Report 08/23/2007 11:44 5032551966 CAPITOL ELECTRIC PAGE 02
NFPA-72 Fire Alarm System Record of Completion
Date: 8/2312007
City of Tigard Information: Permit No. BUP2007- 00305
Name of protected property: _ AMERICAN FAMILY INSURANCE, SUITE 100 TIGARD TRIANGLE COMMONS
Address of protected property: 11850 SW 67TH AVE TIGARD, OR 97223
Representative of protected property (name /phone): _
Authority having jurisdiction: Cit ofTisand Buildin ! Services
Address /telephone number: 13125 SW Hall Blvd. Ti. and 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 11:44 5032551966 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 Suite 100 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 08/23107
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 Suite 100 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: 8123/2001
Organization: Capitol Electric Company, Inc. _
4. Alarm Initlating Devices and Circuits Suite 100 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
(e) Other (list): _
08/23/2007 11:44 5032551%6 CAPITOL ELECTRIC PAGE 04
5. Supervisory Signal - Initiating Devices and Circuits Suite 100 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) 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
(0 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
(I) Control panel trouble
(m) Transfer switches
(n) Engine running
Other supervisory functions(s) (specify):
6. Alarm Notification Appliances and Circuits Suite 100 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: 26 Style Y Class: B
(a) Bells Inch
(b) Speakers
(c) 3 Horns
(d) Chimes
(e) Other:
(f) 23 Visual signals Type: ADA SYNCHRONIZED
18 with audible 5 w/o audible
(g) Local annunciator
08/23/2007 11:44 5032551966 CAPITOL ELECTRIC PAGE 05
7. Signaling Line Circuits Suite 100 Only
Quantity and class (see NFPA 72, Tabfe 3 -6) of signaling line circuits connected to system:
Quantity: Style: Class:
8. 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
9. System Software
(a) Operating system software revision level(s): N/A
(b) Application software revision level(s):
(c) Revision completed by: N/A
(name) (firm)
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 Suite 100 Only
Devices Installed conform to NFPA standards.
Syst - deviations from the referenced NFPA standard(s) are: NONE
fi
wig V ' � Dan Wilson Ca. itol Electric Co., FLS Su • ervtsor
(sig e• for central stati• - • -lar service company or Installation contractor /supplier (title)
U • on . pletion of th- , atisfactory test(s) witnessed (if required by the authority having jurisdictio : 3 O
(signed) repres- trin e of the authority having jurisdiction (title) (date)