Report Ertell Electric 5033595652 p.2
(—S— 15S
FIRE ALARM SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time of system acceptance and approval_
1. Protected Property Information
Name of property: KRONOS
Address: 11850 SW 67TH AVE.STE.200 TIGARD OR.97233
Description of property: OFFICE BLDG.
Occupancy type:
Name of property representative: PNWP,LLC
Address: 660C SW 105TH AVE.STE. 175 BEAVERTON OR 97008
Phone: 503 Fax: E-mail:
Authority having jurisdiction over this property:
Phone: Fax: E-mail:
2. Fire Alarm System Installation,Service,and Testing Information
Installation contractor for this equipment: ERTELL'S ELECTRIC
Address: PO BOX 279 FOREST GROVE OR 97116
Phone: 503-B41-45'1 Fax: E-mail:
Service organization for this equipment: PRO-TECH
Address:
Phone: Fax: E-mail:
Location of as-built drawings: IN PANEL DOOR Location of Historical Test Reports:
Location of system operation and maintenance manuals:
A contract for test and inspection in accordance with NFPA standards is in effect as of
Contracted testing company:
Address:
Phone: Fax: E-mail:
Contract expires: Contract number: Frequency of routine inspections:
3. Type of Fire Alarm System or Service
NFPA 724'',Chapter Reference of System Type:
Name of organization receiving alarm signals with phone numbers(if applicable):
Alarm: Phone:
Supervisory: Phone:
Trouble: Phone:
Entity to which alarms arc retransmitted: Phone:
Method of retransmission of alarms to that organization or location:
NFPA 72, Fig.4.5.2 1 ;p. 1 of 5)
CopyriGht 2019.Yationa Fire Protection Association.This forth may be copied for indiutctoal use outer than for resale.it may not be copied far commorciel sale or diatribulion.
Ertell Electric 5033595652 p.1
rtell' s
FAX COVER SHEET
Eiectric
P.O.Box 279, Forest Grove Or., 97116
DATE: TO/ATTN:
13-Mar-14
COMPANY:
city of tigard
RECEIVER'S PHONE NO.: RECEIVER'S FAX NO.:
503-624-3681
FROM:
ERTELL'S ELECTRIC,LLC Randy Rand
SENDER'S PHONE NO.: SENDER'S FAX NO.:
503-781-4071 503-359-5652
NUMBER OF PAGES(including cover sheet):
6
MEMO:
Here is the signed record of completion 72 for the Kronos TI that we completed last year.
Thanks,
Eltell Electric 5033595652 p.2
FIRE ALARM SYSTEM RECORD OF COMPLETION
To be completed by the system installation contractor at the time ofsystem acceptance and approval.
1. Protected Property Information
Name of property: KRONOS
Address: 11 SW 67TH AVE.STE.200 TIGARD OR.97233
Description of property: OFFICE BLDG.
Occupancy type:
Name of property representative: PNwP,LLC
Address: 6600 SW 105TH AVE.STE. 175 BEAVERTON OR 97008
Phone: 503 Fax: E-mail:
Authority having jurisdiction over this property:
Phone: Fax: E-ma:l:
2. Fire Alarm System Installation, Service, and Testing Information
Installation contractor for this equipment: ERTELL'S ELECTRIC
Address: PO BOX 279 FOREST GROVE OR 97116
Phone: 503-841-4511 Fax: E-mail:
Service organization for this equipment: PRO-TECH
Address:
Phone: Fax: E-mail:
Location of as-built drawings: IN PANEL DOOR Location of Historical Test Reports:
Location of system operation and maintenance manuals:
A contract for test and inspection in accordance with NFPA standards is in effect as of
Contracted testing company:
Address:
Phone: Fax: E-mail:
Contract expires: Contract number: Frequency of routine inspections:
3. Type of Fire Alarm System or Service
NFPA 72',Chapter Reference of System Type:
Name of organization receiving alarm signals with phone numbers afappiicabie):
Alarm: Phone:
Supervisory: Phone:
Trouble: Phone:
Entity to which alarms are retransmitted: Phone:
Method of retransmission of alarms to that organization or location: _
NFPA 72,Fig.4.5.2.1 ip. 1 of 5}
Copyright• 2009 Naltcnal Fire Protection Association.This form may be copied for Individual use other Ihai for resale-It may not be copied for commercial sale or distdtutian.
