2202 Alarm Inspection Admin Bldg.pdf

NFPA 72 REPORT

© Siemens Industry, Inc., Smart Infrastructure Division, 2009-2022. All rights reserved.

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SYSTEM RECORD OF INSPECTION AND TESTING

System Name: ADMIN 4100ES Panel Name: 01 - ADMIN 4100ES

Inspection/Test Start Date/Time: 10 Aug 2022 0545 Inspection/Test Completion Date/Time: 10 Aug 2022 1045

Contract Info: Kenosha County 2022 (2600149454) Notification Number: 5102270780

Supplemental Form(s) Attached: Yes

1. PROPERTY INFORMATION

Name of property: KENOSHA COUNTY ADMIN BUILDING (4433-53140-00026)

Address: 1010 56TH ST. KENOSHA, WI. 53140

Description of property:

Name of property representative: KENOSHA COUNTY (30078447), None

Address: 1010 56TH ST, KENOSHA, WI 53140-3738

Phone: None Fax: None E-mail: None

2. TESTING AND MONITORING INFORMATION

Testing organization: SIEMENS

Address: 6737 West Washington Street, Suite 2110, Milwaukee, WI 53215

Phone: 414-475-3700 Fax: NA E-mail: NA

Monitoring organization: ALARM DETECTION SERVICE

Address: NA

Phone: NA Fax: NA E-mail: NA

Account number: NA Phone line 1: NA Phone line 2: NA

Means of transmission: Digital

Entity to which alarms are retransmitted: NA Phone: NA

3. DOCUMENTATION

On-site location of the required record documents and site-specific software:

4. DESCRIPTION OF SYSTEM OR SERVICE

4.1 Control Unit

System Name: ADMIN 4100ES Panel Name: 01 - ADMIN 4100ES

Panel Location and Address: LL ELECTRICAL ROOM, 1010 56TH ST., KENOSHA, WI. 53140

Manufacturer: SIMPLEX Model number: 4100ES

4.2 Software and Firmware

Firmware revision number:

4.3 System Power

4.3.1 Primary (Main) Power

Nominal voltage: 120 Amps: 20 Location: LL ELECTRICAL ROOM

Overcurrent protection type: BREAKER Amps: 20

Disconnecting means location: LL ELECTRICAL ROOM ACROSS FROM FACP

4.3.2 Secondary Power

Type: Storage Battery Location: LL ELECTRICAL ROOM

Battery type (if applicable): Sealed Lead Acid Manufactured Date: 22 Feb 2019

Calculated capacity of batteries to drive the system:

In standby mode (hours): 24 In alarm mode (minutes): 15

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4.4 Notification Appliance Power Extender Panels

4.4.1 Primary Power

ID Location Input Volts

Panel Amps

Over-current Type

Over-current Amps

Primary Supply Location

Disconnect Location

01:NAC-01 LL ELECTRICAL BY

FACP

120 FUSED

DISCONNECT

SWITCH

20AMP LL ELECTRICAL RM

ACROSS

MARKED FIRE

ALARM

01:NAC-02 LL ELECTRICAL BY

FACP

120 FUSED

DISCONNECT

SWITCH

20AMP LL ELECTRICAL RM

ACROSS

MARKED FIRE

ALARM

4.4.2 Secondary Power

ID Location Battery Type

Manufactured Date

Voltage Rating

Amp Rating

Standby Hours

Alarm Minutes

01:NAC-01 LL ELECTRICAL BY FACP SLA 2019-04-30 12/12 7AH 24 10

01:NAC-02 LL ELECTRICAL BY FACP SLA 2019-04-30 12/12 7AH 24 10

5. NOTIFICATIONS MADE PRIOR TO TESTING

Monitoring organization Contact: CALLED BY RHONDA HAIDINGER Time: 0600

Building management Contact: RHONDA HAIDINGER Time: 0600

Building occupants Contact: BY RHONDA HAIDINGER Time: 0600

Authority having jurisdiction (AHJ) Contact: Time:

