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Report (100) Fs: \\` 1 \ k 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 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: 10/23/2018 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Brightwater at Redhawk Apts Address: 16194 SW 108th Ave, Tigard OR 97224 Description of property: Multifamily Residential Name of property representative: DHP Brighwaters LLC Address: 32 Meadow Hill Dr, Tiburon CA 94920 Phone: 503-684-8000 Fax: E-mail: 2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: Fire Systems West Address: 600 SE Maritime Dr Vancouver,WA 98661 Phone: 360-693-9906 Fax: E-mail: marks@firesystemswest.com Service organization: Fire System West Address: 600 SE Maritime Dr Vancouver, WA 98661 Phone: 360-693-9906 Fax: E-mail: marks@firesystemswest.com Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Local Only 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: FACP 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system ❑■ Modification to existing system Permit number: FPS2018-00111 NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: Silent Knight Model number: SK-4 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 VAC Control panel amps: 4 Overcurrent protection: Type: Thermal Amps: 20 Branch circuit disconnecting means location: House Panel Number: 5.1.2 Secondary Power Type of secondary power: SLA 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 1 B 3 Device Power Initiating Device Notification Appliance 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 1 Conventional Alarm Heat Gas Detectors Waterflow Switches Tamper Switches 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 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers Door Unlocking Elevator Recall Elevator Shunt Trip Fire Panel 1 11. INTERCONNECTED SYSTEMS ❑■ This system does not have interconnected systems. 0 Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system. :.: ifi herein has been installed according to all NFPA standards cited herein. Signed: A jV/ ./I !�.J.,�� Printed name: Randall Deer Date: 10/23/2018 Organization: Fire Systems West Title: Fire Alarm Technician Phone: 360-693-9906 12.2 System Operational Test This system aZ14b tfied h h tested according to all NFPA standards cited herein. Signed: Printed name: Randall Deer Date: 10/23/2018 Organization: Fire Systems West Title: Fire Alarm Technician Phone: 360-693-9906 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: 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)