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Report • • • 4 .. . WS Z- 6 III Sc.---- ... . . IrUNDAMENTALB OF.FIREALAI2M SYMMS /J 73 !3 72 e e• !2 I • • • • • • • .pind.,AtARM.SYBTEM pECORCI OF•COMPL•ETION'. To be completed by the system InateflafioA contractor et the time of system acceptance end approval. • .1.•PROTECTEb•PROPERTY INFORMATION • Name of property; ,`'1r°,;2'='f•ti '^ • Address: •.��i�O L•-•"7�7-5•A. ut A) 2'r Gn:- RP.: • 7-0.a r-! z" e-f`t. . -72 2-,7' • Description.ofproperty:. . 5J-e-5 '-0.6, 4"g,y; r Occupancy,type: . . _ .• • . . • . • • . Name ofproperty representative. _, f c� v�� o fdsebrJ �Dit /!G'7°mt •v Address: • Phone: ••'';'� "�'�q_ - Pam . property: J "re mail'Authority having jurlsdictionover this• 6 1 "I"): I Phon e: " A��a �/,f Fe. : . r x ••E•mall: • , 2. FIRE•ALARM SYSTEM INSTALLATION,SERVICE,AND TESTINQ IN ORMATION . • Installation contractor for this equipment: t/R/414/•5k Call • Address: S411/ S'j McLoupaml BcuD, Ppjq OR '97ZOZ. Phone: 5a3 2.,31:i 0303 Fax:' S d 3= 2 O-/o.y.y•' E-majl::$e cc A-sm a vz•4,s.Co.ti Service organization for this equipment;�r"l6R/CAct/ ' rEGit�rT • Address: -5"9// -r e fecomP L/ry BL✓D;. PORrc,4+J) •. 02 • 9720 z Phone: 633•.231- 0303 Pax:•S-b3.. 230 • •` �• 'Oily : ;:•P!•thall:i$RVrCe:.PA•s•►fit-RYtMS.Co/ • Location of as-built drawings:— •O.f' .SIT • Loitaatfon of historical feet reports:6"-S1T4, • Location of system operation aid maintenance manuals: ON' £i7 . A contract for.test and inspection in accordanee•with NITA standards lain efect•aa of . Contracted testing company: . • • Address: • • \ - Fax: Email:•• • Phone: Contract expires: Contract number. :Frequency of routine inspect r.;ir 3.TYPE OF FIRE ALARM'SYSTEM QRISERVICE : ' ' • NFP•A72 Chapter Reference•afSystemTipe: W1/4 P7Eae.s: ro f 8 .• • Name of organisation receiving alarm Signal' ►th'pitons numbers fl/'appllcalifs): ' Alat'm: e//5. CC�rl'/GOM� Phone: /L'� 9Z 8800 DO•- Supervisory: �� , Is.hone• /, Trouble: // Phone: Entity to which alarms are retransmitted: . A 2E '09E'PT,: .phone:• . Method of retransmission of alarms to that organisation or location: 7GEp '�E • .'02007 National Flre Protection Association • NFPA72O t GI 5) •FICT.rnz 4.5.2.1 .Record of Completion. • • I. • • 2007 Edition al• • • • • 1 • • • • • 72-84 • .:•NATIONAL Fin ALUM:C.0.D 2. : • • • 3. TYPE OF FIRE ALARM SYSTEM ORSERVICE(continued): • If Chapter 8,note the means of transmission from.the protected premises to the central station: • Digital alarm communicator ❑ IvlcCulloh .0.Multiplex 0.2-way radio ❑ 1-way radio 0 N/A •If Chapter 9,note the type of connection 0 Local energy. 0.Shunt ❑ N/A. 3.1 System Software • . Operating system(executive)software revision level: • . Site-specific software revision date: Revision completed by: 4.SIGNALING LINE CIRCUITS ' . • Characteristics of signaling line circuits connected to this system(see NFPA 72,Table 6,6,1): Quantity: !�) Style: ' Os Clara; 5.•.ALARM-INITIATING DEVICES AND CIRCUITS • • . • Characteristics of initiating device droplet connected to this system(see NFPA 72•?able ti 5): Quantity: g.. Style:- i9 Class: 23 S.l.Manuel'Initiating Devices • 5.1.1 Manual Pull Stations I! Number of manual pull stations: 2:— • Type of devices: 0 Addressable. 