Report FIRE ALARM SYSTEM
RECORD OF COMPLETION / S 7r Q 0 0 YJ
Name of protected property: FANNO CREEK PLACE, BUILDING `B"
Name of project: Amedisys TI Suite 100
Address: 16083 S.W. UPPER BOONES FERRY ROAD, TIGARD, OR 97214
Representative of protected property (name /phone):
Authority having jurisdiction: CITY OF TIGARD BUILDING DEPT.
Address /telephone number: - -
(Organization name /phone) (Representative name /phone)
Installer: LEAR ELECTRIC / 503 - 665 -9840 OLEG PRIMACHENKO
Supplier: LEAR ELECTRIC / 503- 665 -9840 OLEG PRIMACHENKO
Service Organization: LEAR ELECTRIC / 503- 665 -9840 OLEG PRIMACHENKO
Location of record (as- built) drawings: ONSITE / ON FILE
Location of operation and maintenance manuals:vi ONSITE / ON FILE
Location of test reports: A contract for test and inspection in accordance with NFPA standard(s): ONSITE
Contract No(s): N/A Effective date: N/A Expiration date: ANNUALLY
System Software VER. 2.50
(a) Operating system (executive) software revision level(s): N/A
(b) Site - specific software revision date: UNK.
(c) Revision completed by (name /firm): UNK.
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 the alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 8- Proprietary
Telephone numbers of the organization receiving the 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 the alarm:
Indicate how alarm is retransmitted:
_XX NFPA 72, Chapter 8- Central Station
Prime contractor: Central station location:
Means of transmission of signals from the protected premises to the central station:
McCulloh Multiplex One -way radio
_XX_Digital alarm communicator Two -way radio Others
Means of transmission of alarms to the public fire service communications center: N/A
(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: Cliff Hoecker
on: 4/14/2011 , includes the devices shown in 5 and 6, and has been in service since: 4/14/2011
_XX_NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (mark all that apply)
_ XX_NFPA 70, National Electrical Code, Article 760
XX Manufacturer's instructions
Other (specify):
Signed: 6/# o ec,>'cnr- Date: 4/14/2011
Organization: LEAR ELECTRIC
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: Cliff Hoecker date: 4/14/2011
and found to be operating properly in accordance with the requirements of:
_XX NFPA 72, Chapters 1 2 3 4 5 .., 6 7 8 9 10 11 (mark all that apply)
XX_NFPA 70, National Electrical Code, Article 760
XX Manufacturer's instructions
Other (specify):
Signed: `61# 3e&e ices Date: 4/14/2011
Organization: LEAR ELECTRIC
4. Signaling Line Circuits
Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1):
Quantity: 1 Style: 4 Class: B
.
( .L
5. Alarm - Initiating Devices and Circuits: NONE ADDED ON THIS PROJECT
Quantity and class of initiating device circuits (see NFPA 72, Table 6.5): N/A
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: X Addressable:
(b) Duct detectors: Ion: Photo: Addressable:
(c) Heat detectors: FT: RR: FT/RR: RC: Addressable:
(d) Sprinkler waterfiow indicators: Transmitters: Coded: Addressable:
(e) The alarm verification feature is disabled XX or enabled , changed from seconds to
seconds.
(f) Other (list):
6. Supervisory Signal- Initiating Devices and Circuits (use blanks to indicate quantity of devices): N/A
GUARD'S TOUR —N /A
(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 - MONITORED, EXISTING
Mark 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): ° '
7. Annunciator(s): 1 - EXISTING
Number: Type: Location:
S. Alarm Notification Appliances and Circuits: NEW DEVICES LISTED BELOW
NFPA 72, Chapter 6- Emergency Voice /Alarm Service: N/A
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: 3 Style: Y Class: B
Types and quantities of notification appliances installed:
(a) Bells: With Visible: -
(b) Speakers: With Visible:
(c ) Horns: 1 With Visible: 1
(d) Chimes: With Visible:
(e) Other: With Visible:,
(f) Visible appliances without audible: 2
9. System Power Supplies:
(a) Fire Alarm Control Panel: Nominal voltage: 120VAC Current rating: 20A
•
Overcurrent protection: Type: BREAKER Current rating: 20A
Location: •
(b) Secondary (standby): 24VDC
Storage battery: S.L.A Amp -hour rating:
Calculated capacity to drive system, in hours: 24 (MINIMUM)
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 staridard(s) are:
6/# .7(6, or• Lyar Electric Inc., 4/14/2011
(signed) for installation contractor /supplier (title) (date)
CO , rvvrn,a,c%er,.t Project Manager, Lear Electric Inc., 4/14/2011
(signed) for alarm service company (title) (date)
(signed) for cen, . stat An (title) (date)
Upon completion oft .- system(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction):
s / /
(signed) representative of the authority having jurisdiction (title) (date)