Other, if required Contact: NA Time: NA

6. TESTING RESULTS

6.1 Control Unit and Related Equipment

Description Visual Inspection or Functional Test Comments

Control unit Functional None

Disconnect switches Functional None

Fuses Functional None

Ground-fault monitoring Functional None

Interface Equipment Functional None

Lamps/LEDs/LCDs Functional None

Local annunciator Functional None

Primary Power Functional None

Remote annunciators Functional None

Remote power panels Functional None

Supervision Functional None

Trouble signals Functional None

6.2 Secondary Power

Description Visual Inspection or Functional Test Comments

Battery condition Functional (2) 35AH BATTERIES

Charger test Functional 27.59

Discharge test Functional 100%/100%

Load voltage Functional 13.72/13.85

Remote panel batteries Not Tested N/A

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6.3 Notification Appliance Power Extender Panels Secondary Power

ID Location Battery Voltage

Battery Amps

Test Method

Pass/ Fail

01:NAC-01 LL ELECTRICAL BY FACP 13.75/13.70 100%/100% Functional Pass

01:NAC-02 LL ELECTRICAL BY FACP 13.77/13.75 100%/100% Functional Pass

6.4 Alarm and Supervisory Alarm Initiating Device

Attach supplementary device test sheets for all initiating devices.

6.5 Notification Appliances

Attach supplementary appliance test sheets for all notification appliances.

6.6 Interface Equipment

Attach supplementary interface component test sheets for all interface components.

6.7 Supervising Station Monitoring

Description Received Time / Elapsed

Time Pass/Fail Comments

Alarm signal Yes NA / NA Pass VERIFIED BY MONITORING THRU RHONDA HAIDINGER

Alarm restoration Yes NA / NA Pass VERIFIED BY MONITORING THRU RHONDA HAIDINGER

Trouble signal Yes NA / NA Pass VERIFIED BY MONITORING THRU RHONDA HAIDINGER

Trouble restoration Yes NA / NA VERIFIED BY MONITORING THRU RHONDA HAIDINGER

Supervisory signal No NA / NA None

Supervisory restoration No NA / NA None

6.8 Public Emergency Alarm Reporting System

Description Yes No Time Comments

Alarm signal NA NA

Alarm restoration NA NA

Trouble signal NA NA

Trouble restoration NA NA

Supervisory signal NA NA

Supervisory restoration NA NA

7. NOTIFICATIONS THAT TESTING IS COMPLETE

Monitoring organization Contact: CALLED BY RHONDA HAIDINGER Time: 1130

Building management Contact: RHONDA HAIDINGER Time: 1130

Building occupants Contact: BY RHONDA HAIDINGER Time: 1130

Authority having jurisdiction (AHJ) Contact: Time:

Other, if required Contact: NA Time: NA

8. SYSTEM RESTORED TO NORMAL OPERATION

Date: 10 Aug 2022 Time: 1045

9. CERTIFICATION

This Testing Was Performed in Accordance with Applicable NFPA Standards.

Signed:

Alexander Hanus Date: 08/10/2022

Printed name: STANLEY LAITINEN,ALEXANDER HANUS Title: Technician License No.: SL#150654 AH#148912

Organization: SIEMENS Phone: 414-475-3700

Qualifications (refer to NFPA 72, Section 10.5.3): Inspection, Testing, Service

10. SUMMARY OF EQUIPMENT MARKED AS FAILED WHEN INSPECTED OR TESTED

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1) STROBE ONLY – LL REGISTOR OF DEEDS N.E. CONFERENCE ROOM. MAKE: SIMPLEX, MODEL: 4906-9101

11. ACCEPTANCE BY OWNER OR OWNER’S REPRESENTATIVE

The undersigned accepted the test report for the system as specified herein:

Signed:

Printed name: RHONDA HAIDINGER Date:

Organization: KENOSHA COUNTY (30078447) Phone: None

Pursuant to applicable codes and standards, the owner or designated representative is responsible for proper maintenance and care of the system(s) identified in this report. During the site inspection, if Siemens has identified code deficiencies or impairments, Siemens will recommend certain corrective actions contained in this report. In the event the owner fails to correct such deficiencies or impairments within the required time period per the code, Siemens may be required to report such deficiencies or impairments to the Local AHJ or Fire Marshall per regulatory requirements.

Customer shall hold Siemens harmless and releases Siemens of any and all liability due to Customer’s failure to correct such deficiencies or impairments.

