INSPECTION AND TESTING FORM

Transcription

1 .. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION PROPERTY NAME (USER) ATE: TIME: 6: Name: Siemens Industries Inc. Name: Kctcs Somerset North,,~til!!!,k Bldg. Address: 27 Stanley Gault Parkway Address: 88 Monticello Street Louisville, Kentucky 4223 Somerset, Kentud<y_ 4251 Representative: _S=re=p=h~e=n~H=o=lb~ro~o=k OwnerContact: ~Jwelf. ~Ca... llen...,..d_er~----~~~-~ License No.: _F;...;.A_R Telephone: {66) Telephone: (52) MONITORING ENTITY APPROVING AGENCY Contact: ;,,,.N/'-'-A"" Contact: Telephone: Telephone: Monitoring Account Ref. No.: TYPE TRANSMISSION McCulloh Multiplex igital Reverse Priority RF o Shunt Parallel Phone li1'.i None System Not Monitored SERVICE Weekly Monthly Quarterly Semiannually li1'.i Annually Other (Specify) Other (Specify) Control Unit Manufacturer: Simplex.:.;=.;:; Model Number: 428 Circuit Styles: Class B Number of Circuits: 2 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 Style 4 Style 4 Style 4 Heat etector Manual Pull Station uct Photo etector Alarm Verification Feature is isabled Enabled X (NFPA Inspection and Testing, 1 of 6)

2 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPUANCES AN CIRCUIT INFORMATION CIRCUIT STYLE 4_ Style Y Homs -----=2:... Style Y Strobe Number of alarm notification appliance circuits: _2 Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG LINE CIRCUITS 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 -=12=' Amps 2 Overcurrent Protection: Type Breaker Amps 2 Location (of Primary Supply Panel Board):..,..:.;. No=..:t:...:.M..:.:a:.:.; rk:.::e:..: d (b) isconnecting Means Location:...:..: M=ec::.h:.::. a:.:.: ni.=ca:.:. l..:.: R:a:;.; oo"""m"'" Secondary (Standby): N/A Storage Battery: Amp-Hour Rating Calculated Capacity to operate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY O ry Cell Nickel-Cadmium o Sealed Lead-Acid O Lead-Acid ~ Other (Specify): Generator (c) Emergency or Standby system used as a backup to primary power supply, instead of using a secondary power supply: X Emergency system described in NFPA 7, Article Legally required standby described in NFPA 7, Article Optional standby system described in NFPA 7, Article 72, which also meets the performance requirements of Article 7 or 71. (NFPA Inspection and Testing, 2 of 6)

3 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments PRIOR To ANY TESTING YES No WHO N/A 6: Ii!! All 6: Ii!! Jeff callender 6: TIME TYPE Control Unit Interface Equipment Lamps/LES Fuses Primary Power Supply Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECllONS VISUAL Ii!! Ii!! Ii!! Ii!! Ii!! Ii!! FUNCTIONAL Ii!! Ii!! Ii!! Ii!! Ii!! Ii!! NAC Extender Panel SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Specific Gravity Transient Suppressors Remote Annunciators VISUAL FUNCTIONAL N/A NOTIFICATION APPUANCES Audible Visual Speakers Voice Clarity VISUAL Ii!! Ii!! FUNCTIONAL Ii!! Ii!! INMATING AN SUPERVISORY EVICE TESTS AN INSPECllONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. LOCAllON & VISUAL functlonal FACTORY MEASURE 5/N EVICE TYPE CHECK TEST SETTING SETTING PASS Mechanical Heat etector x x p Room New Computer Heat etector x x p Lab ellv~ ock Manual Pull Station x x p Testing Hall Exit Manual Pull Station x x p Rear Exit by Manual Pull Station x x p Office Rear Exit by Manual Pull Station x x p Restrooms Front esk Heat etector x Main Entrance Manual Pull Station x x p Janitor's Ooset Heat etector x p ata Room Heat etector x p Office Heat etector x p (NFPA Inspection and Testing, 3 of 6) FAIL F

4 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION& VISUAL FUNCTlONAL FACTORY MEASURE S/N MCETYPE CHECK TEST SETTING SETTING PASS FAIL Office Heat etector p Office Heat etector p Office Heat etector p Library by Isle Heat etector x F N 31 Office Heat etector p Library, Heat etector x p Computers by Offices Office Heat etector x p Library Heat etector x p Computers by Restrooms Mechanical uct Photo etector x x p Room Mechanical uct Photo etector x x p Room Mechanical uct Photo etector x x p Room, above FACP * = Manually set the 'Pass' state (NFPA Inspection and Testlng, 4 of 6)

5 .. SIEMENS SIEMENS BUILOlNG TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION & S/N Main UbraN Far Wall by Books Main Library by Break Area Computer Lab Testing Room Womens Restroom Mens Restroom AUIO VISUAL FAILURES EVICE LIST AudioNisual AudioNlsual AudloN isual Audio/Visual Strobe Strobe EVICE TYPE PASS x x FAIL Comments: All devices worked properly. (NFPA Inspection and Testing, 5 of 6)

6 .. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT VISUAL FUNcnONAL Phone Set Phone Jacks Off-Hook Indicator Amplifier(s) Tone Generator(s) Call-in Signal System Performance EVICE INTERFACE EQUIPMENT VISUAL OPERATION (Specify) NAC Extender Panel ltj ltj (Specify) (Specify) SPECIAL HAZAR SYSTEMS (Specify) (Specify) (Specify) SIMULATE OPERATION ltj Special Procedures: None SUPERVISING STATION MONITORING Yes No TIME Alarm Signal NLA Alarm Restoration Supervisory Signal Supervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE Yes No WHO Monitoring Agency NLA Building Occupants ltj All Building Management ltj Jeff ~llen~er Other (Specify) 7: 7: TIME The following did not operate correctly: One uct in the Me!:hsini!;i!l [QQm did not shutdown the ynit. THIS TEmNG WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Inspector: Stephen Holbrook ate: nme: 7._.:..,.,., _ Signature: Name of owner or Representative: -=J=eff'-'--"Ca=l=le=n=de=r ate: Time: _7:..::=,. _ Signature: (NFPA Inspection and Testing, 6 of 6)

