Building_8-CRAFT_COTTAGE-FA-611-12.pdf

Inspection Date 6/11/2012

Company Name SimplexGrinnell

Address Address

City State & Zip City, State & Zip

Owner Contact

Building

Transmission Type

Last Service Date

Quantity Circuit Style

4 B

2 B

2 B

Comments

Photoelectric Smoke Detector

Date of Last Software Revision

Service Type Manufacturer

Alarm Verification feature is

Ionazation Smoke Detector

Annual Inspection Simplex 4010

ALARM INITIATING DEVICES AND CIRCUIT INFORMATION

Building Occupants AHJ Notified of pre-existing Impairments

Manual Pull Station

Beam Detector

Initiating Circuit Style # Of Circuits Notification Circuit Style

DULLES, VA 20166

Office Phone

Office License # 564

Monitoring System Account Number

Secuirty Office

Central Station Phone Number 202-730-3111

David Browne

MODEL

Inspection Time

DC METRO

22712 COMMERCE CTR CT

Central Station Operator JUNE 8, 2011 1:00PM

BUILDING 8 CRAFT COTTAGE

703-996-0782

Monitoring Entity

NAMEENTITY NOTIFIED

Building Management

NOTIFICATIONS MADE PRIOR TO ANY TESTING

DATE & TIME

Secuirty Office

Device Type

Fire Pump Run

Multi-Sensor

Kitchen Hood System

Optical Detector

Heat Detector

Waterflow Switch

High Pressure Switch

FIRE ALARM SYSTEM

NFPA 72 REPORT OF INSPECTION and TEST (Page 1 of 4)

Duct Detector

3700 North Capitol St. NW

Inspection Report Number

Washington, DC 20011

Armed Forces Retirement Home

Inspection Contract Number

Approving Agency

Contact

Telephone

DISTRICT OF COLUMBIA

DC FIRE

# Of Circuits

Software Revision

Chemical Fire Suppression System

Inspection Technician SignatureLicense Number

Owner: Jack Kleminich Author: Eugene Turek Last Revised: 11/13/2003

Company Name

Quantity Circuit Style

1 B

Quantity Circuit Style

Quantity

120 VAC 20

Breaker 20

VISUAL

YES

N/A

YES

YES

YES

YES

YES

YES

N/A N/A

VISUAL

YES

Specific Gravity N/A

Transient Suppressors

Charger Test YES Discharge Test YES

SYSTEM TESTS AND INSPECTIONS SECONDARY POWER

Trouble Signals Disconnect Switches

Remote Annunciators

Low Pressure Switch

PRIMARY SYSTEM POWER SUPPLIES SECONDARY (STANDBY) POWER SUPPLY

Fire Pump Loss of Phase

Generator Run Indicator

Bell

AND STYLE OF SIGNALING LINE CIRCUITS CONNECTED TO THIS SYSTEM

Water Tank Level

PIV Tamper

ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION

Are circuits monitored for electrical integrity?

Device Type

YES

Comments

Horn / Strobe

Speaker / Strobe

Chime / Strobe

Horn

Speaker

Chime

Amps Battery Type 12 Volt Amp Hr Rating

Is an Emergency or Standby system used as a backup to primary power supply, instead of using a secondary power supply

Type of engine-driven generator dedicated to alarm system

Primary Main Nominal Voltage

If the answer is "YES" what type & article as defined in NFPA 70

Fire Pump Trouble

Over current Protection Type Amps Calculated capacity to operate the system, in hours 24

Location of Supply Panel board Underneath the House

Ground - Fault Monitoring N/A

FUNCTIONALTYPE

YES

YES

Control Unit Interface Equipment Lamps & LED's Fuses

YESPrimary Power Supply

Battery Condition Load Voltage YES

Device Type

Inspection Date

Location of Fuel Storage

FIRE ALARM SYSTEM

NFPA 72 REPORT OF INSPECTION and TEST (Page 2 of 4)

