Report (58) FPSZc718 - «DOce-y
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Northwest Fire Suppression, Inc.
FIRE ALARM/SUPPRESSION SYSTEM RECORD OF COMPLETION
Protected Premise: Owner's Rep & Phone:
Natural Grocers
13115 SW Pacific Highway
Tigard, OR 97223
This system was designed by, and equipment supplied by:
Northwest Fire Suppression,Inc., 1800 NW 169th Place Suite C#600
Beaverton,OR 97006 Phone: 503-644-7720 Fax: 503-644-8289
1. Types(s) of System or Service
Control Unit Manufacturer: Firelite Other
Model Number: MS-9600UDLS
❑ ❑
❑ ❑ Other(Specify)
Type of Communication: ❑ ❑ N/A
❑ Other(Specify)
Monitoring Provided By: Protection One
Account Number: 16-2051324
Alarm Code Style:
Phone Line 1 Number:
Phone Line 2 Number:
2. System Power Supplies
(a)Fire Alarm Control Panel:
Nominal Voltage: Current Rating: Amps
Breaker Location:
(b) Secondary(standby):
Sealed Lead Acid Batteries AH Providing: Hours Of Backup
3. System Software
Panel Firmware Rev#:
Application Software:
Rev Completed By: Name Company
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4. Notification Devices
Quantity Device Type
Bells
Horns
1 Horn/Strobes
Strobes
Speakers
Annunciators
Other(Specify)
S. Initiating Devices
Quantity Device Type
1 Fire Alarm Pullstations
Suppression Manual Release Station
Ion Detectors
1 Photo Detectors
Duct Detectors Type:
Heat Detectors
Waterflow Switches/Pressure Switches
Abort Switches
Tamper Switches
Low Air Switches
Other(Specify)
Other(Specify)
6. Record of System Installation
This system has been installed in accordance with the National Electric Code, and
meets all requirements of Article 760 as a Power Limited Fire Alarm system.
After all device installation was complete (except control equipment final
terminations), all initiation, signal and control circuit wiring was tested and found to
be free of opens, shorts and ground faults.
The entire system was installed per the AHJ approved plans,and complete, accurate
"as built"notations have been provided to Northwest Fire Suppression,Inc.
Installing Northwest Fire Suppression, Inc.
Contractor:
Responsible Kevin Hood/Henry License#: 4751LEA/4937LEA
Journeyman: Tavison
Signature: Date:
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/47 2/7452
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7. Record of System Operation
All operational functions and features of this system were tested and found to be
working properly in accordance with the approved plans,per NFPA 70,National
Electric Code, Article 760,per NFPA 72, Chapters 1, 3, 4, 5, 6 and 7, and per the
manufacturer's instructions.
I have reviewed the"as built"drawings and find that they are accurate and complete.
Certifying Contractor: Northwest Fire Suppression, Inc.
Responsible Journeyman: Kevin Hood License#: 4751LEA
Signature: Date:
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8. Acceptance Testing Statements
Commissioning Technician:
I have tested and witnessed satisfactory performance of all system devices and control
functions, and/or have noted any exceptions on this Record of Completion.
Name: Dan Brayton Representing: ,duy „7:_c_.
Signature: Date:
Local Authority(or Authorities) Having Jurisdiction:
This system has en inspected and is accepted for the jurisdiction I represent.
Name: Representing: C �� l
Signature: Date:
ITJ
9. Comments
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