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Permit a ��d CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT V COMMUNITY DEVELOPMENT Permit #: FPS2010 -00044 Date Issued: 04/28/2010 TtGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135AB01004 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 380 Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0 Project: Waldron Co. Project Description: Fire alarm. Owner: FEES LINCOLN CENTER LLC Description Date Amount BY SHORENSTEIN PROPERTIES LLC, 555 Permit Fee - COM 04/28/2010 $112.96 CALIFORNIA ST 49TH FL 12% State Surcharge - Building 04/28/2010 $13.56 PHONE: Plan Review - Fire Life Safety - COM 04/28/2010 $45.18 Contractor: SAFE TECHNOLOGY GROUP INC 6400 NE HWY 99 SUITE 375 VANCOUVER, WA 98665 PHONE: 360 - 699 -2130 FAX: 360- 719 -1527 Type of Use: COM Class of Work: ALT Type of Const: IIB Occupancy Grp: B Height: ft Stories: 5 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: No Smoke Detectors Req: No Battery Calcs Provided: Yes Cut Sheets Required: Yes Total $171.70 Valuations: Required Items and Reports (Conditions) Sprinkler Valuation: 0 Residential Square Footage: 0 Fire Alarm Valuation: 3050 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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifica • - - - _ Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct • •estions to OUN4 by . .n• 503.246.6699 or 1.800.332.2344. Issue. By: / 0 ►'c.14. Permittee Signature: � x Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. iiuilding Permit Application A/C 8A , 6 5 X29 Ao Fire Protection System ,: t I. OR OI FI CI U O ,�, .„ 4 E ,.,f Received • : ' P :: 2 ° c, 13125 SW Hall BlvdTard OR 97223 PR 2 1 2010 Plan Review -'0 po 6 7 T 1 G A R D' Inspection Line: 503.639.4175 Date Ready /By: „/ Jura ® See Page 2 for I. Internet: www.tigard -ocgov CITY OF TIGARD Notif ethod: 7;I o Supplemental Information BUILDING DIVISIOw f am r - a�� TYPE OF WORK QUIRED DATA: 1- AND-2- FAMILY DWELLING ❑ New construction ❑ Demolition Perk It 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. • ❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB' SITE INFORMATION AND LOCATION Total number of floors: Job site address: 10220 SW Greenburg Rd New dwelling area: square feet City /State /ZIP: Tigard OR Garage /carport area: square feet Suite/bldg. /apt. no.: 380 Project name: Waldron Covered porch area: square feet Cross street/directions to job site: Lincoln 2 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. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Fire alarm Valuation: 553,050.00 Existing building area: 1600 square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: Name: Type of construction: Address: Occupancy groups: City /State /ZIP: Existing: B g� Phone: ( ) Fax: ( ) New: B '. 0 .APPLICANT ❑ CONTACT :PERSON , NOTICE, . Business name: Safe Technology Group Inc. All contractors and subcontractors are required to be Contact name: Jason Sweet licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 6400 NE Hwy 99 Suite G375 jurisdiction in which work is being performed. If the City /State /ZIP: Vancouver WA 98665 applicant is exempt from licensing, the following reasons apply: Phone: (360) 699 -2130 Fax: : (360) 719-1527 E -mail: sales @safetechnology.net . CONTRACTOR BUILDING PERMIT FEES* : - Business name: Safe Technology Group Inc. (Please refer royeeacdedule) Permit fee: Address: 6400 NE Hwy 99 Suite G375 State surcharge (12 City /State /ZIP: Vancouver WA 98665 FLS permit fee): FLS plan review (40% of permit fee): Phone: (360) 699 -2130 Fax: (360) 719 -1527 (Due upon application.) CCB lic.: 173731 Total permit fees: / 7/, 70 Authorized signature: Pfo-er Amount received: T his permit application expires if a permit is not obtained Print name: Jason Sweet Date: 4 -20 -10 within 180 days after it has been accepted as complete. * Fee methodology set by Tri- County Building Industry Service Board. 