Bldgs 37 38 2024 Fire Alarm Annual Inspection 9-25-24.pdf

Date:

Time:

Service Organization Property Name (User)

Name: Name:

Address: Address:

Representative: Owner Contact:

License No.: Telephone:

Telephone: Email:

Monitoring Entity Approving Agency

Contact: Contact:

Telephone: Telephone:

Monitoring Account Ref. No.: Email:

Type Transmission Service McCulloch Multiplex Digital Weekly Monthly Quarterly

X RF Reverse Polarity Semiannually X Annually Other (Specify) Other (Specify)

Manual Fire Alarm Boxes Ion Detectors Photo Detectors Duct Detectors Heat Detectors Waterflow Switches Supervisory Switches Other (Specify)

Bells Horns Chimes Strobes Speakers Other (Specify)

No. of Alarm Notification Circuits: Are Circuits Monitored for Integrity: X Yes No

Building Temp.

Building Water Temp.

Site Water Level Fire Pump Power Fire Pump Running Fire Pump Auto Position Fire Pump or Pump Controller Trouble Generator in Auto Position Switch Transfer Generator Engine Running Other (Specify)

NFS-3030

Software Rev:

East Hallway by Room 125A Control Unit Manufacturer: Notifier Model No.:

Circuit Styles:

Last Day of Any System Service:

Last Day of Any Software or Configuration Revision:

Main FACP Location:

Alarm Notification Appliances and Circuit information Quantity Circuit Style

B9

Horn/Strobes

Supervisory Signal Initiating Devices and Circuit Information Quantity Circuit Style

104 B

41 B

CFP Life Safety Systems,LLC Inspection And Testing Form

Jim Norris

9/24/2024

4:00

Barry Johnson

Alarm initiating Devices and Circuit Information

Number of Circuits:

CFP Life Safety Systems, LLC 10355 S Kedzie Ave

262.6179 773.366.3477

Hines VA Buildings 37&38 1st Ave, 1 Blk North of 22nd St. Bldg. 37, Hines, IL 60141

708.746.7850 barry.johnson2@va.gov

Broadview FD 708.343.6124

Position 87

Circuit Style B

B B

B

Quantity

Signaling line Circuits Quantity and Style (See NFPA 72, Table 3-6) of signaling line circuits connected to system:

Quantity: Style:

System Power Supplies

a. Primary (Main): Nominal Voltage: Amps:

Overcurrent Protection: Type: Amps:

Location of Primary Supply Panelboard:

Disconnecting Means Location:

b. Secondary (Standby): Storage Battery Amp-Hr Rating:

Calculated Capacity to Operate the System, in Hours: 24 60 Engine-Driven Generator Dedicated to Fire Alarm System:

Location of Fuel Storage:

Type Battery Dry Cell Nickel-Cadmium X Sealed Lead-Acid Lead-Acid Other (Specify)

c. Emergency or Standby System used as Backup or Primary Power Instead of usinga Secondary Power Supply:

Emergency System Described in NFPA 70, Article 700 Legally Required Standby Described in NFPA 70, Article 701 Optional Standby System Described in NFPA 70, Article 702 (meets Article 700 or 701 performance requirements)

Notifications Are Made No Monitoring Entity X Building Occupants X Building Management X Other (Specify) AHJ Notified of Any impairments

Type

Control Unit X X Interface Equip. X Lamps/LEDs X X Fuses X X Primary Power Supply X X Trouble Signals X X Disconnect Switches X X Ground-Fault Monitoring X Type (Secondary Power) Battery Condition X X Load Voltage X Discharge Test X Charger Test X Specific Gravity Transient Suppressors Remote Annunciators X X Notification Appliances Audibles X X Visuals X X Speakers Battery Condition X X Voice Clarity Emergency Communications Equipment Phone Set Phone Jacks Off-Hook indicator Amplifier(s) Tone Generator Call-In Signal System Performance

2 B

Panel: HR-130, Circuit: 14

X

120VAC 20

Breaker 20

Human Resource Room 130

Prior to Any Testing

Time Who 4:00 4:00 4:00

BFD

Paul Paul

System Tests and inspections Visible Functional Comments

Visible Functional Comments

Visible Functional Comments

Yes

Interface Equipment (Specify) (Specify) (Specify)

Special Hazard Systems

(Specify) (Specify) (Specify)

Special Procedures:

Comments:

Supervising Station Monitoring Alarm Signal X Alarm Restoration X Trouble Signal X Supervisory Signal Supervisory Restoration

