inspection and testing form per nfpa 72
109-B Concord Drive Casselberry, FL 32707 407.830.6500 DynaFire.com
INSPECTION AND TESTING FORM PER NFPA 72
Pg 1 of 4
Equity One 11180600 Owner/Representative:____________________________________________________________________ WO#: ____________________________Customer#: ________________________________ NE Miami Garden Dr #500 North MiamiFL 957-1229 Beach 33179 Owner's Phone Number: _(305) Owner’s Address: _1550 ________________________________________________________________________ _______________________________________________________
Shoppes At Lago Mar Property Being Evaluated: _E1 ___________________________________________________________________________________________________________________________________________________
15740 SW 72nd St Miami FL 33193 Property Address:______________________________________________________________________________________________________________________________________________________________
Valter Perez Technician :___________________________________________ Certified: Yes
FASA Issued:______________________________ Certification Type:_________________________
No
(786) 331-5000 Miami Dade County Fire Rescue ________________________________________________________________ Approving Agency : Contact:_________________________________________________________________________________Telephone:
11:00 am Time Of Inspection:_____________________ SYSTEM TYPE Remote Station Local Proprietary Central Station
07/05/2016 Date: _________________________
Security Partners Name: _________________________ UL Certificate No.:_________________________
Date Issued: ________________
SERVICE Monthly Quarterly Semiannually Annually Other (Specify)___________________________________________________
Expires:____________________
MONITORING ENTITY
(188) 899-6396 Telephone: ____________________________________________________
DYNA-4793 Monitori ng Account Ref. No.: ______________________________________ TYPE TRANSMISSION Built in UDACT Digital RF Slave Dialer
✔ Visual ✔ Functional Fail
Control Unit Silent knight Control Unit Manufacturer:_________________________________ 5104 Model No.:___________________________ Software Rev: 1 Number of Circuits:_____________________________ Style:____________ 02/2014 Last Date System Had Any Service Performed:_________________________ Last Date Software or Configuration Was Revised:______________________ Serial No:_______________________________________________________ SYSTEM POWER SUPPLIES 2.0 120 VAC Amps: ________ (a) Primary (Main): Nominal Voltage:_______________ Overcurrent Protectio n: Type:
Breaker
Amps:
20
Beside FACP Location (of Primary Supply Panelboard):__________________________ Circuit #8 Disconnecting Means Location:_________________________________
No Yes Breaker Lock Present:________________ Breaker Labeled:____________
8 Ah 24 Hours Calculated capacity to operate system, in hours:_________________________
(b) Secondary (Standby): Storage Battery Amp-Hr Rating:______________
Engine-driven generator dedicated to fire alarm system:_______________
Red Tag
No
Battery Size:___________ Voice Evacuation: Remote Microphone: Microphone Functions:
N/a Quantity of nodes:__________ N/a Type:____________________ N/a N/a Type:________ Qty:________ N/a N/a Type:________ Qty:________ Visual:
Functional:
Pass:
Fail:
BattQty:______
N/a Type:___________________
TYPE BATTERY Dry Cell 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: N/a Emergency system described in NFPA 70, Article 700:________________________ N/a Legally required standby described in NFPA 70 Article701:____________________
Optional standby system described in NFPA 70 Article 702, which also meets the N/a performance requirements of Article 700 or 701.:_____________________________
Location of fuel storage:_________________________________________
FORM ID: SERV01 FP16481600012009
EF20000528
Green Tag
Monthly Quarterly Semiannually Annually DynaFire Completed by (Company Name):______________________________________ SYSTEM COMPONENTS Yes Networked System: Network Functions: Remote Annunciator: Annunciator Functions: NAC Panels: NACs Function:
AES 7788F Type:__________________ 8ah Battery Size:____________ Pass
SPRINKLER SYSTEM 07/2016 Inspection Completed on:_________________________
Florida PE 26483
NICET IV 99907
FPC15-000057
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 2 of 4