'OtConventional 0 Coded 0 Transmitter 0 N/A-- : .._----• 5.2 Automatic Initiating Devices ( ) N - tv' Y) 6,2.1 Area Smoke Detectors - • Number of smoke detectors; Type of coverage: 0.Complete area *Partial.area : •0-Namequired partial area 0.N/A Type of devices: . ❑ Addressable Atorrientional 0 Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: •0 Ionization• ,Photoelectric • 5,2.2 Duct'Smoke Detectors 1: Number of duct smoke detectors: 0. . Type of coverage: % • . .Type of devices: 0.Addressable ❑ Conventional ❑ Coded 0 Transmitter ❑ N/A • • . Type of smoke detector Sensing technology:. 0 Ionization• 0 Photoelectric 6.2.9 Heat Detectors Number of heat detectors: 7" • Type of coverage: . Q Complete area -,Partial area 0 Nonrequired partial area 0 N/A Type of devices: ❑ Addressable J Conventional .0 Coded 0 Transmitter 0 N/A. 5.2.4 Sprinkler WaterIIowDeteoto;s Number of waterflow detectors: Type of devices ❑ Addressable CI Conventional 0 Coded . 0 Transmitter 0 N/A 5.2.5 Alarm Verification • . ' Number of devices subject to•alarm verification: Alarm verification on this system is: • ❑ Enabled Xpleabled 0 Sat for aeconda • 0 2007 National Fire Protection Association • NFPA72(p.2of5) . FIGURE 4.5.2.1 Continued • . 1.. , • . _ • (Z I 2007 Edition . • • . • • • • • • . - • FUNDAMENTAL40FF1REAIARM•SYSTEMS • • 72-35 •6; SUPERVISORY SIQNAL•INITIAtINGDEVICES.ANDCIRCUITS 6.1 5prinkier.3ystem • Number of valve supervisory switches: Type of devices: ❑ Addressable . ❑ Conventional 0 Coded 0 Transmitter 0 N/A 6, • 2 Fire Pump A,1/4 • .Type.of fire pump:• 0.Electric. '0 Diesel • Type of tire pump supervisory devicesi 0 Addressable 0 Conventional 0.Coded .0 Transmitter ❑ N/A Fire Pump Functions Supervised . 0 Fire pump power 0 Fire pump-running . 0 Fire pump phase reversal 0 Selector switch not in auto ❑ Engine or control panel trouble 0•Low fuel • • Other: 6.3.Engine•Driveri Generator :H/14- • Type of generator supervisory devices; :0 Addressable• .0 Conventional. 0 Coded 0•Transmitter ❑ N/A • ❑ Engine or control panel trouble..: Ol Generator running ❑ Salaam-switch not in auto ❑ Low fuel Other: • 7.•ANNUNCIATORS ,& 49. I' ; 7.1 Annunciator 1 0 Local •0 Remote • • • Type: ❑ Addressable ••Directory 0 Graphic •0 N/A • Location: • 7.2 Annunciator 2 13 Local 0 Remote . Type: 0 Addressable 0 Directory 0 Graphic ' 0 N/A . Location: . 7.3 Annunciator 3 0 Local .0 Remote • Type: ❑ Addressable 0 Directory . 0'Graphic q N/A Location: •8..ALARM NOTIFICATION DEVICES AND CIRCUITS . • 8.1 Emergency Voice Alarm Servlca Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: . i Number•of speaker zones: 8.2 Telephone'Jacks . Number of telephone Jacks installed: a' Number of telephone handaets•stored do site: Type of telephone system installed: 0 Electrically powered 0.Sound powered 0 N/A 8.3 Nonvoice Audible System . Characteristics of notification device alrvults eonnected•IQ this System(see NFPA 72,Table 6.6): Quantity: / Style: . . •W Class: B • • ©2007 National Fire Protection Association NFPA 7?(p.3ofb) FIGURE 4.5.2.1 Continued • • • f 2007 Edillon I<.