Notifications That Testing is Complete No Monitoring Entity X Building Occupants X Building Management X Other (Specify) AHJ Notified of Any impairments

Comments:

The Following Did Not Operate Correctly:

System Restored to Normal Operation: Date: Time: Initials:

Name of Inspector: Date: Time:

Signature:

Name of Owner Representative:

Date: Time: Signature:

Visible Device Operation Simulated Operation

Comments 1:45 25-Sep 1:45 25-Sep

Yes Time

Visible Device Operation Simulated Operation

Time Who

6:00 BFD

1:45 25-Sep

Jim Norris

Paul Coppola

THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS

10/15/2024 6:00

10/15/2024 6:00

10/15/2024 6:00

Batteries ( 20 ) in the following locations need replacement: Main FACP 2- 12 volt 55 amp hour, Simplex Panel by FACP 2- 12 volt 55 amp hour, Nac Panel 2 in Ceiling Above FACP 2- 12 volt 7 amp hour, Nac Panel 1 by FACP 2- 12 volt 7 amp hour, Engineer's Shop NAC 2- 12 volt 7 amp hour, Warehouse by LP3 NAC 2- 12 volt 7 amp hour, Warehouse by Door 21 NAC 2- 12 volt 7 amp hour, Janitor Closet 1014 NAC 2- 12 volt 7 amp hour, CMOP by Dock Door 17 NAC 2- 12 volt 7 amp hour, CPAP West Wall NAC 2- 12 volt 7 amp hour.

Keyswitch did not activate Duct Detector in the following location and needs to be investigated: RTU RT-8 Return Column AB-19.

Elevator machine room smoke detector and elevator shaft heat detector did not recall the elevator to the proper floors.

Duct Detector Key Switch ( 1 ) in the following location needs replacement: Room 154 RTU 5 (L1D32) (Notifier RTS 151 Key).

No

ALL KNOWN AND ACCESSIBLE INITIATING AND NOTIFICATION APPLIANCES HAVE BEEN TESTED IN ACCORDANCE WITH NFPA STANDARDS

6:00 Paul 6:00 Paul

Yes

Device Zone Device PE Type Number Address Sensitivity

PE L1D01 2.12% Pass PE L1D02 2.12% Pass PE L1D03 2.12% Pass PE L1D04 2.12% Pass PE L1D05 2.12% Pass PE L1D06 2.12% Pass PE L1D07 2.12% Pass PE L1D08 2.12% Pass HD L1D11 Pass HD L1D12 Pass PE L1D15 2.12% Pass PE L1D16 2.12% Pass HD L1D17 Pass HD L1D18 Pass HD L1D19 Pass PE L1D20 2.12% Pass PE L1D21 2.12% Pass PE L1D22 2.12% Pass PE L1D23 2.12% Pass PE L1D24 2.12% Pass PE L1D25 2.12% Pass PE L1D26 2.12% Pass PE L1D27 2.12% Pass PE L1D28 2.12% Pass PE L1D29 2.12% Pass PE L1D30 2.12% Inaccessible PE L1D32 2.12% Pass PE L1D33 2.12% Pass PE L1D34 2.12% Pass PE L1D35 2.12% Pass PE L1D36 2.12% Pass PE L1D37 2.12% Pass PE L1D38 2.12% Pass PE L1D39 2.12% Pass PE L1D40 2.12% Pass

CMOP Warehouse Column Q-23 Data Room DC 00

CMOP Warehouse Column U-23 CMOP Warehouse Column S-25 CMOP Warehouse Column S-23 CMOP Warehouse Column R-25 CMOP Warehouse Column R-23 CMOP Warehouse Column Q-24

Operations Column Z25 Operations Column Z22

Operations Column AB25 Operations Column AB22

Operations CMOP Warehouse Column U-25

Room 142 Column K4 Hall by Conf. Rm. 141

Operations Column X25 Operations Column X22 Operations Column Y26 Operations Column Y22

SDC Area Hallway by Rm 148 SDC Area Closet by Rm 151 SDC Area Closet in Kitchen SDC Staging Area in Kitchen

Elevator Equipment Room 2nd Fl. Elevator Lobby

Data Closet DC0.15 SDC Mech. Rm 142 Data Closet DC03 SDC Area Hallway

PBM Space 139-PH104 PBM Space 139-PH106 PBM Space 139-PH109 1st Fl. Elevator Lobby