6,*1$/,1*/,1(&,5&8,76 Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
N/A
Quantity:_______________________________________________ Style(s):______________________________________________________________
INITIATING DEVICES AND CIRCUIT INFORMATION Visual Functional Alarm Supervisory
Quantity
Circuit Style
_________
___________ Pull Station
_________
___________ Ion Detectors
_________
___________ Photo Detectors
_________
___________ Duct Detectors
_________
___________ Heat Detectors
1
B
_________
___________ Water Flow Switches
_________
___________ Gas Detectors
_________
___________ CO Detector
_________
___________ Tamper Switches
_________
___________ Fire Pump Power
_________
___________ Fire Pump Running
_________
___________ Pump Phase Reversal
_________
___________ Pump Auto Position
_________
___________ Pump Trouble
_________
___________ Generator Auto Position
_________
___________ Generator Trouble
_________
___________ Switch Trouble
_________
___________ Generator Engine Run
_________
___________ Lock Box
_________
___________ Ansul/ Hood System
Alarm Verification feature is:
✔
✔
Latching
Non-Latching Pass Fail
✔
View Report
✔
Disabled
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity
Circuit Style
Visual Functional Factory Setting
Measured Setting
_________
___________ Strobes
_____________
_____________
_________
___________ Horns
_____________
_____________
_________
___________ Horn Strobes
_____________
_____________
_________
___________ Speakers
_____________
_____________
_________
___________ Speaker Strobe
_____________
_____________
_________
___________ Chimes
_____________
_____________
_________
___________ Chime Strobes
_____________
_____________
_________
___________ Bells
_____________
_____________
_____________
_____________
_____________
_____________
_________
1
115vac ___________
_________
___________ Other (Specify)
Water Flow Bell
✔
✔
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________ N/A No. of alarm notification appliance circuits:_________________________
Pg 3 of 4
N/a
Are circuits monitored for integrity?:______________
PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments
No
Yes
Who
Time 11:00 am
Security Partners
SYSTEM TEST AND INSPECTION TYPE Control Unit Interface Equipment Lamps/LEDS Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault Monitoring SECONDARY POWER TYPE Battery Condition Load Voltage Discharge Test Charger Test TRANSIENT SUPPRESSORS
Visual
Functional
✔ ✔ ✔ ✔ ✔ ✔
✔ ✔ ✔ ✔ ✔ ✔
N/a
✔
✔
N/a
✔
✔
Passed
Comments
N/a N/a N/a N/a N/a N/a
Comments N/a N/a
✔
13.65v N/a
NOTIFICATION APPLIANCES Audible Visible Speakers Voice Clarity
N/a N/a N/a N/a
Comments: EMERGENCY COMMUNICATIONS EQUIPMENT Visual N/a Qty:________ Comments Phone Set Phone Jacks Off Hook Indicator Call-in Signal INTERFACE EQUIPMENT N/a N/a Suppression Systems Type: ______________________ Qty:________ N/a N/a Smoke Aspirating Type: ______________________ Qty:________ N/a N/a Releasing Panels Type: ______________________ Qty:________ N/a Other: N/a Qty:________ RELAY INTERFACE AHU Shutdown Door Holders Gas Valve Shutoff Sound System Shutoff N/a Other:_______________
Addressable Conventional N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________
ELEVATOR INTERFACE Primary Recall Alternate Recall Shunt Trip Battery Backup SMOKE CONTROL
N/a Floor: ________ N/a Floor: ________
Active
Passive
N/a Other:_____________________________________________________
Special Procedures:
Functional
Simulated Operation
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 4 of 4
Comments:
SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Trouble Signal Supervisory Signal Supervisory Restoration
Yes
No
MISCELLANEOUS ITEMS Log Book Onsite Panel Tags Updated Manuals Onsite “FACP Inside” Sign on Door As-Built Drawings Onsite UL Certificate Previous Years Inspection Form Onsite
Yes
No
NOTIFICATIONS THAT TESTING IS COMPLETE Building Management Monitoring Agency Building Occupants Other (Specify) Fire Watch Needed
Yes
No
Time
Comments
11:01 am 11:02 am 10:55 am 10:49 am 11:25 am
Time
Who
11:45 am
Security Partners
The following did not operate correctly:
Breaker #8 for FACP A/C power is missing breaker lock. FACP piezo will not ring from waterflow alarm. 07/05/2016 System restored to normal operation: Date:_____________________________________
11:45 Time:____________________________________________________________
THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS.