Armed Forces Retirement Home

Disconnecting means location

Inspection Report Number Inspection Contract Number

SYSTEM TESTS AND INSPECTIONS CONTROL PANELS

TYPE FUNCTIONAL COMMENTS

Strobe

Comments, Incidents, or Deficiency Notes

OS & Y Tamper

Plug Tamper

SUPERVISORY SIGNAL INITIATING DEVICES AND CIRCUIT INFORMATION

COMMENTS

N/A

YES

N/A

YES

YES

VISUAL

YES

N/A N/A

VISUAL

N/A N/A N/A N/A N/A N/A

VISUAL

N/A N/A N/A N/A N/A N/A N/A N/A N/A

VISUAL

N/A N/A N/A N/A N/A N/A

RESULT

YES

YES

YES

YES

# YES

AFFF Foam System N/A

Kitchen Hood System N/A

Dry Chemical System N/A

TYPE TIME COMMENTS

Pre-Action System N/A

CENTRAL STATION SIGNAL VERIFICATION

N/A Alarm Restoration N/A Trouble Signals N/A

Deluge System N/A

Alarm Signal

Emergency Power Shunt Trip N/A

TYPE FUNCTIONAL COMMENTS

SYSTEM TESTS AND INSPECTIONS SPECIAL HAZARD SYSTEMS

Exhaust Fan Shut Down

Supervisory Signal N/A

Fire Damper Control N/A

Gas Suppression System N/A

Amplifier (s) N/A

TYPE FUNCTIONAL COMMENTS

Tone Generator (s) N/A

N/A Phone Jacks N/A

N/A

SYSTEM TESTS AND INSPECTIONS EMERGENCY COMMUNICATIONS EQUIPMENT

Audible

Speakers N/A

YES

N/A N/A

Visible N/A

SYSTEM TESTS AND INSPECTIONS NOTIFICATION APPLIANCES

TYPE FUNCTIONAL COMMENTS

Voice Clarity

Inspection Date

FIRE ALARM SYSTEM

NFPA 72 REPORT OF INSPECTION and TEST (Page 3 of 4)

Armed Forces Retirement Home

Inspection Report Number Inspection Contract Number

SYSTEM TESTS AND INSPECTIONS INTERFACE EQUIPMENT

Elevator Recall

Door Release to Close N/A Door Unlock N/A

N/A

TYPE FUNCTIONAL

Off - Hook Indicator N/A

Phone Set

Supervisory Restoration N/A

Smoke Control System N/A HVAC Shut Down

Elevator Shunt Trip N/A

COMMENTS

N/ACall - in Signal

Date

System Restored to Normal Operation? NO Date January 15th 2009 Time 11:15am

Building Occupants

Central Station Operator Secuirty Office

Building Management

Supervising Technician License Number

FIRE ALARM SYSTEM

NFPA 72 REPORT OF INSPECTION and TEST (Page 4 of 4)

Armed Forces Retirement Home Inspection Date

Inspection Report Number Inspection Contract Number

NOTIFICATIONS THAT TESTING IS COMPLETE

ENTITY NOTIFIED NAME DATE & TIME

This Fire Alarm System was left with 1 trouble.

THIS IS TO CERTIFY THAT THE FIRE ALARM SYSTEM HAS BEEN TESTED AND INSPECTED IN ACCORDANCE WITH THE APPLICABLE NFPA STANDARDS

SYSTEM WIDE INCIDENT, COMMENTS, AND DEFICIENCY SECTION

The panel had 1 TROUBLE prior to testing.

1). Card 8 Network Card, Netcom Failure , (Trouble)

FIRE ALARM SYSTEM DEVICE RECORD

Armed Forces Retirement Home

Inspection Report Number

Location Are a or Fl oo r

Dev ice

De sc rip tio n Ta sk Fr eq ue nc y

Dev ice

Ad dr es s or

Circ ui t N um be r

Ala rm

O pe ra tio n Ve rif ie d

Ann un ci at or In di ca tio n

Rem ot e In di ca tio n

La m p

Su pe rv is io n of Dev ic e

Dev ic e Cle an ed th is in sp ec tio n

Se ns iti vi ty Se tti ng

(0

4) or

Fl ow

Sw itc h De la y

Ti m er

Comments

Back of Building Main Floor Smoke Detector Annual

Main Hallway Main Floor Smoke Detector Annual Sewing Room Main Floor Smoke Detector Annual X X X X X Work Room Main Floor Smoke Detector Annual X X X X X Underneath the House Basement Heat Detector Annual X X X X Underneath the House Basement Heat Detector Annual X X X X

Rear Exit Main Floor Pull Station Annual X X X Main Hallway Main Floor Pull Station Annual X X X

Company Name: Armed Forces Retirement Home Inspection Report Number:

Date:

Page:

