Report Cover Contractor Contact Activ Log ROC Insp & Test Trouble & Maint. Log
NFPA-72 Fire Alarm System Record of Completion
Date: 02/16/22
City of Tigard Information: Permit No. FPS2022-00011
Name of protected property: Variant TI 1Lincoln Suite 302
Address of protected property: 10300 SW Greenburg Road Tigard,OR 97223
Representative of protected property(name/phone):
Authority having jurisdiction: City of Tigard,Building Services
Address/telephone number: 13125 SW Hall Blvd. Tigard,OR 97223 (503)639-4171
1. Type(s)of System or Service
NFPA 72,Chapter 3—Local
If alarm is transmitted to locations(s)off premises,list where received:
NFPA 72,Chapter 3--Emergency Voice/Alarm Service
Quantity of voice/alarm channels: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
NFPA 72,Chapter 5--Auxiliary
Indicate type of connection:
Local energy Shunt Parallel telephone
Location of telephone number for receipt of signals:
NFPA 72,
Alarm:
Supervisory:
NFPA 72,Chapter 5—Proprietary
If alarms are retransmitted to public fire service communications centers or others,indicate location and
telephone numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
x NFPA 72,Chapter 5--Remote Station
Prime contractor:
Central station location:
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One-way radio
Digital alarm communicator x Two-way radio Others
Means of transmission of alarms to the public fire service communications center:
(a)
(b)
System location:
Organization name/phone Representative name/Phone
Installer Capitol Electric Co.Inc. Shane Tercek 503 255-9488
Supplier Capitol Electric Co.Inc. Shane Tercek 503 255-9488
Service organization Capitol Electric Co.Inc. Shane Tercek 503 255-9488
Location of record(as-built)drawings:
Location of owners manuals:
Location of test reports:
A contract,dated ,for test and inspection in accordance with NFPA standard(s)
No(s). ,dated ,is in effect,
2. Record of System Installation Suite 302 Only
(Fill out after installations complete and wiring checked for opens,shorts,ground faults,and improper
branching,but prior to conducting operational acceptance tests.)
This system has been installed in accordance with the NFPA standards as shown below,was inspected
by Carson Dodge on 02/16/22 ,included the devices shown below,and has been in service
since 02/16/22
x NFPA 72(2010),Chapters _ 1Q j2 j4 it lfl 2j 21 (underline all that apply)
x NFPA 70(2011),National Electrical Code,Article 760
x Manufacturer's instructions
Other(specify):
Signed: Carson Dodge Date: 2/16/22
Organization: Capitol Electric Company,Inc.
3. Record of System Operation Suite 302 Only
All operational features and functions of this system were tested by Carson Dodge on 02/16/22
and found to be operating properly in accordance with the requirements of:
x NFPA 72(2010),Chapters _ jQ la 14 la 11 a. al (underline all that apply)
x NFPA70(2011),National Electrical Code,Article 760
x Manufacturer's instructions
Other(specify):
Signed: Carson Dodge Date: 2/16/22
Organization: Capitol Electric Company,Inc.
4. Alarm-Initiating Devices and Circuits Suite 302 Only
Quantity and class of initiating device circuits(see NFPA 72,Table 3-5) Quantity: Style: Class:
MANUAL
(a) 0 Manual stations Noncoded,activating Transmitters Coded
(b) Combination manual fire alarm and guard's tour coded stations.
AUTOMATIC
Coverage:Complete: Partial:
(a) 0 Smoke detectors Ion Photo
(b) 0 Duct detectors Ion Photo
(c) 0 Heat detectors FT RR FT/RR RC
(d) 0 Sprinkler waterflow switches: Transmitters Noncoded,activating Coded
(e) Other(list):
5. Supervisory Signal-Initiating Devices and Circuits Suite 302 Only
HVAC
(a) 0 Duct detectors Ion Photo
SPRINKLER SYSTEM
(a) Non coded valve supervisory switch at sprinkler riser
(b) Non coded valve supervisory switch at sprinkler vault
(c) Non coded supervisory air pressure switch at sprinkler riser
(d) Site water supply level points
Electric fire pump:
(e) Fire pump power
(f) fire pump running
(g) Phase reversal
Engine-driven fire pump:
(h) Selector in auto position
(I) Engine or control panel trouble
Q) Fire pump running
Engine-driven generator:
(k) Selector in auto position
(I) Control panel trouble
(m) Transfer switches
(n) Engine running
Other supervisory functions(s)(specify):
6. Alarm Notification Appliances and Circuits Suite 302 Only
Quantity and class(see NFPA 72,Table 3-7)of notification appliance circuits connected to the system:
Types and quantities of notification appliances installed: Quantity: 3 Style Y Class:B
(a) Bells Inch
(b) Speakers
(c) Horns
(d) Chimes
(e) Other:
(f) 3 Visual signals Type: ADA SYNCHRONIZED
with audible 3 w/o audible
(g) Local annunciator