Initiating Devices PBM Space 139-PH114

Location

Hines VA Buildings 37 & 38

PE L1D42 2.12% Pass PE L1D43 2.12% Pass PE L1D45 2.12% Pass PE L1D46 2.12% Pass PE L1D47 2.12% Pass PE L1D49 2.12% Pass PE L1D51 2.12% Pass PE L1D52 2.12% Pass HD L1D54 Pass HD L1D55 Pass HD L1D56 Pass DD L1D64 Pass DD L1D65 Pass DD L1D66 Pass DD L1D67 Pass DD L1D68 Pass DD L1D69 Pass PE L1D70 2.12% Pass PE L1D71 2.12% Pass DD L1D72 Pass DD L1D73 Pass DD L1D74 Pass DD L2D01 Pass DD L2D02 Pass DD L2D03 Pass DD L2D04 Pass DD L2D05 Pass DD L2D06 Pass DD L2D07 Pass DD L2D08 Pass DD L2D09 Pass DD L2D10 Pass DD L2D11 Pass DD L2D12 Fail-DNO DD L2D13 Pass DD L2D14 Pass DD L2D15 Pass DD L2D16 Pass DD L2D17 Pass DD L2D18 Pass DD L2D19 Pass DD L2D20 Pass DD L2D21 Pass DD L2D22 PassRTU RT-2 S. Return Column M13

RTU RT-1D S. Supply Column X-13 AHU-1 Supply Mech Rm 112 AHU-1 Return Mech Rm 112 RTU RT-4 Supply 2nd Floor RTU RT-4 Return 2nd Floor

RTU RT-2 N. Return Column M13

RTU RT-1B S. Supply Column Y-18 RTU RT-1B N. Supply Column Y-18

RTU RT-8 Return Column AB-19 RTU RT-8 Supply Column AB-19 RTU RT-1D Return Column X-13

RTU RT-1D N. Supply Column X-13

RTU RT-1 N. Supply Column R-13 RTU RT-1 Return Column R-13

RTU RT-1A Return Column S-18 RTU RT-1A S. Supply Column S-18 RTU RT-1A N. Supply Column S-18

RTU RT-1B Return Column Y-18

CMOP RTU-10 Return Column F-16 CMOP RTU-11 Return Column J-18

RTU1 Return Mech. Closet 6 RTU RT-7 Supply New Conf Rm 165 RTU RT-7 Return New Conf Rm 165

RTU RT-1 S. Supply Column R-13

CMOP RTU-10 Return Column F-16 CMOP RTU-11 Supply Column J-18 CMOP RTU-10 Return Column J-19

Janitors Closet C1014 IDF Closet C1060

Panel Smoke Mail Rm Closet DC02

Tele. Closet DC99 SDC/S and R Closet DC04

CMOP RTU-9 Supply Room C1018 CMOP RTU-9 Return Room C1018

New PNM Area Center New PNM Area Center

New PNM Area by Rm PH126 New PNM Area by Rm PH123

SDC Gen Office North

Location

CMOP RTU-10 Supply Column F-16

Initiating Devices New PBM Area by Rm PH132 New PBM Area by Rm PH140

DD L2D23 Pass DD L2D24 Pass DD L2D25 Pass DD L2D26 Pass DD L2D27 Pass DD L2D28 Pass DD L2D29 Pass DD L2D30 Pass DD L2D31 Pass DD L2D32 Fail-Damaged MP L1M04 Pass MP L1M09 Pass MP L1M18 Pass MP L1M19 Pass MP L1M20 Pass MP L1M23 Pass MP L1M26 Pass MP L1M27 Pass MP L1M28 Pass MP L1M29 Pass MP L1M32 Pass MP L1M33 Pass MP L1M35 Pass MP L1M40 Pass MP L1M41 Pass MP L1M42 Pass MP L1M43 Pass MP L1M44 Pass MP L1M45 Pass MP L1M46 Pass MP L1M47 Pass MP L1M48 Pass MP L1M49 Pass MP L1M50 Pass MP L1M51 Pass MP L1M52 Pass MP L1M53 Pass MP L1M54 Pass MP L1M55 Pass DD L1M59 Pass MP L1M60 Pass MP L1M61 Pass MP L1M62 Pass MP L1M63 Pass