7 - SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFl!TY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION PROPERTY NAME (USER) ATE: B:1 TIME: 1:3 Name: Siemens Industries Inc. Name: Kctcs Somerset North Campus, Stoner Bldg. Address: 27 Stanley Gault Parkway Address: 88 Monticello Road Louisville, Kentucky 4223 Somerset Kentucky 4251 Representative: _S~t ep~h~e~n_h~o=lb~ro~o~k Owner Contact: _J~e~ff~Ca """':"": lle~n.de~r.,... License No.: ---'-' FA_R_-1_4-'-9_5 Telephone: {66) Telephone: (52) MONITORING ENTITY Contact: Siemens Monitoring Telephone: (877) Monitoring Account Ref. No.: --=11= = APPROVING AGENCY Contact: Telephone: TYPE TRANSMISSION McCulloh Multiplex Ii:! igital Reverse Priority ORF Shunt Parallel Phone None other (Specify) SERVICE Weekly Monthly Quarterly Semiannually It! Annually other (Specify) """"'"--'-'--~ Control Unit Manufacturer: Notifier Model Number: AFP-2 Circuit Styles: Class B Number of Circuits: 5 Software Rev.: Last ate System Had Any Service Performed: Last ate that Any Software or Configuration Was Revised: QUANTTIY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYt.E Style 4 Style 4 Style 4 Photo etector Manual Pull Station uct Photo etector Alarm Verification Feature is isabled Enabled X (NFPA Inspection and Testing, 1 of 6)

8 . SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPLIANCES AN CIRCUIT INFORMATION CIRCUIT STYLE ;2='-- Style Y Horn/Strobes 4'-- Style Y Strobe Number of alarm notification appliance circuits: _4 Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE SIGNAUNG UNE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1}: Quantity 1 Style(s) Sty!..._ e... 4 SVSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage 12 Amps _2~: vercurrent Protection: Type Breaker Amps 2 ~-= ~~~---- Location (of Primary Supply Panel Board): -=L..a;;.;;b..;;. el~ed;;;...; "E;;;.;m~e-rg;L;e;;.;ncv ;.;::.&...P;...;:a;;.;.;n;;;;; el:... " isconnecting Means Location: BasemeQ!:_Mechanical, Next to FACP (b) Secondary (Standby): Storage Battery: Amp-Hour Rating _7"' Calculated Capacity to operate system, in Hours: 24 24,..., ,..., Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY O ry Cell Nickel-Cadmium Ii!! Sealed Lead-Acid Lead-Acid Other (Specify): (c) Emergency or Standby system used as a backup to primary power supply, instead of using a secondary power supply: Emergency system described in NFPA 7, Artide 7. Legally required standby described in NFPA 7, Article 71. Optional standby system described in NFPA 7, Article 72, which also meets the performance requirements of Article 7 or 71. (NFPA Inspection and Testing, 2 of 6)

9 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments YES PRIOR To ANY TESTlNG No WHO Operator All Jeff callender 1:3 1:3 1:3 TIME TYPE Control Unit Interface Equipment Lamps/LES Fuses Primary Power Supply Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN lnspecfions VISUAL FUNCTIONAL Elevator Recall. AHU Shutdown, oor Holders SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Specific Gravity Transient Suppressors Remote Annunciators VISUAL FUNCTIONAL Main Lobby NOTIFICATION APPUANCES Audible Visual Speakers Voice Clarity VISUAL FUNCTIONAL lnitiatlng AN SUPERVISORY EVICE TESTS AN lnspecfions *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLU E: HERE. LOCATION & VISUAL FUNCTIONAL FACTORY MEASURE S/N EVICE TYPE CHECK TEST SETTING SETTING PASS Ol, 1 11 fl. Elev. Photo etector x x p Mech Room 2, l si,fl. Photo etector x x p Elevator Lobbl:'.: 3, 2iiii.fl. Photo etector x x p Elevator Lob!?i FAIL 5, Basement Photo etector x x p Mech. Room 6, Room uct Photo etector x x p 14 (NFPA Inspection and Testing, 3 of 6)

10 S'IEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION& VISUAL FUNCTlONAL FACTORY MEASURE S/N EVICE TYPE CHECK TEST SETTING SETTING PASS FAIL -1, 2nc1.fl. uct Photo etector x x p Mech. Room lll 2nc1.fl. Hall uct Photo etector x x p M-2,Basement Manual Pull Station x x p Mech. Room M-3, 1 51.fl. Manual Pull Station x x p Main Lobb M 4, Theatre Manual Pull Station x x p Exit M OS, Hall by Manual Pull Station x x p 114A M 6, Stair Exit Manual Pull Station x x p b Room 12 M-7, Exit by Manual Pull Station x x p Room 211 M OS, Exit by Manual Pull Station x x p Mech. Room M 9, Primary Relay x x p Elevator Recall M 1, Alternate Relay x x p Elevator Recall M ll, Fire Hat Rela'.l'. x x p M-12, Shunt Relay x x p Tri M-13, oor Relay x x p Holders M l5, AHLI Relay x x p Shutdown Mech M-16, AHLI Relay x x p Shutdown Hall M-17, Exhaust Relay x x p Fan Shutdown 14 * = Manually set the 'Pass' state Comments: All initiating evices Worked Properly. The units did not shutdown when ducts were in alarm. (NFPA Inspection and Testing, 4 of 6)

11 . s1 EMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION AUIO VISUAL FAILURES EVICE LIST LOCATION & S/N Basement Mechan!cal Room ""!ntry by Art Gallery Hall by Room 12 Room 14 Room l4c Room 11 Room 198, Men's ressing Room Room 19 Men's Restroom Room 19A, Women's ressing Room Room 19 Womens Restroom Hall by Room 11 Rear Exit Auditorium Backstage Top Q! f"lain Stairs Hall by Room 223 Room 219 Room 26 Room 211 Hall by Room 211 Main Lobby Men's Restroom Main LobbyW omen's Restroom 2"'. Fl. Men's Restroom 2,a. Fl. Women's Restroom Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Horn/Strobe Strobe Hom/Strobe Strobe Hom/Strobe. Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Hom/Strobe Strobe Strobe Strobe Strobe EVICE TYPE PASS x x x x x x x x x F.ut. Commefl.ts: All Hom!Strotes worked Properly. (NFPA Inspection and Testing, S of 6)