1 : \Building\Permits \FPS- PermitApp.doc 10 /01/09 440- 4613T(I I /02 /COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2 - Supplemental Information Describe work to be done: 1.) ❑ New 2.) Modification to sprinkler heads only: El Addition ❑ 1 -10 heads: No plan review required. ® Alteration El 11+ heads: Plan review required. ❑ Repair Number of sprinkler heads: Additional description of work: Type of System (Complete A, B, C or D as applicable): A.) Commercial Sprinkler. ❑ Wet ❑ Dry Additional Standpipes Information: Hazard Group Density Design Area K. Factor Sprinkler Project Valuation: $ B.) Type I Hood Fire Suppression System Hood Project Valuation: $ • C.) Fire Alarm Submittal shall Battery Calculations ® Yes include: Individual Component ® Yes Cut Sheets Fire Alarm Project Valuation: $ 3050.00 • D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: • 0 to 2,000 $198.75 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinkler Project Square Footage: sq. ft. Fire Protection Permit Fees Project valuation subtotal (see A, B & C above): $ Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage (see D above): $ State Surcharge (12% of permit fee): $ FLS Plan Review (40% of permit fee): $ TOTAL: $ Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal. \ \Safesenvcr \dS \SAFE \ Forms \Use these forms \Permit Apps \Tigard \PPS- PermitApp.c c 10/01/09 FE'S JCS /v c :)o L( FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 - FIRE ALARM SYSTEM / RECORD OF COMPLETION Name of protected property: �✓ e"f1.1 . y � Address: 0 2 20 - - _ G _ �_ L (t'. 5 (,L/ f r 7,1b Representative of protected property (name /phone : Authority having jurisdiction: a l Address/telephone number: Organization name phone Representative name Iphone Installer $a-ft. re c /. w ®�o Y 47ec y,/ 3 -- 'f j -1 3o Supplier fel f{' 7Y citn. -d4o7 � 6rn s /sd -F^q- -2 /�c� Service organization 5.54- fc cp Location of record (as- built) drawings: Location of operation and maintenance manuals: o Location of test reports: 11-o . f0 f (.t f S/A-- a -- A contract for test and inspection in accordance with NFPA standard(s) Contract No(s): Effective date: Expiration date: System Software (a) Operating system (executive) software revision level(s): (b) Site - specific software revision date: (c) Revision completed by: • (name) (firm) 1.Type(s) of System or Service NFPA 72, Chapter 6 — Local If alarm is transmitted to location(s) off premises, list where received: NFPA 72, Chapter 8 — Remote Station Telephone numbers of the organization receiving alarm: Alarm: Supervisory: Trouble: 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: NFPA 72, Chapter 8 — Proprietary Telephone numbers of the organization receiving alarm: Alarm: Supervisory: Trouble: 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: NFPA 72, Chapter 8 — Central Station Prime contractor: Central station location: (NFPA 72, 1 of 4) FIGURE 4.5.2.1 Record of Completion. 2002 Edition 72 - NATIONAL FIRE ALARM CODE Means of transmission of signals from the protected premises to the central station: McCulloh Multiplex One -way radio ,'C1 Digital alarm communicator Two -way radio Others Means of transmission of alarms to the public fire service communications center: (a) (b) System location: NFPA 72, Chapter 9 — Auxillary Indicate type of connection: Local energy Shunt Parallel telephone Location of telephone number for receipt of signals: 2. Record of System Installation (Fill out after installation is complete and wiring is 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 on , includes the devices shown in 5 and 6, and has been in service since .INFPA 72, Chapters 1 2 3 ( 67 & 9 10 11 (circle all that apply) NFPA 70, National Electrical Code, Article 760 A) Manufacturer's instructions Other (specify): Signed: Date: Organization: 3. Record of System Operation Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached • All operational features and functions of this system were tested by date and found to be operating properly in accordance with the requirements of: NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 11 (circle all that apply) f/0 NFPA 70, National Electrical Code, Article 760 r C) Manufacturer's instructions Other (specify): Date: Lf -1 ! - !v Organization: S ct F.e_ - _ _ _ o 4. Signaling Line Circuits Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity: r Style: p Class: Y (NFPA 72, 2 of 4) FIGURE 4.5.2.1 Continued 2002 Edition FUNDAMENTALS OF FIRE ALARM SYSTEMS 72 - 5. Alarm- Initiating Devices and Circuits Quantity and class of' initiating device circuits (see NFPA 72, Table 