-~-
...
.,.
-
0#'
ALARM NOTIFICATION APPLiANCES AND CIRCUIT INFORMATION
Cireult Style
-
B el1~
Horns
ChimeJ:\
StrobeR
Speakers ~
Other (Specify): _ _~...~, \:)c..
-
--_.......-....-
--.--_...
J l
No, of alarm notificatioD appliance cirouit.s: .
Are circuits monitored for lntogrity? J' YO"
SUPERVISORY SIGNAL-INITIATING DeVICES AND ClRCUIT INFORMATION
QgAntity
r
1:1 No
Circuit Style
Building'l\!mp.
Site W~tE!'I" Temp.
Site Wnter Luv(!1
Fire Pump Power
Fire Pump Runl1inll'
Fife PuInp Auto position
Fire Pump or Pump Controller Trol"lb1e
Fire Pump Rllnning
GenerlltoJ' In Auto 'f>oyiLiun
Gene'\'!ltOT OT Controller Trouble
Switch Trunet'er
Generator Engine Running
Other:
-,_......_-- -..-..-.---
SIGNAUNG LINE CIRCUITS
q""llntity II.nd style tlf~i"n1\li"lt Uno circ\lilfl col\tlocted to ~~m (lief! NFPA 72. T~bl/16.6.1):
Quantity _ - Style(B) -
SYSTEM POWER SUPPLIES
(II) PrimllT)' (Main); Nomil1~l Voltajc ~~D V~c.
Overcurrel'1t Protection: Typu.J:.J.1l...1 ,... rt..r
Location (of Primary Supply panelboard): lJ ()
Disconnecting Means Location: -
(b) Secondt\~ (Stllnp,by):
,.)1 ,2(/ __ Storllge Bottory: Amp.Hr, Jqtting l4/...
Calculated capacity to op0l"ate system, in hClU1's: X 24 60
.~_:Eng\no-driVl'n Ftenerator dedicated to fire olllrm system:
Amps .'"
A.mP~ ~~.g..___-,
Location offuel storage:
TYPE BATTERY
D Dry Cell
Q .JUckel.Cadmium
KJ Selllud Lead.Acid
Q Lead-Acid
I:J Other (Specify):
(cl :Emergency or standby system used lIS a backup Lo primary power supply, inld\CI\d of u~jnS' nllOconclnry power ~upply;
__~___- Emergency 8YBteIl\ described in NFPA 70, Article 700
Legally required Htandby ueflCribud. in NFPA '70, Artickl 701
__-..----.. Optional lltandl>>' 8)'6teIl\ described in NFJ?A 70, Article 70Z, which al60 meets the performance
rcqulrllment!l of Article 700 or 701.
(NFPA IMpectlon snd resting, 2 01 ~ l
FIGURE 10.6.2.3 CQJlhllue4
2002 Edition
11/08/2007 11: 14 FAX 7835864474
LIFE SAFETY GROUP
III 008/008
.t \. ). ~ \ D~;SPE~~:' ~~'1, ^,,~~~N~\
72-1lil
INSPECTION AND TESTING FORM
H-'.Ol
\OOb
DATE:
TIME:
PRopERTY NAME (uSeR)
Namc:..S.....t\,. L..s.lr.&. '^'~..
AddreBs.J~:.:UI ~. tt.W'1' '9r..... ""'...
Owner Contnct: Suw.t"" l'"
Telephone; _~'Sl- ~..q~Z:1
SERVICE ORGANIZATION
Nllmc; J.J.~c ~~t""!._J'1~ ....-.". -
Address: tIoo 7CI~ IIcOi - D.,..,lf..Lot... p.rI(...
Reprer;ent.a.tive:..k.'" C r......r.rcl
Liconlle No.;~. .:rol.~
'rele-phonc: -.y (., ') . 'Sc.rl> - 16.., eo
APPROVING AGENCY
Contact: __'
Telephone:
MONITORING ENTITY
Contact: Pru. 1iGo
Telephone: L- 8H" t S .... '11 II
Monitoring Account Ref: No.: ():I. 72,01-
TYPE TRANSMISSION
Q McCulloh
a Multiplex
)! Di(lital
Q Reverse Priority
aRF
Q Other (Specify)
SERVICE
Q Weekly
o Monthly
Cl Quarterly
o SemiannuAlly
Q Annually
.. Other (Specify) ~\L.",,~
Control Unit Mllnufaetu1'er: S, I~..... k,..J~_._
Circuit Stylell: IJ At! = Y JtJ"1.; 8
Number ofCirC\lits: ~'" :: If I~ Jr ~ '0
Sot\:.ware Rev.:
Last Dllte Syliltem Had Any Service Performed; ~..
