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Report Fire Alarm System Record of Completion Name of property protected: Providence Scholls Ferry MOB (Phase II) Address: -SW Scholls Ferry Rd, Tigard, OR 97223 Representative of protected property (name /phone): Authority having jurisdiction: Tigard Address /telephone number: Organization name / phone Representative name / phone Installer: Cochran Electric Supplier: Johnson Controls Service Organization: Johnson Controls, Inc. Location of record (as -built) drawings: FACP Room Location of operation and maintenance manuals: Location of test reports: FACP Room A contract for test and inspection in accordance with NFPA standard(s) Contract No(s): Effective date: Expiration date: System Software (a) Operating system (executive software revision level(s) : (b) Site - specific software revision date: (c) Revision completed by: Steven Beachner Johnson Controls Inc (name) (firm) 1. Type(s) of System or Service FPS 2 Q - v v / 3-0 C Q` S-e Z ) XX NFPA 72, Chapter 6 - Local If alarm is transmitted to location(s) off premises, list where received: Metro NFPA 72, Chapter 8 - Central Station Prime contractor: Central station location: Means of transmission of signals from the protected premises to the central station: XX Digital alarm communicator Two -way radio Others Means of transmission of alarms to the public fire service communications center: (a) PUBLIC TELEPHONE (b) System location: 2. Record of System Installation (Fill out after installation is complete and wiring checked for opens, shorts, ground faults, and improper branching, but prior to conducting operational acceptance tests.) This system has been installed in accordance with NFPA standards as shown below, was inspected by Steven Beachner on 2/16/11 , includes the devices shown in 5 and 6, and has been in service since 2/16/11 X NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply) X NFPA 70, National Electrical Code, Article 760 X Manufacturer's instructions Other (spe • ): Signed: - Date: 2/16/11 Organization: J nson Controls 3. Record of System Operation r� Fire Alarm System Record of Completion (based on NFPA 72 - 2002) NFPA 72, 1 of 3 2/16/2011 10:06.00 PM R.L. Suckow Reprinted with permission from NFPA 72 -2002, National Fire Alarm Code ®, Copyright 0 2002, National Fire Protection Association, Quincy, MA, 02269 Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached N/A All operational features and functions of this system were tested by Steven Beachner date 2/16/11 And found to be operating properly in accordance with the requirements of: X NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply) X NFPA 70, National Electrical Code, Article 760 X Manufacturer's instructions Other (spe ify): Signed: �� �r✓� Date: 2/16/11 Organization: Jo son Controls 4. Signaling Line Circuits Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity: 4 Style: 4 Class: B 5. Alarm Initiating Devices and Circuits Quantity and class of initiating device circuits (see NFPA 72, Table 6.5): Quantity: 1 Style: C Class: B MANUAL (a) Manual stations: Non -coded Transmitters Coded Addressable (b) Combination manual fire alarm and guard's tour coded stations AUTOMATIC Coverage: Complete Partial Selective x Nonrequired (a) Smoke detectors Ion Photo 4 Addressable (b) Duct detectors Ion Photo Addressable (c) Heat detectors FT RR FT /RR RC Addressable (d) Sprinkler waterflow indicators: Transmitters Noncoded Coded _ Addressable (e) The alarm verification feature is disabled XX or enabled , changed from seconds to seconds. (f) Other (list): 6. Supervisory Signal Initiating Devices and Circuits (use blanks to indicate quantity of devices) SPRINKLER SYSTEM Check if provided (a) Valve supervisory switches (b) Building temperature points (c) Site water temperature points (d) Site water supply level points 7. Annunciator(s) Number: Non Added Type: Location: 8. Alarm Notification Appliances and Circuits NFPA 72, Chapter 6 — Emergency Voice /Alarm Service Quantity of voice /alarm channels: Single: Multiple: Quantity of speakers installed: Quantity of speaker zones: Types and quantities of notification appliance circuits connected to system (see NFPA 72, Table 6.7): Quantity: Style: Y Class: B (a) Bells With Visible (b) Speakers With Visible (c) Horns With Visible 2 (d) Chimes With Visible (e) Others With Visible (f) Visible appliances without audible 9 9. System Power Supplies (a) Fire Alarm Control Panel: Nominal voltage: 24VDC Current rating: 5 Fire Alarm System Record of Completion (based on NFPA 72 - 2002) NFPA 72, 2 of 3 2/16/2011 10:06:00 PM R.L. Suckow `b Reprinted with permission from NFPA 72 -2002, National Fire Alarm Code ®, Copyright © 2002, National Fire Protection Association, Quincy, MA, 02269 Overcurrent protection: Type: Current rating: Location (b) Secondary (standby: Storage battery: MAIN PANEL Amp -hour rating: Exsisting System Storage battery: FCPS (2 Fl Elec Rm) Amp -hour rating: 7 Storage battery: Amp -hour rating: Calculated capacity to drive system, in hours: 24+ 10. Comments Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): System deviations from the referenced NFPA standard(s) are: ; L ✓.e-r-� 74 >(- signefor installation contr ctor /supplier (title) 0‘)1/ ate �� ./ R (signed) f. — alarm service company (title) (d -te) (signed) central sta . . (title) (date) Upon completion • : system(s) satisfactory test(s) witnessed (if require ■ A L--_. .,,,\s__ - by the authority having jurisdiction)(: 4 `� 1 / (signed) representative of the authority having jurisdiction (title) l (date) • Fire Alarm System Record of Completion (based on NFPA 72 - 2002) NFPA 72, 3 of 3 2/16/2011 10:06:00 PM R.L. Suckow E S Reprinted with permission from NFPA 72 -2002, National Fire Alarm Code ®, Copyright e 2002, National Fire Protection