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ININ two u 'FS tc7i 3 -0011) 11 Nil 111111 11 11 11 Fire Alarm Record of Completion 8806UE00 Date:425 Na f / 3 Customer#:‘,4 3-01X-.0)Job#: G G$ Primary System#: /flf®Q2d 3? O l b8 Secondary System#: Customer Name: bArajr. P.-e Ts'-, ( (V to S r, Address(City/State/ZIP): f 0 3 j(J rj) j , c-, Representative of Protected Property(Name/Phone): Authority Having Jurisdiction: Telephone#: Location of As-Built Drawings: Li N 5 A4, ( u44 r�. Location of Operation and Maintenance Manuals: o" s•l-e A 4 ( cam-( z„, Location of Inspection&Testing Reports: c r j r c•/s,(, Location of Control Panel: A� (1 r_F{'. c Primary Telephone#: sU 3 - 9 to — 4179'6 Secondary Telephone#: 5t✓3 - 5 y8 — .t/< ) Does Tyco have a contract for testing and inspection in accordance with NFPA standard(s)? Ig Yes ❑ No If no,who?: Inspection Start Date: 4 c- I j Inspection Frequency: IPl Annually ❑ Semiannually ❑ Quarterly• ❑ Bimonthly ❑ Monthly ❑Weekly System Software (a)Operating system(executive)software revision level(s): lD z (b)Site-specific software revision date: /14,64- -Z-O i -S _ (c)Revision completed by: 'r'c ■ F I. (Name) (Company) (Date) 1.Type(s)of System or Service W, NFPA 72,Chapter 8-Tyco Central Monitoring Center Means of transmitting signals from the premises to the central station:(Check all that apply) Pr Digital Alarm Communicator ❑ McCulloh ❑ Multiplex ❑ One-way Radio ❑ Two-way Radio ❑ Other: Means of transmission of alarms to the public fire service communications center: System locations: ❑ NFPA 72,Chapter 6-Local If alarm is transmitted to location(s)off premises,list where received: I k NFPA 72,Chapter 8-Remote Station Telephone numbers of the organization receiving alarms: X( .- 02�q _ ,� / 7 ❑ NFPA 72,Chapter 8-Proprietary Telephone numbers of the organization receiving alarm: ❑ NFPA 72,Chapter 9-Auxiliary Check type of connection: ❑ Local Energy '/ ❑ Shunt ❑ Parallel Telephone Telephone numbers of the organization receiving alarm: V 0 0 ! "' )6117 `l 7 If alarms are retransmitted to a public fire service communications center or other,indicate name and telephone numbers of the organization receiving alarm: Indicate how alarm is retransmitted: 2.Record of System Installation (Complete this section 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 T)S (-7,Hs('f on ,75 No J /' ,includes the devices shown in sections 4&5,and has been in service since )SAJp iJ f 3 This system has been installed in accordance with the standards as shown below: NFPA 72,Chapters 0"1 2'2 a 3 ❑e4 Q'5 0 6 ® 7 0-8 2"9 12/10 E7"11 (Check all that apply) NFPA 70, ''•nal Electrical Code,Article 760 , Manufacturer's Instructions ❑ AHJ or d er Source: t C� / t, igned• 1 jl - Date: //' i / ` • ,Organization: ( ( ' O l> //l7 Ffeprinted with permission from NFPA 72®2002,National Fire Alarm Code®,Copyright©2002,National Fire Protection Association,Quincy,MA 02169. This reprinted material is not the complete and official position of the NFPA on the referenced subject,which is represented only by the standard in its entirety. ©2012 Tyco Integrated Security. All rights reserved.