Last Date that Any SoRWllre ~ Configuration Was Revised: rl"
Mod!)l No.: ~ nO.
Quantity
ALARM-INmATlNG DEVICES AND CIRCIJIT INFORMATION
Circuit Style
Manual Fire Alarm aOXE!~
Ion Detoctors
Photo DIlLelltOr~
Puct Detectors
Heat Deteetora
Wnterflow Switches
Supervisal)' Switches
other (Spocify):
Al(l,.m voritklltion f'SlltLlI'B iy dUi..blod _ l'nllhll'c1
(NFPA It'le1=OC~Of\ IIl1d r,..Ung, 1 01 41
nGURE 10.6.2.3 Example af 8n Inllpettiol'l lUld Testing Form.
2002 Edition
11/08/2007 11:14 FAX 7835884474
LIFE SAFETY GROUP
~ 005/008
72-.'14
NATIONAL FIRE AlARM CODE
7. Annunciator{s)
Numbe.r: ----1--- Type: S" r ,IS'
Lo(,auon: ~ '0IlC..
8. Alarm Notification Appliances and CIrcuits
NFPA 72, Chaptor 6 - Emcl'gl!ney Voicu/Alllnn Sm-vicc
Quantity of voice/alarm channels: Single: __'-- Multiple:
Quantit.y ofspcaker!l instllllod: QuuntHy of Hpcllker ~oneB:_.._. .--.-.--.--.- ~-
QWilntity oft.elcphones or telephone jacks included in system: -
Quantity and the class ofnotificatlon applia.nce a:reuits CQ);Inected to system (see NFPA 72, Table 6.7):
Quantity:---.!l~. StYle~~_.~ CIQI!I~:.u~~' - -.--.--.--
Type~ and quantities ornotifiClltion upplianceol iJl~ta]](Jd:
(a) Bells _.__.~_ With Visible ""
tb) Speakers. WiLh visibl11 ..
(e) HornB~._---I--.- With Visible I
(d) Chimes With Visible
(e) Oth(Jr:_~--'::_ __ WithVisibJe~ ~,--
(0 Visible appliances without audible: -
9. Sy$\eM Power Supplies
(nl Fir(l Alllrm COl'ltrol Panol:
Overcu~nt protection:
Nil It . J ". ""
om nil VO a,j{Ii!. -LJ.-..- ---_.-
Type:..cl'rh~"" /1,ew
Lo~(\t;on: _.. :I:.D.I) ~_.. -- .--.- --'-
Curnmt rating: '41 .
Current rating: 1......_.--
(b) Secondary (/iotand,:
Storage battery: X, r'Z.. ~ Amp.ho~r l'ating: 1. ~-- -"-' -'-
Calc!':\lated capacity to drive system, in houre: "r
Engine.driven genl!rator dedicut.cd to lire 1l1l\rm lIystem:
LocatioIl of Cuel BtorB,l)'C: -
(el Emergency aYlltem u1\f:!d as bacl(up to. primll.rY l'owel" lIupply:~.__.
Emergency ~ystcm dl!Hcribed in NFPA 70. A1''ticle 700: --
.--.--"."--
10. Comments
Fraquency of routine teets and inepeetionll. if other thll.n in Ilccorolll1ce with the referenced NFPA Iltondard(e):
._._~__.__.~4o"" - ~..-'
System deviations from the referenced NFPA Iltandard(e) are: ..~ I JJ-
=ft++fA: - ---=-.-----
~ ~.gf.. -no.."'''fll.,i _
(lIlgnedr lor inBlalladoo COI'1lruCltOr/$upplier (lilla)
(1- .,-~ 7
(dale)
(utle)
(date)
(signed) lor illsi'm service com~tIy
(~lQn&d) lo~'~~m~;n---'
(dale)
(lIt1e)
Upon completion of the IlYlltQffi(8) sllti~faetory !.I3tlt(s) wi~neJlSCld (if rl,'lquirod by th(! 9Llthorit,Y having j\lrilldiction):
(signed) represenlaliYe at ltleaulhorily navlng jutislic:tlon- ..
(title)
--"-- .--... '---(dlil'eY--' .- -.-----.-..--.--
(NFPA 7>1, 4014)
FIGURE 4.5.2.1 CQntinut:tl
2002 Edlllon
11/08/2007 11: 13 FAX 7835864474
LIFE SAFETY GROUP
~ 004/008
~.
