Report (99) 1
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NFPA 72 (2016 Edition) \ Sk'
Record of Completion1C�
Name of Protected Property: RIVERVIEW TERRACE Date 12-19-2018
Address 17077 SW Appledale Tigard,OR
Owner's Representative(name/phone):
Authority Having Jurisdiction: Washington County.
Address/Phone Number:
1. NFPA 72,Chapter 4-3 Proprietary Supervising Station System
If Alarms are transmitted to a public fire service communications center or others,indicate location
and telephone number of the organization receiving alarm:
Indicate how alarm is transmitted:
GSM Cellular
The Prime Contractor:
Polygon
Proprietary Station Location:
BEAVERTON ORE
Means of transmission of signals from the protected premises to the proprietary station:
X GSM Digital Alarm Communicator Other
Organization Name/Phone Representative Name/Phone
Installer: David M Phipps 503-590-3732
Alarm Service Company FIRE PROTECTION SERVICES INC.
Location of Record(As-Built)Drawings:
INSIDE FIRE PANEL RISER ROOM Command Center
Location of Owners Manuals:
INSIDE FIRE PANEL RISER ROOM Command Center
2. Record of System Installation
(Fill out after installation is complete and wiring checked for opens,shorts,ground faults,and
improper branching,but prior to conducting operational acceptance tests.)
3. Record of System Operation
All operational features and functions of this system were tested by DAVE PHIPPS on and found
to be operating properly in accordance with the requirements of:
X NFPA 72,Chapters
X NFPA 70,National Electrical Code,Article 760
X Manufacturer's Instructions
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Other(specify):
Organization:FIRE PROTECTION SERVICES INC.
4. Alarm-Initiating Devices and Circuits(use blanks to indicate quantity of devices)
MANUAL
1 Manual Stations Noncoded,Activating Transmitters Coded
AUTOMATIC
Coverage:Complete: Partial:
(a) _2 lmoke Detectors Ion X Photo
(b) Duct Detectors Ion Photo
(c) Heat Detectors FT RR FT/FF RC
(d) Sprinkler Water flow Switches: Transmitters Noncoded,Activating
Coded
(e) Other(list):
5. Supervisory Signal-Initiating Devices and Circuits(use blanks to indicate quantity of devices)
SPRINKLER SYSTEM
(a) Valve Supervisory Signaling Attachments
Valve Supervisory Switches,Activating Transmitters
(b) Building Temperature Points
(c) Site Water Temperature Points
(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
(1) Control Panel Trouble
(m) Transfer Switches
(n) Engine Running
Other Supervisory Functions(s)(specify): N/A
6. Alarm Notification Appliances and Circuits
Quantity of indicating appliance circuits connected to the system: 18
Types and quantities of alarm indicating appliances installed:
(a) Bells Inch diameter
(b) Speakers
(c) 32 Horns
(d) Chimes
(e) Other:
(f) 4 Visual Signals Type: System Sensor
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t
(g) Local Annunciator
7. Signaling Line Circuits
Quantity and Style(see NFPA 72,Table 3-6)of signaling line circuits connected to system:
Quantity: 1 Style: _CLASS B
8. System Power Supplies
(a) Primary(Main): Nominal Voltage: 120V Current Rating:
Overcurrent Protection:Type: Current Rating:
Location:
(b) Secondary(Standby):
2 Storage Battery: Amp-Hour Rating 12 V 17.0AH x 2
Calculated capacity to drive system, in hours: 5MIN (24) (60)
Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
(c) Emergency or Standby System used as backup to Primary Power Supply,instead of using a
Secondary Power Supply:
X Emergency System described in NFPA 70,Article 700
X Legally Required Standby System described in NFPA 70,Article 701
X Optional Standby System described in NFPA 70,Article 702,which also meets the
performance requirements of Article 700 or 701
9. System Software
(a) Operating System Software Revision Level(s): 15.0
(b) Application Software Revision Level(s): 15.0
(c) Revision Completed by: David M Phipps FIRE PROTECTION SERVICES INC.
(name) (firm)
IN4 ) 11S
jj� TALLATION SUPERVISOR
(signe (title)
Frequency of routine tests and inspections,if other than in accordance with the referenced NFPA
standard(s):
System deviations from the referenced NFPA standard(s)are: NONE
Upon completion of the system(s)satisfactory test(s)witnessed by the authority having jurisdiction:
(signed)representative of the Authority Having Jurisdiction (title) (date)
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