Valter Perez Name of Inspector:____________________________________________________________ Signature:_____________________________________________________________________
Date:
07/05/2016
Time: 11:45
Name of Owner/Representative :_______________________________________________ Signature:_____________________________________________________________________
DEFICIENCY RESOLUTIONS Date Part # & Deficiency
Date:
07/05/2016
Resolution
Time: 11:45
109-B Concord Drive Casselberry, FL 32707 407.830.6500 DynaFire.com
INSPECTION AND TESTING FORM PER NFPA 72
Pg 1 of 4
Equity One 11180600 Owner/Representative:____________________________________________________________________ WO#: ____________________________Customer#: ________________________________ NE Miami Garden Dr #500 North MiamiFL 957-1229 Beach 33179 Owner's Phone Number: _(305) Owner’s Address: _1550 ________________________________________________________________________ _______________________________________________________
Shoppes At Lago Mar Property Being Evaluated: _E1 ___________________________________________________________________________________________________________________________________________________
15732 SW 72nd St Miami FL 33193 Property Address:______________________________________________________________________________________________________________________________________________________________
Valter Perez Technician :___________________________________________ Certified: Yes
FASA Issued:______________________________ Certification Type:_________________________
No
(786) 331-5000 Miami Dade County Fire Rescue ________________________________________________________________ Approving Agency : Contact:_________________________________________________________________________________Telephone:
9:00 am Time Of Inspection:_____________________ SYSTEM TYPE Remote Station Local Proprietary Central Station
07/05/2016 Date: _________________________
Security Partners Name: _________________________ UL Certificate No.:_________________________
Date Issued: ________________
SERVICE Monthly Quarterly Semiannually Annually Other (Specify)___________________________________________________
Expires:____________________
MONITORING ENTITY
(188) 899-6396 Telephone: ____________________________________________________
DYNA-4794 Monitori ng Account Ref. No.: ______________________________________ TYPE TRANSMISSION Built in UDACT Digital RF Slave Dialer
✔ Visual ✔ Functional Fail
Control Unit Silent knight Control Unit Manufacturer:_________________________________ 5104 Model No.:___________________________ Software Rev: 1 Number of Circuits:_____________________________ Style:____________ 12/2015 Last Date System Had Any Service Performed:_________________________ Last Date Software or Configuration Was Revised:______________________ Serial No:_______________________________________________________ SYSTEM POWER SUPPLIES 2.0 120 VAC Amps: ________ (a) Primary (Main): Nominal Voltage:_______________ Overcurrent Protectio n: Type:
Breaker
Amps:
20
Beside FACP Location (of Primary Supply Panelboard):__________________________ Circuit #28 Disconnecting Means Location:_________________________________
No No Breaker Lock Present:________________ Breaker Labeled:____________
7Ah 24 Hours Calculated capacity to operate system, in hours:_________________________
(b) Secondary (Standby): Storage Battery Amp-Hr Rating:______________
Engine-driven generator dedicated to fire alarm system:_______________
Red Tag
No
Battery Size:___________ Voice Evacuation: Remote Microphone: Microphone Functions:
N/a Quantity of nodes:__________ N/a Type:____________________ N/a N/a Type:________ Qty:________ N/a N/a Type:________ Qty:________ Visual:
Functional:
Pass:
Fail:
BattQty:______
N/a Type:___________________
TYPE BATTERY Dry Cell 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: N/a Emergency system described in NFPA 70, Article 700:________________________ N/a Legally required standby described in NFPA 70 Article701:____________________
Optional standby system described in NFPA 70 Article 702, which also meets the N/a performance requirements of Article 700 or 701.:_____________________________
Location of fuel storage:_________________________________________
FORM ID: SERV01 FP16481600012009
EF20000528
Green Tag
Monthly Quarterly Semiannually Annually DynaFire Completed by (Company Name):______________________________________ SYSTEM COMPONENTS Yes Networked System: Network Functions: Remote Annunciator: Annunciator Functions: NAC Panels: NACs Function:
AES 7788F Type:__________________ 7ah Battery Size:____________ Pass
