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Report (2) 1—Ps2.0101--o0{2{0 6Q50 feeztwoodi (t✓ 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: 10-30-2019 Supplemental Pages Attached: 0 1. PROPERTY INFORMATION Name of property: Sellwood Consulting Address: 6650 SW Redwood Lane, 370 Description of property: low rise office Name of property representative: VanOsdel Construction Address: Phone: Fax: E-mail: 2. INSTALLATION,SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Point Monitor Address: 5863 Lakeview Blvd Phone: 503.627.0100 Fax: E-mail: Service organization: Stanley Address: Phone: Fax: E-mail: Testing organization: Point Monitor Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Unchanged Monitoring organization: Unchanged Address: Phone: Fax: E-mail: Account number: Unchanged Phone line 1: Unchanged Phone line 2: Unchanged Means of transmission: Unchanged Entity to which alarms are retransmitted: Unchanged Phone: Unchanged 3. DOCUMENTATION On-site location of the required record documents and site-specific software: Panel,secind floor 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system ®Modification to existing system Permit number: FPS2019-00126 NFPA 72 edition: 2019 4.1 Control Unit Manufacturer: Silent Knight Model number: 5820XL 4.2 Software and Firmware Firmware revision number: Unchanged 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. ir, 7 o1. 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: 8 Overcurrent protection: Type: Breaker Amps: 20 Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: Battery 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 Unchanged Device Power Unchanged Initiating Device Unchanged Notification Appliance B 0 Other(specify): Unchanged 7. REMOTE ANNUNCIATORS Type Location Unchanged 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations Unchanged Smoke Detectors Unchanged Duct Smoke Detectors Unchanged Heat Detectors Unchanged Gas Detectors Unchanged Waterfiow Switches Unchanged Tamper Switches Unchanged 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. - ;f 3) SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible 3 Strobes Combination Audible and Visible 2 Horn Strobes 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices Unchanged HVAC Shutdown Unchanged Fire/Smoke Dampers Unchanged Door Unlocking Unchanged Elevator Recall Unchanged Elevator Shunt Trip Unchanged 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 as specified herein has been installed according to all NFPA standards cited herein. Signed: Printed name: Brian Downey Date: 10-31-2019 Organization: Point Monitor Title: Tech Phone: 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Brian Downey Date: 10-31-2019 Organization: Point Monitor Title: Tech Phone: 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 d-istribution. p.