Ertell Electric 5033595652 p.3
If Chapter S.note the means of transmission from the protected premises to the central station:
El Digital alarm communicator ❑McCulloh ❑Multiplex ❑2-way radio ❑ 1-way radio ❑N/A
If Chapter 9,note the type of connection: ❑Local energy ❑Shunt ❑NIA
3.1 System Software
Operating system(executive)software revision level:
Site-specific software revision date: Revision completed by:
4. Signaling Line Circuits
Characteristics of signaling line circuits connected to this system(see NFPA 724', Table 6.6.1):
Quantity: Style: Class:
5. Alarm-Initiating Devices and Circuits
Characteristics of initiating device circuits connected to this system(see NFPA 721', Table 6.5)
Quantity: Style: Class:
5.1 Manual Initiating Devices
5.1.1 Manual Pull Stations Number of manual pull stations:
Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ❑NiA
5.2 Automatic Initiating Devices
5.2.1 Area Smoke Detectors Number of smoke detectors:
Type of coverage: ❑Complete area ❑Partial area ❑Nonrequired partial area ❑N/A
Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ❑N/A
Type of smoke detector sensing technology: ❑Ionization ❑Photoelectric
5.2.2 Duct Smoke Detectors Number of duct smoke detectors:
Type of coverage:
Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ❑NIA
Type of smoke detector sensing technology: ❑Ionization ❑Photoelectric
5.2.3 Heat Detectors Number of heat detectors:
Type of coverage: ❑Complete area ❑Partial area Cl Nonrequired partial area El N/A
Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ❑NIA
5.2.4 Sprinkler Watertiow•Detectors Number of waterflow detectors:
Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ❑WA
5.2.5 Alarm Verification Number of devices subject to alarm verification:
Alarm verification on this system is:❑Enabled ❑Disabled ❑Set for seconds
6. Supervisory Signal-Initiating Devices and Circuits
6.1 Sprinkler System Number of valve supervisory switches:
Type of devices: ❑Addressable ❑Conventional El Coded ❑Transmitter ❑N/A
NFPA 72. Fig.4.5.2,1 (p 2 of 5)
Copyright®2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be=pied for commercial Bale or distribtAion.
Ertell Electric 5033595652 p.4
6.2 Fire Pump
Type of fire pump: ❑Electric ❑Diesel
Type of fire pump supervisory devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter El N/A
Fire Pump Functions Supervised
❑Fire pump power ❑Fire pump running ❑Fire pump phase reversal Cl Selector switch not in auto
❑Engine or control panel trouble ❑Low fuel
Other:
6.3 Engine-Driven Generator
Type of generator supervisory devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ❑NIA
❑Engine or control panel trouble ❑Generator running ❑Selector switch not in auto ❑Low fuel
Other:
7. Annunciators
7.1 Annunciator 1 ❑Local ❑Remote
Type:❑Addressable ❑Directory ❑Graphic ❑N/A Location:
7.2 Annunciator 2 ❑Local ❑Remote
Type: ❑Addressable ❑Directory ❑Graphic El N/A Location:
7.3 Annunciator 3 ❑Local ❑Remote
Type: ❑Addressable ❑Directory ❑Graphic El NiA Location:
8. Alarm Notification Devices and Circuits
8.1 Emergency Voice Alarm Service
Number of single voice alarm channels: Number of multiple voice alarm channels:
Number of speakers: Number of speaker zones:
8.2 Telephone Jacks
Number of telephone jacks installed: Number of telephone handsets stored on site:
Type of telephone system installed: ❑Electrically powered El Sound powered ❑N/A
8.3 Nonvoice Audible System
Characteristics of notification device circuits connected to this system(see NF'PA 72'". Table 65):
Quantity: Style: Class:
8.4 Types and Quantities of Nonvoice Notification Appliances Installed
Bells: With visual device: Horns: X With visual device: 8
Chimes: With visual device: Bells: With visual device:
Visual devices without audible devices: Other(describe):
PIFPA 72,Fag,4.5.2 1 :p.3 of 5)
Copyright 6J 2070.labore Fire Protection Assoaadon.-Fria form may be oopiedfor it ink:Lel use other then for resale tt may not be soared far commercial sale or distribution.
