INSPECTION AND TESTING FORM

Transcription

1 SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION PROPERTY NAME (USER) ATE: TIME: 4: Name: _Si_em_ en_s_i_nd_u_sm_ es_ In_c_. Name: Kctcs Maysville, Admin Bldg. Address: 27 Stanley Gault Pkwy Address: 1755 US Hwy. 68 Louisville, Kentucky 4223 Maysville, Kentucky 4156 Reresentative: _M_att _ S_he_r_lo_ck OwnerContact: _a_le_ Reyn_o_ld_s License No.: _FA_R_-1_4_83 Telehone: (66) {Cell) (66) Telehone: (52) MONITORING ENTITY TYPE TRANSMISSION McCulloh O Multile igital (Onboard Panel) Reverse Priority RF Shunt Parallel Phone None APPROVING AGENCY Contact: Siemens Monitoring Contact: Telehone: (877) Telehone: Monitoring Account Ref. No.: SERVICE Weekly Monthly Quarterly Semiannually Annually Other (Secify) c:j Other (Secify) Control Unit Manufacturer: Fire-Ute Model Number: 521 H Circuit Styles: CI ass B Location: Hall By Main Entrance Number of Circuits: 8 Software Rev.: Last ate System Had Any Service Performed: Last ate that Any Software or Configuration Was Revised: QUANTITY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Heat etector Photo etector Manual Pull Station Alarm Verification Feature is isabled _ Enabled X (NFPA I nsection and Testing, 1 of 7)

2 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPUANCES AN CIRCUIT INFORMATION CIRCUIT STYLE '3;;;.;;lc... Style Y s...;;2c... Style Y s Number of alarm notification aliance circuits: _4 Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INmATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG LINE CIRCUITS Quantity and style of signaling tine circuits connected to system (see NFPA 72, Table 6.6.1): Quantity O Style(s) SYSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage 12 Ams --:-, 2: vercurrent Protection: Tye Breaker Ams 2 Location (of Primary Suly Panel Board): isconnecting Means Location: El... ectr...,... ica..., 1 C;;;;l.;;,; ose t {b) Secondary (Standby): Storage Battery: Am-Hour Rating --'-' 7...;;.. calculated caacity to oerate system, in Hours: ,------,-- 6 Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ry Cell o Nickel-cadmium I!! Sealed Lead-Acid Lead-Acid Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described In NFPA 7, Article Legally required standby described in NFPA 7, Article Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insection and Testing, 2 of 7)

3 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments YES PRIOR To ANY TESTING No WHO Oerator All ale Reynolds TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS FUNCTIONAL Elevator Recall, oor Holders Ii!:! SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators FUNCTIONAL NOTIFICATION APPLIANCES Audible Visual Seakers Voice Clarity FUNCTIONAL INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *Nor e: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. FUNC11NAL FACTORY MEASURE LOCATION &S/N EVICE TYPE CHECK TEST SETTING SETTING Room A-27, Janitors Heat etector Ooset Room A Storage Heat etector Hall by FACP Photo etector Eit bz'. Room A-265 Manual Pull Station 1st fl. Elevator Lobbz'. Photo etector 1st. fl. Lobby by Service Photo etector Elevator 1st.fl. Lobby by A 272 Photo etector Womens Room 1st.fl. Lobby by A-272 Manual Pull Station Womens Room Hall to Library, To of Photo etector Ram Hall Eit bz'. Ubra!J'. Photo etector PASS FAIL {NFPA Insection and Testing, 3 of7)