Association, Quincy, MA, 02269 PS 1010- 00 IS � Fire Alarm System �. Record of Completion Name of property protected: Providence Scholls Ferry MOB suite 101 Address: 12422 SW Scholls Ferry Rd, Tigard, OR 97223 Representative of protected property (name /phone): Authority having jurisdiction: Tigard Address /telephone number: Organization name / phone Representative name / phone Installer: Cochran Electric Supplier: Johnson Controls Service Organization: Johnson Controls, Inc. Location of record (as- built) drawings: FACP Room Location of operation and maintenance manuals: Location of test reports: FACP Room A contract for test and inspection in accordance with NFPA standard(s) Contract No(s): Effective date: Expiration date: System Software (a) Operating system (executive software revision level(s) : (b) Site - specific software revision date: (c) Revision completed by: Steven Beachner Johnson Controls Inc (name) (firm) 1. Type(s) of System or Service XX NFPA 72, Chapter 6 — Local If alarm is transmitted to location(s) off premises, list where received: Metro NFPA 72, Chapter 8 — Central Station Prime contractor: Central station location: Means of transmission of signals from the protected premises to the central station: XX Digital alarm communicator Two -way radio Others Means of transmission of alarms to the public fire service communications center: (a) PUBLIC TELEPHONE (b) System location: 2. Record of System Installation (Fill out after installation is complete and wiring checked for opens, shorts, ground faults, and improper branching, but prior to conducting operational acceptance tests.) This system has been installed in accordance with NFPA standards as shown below, was inspected by Steven Beachner on 1/06/11 , includes the devices shown in 5 and 6, and has been in service since 1/06/11 X NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply) X NFPA 70, National Electrical Code, Article 760 X Manufacturer's instructions Other (specify): Signed: �` Date: 1/06/11 ��� � Organization: Johnson Controls 3. Record of System Operation R Fire Alarm System Record of Completion (based on NFPA 72 - 2002) NFPA 72, 1 of 3 1/11/2011 9:39:00 AM R.L. Suckow ES Reprinted with permission from NFPA 72 -2002, National Fire Alarm Code A, Copyright © 2002, National Fire Protection Association, Quincy, MA, 02269 Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached N/A All operational features and functions of this system were tested by Steven Beachner date 1/06/11 And found to be operating properly in accordance with the requirements of: X NFPA 72, Chapters 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply) X NFPA 70, National Electrical Code, Article 760 X Manufacturer's instructions Other (spe ify): Signed: l Date: 1/06/11 Organization: Johnson Controls 4. Signaling Line Circuits Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1): Quantity: 4 Style: 4 Class: B 5. Alarm Initiating Devices and Circuits Quantity and class of initiating device circuits (see NFPA 72, Table 6.5): Quantity: 1 Style: C Class: B MANUAL (a) Manual stations: Non -coded Transmitters Coded Addressable (b) Combination manual fire alarm and guard's tour coded stations AUTOMATIC Coverage: Complete Partial Selective x Nonrequired (a) Smoke detectors 4 Ion Photo Addressable (b) Duct detectors Ion Photo Addressable (c) Heat detectors FT RR FT /RR RC Addressable (d) Sprinkler waterflow indicators: Transmitters Noncoded Coded Addressable (e) The alarm verification feature is disabled XX or enabled , changed from seconds to seconds. (f) Other (list): Replaced exsisting smoke detectors. 6. Supervisory Signal Initiating Devices and Circuits (use blanks to indicate quantity of devices) SPRINKLER SYSTEM Check if provided (a) Valve supervisory switches (b) Building temperature points (c) Site water temperature points (d) Site water supply level points 7. Annunciator(s) Number: Non Added Type: Location: 8. Alarm Notification Appliances and Circuits NFPA 72, Chapter 6 — Emergency Voice /Alarm Service Quantity of voice /alarm channels: Single: Multiple: Quantity of speakers installed: Quantity of speaker zones: Types and quantities of notification appliance circuits connected to system (see NFPA 72, Table 6.7): Quantity: Style: Y Class: B (a) Bells With Visible (b) Speakers With Visible (c) Horns With Visible 3 (d) Chimes With Visible (e) Others With Visible (f) Visible appliances without audible 8 9. System Power Supplies (a) Fire Alarm Control Panel: Nominal voltage: 24VDC Current rating: 5 Fire Alarm System Record of Completion (based on NFPA 72 - 2002) NFPA 72, 2 of 3 1/11/2011 9:39:00 AM R.L. Suckow Reprinted with permission from NFPA 72 -2002, National Fire Alarm Code ®, Copyright © 2002, National Fire Protection Association, Quincy, MA, 02269 Overcurrent protection: Type: Current rating: Location (b) Secondary (standby: Storage battery: MAIN PANEL Amp -hour rating: Exsisting System Storage battery: FCPS (2 Fl Elec Rm) Amp -hour rating: 7 Storage battery: Amp -hour rating: Calculated capacity to drive system, in hours: 24+ 10. Comments Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): System deviations from the referenced NFPA standard(s) are: l`B6 (signed) for insta{ ation ctor /supplier (title) (date) --% dip d�� S ..S`7c - 't P / oC l/ (signed - : alarm service company (title) (dat- (signed) central station (title) (date) Upon comp lion of the syst m(s) satisfactory test(s) witnessed (if required by the authority having jurisdiction): (signed) representative of the authority having jurisdiction (title) (date) • Fire Alarm System Record of Completion (based on NFPA 72 - 2002) NFPA 72, 3 of 3 1/11/2011 9:39:00 AM R.L. Suckow Reprinted with permission from NFPA 72 -2002, National Fire Alarm Code ®, Copyright © 2002, National Fire Protection Association, Quincy, MA, 02269