Report Communications & Security Systems (503) 682 -9900
, 25977 SW Canyon Creek Rd., Suite E, Wilsonville, OR 97070
/ / OR Contractor's License 34- 174CLE
k4 ?a008- 00 f � Inspection and Testing Form
Date: 1/26 X0 8
Time: q: oV 4..1.
Service Company: Facility Name:
RFI Communications Name: hi envvt - 174.E
25977 SW Canyon Creek Rd. Suite E Address: • :1 I 622 1 Ci . i4iw__+ ^
Wilsonville OR 97070 City, State: i,et4,¢ -n n
CCB# 67147 Contact:
(503) 682-9900 Phone:
Monitoring Company Approving Agency
Contact: &l/Eju ,v Ne Contact:
Telephone: gv}- 70.4010 Telephone:
Monitoring Account: 57 -1 L
Type Transmission Service
❑ McCulloh ❑ Weekly
❑ Multiplex ❑ Monthly
B ❑ Quarterly
❑ Reverse Priority ❑ Semi - Annually
❑ RF ❑ Annually
❑ Other (specify) ❑ Other (Specify)
Panel Manufacturer: St (Q A . vt %I Model No.
Circuit Styles:
Number of Circuits:
Software Rev.
Last Date system had any service performed: 1 f O$ •
Last Date that any software or configuration was revised:
Alarm Initiating Devices And Circuit Information
Quantity Circuit Style
1I
Manual Stations
Ion Detectors
Photo Detectors
Duct Detectors
Heat Detectors
Waterflow Switches
• " • Supervisory
Other (Specify)
Alarm Notification Appliances and Circuit Information
Quantity Circuit Style
Bells
11 Horns
Chimes
b Strobes
Speakers
Other (Specify)
Number of Alarm Indicating Circui : pZ
Are Circuits Supervised? s ❑ No
Supervisory Signal - Initiating Devices and Circuit Information
Quantity Circuit Style
Building Temp.
Site Water Temp.
Site Water Level
Fire Pump Power
Fire Pump Auto Position
Fire Pump or Pump Controller Trouble
Fire Pump Running
Generator in Auto Position
Generator or Controller Trouble
Switch Transfer
Generator Engine Running
Other (Specify)
Signaling Line Circuits
Quantity and style (See NFPA 72, Table 3 -6) of signaling line circuits connected to system:
Quantity ( Style(s)
- System - Power - Supplies
a. Primary (Main): Nominal Voltage 111/ , Amps QO Pr
Overcurrent Protection: Type `- ,p.ec k e.44.-- , Amps 20 A - -
Location (panel Number):
Disconnecting Means Location:
b. Secondary (Standby)
Storage Battery: Amp Hour Rating 7 p
Calculated capacity to operate system, in hours: ✓ 24 60
Engine- driven generator dedicated to fire alarm system
Location of fuel storage:
Type Battery
❑ Dry Cell
❑ Nickel- Cadmium
healed Lead -Acid
❑ Other (Specify)
c. Emergency or standby system used as a backup to primary power supply, instead of using a secondary power supply:
Emergency system described in NFPA 70 Article 700
Legally required standby described in NFPA Article 701
Optional standby system described in NFPA Article 702, which meets performance
requirements of Article700 or 701
Ur Prior To Any Testing
Notifications are Made Yes No Who Time
Monitoring Entity ❑
Building Occupants B' ❑
Building Management er ❑
Other (Specify) 17 ❑
AHJ (notified) of Any Impairments H ❑
System Tests and Inspections
Type Visual Functional Comments
Control Panel B' Er
Interface Eq. ❑ e e
Lamps /LED's 2 -B'
Fuses 8- Er
Primary Power Supply C" B'
Trouble Signals C3�
Disconnect Switches 0— fr
Ground Fault Monitoring 8 -
Secondary Power Visual Functional Comments
Type �
Battery Condition
Load Voltage. ❑
Discharge Test ❑
Charger Test ❑
Specific Gravity ❑
Transient Suppressors ❑
Remote Annunciators e
Notification Appliances
Audible •El g'"
Visual lE
Speakers ❑ ❑
Voice Clarity ❑ ❑
Initiating and Supervisory Device Tests and Inspections
Loc. & Serial # Device Type Visual Check Functional Test Meas. Setting Pass Fail
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ 0 ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ 0 ❑ ❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
(Use additional sheets as required)
Comments
l
1. r
Emergency Communications Equipment Visual Functional Comments
Phone Set Cr Er
Phone Jacks , 13" Off Hook Indiator • t�
Amplifier(s) ❑
Tone Generator(s) ❑ ❑
Call -in Signal ❑ 0
System Performance ❑ 0 .
Interface Equipment Visual Device Operation Simulated Operation
(Specify) ❑ ❑ ❑
(Specify) 0 ❑ ❑
(Specify) ❑ ❑ ❑
Special Hazard System Visual Device Operation Simulated Operation
(Specify) 0 ❑ ❑
(Specify) 0 ❑ 0
(Specify) ❑ 0 ❑
SpecialProcedures
Comments
On /Off Premises Monitoring Yes No Time Comments
Alarm Signal tT 0
Alarm Restoral l!( ❑
Trouble Signal ffr ❑
Supervisory Signal p ❑
Supervisory Restoral L1 ❑
Notification Thaf Testing is Complete - Yes N o Who Time
Building Management 13' 0
Monitoring Agency 21 ❑
Building Occupants 2' ❑
Other (Specify) 0 ❑
The following did not o e on ,
/kg . ,
System restored to normal operation: Date •?//Z, //0 ? Time il „
This testing was performed in accordance with applicable NFPA Standards.
Name of Inspector: , 4 i � • Date l / /o98 / /CPS Time:
►--
Signature: - /yfi��
Name of Owner or Representati e:
Date // // Time -
Signature