4 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY JVISION FUNtnONAL FACTORY MEASURE LOCATION IL S/N EVICE TYPE CHECK TEST SETTING SETTING PASS FAIL Hall Eit by Libra!)'. Manual Pull Station Hall by Room A-273, Photo etector Comuter Lab Room A 273B Heat etector RoomA-2748 Photo etector Room A Storage Heat etector Room A-274A Heat etector Libra!)'. by Emergen9'. Eit Manual Pull Station Hall by Room A-264 Photo etector Hall by Room A-261 Photo etector Room A-26 Photo etector Hall b:t'. Room A-257 Photo etector Eit by Room A-255 Manual Pull Station Hall by Room A-255 Photo etector Room A-253 Photo etector Hall by Room A-25 Manual Pull Station Hall by Room A 252 Manual Pull Station RoomA-252 Heat etector To of Stairs by Room A Photo etector 251 Hall by Room A-31 Manual Pull Station Room A-31 Photo etector Room A-31C Heat etector Room A-32 Heat etector Hall by A-32 Photo etector Hall by Room A-34 Manual Pull Station Hall by Room A-33A Photo etector Room A-33A Heat etector Hall by Room A-33 Photo etector RoomA-35 Heat etector RoomA-35 Heat etector Room A-35, Comuter Heat etector Room Hall by Room A-37 Photo etector Room A-37 Heat etector Room A-37 Heat etector Room A-378 Heat etector Hall by Room A-38 Photo etector Hall by Room A-38 Manual Pull Station Hall by Room A 39A Photo etector Room A-39A, Janitor Heat etector Su I Room Room A-31, Storage Heat etector 2nd.fl. Elevator Lobby Photo etector 2nd.fl. Lobby by Service Photo etector Elevator Lobby by Room A-311, Photo etector Womens Restroom Hall by Room A-32 Manual Pull Station Hall by Room A-32 Photo etector Hall by Room A-318 Photo etector Hall by Room A-318 Manual Pull Station Hall To of Stairs by Room Photo etector A-318 Hall by Room A-317 Photo etector Hall by Room A-315 Photo etector Hall by Room A-313 Photo etector Basement Elevator Lobb:t'. Heat etector Boiler Room A-11 Heat etector Boiler Room A-11 Heat etector Boiler Room A-11 Heat etector (NFPA Insection and Testing, 4 of 7)

5 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION FUNcnONAL LOCATlON & 5/N EVICE TYPE CHECK TEST Basement by Bottom of Heat etector Stairs Basement Elevator Photo etector Mechanical Room Basement Room A 12 Heat etector FACTORY SETTING MEASURE SETTlNG PASS FAIL * = Manually set the 'Pass' state (NFPA Insection and Testing, 5 of 7)

6 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION & 5/N Hall by Room A fl. by Service Elevator Hall to Library Room A 273, Comuter Lab Room A-275, Early O,ildhood Education Library by A 274C Library by Emergency Eit Library Rear by Tables (study area) Hall by Room A 264 RoomA 264 Auditorium RoomA 263 RoomA 26 Room A 256, Office Room A-257 Room A 257 Hall by Room A 257 Room A 253 Room A 25 Hall by Room A-257 Hall by Room A 31 Hall by Room A 33A Hall by Room A 33 Room A-36 RoomA-37 Hall by Room A 38 RoomA-38 Hall by Room A 39A 2nc1.fl. Lobby Elevators Hall by Room A 318 Hall by Room A 31S Room A 31C Room A-33 AUIO FAILURES EVICE LIST EVICE TYPE PASS FAIL Comments: s functioned correctly (NFPA Insection and Testing, 6 of 7)

7 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT Phone Set Phone Jacks Off-Hook Indicator Amlifier(s) Tone Generator(s) can-in Signal System Performance FUNCTIONAL INTERFACE EQUIPMENT (Secify) oor Holders (Secify) Elevator Recall (Secify) EVICE OPERATION SIMULATE OPERATION SPECIAL HAZAR SYS'TEMS (Secify) (Secify) (Secify) Secial Procedures:...i..:.,O..,_n,.,.e' Comments:...,N..._n SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTlNG IS COMPLETE YES No WHO TIME Monitoring Agency Oerator Building Occuants All Building Management ale Reynolds Other (Secify) The following did not oerate correctly: Heat etector in Room A-31. and A-39 Janitors Suly Room is amaged and not Connected to the System. Some Heat etectors in 2nc1. Fl. Classrooms are Above the New Lift-Out Ceiling. and are Not in This Count. They Were Never Moved Below Ceiling After New Ceiling Installation.. System restored to normal oeration: ate: _..,.3""'-3"""1,_-=16. _ Time: 4: THIS TEmNG WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Insector: Matt Sherlock ate:..,..,.3-3,...1,_-1=6. Time: _4..:.;::..,._,. Signature: Name of Owner or Reresentative: _ale Reynolds. ate: Time: 4: Signature: (NFPA Insection and Testing, 7 of 7)

