Report (21) r .
X A 72, p 4 Cal St
The
NFPPrime ChaContractor:SIEMENSter -Central
INDUationSTRY, INC.
Central Station Location: Dallas Call Center 1-866-552-7823
Means of transmission of signals from the protected premise to the central station:
McCulloh Multiplex One-Way Radio
X Digital Alarm Communicator Two-Way Radio Others
Means of transmission of alarms to the public fire service communications center:
1. Telephone
2.
System Location: 9585 SW WASHINGTON SQUARE DRIVE TIGARD, OR
Organization Name/Phone Representative Name/Phone
Installer Frahler Electric
Supplier SIEMENS INDUSTRY CJ Volesky 503-896-9387
Service Organization SIEMENS INDUSTRY SERVICE DEPT 503-207-1900
Location of Record (As-Built) Drawings:
WASHINGTON SQUARE MALL FACILITIES DEPT
Location of Owners Manuals:
WASHINGTON SQUARE MALL FACILITIES DEPT
Location of Test Reports:
WASHINGTON SQUARE MALL FACILITIES DEPT
A contract, dated for test and inspection in accordance with NFPA standard(s)
No.(s) dated is in effect.
2. Certification of System Installation
This system has been installed in accordance with the NFPA standards as listed below, was
inspected by on , includes the devices
listed below and has been in service since
X NFPA 72, Chapters X4 X5 X6 X7 X 10
X NFPA 70, National Electrical Code, Article 760
X Manufacturer's Instructions
Other(specify):
Signed: Date:
Organization:
Updated: 10/27/2014 Page 2
3. Certification of System Operation
All operational features and functions of this partial system were tested by SAM CORRELL
on 01/09/2014 and found to be operating properly in accordance with the requirements of:
X NFPA 72, Chapters X 4 X 5 X 6 X 7 X 10
X NFPA 70, National Electrical Code, Article 760
X Manufacturer's Instructions
Other(specify):
Signed: Date: 10/28/14
Organization:SIEMENS INDUSTRY, INC.
4. Alarm Initiating Devices and Circuits
MANUAL
a) Manual Stations Noncoded, Activating Transmitters Coded
b) Combination Manual Fire Alarm and Guard's Tour Coded Stations
AUTOMATIC
Coverage: Complete NO Partial YES
a) Smoke Detectors: Ion Photo
b) Duct Detectors: Ion Photo
c) Heat Detectors: FT RR FT/RR RC
d) Sprinkler Water Flow Switches: Noncoded, Activating
Transmitters Coded
e) Other(list):
5. Supervisory Signal Initiating Devices and Circuits
GUARD'S TOUR
a) 0 Coded Stations
b) 0 Noncoded Stations Activating 0 Transmitters
c) 0 Compulsory Guard Tour System Comprised of 0 Transmitter Stations
and 0 Intermediate Stations
Note: Combination devices recorded under 4(b) and 5(a).
SPRINKLER SYSTEM
a) 0 Coded Valve Supervisory Signaling Attachments
Valve Supervisory Switches Activating Transmitters
b) 0 Building Temperature Points
c) 0 Site Water Temperature Points
d) 0 Site Water Supply Level Points
Updated: 10/27/2014
Page 3
( ,
Electric Fire Pump:
e) 0 Fire Pump Power
f) 0 Fire Pump Running
g) 0 Phase Reversal
Engine-Driven Fire Pump:
h) 0 Selector in Auto Position
i) 0 Engine or Control Panel Trouble
j) 0 Fire Pump Running
Engine-Driven Generator:
k) 0 Selector in Auto Position
I) 0 Control Panel Trouble
m) 0 Transfer Switches
n) 0 Engine Running
Other Supervisory Function(s) (specify):
6. Alarm Notification Appliances and Circuits
Quantity of indicating appliance circuits connected to the system:
Types and quantities of alarm indicating appliances installed:
a) 0 Bells Inch
0 Speakers
b) Horns
c) Chimes
d) 0 Other:
e) 4 Visual Signals Type:
3 with audible w/o audible
f) 0 Local Annunciator
7. Signaling Line Circuits:
Quantity and Style of signaling line circuits connected to system:
Quantity: Style:
8. System Power Supplies
a) Primary(Main): Nominal Voltage: 120VAC Current Rating: 20A
Overcurrent Protection: Type: CB Current Rating: 20A
Location:
b) Secondary(Standby):
X Storage Battery: Amp-Hour Rating 8A HR
Calculated capacity to drive system, in hours:
Engine-driven generator dedicated to fire alarm system:
Location of fuel storage:
Updated: 10/27/2014 Page 4
AMMO
c) Emergency or Standby System used as backup to Primary Power Supply, instead of using a
Secondary Power Supply:
0 Emergency System described in NFPA 70, Article 700
0 Legally Required Standby System described in NFPA 70, Article 701
0 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) 10/28/14 Revision Completed by: SAM CORRELL SIEMENS
(name) (firm)
10. Comments:
This project was for the purpose of a remodel space only, it involved the addition of 3 Speaker
Strobes and 1 strobe only devices in the retail area of the space.
PROJECT MANAGER 10/28/2014
(signed)for Alarm Service Company (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: None
_CJ VoLecky PROJECT MANAER 04/17/2014
(signed)for Alarm Service Company (title) (date)
Upon completion of the system(s) satisfactory test(s)witnessed (if required by the authority
having jurisdiction:
04/17/2014
(signed) representative of the authority having jurisdiction (title) (date)
Updated: 10/27/2014
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