12 s1emens SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT VISUAL FUNCTIONAL Phone Set Phone Jacks Off-Hook Indicator Amplifier(s) Tone Generator(s) Call-in Signal System Performance EVICE INTERFACE EQUIPMENT VISUAL OPERATION (Specify) Elevator Recall ~ ~ (Specify) AHU Shutdown,/ ~ (Specify) oor Holders ~ ~ (Specify) SPECIAL HAZAR SYSTEMS (Specify) (Specify) (Specify) SIMULATE OPERATION Special Procedures: Units did not shutdown when any of the duct detectors were activated SUPERVISING STATION MONITORING YES No TIME Alarm Signal ~ Alarm Restoration ~ Supervisory Signal Supervisory Restoration Trouble Signal ~ Trouble Restoral ~ NOTIFICATIONS THAT TESTING IS COMPLETE YES No WHO TIME Monitoring Agency OE!erator 5: Building Occupants ~ All 5: Building Management ~ Jeff Callender 5: Other (Specify) The following did not operate correctly: System restored to normal operation: ate: Time: 5: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS, Name of Inspector:... s...,te... o... he... n... H broo... k"' ate: Time: """'S"":~~---- Signature: Name of Owner or Representative: _Jeff Callender ate: Time: 5:. Signature: (NFPA Inspection and Testing, 6 of 6)

13 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM ATE: TIME: 1:3 SERVICE ORGANIZATION PROPERTY NAME (USER} Name: -=Si=em... en s-al... nd=u=stri = e.:;.. s=in=c.;_. Name: Kctcs Somerset North, Meece Bldg. Address: 27 Stanley Gault Parkway Address: 88 Monticello Road Louisville, Kentucky 4223 Somerset, Kentucky 4251 Representative: -=st~e~ph~e_n_h~o~lb~roo a... k OWnerContact: _J~e~ff~Ca... lle~n=d~er ~~--~ License No.:...;..;. FA_R_-1_4_9_5 Telephone: (66) Telephone: (52) MONITORING ENTITY APPROVING AGENCY Contact: -=Si=em---'- en~s Contact: Telephone: Telephone: Monitoring Account Ref. No.: --=11=2==9;;..;.7..;;. 8;;;... TYPE TRANSMISSION McCulloh Multiplex ~ igital Reverse Priority RF Shunt Parallel Phone None Other (Specify) SERVICE Weekly O Monthly Quarterly Semiannually ~Annually Other (Specify) _ Control Unit Manufacturer: EST Model Number:...;.;; i5g... ~;..._ Circuit Styles: """""' Cl=as=s;...;;B;... Number of Circuits: -=2 Software Rev.: Last ate System Had Any Service Performed: -=2-4...:...:-1=5 Last ate that Any Software or Configuration Was Revised: -=- 2-..;;; 3...;; -1;.;;5 QUANTITY ALARM-INMATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style 4 Style 4 Style4 Style 4 Manual Pull Station Heat etector Photo etector uct etector Alarm Verification Feature is isabled Enabled X (NFPA Inspection and Testing, 1 of 6)

14 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION ALARM NOTIFICATION APPUANCES AN CIRCUIT INFORMATION QUANTllY CIRCUIT STYLE 44.;..;... Style Y Hom/Strobe ;;2;... Style Y Strobe Number of alarm notification appliance circuits: _4...;... Are circuits monitored for integrity? Yes QUANTITY SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT SlYLE SIGNAUNG LINE CIRCUITS Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity 1 Style(s) SYSTEM POWER SUPPUES (a) ;... Primary (Main): Nominal Voltage ---=12=' Amps ~2;... Overcurrent Protection: Type Breaker Amps 2 Location (of Primary Supply Panel Board): isconnecting Means location: ;;:;. El;.;:; ectri =-" ca ~ I R"-"oo = m., (b) Secondary (Standby): Storage Battery: Amp~Hour Rating --'- 7 calculated capacity to operate system, in Hours: X Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY O ry Cell Nickel-cadmium ~Sealed lead-acid Lead-Add other (Specify): (c) Emergency or Standby system used as a backup to primary power supply, instead of using a secondary power supply: Emergency system described in NFPA 7, Article Legally required standby described in NFPA 7, Article Optional standby system described In NFPA 7, Article 72, which also meets the performance requirements of Article 7 or 71. (NFPA Inspection and Testing, 2 of 6)

15 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occupants Building Management other (Specify) AHJ Notified of Any Impairments PRIOR TO ANY TESTING YES No WHO N/A 1:3 21 All 1:3 21 Jeff Callender 1:3 TIME TYPE Control Unit Interface Equipment Lamps/LES Fuses Primary Power Supply Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS VISUAL FUNCTIONAL oor Holders (Qty. 4) SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Specific Gravity Transient Suppressors Remote Annunciators VISUAL 21 FUNCTIONAL new NOTIFICATION APPLIANCES Audible Visual Speakers Voice Clarity VISUAL 21 FUNCTIONAL 21 INmATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVI CfS THAT HAVE BEEN TESTE ARE INCLUE HERE. LOCATION& VISUAL FUNtnONAL FACTORY MEASURE 5/N EVICE TYPE CHECK TEST 5ETT1NG SETTlNG PASS FAIL Front office uct etector x x p Boller Room Heat etector x x p Boller Room Heat etector x x p Ga@!Je Heat etector x x p Garage Tool Heat etector x x p Crib Auditorium Heat etector x x p Auditorium Heat etector x x p Auditorium Heat etector x x p Auditorium Heat etector x x p Math Lab Heat etector x x p Math Lab Heat etector x x p Math Lab Heat etector x x p (NFPA Inspection and Testing, 3 of 6)

