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Report FIRE ALARM SYSTEM RECORD OF COMPLETION FPS 20 1-3-00/ 0 / Name of protected property: FANNO CREEK PLACE,BUILDING`B" Name of project: Sterling Bank Suite 310 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/503-255-0733 OLEG PRIMACHENKO Supplier: LEAR ELECTRIC/503-255-0733 OLEG PRIMACHENKO Service Organization: LEAR ELECTRIC/503-255-0733 OLEG PRIMACHENKO Location of record(as-built)drawings: ONSITE/ON FILE Location of operation and maintenance manuals: 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-Auxiliary 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: Oleg Primachenko on: 8/28/2013 , includes the devices shown in 5 and 6,and has been in service since: 8/28/2013 _XX_NFPA 72,Chapters I 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: U/ley, .`pnim,.acll,enh Date: 8/28/2013 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: Oleg Primachenko date: 8/28/2013 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: (0/e y, `��inn,acli enlc o- Date: 8/28/2013 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: EXST Style: Class: • 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 waterflow indicators: Transmitters: Coded: Addressable: (e)The alarm verification feature is disabled XX_ , 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): l -EXISTING Number: Type: Location: 8.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: EXST Style: Class: 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: 3 9.System Power Supplies: (a)Fire Alarm Control Panel: Nominal voltage: 120VAC Current rating: 20A Overcurrent protection: Type: BREAKER Current rating: 20A Location: Electrical Room 3Rd Floor (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 standard(s)are: 0/.9, Pm�,,,,a,c/uo,,k,G, Lear Electric Inc., 8/28/2013 (signed)for installation contractor/supplier (title) (date) (signed)for alarm service company (title) (date) (si: I for central station (title) (date) U r y'completion f the system(s)satisfactory test(s)witnessed(if required by the authority having jurisdiction): signed)represbntative of the authority having jurisdiction (title) (date)