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Report (43) � � s . ;esu 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: 7/16/19 Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: Fanno Creek Place Building B Address: 16083 SW Upper Boones Ferry Rd Suite 250 Description of property: The Good Life-Tenant Improvement Name of property representative: BUILT ENVIROMENTS NORTHWEST Address: 135 East Hereford Street PO Box 160 Gladestone,OR 97027 Phone: 503.819.9623 Fax: 503.650.4101 E-mail: steves@BE-nw.com 2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: PROTEK SYSTEMS,LLC Address: 305 SE Chkalov Drive Suite 111#361 Vancouver,WA 98683 — _Phone: (360)314-2017 Fax: —T'E-mag: admin@protek.sistems Service organization: PROTEK SYSTEMS,LLC Address: 305 SE Chkalov Drive Suite 111#361 Phone: (360)314-2017 Fax: E-mail: admin@protek.systems Testing organization: PROTEK SYSTEMS,LLC Address: 305 SE Chkalov Drive Suite 111#361 Phone: (360)314-2017 Fax: E-mail: admin@protek.systems Effective date for test and inspection contract: Monitoring organization: Central Station Monitoring Address: Phone: — Fax: __--. E-mail: Account number: Phone line l: 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: Document Box 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: -1 New system 21 Modification to existing system Permit number: FPS2019-00073 NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: EST Model number: Quickstart 4.2 Software and Firmware - utnwate tenstuu nwuLet. 4.3 Alarm Verification NI This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds ©2012 National Fire Protection Association NFPA 72(p.1 of 3) 2013 Edition liw1F SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel. 120VAC Control panel amps: 3.6A Overcurrent protection: Type: Breaker Amps: 20A Branch circuit disconnecting means location: House Panel Number: 5.1.2 Secondary Power Type of secondary power: Batteries-12VDC 7AH 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 J This system does not have power extender panels )4 Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Dual Media Separate Survivability Pathway Type Pathway Pathway Class Level Signaling Line X B 0 Device Power Initiating Device Notification Appliance X B 0 Other(specify): 7. REMOTE ANNUNCIATORS Type Location S-BUS Lobby S. ! —__ Addressable or Alarm or Sensing Type Quantity Conventional. Supervisory Technology Manual Pull Stations Existing Addressable Alarm N/A Smoke Detectors Existing Addressable Alarm N/A Duct Smoke Detectors Existing Addressable Alarm N/A Heat Detectors Existing Addressable Alarm N/A Gas Detectors N/A N/A N/A N/A Waterflow Switches Existing Addressable Alarm N/A Tamper Switches Existing Addressable Supervisory N/A ©2012 National Fire Protection Association NFPA 72(p.2 of 3) • SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible. ___ _ Horn Visible 2 Strobes Combination Audible and Visible 4 Horn Strobes 10. SYSTEM CONTROL FUNCTIONS Type Quantity, Hold-Open Door Releasing Devices Existing HVAC Shutdown Existing Fire/Smoke Dampers Existing Door Unlocking Existing Elevator Recall --- --- --- Existing _ Elevator Shunt Trip _Existing 11. INTERCONNECTED SYSTEMS JO This system does not have interconnected systems. J Interconnected systems are listed on supplementary sheet__-_----__-_--__ 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specified herein has been installed according to all NFPA standards cited herein. Signed: 4 ,55U t Printed name: Adam Sweet Date: 7/16/19 Or anization:. PROTEK SYSTEMS Title: Phone: ( ) LLCFire Alarm SystemsCET III253 448-1604 g _. NI 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited 1-.erein. Signed: 'A 371v4¢t- Printed name: Adam Sweet_-_—_— Date: 7/16/19 _--` Organization:__PROTEK SYSTEMS,LLC Title: Fire Alarm Systems NICET III Phone: (253)448-1604 12.3 Acceptance Test ta;d_timeafacoeptance 7116/19-6A0am- -_ Installing contractor representative: Adam Sweet — Testing contractor representative: Adam Sweet Property representative: AHJ representative: X32012 National Fire Protection Association NFPA 72(p.3 of 3) NOTIFICATION APPLIANCE POWER PANEL SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion.It includes a list of types and locations of notification appliance power extender panels. This form is to be completed by the system installation contractor at the time of system acceptance and approval. ft shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert NIA in all unused trees. Form Completion Date: 7/16/19 Nutter of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Fanno Creek Place Building B Address: 16083 SW Upper Boones Ferry Road 2. NOTIFICATION APPLIANCE POWER EXTENDER PANELS Make and Model Location Area Served Power Source EST- BPS10A Elec Room 2nd Floor 120VAC See Main System Record of Completion for additional information,certifications,and approvals. ®2C12 National Fire Protection Association NFPA 72