6.5): Quantity: Style: Class: MANUAL (a) Manual stations Noncoded Transmitters Coded Addressable (b) Combination manual fire alarm and guard's tour coded stations AUTOMATIC Coverage: Complete Partial Selective Nonrequired (a) Smoke detectors Ion Photo Addressable (b) Duct detectors Ion Photo Addressable (c) Heat detectors FT RR FT/RR RC Addressable (d) Sprinkler waterflow indicators: Transmitters Noncoded Coded Addressable (e) The alarm verification feature is disabled or enabled , changed from seconds to _ seconds. (f) Other (list): 6. Supervisory Signal- Initiating Devices and Circuits (use blanks to indicate quantity of devices) GUARD'S TOUR (a) Coded stations (b) Noncoded stations (c) Compulsory guard's tour system comprised of transmitter stations and intermediate stations Note: Combination devices are recorded under 5(b), Manual, and 6(a), Guard's Tour. SPRINKLER SYSTEM Check if provided (a) Valve supervisory switches (b) Building temperature points (c) Site water temperature points (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 (j) Fire pump running ENGINE - DRIVEN GENERATOR: (a) .Selector in auto position (b) Control panel trouble (c) Transfer switches (d) Engine running Other supervisory function(s) (specify): (NFPA 72, 3 of 4) FIGURE 4.5.2.1 Continued 2002 Edition • 72 -34 NATIONAL FIRE ALARM CODE 7. Annunciator(s) Number: Type: Location: 8. Alarm Notification Appliances and Circuits NFPA 72, Chapter 6 — 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: Quantity and the class of notification appliance circuits connected to system (see NFPA 72, Table 6.7): Quantity: Style: Class: Types and quantities of notification appliances installed: (a) Bells With Visible (b) Speakers With Visible (c) Horns X With Visible X (d) Chimes With Visible (e) Other: With Visible (f) Visible appliances without audible: 3 9. System Power Supplies (a) Fire Alarm Control Panel: Nominal voltage: 1 l 0 Current rating: s v� Overcurrent protection: Type: 17 Current rating: ,2.D Location: (b) Secondary (standby): �7 Storage battery: o_ Amp -hour rating: / !/1✓ Calculated capacity to drive system, in hours: ,2 Engine- driven generator dedicated to fire alarm system: Location of fuel storage: (c) Emergency system used as backup to primary power supply: Emergency system described in NFPA 70, Article 700: 10. Comments Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): System deviations from the referenced NFPA standard(s) are: • • - . / l - ..— ! 1 - / G (signed) for installation tractor /supplier (title) (date) (signed) for alarm service company (title) (date) (signed) for central station (title) (date) Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction): (signed) representative of the authority having jurisdiction (title) (date) (NFPA 72, 4 of 4) FIGURE 4.5.2.1 Continued 2002 Edition T FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. PROTECTED PROPERTY INFORMATION Name of property: I ^ C)v n c0) 1 1 1 Address: 4 2 2c9 Sc.) &-t-c el V.) a K. 94-0z Description of property: Q �5 *"c .S 6- Occupancy type: 6 Name of property representative: S ( +�''c��4 -c " (•k•-/ . Address: (0Z2r) Sw G ^c (,) �� (L� �.������ 00, 5 7 2 2 3 Phone: Fax: E -mail: Authority having jurisdiction over this property: Phone: Fax: E -mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION Installation contractor for this equipment: S ("C. Ter 6 too lJ I� f �W' l V A 1. Address: y / / �1toWove,- l✓ � - 1S - 66 - 7 S 6 5 Phone: Fax: E -mail: Service organization for this equipment: S; ni6T)l Address: 6, la j S(.i co ` \ q n Q ' T J < Phone: Sb C is 5- `j co o Fax: E -mail: Location of as -built drawings: 1 \ a ti Location of historical test reports: Location of system operation and maintenance manuals: �� i 1A % \e A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: E -mail: Contract expires: Contract number: Frequency of routine inspections: 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE NFPA 72 Chapter Reference of System Type: Cc I t rA \ Si 4) A : ->n Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: e„ 6^ ^c l\ Phone: I S "% f - Supervisory: 1 Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.1 of 5) NATIONAL FIRE ALARM CODE - 4. 