SPRINKLER SYSTEM 07/2016 Inspection Completed on:_________________________
Florida PE 26483
NICET IV 99907
FPC15-000057
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 2 of 4
6,*1$/,1*/,1(&,5&8,76 Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
N/A
Quantity:_______________________________________________ Style(s):______________________________________________________________
INITIATING DEVICES AND CIRCUIT INFORMATION Visual Functional Alarm Supervisory
Quantity
Circuit Style
_________
___________ Pull Station
_________
___________ Ion Detectors
_________
___________ Photo Detectors
_________
___________ Duct Detectors
_________
___________ Heat Detectors
1
B
_________
___________ Water Flow Switches
_________
___________ Gas Detectors
_________
___________ CO Detector
_________
___________ Tamper Switches
_________
___________ Fire Pump Power
_________
___________ Fire Pump Running
_________
___________ Pump Phase Reversal
_________
___________ Pump Auto Position
_________
___________ Pump Trouble
_________
___________ Generator Auto Position
_________
___________ Generator Trouble
_________
___________ Switch Trouble
_________
___________ Generator Engine Run
_________
___________ Lock Box
_________
___________ Ansul/ Hood System
Alarm Verification feature is:
✔
✔
Latching
Non-Latching Pass Fail
✔
View Report
✔
Disabled
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity
Circuit Style
Visual Functional Factory Setting
Measured Setting
_________
___________ Strobes
_____________
_____________
_________
___________ Horns
_____________
_____________
_________
___________ Horn Strobes
_____________
_____________
_________
___________ Speakers
_____________
_____________
_________
___________ Speaker Strobe
_____________
_____________
_________
___________ Chimes
_____________
_____________
_________
___________ Chime Strobes
_____________
_____________
_________
___________ Bells
_____________
_____________
_____________
_____________
_____________
_____________
_________
1
115vac ___________
_________
___________ Other (Specify)
Water Flow Bell
✔
✔
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________ N/A No. of alarm notification appliance circuits:_________________________
Pg 3 of 4
N/a
Are circuits monitored for integrity?:______________
PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments
No
Yes
Who
Time
Security Partners
9:00 am
SYSTEM TEST AND INSPECTION TYPE Control Unit Interface Equipment Lamps/LEDS Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault Monitoring SECONDARY POWER TYPE Battery Condition Load Voltage Discharge Test Charger Test TRANSIENT SUPPRESSORS
Visual
Functional
✔ ✔ ✔ ✔ ✔ ✔
✔ ✔ ✔ ✔ ✔ ✔
N/a
✔
✔
N/a
✔
✔
Failed- See Report
Comments
N/a N/a N/a N/a N/a N/a
Comments N/a N/a
✔
13.7v N/a
NOTIFICATION APPLIANCES Audible Visible Speakers Voice Clarity
N/a N/a N/a N/a
Comments: EMERGENCY COMMUNICATIONS EQUIPMENT Visual N/a Qty:________ Comments Phone Set Phone Jacks Off Hook Indicator Call-in Signal INTERFACE EQUIPMENT N/a N/a Suppression Systems Type: ______________________ Qty:________ N/a N/a Smoke Aspirating Type: ______________________ Qty:________ N/a N/a Releasing Panels Type: ______________________ Qty:________ N/a Other: N/a Qty:________ RELAY INTERFACE AHU Shutdown Door Holders Gas Valve Shutoff Sound System Shutoff N/a Other:_______________
Addressable Conventional N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________
ELEVATOR INTERFACE Primary Recall Alternate Recall Shunt Trip Battery Backup SMOKE CONTROL
N/a Floor: ________ N/a Floor: ________
Active
Passive
N/a Other:_____________________________________________________
Special Procedures:
Functional
Simulated Operation
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 4 of 4
Comments:
SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Trouble Signal Supervisory Signal Supervisory Restoration
Yes
No
MISCELLANEOUS ITEMS Log Book Onsite Panel Tags Updated Manuals Onsite “FACP Inside” Sign on Door As-Built Drawings Onsite UL Certificate Previous Years Inspection Form Onsite
Yes
No
NOTIFICATIONS THAT TESTING IS COMPLETE Building Management Monitoring Agency Building Occupants Other (Specify) Fire Watch Needed
Yes
No
Time
Comments
9:46 am 9:46 am 9:50 am 9:29 am 10:00 am
Time 10:20 am
Who Security Partners
The following did not operate correctly:
FACP battery is faulty. (1) 12v 7ah Breaker #28 for FACP A/C power is not labeled and missing breaker lock. FACP piezo will not ring from waterflow alarm. 07/05/2016 System restored to normal operation: Date:_____________________________________
10:30 Time:____________________________________________________________
THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS.
