Report Certificate of Completion
Name of Protected Property:Washington Square Mall- Hollister(D09) FPS2019-00063
Address: 9777 SW Washington Square Rd
Tigard,OR 97223
Rep. of Protected Prop. (name/phone):Roger Ott/503-352-8862
Authority Having Jurisdiction:City of Tigard
Address: 13125 SW Hall Blvd.
Tigard,OR 97223
Phone Number:503.718.2439
1. Type(s) of System or Service:
X NFPA 72,Chapter 3-Local
If alarm is transmitted to location(s)off premise, list where received:
NFPA 72, Chapter 3-Emergency Voice/Alarm Service
Quantity of voice/alarm channels: Single: Multiple:
Quantity of speakers installed: Quantity of speaker zones:
Quantity of telephones or telephone jacks included in system:
NFPA 72,Chapter 4-Auxiliary
Indicate type of connection:
Local energy, Shunt, Parallel telephone
Location and telephone number for receipt of signals:
NFPA 72,Chapter 4-Remote Station
Alarm:
Supervisory:
NFPA 72, Chapter 4-Proprietary
If alarms are retransmitted to public fire service communications center or others, indicate
location and telephone number of the organization receiving alarm:
Indicate how alarm is retransmitted:
Updated: 10/3/2013 Page 1
NFPA 72,Chapter 4-Central Station
The Prime Contractor:.ISA Monitoring
Central Station Location:
Means of transmission of signals from the protected premise to the central station:
McCulloh Multiplex One-Way Radio
x Digital Alarm Communicator Two-Way Radio Others
Means of transmission of alarms to the public fire service communications center:
1.
2.
System Location:
Organization Name/Phone Representative Name/Phone
Installer Frahler Electric Dave Mannix
503.936.7192
Supplier
Siemens Industry Moses Frangopoulos
Service Organization 15201 NW Greenbrier Parkway 503.207.1834
Beaverton,OR 97006
Location of Record (As-Built) Drawings:
Washington Sq Facility Department
Location of Owners Manuals:
Location of Test Reports:
A contract, dated 6/1/18-5/31/20 for test and inspection in accordance with NFPA standard(s)
No.(s) dated is in effect.
2. Certification of System Installation
This system has been installed in accordance with the NFPA standards as listed below,was
inspected by on , includes the devices
listed below arid has been in service-since
NFPA 72, Chapters_ 4 _ 5 6 7 _ 10
NFPA 70, National Electrical Code, Article 760
Manufacturer's Instructions
Other(specify):
Signed: Date: ‘-7—f7
Organization:Frahler Electric
Updated: 10/3/2013 Page 2
3. Certification of System Operation
All operational features and functions of this partial system were tested by
on and found to be operating properly in accordance with the
requirements of:
X NFPA 72, Chapters _ 4 _ 5 _ 6 _ 7 _ 10
NFPA 70, National Electrical Code, Article 760
Manufacturer's Instructions
Other(specify):
--s
Signed "�— Date: t9I
Organization:Siemens Industry
4. Alarm Initiating Devices and Circuits
MANUAL
a) Manual Stations BG—CHEMICAL Transmitters Coded
b) Combination Manual Fire Alarm and Guard's Tour Coded Stations
AUTOMATIC
Coverage: Complete Partial
a) Smoke Detectors: Ion Photo
b) Duct Detectors: Ion Photo
c) Heat Detectors: FT RR FT/RR RC
d) Sprinkler Water Flow Switches: Noncoded,Activating
Transmitters Coded
e) Other(list):
5. Supervisory Signal Initiating Devices and Circuits
GUARD'S TOUR
a) Coded Stations
b) Noncoded Stations Activating Transmitters
c) Compulsory Guard Tour System Comprised of Transmitter Stations
and Intermediate Stations
Note: Combination devices recorded under 4(b)and 5(a).
SPRINKLER SYSTEM
a) Coded Valve Supervisory Signaling Attachments
Valve Supervisory Switches Activating Transmitters
b) Building Temperature Points
c) Site Water Temperature Points
d) Site Water Supply Level Points
Updated: 10/3/2013 Page 3
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
I) Control Panel Trouble
m) Transfer Switches
n) Engine Running
Other Supervisory Function(s)(specify):
6. Alarm Notification Appliances and Circuits
Quantity of indicating appliance circuits connected to the system:
Types and quantities of alarm indicating appliances installed:
a) Bells Inch
Speakers
b) Horns
c) Chimes
d) Other:
e) 15 Visual Signals Type:
11 with audible 4 w/o audible
f) Local Annunciator
7. Signaling Line Circuits:
Quantity and Style of signaling line circuits connected to system:
Quantity: 2 Style:Class B/Style 4
8. System Power Supplies
a) Primary(Main):_ Nominal Voltage___ Current Rating:
Overcurrent Protedton: Type: - Currey Rating:
Location:
b) Secondary(Standby):
Storage Battery: Amp-Hour Rating
Calculated capacity to drive system, in hours:
Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
Updated: 10/3/2013 Page 4
c) Emergency or Standby System used as backup to Primary Power Supply, instead of using a
Secondary Power Supply:
0 Emergency System described in NFPA 70,Article 700
0 Legally Required Standby System described in NFPA 70, Article 701
0 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):
b) Application Software Revision Level(s):
c) Revision Completed by:
(name) (firm)
10. Comments:
Project Scope—
Alterations to Fire Alarm system to support TI work for Hollister(D09)
Service Technician
(signed)for Alarm Service Company (title) (date)
Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA
q Y
standard(s):
System deviations from the referenced NFPA standard(s)are: None
Service Technician
(signed)for Alarm Service Company (title) (date)
Upon completion of the system(s)satisfactory test(s)witnessed (if required by the authority
having jurisdiction:
(signed)representative of the authority having jurisdiction (title) (date)
Updated: 10/3/2013 Page 5