8 ., SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION PROPERTY NAME (USER) ATE: TIME: 1: Name: Siemens Industries Inc. Name: Kctcs Maysville camus, ca1vert Bldg. Address: 27 Stanley Gault Pkwy Address: 1755 US Hwy 68 LOuisville, Kentucky 4223 Maysville, Kentucky 4156 Reresentative: Matt Sherlock Owner Contact: ale Reynolds License No.: ;_; FA...:..;.R..;_-1=-4=8-=- 3 Telehone: (66)) Telehone: (52) MONITORING ENTITY Contact: Siemens Monitoring Telehone: (877) Monitoring Account Ref. No.: --=- 11=2==8=8:..:... 7.=... TYPE TRANSMISSION McCulloh O Multile It! igital Reverse Priority ORF Shunt Parallel Phone None other (Secify) APPROVING AGENCY Contact: Telehone: SERVICE o Weekly Monthly Quarterly Semiannually Ii!:! Annually other (Secify) Control Unit Manufacturer: Notifier Model Number: Model 5 (First Floor Lobby) Circuit Styles:...: a;:,::: a.:a: ss:...:b::... Number of Circuits:...;;;.;;;_ 28 Software Rev.:...;..;. N{.,.;..A.;... last ate System Had Any Service Performed: -,---, last ate that Any Software or Configuration Was Revised: QUANTITY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style4 Photo etector Manual Pull Station uct Photo etector Waterflow Alarm Alarm Verification Feature is isabled Enabled X (NFPA Insection and Testing, 1 of 6)

9 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPUANCES AN CIRCUrT INFORMATION CIRCUIT STYLE ----=2'- Style Y s Number of alarm notification aliance circuits: _4 Are circuits monitored for integrity? Yes QUANTITY 5 SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUrr INFORMATION CIRCUIT STYLE Style4 SIGNAUNG LINE CIRCUITS Tamer Switch Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity O Style(s) SYSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage _1=2=-= Ams 2 Overcurrent Protection: Tye Breaker Ams 2 Location (of Primary Suly Panel Board): _EP' isconnecting Means Location: Mechanical Room Lower Level by Eterior oor (b) Secondary (Standby): Storage Battery: Am-Hour Rating 26' (alculated caacity to oerate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ry Cell Nickel-Oldmium Sealed Lead-Acid Lead-Acid O Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described in NFPA 7, Article Legally required standby described in NFPA 7, Article Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA I nsection and Testing, 2 of 6)

10 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION PRIOR To ANY TESTING NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments Yes!ti No WHO Oerator All ale Reynolds TIME TYPE Control Unit Interface Equiment lams/les Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS FuNcnONAL!ti!ti!ti!ti oor Holders, AHU Shutdown SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators funcilonal NOTIFICATION APPUANCES Audible Visual Seakers Voice Clarity funcilonal li1'.i li1'.i a See Failure List INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE, FUNcnONAL FACTO RV MEASURE LOCATION & S/N EVICE TYPE CHECK TEST SETTING SETTING oors at FACP Side Photo etector oors Mechanical Room Photo etector Side Hall b Room 115 Photo etector 1st.fl. Elevator Lo Photo etector Lob b FACP Manual Pun Station 1st.ft. Eit Manual Pull Station 1st.fl. Eit Manual Pull Station AtFACP Manual Pull Station Vending Eit Manual Pull Station Hall bl Bookstore Side Photo etector AtFACP Photo etector Room, Bookstore Room uct Photo etector C-13A PASS FAIL (NFPA Insection and Testing, 3 of 6)