Location Are a or Fl oo r

Dev ice

De sc rip tio n Ta sk Fr eq ue nc y

Dev ice

Ad dr es s or

Circ ui t N um be r

Ala rm

O pe ra tio n Ve rif ie d

Ann un ci at or In di ca tio n

Rem ot e In di ca tio n

La m p

Su pe rv is io n of Dev ic e

Dev ic e Cle an ed th is in sp ec tio n

Se ns iti vi ty Se tti ng

(0

4) or

Fl ow

Sw itc h De la y

Ti m er

Comments

Company Name: Armed Forces Retirement Home Inspection Report Number:

or Fl oo r

Dev ice

De sc rip tio n Ta sk Fr eq ue nc y

Dev ice

Ad dr es s or

Circ ui t N um be r

Ala rm

O pe ra tio n Ve rif ie d

Ann un ci at or In di ca tio n

Rem ot e In di ca tio n

La m p

Su pe rv is io n of Dev ic e

Dev ic e Cle an ed th is in sp ec tio n

Se ns iti vi ty Se tti ng

(0

4) or

Fl ow

Sw itc h De la y

Ti m er

Comments

Company Name: Armed Forces Retirement Home Inspection Report Number:

or Fl oo r

Dev ice

De sc rip tio n Ta sk Fr eq ue nc y

Dev ice

Ad dr es s or

Circ ui t N um be r

Ala rm

O pe ra tio n Ve rif ie d

Ann un ci at or In di ca tio n

Rem ot e In di ca tio n

La m p

Su pe rv is io n of Dev ic e

Dev ic e Cle an ed th is in sp ec tio n

Se ns iti vi ty Se tti ng

(0

4) or

Fl ow

Sw itc h De la y

Ti m er

Comments

Company Name: Armed Forces Retirement Home Inspection Report Number:

or Fl oo r

Dev ice

De sc rip tio n Ta sk Fr eq ue nc y

Dev ice

Ad dr es s or

Circ ui t N um be r

Ala rm

O pe ra tio n Ve rif ie d

Ann un ci at or In di ca tio n

Rem ot e In di ca tio n

La m p

Su pe rv is io n of Dev ic e

Dev ic e Cle an ed th is in sp ec tio n

Se ns iti vi ty Se tti ng

(0

4) or

Fl ow

Sw itc h De la y

Ti m er

Comments

Company Name: Armed Forces Retirement Home Inspection Report Number:

OTHER

SMOKE/FIRE DAMPERS

SMOKE HATCH

EXHAUST FAN

DOOR UNLOCK

DOOR RELEASE

FAN SHUTDOWN

HORN

HORN/STROBE

VISUAL ONLY (STROBE)

CHIME

CHIME/STROBE

OTHER

OS & Y TAMPER SWITCH

LOW PRESSURE SWITCH

PLUG TYPE TAMPER

WATER LEVEL SWITCH

FIRE PUMP INDICATOR

ANNUNCIATOR

SPEAKER

SPEAKER/STROBE

Comments

1 1 0

2 2 0 0

FIRE PUMP RUNNING

4 4 0

2 2 0

NUMBER NOT

TESTED THIS

INSPECTION

Comments

SMOKE DETECTORS

HEAT DETECTORS

DUCT DETECTORS

BEAM DETECTORS

MANUAL PULL STATION

ELECTROMECHANICAL RELEASING DEVICE

FIRE EXTINGUISHING OR SUPPRESSION SYS SWITCHES

FIRE/GAS & OTHER DETECTORS

DEVICE TYPE FIRE

ALARM SUPERVISORY DEVICES

SYSTEM TOTAL

NUMBER TESTED

THIS INSPECTION

NUMBER FAILED

THIS INSPECTION

NUMBER NOT

TESTED THIS

INSPECTION

CommentsDEVICE TYPE FIRE

ALARM INITIATING

SYSTEM TOTAL

FIRE ALARM DEVICE and TEST SUMMARY

Inspection Contract NumberInspection Report Number

Company Name: Armed Forces Retirement Home Inspection Date

NUMBER TESTED

THIS INSPECTION

NUMBER FAILED

THIS INSPECTION

NUMBER NOT

TESTED THIS

INSPECTION

CommentsNUMBER FAILED

THIS INSPECTION

DEVICE TYPE FIRE

ALARM NOTIFICATION

SYSTEM TOTAL

DEVICE TYPE FIRE

ALARM AUXILIARY CONTROL

SYSTEM TOTAL

NUMBER TESTED

THIS INSPECTION

NUMBER TESTED

THIS INSPECTION

NUMBER FAILED

THIS INSPECTION

NUMBER NOT

TESTED THIS

INSPECTION