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SYSTEM COMPLETION FIRE ALARM TESTING NFPA 72 TO CEO SYSTEM RECORD OF Fire Alarm& INSPECTION AND TESTING Security Integration Report No: 1903-2710 Inspection/Test Start Date: Wednesday, March 27, 2019 Start Time: 10:00 AM Inspection/Test Completion Date: Wednesday, March 27, 2019 Completion Time: 12:00 PM Supplemental Form(s)Attached [Form (no. of pages)]: 1 PROPERTY INFORMATION Name of property: HARBOR LAFAYETTE HOMES Address: 15 HARBOR ST.SALEM, MA Description of property: APARTMENT BUILDING Name of property representative: KRISTEN CARLESON Address: PO BOX 507 BEVERLY, MA 01915 Phone: 978-922-1305 Fax: E-mail: 2 TESTING AND MONITORING INFORMATION Testing organization: FOCCO FIRE ALARM & SECURITY INTEGRATION Address: 29 COOK STREET, UNIT A, BILLERICA, MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: firealarm@toccocorp.com Monitoring organization: CENTRALARM Address: 994 CANDIA RD, MANCHAESTER, NH 0309 Phone: 800-639-4068 Fax: E-mail: Account number: GSM007173 Phone line 1: Phone line 2: Means of transmission: GSM RADIO Entity to which alarms are retransmifted: SALEM FIRE DEPT Phone: 978-744-1235 3 DOCUMENTATION On-site location of the required record documents and site-specific software: NEXT TO PANEL 4 DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer: SIEMENS Model number: FC901 4.2 Software and Firmware Firmware revision number: 4.3 System Power 4.3.1 Primary (Main) Power Nominal voltage: 120V Amps: 20 Location: Overcurrent protection type: BRKR Amps: 20 Disconnecting means location: NFPA 72 CO SYSTEM RECORD OF Fire Alarm& INSPECTION AND TESTING Security Integration Report No: 1903-2710 4 DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: BATTERY Location: IN PANEL Battery type(if applicable): 12V18AH Calculated capacity of batteries to drive the system: 24V In standby mode (hours): 24 In alarm mode(minutes): 15 5 NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: CENTRALARM Time: 10:00 AM Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other, if required Contact: Time: 6 TESTING RESULTS 6.1 Control Unit and Related Equipment Visual Functional Description Inspection � Test Comments _ P Control unit ❑ El PASSED Lamps/LEDs/LCDs ❑ 0 PASSED Fuses ❑ 0 PASSED Trouble signals ❑ R PASSED Disconnect switches ❑ p PASSED Ground-fault monitoring ❑ El PASSED Supervision ❑ 2 PASSED Local annunciator ❑ FA PASSED Remote annunciators ❑ FA PASSED Remote power panels ❑ F±1 PASSED 6.2 Secondary Power Description Visual Functional Comments Inspection Test Battery condition ❑ ❑ NEW 3/2019 Load voltage ❑ 0 13.7V Discharge test ❑ FA 100% Charger test ❑ F±1 100% Remote panel batteries ❑ ❑ 100% NFPA 72 TO CCO SYSTEM RECORD OF Fire Alarm& INSPECTION AND TESTING Security Integration Report No: 1903-2710 6 TESTING RESULTS (continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices. Manual Station Rate/Rise Heat Detector Tamper 16 Smoke Detector Fixed Temp Heat Detector Low Pressure Duct Smoke Detector 1 Waterflow 16 Carbon Monoxide 6.4 Notification Appliances Attach supplementary appliance test sheets for all notification appliances. Horn/Strobe Speaker/Strobe Low Frequency Sounder Strobe Speaker Beacon Horn Mini Horn Bell 6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface/Signaling Line Circuit Interface/Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes No Time Comments Alarm signal 0 ❑ 10:00 AM PASSED Alarm restoration 21 ❑ 12:00 PM PASSED Trouble signal F21 ❑ 10:05 AM PASSED Trouble restoration p ❑ 12:00 PM PASSED Supervisory signal 0 ❑ 10:30 AM PASSED Supervisory restoration p ❑ 12:00 PM PASSED 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal ❑ ❑ N/A Alarm restoration ❑ ❑ N/A Trouble signal ❑ ❑ N/A Trouble restoration ❑ ❑ N/A Supervisory signal ❑ ❑ N/A Supervisory restoration ❑ ❑ N/A NFPA 72 TO rCO SYSTEM RECORD OF Fire Alarm& INSPECTION AND TESTING Security Integration Report No: 1903-2710 7 NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: CENTRALARM Time: 12:00 PM Building management Contact: Time: Building occupants Contact: Time: _ Authority having jurisdiction Contact: Time: Other, if required Contact: Time: 8 SYSTEM RESTORED TO NORMAL OPERATION Date: Wednesday, March 27, 2019 