11 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION FUNcnONAL LOCATION & S/N EVICE TYPE CHECK TEST Room C-111 Above uct Photo etector Room C-112, Mechanical uct Photo etector Room Rear Wall Room C-112, Mechanical uct Photo etector Room Floor Level Room C-112, Mechanical uct Photo etector Room on Loft Hall b Mens Room Manual Pull Station Hall b Ticket Office Manual Pull Station 2nd.fl. b oors Photo etector 2nd.fl. Elevator Lobby Photo etector Rear Stage oor Manual Pull Station Hall b Room C-223 Photo etector Hall b Room C-223 Manual Pull Station 2nd.fl. Stairs b Elevator Manual Pull Station 2nd.fl. Breezeway Photo etector Entrance 2 2nd.fl. Breezeway Photo etector Entrance 2 2nd.fl. Breezeway Center Photo etector Entrance 2nd.fl. Breezeway Photo etector Entrance Lobb 2nd.fl. Entrance to Photo etector TechnOIQ!ll Bldg. 2nd.fl. Entrance to Manual Pull Station Technology Bldg. 2nd.fl. Entrance by Photo etector Auditorium Lobb:i: Room 233 Photo etector Mechanical Room, Lower Waterflow Alarm Mechanical Room, Loft Waterflow Alarm Mechanical Room, Lower Tam12er Switch Mechanical Room 1 Loft TamQ!r Switch Mechanical Room 1 Lower Tarroer Switch Mechanical Room 1 Lower Tam(!! Switch Back Stage Above Tamer Switch Interior ouble rs FACTORY MEASURE SEmNG SEmNG PASS FAIL * = Manually set the 'Pass' state Comments: All Initiating evices worked Proerly. (NFPA Insection and Testing, 4 of 6)

12 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION AUIO FAILURES EVICE LIST LOCATION & 5/N Hall Outside Auditorium Hall Outside Auditorium By Rm.C 22 In Office EVICE TYPE PASS FAIL Comments: All s worked Good (NFPA Insection and Testing, 5 of 6)

13 .. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT Phone Set Phone Jacks Off Hook Indicator Amlifier(s) Tone Generator(s) cajhn Signal System Performance FUNCTIONAL INTERFACE EQUIPMENT (Secify) (Secify) oor Holders AHU Shutdown (Secify) (Secify) EVICE OPERATION SIMULATE OPERATION SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) Secial Procedures:... N..,.,._n= Commen3:...,,,.N=n... _ SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring Agency Building Occuan3 Building Management Other (Secify) YES No TIME No WHO TIME Oerator All ale Reynolds The following did not oerate correctly:. System restored to normal oeration: ate: -3 _3=1 """1_6 Time: 1: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Insector: Martin Hinkle. ate: Time: 1: Signature: Name of Owner or Reresentative: ale Reynolds. ate: Time: _ :... Signature: (NFPA Insection and Testing, 6 of 6)

14 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION PROPERTY NAME (USER) ATE: TIME: 1: Name: Siemens Industries Inc. Name: Kctc:s Maysville, enham Hall Address: 27 Stanley Gault Pkwy Address: 1755 US Hwy. 68 Louisville, Kentucky 4299 Maysville, Kentucky 4156 Reresentative: M att a.a...;. Sherloc=k OwnerContact:...;;;;. ajereynolds License No.:...;..; FA_R_-_14_ Telehone: ( 66) Telehone: (52) MONITORING ENTITY Monitored at the administrator building Contact: anel. Siemens Monitoring Telehone: Monitoring Account Ref. No.: _ 1_ TYPE TRANSMISSION McCulloh Multile igital Reverse Priority ORF Shunt Parallel Phone None APPROVING AGENCY Contact: Telehone: SERVICE Weekly Monthly Quarterly Semiannually 611 Annually other (Secify) Other (Secify) Control Unit Manufacturer: Simle Model Number: 21 arc u it Styles: _c_1a_ss_b -'-' Number of Circuits: 8 Software Rev. : N/ A Last ate System Had Any Service Performed: Last ate that Any Software or Configuration Was Revised: QUANTITY 1 6 s 1 ALARM.. INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style4 style 4 Heat etector Photo etector Manual Pull Station Waterflow Alarm Alarm Verification Feature is isabled Enabled (NFPA Insection and Testing, 1 of 6)

15 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION ALARM NOTIFICATION APPUANCES AN CIRCUIT INFORMATION QUANTITY CIRCUIT STYLE...;;8'- Style Y Si Audio/Visuals, and Two s Number of alarm notification aliance circuits: Are circuits monitored for integrity? Yes QUANTITY 1 SUPERVISORY SIGNAL-INmATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG UNE CIRCUITS Tamer Switch Quantity and style of signaling Une circuits connected to system (see NFPA 72, Table 6.6.J): Quantity O Style(s) SYSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage _12 Ams -=2" vercurrent Protection: Tye Breaker Ams -=2" Location (of Primary Suly Panel Board): isconnecting Means Location: _ Ro_o_m -2 3_7 (b) Secondary (Standby): Storage Battery: Am-Hour Rating...;..; 7."'" calculated caacity to oerate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BAlTERY ry Cell Nickel-cadmium Sealed Lead-Acid Lead-Add other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, Instead of using a secondary ower suly: Emergency system described in NFPA 7, Article Legally required standby described in NFPA 7, Article Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insection and Testing, 2 of 6)

