Report y s FUNDAMENTALS OF FIRE ALARM SYSTEMS • 72 -27
7 ,
Figure 1 -6.2.1 Record of completion.
FIRE ALARM SYSTEM
+f.; RECORD OF COMPLETION
rkt
R: Name of protected property: CI r 00-Pc d t cr
_:":' Address: (I. 56 0 S W 67 egO rt n d R
^ r Representative of protected property (name/phone): 1 E r 6 6 75- b 2 64,
Authority having jurisdiction:
Address /telephone number:
1. Type(s) of System or Service
NFPA 72, Chapter 3 — Local
If alarm is transmitted to location(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
ty speaker zones:
Quantity of telephones or telephone jacks included in system:
NFPA 72, Chapter 6 — Auxiliary
Indicate type of connection:
Local energy Shunt Parallel telephone
Location of telephone number for receipt of signals:
NFPA 72, Chapter 5 — Remote Station
Alarm:
Supervisory:
NFPA 72, Chapter 5. — Proprietary
;1
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 5 — Central Station
Prince contractor:
Central station location: P t et r BA. e rQ 1 1
i Q,q v et- i -o A. 6
Means of transmission of signals from the protected premises to the central station: ( —o 1 Z Li ✓�
McCulloh Multiplex One -way radio
Digital alarm communicator Two -way radio Others
Means of transmission of alarms to the public fire service communications center.
(a) 4
(b)
System location: F1 r E e e✓ \tat R o o pet — r i , p
i t Fir (. i A E rL l .i r' V — F A- Ft- (NFPA Record of Completion 1 of 4) ;p
'EI
1999 Edition f�
,, 72 -28 NATIONAL FIRE ALARM CODE
Figure 1- 6.2.1 (Continued)
Organization name /phone Representative name /phone
Installer
Supplier
Service organization rso i r d (M.o rt i +o or Ge r il.. ig.,1 c o t < G1 e .'lc. k b 3 9 2 - 3 3 3
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
(Fill out after installation is 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
b 1> M C.-- on ' 5/2-V) (pincludes the devices shown below, and has been in service
since - 5/ VIVO (A• .
NFPA 72, Chapters 1 2 3 4 - 5 6 7 (circle all that apply)
— NFPA 70, National Electrical Code, Article 760
Manufacturer's instructions
_ Other (specify):
Signed: ei? ( ► 4:s- $ l C Date: 4, ql o 4 _
Organization: ft, At M 0 A i 0 ! 0 r 1:.
3. Record of System Operation -
All operational features and functions of this . system were tested by : P j C-- on 6/9 /B 6
and found to be operating properly in accordance with the requirements of
_ NFPA 72, Chapters 1 2 3 4 5 6 7 (circle all that apply)
_ NFPA 70, National Electrical Code, Article 760
_ Manufacturer's instructions
_ Other (specify): del_ _'
Signed: I1� i C.- Date: 6° f 9 ��
Organization:
i'A i At M o w. fio r (6.10 rr - , ;
4. Alarm- Initiating Devices and Circuits
Quantity and class of initiating device circuits (see NFPA 72, Table 3 - 5). Quantity: t Style: 4 Class:
MANUAL
(a) 6 Manual stations Noncoded, activating Transmitters Coded
(b) Combination manual fire alarm and guard's tour coded stations
AUTOMATIC ✓ ? 3 '
Cover .5.1e: y
'� e: Complete: Partial: . Photo
(a) Smoke detectors Ion N : 7
(b) Duct detectors Ion Photo
Heat detectors ✓ FT RR FT/RR RC " J s
1999 Edition _ '
4%; ^
• '
FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-29
Figure 14.2.1 (Continued)
(d) ( Sprinkler waterfiow switches: Transmitters Noncoded, activating Coded
(e) Other (list):
5. Supervisory Signal-Initiating Devices and Circuits (use blanks to indicate quantity of devices)
, GUARD'S TOUR
(a) Coded stations
(b) Noncoded stations, activating transmitters
(c) Compulsory guard tour system comprised of transmitter stations and
intermediate stations
Note: Combination devices are recorded under 4(b) and 6(a).
SPRINKLER SYSTEM
(a) 1 Coded valve supervisory signaling attachments
Value supervisory switches, activating transmitters
(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:
(k) Selector in auto position
(1) Control panel trouble
(m) Transfer switches
(n) Engine running
Other supervisory function(s) (specify):
6. Alarm Notification Appliances and Circuits
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: 4 ? Style: Y Class: 13
(a) 1 Bells Inch
(b) Speakers
(c) Horns
(d) Chimes
(e) Other:
1989 Edition
i
'.72 N ATIONAL FIRE ALARM CODE `;
Figure 1 -6.2.1 (Cu 8d)
• ,(fl __ Visual signals Type: �, "
_ with audible .� w/o audible
( Local annunciator -
system: ' -ii
7. Signaling Line Circuits {
Quantity and class (see NFPA 72, Tabt 3 -6) of signaling line circuits connected to
Quantity: Style: Class: TO
8: System Power Supplies
(a) Primary (main):
�- V (� Nominal voltage: -2-� t.c-, Current rating: j
Current rating.