Time: 12:00 9 CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72, 2013 edition, Chapter 14. Signed: - Printed name: TONY MARTELLO Date: 03/28/19 Organi ion: Tosco Fire Alarm&Security Integration Title:INSPECTION TECHNICIAN Phone: 978-663-0292 Qualifications(refer to 10.5.3): (,TCp I_� (eG(r; —a, 10 DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: `Z � �✓� Printed name: ��1i N� `) Date: _13, I-Z I Organizatior . ��(�` Lb�l�� Title: Phone: 701 1(pp S�9 5 Z- SYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time of system 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: 3-27-2019 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: HARBOR LAFAYETTE HOMES Address: 15 HARBOR ST.SALEM MA Description of property: APARTMENT BUILDING Name of property representative: KRISTEN CARLESON Address: PO BOX 507 BEVERLY,MA 01915 Phone: 978-922-130` Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING,AND MONITORING INFORMATION Installation contractor: Tocco Building Systems Address: 29 COOK STREET, UNIT A,BILLERICA,MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: FIREALARM@TOCCOCORP.COM Service organization: Tocco Building Systems Address: 29 COOK STREET,UNIT A,BILLERICA,MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: FIREALARM@TOCCOCORP.COM Testing organization: Tocco Building Systems Address: 29 COOK STREET,UNIT A,BILLERICA,MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: FIREALARM@TOCCOCORP.COM Effective date for test and inspection contract: 3-27-2019 Monitoring organization: CENTRALARM Address: 994 CANDIA RD,MANCHESTER NH,03095 Phone: 800-639-4068 Fax: E-mail: Account number: GSM007173 Phone line 1: Phone line 2: Means of transmission: GSM RADIO Entity to which alarms are retransmitted: SALEM FIRE DEPT Phone: 978-744-1235 3. DOCUMENTATION On-site location of the required record documents and site-specific software: NEXT TO PANEL 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ®New system ❑Modification to existing system Permit number: FA-18-898 NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: SIEMENS Model number: FC901 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 Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120V Control panel amps: 5 Overcun-ent protection: Type: BREAKER Amps: 20 Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: SEALED ACID LEAD BATTERY 12V18AH Location,if remote from the plant: IN PANEL Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 15 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 Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line Device Power A Initiating Device X A Notification Appliance X A Other(specify): 7. REMOTE ANNUNCIATORS Type Location N/A 8. INITIATING DEVICES Type Quantity Addressable or Alarm or Supervisory Sensing Technology Conventional Manual Pull Stations 7 ADDRESSABLE ALARM MANUAL Smoke Detectors 16 ADDRESSABLE ALARM AUTOMATIC Duct Smoke Detectors 0 Heat Detectors 16 ADDRESSABLE ALARM AUTOMATIC Gas Detectors 16 ADDRESSABLE ALARM AUTOMATIC Waterflow Switches 1 ADDRESSABE ALARM AUTOMATIC Tamper Switches 2 ADDRESSABLE ALARM AUTOMATIC Copyright©2012 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. SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible 17 LOW FREQUENCY SOUNDERS Visible 2 BEACONS Combination Audible and Visible 17 HORN STROBES 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices 0 HVAC Shutdown 0 Fire/Smoke Dampers 1 Door Unlocking 1 Elevator Recall 0 Elevator Shunt Trip 0 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 herein has been installed according to all NFPA standards cited herein. Signed: Printed name: J7�2�� ���rc,Rt.✓ Date: Organization: '6ev Title: )"Jc.hcue,- Phone: 12.2 System Operational Test This system as specified here' has tested according to all NFPA standards cited herein. Signed: Printed name: Date: 1/ q/l Organization: Title: y;c(-f' MA)'1a tic r Phone: 92Sr-G6 3—C2q L 12.3 Acceptance Test G c+/ Date and time of acceptance test: f Installing contractor representative: ) t.re/C yy)a ti u r e.1 rr�' c t many x r- Testing contractor representative: e L 11`G "reA re ivJ, phot 41— Property representative: AHJ representative: copyright©2012 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.