FUNDAMtNT,\!'S OF FIItEAlARM SY~(Ji.MS
72-3~
5. Alarm-Initiating Devices and CIrcuits
Quantity ilud ellls~ orinitiatinll' dovice drc:uibi (~r() Nli'PA 72, Thblc 6.5);
Q\l$rttity: I tJ _ Style; ~ jj . Cll;I.,s:
MANUAL
(ll) Mllnuo.l ~tationfl Nonoodcd___. Transmitte"'~ .........._,.,. ,
(b) Combination manual fire alarm and guard's tour coded stations
AU'l'OMATIC
Coverage: Complete
Selective
g
l
I
Codod_.... --
Addresssble_
Parti a)
Nonrequired
(a) Smolu! detectors __..__ Ion Photo Arldl'tlll~ll.blc _uo'..-_
(b) Duct detectors Ion Photo Addressable
(c)Heatdl!ooct.arll FT _ RR_.__ lo""T/RR RC__ Addre~~lIbl~
(d) Sprinkler wo.tcrflow indicators: Transmitters_._ Noncoded Coded ~ Addresso.ble
(e) The alarm verification feature is di~e.blod _ . __ or l.!IUl.blod ~. changed from _ ~econd8 to - ~Ilconds.
(f) Otl1eT (li",t): JJf..!r:.'~
6. Supervisory Sigmd-lnltl8tlng Devices and Circuits (use blanks to Indicate quantity 01 devIces)
GUARD'S TOUR
(a)~ Coded stations
(b)~NoJ)coded ~tliltionB
(c)_Comp\1hwry guard's tour system compriFled of tram.mittcr stations and intermediate station..
Note: Combination device$! are recorded under 5(b). Manual, and 6(9). Guard's Tour.
SPRINKLER Sysn:M
Cheek if provided
(a)~ V"lv'll HUp"rvillory IlwitehcliI
(b).. ,__ Building tem~rature points
(cJ ~ Site water temperlltun! point~
(d)~_ Site water eupply level points
Electric fire pump:
(e)~Firl! pump power
(f) __ Fire pump running
(S)- Pha!18 rev~r!llll
Engine-driven fiu pump:
(h)__.._,Selector in auto position
(i) __ Engine or control pll.nlll trouble
(j) _Fire pump running
ENGINE.DRIVEN GENERATOR:
(1iI)_ Selector in auto position
(bl_Control panel trouble
(c)__ Trl1J1l'lret Hwitche~
(a)_ Engine running
otner ~upcrvil\ory f1,lnction(R) ("peci ry): Jt.!~ ___.._....
(~-~3;r.) J
FIGURE 4.5.2.1 Colttinl/cd
:ZOO;! E;dlllon
11/08/2007 11: 13 FAX 7835884474
LIFE SAFETY GROUP
I4l 003/008
NA TI 0 NAL FIRl ALARM COOE.
72-32
Me3n~ of transmission of i;igna16 from the prot.ected premises to the centrallltation;
_. ._ McCulloh __ MultipleJt __ Onc-wliY rndio
_n-X . Dil(iLiAl LllQl'm communicator _ --- 'Two-way radio ~- Others
Means (I 'transmission of a.larms to the public fire service communications center:
l[l) . h.~ I~~ ~. . ---
(bL
l
System location:
_ NPPA 72, Chapter 9 - Auxillary
Indicato type I)f connection: LocClI enerlOCY ~ Shunt . -- Parallel telephone
Location of telephone nUJ1lber for receipt of signals~
2. Record of System InstallatIon
(Fill out after in~ta1.lation is complete find wiring ili chcclt~d rol" OpiU~1!l, shnrtll, l\'I"ound fnult9, and imptopC1" bl't\nching,
but priol' to conducting operational acceptance tests.)
'rhis 6yste~stenlin.!ltalled in ncool'dance with the Nl<'PA stnndflrw. liS shown below, WI.I' iOllptl<l1;QQ by
.. .t \,~ ,,_ on Il - ,- I)' . . indudes the devices shown
in 5 and 6, llnd haa been in :'lervico since -
_~NFPA 72, Chapters .r- 2J-..a--.......... 6 ;roo a ~ 10 11 (circle all that npply>
1 NFPA 70, National1.<:ll!cr.rical Crld~, Articl", 760
... !!:":"M 1Illufacluror's iI1Btr\1ctian.!\
~ Oth",~"/J-
SJgned: ~ -----
Organization: ~ 1-.51
Date: /1-,.07
3. Record of System Operation
Documentation in accordance with In9pc~tiun '.l'eolth~g Fonn, FiJ;Uro 10.~.3, i1:l1li)tachud
All operational features and fun~tions ofthia system were tllsted by -1'L" ( ()(dt-'
and tound to be operating properly in accordllnce with the requiroment~ of:
~ NF'PA 72, Chlipt~t~ or a- :r .... r 6 tiI'- 8 r 10 II (circle all that apply)
v' NFPA 70, Na.r.irmal Eu!ttrical Codt', A1'Licle 760
"".
