Fire Alarm Testing and Inspection Report Property Name: Property Address: Property Manager: Contact: Phone Number: Central Station: Phone Number: PELICAN ISLE II 35 DOCKSIDE RD. NAPLES, FLORIDA 3110 BILL WALLICK 239-287-6608 SIMPLEXGRINNELL Fire Dept: Result: Inspector: Contract No.: Date: Account #: 1-888-76-7539 103-1701 NORTH NAPLES FIRE DEPT PABLO AGUERO 07-06-16 Service Period: Monthly Quarterly Semi-Annual Annual Five-ear 1)SMOKE DET M1-55 TH FL IN SE MECHANICAL RM DID NOT GO INTO ALARM WHEN TESTED. NEEDS TO BE REPLACED. Date: 07-06-16 Inspector Signature: PABLO AGUERO Customer Name: Customer Sigature: Rev #7 10-08-1 1 of 5
Service Period Weekly Monthly Rotation & Communicator Communication Type McCulloh Multiplex Quarterly Semi-Annual Digital Reverse Polarity Annual Other (specify) RF Other (specify) Manufacturer: Model: Software Rev: SIMPLEX Last Date Software or Configuration Changed: Control Panel : Number of Circuits: 100-8201 2 MAPNET 27 NACS Last Date of Service: 09-02-20 06/2016 Alarm Notification Appliances and Circuit Information Bells Horns Strobe Horn Strobe Chime Speakers Other Number of NAC Circuits: 10-11-15 Are Circuits Monitored for Integrity?: 27 2 67 125 ES Alarm-Initiating Devices and Circuit Information Pull Stations 51 Ion Detectors Photo Detectors Duct Detectors Heat Detectors Water Flow Switches Supervisory Switches 8 20 2 15 18 Other (Specify): & : Signaling Line Circuits and Style (See NFPA 72, Table 3-6) of Signaling Line Circuits connected to System: Style: 2 Rev #7 10-08-1 2 of 5
Alarm Notification Appliances and Circuit Information Still Water Temp Site Water Level Fire Pump Power Fire Pump Running Fire Pump Auto Position Fire Pump or Pump Controller Trouble Generator in Auto Position Generator or Controller Trouble Generator Engine Running Transfer Switch Other (Specify): System Power Supplies A. Primary (Main): Nominal Voltage: Amps: Over Current Protection Type: Location of Primary Supply Board: Disconnection Means Location: B. Secondary, Standby: BREAKER 120 20 2ND FLOOR MECH RM PANEL EM2 CRKT #8 2X12VDC 33AH BATTERIES Amps: 20 Calculated Capacity to Operate System, In Hours: 2 60 Engine Driven Generator Dedicated to Fire Alarm System: Location of Fuel Storage: Battery Type: Sealed Lead-Acid Dry Cell Nickel-Cadmium Lead-Acid 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 70, Article 700 Legally Required Standby Described in NFPA 70, Article 701 Optional Standby System Described in NFPA 70, Article 702, Which also Meets the Performance Requirements of Article 700 or 701 Other Monitoring Entity Building Occupants Building Management Other (Specify) AHJ (Notified) of Any Impairments Prior to any Testing es No N/A Who SIMPLEXGRINNELL RESIDENTS BILL WALLICK When Rev #7 10-08-1 3 of 5
Initiating and Supervisory Device Tests and Inspections Local & S/N Device Type Visual Test Functional Test Factory Settings Meas. Settings 51 OF 51 P/S 8 OF 8 PSD 20 OF 20 DUCT DET 2 OF 2 HEAT DET Pass Fail : Control Unit System Tests and Inspections Visible Functional Interface Eq. Lamps/Leds Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground Fault Monitoring Battery Condition Load Voltage Discharge Test Charger Test Specific Gravity Transient Suppressors Remote Annunciators Visible Secondary Power Functional Audible Notification Appliances Visible Functional Visual Speakers Voice Clarity Rev #7 10-08-1 of 5
Phone Set Emergency Communications Equipment Phone Jacks Off-hook Indicator Amplifier Tone Generator Call-In Signal System Performance ELEV RECALL AHU SHUTDOWN Interface Equipment Special Hazard Systems Special Procedures: : Alarm Signal Alarm Restoration Trouble Signal Supervisory Trouble Supervisory Restoration Monitoring Entity Building Occupants Building Management Other (Specify) Supervising Station Monitoring es No Time Notification That Testing Is Complete es No N/A Time :30 PM :30 PM :30 PM Comment Comment AHJ (Notified) of Any Impairments Rev #7 10-08-1 5 of 5