(06/12) (p. 1 of 3) Control Panel taco III, Ill 11.111 III II II Integrated Security Fire Alarm Record of Completion, cont. 8806UE00 3. Record of System Operation Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3,is attached All operational features and functions of this system were tested by ! `/C c- _L c date 0)S $ e✓ / And found to be operating properly in accordance with the requirements of: _2'-NFPA 72,Chapters ❑-1 Ef'2 ,Q"3 p 4 ❑ 5 ❑ 6 ,O 7 ❑ 8 a 9 ❑ 10 a 11 (Check all that apply) NFPA 70,National Electrical Code,Article 760 0 Manufacturer's Instructions ❑ AHJ or OjFter Source: Signed: I Date: /' / • i Organization: C.- 1 - 4. Signaling Line Circuits Quantity and class of signaling line circuits connected to system(see NFPA 72,Table 6.6.1): Quantity Style Class 5. Alarm-Initiating Devices and Circuits Quantity and class of signaling line circuits connected to system(see NFPA 72,Table 6.6.1): Quantity Style Class Manual (a)Manual stations Non-coded Coded Transmitters Addressable (b)Combination manual fire alarm and guard's tour coded stations Automatic Coverage: (Check all that apply) ❑ Complete ❑ Partial ❑ Selective ❑ Non-required Enter quantities and check if the devices are addressable. (a)Smoke detectors Ion Photo ❑ Addressable (b)Duct detectors Ion Photo 0 Addressable (c)Heat detectors FT RR FT/RR RC ❑ Addressable (d)Sprinkler waterflow indicators: Non-coded • Coded Transmitters (Q Addressable (e)The alarm verification feature is ❑ Disabled ❑ Enabled ,changed from seconds to seconds. (f)Other(list): 6. Supervisory Signal-Initiating Devices and Circuits Guards Tour: ❑ (a)Coded stations ❑ (b)Non-coded stations ❑ (c)Compulsory guard's tour system comprised of transmitter stations and intermediate stations. Note: Combination devices are recorded under 5(b),Manual,and 6(a),Guard's Tour. (Check if provided.) Sprinkler System: Electric fire pump: Electric-driven fire pump: Electric-driven generator: B. (a)Valve supervisory switches ❑ (e)Fire pump power ❑ (h)Selector in auto position ❑ (k)Selector in auto position ❑ (b)Building temperature points ❑ (f)Fire pump running ❑ (i)Engine or control panel trouble ❑ (I)Control panel trouble ❑ (c)Site water temperature points ❑ (g)Phase reversal ❑ (j)Fire pump running ❑ (m)Transfer switches ❑ (d)Site water supply level points ❑ (n)Engine running [) Other supervisory function(s)(specify): Reprinted with permission from NFPA 72®2002,National Fire Alarm Code®,Copyright©2002,National Fire Protection Association,Quincy,MA 02169. This reprinted material is not the complete and official position of the NFPA on the referenced subject,which is represented only by the standard in its entirety. ©2012 Tyco Integrated Security. All rights reserved.