16 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments PRIOR To ANY TESTING YES No WHO Oerator 7: It! All 7: ale Reynolds 7: TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS It! It! It! It! FUNCTIONAL It! It! It! SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators FUNCTIONAL CoMMENTS BatterieS need to be relaced in main anel they are over 6 years old. NOTIFICATION APPUANCES Audible Visual Seakers Voice Clarity It! FUNCTIONAL It! INMATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. VlsUAL FUNtnONAL FACTORY MEASURE LOCAON & 5/N EVICE TYPE CHECK TEST SETTlNG SETTlNG Boiler Room 237 Heat etector Hall b)'. Room 238A Photo etector Hall b)'. Room 238 Photo etector Hall b)'. Room 242 Photo etector Hall b)'. Room 244 Photo etector Hall by ouble oors to Photo etector Administration Eit bv Room A 257 Photo etector Eit b)'. Room A 257 Manual Pull Station Eit b)'. Room -237 Manual Pull Station Room 242 Manual Pull Station Eit b)'. Room 245 Manual Pull Station Room -237 Waterflow Alarm PASS FAIL F (NFPA Insection and Testing, 3 of 6)

17 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION&S/N Room -237 Hall by Room -232 EVICE TYPE Transfer Switch Manual Pull station CHECK FUNCTIONAL TEST * = Manually set the 'Pass' state FACTORY SETTING MEASURE SETTING PASS FAIL Comments: All Initiating evices worked Proerly. (NFPA Insection and Testing, 4 of 6)

18 SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION LOCATION & 5/N Hall by Room -237 Hall by Room -232 Hall by Mens Room Hall by Room -241 Hall by Room -242 Hall by Room -23 Mens Room Womens Room AUIO FAILURES EVICE LIST Audio/Visual Audio/Visual Audio/Visual Audio/Visual Audio/ViS1Jal Audio/Visual EVICE TYPE PASS Fall Fail FAIL Bulb Out Bulb Out (NFPA Insection and Testing, 5 of 6)

19 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT FUNCTIONAL Phone Set Phone Jacks Off Hook Indicator Amlifier(s) Tone Generator(s) calhn Signal System Performance EVICE SIMULATE INTERFACE EQUIPMENT OPERATION OPERATION (Secify) (Secify) (Secify) SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) Secial Procedures: Non SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE YES No WHO TIME Monitoring Agency O rator 1: Building Occuants!!I All 1: Building Management!!I ale Rel nolds 1: Other (Secify) The following did not oerate correctly: System restored to normal oeration: ate: Time: 1: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS, Name of Insector: Matt Sherlock. ate: Time: _1: _ Signature: Name of Owner or Reresentative: a... le... R... e... v... no... 1=ds... ate: Time: --'l-":..... _ Signature: {Nf PA Insection and Testing, 6 of 6)

20 .. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM ATE: TIME: 2:3 SERVICE ORGANIZATION PROPERTY NAME (USER) Name: -=-Si:..:: e:..:.; mc.=en:..:::s:...:i:.:..:. nd=-=u==str = ie=s=in..:..::c;: Name: Kctcs Maysville, Science Bldg. Address: 27 Stanley Gault Pkwy Address: 1755 US Hwy. 68 Louisville, Kentucky 4223 Maysville, Kentucky 4156 Reresentative:...:...M:..::attSher..:..:: loc c.=k"' OwnerContact: -==-= al=er=eyn=o:..:: ld=s =---- License No.:...;..;; FA..;.;.R"""'-1"""' 4=83= Telehone: (66) (Cell) (66) Telehone: (52) MONITORING ENTlTY TYPE TRANSMISSION McCulloh Multile el igital (SK-5146) Reverse Priority RF Shunt Parallel Phone None APPROVING AGENCY Contact: Siemens Monitoring Contact: Telehone: (877) Telehone: Monitoring Account Ref. No.:...:.; 11=2==-4=844 '-'-'----- SERVICE Weekly Monthly Quarterly Semiannually el Annually Other (Secify) Other (Secify) Control Unit Manufacturer:...:...: N.=.: oti ::..:..fi=e'- r Model Number:...:...: N;;...; FS::;.;;2:...; -3a.a;.:. 3.=.a H""" Circuit Styles: Class B Location: 1st.Fl. Mechanical Room Number of Circuits: 6 Communicator: 1st.Fl. Mechanical Room Software Rev.: Last ate System Had Any Service Performed: ----, Last ate that Any Software or Configuration Was Revised: QUANTlTY ALARM.. INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style4 Style4 Manual Pull Station Photo etector Waterflow Alarm uct Photo etector Heat etector Annunicator Alarm Verification Feature is isabled Enabled X (NFPA Insection and Testing, 1 of 6)

