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Report (2) SYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data,or calculations as necessary to provide a complete record. Form Completion Date: 4/7/21 Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: Tigard Business Park Building 7 TI Space Address: 11950 SW Garden Place,Tigard,OR 97223 Description of property: Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: Point Monitor Corporations Address: 5863 Lakeview Blvd,Lake Oswego,OR 97035 Phone 503-627-0100 Fax: 503-627-0110 E-mail: Service organization: Address: Phone: Fax: E-mail: Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Address: Phone: Fax: E-mail: Account number: Phone line 1: Phone line 2: Means of transmission: Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific software: Document Enclosure 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system ®Modification to existing system Permit number: FPS2021-00006 NFPA 72 edition: 2019 4.1 Control Unit Manufacturer: FCI Model number: 7200 4.2 Software and Firmware Firmware revision number: Unknown 4.3 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120VAC Control panel amps: Overcurrent protection: Type: Breaker Amps: Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: Battery Location,if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 Hours In alarm mode(minutes): 5 Minutes 5.2 Control Unit ❑ This system does not have power extender panels ® Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line Device Power Initiating Device Notification Appliance Other(specify): 7. REMOTE ANNUNCIATORS Type Location 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 1 Conventional Alarm Photo Smoke Detectors 1 Conventional Alarm Photo Duct Smoke Detectors 10 Conventional Supervisory Photo Heat Detectors Gas Detectors Waterflow Switches Tamper Switches Copyright 02012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible 28 Combination Audible and Visible 34 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers 10 Door Unlocking Elevator Recall Elevator Shunt Trip 11. INTERCONNECTED SYSTEMS ❑ This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specified herein has been installed according to all NFPA standards cited herein. Signed: Printed name: Enrique Vallejo Date: 04/7/21 Organization: Point Monitor Corporation Title: Tech Phone: 503-627-0100 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Enrique Vallejo Date: 04/7/21 Organization: Point Monitor Corporation Title: Tech Phone: 503-627-0100 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.