(06/12) (p.2 of 3) Control Panel f'qCO 111 11 1 II II 11111 11 Integrated Security Fire Alarm Record of Completion, cont. 8806UE00 7. Annunciator(s) Quantity: Type: Location(s): Fr t,rt �_^t r 8. Alarm Notification Appliances and Circuits NFPA 72,Chapter 6—Emergency Voice/Alarm Service Quantity of voice alarm/alarm channels:: Single: Multiple: Quantity of speakers: Quantity of speakers zones: Quantity of telephones or telephone jacks attached to the system: Types and quantities of notification appliances installed: (a)Bells With Visible: (d)Chimes With Visible: (b)Speakers With Visible: (e)Other: With Visible: (c)Horns ,;! " (;j With Visible: ' {0 (f)Visible appliances without audible: 9. System Power Supplies (a)Fire Alarm Control Panel: Nominal voltage: �_-1 U Current rating Z-G' Over-current protection: Type: 7 ,c iG r Current rating .Zi9 A Location: ( -=pi/ (b)Secondary(standby): Storage battery: Amp-hour rating: S' Calculated capacity to drive system, in hours:(24) ) l/ (60) Engine-driven generator dedicated to fire alarm system: Location of fuel storage: (c)Emergency system used as backup to primary power supply: Emergency system described in NFPA 70,Article 700 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 Customer Comments: Customer Name: Signature: Print Name Date Tyco Representative Name: ?1� A t"! i':r;( )Sjjt,J/3 Signature: Print Name Date Upon completion of the system(s)satisfactory test(s)witnessed(if required by the Authority Having Jurisdiction : ? 'AHJ Representative: /I t 1"jfi l C ri I- 1 r 7/i -5 Signature: • Print Name Date Title: -��-, �, c , r,r Z) IC. Telephone#: Reprinted with permission from NFPA 72®2002,National Fire Alarm Code®,Copyright©2002,National Fire Protection Association,Quincy,MA 02169. This reprinted material is not the complete and official position of the NFPA on the referenced subject,which is represented only by the standard in its entirety. ©2012 Tyco Integrated Security. All rights reserved.(06/12) (p.3 of 3) Control Panel 11/-13/2013 x+:46 am Event History Report Page 1 of 3 I CS# H022890188 Dates 11/25/2013 00:00 to 11/25/2013 23:59 Corp Account# All On Test? B Site# All Event Class All Reporting Group All Open/Close? N Affiliation All In Service? B Date Zone Operator Event Description Zone Comment Additional Info User Comment CS# H022890188 Site Name RED LOBSTER 0457 Address 10330 SW GREENBURG RD TIGARD,OR 97223 Alt# 11/25/2013 12:38:08 pm 170E14 CIE144 TR-SENSOR TAMPER OOS zone: 170 11/25/2013 12:38:10 pm 144R14 CIR144 RE-SENSOR TAMPER OOS zone: 170 11/25/2013 12:38:15 pm 170E14 CIE144 TR-SENSOR TAMPER OOS zone: 170 11/25/2013 12:38:17 pm 144R14 CIR144 RE-SENSOR TAMPER OOS zone: 170 11/25/2013 12:38:21 pm 169 7894 FA-FIRE-WATERFLOW SPRINKLER OOS 11/25/2013 12:38:23 pm 169 CIR113 RE-RESTORE WATERFL SPRINKLER OOS 11/25/2013 12:38:28 pm 162 45 FA-FIRE-MANUAL PULL KITCHEN PULL STATIO OOS 11/25/2013 12:38:30 pm 162 CIR115 RE-RESTORE PULL STA KITCHEN PULL STATIO OOS 11/25/2013 12:38:32 pm 162 45 FA-FIRE-MANUAL PULL KITCHEN PULL STATIO OOS 11/25/2013 12:38:37 pm 162 CIR115 RE-RESTORE PULL STA KITCHEN PULL STATIO OOS 11/25/2013 12:38:39 pm 162 45 FA-FIRE-MANUAL PULL KITCHEN PULL STATIO OOS 11/25/2013 12:38:43 pm 162 CIR115 RE-RESTORE PULL STA KITCHEN PULL STATIO OOS 11/25/2013 12:38:45 pm 162 45 FA-FIRE-MANUAL PULL KITCHEN PULL STATIO OOS 11/25/2013 12:38:50 pm 162 CIR115 RE-RESTORE PULL STA KITCHEN PULL STATIO OOS 11/25/2013 12:39:17 pm 162 45 FA-FIRE-MANUAL PULL KITCHEN PULL STATIO OOS 11/25/2013 12:39:21 pm 19 54 FA-FIRE-SMOKE DET RTU#3 