12. OTHER

12.1 Special Procedures

12.2 Comments

DEVICE LOCATIONS ON REPORT REFLECT ACCURATE AND MOST IDENTIFIABLE DECRIPTIONS. COMMENTS FOR THE

DEVICES, IF NOTED, REFLECT DESCRIPTIONS AS THEY REPORT TO THE PANEL.

ALL SMOKE DETECTORS PASSED SENSITIVITY TESTING.

*Reviewed the sensitivity of the Analog Smoke/Duct detectors with use of Fire Alarm Control Panel whereby the detector causes a signal at the control panel when its sensitivity is outside its listed sensitivity range.

NFPA 72-2016 14.4.3.2-17 (h)(4) states that *Smoke detector/control unit arrangement whereby the detector causes a signal at the control unit when its sensitivity is outside it listed sensitivity range*

08/15/22

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NOTIFICATION APPLIANCE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING

1. PROPERTY INFORMATION

Name of property: KENOSHA COUNTY ADMIN BUILDING (4433-53140-00026)

Address: 1010 56TH ST. KENOSHA, WI. 53140

2. NOTIFICATION APPLIANCE TEST RESULTS

2.1 Notification Appliances Equipment Summary by Type

Total Qty Functionally Tested Qty

Functionally Tested %

Visually Tested

Qty

Visually Tested %

Failed Qty Failed % Device or System Type

NO DEVICE

LISTING OR

COUNTS

AVAILABLE.

100% 100% 1

2.2 Notification Appliances Testing Results by Type

ALL NOTIFICATION DEVICES WERE FUCNTIONALLY TESTED AND PASSED WITH EXCEPTION TO THE LISTED BELOW

FAILURES:

1) STROBE ONLY – LL REGISTOR OF DEEDS N.E. CONFERENCE ROOM. MAKE: SIMPLEX, MODEL: 4906-9101

See main System Record of Inspection and Testing for additional information, certifications, and approvals.

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INITIATING DEVICE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING

1. PROPERTY INFORMATION

Name of property: KENOSHA COUNTY ADMIN BUILDING (4433-53140-00026)

Address: 1010 56TH ST. KENOSHA, WI. 53140

2. INITIATING DEVICE TEST RESULTS

2.1 Initiating Devices Equipment Summary by Type

Total Qty Functionally Tested Qty

Functionally Tested %

Visually Tested

Qty

Visually Tested %

Failed Qty Failed % Device or System Type

4 4 100% 0 0% 0 0% Heat Detectors

14 14 100% 0 0% 0 0% Manual Pull Stations

13 13 100% 0 0% 0 0% System Smoke Detectors (P)

