Report C'PS 611t0 -000610
Certificate of Completion
Name of Protected Property: Cham is—D11
Address: 9779 SW Washin•tonS•uare Road
Ti•ard OR 97223
Rep. of Protected Prop. (name/phone): Roser Ott 503.352.8879
Authority Having Jurisdiction:,City of Tigard
Address: 13125 SW Hall Blvd.
Tigard, OR 97223
Phone Number: 503-718-2439
1. Type(s) of System or Service:
X NFPA 72, Chapter 3 -Local
If alarm is transmitted to location(s) off premise, list where received:
Stanle Securit Account#10575
NFPA 72, Chapter 3 -Emergency Voice/Alarm Service
Quantity of voice/alarm channels: Single:
Quantity of speakers installed: Multiple:
r
Quantity of telephones or telephone jacks included in systemantity of:
zones:
NFPA 72, Chapter 4-Auxiliary
Indicate type of connection:
Local energy, Shunt,
Location and telephone number for receipt of signals: Parallel telephone
NFPA 72, Chapter 4-Remote Station
Alarm:
Supervisory:
NFPA 72, Chapter 4-Proprietary
If alarms are retransmitted to public fire service communications center or others, indicate location
and telephone number of the organization receiving alarm:
Indicate how 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 premise to the central station:
McCulloh Multiplex One-Way Radio
Digital Alarm Communicator Two-Way Radio Others
Means of transmission of alarms to the public fire service communications center:
1.
2.
System Location:
Organization Name/Phone Representative Name/Phone
Installer Ertell Electric Randy Rand
503-781-4071
Supplier Siemens Industry, Inc. E.J. Fannuchi
971.563.8869
Service Organization Siemens Industry, Inc. Service Department
503.207.1900
Location of Record (As-Built) Drawings:
Location of Owners Manuals:
Location of Test Reports:
A contract, dated for test and inspection in accordance with NFPA standard(s)
No.(s) dated is in effect.
2. Certification 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.)
Thispsystem has b9n in Iled irccor nce with the NFPA standards as listed below, was
inspected byi' , �p n on May18, 2016 , includes the devices
listed below and has beef in service since May18, 2016
X NFPA 72, Chapters X 1 X 3 X 4 X 5 X 6 X 7(check all that apply)
X NFPA 70, National Electrical Code, Article 760
X Manufacturer's Instructions
Other(specify):
Signed: W2y 4-1d Date: May18, 2016
Organization:Ertell Electric
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3. Certification of System Operation
All operational features and functions of this system were tested by C.J. Volesky
on May18, 2016 and found to be operating properly in accordance with the
requirements of:
X NFPA 72, Chapters X1 X3 X4 X5 X 6 X7 (check all that apply)
X NFPA 70, National Electrical Code, Article 760
X Manufacturer' Instructions
X Other(s.-cify •
Signed: Date: May18, 2016
Organization: Sie' ens Indust Inc.
4. Alarm Ini '-ting Devices and Circuits (Use blanks to indicate quantity of
devices.)
MANUAL
a) 0 Manual Stations Noncoded, Activating Transmitters Coded
b) 0 Combination Manual Fire Alarm and Guard's Tour Coded Stations
AUTOMATIC
Coverage: Complete Partial
a) 0 Smoke Detectors: Ion Photo
b) Duct Detectors: Ion Photo
c) 0 Heat Detectors: FT RR FT/RR RC
d) 0 Sprinkler Water Flow Switches: Noncoded, Activating
Transmitters Coded
e) 0 Other(list):
5. Supervisory Signal Initiating Devices and Circuits (Use blanks to indicate
quantity of devices.)
GUARD'S TOUR
a) 0 Coded Stations
b) 0 Noncoded Stations Activating Transmitters
c) 0 Compulsory Guard Tour System Comprised of Transmitter Stations
and Intermediate Stations
Note: Combination devices recorded under 4(b) and 5(a).
SPRINKLER SYSTEM
a) 0 Coded Valve Supervisory Signaling Attachments
0 Valve Supervisory Switches Activating Transmitters
b) 0 Building Temperature Points
c) 0 Site Water Temperature Points
d) _ 0 Site Water Supply Level Points
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Electric Fire Pump:
e) 0 Fire Pump Power
f) 0 Fire Pump Running
g) 0 Phase Reversal
Engine-Driven Fire Pump:
h) 0 Selector in Auto Position
i) 0 Engine or Control Panel Trouble
j) 0 Fire Pump Running
Engine-Driven Generator:
k) 0 Selector in Auto Position
I) 0 Control Panel Trouble
m) 0 Transfer Switches
n) 0 Engine Running
Other Supervisory Function(s) (specify):
N/A
6. Alarm Notification Appliances and Circuits
Quantity of indicating appliance circuits connected to the system: 2 modified
Types and quantities of alarm indicating appliances installed:
a) 0 Bells Inch
0 Speakers
b) 0 Horns
c) 0 Chimes
d) 0 Other:
e) 10 Visual Signals Type: Speaker/Strobes and Strobes
4 with audible 6 w/o audible
f) 0 Local Annunciator
7. Signaling Line Circuits:
Quantity and Style (See NFPA 72, Table 3-6.1) of signaling line circuits connected to system:
Quantity: 0 Style:
8. System Power Supplies
a) Primary(Main): Nominal Voltage: 120VAC Current Rating: 20a
Overcurrent Protection: Type: Breaker Current Rating: 2a
Location: Fire Alarm Control Panel power supply
b) Secondary(Standby):
X Storage Battery: Amp-Hour Rating 55ah (main), 8ah (booster)
Calculated capacity to drive system, in hours: X 24 60
0 Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
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c) Emergency or Standby System used as backup to Primary Power Supply, instead of using a
Secondary Power Supply:
0 Emergency System described in NFPA 70, Article 700
0 Legally Required Standby System described in NFPA 70, Article 701
0 Optional Standby System described in NFPA 70, Article 702, which also meets the
performance requirements of Article 700 or 701
9. System Software
a) X Operating System Software Revision Level(s): CSGM 17.07
b) NA Application Software Revision Level(s):
c) NA Revision Completed by: No program change
(name) (firm)
10. Comments:
(signed) for Central Station or Alarm Service Company (title) (date)
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 Station or Alarm Service Company (title) (date)
Upon completion of the system(s) satisfactory test(s)witnessed (if required by the authority having
jurisdiction:
(signed) representative of the authority having jurisdiction (title) (date)
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