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Report (81) s SYSTEM RECORD OF COMPLETIO 741.6tY 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. V�J Attach additional sheets, data,or calculations as necessary to provide a complete record. k- c%+( r ? Form Completion Date: 10/12/17 Supplemental Pages Attached: ` '��'\ 1. PROPERTY INFORMATION Name of property: TIGARD DISTRIBUTION CENTER Address: 8001 SW HUNZIKER ST Description of property: WAREHOUSE Name of property representative: DEERING MANAGEMENT Address: 4800 SW MACADAM PORTLAND,OREGON Phone: 503.225.1545 Fax: E-mail: 2. INSTALLATION, SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: WESTERN STATES FIRE PROTECTION Address: 17500 SW 65TH AVE LAKE OSWEGO,OR 97035 Phone: 503.657.5155 Fax: E-mail: jeremy.whisenhunt@wsfp.us Service organization: SAME AS ABOVE Address: Phone: Fax: E-mail: Testing organization: SAME AS ABOVE Address: Phone: Fax: E-mail: Effective date for test and inspection contract: 10/13/17 Monitoring organization: WESTERN MONITORING Address: Phone: 877.367.9737 Fax: E-mail: Account number: AE09-0413 Phone line 1: Phone line 2: Means of transmission: AES RADIO NETWORK Entity to which alarms are retransmitted: MONITORING CENTER Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific software: RISER/FACP CLOSET 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ®New system 0 Modification to existing system Permit number: FPS2017-00139 NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: SILENT KNIGHT Model number: 5700 4.2 Software and Firmware Firmware revision number: 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. (p 1 of 3) SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120 Control panel amps: 3 Overcurrent protection: Type: 20 AMP BREAKER Amps: 20 Branch circuit disconnecting means location: ELECTRICAL PANLEL C Number: 19 5.1.2 Secondary Power Type of secondary power: 24 VOLT SLA BACKUP BATTERY 7 AMP HOUR 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 B 1 Device Power B 1 Initiating Device B 1 Notification Appliance B 1 Other(specify): 7. REMOTE ANNUNCIATORS Type Location 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 1 ADDRESSABLE ALARM SINGLE Smoke Detectors 1 ADDRESSABLE ALARM PHOTO Duct Smoke Detectors Heat Detectors Gas Detectors Waterflow Switches 1 ADDRESSABLE WATERFLOW MODULE Tamper Switches 1 ADDRESSABLE TAMPER BUTTERFLY 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. (p.2 of 3) SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible Combination Audible and Visible 1 EXTERIOR WEATHERPROOF HORN STROBE 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers Door Unlocking Elevator Recall Elevator Shunt Trip 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 syste •: '•- -• i= _' +Keen i I stalled according to all NFPA standards cited herein. SigneV:i° tinted name: JEREMY WHISENHUNT Date: 10/12/17 Org!•' . ion: WSFP Title: ALARM AND DETECTION Phone: 971.235.0170 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 12.3 Acceptance Test Date and time of acceptance test: 10/8/17 Installing contractor representative: JEREMY WHISENHUNT Testing contractor representative: Property representative: 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. (p. 3 of 3)