16 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION& VISUAL FUNcnONAL FACTORY MEASURE S/N EVICE TYPE CHECK TEST SETTING SETTING PASS FAIL Math Lab Heat etector p Janitor Ooset Heat etector p Janitor aoset Heat etector p Chem Lab Heat etector p Chem Lab Heat etector p Chem Lab Heat etector p Blol29t lab Heat etector p BIOIQ2i:'. Lab Heat etector p BIOIQI: Lab Heat etector p Ph~ cs Lab Heat etector p Ph~ cs Lab Heat etector p Above FACP Heat etector x p Storage Heat etector p Teachers Heat etector x x p Lou e Auditorlum Heat etector x x p Ooset Comm aoset Heat etector x x p Mall Room Heat etector x x p Mail Room Heat etector x x p aassroom Heat etector x p aassroom Heat etector x p a ass room Heat etector x p Central Hanwal Photo etector x x p Central HaHwai Photo etector x x p Central Hallwal Photo etector x x p Central Hallwa:r: Photo etector x x p Central Hanwa~ Photo etector x x p Central Hanwa~ Photo etector x x p Central Hallwal Photo etector x x p Central HaHwa~ Photo etector x x p Lobb~ Photo etector x x p Lobbi Photo etector x x p Front Entrance Photo etector x x p Employee Photo etector x x p Loun e WestHaHwa~ Photo etector x x p WestHaHwa:r: Photo etector x x p WestHallw~ Photo etector x x p WestHanw~ Photo etector x x p West Hanwal Photo etector x x p West Hanwai Photo etector x x p West Hanwai Photo etector x x p WestHallwa:t: Photo etector x x p East Hallwai Photo etector x x p East Haflwa)'. Photo etector x x p East Hanwak': Photo etector x x p East Hallwal:'.: Photo etector x x p East Hanwa~ Photo etector x x p East Hallwa~ Photo etector x x p East Hallwa~ Photo etector x x p EastHallwa~ Photo etector x x p Above FACP Photo etector x x p. Bl FACP Manual Pull Station x x p *=Manually set the 'Pass' state Comments: All Initiating evices Worked Properly. (NFPA Inspection and Testing, 4 of 6)

17 '. SIEMENS SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION AUIO VISUAL FAILURES EVICE LIST LOCATION & S/N EVICE TYPE PASS FAR (NFPA Inspection and Testing, 5 of 6)

18 . St'EMENS SIEMENS BUILING TECHNOLOGIES, INC, FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT VISUAL FUNCTIONAL Phone Set Phone Jacks Off-Hook Indicator Amplifier(s) Tone Generator(s) call-in Signal System Performance EVICE INTERFACE EQUIPMENT VISUAL OPERATION (Specify) (Specify) AHU Shutdown,/ (Specify) oor Holders (Specify) SPECIAL HAZAR SYSTEMS (Specify) (Specify) (Specify) SIMULATE OPERATION Ii'.[ It[ [J Special Procedures: Units did not shutdown when any of the duct detectors were activated SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Ii'.[ Supervisory Signal Supervisory Restoration Trouble Signal It[ Trouble Restoral It[ NOTIFICATIONS THAT TESTING IS COMPLETE YES No WHO TIME Monitoring Agency It[ OE!erator 5: Building Occupants It[ All 5: Building Management It[ Jeff carrender 5: Other (Specify) The following did not operate correctly: System restored to normal operation: ate: nme: 5: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS, Name of Inspector: --=st=e... o... he... n... H... o... 1b... r... oo' "k., _ ate: 3+16 nme:~5=:=,. _ Signature: Name of Owner or Representative: Jeff caljender ate: nme: 5: Signature: {NFPA Inspection and Testing, 6 of 6)

19 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION PROPER1Y NAME {USER} ATE: TIME: 1:3 Name: Siemens Industries Inc. Name: Kctcs Somerset North, Cooper Bldg Address: 27 Stanley Gault Parkway Address: 88 Monticello Road Louisville, Kentucky 4223 Somerset, Kentucky 4251 Representative: _S~t=ep=h=e~n~H=o=lb~roo~k Owner Contact: ~J~e~ff~Ca =,;.a lle~n=d~er ~ License No.: --'--'FA""""R""--1.;;_4;..c..9.;;_5 Telephone: (66) Telephone: (52) MONITORING ENT11Y TYPE TRANSMISSION McCulloh Multiplex li1'.i igital O Reverse Priority ORF Shunt Parallel Phone None APPROVING AGENCY Contact: Siemens Monitoring Contact: Telephone: (877) Telephone: Monitoring Account Ref. No.: --=1=12=..;;.8=8;;...;;8=3 SERVICE Weekly O Monthly Quarterly o Semiannually li1'.i Annually Other (Specify) Other (Specify) Control Unit Manufacturer: Simplex Model Number: -=2;;..,;""' 1 Circuit Styles: Number of Circuits: _C=l ass ;;.;;...;;;B' _2 Software Rev.: Last ate System Had Any Service Performed: Last ate that Any Software or Configuration Was Revised: QUANT11Y ALARM.. INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT SlYLE Style 4 Style 4 Style 4 Manual Pull Station uct Photo etector Waterflow Alarm Alarm Verification Feature is isabled Enabled x (NFPA Inspection and Testing, 1 of 6)

20 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION ALARM NOTIFICATION APPLIANCES AN CIRCUIT INFORMATION QUANTITY CIRCUIT STYLE...;;; 6_ Style Y Six Audio/ Visuals Number of alarm notification appliance circuits: _2 Are circuits monitored for integrity? Yes QUANTITY 1 SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style 4 SIGNAUNG LINE CIRCUITS PIV Tamper Switch, Outside of Mechanical Room. 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 12 Amps 2 Overcurrent Protection: Type Breaker Amps 2 Location (of Primary Supply Panel Board): _E... "-' A isconnecting Means Location:...;.;; Ro;;;;..;o;.;;m;.;..;;;.; 11:a.;;3;.i;..;..M""' ec.aa;.h""a.a ni""' ca""i (b) Secondary (Standby): Storage Battery: Amp Hour Rating calculated capacity to operate system, in Hours: Engin~driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ry Cell Nlckel cadmium ~ Sealed Lead Acid Lead-Acid Other (Specify): (c) Emergency or Standby system used as a backup to primary power supply, instead of using a secondary power supply: Emergency system described in NFPA 7, Article Legally required standby described in NFPA 7, Article Optional standby system described in NFPA 7, Article 72, which also meets the performance requirements of Article 7 or 71. (NFPA Inspection and Testing, 2 of 6)