Overcurrent protection: Type: ;
^u
Location:
(b) Secondary (standby): 7 (° Z
1
%Z Storage battery: Amp -hour rating: ` '
Calculated capacity to drive system, in hours:
Engine- driven generator dedicated to fire alarm system: is
Location of fuel storage: supply: (c) Emergency or standby system used as backup to primary power supply, instead of using a secondary po wer pP y
Emergency system described in NFPA 70, Article 700
Legally required standby system described in NFPA 70, Article 701
Optional standby y
db system described in NFPA 70, Article 702, which also meets the performance
requirements of Article 700 or 701 .
.
9. System Software 4,.,
(a) Operating system software revision level(s): 1
(b) Application software revision level(s):
(c) Revision completed by: (tee) (,)?
• il
10. Comments:
n
( data) ' i s
--:,,s • (signed) for central station ar alarm service company or installation contractor /supplier (titl
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): .= ; ` .z ' "
u
Jj
=: Y
System deviations from the referenced NFPA standard(s) are
- 4 ',
vY .
date) :; ='`'.
(sign ) for central station or alarm service company or installation contractor /supplier (title) ( - x.
• - di ction): '
the - - (s (_ witness • • (if required by the authority ha . g ] g
Upon om� etion ° "• test :
� —1 ? ' t ' e (title) (date : `
= unsdution `'�' i
: p i s �tativeo •ea ontyha ;r � z ��_ :
V t
1999 Edition ::
JUN -08 -2006 13 16 P.02
OR CCB # 090981 � M
ti1eK�
/n�
5400 NE Columbia Blvd MATERIAL & TEST REPORT FOR ABOVEGROUND PIPING Portland OR 97218
-. - -- _ ..... _. .---. ..::::M__: 1”..,. . , ....... :t : : : : : :, :— : :I. 5111.....,33.1 :Q. .34.....
90CEDURE
non oomOIetion of work. inspection and testa shall be made by the contractor's ropresentative and witnessed by an owner 's representative. All defects
shall be corrected and system left in Senior) before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies sh.111 be prepared for approving authorities. owners. and contractor. It is under-
stood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or lailure to comoly
with approving authority's requirements of IOCai ordinances.
PROPERTY NAME • A OATE
7Il ,r (life c w de( ; , . . ..-/o-61.6-
PROPERTY ADDRESS
/ - 0 W , 77 Q
rein -. r : • ; = =i 1 - •U HO - Ti S Rte
ADO - - SS
INSTALLATION C•NFORMS TO ACCcPTEO PUNS 1;n YES R NO
PLANS EQUIPMENT USED IS APPROVED . ►,: YES ❑ NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHA - GE OF FIRE EQUIPMENT BEEN IN - U 0 • ' 0 LOCATION P=" ES R NO
OF CONTROL. VALVE ANO CARE ANO MAINTENANCE OF THIS NEW EOUIPMENT7
IF NO, EXPLAIN -
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: YE5 NQ
INSTRUCTIONS 1. SYSTEM COMPONENTS INSTRUCTIONS YES NO
2 CARE AND MAINTENANCE INSTRUCTIONS. ES 0 N
3. NFPA 13A ES ❑ NC _
LOCATION SUPPUES BUILDINGS ( k
OF SYSTEM { 4Ae1!a1. &A i ' /t1 14"
MAKE 1 MOOEL I MANUFACTURE ORIFICE E OUANTTTY TE RATING
/ I 5 CI. 1 z -0 I Y...7 1 /3O /00- SPRINKLERS / I I I I
I I I
1
1 I
I _
/• I I I
PIPE AND TYP£ OF PIPE ., /t 5'd.. / d
FITTINGS TYPE OF FRTINGS =.•
ALARM • ALARM DEVICE MAXIMUM TIME TO OPERATE
VALVE • THROUGH TEST CONNECTION
OR FLOW .TYPE I • E MODEL MIN I SEC.
INDICATOR /C i i /J 1 I
1 1 1
1 1
DRY VALVE 1 0.00.
MAKE MOO!L I SERIAL NO. 1 MAKE I MODEL 1 SERIAL NO.
• 1 I I
PIPE TIME TO TRIP TIME WATER 1 ALJWM
DRY PIPE
OPHRATI TFiRU TEST WATER AIR TRIP POINT REACHED I OPERATED
CONNECTION I PRESSURE PRESSURE AIR PRESSURE TEST OUTLET { PROPERLY
• TEST MIN. • SEC. I PSI 1 PSI 1 PSI ; MIN. 1 SEC• IYES I NO
0.0.0. I I I I i 1
I I 1_ I 1 1 I
IF NO. EXPLAIN
•
• MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED
SSA (OVERT
JUN -08 -2006 13 17 • P.03
OPERATION
. • ' 0 PNEUMATIC ❑ ELECTRIC 0 HYORAUUC
PIPING SUPERVISED • YES • NO DETECTING MEDIA SUPERVIS • ■ YE • NO
DELUGE L OES VALVE OPERATE ROM THE MANUAL TRIP ANCHOR REMOTE CONT OF� STATIONS YES NO
PREACTION
LVES
VALVES IS THERE AN ACCE5$IBL FACIUTY IN EACH CIRCUIT FOR TESTIN I IF NO. - • N
VALVES Q YES D NO j
J GOES EACH CIRCUIT OPERATE . DOES .A H CIRCUIT MAXIMUM TIME TO
ID I
MA MODEL SUPERVISION LOSS ALARM I OPERATE VALVE RELEASE OPERATE RELEASE
.• . • 4 .