CMOP Rm 215 Column P28 CMOP Office DD

SDC Gen Offices Door 32 SDC Staging Area in Kitchen

SDC Gen Office SDC Gen Office

Room 107 East Exit PBM Space 139 by Reception

PBM Space 139 by Door PH109 PBM Space 139 by Warehouse DD

Main Entrance 30 CPAP West Wall Emergency Exit

SDC Office South by Door 38 North Warehouse Exit by Door 31

New PBM Area N/E by Door PH131 Comp Rm 127 North Exit Computer Rm 127 East

Computer Rm 127 South Exit

Hall by Mech. Rm 5 2nd Floor SDC Area by Elevator

South Dock Outside by OVHD 14 SDC Lunch Rm North by Door 34

SDC East Office by Door 36 South Closet DC01 East of Room 107

CMOP Warehouse Column N26 CMOP Warehouse Jan Closet C1014 N/E Warehouse SDC Shop by Riser 9 Center Warehouse Elec Panel RP1A Middle Warehouse Elec. Panel P1

S/Center Warehouse Elec Panel LP3

RTU RT-6 Supply Rm 153 Col. C2 RTU RT-5 Rm 154/Maintenance

S/E Warehouse by Riser 2 in Rm 119B South Warehouse by Riser 3 by Batt Charge

West Warehouse by Door 17 CMOP Warehouse Column Q26

RTU RT-2 S. Supply Column M13 RTU RT-3 Supply PBM 139 Cent RTU RT-3 Return PBM 139 Cent AHU-2 Supply Mezz. East Wall AHU-2 Return Mezz. East Wall

RTU RT-6 Return Rm 153 Col. C2

Location Initiating Devices

RTU RT-2 N. Supply Column M13 RTU RT-2 E. Supply Column M13

DD L1M67 Pass MP L1M72 Pass MP L1M98 Pass MP L1M99 Pass DD L1M104 Pass DD L1M105 Pass DD L1M106 Pass DD L1M107 Pass DD L1M108 Pass MP L1M109 Pass MP L1M111 Pass MP L1M112 Pass MP L1M113 Pass MP L1M143 Pass MP L1M145 Pass MP L1M146 Pass MP L1M147 Pass MP L1M148 Pass MP L1M152 Pass MP L1M153 Pass MP L1M155 Pass MP L1M156 Pass MP L1M157 Pass MP L1M158 Pass HD L1M34 Pass

Maintenance Shop Stor. NE Exit Maintenance Shop Stor. SW Exit

Maintenance Shop Stor. SE Center Exit Elevator Shaft (Conventional)

CMOP N/W Center Exit Door 26 Ext Steam Room Door 25 CMOP West Exit Door 24

CMOP East Center Maintenance Shop Stor. NW Exit

CMOP East S/E Exit

Maintenance Shop Stor. SE Exit CMOP Ramp Door 21

CMOP Employee Entrance by Door 20 CMOP North Entrance by Door 22

CMOP N/E Exit Door 28 CMOP N/E Center Exit

South Turnstyle Door 37 CMOP N/W Duct Det CMOP S/E Duct Det CMOP N/E Duct Det CMOP S/W Duct Det

CMOP N/Center Duct Det

Location Initiating Devices CMOP Duct Det.

Riser 1 by FACP

Corridor by Room 163

PE L1D04 2.12% Pass MP L1M01 Pass MP L1M02 Pass MP L1M03 Pass

Node 3 Building 38 Initiating Devices North Electric Panel

South Exit East Exit

North Exit

Location

Panel Type Installed Size Load Test Result FACP Feb-21 55 Ahr 30 Ahr Fail SUB Feb-21 55 Ahr 29 Ahr Fail NAC Dec-20 7 Ahr Fail Fail SUB Oct-22 7 Ahr 6.2 Ahr Pass NAC Dec-20 7 Ahr Fail Fail NAC Apr-21 7 Ahr 6.2 Ahr Pass NAC 20-Dec 7 Ahr Fail Fail NAC 20-Dec 7 Ahr Fail Fail NAC 20-Dec 7 Ahr Fail Fail NAC 20-Dec 7 Ahr Fail Fail NAC 23-Dec 7 Ahr 7 Ahr Pass NAC 20-Nov 7 Ahr Fail Fail NAC 20-Dec 7 Ahr Fail Fail

IDF Closet C 1060 CMOP by Dock Door 17

CPAP West Wall

Warehouse by LP3 Warehouse by Door 21

Janitor Closet 1014

Nac 1 by FACP Mech Room 5

Engineer's Shop

Simplex Panel by FACP NAC 2 Above Ceiling Above FACP

Building 38 by Entrance

Panel Batteries Location Comments

East Hallway by Room 125A