JOB#: 12775876 VSC Fire & Security, Inc. 10640 Iron Bridge Road, Suite G Jessup MD 20794 (301) 575-1500 www.vscfs.com Important: Deficiencies, Comments and Explanations any FAIL or NEGATIVE responses are indicated on the Work Acknowledgement attachment for this Service and/or Inspection. Frequency: Annual Inspection/Test: Fire Protection Systems Inspection Technician's Name: In Accordance With: Inspection Date: James Ivison, Anthony Ivison 7/10/17 Applicable NFPA, State and Local Codes and Standards Site and Billing Information Site Name, Account Number and Inspection Contract #: Site Address: 5701 Grosvenor Lane Owner/Customer Name: Bethesda Montgomery County Public Schools Billing Address: 8301 Turkey Thicket Dr Bldg A 1st Floor Contact Name: Patrick Schmidt Phone: Notifications 20814 MD 20879 notes 01088M0036 Gaithersburg (301) 217-5312 MD Email: Patrick_M_Schmidt@mcpsmd.org Note: If checked this test/service does not involve disabling a Fire Alarm System and/or notifying a monitoring service. Date(s) put on test: 7/10/17 Time(s) put on test: 6am Date(s) restored: 7/10/17 Time(s) restored: 10am Operator 3831&3849 Monitoring Company and Operator Name(s) notified test and restoral: Name(s) Owner, Owner's Rep, Building Occupants and/or Tenants who were notified test, restoral and deficiencies: Building Services Local Emergency Services, AHJ or Insurance Representatives notified test, restoral or any impairments, if required: Montgomery County Fire and Rescue Comments regarding any known adverse conditions noted on Fire Protection System(s) existing prior to this inspection and test: FACP Normal upon arrival Comments regarding restoral, or conditions which preclude full restoral, Fire Protection System: FACP Normal upon departure
Monitoring Entity / Communication Signal Test Agency Name: ARK Phone #: 1-800-356-2222 Service Type: Phone Line Monitoring Agency verify sig received? Comm. Panel and components in service, free from damage? Operator ID #/Name, who verified receipt signals: Signal transmitted/received properly? Trouble signal tested this inspection? Time Sig Transmitted: Time Agency Received: Supervisory signal tested this inspection? Time Sig Transmitted: Time Agency Received: Alarm signal tested this inspection? Time Sig Transmitted: Time Agency Received:
Alarm System Panels Panel Information, Inspection and Test ID #/Area/Location Make FACP Building Service Manager Office Silent Knight Stware Revision 5820XL Revision Date 15.2 Panel Use Main FACP S/N Type System 04/16/2015 Visual Inspect Addressable Functional Test Power Supply Information Primary Power Supply Nominal Voltage 120 Overcurrent Protection Type Secondary Battery Power Supply Amp Rating 3 Battery Type Overcurrent Protection Rated Amps 2 Breaker Quantity Voltage Rating Overcurrent Protection Location (Panel #) Unknown Install Date Disconnecting Means Location (Breaker #) Unknown Discharge Test Amp Hour Rating 12 11/28/2016 18 Load Test Batt Charger Test Secondary Generator Power Supply or Emergency Power Supply System Emergency Standby Power Supply System, other than battery or dedicated generator secondary power supply? If yes, indicate which type Alarm System Panels Panel Information, Inspection and Test ID #/Area/Location Panel Use Make Stware Revision S/N Revision Date Type System Functional Test Visual Inspect Power Supply Information Primary Power Supply Nominal Voltage Amp Rating Secondary Battery Power Supply Battery Type Quantity Overcurrent Protection Type Overcurrent Protection Rated Amps Voltage Rating Amp Hour Rating Overcurrent Protection Location (Panel #) Install Date Load Test Disconnecting Means Location (Breaker #) Discharge Test Batt Charger Test Secondary Generator Power Supply or Emergency Power Supply System Emergency Standby Power Supply System, other than battery or dedicated generator secondary power supply? If yes, indicate which type
