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Report M 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: 03/12/2020 Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: 4th Floor Common Areas-Atrium West Address: 9600 SW Oak St.Ste.400 Tigard,OR 97223 Description of property: Hallway, restrooms Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE,TESTING, AND MONITORING INFORMATION Installation contractor: Point Monitor Corp. Address: 5863 Lakeview Blvd.#100 Lake Oswego,OR 97035 Phone: 503-627-0100 Fax: E-mail: Service organization: Western States Fire Protection Address: 13896 Fir St,Ste B Oregon City, OR 97045 Phone: 503-657-5155 Fax: E-mail: Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Existing Monitoring organization: Avantgaurd Monitoring Address: Phone: 800-660-2673 Fax: E-mail: Account number: A9-3000 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: Fl.2 FACP/Telecom Closet 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system ®Modification to existing system Permit number: FPS2020-00022 NFPA 72 edition: 2019 4.1 Control Unit �x�57 1\11,i Manufacturer: Silent Knight J Model number: 5820XL 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 coped for individual use other than for resale.It may not be copied for commercial sale or distribution. of 3 SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control linit 5.1.1 Primary Power Input voltage of control panel: 120 Control panel amps: Overcurrent protection: Type: Breaker Amps: Branch circuit disconnecting means location: Panel LB-2 Number: 1 5.1.2 Secondary Power Type of secondary power: (2) 12V18Ah 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 B 1 Device Power Initiating Device B 1 Notification Appliance B 1 Other(specify): 7. REMOTE ANNUNCIATORS Nl/°1 Type Location 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 1 Conventional Alarm Smoke Detectors 1 Addressable Alarm Photo Duct Smoke Detectors Heat Detectors Gas Detectors Waterflow Switches Tamper Switches Copyright CO 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 SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible 2 System Sensor SWL Combination Audible and Visible 2 System Sensor P2WL 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices 1 HVAC Shutdown Fire/Smoke Dampers Door Unlocking Elevator Recall Elevator Shunt Trip 11. INTERCONNECTED SYSTEMS ® This system does not have interconnected systems. ❑ 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: .7 �' Printed name: Jason Devine Date: 03/12/2020 Organiza o(f n: Point Monitor Corp. Title: Technician Phone: 503-627-0100 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Jason Devine Date: 03/12/2020 Organizati n: Point Monitor Corp. Title: Technician Phone: 503-627-0100 12.3 Acceptance Test Date and time of acceptance test: 03/13/2020 6:00am Installing contractor representative: Jason Devine Testing contractor representative: Jason Devine Property representative: AHJ representative: Jeff Grove 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. n. 3c:t 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. 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. Form Completion Date: 03/12/2020 Number of Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: 4'"Floor Common Areas-Atrium West Address: 9600 SW Oak St.Tigard,OR 97223 2. NOTIFICATION APPLIANCE POWER EXTENDER PANELS 1\ Make and Model Location Area Served Power Source Notifier FCPS-24F Fl.4 Telecom Closet Fl.4 Panel L(A-1 3 See Main System Record of Completion for additional information,certifications,and approvals. Copyright 02012 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.