21 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY JVIStON QUANTTTY ALARM NOTIFICATION APPUANCES AN CIRCUIT INFORMATION CIRCUIT STYLE...;a;... Style Y Seaker/s 1-'8- Style Y s Number of alarm notification aliance circuits: _4 Are circuits monitored for integrity? Yes QUANTITY 4 SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style4 Tamer Switch SIGNALING LINE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity 2 Style(s) Sty.._1... e_4 _ SYSTEM POWER SUPPLIES (a) Primary (Main): Nominal Voltage 12 Ams vercurrent Protection: Tye Breaker Ams 2 Location (of Primary Suly Panel Board): _;;. Em=erQency.;;;,,,,..;..P;;;,; an,;.;;e;.;.. I '..; 'E;..;-B;;.." isconnecting Means Location:... M... ec... h... a... ni=ca R... oo... m (b) Secondary (Standby): Storage Battery: Am-Hour Rating...;c.. 18;; calculated caacity to oerate system, in Hours: :---:------: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY O ry Cell Nickel-cadmium Sealed Lead-Acid Lead-Acid Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described in NFPA 7, Article Legally required standby described in NFPA 7, Article Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insection and Testing, 2 of 6)

22 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments PRIOR To ANY TESTING Yes No WHO Oerator All ale Reynolds TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECilONS FUNCTIONAL Elevator Recall, AHU Shutdown SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Secific Gravity Transient Suressors Remote Annunciators FUNCTIONAL Entry Foyer CoMMENTS NOTIFICATION APPLIANCES Audible Visual Seakers Voice Clarity FUNCTIONAL INITIATING AN SUPERVISORY EVICE TESTS AN INSPECilONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. FUNCTIONAL FACTORY MEASURE LOCATION & S/N EVICE TYPE CHECK TEST SETTING SETTING ock oor, Mechanical Manual Pull Station Room Mechanical Room, above Photo etector FACP Mechanical Room Waterflow Alarm Mechanical Room Tameflr Switch PiV Outside Mechanical Tamer Switch Room Pit Outside Mechanical Tamer Switch Room Mechanical Room Waterflow Alarm Mechanical Room Waterflow Alarm Mechanical Room Ta!!J2:!r Switch Mechanical Room uct Photo etector Mechanical Room uct Photo etector PASS FAIL (NFPA Insection and Testing, 3 of 6)

23 SIEMENS BUILING TECHNOLOGIES, INC. FlAE SAFETY IVISION FUNCTIONAL FACTORY MEASURE LOCAllON & S/N EVICE TYPE CHECK TEST SETTING SETTING PASS FAIL Elevator Mechanical Manual Pull Station Room Outside. Elevator Mechanical Photo etector Room Outside. Elevator Mechanfcal Heat etector Room Outside. Rear Eit by Elevator Manual Pull Station 1st. fl. Bevator Lobbi'. Photo etector 1st.ff. Hall by Mens Photo etector Restroom 1st.fl. Hall by Womens Photo etector Restroom Hall by Room S-23A Photo etector Hall by Room S-22A, Photo etector Custodal Room 23 Manual Pull Station Room 22 Manual Pull Station 1st. ff. Hall by Office Photo etector Annunlcator Main Lobby Local Annunciator Main Entrance Manual Pull Station 2nd. fl. Elevator Lobby Photo etector 2ndff. Hall by Womens Photo etector Restroom Hall by Room S-33A Photo etector Hall by Room 5-32 Photo etector Hall bi'. Vending Room Photo etector Hall by Coy Room Photo etector * = Manually set the 'Pass' state Comments: All Initiating evices Tested Proerly. (NFPA Insection and Testing, 4 of 6)