Valter Perez Name of Inspector:____________________________________________________________ Signature:_____________________________________________________________________
Date:
07/05/2016
Time: 10:30
Name of Owner/Representative :_______________________________________________ Signature:_____________________________________________________________________
DEFICIENCY RESOLUTIONS Date Part # & Deficiency
Date:
07/05/2016
Resolution
Time: 10:30
INSPECTION AND TESTING FORM PER NFPA 72
Pg 1 of 4
Equity One 11180600 Owner/Representative:____________________________________________________________________ WO#: ____________________________Customer#: ________________________________ NE Miami Garden Dr #500 North MiamiFL 957-1229 Beach 33179 Owner's Phone Number: _(305) Owner’s Address: _1550 ________________________________________________________________________ _______________________________________________________
Shoppes At Lago Mar Property Being Evaluated: _E1 ___________________________________________________________________________________________________________________________________________________
15740 SW 72nd St Miami FL 33193 Property Address:______________________________________________________________________________________________________________________________________________________________
Valter Perez Technician :___________________________________________ Certified: Yes
FASA Issued:______________________________ Certification Type:_________________________
No
(786) 331-5000 Miami Dade County Fire Rescue ________________________________________________________________ Approving Agency : Contact:_________________________________________________________________________________Telephone:
11:00 am Time Of Inspection:_____________________ SYSTEM TYPE Remote Station Local Proprietary Central Station
07/05/2016 Date: _________________________
Security Partners Name: _________________________ UL Certificate No.:_________________________
Date Issued: ________________
SERVICE Monthly Quarterly Semiannually Annually Other (Specify)___________________________________________________
Expires:____________________
MONITORING ENTITY
(188) 899-6396 Telephone: ____________________________________________________
DYNA-4793 Monitori ng Account Ref. No.: ______________________________________ TYPE TRANSMISSION Built in UDACT Digital RF Slave Dialer
✔ Visual ✔ Functional Fail
Control Unit Silent knight Control Unit Manufacturer:_________________________________ 5104 Model No.:___________________________ Software Rev: 1 Number of Circuits:_____________________________ Style:____________ 02/2014 Last Date System Had Any Service Performed:_________________________ Last Date Software or Configuration Was Revised:______________________ Serial No:_______________________________________________________ SYSTEM POWER SUPPLIES 2.0 120 VAC Amps: ________ (a) Primary (Main): Nominal Voltage:_______________ Overcurrent Protectio n: Type:
Breaker
Amps:
20
Beside FACP Location (of Primary Supply Panelboard):__________________________ Circuit #8 Disconnecting Means Location:_________________________________
No Yes Breaker Lock Present:________________ Breaker Labeled:____________
8 Ah 24 Hours Calculated capacity to operate system, in hours:_________________________
(b) Secondary (Standby): Storage Battery Amp-Hr Rating:______________
Engine-driven generator dedicated to fire alarm system:_______________
Red Tag
No
Battery Size:___________ Voice Evacuation: Remote Microphone: Microphone Functions:
N/a Quantity of nodes:__________ N/a Type:____________________ N/a N/a Type:________ Qty:________ N/a N/a Type:________ Qty:________ Visual:
Functional:
Pass:
Fail:
BattQty:______
N/a Type:___________________
TYPE BATTERY Dry Cell 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: N/a Emergency system described in NFPA 70, Article 700:________________________ N/a Legally required standby described in NFPA 70 Article701:____________________
Optional standby system described in NFPA 70 Article 702, which also meets the N/a performance requirements of Article 700 or 701.:_____________________________
Location of fuel storage:_________________________________________
FORM ID: SERV01 FP16481600012009
EF20000528
Green Tag
Monthly Quarterly Semiannually Annually DynaFire Completed by (Company Name):______________________________________ SYSTEM COMPONENTS Yes Networked System: Network Functions: Remote Annunciator: Annunciator Functions: NAC Panels: NACs Function:
AES 7788F Type:__________________ 8ah Battery Size:____________ Pass
SPRINKLER SYSTEM 07/2016 Inspection Completed on:_________________________