- Mann"""i7 iM~'
~Other(A ~
Signed:
_ da~'-i-;"'-Q.'7 _
Date: /I-7'fJ1
Organization;
L.. ~J
4. Signaling Line CircuitS
Q\lantit.y and clatlll of llignnling line dtcmits connectl;!d 1,0 system (M(it! NFFA 72. 7hblIJ (Ull):
Qunn~ity: Style:_ ,_ --=-_-.- Class: -
INt:PA 72. 2 of 4)
FiGURE 4.5.2.1 Clmtinucd
2002 Edition
11/08/2007 11:12 FAX 783~884474
LIFE SAFETY GROUP
~ 002/008
"* 1 ~~+, /iJl{-
JJ;r~{(.s.J
tJAl f.., if
~
FUNDAMbNTAl...') or FIN.KAW\RM ~'i':STEMS
D~I'(if
72-~\1
FIRE ALARM SYSTEM
RECORD OF COMPLETION
Name of protected pnlperty; (' ~ fk L.. k:t. I/Nl~" --
AJ1dr~~~:/'?31 3.11.~~~-;--~---r; i. ....eC(..~..---- --..-
Reprcsellt.ativeofprotededproperty(naII1e/Pho~. F.1.c ...n'lf"' ,~/. "f"'-fl 2y
Authorityhllvingjuti~dictio":_, .-- .- ,,--..-- .-----------.--
AddreB~!telephone number:
H.4pn!~e:nllltiue name (phlllle
,..__J~~.t~~ 11U:.t(lq.:~-
. II "'t . .II .~
SI,ff ~~~t:!.. __'.~_,.,."__--7 _._,-
Otg(l.n,zatwn /).(<"'0/ phO'I.o)
J ntJtJJ.Ucr J d.. ~/."" S'~.t~..S'
Supplier ~ · & ·
Sllrviec organization /I ·
J..ocation ofnoord (as.buil~) drawingi:>:
Loca.tion of ope Tilt ion and Mllinwnancc mlinl,llll~: -...-" ,...-'
l..otllltion of test report~:
A contract for tCl>t and inspec~ion in ClccordHncll with NFPA ~tulld[lrd(,,)
Contract No(s): _" Effective date:
.
---....,...---.. .-..--.....--
Expiration date: _
System Software
(II) Operating "Yflt:cm (el(DcutiV/;l) ~oftwBra ,.wildon levElJ("): . -----....
(b) Site-specific software revision datl!!~
(c) Revi~ion completed b)':
(name)
(IIrm)
1. TypEl($) 01 System or Service
__ NJ,'PA 72, Chupt.cl' fj - LoCLLl
Ifalarrn i6 ttllnsmitted to location(s) olfpremise~, list where received:
_._____-.-. ___--. ...._...._._........&&......
NFPA. 72. Chapter B - Remote Station
Telephone numbers of the orgaDjza~ion receiving alarm:
Nann: _._" ._..~- -...""...----. .-" --
Supervisory: __.
TI'oublo: _. _. ._.,,---."- ,-~-, "..
U alarms are retransmitted to public tire service communielltiona centers or others, indicate location and ~elllphone
numben of tho ol'll'anizl.ltion receivin" iliaI'm: _..~_.. .-.-
Indicatc how lllann i~ rl.lLI'i:lIl/lmittod;~... ____.. ...-
_ ___ NFPA 72, Chapter 8 - prl'J'rictnry
Thlephone nuroberil of the organization l'cceiving alann:
Alarm: _..
Supervi6ol)':
Trouble: _._.--.......-..".--.-..
If alarms are retransmitted to public fire llertficc communications center~ Or' others, indieaLe lClClltiOl1 and tf;!ll!pl\Ol\C
numbers of the o"Kl1nizlltion rec!!iving alarm: _- -..--
/Ind'jCnte how 1I111TTI1 ill rctl'an~mit1:A.ld: _~"
_ NFPA 72, Chapter 8 - Central Station
Prime contractor: _~u.. "Ti~
Central Flwtion location:..k... Of}" r~r~ ,1' II
(NFPA 72. 1 of 4)
nGURE 4.S.2.1 R.ccotd or Complcrion.
2002 Edllion