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Report (79) • 0r 7- Q�/`'q3 ,,� SYSTEM RECORD OF COMPLf-020( O 2. N C.� This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data,or calculations as necessary to provide a complete record. Form Completion Date: 8/24/17 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Landmark Ford-Service Building Address: 12300 SW 68th ave Description of property: Office building with attached commercial garage Name of property representative: Kurt Sorg Address: 12300 SW 68th ave Phone: 5036391131 Fax: E-mail: 2. INSTALLATION, SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: Phillips Electronics Address: 3247 NW 29th ave Portland,Or 97210 Phone: 5032225083 Fax: 5032274992 E-mail: Service organization: Phillips Electronics Address: 3247 NW 29th ave Portland,OR 97210 Phone: 5032225083 Fax: 5032274992 E-mail: Testing organization: Phillips Electronics Address: 3247 NW 29th ave Portland,OR 97210 Phone: 5032225083 Fax: 5032274992 E-mail: Effective date for test and inspection contract: 6/22/17 Monitoring organization: Phillips Electronics-National Monitoring Center Address: 25341 Commerce Centere Dr.Lake Forest,CA 92630 Phone: 18662225083 Fax: E-mail: Account number: 1490906 Phone line I: cellular comm. Phone line 2: cellular comm. Means of transmission: cellular comm. Entity to which alarms are retransmitted: TVFR Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific software: FACP 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: 0 New system ®Modification to existing system Permit number: FPS2017-00093 NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: Silent Knight Model number: 5208 4.2 Software and Firmware Firmware revision number: n/a 4.3 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds Copyright®2012 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. SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 110vac Control panel amps: 20a Overcurrent protection: Type: Breaker Amps: 20a Branch circuit disconnecting means location: Panel- Number: ckt# 5.1.2 Secondary Power Type of secondary power: n/a Location,if remote from the plant: n/a Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 5.2 Control Unit ® This system does not have power extender panels ❑ Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line Device Power Initiating Device X B Notification Appliance Other(specify): 7. REMOTE ANNUNCIATORS Type Location none 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations Smoke Detectors 2 cony alarm photo electric Duct Smoke Detectors Heat Detectors 1 cony alarm fixed heat/ror Gas Detectors Waterflow Switches Tamper Switches Copyright©2012 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. SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible Combination Audible and Visible 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers Door Unlocking Elevator Recall 2 Elevator Shunt Trip 1 11. INTERCONNECTED SYSTEMS ® This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specified herein has been installed according to all NFPA standards cited herein. Signed: M Hanley Printed name: Matthew Hanley Date: 8/24/17 Organization: Phillips Electronics Title: Supv.Technician-4680LEA Phone: 5032225083 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: M Hanley Printed name: Matthew Hanley Date: 8/24/17 Organization: Phillips Electronics Title: Supv.Technician-4680LEA Phone: 5032225083 12.3 Acceptance Test Date and time of acceptance test: 8/24/17 9:00am Installing contractor representative: M Hanley Testing contractor representative: M Hanley Property representative: AHJ representative: Copyright 02012 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.