Florida PE 26483
NICET IV 99907
FPC15-000057
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 2 of 4
6,*1$/,1*/,1(&,5&8,76 Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
N/A
Quantity:_______________________________________________ Style(s):______________________________________________________________
INITIATING DEVICES AND CIRCUIT INFORMATION Visual Functional Alarm Supervisory
Quantity
Circuit Style
_________
___________ Pull Station
_________
___________ Ion Detectors
_________
___________ Photo Detectors
_________
___________ Duct Detectors
_________
___________ Heat Detectors
1
B
_________
___________ Water Flow Switches
_________
___________ Gas Detectors
_________
___________ CO Detector
_________
___________ Tamper Switches
_________
___________ Fire Pump Power
_________
___________ Fire Pump Running
_________
___________ Pump Phase Reversal
_________
___________ Pump Auto Position
_________
___________ Pump Trouble
_________
___________ Generator Auto Position
_________
___________ Generator Trouble
_________
___________ Switch Trouble
_________
___________ Generator Engine Run
_________
___________ Lock Box
_________
___________ Ansul/ Hood System
Alarm Verification feature is:
✔
✔
Latching
Non-Latching Pass Fail
✔
View Report
✔
Disabled
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity
Circuit Style
Visual Functional Factory Setting
Measured Setting
_________
___________ Strobes
_____________
_____________
_________
___________ Horns
_____________
_____________
_________
___________ Horn Strobes
_____________
_____________
_________
___________ Speakers
_____________
_____________
_________
___________ Speaker Strobe
_____________
_____________
_________
___________ Chimes
_____________
_____________
_________
___________ Chime Strobes
_____________
_____________
_________
___________ Bells
_____________
_____________
_____________
_____________
_____________
_____________
_________
1
115vac ___________
_________
___________ Other (Specify)
Water Flow Bell
✔
✔
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________ N/A No. of alarm notification appliance circuits:_________________________
Pg 3 of 4
N/a
Are circuits monitored for integrity?:______________
PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments
No
Yes
Who
Time 11:00 am
Security Partners
SYSTEM TEST AND INSPECTION TYPE Control Unit Interface Equipment Lamps/LEDS Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault Monitoring SECONDARY POWER TYPE Battery Condition Load Voltage Discharge Test Charger Test TRANSIENT SUPPRESSORS
Visual
Functional
✔ ✔ ✔ ✔ ✔ ✔
✔ ✔ ✔ ✔ ✔ ✔
N/a
✔
✔
N/a
✔
✔
Passed
Comments
N/a N/a N/a N/a N/a N/a
Comments N/a N/a
✔
13.65v N/a
NOTIFICATION APPLIANCES Audible Visible Speakers Voice Clarity
N/a N/a N/a N/a
Comments: EMERGENCY COMMUNICATIONS EQUIPMENT Visual N/a Qty:________ Comments Phone Set Phone Jacks Off Hook Indicator Call-in Signal INTERFACE EQUIPMENT N/a N/a Suppression Systems Type: ______________________ Qty:________ N/a N/a Smoke Aspirating Type: ______________________ Qty:________ N/a N/a Releasing Panels Type: ______________________ Qty:________ N/a Other: N/a Qty:________ RELAY INTERFACE AHU Shutdown Door Holders Gas Valve Shutoff Sound System Shutoff N/a Other:_______________
Addressable Conventional N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________
ELEVATOR INTERFACE Primary Recall Alternate Recall Shunt Trip Battery Backup SMOKE CONTROL
N/a Floor: ________ N/a Floor: ________
Active
Passive
N/a Other:_____________________________________________________
Special Procedures:
Functional
Simulated Operation
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 4 of 4
Comments:
SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Trouble Signal Supervisory Signal Supervisory Restoration
Yes
No
MISCELLANEOUS ITEMS Log Book Onsite Panel Tags Updated Manuals Onsite “FACP Inside” Sign on Door As-Built Drawings Onsite UL Certificate Previous Years Inspection Form Onsite
Yes
No
NOTIFICATIONS THAT TESTING IS COMPLETE Building Management Monitoring Agency Building Occupants Other (Specify) Fire Watch Needed
Yes
No
Time
Comments
11:01 am 11:02 am 10:55 am 10:49 am 11:25 am
Time
Who
11:45 am
Security Partners
The following did not operate correctly:
Breaker #8 for FACP A/C power is missing breaker lock. FACP piezo will not ring from waterflow alarm. 07/05/2016 System restored to normal operation: Date:_____________________________________
11:45 Time:____________________________________________________________
THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS.
