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Report (59) The St,see'& Electric Group PPSzoi 6-©O ofii Stoner Electric •Advanced Entry Systems •Commercial Electric ♦Stoner Controls♦Stoner Protective Systems 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: PCC UMPQUA Address: 6610 SW CARDINAL LANE • Description of property: OFFICE AND RETAIL BANK Occupancy type: Name of property representative: Address: Phone: 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: Stoner Protective Address: 1904 S.E.Ochocco Milwaukee,Or.97222 Phone: 503-462-6500 Fax: 503-659-2765 E-mail: www.stonergroup.com Service organization for this equipment: Stoner Protective Address: 1904 S.E.Ochocco Milwaukee.Or.97222 Phone: 503-462-6500 Fax: 503-659-2765 E-mail: www.stonergroup.com Location of as-built drawings: NEXT TO FACP Location of Historical Test Reports: N/A Location of system operation and maintenance manuals: NEXT TO FACP IN DOC BOX A contract for test and inspection in accordance with NFPA standards is in effect as of N/A Contracted testing company: N/A 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: SILENT KNIGHT 5808 Name of organization receiving alarm signals with phone numbers(if applicable): Alarm: CSM Phone: 503-630-2896 Supervisory: CSM Phone: Trouble: CSM 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 (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. 11 Ltlaptcl o,11utc MC 111cILLS Ul U 1IIISI111JJ1011 110111 010 pt oteCtcu X11 c111ISCS LU 010 eclltl dl SL'dLlU11: ( , Digital alarm communicator 0 McCulloh ❑Multiplex ❑2-way radio 0 1-way radio 0 N/A If Chapter 9,note the type of connection: 0 Local energy ❑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 66.1): Quantity: 3 Style: Y Class: B 5. Alarm-Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system(see NFPA 72®, Table 65): Quantity: 3 Style: Y Class: B 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: 7 Type of devices: ®Addressable ❑Conventional ❑Coded ❑Transmitter ❑N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: 8 Type of coverage: ❑Complete area ®Partial area 0 Nonrequired partial area 0 N/A Type of devices: ®Addressable 0 Conventional 0 Coded 0 Transmitter ❑N/A Type of smoke detector sensing technology: 0 Ionization ®Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: ®Addressable ❑Conventional ❑Coded ❑Transmitter ®N/A Type of smoke detector sensing technology: ❑Ionization ®Photoelectric 5.2.3 Heat Detectors Number of heat detectors: 4 Type of coverage: ❑Complete area ❑Partial area ❑Nonrequired partial area ®N/A Type of devices: ®Addressable ❑Conventional 0 Coded ❑Transmitter ®N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ®N/A 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 0 Conventional ❑Coded 0 Transmitter ®N/A 6.2 Fire Pump Type of fire pump: 0 Electric ❑Diesel Type of fire pump supervisory devices: ❑Addressable 0 Conventional ❑Coded 0 Transmitter 0 N/A Fire Pump Functions Supervised 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. U ruc pump puwet U rue pump running U rue pump pHase Icy eisal u oeiec1ut Swtteu MR Ill Quw ❑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 ®Local 0 Remote Type: ElAddressable 0 Directory 0 Graphic X N/A Location: MAN FACP 7.2 Annunciator 2 0 Local ®Remote Type: ®Addressable 0 Directory 0 Graphic 0 N/A Location: MAIN LOBBY ENTRY 7.3 Annunciator 3 0 Local 0 Remote Type: 0 Addressable 0 Directory 0 Graphic ❑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 X 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: 17 Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: 17 Other(describe): 9. Emergency Control Functions Activated ❑Hold-open door releasing devices 0 Smoke management or smoke control ❑Door unlocking 0 Elevator recall 0 Other NFPA 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. iu.aysrrm rower oupply 10.1 Primary Power Nominal voltage: 120VAC Amps: 3 Overcurrent protection: Type: BREAKER Amps: 20 Location(of primary supply panelboard): L2 CRKT 8 Disconnecting means location: IN ELECTRICAL RM BEHIND FACP ROOM 10.2 Secondary Power Location: FACP Type: BATTERY Nominal voltage: 24VDC Current rating: Number of standby batteries: 2 Amp hour rating: 7 Location of emergency generator: N/A Location of fuel storage: N/A Calculated capacity of secondary power to drive the system In standby mode: 24HRS In alarm mode: 10MIN 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 ®Manufacturer's published instructions 0 Other(please specify): System deviations from referenced NFPA standards: Signed: Heist lionclOtaou Printed name: Brent Nordstrom Date: 06-10-2016 Organization: Stoner Protective Title: Technician Phone: 503-462-6500 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® ®NFPA 70®,Article 760 ®Manufacturer's published instructions 0 Other(please specify): ®Documentation in accordance with Inspection and Testing Form(Figure 10.6.2.3 of NFPA 72®)is attached Signed: Printed name: Brent Nordstrom Date: 06-10-2016 Organization: Stoner Protective Title: Technician Phone: 503-462-6500 13.Certifications and Approvals 13.1 System Installation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Brent Nordstrom Date: 06-10-2016 Organization: Stoner Protective Title: Technician Phone: 503-462-6500 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. 1J.G JysLCIII Aervlce 1.1/11Ltactor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Sit Tioadatitem Printed name: Brent Nordstrom Date: 06-10-2016 Organization: Stoner Protective Title: Technician Phone: 503-462-6500 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: 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: 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.