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Permit (83)
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT t:. COMMUNITY DEVELOPMENT Permit #: FPS2012 -00137 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012 Parcel: 1S 136DD05300 Jurisdiction: Tigard Site address: 11850 SW 67TH AVE, STE# 140 Project: Broad River Expansion Subdivision: WEST PORTLAND HEIGHTS Lot: 9 Project Description: Fire alarm modification Contractor: POINT MONITOR CORP Owner: PNWP LLC #2 7869 SW NIMBUS AVE PNWP LLC BEAVERTON, OR 97008 6600 SW 105TH AVE #175 BEAVERTON, OR 97008 PHONE: 503 - 627 -0100 PHONE: FAX: 503 - 627 -0110 FEES Description Date Amount Specifics: Permit Fee - COM 08/30/2012 $61.85 12% State Surcharge - Building 08/30/2012 $7.42 Type of Use: COM Plan Review - Fire Life Safety - COM 08/30/2012 $24.74 Class of Work: ALT Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 08/30/2012 $3.00 Occupancy Grp: B Height: ft 11x17) Stories: Commercial Sprinkler System: Sprinkler Required: Sprinkler Type: Standpipe Required: Hazard: Density: 0 Design Area: 0 K Factor: 0 Commercial Fire Alarm System: Fire Alarm Required: Yes Alarm Type: Automatic Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: No Cut Sheets Required: Yes Total $97.01 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $825.00 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utili otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or erect questions to OUN1q by in 503.232.1987 or 1.800.332.2344. • 1/4._;e611,22.,04_424, 41111.,. sued By: Permlttee Signature: - Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application Commercial � { " FOR OFFICE USE ONLY � U y ' - I L. Received Q� City of Tigard �� -: Date/By: : 0 r 411111- Permit No.: cps �`p..4o ` z / :� • 13125 SW Hall Blvd., Tigard, oil 97,221 e / ' n ` C g M9 � Plan Revie fi i 2 �� they Permit: �►.. //QA/� /:�✓1 Da Phone: 503.718.2439 Fax: 50 1 2 012 re /By: F ! 7� I i 4/449 . a Information ///CC2 l A IZ 1] Inspection Line: 503.639.4175 Date Ready /By: 1 ® See Page 2 for f I Internet: www.tigard- or.gov CM,' F� i ° �� Nat�ed/Method: g /� Supplemental Information rule t ."' 6� ''5 i � e2 f.t A) S f 0 /a,44 JO� TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I -and 2- family dwelling ® Commercial /industrial Valuation: $ ❑ Accessory building CI Multi-family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 11850 SW 67 Avenue New dwelling area: square feet City/State /ZIP: Tiagard, OR 97223 Garage/carport area: square feet Suite/bldg. /apt. no.: 140 Project name: Broad River Expansion Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Add/relocate Fire Alarm notification in TI Space Valuation: $$825.00 Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City/State /ZIP: Existing: Phone: ( ) Fax: ( ) New: ® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES* Business name: Point Monitor Corporation (Please refer to fee schedule) Structural plan review fee (or deposit): Contact name: Steve Bruns Address: 7869 SW Nimbus Ave FLS plan review fee (if applicable): City/State/ZIP: Beaverton, OR 97008 Total fees due upon application: Amount received: Phone: (503) 627 -0100 I Fax: : (503) 627 -0110 E -mail: SBruns@PointMonitor.com PointMonitor.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* CONTRACTOR Commercial and residential prescriptive installation of roof- .. mounted Photo Voltaic Solar Panel System. Business name: Point Monitor Corporation Submit t . - -is of roof plan with connecti. • . -tails and fire department ac - •, • . ng with • - 110 Oregon Address: 7869 SW Nimbus Avenue Solar Installation Specialty Code t• list. City/State /ZIP: Beaverton, OR 97008 Permit fee (include :. n review $180.00 and a. • nistrative fees): , Phone: (503) 627 -0100 Fax: (503) 627 -0110 State sur • : ge (12% of permit fee): • $21.60 CCB lic.: 135901 I Total fee due upon application: $201.60 Authorized signature: )7? This permit application expires if a permit is not obtained ,../tir.e/1„,.., within 180 days after it has been accepted as complete. Print name: Steven M Bruns Date: 8/13/12 * Fee methodology set by Tri-County Building Industry Service Board. 