The URL can be used to link to this page

Report (80) SYSTEM RECORD OF COMPLETION 4v Hriki iv 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%2/2017 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: 12670 SW Hall Blvd. Blda#3 Address: 12670 SW Hail Blvd.Tigard. OR 97223 Description of property: OfficeiManufacturino Name of property representative: Mike Hamilton Address: SAME Phone: 360-910-4891 Fax: 503-352-3636 E-mail: mhamilton@apexind.corn 2. INSTALLATION, SERVICE, TESTING,AND MONITORING INFORMATION Installation contractor: Fire Systems West Address: 600 SE Maritime Ave ste 300 Vancouver.WA 98661 Phone: 360-693-9906 Fax: 360-289-2208 E-mail: dand@firesystemswest.com Service organization: Same Address: Phone: Fax: E-mail: Testing organization: Same Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Central Station Monitoring Address: Beaverton. OR Phone: 503-630-8991 Fax: E-mail: hoppenn@csmtll com Account number: Phone line 1: N%A Phone line 2: N%A Means of transmission: AES Radio/7750 Subscriber Unit Entity to which alarms are retransmitted: TVF&R 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: ®New system ®Modification to existing system Permit number: FP2017-00115 NFPA 72 edition: 13 4.1 Control Unit Manufacturer: Silent Knight Model number: 5208 4.2 Software and Firmware Firmware revision number: 15 4.3 Alarm Verification ►,moi 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: 120 VAC Control panel amps: 3 Overcurrent protection: Type: Circuit Breaker Amps: 20 Branch circuit disconnecting means location: Panel 2BB Number: #9 5.1.2 Secondary Power Type of secondary power: Sealed Lead Acid Batteries Location,if remote from the plant: 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 Notification Appliance Other(specify): 7. REMOTE ANNUNCIATORS Type Location NIA 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 1 Conventional Alarm Zone Smoke Detectors 1 Conventional Alarm Zone Duct Smoke Detectors 3 Conventional Alarm Zone Heat Detectors Gas Detectors Waterflow Switches 2 Conventional Alarm Zone Tamper Switches 2 Conventional Alarm Zone 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 1 Restroom Combination Audible and Visible 2 Warehouse,'Qutdoor 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices NIA HVAC Shutdown N/A Fire/Smoke Dampers N/A Door Unlocking N/A Elevator Recall N/A Elevator Shunt Trip N/A 11. INTERCONNECTED SYSTEMS A 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: Dan Duggan Printed name: Dan Duggan Date: 8/1/2017 Organization: Fire Systems West Title: Technician Phone: 360-771-2694 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Dan Duggan Printed name: Dan Duggan Date: 8/1/2017 Organization: Fire Systems West Title: Technician Phone: 360-771-2694 12.3 Acceptance Test Date and time of acceptance test: 8/1/2017-1300 Installing contractor representative: Dan Duggan Testing contractor representative: Fire Systems West, Dan Duggan Property representative: Mike Hamilton AHJ representative: 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.