21 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION PRIOR To ANY TESTING NOTIFICAnONS ARE MAE YES No WHO TIME Monitoring Entity O~ rator Building Occupants All Building Management Jeff Callender other (Specify) AHJ Notified of Any Impairments SYSTEM TESTS AN INSPECTIONS TYPE VISUAL FUNCTIONAL Control Unit Interface Equipment Lamps/LES Fuses Primary Power Supply Trouble Signals isconnect Switches Ground-Fault Monitoring SECONARY POWER TYPE VISUAL FUNCTIONAL Battery Condition Load Voltage ischarge Test Charger Test Specific Gravity Transient Suppressors Remote Annunciators NOTIFICATION APPLIANCES VISUAL FUNCTIONAL Audible Visual Speakers Voice arity INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. LOCATlON& VISUAL FUNCTlONAL FACTORY MEASURE S/N EVICE TYPE CHECK TEST SETTlNG SETTlNG PASS FAIL Zone 1, Hall by Manual Pull Station x x p Break Room Zone 1, Main Manual Pull Station x x p Entrance Zone 1, Room Manual Pull Station x x p 1 Exit Zone 1, Loading Manual Pull Station x x p ock Zone 3, uct Photo etector x x p Mechanical Rm. Zone 3, uct Photo etector x x p Mechanical Rm. Zone 5, Waterflow Alarm x x p Mechanical Rm. (NFPA Inspection and Testing, 3 of 6)

22 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCA11N& VISUAL FUNCTIONAL FACTORY MEASURE 5/N EVICE TYPE CHECK TEST SET11NG 5ET11NG PASS Zone 6, tamper Switch x x p FAIL Mechanical Rm. Zone 1, Manual Pull Station x x p Mechanical Rm. Zone 1, Room Manual Pull Station x x p 114 Zone 2, Hall Manual Pull Station x x p Exit to Parking Lot * = Manually set the 'Pass' state Comments: All Initiating evices worked Properly. ucts didn't not shut down units. (NFPA Inspection and Testing, 4 of 6)

23 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION AUIO VISUAL FAILURES EVICE UST LOCATlON & Sf N Hall by Room 114 Room 112, Supply Room Room 113. Mechanical Room Hall by Room 11 Hall by Room 11 _ Hall by Restrooms Audio,Ms~al Audio/Visual Audio/Visual Audlo(Yisual AudJoJylsual AudioM sual EVICE TYPE PASS x FAil. Comments: All indicating devices worked properly. (NFPA Inspection and Testing, s of 6)

24 fl/j II_ I I SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT VISUAL funcilonal Phone Set Phone Jacks Off-Hook Indicator Amplifier(s) Tone Generator(s) can-in Signal,IJ System Performance EVICE INTERFACE EQUIPMENT VISUAL OPERATION (Specify) (Specify) (Specify) SPECIAL HAZAR SYSTEMS (Specify) (Specify) (Specify) SIMULATE OPERATION Special Procedures: N ne SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Supervisory Signal Supervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE YES No WHO Monitoring Agency 12erator Building Occupants All Building Management Jeff Callender other (Specify) TIME The following did not operate correctly: System restored to normal operation: ate: Time: 3: THIS TEmNG WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Inspector: Stephen Holbrook Time: 3: Signature: Name of Owner or Representative: _Jeff callender ate: Time: _.3... :=... Signature: (NFPA Inspection and Testing, 6 of 6)

25 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM SERVICE ORGANIZATION Name: Address: Representative: License No.: Telephone: (52) PROPERTY NAME (USER} ATE: TIME: 1: Kctcs Somerset North, Hal Rodgers Student Siemens Industries Inc. Name: -=Co~m,:.::m-...o::..:n.::s;...,,,, 27 Stanley Gault Parkway Address: 88 Monticello Road Louisville, Kentucky 4223 Somerseti entucky 4251 St=e=ph~e=n~H=o=lb~ro=o~k OwnerContact: _.. Jeff~ca..a..Uewn~d.er..._~ '-'FA-'-R"" '-o, Telephone: (66) MONITORING ENTITY AJIPROVING AGENCY Contact: Siemens Monitoring Contact: Telephone: (52) Telephone: Monitoring Account Ref. No.: -=11=2==5;;..;4""" " TYPE TRANSMISSION McCulloh Multiplex l!i igital Reverse Priority ORF Shunt Parallel Phone None Other (Specify) SERVICE O Weekly O Monthly Quarterly Semiannually l!i Annually Other (Specify) Control Unit Manufacturer: Siemens _;_;.;...;.;;c..;,... ~ Model Number: MXLV Orcuit Styles: ;;.==;...;;;_ Oass B Number of Circuits: --=- 4 Software Rev.: --=- 1::..:.=. 24..;. Last ate System Had Any Service Performed: Last ate that Any Software or Configuration Was Revised: -=12=--.:; 1=---=.c 9:: QUANilTY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style 4 Style 4 Style 4 Style4 Style 4 Photo etector Manual Pull Station Heat etector Waterflow Alarm uct Photo etector Alarm Verification Feature is isabled Enabled X (NFPA Inspection and Testing, 1 of 7)

26 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION ALARM NOTIFICATION APPLIANCES AN CIRCUIT INFORMATION QUANTI1Y CIRCUIT STYLE 4.:..:6:... Style Y Speaker/Strobes...::;.;; 21a... Style Y Strobe Number of alarm notification appliance circuits: -=- 2 Are circuits monitored for integrity? QUANTTIY 6 Yes SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style4 SIGNAUNG LINE CIRCUITS Tamper Switch Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity 2 Style(s) _;styl=e=-4...:... _ SYSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage 12 Amps _2:.:= vercurrent Protection: Type Breaker Amps _ 2:.:= Location (of Primary Supply Panel Board): _;..; Pa;.;.:n~el:... "..: E...:1:... " isconnecting Means Location:...,,. El""' ectri ::;:..:; ca ;::;.. t R:...:o;;.;;o;.;.;m.;..;Ba = se.;;;m~e;::;.;n.:..: t (b) Secondary (Standby): Storage Battery: Amp-Hour Rating...;;;;.; 35' calculated capacity to operate system, in Hours: Engine-driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY ry Cell Nickel-cadmium ti'.'.l Seated Lead-Acid Lead-Acid Other (Specify): (c) Emergency or Standby system used as a backup to primary power supply, instead of using a secondary power supply: Emergency system described in NFPA 7, Artide Legally required standby described in NFPA 7, Artide Optional standby system described in NFPA 7, Artide 72, which also meets the performance requirements of Article 7 or 71. (NFPA Inspection and Testing, 2 of 7)