1: \Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(I 1/02 /COM/WEB) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT t:. COMMUNITY DEVELOPMENT Permit #: FPS2012 -00137 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012 Parcel: 1S 136DD05300 Jurisdiction: Tigard Site address: 11850 SW 67TH AVE, STE# 140 Project: Broad River Expansion Subdivision: WEST PORTLAND HEIGHTS Lot: 9 Project Description: Fire alarm modification Contractor: POINT MONITOR CORP Owner: PNWP LLC #2 7869 SW NIMBUS AVE PNWP LLC BEAVERTON, OR 97008 6600 SW 105TH AVE #175 BEAVERTON, OR 97008 PHONE: 503 - 627 -0100 PHONE: FAX: 503 - 627 -0110 FEES Description Date Amount Specifics: Permit Fee - COM 08/30/2012 $61.85 12% State Surcharge - Building 08/30/2012 $7.42 Type of Use: COM Plan Review - Fire Life Safety - COM 08/30/2012 $24.74 Class of Work: ALT Type of Const: VB Info Process /Archiving - Sm $0.50 (up to 08/30/2012 $3.00 Occupancy Grp: B Height: ft 11x17) Stories: Commercial Sprinkler System: Sprinkler Required: Sprinkler Type: Standpipe Required: Hazard: Density: 0 Design Area: 0 K Factor: 0 Commercial Fire Alarm System: Fire Alarm Required: Yes Alarm Type: Automatic Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: No Cut Sheets Required: Yes Total $97.01 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $825.00 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utili otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or erect questions to OUN1q by in 503.232.1987 or 1.800.332.2344. • 1/4._;e611,22.,04_424, 41111.,. sued By: Permlttee Signature: - Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 5 L/1 e / /UA C /i'11YDfACATTCU S FF5 c t Z - 1S FIRE ALARM AND EMERGENCY COMMUNIC TION SYSTEM RECORD OF COMPLETION 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. 1. PROPERTY INFORMATION Name of property: G ° "' River d Address: // d S U S W ^ 4 trev►v¢ e /�/C� 779.."4, Oft. � � � � 3 � Description of property: fr3t t l Pk r Spoke (5. ,re /49 i offjc d vt,t�t t Occupancy type: Name of property representative: Address: Phone: Fax: E -mail: Authority having jurisdiction over this property: Phone: Fax: E -mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: p0,. i /N0ri i? .t" Ce-r, Address: 7869' Stti A ro of i (5oou„P e+, , © `r L License or certification number: Phone: sa3 ^G2.7 -0100 Fax: S °3 - 6z5 1 -olom E - mail: hmexceOpoinrvwni .fe,s� Service organization for this equipment: A /A Address: License or certification number: Phone: Fax: E -mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: NA Address: Phone: Fax: E -mail: Contract expires: Contract number: Frequency of routine inspections: 3. DESCRIPTION OF SYSTEM OR SERVICE ire alarm system (nonvoice) ❑ Fire alarm with in- building fire emergency voice alarm communication system (EVACS) ❑ Mass notification system (MNS) ❑ Combination system, with the following components: 0 Fire alarm 0 EVACS ❑ MNS ❑ Two -way, in- building, emergency communication system ❑ Other (specify): Copyright C 2009 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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: Additional description of system(s): 3.1 Control Unit - Manufacturer: / /e,r /ei 1 1 Model number: S :- 3.2 Mass Notification System ❑ This system does not incorporate an MNS 3.2.1 System Type: ❑ In- building MNS— combination ❑ In- building MNS —stand -alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features:. ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ Wide -area MNS to regional national alerting interface ❑ Local operating console (LOC) ❑ Direct recipient MNS ( DRMNS) ❑ Wide -area MNS to DRMNS interface ❑ Wide -area MNS to high -power speaker array (HPSA) interface ❑ In- building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ❑ An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: � 3.4 System Software 0 This system does not have alterable site - specific software. Operating system (executive) software revision level: Site - specific software revision date: Revision completed by: ❑ A copy of the site - specific software is stored on site. Location: 3.5 Off - Premises Signal Transmission ❑ This system does not have off - premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: Phone: Supervisory: Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission: If Chapter 26, specify the means of transmission from the protected premises to the supervising station: f Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless 72. Fig. 10 18.2.1 .1 (I), 2 of 12) Copyright © 2009 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: Survivability level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: Description: 4.13 Device Power Pathways ❑ No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: \\ 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: Survivability level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: Description: 4.23 Device Power Pathways ❑ No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: Survivability level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: Description: 4.3.3 Appliance Power Pathways • No separate power pathways from the notification appliance pathway 11 Power pathways are separate but of the same pathway classification as the notification appliance pathway • 'ower pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18 2.1.1 (C. 3 ;,f Copyright 0 2009 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. 