Valter Perez Name of Inspector:____________________________________________________________ Signature:_____________________________________________________________________
Date:
07/05/2016
Time: 11:45
Name of Owner/Representative :_______________________________________________ Signature:_____________________________________________________________________
DEFICIENCY RESOLUTIONS Date Part # & Deficiency
Date:
07/05/2016
Resolution
Time: 11:45
109-B Concord Drive Casselberry, FL 32707 407.830.6500 DynaFire.com
INSPECTION AND TESTING FORM PER NFPA 72
Pg 1 of 4
Equity One 11180600 Owner/Representative:____________________________________________________________________ WO#: ____________________________Customer#: ________________________________ NE Miami Garden Dr #500 North MiamiFL 957-1229 Beach 33179 Owner's Phone Number: _(305) Owner’s Address: _1550 ________________________________________________________________________ _______________________________________________________
Shoppes At Lago Mar Property Being Evaluated: _E1 ___________________________________________________________________________________________________________________________________________________
15732 SW 72nd St Miami FL 33193 Property Address:______________________________________________________________________________________________________________________________________________________________
Valter Perez Technician :___________________________________________ Certified: Yes
FASA Issued:______________________________ Certification Type:_________________________
No
(786) 331-5000 Miami Dade County Fire Rescue ________________________________________________________________ Approving Agency : Contact:_________________________________________________________________________________Telephone:
9:00 am Time Of Inspection:_____________________ SYSTEM TYPE Remote Station Local Proprietary Central Station
07/05/2016 Date: _________________________
Security Partners Name: _________________________ UL Certificate No.:_________________________
Date Issued: ________________
SERVICE Monthly Quarterly Semiannually Annually Other (Specify)___________________________________________________
Expires:____________________
MONITORING ENTITY
(188) 899-6396 Telephone: ____________________________________________________
DYNA-4794 Monitori ng Account Ref. No.: ______________________________________ TYPE TRANSMISSION Built in UDACT Digital RF Slave Dialer
✔ Visual ✔ Functional Fail
Control Unit Silent knight Control Unit Manufacturer:_________________________________ 5104 Model No.:___________________________ Software Rev: 1 Number of Circuits:_____________________________ Style:____________ 12/2015 Last Date System Had Any Service Performed:_________________________ Last Date Software or Configuration Was Revised:______________________ Serial No:_______________________________________________________ SYSTEM POWER SUPPLIES 2.0 120 VAC Amps: ________ (a) Primary (Main): Nominal Voltage:_______________ Overcurrent Protectio n: Type:
Breaker
Amps:
20
Beside FACP Location (of Primary Supply Panelboard):__________________________ Circuit #28 Disconnecting Means Location:_________________________________
No No Breaker Lock Present:________________ Breaker Labeled:____________
7Ah 24 Hours Calculated capacity to operate system, in hours:_________________________
(b) Secondary (Standby): Storage Battery Amp-Hr Rating:______________
Engine-driven generator dedicated to fire alarm system:_______________
Red Tag
No
Battery Size:___________ Voice Evacuation: Remote Microphone: Microphone Functions:
N/a Quantity of nodes:__________ N/a Type:____________________ N/a N/a Type:________ Qty:________ N/a N/a Type:________ Qty:________ Visual:
Functional:
Pass:
Fail:
BattQty:______
N/a Type:___________________
TYPE BATTERY Dry Cell 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: N/a Emergency system described in NFPA 70, Article 700:________________________ N/a Legally required standby described in NFPA 70 Article701:____________________
Optional standby system described in NFPA 70 Article 702, which also meets the N/a performance requirements of Article 700 or 701.:_____________________________
Location of fuel storage:_________________________________________
FORM ID: SERV01 FP16481600012009
EF20000528
Green Tag
Monthly Quarterly Semiannually Annually DynaFire Completed by (Company Name):______________________________________ SYSTEM COMPONENTS Yes Networked System: Network Functions: Remote Annunciator: Annunciator Functions: NAC Panels: NACs Function:
AES 7788F Type:__________________ 7ah Battery Size:____________ Pass
SPRINKLER SYSTEM 07/2016 Inspection Completed on:_________________________
Florida PE 26483
NICET IV 99907
FPC15-000057
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 2 of 4
6,*1$/,1*/,1(&,5&8,76 Quantity and style of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
N/A
Quantity:_______________________________________________ Style(s):______________________________________________________________