27 SIEMENS BUILING TECHNOLOGtES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments PRIOR To ANY TESTING YES No WHO!ti Operator!ti CJ All!ti Jeff canender TIME TYPE Control Unit Interface Equipment Lamps/LES Fuses Primary Power Supply Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPECTIONS VISUAL c!ti FUNCTIONAL ~ oor Holders!ti It'.! SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Specific Gravity Transient Suppressors Remote Annunciators VISUAL It'.! FUNCTIONAL NOTIFICATION APPUANCES Audible Visual Speakers Voice Oarity VISUAL!ti It'.! FUNCTIONAL ~ INITIATING AN SUPERVISORY EVICE TESTS AN INSPECTIONS *NOTE: ONLY EVICES THAT HAVE BEEN TESTE ARE INCLUE HERE. LOCATION& VISUAL FUNCTlONAL FACTORY MEASURE S/N EVICE TYPE CHECK TEST SETTING SETTING PASS 1 1, Photo etector x p Basement Stailwell"B" 1-2, Basement Hall Photo etector x p , Basement Hall Photo etector x p , Basement Photo etector x p Elevator Lobb:t'. 1-5, Basement Photo etector x p Lobb 5 FAIL (NFPA Inspection and Testing, 3 of 7)

28 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION& VISUAL FUNCTIONAL FACTORY MEASURE 5/N EVICE TYPE CHECK TEST SEmNG SEmNG PASS 1-6, Photo etector x p Basement Hall FAIL , Basement Photo etector x p Elevator Mech. Room 1-8, Photo etector x p Basement Comm 6 1-9, Heat etector x p Basement Elevator Mech. Room 1-11, Basement Manual Pull Station x p Lobb , Basement Manual Pull Station x p Stairwell "B" 1-13, Basement by Manual Pull Station x p Electrical Room 1-14, Waterflow Alarm x p Basement , Tamper x p Basement , uct Photo etector x p Basement Mech. Room 1-18, Fl. 1 Photo etector x p Stairwell "A" 1-19, Recptlon Photo etector x p Area l 2, Records Photo etector x p 11A 1-21, Records Photo etector x p lla 1 22, Storage Photo etector x p , Fl.1 Photo etector x p Central Records 1-24, Fl.1 Photo etector x p Central Records 1-25, Common Photo etector x p Room , Fl.1 Photo etector x p Elevator Lobb~ 1 27, A.1 Photo etector x p Stairwell "B" 1-28 Hall 134 Photo etector p 1-29, Lobby Photo etector x p Hall 138 Photo etector p 1 31, Fl. 1 Manual Pull Station x p Stairwell "A" 1 32, Main Manual Pull Station x p Lobbt Recotion 1-33, Main Manual Pull Station x p Lobt!}i; Rm:itlon 1 34, A. 1 Stairwell "B" Manual Pull Station x p (NFPA Inspection and Testing, 4 of 7)

29 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION LOCATION& VISUAL functlonal FACTORY MEASURE 5/N EVICE TYPE CHECK TEST SETTING SETTING PASS FAIL 1 35, Main Manual Pull Station x p Lobb 1 36, Main Manual Pull Station x p Lobb 1-37, Manual Pull Station x p Vestibule , ryfood Manual Pull Station x p Stora e 1-39, Fl. 1 Manual Pull Station x p Receiving Exit 1-4, Waterflow Alann x p Basement , Tamper x p Basement , Room Waterflow Alann x p , Room Tamper x p 16 1~44, ialer Relfil:: x p 1-45, Custodal Photo etector x p , Fl. 1 Manual Pull Station x p Stairwerl "C" 1 51, PA Relay x p CUstodal , Fl.2 Photo etector x p Stairwell "A" 2 2 Hall 23 Photo etector x p 2 3, Comm Photo etector x p Room , 2na.n. Photo etector x p Elevator LobI:: 2-6, Custodal Photo etector x p Room , Fl.2 Heat uct Photo etector x p Pum 1 2 8, FJ.2 Heat uct Photo etector x p Pu 2 2 9, Fl.2 uct Photo etector x p MAU l 2 1, 2n.1.fl Photo etector x p Stairwell "B" 2-11 Hall 229 Photo etector x p Hall 23 Manual Pull Station x p 2 13 Hall 229 Manual Pull Station x p 2-14, Custodal Waterflow Alann x p Room , Custodal Tamper x p Room , Above Photo etector x p FACP *.. Manually set the 'Pass' state Comments: All initiating evices Worked Properly. We were unable to test shutdowns due to the units not running. They are set up on a system to shutdown in the evening. (NFPA Inspection and Testing, 5 of 7)

30 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY OtVISJON AUIO VISUAL FAILURES EVICE LIST LOCATION & Sf N EVICE TYPE PASS FA.tt. Comments: All Speaker/Strobes Worked Properly. (We did replace a speaker strobe in the cafeteria} (NFPA Inspection and Testing, 6 of 7)

31 SIEMENS BUILOING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT VISUAL FUNCTIONAL Phone Set Phone Jacks Off-Hook Indicator Amplifier(s) Tone Generator(s) call-in Signal System Performance EVICE SIMULATE INTERFACE EQUIPMENT VISUAL OPERATION OPERATION (Specify) Elevator Recall Ii:'.! (Specify) oor Holders (Specify) SPECIAL HAZAR SYSTEMS (Specify) (Specify) (Specify) Special Procedures: None SUPERVISING STATION MONITORING YES No TIME Alarm Signal Alarm Restoration Ii:'.! Supervisory Signal Supervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING IS COMPLETE YES No WHO TIME Monitoring Agency O~ rator Building Occupants Ii:'.! All Building Management Ii:'.! Jeff canender Other (Specify) The following did not operate correctly: System restored to normal operation: ate: Time: 3: THIS TESTING WAS PERFORME IN ACCORANCE WITH APPUCABLE NFPA STANARS. Name of Inspector:...,,S=te,..p=h=en:.:...:..:H=ol=b"-"roo=k ate: Time:~3~:~.. _ Signature: Name of Owner or Representative: _.J""eff,.,_,.C,...al,...,,le...:ne.:.de:.:.:r ate: Time:.3=:""". _ Signature: (NFPA Inspection and Testing, 7 of 7)

