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Report 08/23/2007 11:41 5032551966 CAPITOL ELECTRIC PAGE 02 .6up 2wL - cvc4:3 NFPA -72 Fire Alarm System Record of Completion Date: 8123/2007 City of Tigard Information: Permit No. BUP2006 -00437 Name of protected property: TIGARD TRIANGLE COMMONS, BUILDING SHELL Address of protected property: 11850 SW 67TH AVE TIGARD, OR 97223 Representative of protected property (name /phone): Authority having jurisdiction: City of Tigard, Building Services Address /telephone number: 13125 SW Hall Blvd. Ti s ard, 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: 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 Two -way radio Others Means of transmission of alarms to the public fire service communications center: (a) (b) System location: 08/23/2007 11:41 5032551%6 CAPITOL ELECTRIC PAGE 03 Organization name /phone Representative name /Phone Installer Capitol Electric Co. Inc. Dan W. Wilson 503 255 -9488 Supplier Capitol Electric Co. Inc. Dan W. Wilson 503 255.9488 Service organization Capitol Electric Co. Inc. Dan W. Wilson 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 Building Shell 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 Jeff Morrow on 08/23/07 , included the devices shown below, and has been in service since 08123/07 x NFPA 72, Chapters 1 2 3 4 5 6 7 (underline all that apply) x NFPA 70, National Electrical Code, Article 760 x Manufacturer's instructions Other (specify): Signed: Jeff Morrow Date: 08/23/07 Organization: Capitol Electric Company, Inc. 3. Record of System Operation Building Shell Only All operational features and functions of this system were tested by Jeff Morrow on 08/23/07 and found to be operating properly in accordance with the requirements of: x NFPA 72, Chapters 1 2 3 4 5 6 7 (underline all that apply) x NFPA 70, National Electrical Code, Article 760 x Manufacturer's instructions Other (specify): Signed: Jeff Morrow Date: _ 8/23/2007 Organization: Capitol Electric Company, Inc. 4. Alarm Initiating Devices and Circuits Building Shell Only Quantity and class of Initiating device circuits (see NFPA 72, Table 3 -5) Quantity: Style: Class: MANUAL (a) 1 Manual stations _ 1 Noncoded, activating Transmitters Coded (b) Combination manual fire alarm and guard's tour coded stations. AUTOMATIC Coverage: Complete: 1 Partial: (a) 6 Smoke detectors Ion 6 Photo (b) 4 Duct detectors ion 4 Photo (c) 2 Heat detectors 2 FT RR FT /RR RC (d) 0 Sprinkler waterflow switches: Transmitters 1 Noncoded, activating (e) Other (list): 08/23/2007 11:41 5032551966 CAPITOL ELECTRIC PAGE 04 • 5. Supervisory Signal- Initiating Devices and Circuits Building Shell Only 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 5(a). SPRINKLER SYSTEM (a) 1 Non coded valve supervisory switch at sprinkler riser (b) 2 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 (1) Engine or control panel trouble (j) 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): Elevator Shunt Trip Voltage Monitor 6. Alarm Notification Appliances and Circuits Building Shell 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: 20 Style Y Class: B (a) Bells Inch (b) Speakers (c) 2 Horns (d) Chimes (e) 1 Other: Outside Sprinkler Flow HIS (f) 17 Visual signals Type: ADA SYNCHRONIZED 10 with audible 7 w/o audible (g) Local annunciator 08/23/2007 11:41 5032551966 CAPITOL ELECTRIC PAGE 05 7. Signaling Line Circuits Building Shell Only Quantity and class (see NFPA 72, Table 3 -6) of signaling line circuits connected to system: Quantity: 1 Style: 4 Class: B 8. System Power Supplies (FACP) (a) Primary (main): FACP Nominal voltage: 120 VAC Current rating: 2.5 Amps Overcurrent protection: Type: Circuit Breaker Current rating: 20 Amps Location: FLOOR 1 ELECTRIC ROOM (b) Secondary (standby): X Storage battery: Amp -hour rating: 12 Ah © 24 VDC Calculated capacity to drive system, in hours: 6.687 Ah 24 60 System Power Supplies (NAC 1.1 Power Supply) (a) Primary (main): NAC 1.1 Nominal voltage: 120 VAC Current rating: 2.5 Amps Overcurrent protection: Type: Circuit Breaker Current rating: 20 Amps Location: FLOOR 1 ELECTRIC ROOM (b) Secondary (standby): X Storage battery: Amp -hour rating: 7 Ah @ 24 VDC Calculated capacity to drive system, in hours: 2.556 Ah 24 60 System Power Supplies (NAC 2.1 Power Supply) (a) Primary (main): NAC 2.1 Nominal voltage: 120 VAC Current rating: 2.5 Amps Overcurrent protection: Type: Circuit Breaker Current rating: 20 Amps Location: FLOOR 2 ELECTRIC ROOM (b) Secondary (standby): X Storage battery: Amp -hour rating: 7 Ah @ 24 VDC Calculated capacity to drive system, in hours: 2.613 Ah 24 60 9. System Software (a) Operating system software revision level(s): SSK V3.14 (b) Application software revision level(s): (c) Revision completed by: N/A (name) (firm) 08/23/2007 11:41 5032551966 CAPITOL ELECTRIC PAGE 06 10. Comments: Dan Wilson Capitol Electric Co., FLS Supervisor (signed) for central station or alarm service company or installation contractor /supplier (title) Frequency of routine tests and inspections, if other than In accordance with the referenced NFPA standard(s): This record of completion applies to Building Shell Only Devices installed conform to NFPA standards. System ,, deviations from the referenced NFPA standard(s) are: NONE 41 em1Wr Dan Wilson Ca • itol Electric Co., FLS Su • ervisor (sig - -r central '• p•r a . m service company or installation contractor /supplier (title) lJ• • ► •.mpletion o 7 - iiiktfactory test(s) witnessed (if required by the authority having jurisdic '•n): .• �. gned) repr- , tative of the authority having jurisdiction (title) (date)