Ertell Electric 5033595652 p.5
•
9. Emergency Control Functions Activated
❑Hold-open door releasing devices 0 Smoke management or smoke control
❑Door unlocking ❑Elevator recall ['Other
10.System Power Supply
10.1 Primary Power
Nominal voltage: 120 VAC Amps: 20
Overcutrent protection: Type: BREAKER Amps: 20
Location(of primary supply panelboard):
Disconnecting means location:
10.2 Secondary Power
Location: PANEL Type: SEALED LEAD Nominal voltage: Current rating:
ACID BATT.
Number of standby batteries: 2 Amp hour rating: 7 AH EACH
Location of emergency generator:
Location of fuel storage:
Calculated capacity of secondary power to drive the system
In standby mode: 24 HRS In alarm mode: 5 MIN
11.Record of System installation
Fill out after all installation is complete and wiring has been checked for opens,shorts,ground faults,and improper
branching,but before conducting operational acceptance tests.
The system has been installed in accordance with the following NFPA standards:(Note any or all that apply.)
NFPA 7? ' ®NFPA 70s.,Article 760
®Manufacturer's published instructions ❑Other(please specify):
System deviations from referenced NFPA standards:
Signed: Printed name: Date:
Organization: Title: Phone:
12. Record of System Operation
All operational features and functions of this system were tested by or in the presence of the signer shown below,on the date
shown below,and were found to he operating properly in accordance with the requirements of
NFPA 72" ®NFPA 7(7,Article 760
®Manufacturer's published instructions ❑Other(please specify):
❑Documentation in accordance with Inspection and Testing Form(Figure 10.6.2.3 of NFPA 7t)is attached
Signed: Printed name: Date:
Organisation: Title: _ Phone:
NFPA 72, Fig.4.5.2 1 ;p.4 of 5)
Copyripnl 0 2009 Mitchel Fire Proleclion Assooation.This lorm may be copied for individual use other Thar for resale.:t may lot be Cooled tar commercial sale or distil:uti i.
Ertel)Electric 5033595652 p.6
13.Certifications and App • .1s
13.1 stem Install i n Cant •ctor
This s stem as s cif.•d h n has been installed and tested according to all NF standards cited herein.
�
Signed: � Printed name:� Date: 3 l3 r l(../
Organization: rfe,I15 Eke C..Titic: c ez:f (14 Phone: Spa-72,e- go 7
13.2 System Service Contractor a
This system as specified herein has been installed and tested according to all NFPA standards cited herein.
Signed: Printed name: NIA Date:
Organization: Title: Phone:
13.3 Central Station
This system as specified herein will be monitored according to all NFPA standards cited herein.
Signed: Printed name: NIA Date:
Organization: Title: Phone:
13.4 Property Representative
I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein.
Signed: Printed name: Date:
Organization: Title: Phone:
13.5 Authority Having Jurisdiction
I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance
with its approved plans and specifications,its approved sequence of operations,and with all NFPA standards cited herein.
Signed: Printed name: Date:
Organization: Title: Phone:
ATPA 72. Fig.4.5.2.1 f o. 5 of 5)
Copyright®20053 National=ire Pro6ection Association This fan may be copied for Individual use ether than fo-resale.It may not be copied fce commercial sae or distribution.