DUCT OOS 11/25/2013 12:39:25 pm 18 54 FA-FIRE-SMOKE DET RTU#2 DUCT OOS 11/25/2013 12:39:27 pm 162 CIR115 RE-RESTORE PULL STA KITCHEN PULL STATIO OOS 11/25/2013 12:39:31 pm 19 CIR111 RE-RESTORE SMOKE RTU#3 DUCT OOS 11/25/2013 12:39:35 pm 18 CIR111 RE-RESTORE SMOKE RTU#2 DUCT OOS 11/25/2013 12:39:37 pm E354 CIE354 CF-COMM FAILURE OOS 11/25/2013 12:39:41 pm E354 CIE354 CF-COMM FAILURE OOS 11/25/2013 12:39:44 pm 0E333 CIE333 TR-EXP MODULE FAIL 00S 11/25/2013 12:39:48 pm E308 CIE308 SU-SYSTEM SHUTDOWI 00S 11/25/2013 12:39:50 pm 160 842 TR-FIRE SYS TRBL MUSIC MUTE OOS 11/25/2013 12:39:54 pm 17 842 TR-FIRE SYS TRBL RTU#1 DUCT OOS 11/25/2013 12:39:56 pm 2E322 CIE322 TR-BELL 2 TROUBLE 005 11/25/2013 12:40:00 pm 4E327 CIE327 TR-BELL 4 TROUBLE OOS 11/25/2013 12:40:28 pm 160 CIR380 RE-TROUBLE ON ZONE MUSIC MUTE OOS 11/25/2013 12:40:32 pm 160 842 TR-FIRE SYS TRBL MUSIC MUTE OOS 11/25/2013 12:40:36 pm 160 CIR380 RE-TROUBLE ON ZONE MUSIC MUTE OOS 11/25/2013 12:40:38 pm R352 CIR352 RE-TELCO LN 2 FAULT OOS 11/25/2013 12:40:43 pm 2E322 CIR322 RE-BELL 2 TROUBLE OOS 11/25/2013 12:40:47 pm R354 CIR354 RE-COMM FAILURE OOS 11/25/2013 12:40:49 pm 4E327 CIR327 RE-BELL 4 TROUBLE OOS 11/25/2013 12:40:52 pm 0E333 CIR333 RE-EXP MODULE FAIL OOS 11/25/2013 12:40:56 pm 0E333 CIE333 TR-EXP MODULE FAIL OOS 11/25/2013 12:41:00 pm 0E333 CIR333 RE-EXP MODULE FAIL OOS 11/25/2013 12:41:02 pm R308 CIR308 RE-SYSTEM SHUTDOWI OOS 11/25/2013 12:41:06 pm E308 CIE308 SU-SYSTEM SHUTDOWI OOS ' CS# H022890188 Page 1 of 3 11(26/2013 9:46 am Event History Report Page 2 of 3 CS# H022890188 Dates 11/25/2013 00:00 to 11/25/2013 23:59 Corp Account# All On Test? B Site# All Event Class All Reporting Group All Open/Close? N Affiliation All In Service? B Date Zone Operator Event Description Zone Comment Additional Info User Comment CS# H022890188 Site Name RED LOBSTER 0457 Address 10330 SW GREENBURG RD TIGARD,OR 97223 Alt# 11/25/2013 12:41:08 pm R308 CIR308 RE-SYSTEM SHUTDOWI OOS 11/25/2013 12:41:12 pm E354 CIE354 CF-COMM FAILURE OOS 11/25/2013 12:55:34 pm 1E321 CIE321 TR-BELL 1 TROUBLE OOS 11/25/2013 12:55:36 pm 3E326 CIE326 TR-BELL 3 TROUBLE OOS 11/25/2013 12:55:40 pm 0E333 CIE333 TR-EXP MODULE FAIL OOS 11/25/2013 12:55:42 pm 0E333 CIR333 RE-EXP MODULE FAIL OOS 11/25/2013 12:55:47 pm 1E321 CIR321 RE-BELL 1 TROUBLE OOS 11/25/2013 12:55:51 pm 3E326 CIR326 RE-BELL 3 TROUBLE OOS 11/25/2013 12:56:22 pm 2E322 CIE322 TR-BELL 2 TROUBLE OOS 11/25/2013 12:56:25 pm 4E327 CIE327 TR-BELL 4 TROUBLE OOS 11/25/2013 12:56:27 pm 4E327 CIR327 RE-BELL 4 TROUBLE OOS 11/25/2013 12:56:31 pm 2E322 CIR322 RE-BELL 2 TROUBLE OOS 11/25/2013 12:57:44 pm 17 54 FA-FIRE-SMOKE DET RTU#1 DUCT OOS 11/25/2013 12:59:14 pm 17 CIR111 RE-RESTORE SMOKE RTU#1 DUCT OOS 11/25/2013 1:07:25 pm E308 CIE308 SU-SYSTEM SHUTDOWI OOS 11/25/2013 1:14:14 pm R308 CIR308 RE-SYSTEM SHUTDOWI OOS 11/25/2013 1:20:32 pm 1E321 CIE321 TR-BELL 1 TROUBLE OOS 11/25/2013 1:20:36 pm 3E326 CIE326 TR-BELL 3 TROUBLE OOS 11/25/2013 1:20:38 pm E351 CIE351 CF-TELCO LN 1 FAULT OOS 11/25/2013 1:20:42 pm 1E321 CIR321 RE-BELL 1 TROUBLE OOS 11/25/2013 1:20:45 pm 3E326 CIR326 RE-BELL 3 TROUBLE OOS 11/25/2013 1:22:04 pm