INITIATING DEVICES AND CIRCUIT INFORMATION Visual Functional Alarm Supervisory
Quantity
Circuit Style
_________
___________ Pull Station
_________
___________ Ion Detectors
_________
___________ Photo Detectors
_________
___________ Duct Detectors
_________
___________ Heat Detectors
1
B
_________
___________ Water Flow Switches
_________
___________ Gas Detectors
_________
___________ CO Detector
_________
___________ Tamper Switches
_________
___________ Fire Pump Power
_________
___________ Fire Pump Running
_________
___________ Pump Phase Reversal
_________
___________ Pump Auto Position
_________
___________ Pump Trouble
_________
___________ Generator Auto Position
_________
___________ Generator Trouble
_________
___________ Switch Trouble
_________
___________ Generator Engine Run
_________
___________ Lock Box
_________
___________ Ansul/ Hood System
Alarm Verification feature is:
✔
✔
Latching
Non-Latching Pass Fail
✔
View Report
✔
Disabled
ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION Quantity
Circuit Style
Visual Functional Factory Setting
Measured Setting
_________
___________ Strobes
_____________
_____________
_________
___________ Horns
_____________
_____________
_________
___________ Horn Strobes
_____________
_____________
_________
___________ Speakers
_____________
_____________
_________
___________ Speaker Strobe
_____________
_____________
_________
___________ Chimes
_____________
_____________
_________
___________ Chime Strobes
_____________
_____________
_________
___________ Bells
_____________
_____________
_____________
_____________
_____________
_____________
_________
1
115vac ___________
_________
___________ Other (Specify)
Water Flow Bell
✔
✔
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________ N/A No. of alarm notification appliance circuits:_________________________
Pg 3 of 4
N/a
Are circuits monitored for integrity?:______________
PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Monitoring Entity Building Occupants Building Management Other (Specify) AHJ Notified of Any Impairments
No
Yes
Who
Time
Security Partners
9:00 am
SYSTEM TEST AND INSPECTION TYPE Control Unit Interface Equipment Lamps/LEDS Fuses Primary Power Supply Trouble Signals Disconnect Switches Ground-Fault Monitoring SECONDARY POWER TYPE Battery Condition Load Voltage Discharge Test Charger Test TRANSIENT SUPPRESSORS
Visual
Functional
✔ ✔ ✔ ✔ ✔ ✔
✔ ✔ ✔ ✔ ✔ ✔
N/a
✔
✔
N/a
✔
✔
Failed- See Report
Comments
N/a N/a N/a N/a N/a N/a
Comments N/a N/a
✔
13.7v N/a
NOTIFICATION APPLIANCES Audible Visible Speakers Voice Clarity
N/a N/a N/a N/a
Comments: EMERGENCY COMMUNICATIONS EQUIPMENT Visual N/a Qty:________ Comments Phone Set Phone Jacks Off Hook Indicator Call-in Signal INTERFACE EQUIPMENT N/a N/a Suppression Systems Type: ______________________ Qty:________ N/a N/a Smoke Aspirating Type: ______________________ Qty:________ N/a N/a Releasing Panels Type: ______________________ Qty:________ N/a Other: N/a Qty:________ RELAY INTERFACE AHU Shutdown Door Holders Gas Valve Shutoff Sound System Shutoff N/a Other:_______________
Addressable Conventional N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________ N/a Qty:________
ELEVATOR INTERFACE Primary Recall Alternate Recall Shunt Trip Battery Backup SMOKE CONTROL
N/a Floor: ________ N/a Floor: ________
Active
Passive
N/a Other:_____________________________________________________
Special Procedures:
Functional
Simulated Operation
Pass Fail
View Report
E1 Shoppes At Lago Mar Cust. No.:____________ Property Name:__________________________________
Pg 4 of 4
Comments:
SUPERVISING STATION MONITORING Alarm Signal Alarm Restoration Trouble Signal Supervisory Signal Supervisory Restoration
Yes
No
MISCELLANEOUS ITEMS Log Book Onsite Panel Tags Updated Manuals Onsite “FACP Inside” Sign on Door As-Built Drawings Onsite UL Certificate Previous Years Inspection Form Onsite
Yes
No
NOTIFICATIONS THAT TESTING IS COMPLETE Building Management Monitoring Agency Building Occupants Other (Specify) Fire Watch Needed
Yes
No
Time
Comments
9:46 am 9:46 am 9:50 am 9:29 am 10:00 am
Time 10:20 am
Who Security Partners
The following did not operate correctly:
FACP battery is faulty. (1) 12v 7ah Breaker #28 for FACP A/C power is not labeled and missing breaker lock. FACP piezo will not ring from waterflow alarm. 07/05/2016 System restored to normal operation: Date:_____________________________________
10:30 Time:____________________________________________________________
THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS.
Valter Perez Name of Inspector:____________________________________________________________ Signature:_____________________________________________________________________
Date:
07/05/2016
Time: 10:30
Name of Owner/Representative :_______________________________________________ Signature:_____________________________________________________________________
DEFICIENCY RESOLUTIONS Date Part # & Deficiency
Date:
07/05/2016
Resolution
Time: 10:30