5. ALARM INITIATING DEVICES 5 .1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes . ❑ This system does not have manual fire alarm boxes. • Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.1.2 Other Alarm Boxes ❑ This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): • IJ p ` Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area Other (specify): Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): 5.2.2 Duct Smoke Detectors ❑ This system does not have alarm- causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ❑ This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: 5.2.4 Gas Detectors ❑ This system does not have gas detectors. Type of detector(s): . Number of devices: Addressable: Conventional: Type of coverage: 5 .2.5 Heat Detectors 0 This system does not have heat detectors. T ype and number of devices: Addressable: Conventional: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ❑ Rate -of -rise ❑ Rate compensated NFPA 72. Fia. 10 18 2.1.1 (p. 4 of 12) ' Copyright 02009 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. 5. ALARM INITIATING DEVICES (continued) 5 .2.6 Addressable Monitoring Modules ❑This system does not have monitoring modules. N umber of devices: 5 .2.7 Waterflow Alarm Devices ❑ This system does not have waterflow alarm devices. T ype and number of devices: Addressable: Conventional: Coded: Transmitter: 5.2.8 Alarm Verification ❑ This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds 5.2.9 Presignal ❑ This system does not incorporate pre - signal. Number of devices subject to presignal: Describe presignal functions: • 5.2.10 Positive Alarm Sequence (PAS) ❑ This system does not incorporate PAS. Describe PAS: 5.2.11 Other Initiating Devices ❑ This system does not have other initiating devices. Describe: \\I-\\ 6. SUPERVISORY SIGNAL - INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ❑ This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) 0 This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices 0 This system does not have other supervisory devices. Describe: • NFPA 72, Fig. 10.18.2.1 1 (p 5 of 12' Copyright 0 2009 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. • 7. MONITORED SYSTEMS 7.1 Engine - Driven Generator ❑ This system does not have a generator. 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel ❑ Other (specify): 7.2 Special Hazard Suppression Systems ❑ This system does not monitor special hazard systems. Description of special hazard system(s): 7.3 Other Monitoring Systems ❑ This system does not monitor other systems. Description of special hazard system(s): 8. ANNUNCIATORS ❑ This system does not have annunciators. 8.1 Location and Description of Annunciators . 1?\ Location 1: \1/4` Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES 9.1 In Building Fire Emergency Voice Alarm Communication System ❑ This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound - processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances ❑ This system does not have nonvoice notification appliances. Horns: With visible: Bells: With visible: Chimes: With visible: • • . e only: Other (describe . 9.3 Notification Appliance Power Extender Panels ❑ This system does not have power extender panels. Quantity: n 1 Locations: /4 fa-CJ NFPA 72. Fig. 10 18.2.1 1 (p. 6 of 12) Copyright ® 2009 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. 10. ASS NOTIFICATION. CONTROLS, APPLIANCES, AND CIRCUITS ❑ This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: \\ 14\ Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS -only visible appliances: Textual signs: Other (describe): Supervision class: 103.1 Special Hazard Notification . ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 7 1 . TWO - WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ❑ This system does not have a two -way telephone system. Number of telephone jacks installed: Number of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System \A \ ❑ This system does not have a two -way radio communications enhancement system. V Percentage of area covered by two -way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFP7 72, Fig, 10 18.2 i 7 of Copyright ® 2009 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. 11. TWO -WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ❑ This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ,\15 ❑ This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two-Way Communication Systems Describe: 2. CONTROL FUNCTIONS This system activates the following control fuctions: • ❑ Hold -open door releasing devices ❑ Smoke management ❑ HVAC shutdown ❑ F/S dampers . ❑ Door unlocking ❑ Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release + ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules ❑ This system does not have control modules. Number of devices: Other (specify): 3. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: Control panel amps: Overcurrent protection: Type: Amps: Location (of primary supply panel board): Disconnecting means location: 13.1.2 Engine- Driven Generator ❑ This system does not have a generator. Location of generator: ocation of fuel storage: Type of fuel: Copyright a 2009 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. 1 .. SYSTEM POWER (continued) 13.1.3 Uninterruptible Power System ❑ This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 13.1.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached \\I 13.2 In- Building Fire Emergency Voice Alarm Communication System or Mass Notification System ❑ This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: Overcurrent protection: Type: Amps: • Location (of primary supply panel board): Disconnecting means location: 13.2.2 Engine - Driven Generator ❑ This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.2.3 Uninterruptible Power System ❑ This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 13.2.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: alculated capacity of batteries to drive the system: • In standby mode (hours): In alarm mode (minutes): ❑ : atteries are marked with date of manufacture ❑ Battery calculations are attached • VCOA 72. t=ia. 10.18.2.1 1 (0. 9 of 121 Copyright © 2009 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. 13. SYSTEM POWER (continued) . 133 Notification Appliance Power Extender Panels ❑ This system does not have power extender panels. 133.1 Primary Power Input voltage of power extender panel(s): 1 f-C, Power extender panel amps: ( Overcurrent protection: Type: t greAke r Amps: 2,CJ Location (of primary supply panel board): /.n 14CP fir , Disconnecting means location: 133.2 Engine - Driven Generator ❑ This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 Uninterruptible Power System 0 This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 133.4 Batteries Location: et Pcu#j Type: at pb Nominal voltage: 24 Amp/hour rating: ,:l Calculated capacity of batteries to drive the system: In standby mode (hours): 'LLI In alarm mode (minutes): S . *-- ItS ❑ Batteries are marked with date of manufacture Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conductin: operational acceptance tests. i This is a: ❑ New system . odification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) .VFPA 72, Edition: . oNFPA 70, National Electrical Code, Article 760, Edition: E ■./ianufacturer's published instructions Other (specify): System deviations fro referenced NFPA standards: 0 I reet P name: 1t �C w 1.Te t c� / Z. Signed: Printed name. Date: 8/ 0 Organization: poih-1- 4.4., i' Title: T Y. iva Imo_ Phone: 5 —6 2 V-: 0/o0 NFPA 72 , Fro. 10.18.2.1. , (p 10 of (2) Copyright et 2009 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. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ❑ New system All operational features and functions of this system were tested by, or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: 'Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: NFPA 72, Edition: h FPA 70, National Electrical Code, Article 760, Edition: Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: auval4 Printed name: fe' ► 1& Date: S/ vze/Z- Organization: P°r ^rt Mo »r7vr' Cate Title: reot.rir Phone: So.? - c 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specifi herein, has een installed and tested according to all NFPA standards cited herein. Signed: Printed name::` erevvvr 74 '- Date: 1/3I/1_0/ Organization: Pvf•,f it/1mi Grp Title: - re .4, e ati Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: .1\f Printed name: Date: Organization: Title: Phone: 16.3 Supervising Station: This system, as specifie herein, will be monitored according to all NFPA standards cited herein. Signed: cr- Printed name: °h 'r Dater /`26/"2, Organization: P / r sir t r &G rp Title: r hrci.t.ti Phone: `" NFPA 72: Fig. 10.18.2.1.1 (p. 11 of 12) Copyright ® 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 165 Authority Having Jurisdiction: I have witness: a a satisfactory acceptance test of this system and find it to be installed and operating properly in accordanc:/ ith its approved plans and specifications, with its approved sequence of operations, and with all NFPA stan r :I'd cited herein. Signed: ' Printed name: 6 � 5 /v.9 L ` Date: 8.-s7 , Organi . ion: e r - y b r T1 C M() Title: S U 1 L ) (tNs Phone: SOS $ 7 6 u C, / Y NFPA 72. Fiq. 10.18.2.1.1 (p. 12 of 12) Copyright ® 2009 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. I