Fire Alarm Inspection Report.pdf
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- W91QF426BA001Amendment01
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This is a Fire Alarm Inspection Report documenting the annual inspection and testing of the fire alarm system at Building 1146 (USDB Warehouse) located at 1301 N. Warehouse Rd., Ft. Leavenworth, Kansas 66027. The inspection was conducted on June 28, 2019, at 0700 hours by David Schaumburg (NICET #90525) of Siemens Industry, Inc., representing the service organization BKS1 Ft. Leavenworth. The system is monitored by DES/Jeff Jackson and approved by the Ft. Leavenworth Fire Department under Contract #2600112458, with a contract period from April 10, 2019, to April 10, 2020.
The fire alarm system utilizes a Notifier Model 500 control unit with Class B circuit style and includes two manual pull stations, one system smoke detector, one waterflow device, and two other supervisory initiating devices. The system is powered by 120VAC primary supply (20-amp breaker) with a 12 AH sealed lead acid battery providing 24-hour backup capacity. All system components—including the control unit, interface equipment, lamps/LEDs, primary power supply, disconnect switches, secondary power, and notification appliances—passed visual and functional testing. All six initiating, supervisory, and notification devices tested successfully. The report notes that tampers cause alarm conditions and waterflow must be reset at the panel to silence alarm conditions. The system was restored to normal operation at 1430 hours on June 28, 2019, and testing was performed in accordance with applicable NFPA standards. Building management, the monitoring agency, and building occupants were notified before and after testing completion.
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Fire Alarm Inspection Report
Building Technologies
© Siemens Industry, Inc., Smart Infrastructure Division, 2009-2019. All rights reserved.
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 1 of 4
INSPECTION AND TESTING FORM
SITE NAME: Ft. Leavenworth
SYSTEM NAME: 1146 - USDB Warehouse
PANEL LOCATION: Front Office PANEL ADDRESS: 1301 N. Warehouse Rd., Ft. Leavenworth, KS 66027
DATE: 28 JUN 2019 CONTRACT #: 2600112458
TIME: 0700 NOTIFICATION #: 5003714623
SYSTEM INFORMATION
Service Organization Property Name (User)
Name: SIEMENS Name: BKS1 Ft. Leavenworth (30406961)
Address:
8066 Flint Street Lenexa, KS 66214
Address:
1301 N. Warehouse Rd.
Ft. Leavenworth, KS 66027
Representative : David Schaumburg Owner Contact: Raymond Murphy
License No.: NICET #90525 Telephone: 913-684-7788
Telephone: 913-905-6734
Contract# 2600112458
Contract Start Date: 4/10/2019
Contract End Date: 4/10/2020
Monitoring Entity Approving Agency
Contact: DES / Jeff Jackson Contact: Ft. Leavenworth Fire Dept.
Telephone: 913-684-2111 / 913-684-3501 Telephone: 913-684-2111
Monitoring Account Ref. No.: Bldg 1146
Type Transmission: Digital Service Type: Annual
Control Unit Manufacturer: Notifier
Model Number: 500
Circuit Styles: Class B
Number of Circuits: 0
Software Rev.:
Last Date System Had Any Service Performed: 28 Jun 2019
Last Date that Any Software or Configuration Was Revised:
COMMENTS:
TAMPERS CAUSE ALARM CONDITION
WATERFLOW MUST BE RESET AT PANEL TO SILENCE ALARM CONDITION
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 2 of 4
ALARM-INITIATING DEVICES INFORMATION
System Qty Report Qty Device Type 2 2 Manual Pull Station
1 1 System Smoke Detector (P) 1 1 Waterflow Device
Alarm Verification Feature is ☑ Disabled ☐ Enabled
SUPERVISORY SIGNAL-INITIATING DEVICES INFORMATION
System Qty Report Qty Device Type 2 2 Other Supervisory Initiating Device
INITIATING AND NOTIFICATION CIRCUIT INFORMATION
Circuit Type Qty Class/Style Survivability
Level Separate Pathway
Level Supervised
Initiating Device Circuits 0 Yes
Signaling Line Circuits 0 No
Notification Circuits 0 Class B Yes
SYSTEM POWER SUPPLIES
(a) Primary (Main) Nominal Voltage: 120VAC Amps 20
Overcurrent Protection Type: Breaker Amps 20
Location (of Primary Supply Panel Board):
Disconnecting Means Location: Warehouse CIR #2
(b) Secondary (Standby):
Sealed Lead Acid Storage Battery: Amp-Hour Rating 12 AH
Calculated Capacity to operate system, in Hours: 24 Hrs
No Engine-driven generator dedicated to fire alarm system:
NOTIFICATIONS MADE PRIOR TO ANY TESTING
Yes No Who Time
Monitoring Entity ☑ ☐ DES
Building Occupants ☑ ☐ David Ray
Building Management ☑ ☐ Jeff Jackson
Other (Specify) ☐ ☑
AHJ Notified of Any Impairments ☐ ☑
SYSTEM TESTS AND INSPECTIONS
Type Visual/ Functional/ Not
Tested/ Failed Comments
Control Unit Visual, Functional
Interface Equipment Visual, Functional
Lamps/LEDS Visual, Functional
Fuses Visual
Primary Power Supply Visual, Functional
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 3 of 4
Disconnect Switches Visual, Functional
SECONDARY POWER
Type Visual/ Functional/ Not Tested/ Failed
Comments
Battery Condition Visual, Functional
Load Voltage Visual, Functional
Discharge Test Visual, Functional
Charger Test Visual, Functional
NOTIFICATION APPLIANCES
Type Visual/ Functional/ Not Tested/ Failed
Comments
Audible Visual, Functional
Visual Visual, Functional
INITIATING, SUPERVISORY, AND NOTIFICATION DEVICE TESTS AND INSPECTIONS
Location & S/N Device Type Functional Test Dev. Reading Pass Fail
01-001-001 OFFICE Smoke Detector X 2.5 X
01-001-002 FRONT ENTERANCE PULL Pull Station X X
01-001-003 BACK EXIT PULL Pull Station X X
01-001-004 SMALL WAREHOUSE Waterflow Device X X
01-001-005 SMALL WAREHOUSE Tamper X X
01-001-006 SMALL WAREHOUSE HIGH/LOW PRESS SW Pressure Switch X X
SUPERVISING STATION MONITORING
Yes No Time Comments
Alarm Signal ☑ ☐
Alarm Restoration ☑ ☐
NOTIFICATIONS THAT TESTING IS COMPLETE
Yes No Who Time
Building Management ☑ ☐ Jeff Jackson
Monitoring Agency ☑ ☐ DES
Building Occupants ☑ ☐ David Ray
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 4 of 4
System restored to normal operation: Date: 28 Jun 2019 Time: 1430
This Testing Was Performed in Accordance with Applicable NFPA Standards.
Name of Inspector: David Schaumburg
Signature:
Name of Owner or Representative: Raymond Murphy
Signature:
| 2019-06-28T11:40:19-0500 | |
| Schaumburg David |
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