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72 FIRE ALARM RECORD OF COMPLETION REV1.PDF

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BROWSE VILLAGE OF LAKE GROVE (NY) FORMS

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INCORPORATED VILLAGE OF LAKE GROVE
OFFICE OF THE FIRE MARSHAL
POST OFFICE BOX 798
LAKE GROVE, NY 11755
VOICE: 516-807-6412 FAX: 866-884-5378
EMAIL: AJB5540@OPTONLINE.NET
WWW.LAKEGROVENY.GOV
Scope
This is to notify you that the procedure for an installation inspection of Fire Alarm Systems shall be done in
the following manner:
All fire alarm systems shall be 100 % tested before an installation inspection can be scheduled with the Lake
Grove Fire Marshals Office.
The “FIRE ALARM SYSTEM RECORD OF COMPLETION” form which is attached to this letter is to be completed
in its entirety then faxed or emailed back to this office via the methods listed above. We will not schedule an
inspection until this form is received reviewed and approved.
The Lake Grove Fire Marshals Office will not schedule any inspections until the Record of Completion Form
is received. In addition,
all telephone lines are to be installed and live, central station should be programmed as per requirements
set forth in your plans
review approval and the central station should be prepared to go live as they will be required to transmit
received signals to the fire
department at the time of final inspection.
Prior to the arrival of a Fire Marshal from this office for the test, insure that all equipment, tools, ladders, 2-
way radios, smoke, magnets and other necessary items are on site and readily available for use. You must
also make sure that all persons; i.e. fire alarm contractor, electrical contractor, sprinkler contractor, elevator
contractor, HVAC contractor, Fire pump contractor, Fixed suppression contractor and any other party whose
equipment is tied in or relies on fire alarm system components is on site with at least one qualified
representative.
If any of these requirements are not met, the test will be cancelled and you will be required to reapply
(which includes repaying the inspection fee).
Printed and electronic As-Built copies if any must be on site at the time of final inspection to be stamped.
At the end of the test, the Stamped Fire Marshal Inspectional Copy of the plans or any as built copies are to
be put into an appropriately sized PVC tube installed as close to the fire alarm panel as possible.
We strongly recommend that you type this form as if any items are not legible or are left blank, the form will
be rejected and no inspection will be done.
Fire Alarm Record of Completion
Page1 of 4 rev 01/07
Date:
Record of Completion
Fire Alarm and
Fire Detection Systems
Name of Facility:
Property Address:
Town/Village:
Installing Company:
Address:
Town/Village:
Installers Name:
License Number:
Owner or Rep:
General Contractor:
Title:
Electrical Contractor:
FACP Mfg: FACP Model:
System Type:
Exact location of panel Ex: (North wall of stock room):
Exact location of remote annunciator:
You must complete the zone list on the next page. If this is an addressable system, you must include a device list.
FACP Circuit Breaker is located in panel: FACP Circuit Breaker is number:
Pull station reset method is (key (specify exact key, allen wrench size, screwdriver type etc:
As required we have left at least one tool/key needed to reset the pull stations in the Fire alarm control panel.
FACP Secondary telephone number:
FACP Primary telephone number:
Central Station name and address:
Central Station 24 Hour Phone:
Central Station 24 Fax:
You must include the required confirmation letter from central station as per Installation instruction sheet.
This system has been installed. pre-tested and operates in accordance with the standards listed below, includes the devices
listed below and was inspected on the date indicated below by the person indicated below.
NFPA 72
NFPA 70, National Electrical Code, Article 760, Manufacturers Instructions.
Manufacturers Instructions.
NYS Fire Code, Chapter
Other (specify)
Inspector signature:
Inspection Date:
Installed version:
System Firmware:
Checksum:
Date:
Initial Program Installation:
Date:
Revisions and reasons:
Programmed by:
Page 2 of 4 rev 01/07
Equipment Installed and Tested
Sprinkler System (Fire Alarm connections only)
Make/Model:
Control Panel
Manual Station
Audio Devices
A/V Devices
Duct Detectors
Heat Detectors
Smoke Detectors
Batteries
Trouble Indicators
Auto Door Release
Visual Devices
Make/Model:
Make/Model:
Make/Model:
Make/Model:
Make/Model:
Make/Model:
Make/Model:
Make/Model:
Make/Model:
Make/Model:
of
of
of
of
of
of
of
of
of
of
of
Readings: On battery:
Full Load:
Charge:
Generator
Make/Model:
of
HVAC Controls
Make/Model:
of
Fire Alarm Dialer
Make/Model:
of
Annunciator
Make/Model:
of
Water Flow Switch
Make/Model:
of
Valve Tamper Switch
Make/Model:
of
PIV
Make/Model:
of
Electric Alarm Bell
Make/Model:
of
Does this installation meet/exceed the audible/visual requirements of NFPA 72, Section 7 of the 2002 Edition? YES
NO
Was the test of this alarm system conducted on battery power with satisfactory results? YES
NO
Comments:
Page 3 of 4 rev 01/07
Fax this form to 866-884-5378 or
EMail to ajb5540@optonline.net
Zone: 1
Zone List
Note: If this is an addressable system you are to submit a typed or
computer generated document listing each device, its location and
its program label. Photocopy this sheet if additional pages are needed.
System is addressable and as such, we have attached the documentation required to this form
Page1 of 4 rev 01/07
Type: Supv
# of devices : 1
Coverage Area(s) Above drop ceiling in the NW corner of the stock room. There is a remote annunciator in the ceiling below.
Zone: Type:
# of devices :
Coverage Area(s)
Examples:
Device Type(s): Duct Detector
Device Type(s):
Zone: 2 Type: Alarm
# of devices : 6
Coverage Area(s): South side of the stock room, bathroom and office areas.
Device Type(s): Ionization Smoke Detectors
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
Type:Zone:
# of devices :
Coverage Area(s)
Device Type(s):
LOCATION):
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Completed 13 July 2020

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