2.2 Initiating Devices Testing Results by Type

Heat Detectors

Row Date Dev.# Location Visual/ Functional

Pass/ Fail

1 08/10/22 01:M1-003 LL Elevator Equipment Room L14 Functional Pass

Comment: PANEL SHOWS: LL L14

2 08/10/22 01:M1-009 LL Elevator Equipment Room #2 L27 Functional Pass

3 08/10/22 01:M1-037 3rd Fl Elevator 1 Top of Shaft Functional Pass

4 08/10/22 01:M1-042 3rd Fl Elevator 2 Top of Shaft Functional Pass

Manual Pull Stations

Functional

Pass/ Fail

1 08/10/22 01:M1-001 LL Lobby By Stairs Functional Pass

Comment: PANEL SHOWS: LL LOBBY L11

2 08/10/22 01:M1-008 LL Stair 5 Functional Pass

3 08/10/22 01:M1-013 LL Mechanical Room L33 Functional Pass

4 08/10/22 01:M1-014 LL Map Area L38 Functional Pass

5 08/10/22 01:M1-018 1st Fl Lobby by Elevator 1 Functional Pass

6 08/10/22 01:M1-020 1st Fl Lobby by Vestibule Main Entrance Functional Pass

Comment: PANEL SHOWS: 1ST FL LOBBY 112 NEAR VESTIBULE 111

7 08/10/22 01:M1-022 1st Fl Mailroom Room 125 Functional Pass

Comment: PANEL SHOWS: 1ST MAIL 125 PULL

8 08/10/22 01:M1-023 1st Fl Clerical 103 Stair 1 Functional Pass

9 08/10/22 01:M1-027 2nd Fl Elevator #1 Lobby Functional Pass

10 08/10/22 01:M1-029 2nd FL Elevator #2 Lobby Functional Pass

Comment: PANEL SHOWS: 2ND BREAK RM 218

11 08/10/22 01:M1-031 2nd Fl Office Area 202 Stair 1 Functional Pass

12 08/10/22 01:M1-035 3rd Fl Elevator #2 Lobby Functional Pass

Comment: PANEL SHOWS: 3RD FL ELEVATOR LOBBY 310 PULL

13 08/10/22 01:M1-039 3rd FL Elevator #2 Lobby Functional Pass

Comment: PANEL SHOWS: 3RD FL WAITING 322 PULL

14 08/10/22 01:M1-043 3rd Fl Hallway by Stair 1 Functional Pass

Comment: PANEL SHOWS: COORIDOR 302 BY STAIR 1

System Smoke Detectors (P)

Row Date Dev.# Location Factory Setting

Model Visual/ Functional

Pass/ Fail

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System Smoke Detectors (P)

Row Date Dev.# Location Factory Setting

Model Visual/ Functional

Pass/ Fail

1 08/10/22 01:M1-002 LL Elevator #1 Lobby 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: LL LOBBY L09

2 08/10/22 01:M1-004 LL Elevator Equipment Room #1 L14 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: LL L14 SMOKE

3 08/10/22 01:M1-005 LL Above FACP 1.5%- 3.7%

SIMPLEX 4098-

Functional Pass

4 08/10/22 01:M1-007 LL Elevator 2 Lobby 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: LL L25 SMOKE

5 08/10/22 01:M1-010 LL Elevator Equipment Room #2 L27 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

6 08/10/22 01:M1-019 1st Fl Elevator #1 Lobby 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: 1ST FL LOBBY 112 SMOKE

7 08/10/22 01:M1-021 1st Fl Rear Elevator #2 Lobby 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: 1ST MAIL 125 SMOKE

8 08/10/22 01:M1-028 2nd Fl Elevator #1 Lobby 209 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

9 08/10/22 01:M1-030 2nd FL Elevator #2 Lobby 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: 2ND FL BREAK RM 218 SMOKE

10 08/10/22 01:M1-036 3rd Fl Elevator 1 Lobby: Top of Shaft 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

11 08/10/22 01:M1-038 3rd Fl Elevator #1 Lobby 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: 3RD FL ELEVATOR LOBBY 310 SMOKE

12 08/10/22 01:M1-040 3rd Fl Rear Elevator #2 Lobby 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

Comment: PANEL SHOWS: 3RD FL WAITING 322 SMOKE

13 08/10/22 01:M1-041 3rd Fl Elevator 2 Top of Shaft 1.5%- 3.59%

SIMPLEX/2098-

Functional Pass

See main System Record of Inspection and Testing for additional information, certifications, and approvals.

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INTERFACE COMPONENT SUPPLEMENTARY RECORD OF INSPECTION AND TESTING

1. PROPERTY INFORMATION

Name of property: KENOSHA COUNTY ADMIN BUILDING (4433-53140-00026)

Address: 1010 56TH ST. KENOSHA, WI. 53140

2. INTERFACE COMPONENT TEST RESULTS

2.1 Equipment Summary by Type

Total Qty Functionally Tested Qty

Functionally Tested %

Visually Tested

Qty

Visually Tested %

Failed Qty Failed % Device or System Type

6 6 100% 0 0% 0 0% Remote Relays

2.2 Equipment Testing Results by Type

Remote Relays

Functional

Pass/ Fail

1 08/10/22 01:M1-005^1 LL ELEVATOR #1 PRIMARY Functional Pass

2 08/10/22 01:M1-006^1 LL ELEVATOR #1 ALTERNATE Functional Pass

3 08/10/22 01:M1-011 LL ELEVATOR #2 PRIMARY Functional Pass

4 08/10/22 01:M1-012 LL ELEVATOR #2 ALTERNATE Functional Pass

5 08/10/22 01:M2-003 LL ELECTRICAL NAC-01 TROUBLE Functional Pass

6 08/10/22 01:M2-004 LL ELECTRICAL NAC-02 TROUBLE Functional Pass

2.3 Additional Equipment Testing Results

Interface Component Type Address Location Test Results

See main System Record of Inspection and Testing for additional information, certifications, and approvals.