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Report (23) (ps z4313 L./ / 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: Pactrust Address: 15350 SW Sequoia Parkway,Suite 220 Description of property: Pactrust Occupancy type: Name of property representative: Ryan McGuire Address: 15350 SW Sequoia Parkway#300 Phone: 503-624-6300 Fax: E-mail: Authority having jurisdiction over this property: City of Tigard Phone: 503-639-4171 Fax: E-mail: 2. Fire Alarm System Installation,Service, and Testing Information Installation contractor for this equipment: Stanley Convergent Security Solutions Address: 15495 SW Sequoia Pkwy Ste. 100, Portland,OR 97224 Phone: 5039683300 Fax: 5039683397 E-mail: Service organization for this equipment: Stanley Convergent Security Solutions Address: 15495 SW Sequoia Pkwy Ste. 100, Portland,OR 97224 Phone: 5039683300 Fax: 5039683397 E-mail: Location of as-built drawings: 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: Stanley Convergent Security Solutions Address: 15495 SW Sequoia Pkwy Ste. 100,Portland,OR 97224 Phone: 5039683300 Fax: 5039683397 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(if applicable): Alarm: Stanley CSS Phone: 8778990001 Supervisory: Stanley CSS Phone: 8778990001 Trouble: Stanley CSS Phone: 8778990001 Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: NFPA 72, Fig.4.5.2.1 (p. 1 of 5) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. i If Chapter 8,note the means of transmission from the protected premises to the central station: ❑Digital alarm communicator 0 McCulloh 0 Multiplex 0 2-way radio 0 1-way radio 0 N/A If Chapter 9,note the type of connection: 0 Local energy 0 Shunt 0 N/A 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 72®, Table 6.6.1): Quantity: Style: Class: 5. Alarm-Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system(see NFPA 72®, 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 0 Conventional 0 Coded 0 Transmitter 0 N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: 0 Complete area 0 Partial area 0 Nonrequired partial area 0 N/A Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: 0 Addressable 0 Conventional 0 Coded ❑Transmitter 0 N/A Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: 0 Complete area 0 Partial area 0 Nonrequired partial area 0 N/A Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: 0 Enabled 0 Disabled 0 Set for seconds 6. Supervisory Signal-Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 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 copied for commercial sale or distribution. 6.2 Fire Pump Type of fire pump: 0 Electric 0 Diesel Type of fire pump supervisory devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A Fire Pump Functions Supervised ❑Fire pump power 0 Fire pump running 0 Fire pump phase reversal 0 Selector switch not in auto ❑Engine or control panel trouble 0 Low fuel Other: 6.3 Engine-Driven Generator Type of generator supervisory devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A ❑Engine or control panel trouble 0 Generator running 0 Selector switch not in auto 0 Low fuel Other: 7. Annunciators 7.1 Annunciator 1 0 Local 0 Remote Type: ❑Addressable 0 Directory 0 Graphic 0 N/A Location: 7.2 Annunciator 2 0 Local 0 Remote Type:❑Addressable 0 Directory 0 Graphic 0 N/A Location: 7.3 Annunciator 3 0 Local 0 Remote Type: ❑Addressable 0 Directory 0 Graphic 0 N/A 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: 0 Electrically powered 0 Sound powered ❑N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system(see NFPA 72°, Table 6.5): Quantity: Style: Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Horns: With visual device: Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: Other(describe): NEPA 72, Fig.4.5.2.1 (p. 3 of 5) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 9. Emergency Control Functions Activated ❑Hold-open door releasing devices 0 Smoke management or smoke control ❑Door unlocking 0 Elevator recall 0 Other 10.System Power Supply 10.1 Primary Power Nominal voltage: Amps: Overcurrent protection: Type: Amps: Location(of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: Type: Nominal voltage: Current rating: Number of standby batteries: Amp hour rating: Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: In alarm mode: 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 72® ®NFPA 70®,Article 760 0 Manufacturer's published instructions 0 Other(please specify): System deviations from referenced NFPA tandards: Signed / Printed name: t l vac/!'��Z� Date: ( / c(/(; Organization: Stanley CSS Title: Fiels Service Technician Phone: 503-968-3300 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 be operating properly in accordance with the requirements of: ❑NFPA 72® 0 NFPA 70®,Article 760 0 Manufacturer's published instructions 0 Other(please specify): 0 Do n a n in accor ance with specti n and Testing Form(Figure 1 .6.2.3 of NFPA 72®)is attached Signed: Printed name: f f' ( fw a Date: l ail19 Organization: Stanley CSS Title: Field Service Technician Phone: 503-968-3355 NFPA 72, Fig.4.5.2.1 (p.4 of 5) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 13.Certifications and Approvals 13.1 System Installation Contractor This system as specified herein has been installed and tested according to allllNFPA standards cited herein. � Signed � (� Printed name: r-7:,,,,,,,�c 1- Date: j 1 -6(l ')_ Organization: Stanley CSS Title: Fiefs Service Technician Phone: 503-968-3300 13.2 System Service Contractor This sys m specif` d herei ha een ins lied and tested according to all NFPA standards cited herein. / ( I Signed Printed name: ( % L�'int� -a4 Date: �-'1)-4 43 Organization: Stanley CSS Title: Field Service Technician Phone: 503-968-3300 13.3 Central Station This system specified herein (/3 wt e monitored according to all NFPA standards cited herein. � Signed: ����(-;1 )�t�k Printed name: Gary ) d--4t(•Tauscher Date: Organization: Stanley CSS Title: Operations Manager Phone: 503-968-3355 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 approv•. i . J s anus a;cifications,its approved sequence of operations,and with all NFPA standards cited her /ein. Signed: /( Printed name: . (, /")c Date: /ici/q --- Organization: `• (i.ral le: -, u S c Phone: e) ? 7 I ^©2 NFPA 72, Fig.4.5.2.1 (p. 5 of 5) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.