1 ► 1 I 1 I
TEST .•••: • . • Myero..ee 1.•b moo W nom a not 1•.41no1200 w 113.6 Pao be too nano to 50 O.1 11r corm •t•w •bale play.. w •4e•14 d 150 10 1107
twig DESCRIPTION is r•o Maw 0111444■1d arrow. MI.. 061:041411 WWI Da I441 UA ,1 o O. ou rq 1r arwwnl ~ow.. ,I41 ' abO g ou.0 12.0.4 1444.4424 WWI to moms.
E.deHM AO OM 0 - 7 bon' 011 Dla..va mIN ,44W4p4 Way vice s Iowa .v1 444;444.2 1.1 R Pei 40.1 Tw41 IA $4 hOtiL T.r D44.aU 4 1a/e0 ea I1pnw41 wane
wr ana W pwiDw and 04444 d 11 Onwo... WOO w.MCn !MA M •.tw.0 1 12 •11 10.1 by11 In 94 Howl.
II • (PING NY - • ATI Y E • A �/141 FOR HRS. IF NO, ATE R ON
DRY PIPING PNEUMATICALLY TESTED ( YES ❑ NO
• EQUIPMENT OPERATES PROPERLY 5 CI
00 YOU CE AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITNES AND CORROSIVE CHEMICALS. SODIUM
. SILICATE OR OERMATIVES OF SODIUM SILICATE. BRINE OR OTHER CORROSNE CHEMICALS WERE NOT USED FOR TEST-
ING SYSTEMS OR STOPPING LEAKS7 !.YES 0 NO
TESTS *PAIN _ •IN • GE Le • NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST
5T I SUPPLY TEST CONNECTION: j 5 PSI CONNECTION OPEN WIDE . 6 Q PSI
UNDERGROUND MAINS AND LSAD IN CONNECTIONS 70 SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO
SPRINKLER PIPING.
RIFTED BY COPY OF THE U FORM NO. MB ri YES 0 NO OTH D.FLAIN
FLUSHED BY INSTALLER OF UNDER- •-
ROUND SPRINKLER PIPING ErY£S ag
BLANKTESTIAG INUMBER SED LOCATIONS I
NUMBER REMOVED
GASKETS
WELDED PIPING I ' YES L
I S.
00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR HAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS 710.8. LEVEL AR-3 ,YES 0 NO
00 YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS OUAUFIED IN
WELDING COMPLIANCE WITH NE REOUIREMENTS OF AT LEAST AWS 010.9. LEVEL AR f, YES ONO
00 YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED OUALLTY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH. THAT SLAG AND OTHER
WELDING RESIDUE ARE REMOVED, ANO THAT THE INTERNAL DIAMETERS OF
PIPING ARE NOT PENETRATED ! YES 0 NO
CUTOUTS i00 YOU CERTI THAT YOu HAVE A CONTROL FEATURE • N ' URE THAI ALL
IOISL;51 ICUTOUTS IDISCSI ARE RETRIEVED?
I.!: ES CI NO
FUN ONAL IDOES M REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? YES • NO
FLOWTEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY7 DYES ❑ NO
HYURAUU1;4 NAME PLATE PROVIDED I IF N0. EXPLAIN
DATA NAMEPLATE liYES ONO
•
DATE LEFT IN SER WITH ALL CONTR L VALVES OPEN: T •
REMARKS - / D - G S
NAME OF SPRINKLER CON A CONTRACT R UC NSE 0
,f het S eft!, • 0
TESTS WITNESSED BY
FORPR•P. Ty AWN 5 N 0) 1I L._ i
SIGNATURES
FOR SP7K -. - r CT • (SIGNED) 11 LE - DATE
•R APP • 1NG AUTHORITY I TITLE DAY
I CEO TsFY THAT THE INFORMATION HEREIN IS TRUE ANO THAT THIS SPRINKLER SYSTEM WAS INSTALLED IN ACCORD-
ANCE WITH RCW 18-160 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY .
CERTIFICATION THE STATE FIRE MARSHAL
• • NAME OP CcRfl•IGTE OP COMPETENCY HMI (PANT OR TYPO
SIGMA A QOP CER 1JICATS OP COMPETENY ►10LDHR
CERTIFICATE REGISTRATION • DATE
ADOITIOIIAI. EJI•LANAI10N ANO.4TT:S
ISA BACK
TOTAL P.03