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Report ps & ôoci FIRE ALARM SYSTEM RECORD OF COMPLETION Name of protected property: B & B Print Source Address: 9040 SW Burnham St. Representative of protected property(name/phone): Gregg Lazoff 503-639-9835 Authority having jurisdiction: Address/telephone number: 1. Type(s)of System or Service ✓ NFPA 72,Chapter 3—Local If alarm is transmitted to location(s)off premises,list where received: Csm NFPA 72,Chapter 3—Emergency Voice/Alarm Service Quantity of voice/alarm channels: Single: Multiple: Quantity of speakers installed: Quantity of speaker zones: Quantity of telephones or telephone jacks included in system: NFPA 72,Chapter 6—Auxillary Indicate type of connection: Local energy Shunt Parallel telephone Location of telephone number for receipt of signals: NFPA 72,Chapter 5—Remote Station Alarm: Supervisory: NFPA 72,Chapter 5—Proprietary If alarms are retransmitted to public fire service communications centers or others,indicate location and telephone numbers of the organization receiving alarm: Indicate how alarm is retransmitted: ✓ NFPA 72,Chapter 5—Central Station Prime contractor: Acton Technology Systems LLC Central station location: Estacada, Oregon Means of transmission of signals from the protected premises to the central station: McCulloh Multiplex One-way radio Digital alarm communicator Two-way radio ✓ Others Means of transmission of alarms to the public fire service communications center: (a) (b) System location: (NFPA Record of Completion 1 of 4) Organization name/phone Representative name/phone Installer Action Technology Systems LLC Paul Haueter 503-231-1992 Supplier Silent Knight 5208 1-888-289-0096 Service organization Action Technology Systems LLC Paul Haueter 503-231-1992 Location of record(as-built)drawings: Document Can Location of owners manuals: Document Can Location of test reports: Document Can A contract,dated N/A ,for test and inspection in accordance with NFPA standard(s) No(s). ,dated ,is in effect. 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 the NFPA standards as shown below,was inspected by Action Technology on 3/11/2014 ,includes the devices shown below,and has been in service since 3/11/2014 ✓ NFPA 72,Chapters 1 2 3 4 5 6 7 (circle all that apply) ✓ NFPA 70,National Electrical Code,Article 760 ✓ Manufacturer's instructions Other(specify): Signed: Date: 3/11/2014 Organization: Action Technology Systems 3. Record of System Operation All operational features and functions of this system were tested by on and found to be operating properly in accordance with the requirements of: ✓ NFPA 72,Chapters 1 2 3 4 5 6 7 (circle all that apply) ✓ NFPA 70,National Electrical Code,Article 760 ✓ Manufacturer's instructions Other(specify): Signed: Date: 3/11/2014 Organization: Action Technology Systems 4. Alarm-Initiating Devices and Circuits Quantity and class of initiating device circuits(see NFPA 72, Table 3-5) Quantity: Style: Class: MANUAL (a) Manual stations Noncoded,activating Transmitters Coded (b) Combination manual fire alarm and guard's tour coded stations AUTOMATIC Coverage: Complete: Partial: (a) Smoke detectors Ion Photo (b) Duct detectors Ion _ Photo (c) Heat detectors FT RR FT/RR RC (NFPA Record of Completion 2 of 4) • (d) Sprinkler waterflow switches: Transmitters Noncoded,activating Coded (e) Other(list): 5. Supervisory Signal-Initiating Devices and Circuits (use blanks to indicate quantity of devices) GUARD'S TOUR (a) Coded stations (b) Noncoded stations,activating transmitters (c) Compulsory guard tour system comprised of transmitter stations and intermediate stations Note: Combination devices are recorded under 4(b)and 5(a). SPRINKLER SYSTEM (a) Coded valve supervisory signaling attachments Value supervisory switches,activating transmitters (b) Building temperature points (c) Site water temperature points (d) Site water supply level points Electric fire pump: (e) Fire pump power (f) Fire pump running (g) Phase reversal Engine-driven fire pump: (h) Selector in auto position (i) Engine or control panel trouble (j) Fire pump running Engine-driven generator: (k) Selector in auto position (1) Control panel trouble (m) Transfer switches (n) Engine running Other supervisory function(s)(specify): 6. Alarm Notification Appliances and Circuits Quantity and class(see NFPA 72,Table 3-7)of notification appliance circuits connected to the system: Types and quantities of notification appliances installed: Quantity: Style: Class: (a) Bells Inch (b) Speakers (c) Horns (d) Chimes (e) Other: (NFPA Record of Completion 3 of 4) (f) 13 Visual signals Type: Horns/Strobes with audible w/o audible (g) Local annunciator 7. Signaling Line Circuits Quantity and class(see NFPA 72, Table 3-6)of signaling line circuits connected to system: Quantity: Style: Class: 8. System Power Supplies (a)Primary(main): Nominal voltage: Current rating: Overcurrent protection: Type: Current rating: Location: (b)Secondary(standby): Storage battery: Amp-hour rating: Calculated capacity to drive system,in hours: 24 60 Engine-driven generator dedicated to fire alarm system: Location of fuel storage: (c)Emergency or standby system used as backup to primary power supply,instead of using a secondary power supply: Emergency system described in NFPA 70,Article 700 Legally required standby system described in NFPA 70,Article 701 Optional standby system described in NFPA 70,Article 702,which also meets the performance requirements of Article 700 or 701 9. System Software (a)Operating system software revision level(s): (b)Application software revision level(s): (c)Revision completed by: (name) (firm) 10. Comments: (signed)for central station or alarm service company or installation contractor/supplier (title) (date) 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: (signed)for central station or alarm service company or installation contractor/supplier (title) (date) Upon completion of the system(s)satisfactory test(s)witnessed(if required by the authority having jurisdiction): (signed)representative of the authority having jurisdiction (title) (date) (NFPA Record of Completion 4 of 4)