Supplementary Fire Alarm System Battery List (Additional batteries which are not previously listed on attached Panel Forms) Panel Type Battery Type Volt Rating Visual/Charge/Load Amp Install Date Rating Pass Fail N/A BPS in Boiler Room x2 NAC Booster Panel BPS in Stage Wire Closet x2 NAC Booster Panel EVS in Stage Wire Closet x2 Power Expander BPS in Wire Closet by BSM Office x2 NAC Booster Panel EVS in Wire Closet by BSM Office x2 Power Expander Dialer in Boiler Room Monitoring Panel
Supplementary Equipment List MAIN ENTRANCE Type Annunciator Panel
SMOKE DETECTION DEVICE INSPECTION AND TEST Note: Smoke Detection Device Sensitivity Testing performed only on a contracted basis at the frequency determined by the Customer/Building Owner. It is the Customer's/Building Owner's responsibility to have these services performed in accordance with your State and Local requirements, and the applicable version the NFPA 72 Standard. For more information, and to arrange Sensitivity Testing your Smoke Detection Devices, please call VSC Fire & Security, Inc. SMOKE DETECTION SENSITIVITY TEST LAST PERFORMED: Zone / Address ID# / Area / Location SMOKE DETECTION SENSITIVITY TEST PERFORMED THIS INSPECTION: Device Type M33:S001 Health Room M33:S002 Stage AHU 1 Supply Duct Smoke- M33:S003 Stage AHU 1 Return Duct Smoke- M33:S004 Stage AHU 2 Supply Duct Smoke- M33:S005 Stage AHU 2 Return Duct Smoke- M33:S006 Stage Wire Closet M33:S008 Fire door ZN 1/2 M33:S009 Fire door ZN 1/2 M33:S010 FACP Building Service Manager Office M33:S011 Fire door M33:S012 Fire door M33:S013 Wire Closet M33:S014 Fire door ZN2/3 M33:S015 Fire door ZN2/3 M33:S016 Main Entrance Sensitivity Range Test Value (if (if applicable) appl.)
Initiating Device List Zone or Address Device Type ML-796 ML-796 ML-761 ML-761 ML-917 ML-917 ML-736 ML-736 ML-791 ML-791 ML-797 ML-797 ML-462 ML-462 ML-763 ML-763 ML-794 ML-794 ML-795 M3:015 ML-795 ML-944 ML-944 ML-792 ML-792 MO-798 MO-798 MO-132 MO-132 MO-146 MO-146 MO-039 MO-039 MO-168 MO-168 M33:001 Corridor Exit by Classroom 3 M33:002 Classroom 3 M33:003 Main Entrance M33:004 Main Office
Initiating Device List Zone or Address Device Type M33:008 Multi-Purpose Room M33:009 Multi-Purpose Room M33:010 Kitchen Exit M33:011 Boiler Room Exit M33:019 Classroom 13 M33:020 Classroom 14 Exit M33:021 Corridor Exit by Classroom 14 M33:022 Corridor Exit by Library M33:024 Corridor Exit by Classroom 16 M33:025 Corridor Exit by Classroom 20 Portable B3 Restrooms (girls) Portable B3 Restrooms (girls) Portable B3 Restrooms (boys) Portable B3 Restrooms (boys) M33:S007 Boiler Room Carbon Monoxide Detector
Audible/Visual Appliance List Type B03 Restrooms Horn/ BO3 Restrooms Horn/ ML-791 Horn/ ML-797 Horn/ ML-761 Horn/ ML-917 Horn/ ML-944 Horn/ ML-462 Horn/ ML-763 Horn/ M0-039 Horn/ ML-794 Horn/ ML-795 Horn/ M0-0168 Horn/ M0-146 Horn/ M0-798 Horn/ MO-132 Horn/
Audible/Visual Appliance List Type
Audible/Visual Appliance List Type