32 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION INSPECTION AN TESTING FORM PANEL: NEW PANEL ATE: 3+16 TIME: 1:3 SERVICE ORGANIZATION PROPERTY NAME (USER) Name:...aa..Si em... en s B u ild in... g._t... ec~hn..;.;;o;.;.clog~ies=--- Name: Kctcs Somerset North Campus, Alton E. Blakley Building Address: 27 Stanley Gault Parkway Address: 88 Monticello Road, Somerset, Kentucky Louisville, Kentucky Representative:...a..st~e~Ph... e... n_h~o... lb... roo... k Owner Contact: _J~e~ff~Ca :=.;; lla~n~d~er;._,. ~ License No.: _F_AR_-_ _5 Telephone: (66) Telephone: (52) Contract# Contract Start ate Contract End ate MONITORING ENTITY APPROVING AGENCY Contact: Siemens Monitoring Contact: Telephone: (877) Telephone: Monitoring Account Ref. No.: _21_s_o_oo_s_o_s TYPE TRANSMISSION McCulloh O Multiplex ~ igital Reverse Priority ORF Shunt O Parallel Phone ONone Other (Specify) SERVICE Weekly Monthly O Quarterly Semiannually &::I Annually Other (Specify) Type of System Control Unit Manufacturer: _S_le_m_e_n_s Model Number: ;_M..;.;.X;;.;;: L Orcuit Styles: aass A and Class B Location: Attic Mechanical Room Number of Circuits: 2 Communicator Location: Next To FACP Software Rev.: Last ate System Had Any Service Performed: Last ate that Any Software or Configuration Was Revised: QUANlITY ALARM-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYU: Style 7 Style 7 Style 7 Style 7 Heat etector Photo etector Manual Pull Station uct etectors Alarm Verification Feature is isabled Enabled X NFPA lnspedion and Testing ocument# Revision#: o Page 1 of 9(NFPA Inspection and Testing, 1 of 9)

33 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION QUANTITY ALARM NOTIFICATION APPLIANCES AN CIRCUIT INFORMATION CIRCUIT STYLE 5_1_ Style Y Horn/Strobes 6_ Style Y Strobes Number of alarm notification appliance circuits: _2 Are circuits monitored for integrity? Yes QUANTITY 7 SUPERVISORY SIGNAL-INITIATING EVICES AN CIRCUIT INFORMATION CIRCUIT STYLE Style 4 SIGNAUNG LINE CIRCUITS Tamper Switch Quantity and style of signaling line circuits connected to system (see NFPA 72 1 Table 6.6.1): Quantity 2 Style(s) no.._n... e SYSTEM POWER SUPPUES (a) Primary (Main): Nominal Voltage _ 1_2 Amps 2 Overcurrent Protection: Type Breaker Amps 2 Location (of Primary Supply Panel Board): Panel "E2" isconnecting Means Location: Mechanical Room #333 (b) ~ ~ Secondary (Standby): Storage Battery: Amp-Hour Rating 18 calculated capacity to operate system, in Hours: Engin~driven generator dedicated to fire alarm system: Location of fuel storage: TYPE BATTERY rycell Nickel-cadmium ~ Sealed Lead-Acid Lead-Acid Other (Specify): (c) Emergency or Standby system used as a backup to primary power supply, instead of using a secondary power supply: Emergency system described In NFPA 7, Article 7. Legally required standby described in NFPA 7, Article 71. Optional standby system described in NFPA 7, Article 72, which also meets the performance requirements of Article 7 or 71. NFPA Inspection and Testing ocument#; 1 Revision #; Page 2 of 9(NFPA Inspection and Testing, 2 of 9)

34 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION NOTIFICATIONS ARE MAE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments YES PRIOR To ANY TESTING No WHO Siemens Monitoring All Jeff canander TIME TYPE Control Unit Interface Equipment Lamps/LES Fuses Primary Power Supply Trouble Signals isconnect Switches Ground-Fault Monitoring SYSTEM TESTS AN INSPEcnONS VISUAL FUNCTIONAL Ii!!' oor holder, Nae extender, elevator recall SECONARY POWER TYPE Battery Condition Load Voltage ischarge Test Charger Test Specific Gravity Transient Suppressors Remote Annunciators VISUAL Ii!!' FUNCTIONAL Main Lobby NOTIFICATION APPLIANCES Audible Visual Speakers Voice Clarity VISUAL Ii!!' Ii!!' Ii!!' FUNCTIONAL INITIATING AN SUPERVISORY EVICE TESTS AN INSPEcnONS MEASURE LoCAnON & S/N EVICE TYPE VISUAL CHECK FUNCTIONAL TEST FACTORY SETTJNG SETTJNG 1-2 STAIR B SMOKE ETECTOR x OOR 1 3 STAIR B SMOKE ETECTOR x OOR 1-4 ELECTRONICS SMOKE ETECTOR x LAB 1-5 ELECTRONICS SMOKE ETECTOR x LAB 1-6 FL 1 SMOKE SMOKE ETECTOR x 1-7 FL 1 SMOKE SMOKE ETECTOR x PASS x x x x x x FAIL NFPA Inspection and Testing ocument#; 1 Revision #: Page 3 of 9(NFPA Inspection and Testing, 3 of 9)

