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Report (52) F StAt f4. Zorn/ -c�orl SYSTEM RECORD OF COMPLETION 4 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 receir1L Insert N/A in all unused lines. • Attach additional sheets,data, or calculations as necessary to provide a complete recaic !'i t 1),!\;(-; Form Completion Date: 9,,/'/3`is Supplemental Pages Attached: 1. PROPERTY INFORMATION �L ! / L Name of property: i e S "f919to �/9 / / -c C /�GC - C A Address: /2 4 30 S W c o/l S- I--6p 'Qd• i 7/9rd OR 9 X02023 Description of property: C A u/'C.�) ` J C A 061 Name of property representative: Al);/9n DeA 7/t an Address: Phone:50 a- 57a- 239.2 Fax: E-mail: 2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: Advanced Security&Fire Address: 14140 SW Linda Lane.,Beaverton OR 97006 Phone: 503-519-4550 Fax: E-mail: advancedsecfire@gmaii.com Service organization: Advanced Security&Fire Address: 14140 SW Linda Lane,Beaverton OR 97006 Phone: 503-519-4550 Fax: E-mail: advancedsecfire@gmail.com Testing organization: Advanced Security&Fire Address: 14140 SW Linda Lane,Beaverton OR 97006 Phone: 503-519-4550 Fax: E-mail: advancedsecfire@gmail.com Effective date for test and inspection contract: Monitoring organization: Central Station Monitoring Address: 303 SW Zobrist,Estacada OR 97023 Phone: 503-630-2896 Fax: 503-630-6630 E-mail: Account number: Phone line 1: 503-630-3128 n Phone line 2: 503-630-3136 Means of transmission: Qa s i I9 CCM/z)U r n e41-01-1 - Dari 1 /-`i On e. Line Entity to which alarms are retransmitted: C(Lr, (WI 5/9 i.O n Phone: 5.0g- 636- .2 8ct 6 3. DOCUMENTATION 1 On-site location of the required record documents and site-specific software: ,��eC Tffn; C 4 1 C/0Se/ 4. DESCRIPTION OF SYSTEM OR SERVICE L' ,r� ) This is a: ®New system 0 Modification to existing system Permit number: ,c p S CJ i'7- LSO/ 1-2 NFPA 72 edition: 4.1 Control Unit Manufacturer: Silent Knight Model number: 5 2Op 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification A This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds Copyright 0 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 ) 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: 20 Overcurrent protection: Type: Breaker Amps: 20 Branch circuit disconnecting means location: BP(✓A ke 1' Number: jr,A L 5.1.2 Secondary Power Type of secondary power: Battery Backup (12V 7.5amp x 2=15amp) 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 Device Power IV Initiating Device Notification Appliance i' S Other(specify): 7. REMOTE ANNUNCIATORS Type Location ACD £nuc f,'s1) /E/9C/c' A-Pon* 1n fy 8. INITIATING DEVICES Addressable or Type Quantity /� Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 3 C_[5 n v e!)7,p n A / /91/9 r cn ,)a#3 f /L/ ,Q rl Smoke Detectors !7 1/ /9/1;'1'ni ,A,91-0 .6 ie c Y r,r C Duct Smoke Detectors Heat Detectors Gas Detectors Waterflow Switches Tamper Switches Copyright 0 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. 2 of 31 4 SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible /3 SyS fSen 56 S ftf b C. Combination Audible and Visible J J Sy S fem ,5 e., sop - ,V®,n r) /Sifiob c 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 lit This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet . 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This systemg specified herein has been i stalled according to all NFPA standards cited herein. Signed: ctujPrinted name:09v d IY)OfAvi Date: 113/J5 Organization:4o(v4/7 C ed Seeu r,/y Title: /"ne$I G e n 1' Phone:503-Sl Q. 1i,5". 12.2 System Operational Test This syste as specified herein has tested according to all NFPA standards cited herein. /i3/i5 Signed: /� Printed name: /f v't Sn LLcr D �o t'�v� K Date: Organization: ,✓i9ne_eJ 5ecur; / Title: ��e5;GiPfl1 Phone: J5-0.3-5/q- 5,51 12.3 Acceptance Test Date and time of acceptance test: //3/f. 1 ./ Installing contractor representative: , S. Testing contractor representative: S Property representative: ,gp,,n ,©t c f tp I) AHJ representative: 2-0p I#e i" 8pr B'a e T 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;i?