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE (continued) If Chapter 8, note the means of transmission from the protected premises to the central station: ADigital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2 -way radio ❑ I -way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: 1 "%--- 0 Site-specific software revision date: t ° —� G p � Revision completed by: S,',-.0teaG ,, , ., ni 11 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits connected to this system (see NFPA 72, Table 6.6.1): Quantity: Style: Class: 5. ALARM - INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: Style: Class: 5.1 Manual initiating devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2:4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: p Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.2 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 6. SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 6.2 Fire Pump Type of fire pump: ❑ Electrical ❑ Diesel Type of pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. ANNUNCIATORS 7.1 Annunciator 1 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: • 8. ALARM NOTIFICATION DEVICES AND CIRCUITS 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker zones: 8.2 Telephone Jacks Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: Style: Class: J2 Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.3 of 5) . NATIONAL FIRE ALARM CODE 8. ALARM NOTIFICATION DEVICES AND CIRCUITS (continued) 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device Horns: _ With visual device: Chimes: With visual device Bells: With visual device: Visual devices without audible devices: 7 Other (describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other 10. SYSTEM POWER SUPPLY 10.1 Primary Power Nominal voltage 20 v Amps e Overcurrent protection: Type Amps Z Location (of primary supply panelboard): 31- ( Disconnecting means location: 20 10.2 Secondary Power Location: Type: Nominal voltage: Current rating: Fl Number of standby batteries: 2 Amp hour rating: -f Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: /- oiv In alarm mode: S 11. 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 conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) 'NFPA 72 4I-NFPA 70, National Electrical Code, Article 760 — Manufacturer's published instructions ❑ Other (please specify): System deviationss ,ffo ∎ refe l\ ced NFPA standards: Signed: ( D►'"`0 r ' r Printed name: a c'R.,- 1 Date: 10- CO -chi Organization: - 'Ce c.1•M c4Oci�/ r � Title: Phone: ra 12. RECORD OF SYSTEM OPERATION 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 of: NFPA 72 ,g,NFPA 70, National Electrical Code, Article 760 t i Manufacturer's published instructions ❑ Other (please specify): ❑ Document 's t in aa ord3pre with Inspection and Testing Form (Figure 10.6.2.3) is attached Signed: v ` Printed name: 1 0 1 -1 vlAc L 4 Date: N - C -06 Organization: 5 ,) -., \\ Title: 'C'cc-h Pe.fp Phone: 5 e)0--y cso Reprinted with permission from fIFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.4 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 13. CERTIFICATIONS AND APPROVALS 13.1 System Installation Contractor This syste ss sp i ed her ' has been installed and tested according to all NFPA standards cited herein. ,� /— Signed: l J Printed name: Y $ ve 4 i `z. Date: (6 ° C�L� ` O9 Organization: __.1_______Ie iw&t y 61zu Title: bVS rter44 - C Phone: 3600' 6R?' Zl3rD 13.2 System Service Contractor This system as ecified herein has been installed and tested according to all NFPA standards cited herein. Signed: ( 1/ ;-- ------ Printed name: pit\pli k`14(. li.;1..er)1 Date: I v°C -` l Organization: , -p .6 x G' , '^ ^ t )1 Title: 1' L ri, r Phone: 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: . Organization: Title: Phone: 13.4 Property 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: 13.5 Authority Having Jurisdiction I have witnr sed a satisfactory , --prance test of this system and find it to be installed and operating properly in accord- - ith it ir• ed plans and specifications, its approved sequence of operations, and with all NFPA standards r G I herein. Signed: / ._ Printed name: G /�l , c/7 Date: Iv - / — 7 .� y' Organization: C r. t. Title: 3ule.>>�vls� � ,�73 71 'J. Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.5 of 5) •