Report AUG /31/2009/M0N 12:57 PM FAX No, F. 002
Page 1 of 2
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CA( -6 s - 1 -- 0 5S. _
Report Run Date: 08/31/09
Report Ron Time: 12:38;20 /�
61- 01-0661 C1: I O ( -'
HARSCH TIGARD TOWN SQUARE PAD BLDG
16230 SW PACIFIC HIGHWAY 1)0()
TIGARD, OR 97224 (((//J •
All Events Detail w /Codes
08 -27 -2009 - 08 -31 -2009
DATE DAY TIME CODE SIGNAL DESCRIPTION U5E1R INFORMATION
08/27 Thu 06:23 6020000 TEST TEST SIGNAL
08/27 Thu 06:23 6020000 TEST TEST SIGNAL
08/27 Thu 09:09
Event Operator: 96B at: 00 Acct opn /Clo: n/a
Out-of-service: D8/27 Until 06/27 Strt: 09:09 Until,: 10:30
Zone(s):
Comment:
06/27 Thu 09:09 ON TEST OUT OF SERVICE
Comment: OUT OF SERVICE PER DWAYNE WEST W /PC TIL 1030. OP96
Passcard Name: HARSCH TIGARD TOWN SQ
Completed on: 08/27/2009 at: 09:10:28 Operator: 96E
Disposition: System Out of Service
08/27 Thu 09:14 2000007 TAMPER SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 09:17 200000? RESTORAL SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
D8/27 Thu 09:25 2000007 TAMPER SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 10:12 2000007 RESTORAL SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 10:14
Event Operator: 96E at: 00 Acct Opn /Clo: n/a
Out -Of- Service: 08/27 Until 08/27 Strt: 10:13 Until: 16:00
Zone(8):
Comment: DWAYNE TIL 1600
08/27 Thu 10:14 ON TEST OUT OF SERVICE
Comment: EXTENDED TEST TIME PER DWAYNE WEST W /PC TIL 1600. OP96
Passcard Name: NARSCH TIGARD TOWN SQ
completed on: 08/27/2009 at: 10:14:20 Operator: 96B
Disposition: System Out of Service
D8/27 Thu 10:23 2000007 TAMPER SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 10:24 2000007 RESTORAL SPRINKLER VAULT VALVE TAMPER --RP /ALARM CO
08/27 Thu 10:26 2000007 TAMPER SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 10:33 2000007 RESTORAL SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 11:47 2000007 TAMPER SPRINKLER VAULT VALVE TAMPER - RP /ALARM CO
0B/27 Thu 11:49 2000007 RESTORAL SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
DB /27 Thu 11:51 2000007 TAMPER SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
06/27 Thu 11;52 2000007 RESTORAL SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 11:53 2000007 TAMPER SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 11:53 2000007 RESTORAL SPRINKLER VAULT VALVE TAMPER -RP /ALARM CO
08/27 Thu 16 :00 OFF TEST RETURNED TO SERVICE
08/28 Fri 06:23 6020000 TEST TEST SIGNAL
http: / /alceste.simsweb.coin /SW HTST.CMD 8/31/2009
AUG /31/2009/MON 12:57 PM FAX No, P. 003
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Page 2of2
08/28 Fri 06:23 6020000 TEST TEST SIGNAL
08/29 Sat 06:23 6020000 TEST TEST SIGNAL
08/29 Sat 06 :23 6020000 TEST TEST SIGNAL
08/30 Sun 06:23 6020000 TEST TEST SIGNAL
08/30 Sun 06:23 6020000 TEST TEST SIGNAL
08/31 Mon 06:23 6020000 TEST TEST SIGNAL
08/31 Mon 06:23 6020000 TEST TEST SIGNAL
http : / /alceste.sirnsweb.corn/SW IlTST.GMD 8/31/2009
elA AIAMIW^t1I 1101 S.E. 3RD AVENUE • PORTLAND, OREGON 97214 • (503) 238 -5700
,, 1111 «111, 850 CONGER • EUGENE, OREGON 97402 • (541) 683 -9333
- HE SAFETY COMPANY 2600 AIRPORT WAY, SOUTH • SEATTLE, WASHINGTON 98134 • (206) 340 -4300
*
_ CERTIFICATION - INSTALLATION /INSPECTION . , ria.....5
Customer Name PiCel /),'�. e_ eke r�' < . d D
Address ;( ') tp .� a " / to ` 1 44- a
/ .,- c_ t ,.. �' �_=•
X d L.7 "I" Or_ q / 2 C( ile
SYSTEM f p
Model(s) and serial numbers f-d el C c.. 1 ^ ! C q� 4 / Number of nozzles and Part No. 2 _ fl1 r 'A 4'I ,ra /. Ate, c.., �( c a m ,, r V i _ i -
Number of detector(s) and degree rating 4 --) can S ® y / � , 7 A 0 C "" t
Energy shut -off devices — type and size 427 lA t. c. dr ,91 /o?
Other accessory equipment provided (pull station, electric switches, etc.) / fe .: '- t' ft !/
7 SI.�� •f c .c. ree S44t.-fi 6)01 4y 44 •
COOKING /VENTILATING EQUIPMENT
r r, I/
Number of duct(s) and size Z. (mo / 7 Y 7 2
r
Hood size and plenum size /--/ n, 7 E . /0 ,c t / e L • /p /44-9a..p, S 2 6 /0 ,r 16
Cooking Appliances and size of cooking surface. (NOTE: List appliances from left to right and indicate those
being protected.)
1. wok /7 / i C_. 4. I/�CJ/ 4 (e r 2, a+
/ ^
2. 41 / r / P/ /L )' /$ r � 5. "/' P/ / t-/ i1 Y13 �/
r
3. vt/( /k l 4 ,'c., 6. F / e!'' / L./ G ,Y/ f r r
FIRE EXTINGUISHER INSPECTION NOTE: t' Gk- ° Z Z
/7
❑ Kitchen ❑ Facility
TO BE COMPLETED BY INSTALLER •
❑ YES ❑ NO 3
The fire suppression system is installed in accordance TO BE COMPLETED BY CUSTOMER
with the manufacturer's instructions, NFPA Standard
96 and 17 (current issue), and all applicable state and
local codes. Exceptions to other provisions of NFPA 96 ❑ YES ❑ NO
that were observed are noted below.
T 1 1 understand that it is the recommendation of ANSUL
Exceptions: 4/ r° 4a/ c t i c -Y'Gt e 1 t—c !, and of the National Fire Protection Association
-J G / Standard 96 and 17 that the fire suppression system be
fi !� t.d 1^ . G, / ` G C C cpGt , ep inspected and maintained every 6 months to ensure
` r A continued efficiency and reliability and that failure to
[n .,../ _et- >�, Pc) , 4t, L+ f e /eY to/ti. do so may result in failure of the system to operate
i if .o /.. GI r
/f 11 properly.
✓ II , ><! / /
1fC� c`�a r S Glar t�+�or ,� C USTOMER NAME A ND TITLE .
❑ YES ❑ NO
All electrical work or work provided by others to SIGNATURE
complete this system installation has bbe�en completed. DATE /"'"",
INSTALLER NAME q �., ,' .1,4 / 1
SIGNATURE_ C/� //I/ t s
y
DISTRIBUTOR
ADDRESS
DATE _ - 7_ 2.-12 .