Report (17) 01/28/2011 13:48 FAX a001/006
SIEMENS Industry
Siemens FAX
Siemens Industry, Inc.
Building Technologies Division
DATE: //Z � g
Pages Sent: (Including Cover)
To: 1.1 C K. 42 :1L- a From: 4w'
Company: r e F Branch: BOR1 Portland
Fax: a 3 G 2'i 3G - / Phone: 501 Sq S 375
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Siemens Industry, Inc. 15 NW Grerier Pkwy. Ste A-4 T®I.: +1 503 207 -1900
Be averton, OR 970 Fax: +1 (503 207 -1901
USA www, usa.slemens.com
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Certificate of Completion
Name of Protected Property:_ 41. S 4& I) it 6741 640
Address: •
Rep. of Protected Prop. (name /phone): 4 ti
Authority Having Jurisdiction: \
Address:
Phone Number:
t Type(s) of System or Service:
.NFPA 72, Chapter 3 - Local ' pto,v iTo rl
If alarm is transmitted to location(s) off premise, list where received:
NFPA 72, Chapter 3 - Emergency Voice /Alarm Service / t ltE - ejgy- rb,/ G.-
Quantity of voice /alarm channels: .2-- _ Single: \/ u tiplldf'�' e
Quantity of speakers Installed: Quantity of speaker zones:_
Quantity of telephones or telephone jacks included in system:
NFPA 7Z Chapter 4 - nary /
Indicate type o nection: / ir
Locale Shunt, Parallel telephone
ion and telephone number for receipt of signals:
NFPA 72, Chapter 4 - Rem • - - - on /le-
Alarm;
Superviso •
- A 72, Chapter 4 - Proprietary
If alarms are retransmitted to pu e service communicati� 9enter or others, indicate location
and telephone number of rganization receiving alarm:
Indicate alarm is retransmitted:
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•
NFPA 72, Chapter 4 - Central Station
The Prime Contractor:
Central Station Location:
• Means of transmission of signals from the protected pr- •.' - o the central station:
McCulloh A i ex One -Way Radio
Digital Alarm Communicator Two -Way Radio Others
Means of transmission of al- s to the public fire service communications center:
1.
2.
tem Location:
Organization Name /Phone Representative Name /Phone
Installer
Supplier .s't cFN 3 Arporry -Sr.+._ C-._ r
5 'Lo 1 14.0 No ¢ 707 I it
Service Organization ;5?�r►..we - 7
503, 24C'i I R of .
Location of Record (As- Built) Drawings:
Location of Owners Manuals:
S , T
Location of Test Reports:
S•"CC
A contract, dated for test and d • _ ' - or• ance with NFPA standard(s)
No_(s) . o ef ... " is in effect.
2. Ce ' cation 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 NFP st ndards as listed below, was
inspected by S1 Cw S on I 1 / I , includes the devices
listed below and has been in service since //a it_ .
., KNFPA 72, Chapt s 1 3 4 „_ 5 r 6 W` 7 c all that apply)
NFPA 70, National Elec r�ca C oae, ArticTe760
t Manufacturer's Instructions
Other (specify): - _
Signed; Date: //Z7 //A
Organization: 57E'04 6 F
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3. Certification of System Operation
All operatl nal f atures and functions of this system were tested by 5t -e_-t S
on t
) and found to be operating properly in accordance with the
requi er m is of
4 NFPA 72, Cha • ers _1 ` 3 _4 ,5 6 7 (check - I that apply)
NFPA 70, Nafi• • - = cfrical Code, Article 7- •
Manufacturer's Instructions
Other (specify):
Signed: ate:_ 1/e. / /
Organization: c �,v_
4. Alarm Initiating Devices and Circuits (Use blanks to indicate quantity of
devices.)
MANUAL Ai
a) tations Noncoded, Activating Transmitters _ Coded
b�)--.. Combination Manual Fire Alarm and Guard's Tour Coded Stations
�'
AUTOMATIC
Coverage: Complete Partial
a) W Smoke Detectors: Ion y Photo
b) 7 Duct Detectors: Ion y Photo
c) L Heat Detectors: FT RR Y FT /RR RC
d) Sprinkler Water Flow Switches: Noncoded, Activating
Transmitters _Coded
e) Other (list) :. "'parerTal� Atli] j' La ►J y'ed% +(Z%-d i ]/43..V.
i. 6 v/! pr et-E c.rr V IS Pic()
5. Supervisory Signal Initiating Devices and Circuits (Use blanks to indicat f /,r If
quantity of devices.)
GUARD'S TOUR
a) Coded St-
b) No -d Statiafg Activating Transmitters
c) ' ompulsory Guard Tour System Comprised of Transmitter Stations
and Intermediate Stations
., •te: Combination devices recorded under 4(b) and 5(a).
SPRINKLER SYSTEM
a) Coded Valve , , p' rv • Signaling Attachments
Valve Super ' • es Activating Transmitters
b) Building T •eratufe�oints
c) Site er Temperature Points
d) .' • ater Supply Level Points
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Electric Fire Pull•
e) - re Pump - • er
f) Fire Pu Running
• Phas versa)
•
Engine- Driven p:
h) ctor i uto Position
i) Engine o ontrol Panel Trouble
Fire Pump Running
Engine - Driven Gen ra r:
k) Select • Auto - •sition
I) Contro P. - = T ouble
m) Tra. -r S , es
n) ' gine Ru i g
• er Supervisory Function(s) (specify):
6. Alarm Notification Appliances and Circuits — Lb es
Quantity of indicating appliance circuits connected to the system:
Types and quantities of alarm indicating appliances installed:
a) Bells Inch
Speakers
b) Horns
c) - Chimes
d) Other:
e) Visual Signals Type:_
with audible w/o audible
f) Local Annunciator
7. Signaling Line Circuits: clr4 T iN 4-
Quantity and Style (See NFPA 72, Table 3 -6.1) of signaling line circuits connected to system:
Quantity: Style:
8. System Power Supplies
a) Primary (Main): Nominal Voltage: I 20 Current Rating:,, 1 2
Overcurrent Protection: Type:,, _.,.+e r Current Rating:
Location:
b) Secondary (Standby):
Storage Battery: Amp -Ho ' - •_
Calculated capacity to dri - : - m, in hours: 24 60
Engine - driven • - • - - or dedicated to fire alarm system:
Locati. - : uel storage:
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i t")
c) Emergency or Standby System used as backu• • - -ry Power Supply, instead of using a
Secondary Power Supply:
Emergency System • - . •ed in NFPA 70, Article 7
Legally Res ti 7 tandby System described in NF A 0, Article 701
Optio• andby System 'described in NFPA 70, Article 702, which also meets the
• • ormance requirements of Article 700 or 701
9. S :- - m Software
a) C Operating System Software Revision Level(s): Cr14••._, / 7c r
b) Application Software Revision Level(s):
c) _ )C Revision Completed by: G re.a,lf
(name) (firm)
10. Comments:
/44 -Z.7/e
(signed) f4 Station or Alarm Service Company (title) d ate)
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA
standard(s):
System deviations from the referenced NFPA standard(s) are:
(signed) for Central = '•n or Alarm Service Company (title) (date)
Upon completi. of the sy.tem(s) satisfactory test(s) witnessed (If required by the authority having
jurisdiction:
1� .►] . � `♦ .DNS
(signed) represeve of the authority having juris• ction (titil` (dare)
•
•
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