%} • • • • • • 72-3G' . • NAITpNAL[r1)tEA[gRM CODE • • 8. ALARM NOTIFICATION DEVICES AND.CIRCUITs(continued) • 8.4 Types end Quentitles•of.Nonvolce Notification Appliancoo Installed Bells:_,�_ With visual davits: • ' Chimes: �-- Horne:�_ With visual device: . l device:_ • Visual.devices without audible devices: Bells: With visual device: • �� Other(describe): 9. EMERGENCY CONTROL FUNCTIONS'ACTIVATED • •O Hold=open door releasing devices' ❑ Smoke management or smoke control • Q. Door unlocking ❑ Elevator recall ' 10. SYSTEM POWER SUPPLY ❑ Other • • 10:1 Primary Power • Nominal voltage ZD,✓.AL Overcu rent protection:. TI,pe• G/2GU Am. mps • Location(of primary su 1 �EArA�Ps PP y panelboard); -c rte.i � a d Disconnecting means location:. i, 10.2 Secondary Power • • Location: /04. - Number of standby batteries:____ Type: Nominal voltage:. Current'rating: Location of einer enc Amp.hour rating: g y generator. : ..rd®i} Location of fuel storage: Calculated capacity of seconds ry power tb drive the system In standby mode:: ,2 9 fj/qu In alarm mode: .5M/A/I:47X•S 11..RECORD OF SYSTEM INSTALLATION. • • Fill out after all.installation is complete and Wiring has.been checked for opens,'shorts,ground faults,and improper branching,but before conducting operational acceptance tests. The system has been installed in accordance with•the following.NFPA standards:(Note any or all that apply.) ArNFPA 72 Manufacturer's published instructions ❑ Other(please tspecfi,)ectrical Code,Article 760 • System devintior s•f om referenced l FPA standards: Printed-name: r e-• .1`:/'t'6`ru-- _ > c�,. / • Organization•�/r16/1/C�rV ���/•�/ Date: • Title: �t c iti, Phone: SW'231-63 o_,3 12:'RECORD OF SYSTEM'OPERATION' All operational features•and fuactions•of this system:were.tested by.or in.the presence of the signer shown below,on the date shown below;and were found to be operating properly in accordance with the requirements of: NFPA 72 jif Manufacturer's published ins %NFPA 70,National Electrical Code,Article 760• tractions ❑.Other(please specify): • ❑ Document i accordance-withInpection and Testing Forth(Figure 10.8:2.9)is attached Signed: ./.� ..L. /�7 � C Printed name: RI /��ILL m >..0 Organization:- ,�6GUQ Date: Tate: TIC Phone: 5-03.13/- .303 • m 2007 National Fire Protection Association • NFPA 72(p.4 of 5) FIGURE 4.5.2.1 Continued • Li) 2007 Edition • • • • FUNDAMENTALS OF FIRE ALARM SYSTEMS • 72-37 13. CERTIFICATIONS AND APPROVALS • 13.1 System Installation Contractor This system as_ecifled'hereinhas been installed and tested according to all NFPA standards cited herein. Signed: ,Printed name: A • IC 4 At/1'lee Date: / Organization: 'AMER/C$M ..Sf_G'4R.rl / Title: /CC 41 • Phone: 5U3-23/-d30;3 13.2 System Service Contractor This system as specified herei has been installed,and tested eccording.to.all NFPA standards cited herein. ' Signed: 41.sfe,----,q) Printed name; eic 14 ea.sL.i'r(e Date: ` �! `/ Organization: / 5-6-41/21P Title: Phone: 53-3" Z3/`63 13.3 Central Station • This system as apgIfied here!'will monitored according to all NFPA standards cited herein. Signed: "die' •t Printed name: C� /I. l�tNf/� f �- / Date: Organization:_1790(e/C. '.f_ '17Y Title: 7-e P 6.33'Z3/•O3,3 hone: 13.4 Property Representative • I accept this system as having been installed and tested tolts specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: • 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and epeciflcations,its approved sequence of.operations,and with all NFPA standards cited herein. • Signed: Printed name: Date: • Organization: Title: Phone: • • • ® 2007 National Flre Protection Aesoclallon r , NFPA 72(p:5 015) FIGURE 4.5.2.1 Continued 2007 Edillon cni