Report (40) NFPA-72 Fire Alarm System Record of Completion
Date: 10/27/17
City of Tigard Information: Permit No. FPS2017-00169
Name of protected property: Radiant Senior Living 3Lincoln-201
Address of protected property: 10220 SW Greenburg Road Tigard, OR 97223
Representative of protected property(name/phone):
Authority having jurisdiction: City of Tigard, Building Services
Address/telephone number: 13126 SW Hall Blvd. Tigard, OR 97223 (603)639-4171
1. Type(s)of System or Service
NFPA 72, Chapter 3--Local
If alarm is transmitted to locations(s)off premises, list where received:
NFPA 72, Chapter 3--Emergency Voice/Alarm Service
Quantity of voice/alarm channels: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
NFPA 72, Chapter 5--Auxiliary
Indicate type of connection:
Local energy Shunt Parallel telephone
Location of telephone number for receipt of signals:
____NFPA 72,
Alarm:
Supervisory:
NFPA 72, Chapter 5--Proprietary
If alarms are retransmitted to public fire service communications centers or others, indicate location and
telephone numbers of the organization receiving alarm:
Indicate how alarm is retransmitted:
NFPA 72, Chapter 6--Remote Station
Prime contractor:
Central station location:
Means of transmission of signals from the protected premises 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:
(a)
(b)
System location:
7M.M.MM..MMmmmmmmmmmmm'mm -----lnstIller Capitol Electric Co.Inc. Shane Tercek 803 265-9488
Supplier Capitol Electric Co. Inc. Shane Tercek 603 266-9488
Service organization Capitol Electric Co. Inc. Shane Tercek 603 266-9488
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. Record of System Installation Suite 201 Only
(Fill out after installations complete and wiring checked for opens, shorts, ground faults, and improper
branching, but prior to conducting operational acceptance tests.)
This system has been installed in accordance with the NfPA standards as shown below,was inspected
by Kevin Wiesner on 10/27/17 , included the devices shown below, and has been in service
since 10/27/17
x NFPA 72 (2010), Chapters 10 l2 14 it 21 a3 (underline all that apply)
x NFPA 70(2011), National Electrical Code, Article 760
x Manufacturer's instructions
Other(specify):
Signed: Kevin Wiesner Date: 10/27/2017
Organization: Capitol Electric Company,Inc.
3. Record of System Operation Suite 201 Only
All operational features and functions of this system were tested by Kevin Wiesner on 10/27/17
and found to be operating properly in accordance with the requirements of:
x NFPA 72 (2010), Chapters 1Q 1z .14 11 18 71 23 (underline all that apply)
x NFPA 70(2011), National Electrical Code, Article 760
x Manufacturer's instructions
Other(specify):
Signed: Kevin Wiesner Date: 10/27/2017
Organization: Capitol Electric Company,Inc.
4. Alarm-Initiating Devices and Circuits Suite 201 Only
Quantity and class of initiating device circuits(see NFPA 72, Table 3-5) Quantity: Style: Class:
MANUAL
(a) 0 Manual stations Noncoded,activating Transmitters Coded
(b) Combination manual fire alarm and guard's tour coded stations.
AUTOMATIC
Coverage: Complete: Partial:
(a) 0 Smoke detectors Ion Photo
(b) 0 Duct detectors _____Ion Photo
(c) 0 Heat detectors FT RR FT/RR RC
(d) 0 Sprinkler waterflow switches: Transmitters Noncoded, activating
(e) ____Other(list):
6. Supervisory Signal-Initiating Devices and Circuits Suite 201 Only
HVAC
(a) 0 Duct detectors Ion Photo
SPRINKLER SYSTEM
(a) Non coded valve supervisory switch at sprinkler riser
(b) Non coded valve supervisory switch at sprinkler vault
(c) Non coded supervisory air pressure switch at sprinkler riser
(d) Site water supply level points
Electric fire pump:
(e) Fire pump power
(f) fire pump running
(g) Phase reversal
Engine-driven fire pump:
(h) Selector in auto position
(I) Engine or control panel trouble
(j) +Fire pump running
Engine-driven generator:
(k) Selector in auto position
(I) Control panel trouble
(m) Transfer switches
(n) Engine running
Other supervisory functions(s) (specify):
6. Alarm Notification Appliances and Circuits Suite 201 Only
Quantity and class(see NFPA 72, Table 3-7)of notification appliance circuits connected to the system:
Types and quantities of notification appliances installed: Quantity: 1 Style Y Class: B
(a) Bells Inch
(b) Speakers
(c) Horns
(d) Chimes
(e) Other:
(f) 1 Visual signals Type: ADA SYNCHRONIZED
1 with audible __w/o audible
(g) Local annunciator
7. Signaling Line Circuits Suite 201 Only
Quantity and class(see NFPA 72, Table 3-6)of signaling line circuits connected to system:
8. System Power Supplies (Notification Power Supply NAC 1)
(a)Primary(main): NAC 1 Nominal voltage: 120 VAC Current rating: 2.6 Amps
Overcurrent protection: Type: Circuit Breaker Current rating: 20 Amps
Location: FLOOR 1 ELECTRIC ROOM
(b) Secondary(standby):
X Storage battery: Amp-hour rating: 7 Ah @ 24 VDC
Calculated capacity to drive system, in hours: 2.7367 Ah 24 60
9. System Software
(a) Operating system software revision level(s): N/A
(b) Application software revision level(s):
(c) Revision completed by: N/A
(name) (firm)
10. Comments:
Shane Tercek Capitol Electric Co., FLS Supervisor
(signed)for central station or alarm service company or installation contractor/supplier (title)
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s):
This record of completion applies to Suite 201 Only
Devices installed conform to NFPA standards.
System deviations from the referenced NFPA standard(s)are: NONE
Shane Tercek Capitol Electric Co., FLS Supervisor
(signed)for central station or alarm service company or installation contractor/supplier (title)
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)