R351 CIR351 RE-TELCO LN 1 FAULT OOS 11/25/2013 1:24:43 pm E311 CIE311 LB-MISSING BATTERY OOS 11/25/2013 1:25:59 pm E602 20 IN-TIMER TEST OOS zone:0 11/25/2013 1:32:17 pm E308 CIE308 SU-SYSTEM SHUTDOWI OOS 11/25/2013 1:35:41 pm R308 CIR308 RE-SYSTEM SHUTDOWI 005 11/25/2013 1:38:38 pm E311 CIE311 LB-MISSING BATTERY OOS 11/25/2013 1:39:32 pm R311 CIR311 RE-MISSING BATTERY OOS 11/25/2013 1:50:23 pm 2 842 TR-FIRE SYS TRBL CONTROL OOS 11/25/2013 1:50:47 pm 2 CIR380 RE-TROUBLE ON ZONE CONTROL OOS 11/25/2013 1:53:15 pm 2 54 FA-FIRE-SMOKE DET CONTROL OOS 11/25/2013 1:54:32 pm 162 45 FA-FIRE-MANUAL PULL KITCHEN PULL STATIO OOS 11/25/2013 1:55:11 pm 174 45 FA-FIRE-MANUAL PULL FRONT DOOR OOS 11/25/2013 1:55:42 pm 175 45 FA-FIRE-MANUAL PULL DINING EMER DR OOS 11/25/2013 1:56:59 pm 162 CIR115 RE-RESTORE PULL STA KITCHEN PULL STATIO OOS 11/25/2013 1:57:03 pm 174 CIR115 RE-RESTORE PULL STA FRONT DOOR OOS 11/25/2013 1:57:06 pm 175 CIR115 RE-RESTORE PULL STA DINING EMER DR OOS 11/25/2013 1:57:10 pm 2 CIR111 RE-RESTORE SMOKE CONTROL OOS 11/25/2013 2:09:30 pm 171 40 FA-FIRE ALARM ANSUL ALARM OOS 11/25/2013 2:10:24 pm 171 CIR115 RE-RESTORE PULL STA ANSULALARM OOS CS# H022890188 Page 2 of 3 11426/2013,9:46 am Event History Report Page 3 of 3 CS# H022890188 Dates 11/25/2013 00:00 to 11/25/2013 23:59 Corp Account# All On Test? B Site# All Event Class All Reporting Group All Open/Close? N Affiliation All In Service? B Date Zone Operator Event Description Zone Comment Additional Info User Comment CS# H022890188 Site Name RED LOBSTER 0457 Address 10330 SW GREENBURG RD TIGARD,OR 97223 Alt# 11/25/2013 2:30:18 pm 170E14 CIE144 TR-SENSOR TAMPER OOS zone: 170 11/25/2013 2:30:20 pm 144R14 CIR144 RE-SENSOR TAMPER OOS zone: 170 11/25/2013 2:30:24 pm 170E14 CIE144 TR-SENSOR TAMPER OOS zone: 170 11/25/2013 2:30:26 pm 144R14 CIR144 RE-SENSOR TAMPER OOS zone: 170 11/25/2013 2:36:08 pm E308 CIE308 SU-SYSTEM SHUTDOWI OOS 11/25/2013 2:38:14 pm R308 CIR308 RE-SYSTEM SHUTDOWI OOS 11/25/2013 2:40:15 pm K03 IS OA-In Service In Service 11/25/2013 2:40:29 pm K03 ONTEST OA-Place on Test Cat: 1 Expires: 11/25/2013 15:40:00 All Zones 11/25/2013 2:46:32 pm 171 842 TR-FIRE SYS TRBL ANSUL ALARM 11/25/2013 2:52:11 pm CHTEST OA-Reschedule Test Cat: 1 Expires: 12/05/2013 18:00:00 11/25/2013 3:02:18 pm 171 CIR380 RE-TROUBLE ON ZONE ANSUL ALARM CS# H022890188 Page 3 of 3 11126/2013.9:44 am Event History Report Page 1 of 1 CS# H022890188 Dates 11/25/2013 00:00 to 11/25/2013 23:59 Corp Account# All On Test? B Site# All Event Class All Reporting Group All Open/Close? N Affiliation All In Service? Y Date Zone Operator Event Description Zone Comment Additional Info User Comment CS# H022890188 Site Name RED LOBSTER 0457 Address 10330 SW GREENBURG RD TIGARD, OR 97223 Alt# 11/25/2013 2:40:15 pm K03 IS OA-In Service In Service 11/25/2013 2:40:29 pm K03 ONTEST OA-Place on Test Cat: 1 Expires: 11/25/2013 15:40:00 All Zones 11/25/2013 2:46:32 pm 171 842 TR-FIRE SYS TRBL ANSUL ALARM 11/25/2013 2:52:11 pm CHTEST OA-Reschedule Test Cat: 1 Expires: 12/05/2013 18:00:00 11/25/2013 3:02:18 pm 171 CIR380 RE-TROUBLE ON ZONE ANSUL ALARM CS# H022890188 Page 1 of 1 1