35 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION MEASURE LOCATION & 5/N EVICE TYPE VISUAL CHECK FUNCTIONAL TEST FACTORY SETIING SETTlNG PASS FAIL 1 8 PHOTO ETECTOR x x FLRl,SMOKE,RE AR ELEV LOBBY 1 9 FLR1, PHOTO ETECTOR x x SMOKE, FRONT ELEV LOBBY 1 11 FLRl, PHOTO ETECTOR x x SMOKE,CUSTO IAL RM FLRl, MANUAL PULL x x MPS,MAIN ENTRY STATION 1 13 FLRl, MPS MANUAL PULL x x BY STAIR B STATION 1 14 FLRl, MANUAL PULL x x MPS,RECEIVING EXIT STATION 1 15 FLR1, MANUAL PULL x x MPS,MACHINE TOOLCONV STATION 1 16 FLR1, MANUAL PULL x x MPS,MACHINE TOOL CNC STATION 1 17 MANUAL PULL x x FLR1,MPS,HALL OUTSIECNC STATION 1 18 CONVENTIONAL x x OUTSIOE,SPRIN KLER PIV ZONE 1 19 FLRl, CONVENTIONAL x x STORAGE, VALV ETAMPER ZONE 1 2 CONVENTIONAL x x WATERFLOW ZONE 1 21 FLR1, CONVENTIONAL x x STORAGE, VALV ETAMPER ZONE 1-22 FLR2, REMOTE RELAY x x IALER SUPERVISORY INPUT 1 23 FLRl,PA CONVENTIONAL x x 3L,CUSTOIAL RM14 ZONE 1 24 FLRl,PA CONVENTIONAL x x 3R,CUSTOIAL RM14 ZONE 2 1 STIR B MANUAL PULL x x STATION 2 2 FLR2, MPS, MANUAL PULL x x OFFICE EXIT STATION 2-3 FLR2, MPS, MANUAL PULL x x LOBBY EXIT STATION NFPA Inspection and Testing ocument#: 1 - Revision #; O Page 4 of 9(NFPA Inspection and Testing, 4 of 9)

36 SIEMENS BUILING TECHNOLOGIES, JNC. FIRE SAFETY IVISION MEASURE LOCATION & 5/N EVICE TYPE VISUAL CHECK FUNCTIONAL TEST FACTORY SETTJNG SETTJNG PASS FAIL 2-4 FLR2, PHOTO ETECTOR x x SMOKE, FIRE ALARM PANEL 2 5 FLR2, CONVENTIONAL x x WATERFLOW ZONE 2 6 FLR2, CONVENTIONAL x x SPRINKLER VALVE TAMPER ZONE 2 7BY STAIR B SMOKE ETECTOR x x 2-8 B OORS SMOKE ETECTOR x x 2 9 FLR2, MPS, MANUAL PULL x x MECHANICAL ROOM STATION 2 1 FLR2, PHOTO ETECTOR x x SMOKE, FRONT ELEV LOBBY 2 11 FLR2, PHOTO ETECTOR x x SMOKE, REAR ELEV LOBBY 2 12 MACHINE RM PHOTO ETECTOR x x 2 2 uer ETECTOR x x FLR2,UCT SMOKE, MECH RM uer ETECTOR x x FLR2,UCT SMOKE, MECH RM FLR2, uer ETECTOR x x UCT,MECH RM 333-A 2-26 FLR2, UCT ETECTOR x x UCT,MECH RM 333 A 2 3 FLR2, UCT ETECTOR x x UCT,MECH RM FLR2, UCT ETECTOR x x UCT,MECH RM 333-B 2 34 FLR2, UCT ETECTOR x x UCT,MECH RM 333-B 2 36 FLR2, uer ETECTOR x x UCT,MECH RM 333 C 2-39 FLR2, UCT ETECTOR x x UCT,MECHANI CAL RM MANUAL PULL x x FLR2,MPS,MEC HAN I CAL RM333 STATION NFPA Inspection and Testing ocument#: 1 - Revision#; Page 5 of 9(NFPA Inspection and Testing, 5 of 9)

37 SIEM ENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION MEASURE LOCATlON & 5/N EVICE TYPE VISUAL CHECK funcjlonal TEST FACTORY SETTING SETTING PASS FAIL COMMON REMOTE RELAY x x ALARM RELAY COMMON REMOTE RELAY x x TROUBLE RELAY USER REMOTE RELAY x x CONFIGURE RELAY SC TO ALARM HORN x x PA-3 STROBE ACTIVATION SC TO ALARM HORN x x PA-3 HORN ACTIVATION * = MANUALLY SET THE 'PASS' STATE Comments: Waterflows and tampers tested by sprinkler contractor. We were unable to test shutdowns due to the units not running. They are set up on a system to shutdown in the evening. NFPA Inspection and Testing ocument#: 1 - Revision#: Page 6 of 9(NFPA Inspection and Testing, 6 of 9)

38 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION AUIO VISUAL FAILURES EVICE LIST LOCAllON &S/N EVICE TYPE PASS FAIL Comments: All Hom/Strobes Worked Properly. (we did replace a horn/strobe in the receiving hall). NFPA Inspection and Testing ocument#: 1 Revision#: Page 7 of 9(NFPA Inspection and Testing, 7 of 9)

39 . ' SIEMENS SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION EMERGENCY COMMUNICATION EQUIPMENT VISUAL FUNCTIONAL Phone Set Phone Jacks Off-Hook Indicator Amplifier(s) Tone Generator(s) can-in Signal System Performance EVICE SIMULATE INTERFACE EQUIPMENT VISUAL OPERATION OPERATION (Specify) Elevator Recall (Specify) oor Holders (Specify) SPECIAL HAZAR SYSTEMS (Specify) (Specify) (Specify) Special Procedures: N Comments: one hqmktrobe failed SUPERVlSING STATION MoNnORING Yes No TIME Alarm Signal Alarm Restoration Supervisory Signal Supervisory Restoration Trouble Signal Trouble Restoral NOTIFICATIONS THAT TESTING JS COMPLETE YES No WHO TIME Monitoring Agency Building Occupants Building Management Other (Specify) The following did not operate correctly: horn strobe in the receiving hall System restored to normal operation: ate: Time: 3:. THIS TEmNG WAS PERFORME IN ACCORANCE WITH APPLICABLE NFPA STANARS. Name of Inspector: Stephen Holbrook ate: Time: 3: Signature: Name of Owner or Representative: _.J""'eff...,,ca... 1.,.1a...,n... de,,..r NFPA Inspection and Testing ocument#: 1 - Revision#: Page 8 of 9(NFPA Inspection and Testing, B of 9)

40 SIEMENS BUILING TECHNOLOGIES, INC. FIRE SAFETY IVISION ate: Time:.._3:... o=o Signature: NFPA Inspection and Testing ocument#: 1 - Revision #: O Page 9 of 9(NFPA Inspection and Testing, 9 of 9)