The URL can be used to link to this page

Report (120) SNkY SYSTEM RECORD OF COMPLETION ,-\ 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 andlor 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: 10/24/18 Supplemental Pages Attached: n/a 1. PROPERTY INFORMATION Name of property: Tualatin Valley Fire&Rescue-Red Rock Center Address: 12115 SW 70th Avenue Tigard Oregon 97223 Description of property: Oregon Reproductive Medicine,Suite 101 Fire Alarm Tenant Improvement Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: Oregon Electric Address: 1709 SE 3rd Avenue Portland,OR 97214 Phone: 503-234-1001 Fax: 503-234-9900 E-mail: Iowell.Leckband©oeg.us.com Service organization: Address: Phone: Fax: E-mail: Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Address: Phone: Fax: E-mail: Account number: Phone line 1: Phone line 2: Means of transmission: Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: El New system ®Modification to existing system Permit number: FPS2018-00092 NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: Honeywell Notifier Model number: NFW2-100 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: N/A Alarm verification set for N/A 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: Overcurrent protection: Type: Circuit Breaker Amps: 20 Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: Battery 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 D 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 B Other(specify): 7. REMOTE ANNUNCIATORS Type Location 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations Smoke Detectors Duct Smoke Detectors Heat Detectors Gas Detectors Water-flow Switches 1 Addressable Alarm Tamper Switches 1 Addressable Supervisory Copyright e 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 15 Wall Mount Strobe Combination Audible and Visible 6 Wall Mount Horn/Strobe 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices N/A 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 ® 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: Printed name: Date: Organization: Title: Phone: 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Scott Autry Date: 10/24/18 Organization: DTS Systems, Inc. Title: Fire Alarm Technician Phone: 503-643-63127 12.3 Acceptance Test Date and time of acceptance test: 10/24/18 Installing contractor representative: Testing contractor representative: Scott Autry 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.