24 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION AUIO FAILURES EVICE LIST LOCATION & 5/N Mechanical Room Mechanical Room Elevator Mechanical Room 1st.fl. Rear Eit 1 51.fl. Mens Restroom 1 51.fl. Womens Restroom Hall by Room S 23A Room S-23 Room S-24 Room S-23A Room S-22 Room S-22A Custodal Main Entrance Room 5 21 Office Office Conference Room Office Kitchen Room 5-38 To of Rear Stairs 2na.n. Womens Restroom 2nc1.fl.Mens Restroom Hall by S-33A Room 33 Room 34 Room S-33 Lab Room To of Front Stairs Room S-31 EVICE TYPE PASS FAIL Comments: All Seaker/s evices Tested Proerly. (NFPA Insection and Testing, S of 6)

25 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT FUNCTIONAL Phone Set Phone Jacks Off-Hook Indicator Amlifier(s) Tone Generator(s) call-in Signal System Performance EVICE INTERFACE EQUIPMENT OPERATION (Secify) Elevator Recall (Secify) AHU Shutdown (Secify) SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) SIMULATE OPERATION Secial Procedures: N n Comments: Non SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE YES No WHO Monitoring Agency Oerator Building Occuants All Building Management ale Reynolds other (Secify) TIME The following did not oerate correctly: The System Tested Good with no eficiencies. System restored to normal oeration: ate: Time: 2=:3---- THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS, Name of Insector: Matt Sherlock' ate: Time: 2:3 Signature: Name of Owner or Reresentative: _ale Reynolds. ate: Time: 2=:-3 Signature: {NFPA Insection and Testing, 6 of 6)

26 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE RGANIZAilON PROPERTY NAME {USER) ATE: TIME: 7: Name: Siemens Industries Inc. Name: Kctcs Maysville camus, Technology Center Address: 27 Stanley Gault Pkwy Address: 1755 US Hwy. 68 Louisville, Kentucky 4223 Maysville, Kentucky 4156 Reresentative: -'-' Matt ;;;;..;a. Sherlock"" OwnerContact: alereynolds=-::=--='."""'.'""" License No.: ;,_;. FA-'-R"-'-lc...;4..;;;_ 83;;... Telehone: (66) (Cell) (66} Telehone: ( 52) MONITORING ENTTTY Contact: Siemens Monitoring Telehone: (877} Monitoring Account Ref. No.: _ 1_12 8_8_7_1 TYPE TRANSMISSION McCulloh Multile!ti igital (SK-5129) Reverse Priority ORF Shunt Parallel Phone None other (Secify) APPROVING AGENCY Contact: Telehone: SERVICE Weekly Monthly Quarterly Semiannually Ii'.! Annually Other (Secify) Control Unit Manufacturer: Circuit Styles: Number of Circuits: Software Rev.: Notifier Class B 9 Model Number: _A F_P_-2 -e Location: 1st. fl. Mechanical Room T-117 Communicator: Net To FACP Last ate System Had Any Service Performed: --.,..., Last ate that Any Software or Configuration Was Revised: QUANTITY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLI: Photo etector Manual Pull Station uct Photo etector Waterflow Alarm Heat etector Annunicator Alarm Verification Feature is isabled Enabled X {NFPA Insection and Testing, 1 of 6)

27 SIEMENS BUILING TECHNOLOGIES, INC, FJRE SAFETY IVISION QUANTI'TY ALARM NOTIFICATION APPLIANCES AN CIRCUIT INFORMATION CIRCUIT STYLE 53_ Style Y s 9_ Style Y s Number of alarm notification aliance circuits: 8 Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYlE SIGNAUNG LINE CIRCUITS Tamer Switch Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity 1 Style(s) -=stv""'l""'e""" 4 SYSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage _12 Ams 2 Overcurrent Protection: Tye Breaker Ams 2 Location (of Primary Suly Panel Board): _... Pa._n""" el... ",..aa EA;..;." isconnecting Means Location:... R... oo... m... T- 1 17_._M_ec..._h... R... m.._ (b) Secondary (Standby): Storage Battery: Am-Hour Rating _7_._o Calculated Caacity to oerate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ry Cell Nickel-cadmium Sealed Lead-Acid Lead-Acid Other (Secify): (c) Emergency or Standby system used as a backu to rimary ower suly, instead of using a secondary ower suly: Emergency system described in NFPA 7, Article 7. Legally required standby described in NFPA 7, Article 71. Otional standby system described in NFPA 7, Article 72, which also meets the erformance requirements of Article 7 or 71. (NFPA Insectlon and Testing, 2 of 6)

28 ... SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occuants Building Management Other (Secify) AHJ Notified of Any Imairments PRIOR To ANY TESTING YES No WHO Oerator All ale Reynolds TIME TYPE Control Unit Interface Equiment Lams/LES Fuses Primary Power Suly Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS FUNCTIONAL Elevator Recall CoMMENTS SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test FUNCTIONAL Secific Gravity Transient Suressors Remote Annunciators 1st.Fl. Front Foyer, 1st.Fl. Rear Foyer NOTIFICATION ALIANCES Audible Visual Seakers Voice Clarity FUNCTIONAL INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE, FUNcnONAL FACTORY MEASURE LOCATION & 5/N EVICE TYPE CHECK TEST SETTING SETTING Room T-117, Mechanical Photo etector Room above FACP Room T 117, Mechanical Manual Pull Station Room Room T 117, Mechanical uct Photo etector Room above FACP Room T-116 Maint. Photo etector Room T-lOlL, Storage Waterflow Alarm b Office Room T-11L, Storage Tamer Switch b Office 1st.fl. Elevator Lobby Photo etector 1st.fl. North Eit Photo etector 1st. fl. North Eit Manual Pull Station 1st. fl. North Eit Manual Pull Station PASS (NFPA Insection and Testing, 3 of 6) FAIL

29 .. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION FuNcnONAL FACTORY MEASURE LOCATlON & 5/N EVICE TYPE CHECK TEST SETilNG SETilNG PASS FAIL 1st.fl. North Stairs Manual Pull Station Hall Eit by Room T 121 Manual Pull Station Hall Eit by Room T 121 Manual Pull Station Hall Eit by Room T 121 Photo etector 1st.fl. South Stairs Manual Pun Station Room T 11L, Storage Manual Pull Station b Office Room T 13, Hydraulics Manual Pull Station Room T los HVAC Manual Pull Station Room T 17, Indusbial Manual Pul Station Arts Room T 19, Manual Pull Station Construction Room T 19, Manual Pull Station Construction Room T 12, Elevator Photo etector Mechan:cal Room Main Foyer Photo etector Main Foyer Manual Pull Statton Main Foyer Manual Pull Station Room T 12, Elevator Heat etector Mechanlcal Room 2nd.fl. Elevator Lobby Photo etector To of Elevator Shaft Photo etector To of Elevator Shaft Heat etector 2nd.fl. Hall North Stairs Manual Pull Station 2nd.fl. Hall South Stairs Manual Pull Station Hall by Room T 219 Photo etector Hall by Room T 219 Manual Pull Station * = Manually set the 'Pass' state Comments: All Initiating evices worked Proerly. (N FPA Insection and Testing, 4 of 6)

30 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION AUIO FAILURES EVICE LIST LOCATION & 5/N EVICE TYPE PASS Comments: All s worked Proerly.. (NFPA Insection and Testing, 5 of 6)

31 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT FUNCTIONAL Phone Set Phone Jacks Off-Hook Indicator Amlifier( s) Tone Generator(s) call-in Signal System Performance EVICE SIMULATE INTERFACE EQUIPMENT OPERATION OPERATION (Secify) Elevator Recall (Secify) NAC Etender Panel (Secify) SPECIAL HAZAR SYSTEMS (Secify) (Secify) (Secify) Secial Procedures: N n SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Suervisory Signal Suervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE YES No WHO TIME Monitoring Agency Oerator Building Occuants All Building Management ale Reynolds other (Secify) The following did not oerate correctly: Nae Etender Panel. Notifier PN-FCP 24 The Fire Panel is Normal. Not Suervised. All Horn/s Tested Good. System restored to normal oeration: ate: Time: 1: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Insector: Matt Sherlock ate: Time: -=1=:=. _ Signature: Name of Owner or Reresentative: _ale Reynolds. ate: Time:...,1..,.:..:.::=' Signature: (NFPA Insection and Testing, 6 of 6)