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Report . kr125 ZO)S—ajt- SYSTEM RECORD OF COMPLETION t c �2. v.\ A C This form is to be completed by the system installation contractor at the time of system acceptance and approval. J It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data, or calculations as necessary to provide a complete record. Form Completion Date: 7-19-2018 Supplemental Pages Attached: 0 1. PROPERTY INFORMATION Name of property: Lincoln 3-Sterling Suite 301 TI Address: 10210 SW Greenburg Road,Tigard,OR 97223 Description of property: B-Business Group Name of property representative: Shorenstein Real Estate Services Address: 10220 SW Greenburg Road,Tigard,OR 97223 Phone: Fax: E-mail: 2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: Capitol Electric Address: 11401 NE Marx Steet,Portland,OR 97220 Phone: Fax: E-mail: Service organization: Address: Phone: Fax: E-mail: Testing organization: Johnson Controls Address: 6305 SW Rosewood St Lake Oswego, OR.97035 Phone: 503-683-9000 Fax: 503-675-6521 E-mail: Effective date for test and inspection contract: Monitoring organization: Address: Phone: Fax: E-mail: Account number: Phone line 1: Phone line 2: Means of transmission: Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION On-site location of the required record documents and site-specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: 0 New system 0 Modification to existing system Permit number: NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: Simplex Model number: 41000 4.2 Software and Firmware Firmware revision number: 14.01.07 4.3 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120 Control panel amps: 3 amps Overcurrent protection: Type: Breaker Amps: 20 Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: Location,if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 5.2 Control Unit ❑ This system does not have power extender panels ❑ Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line Device Power Initiating Device Notification Appliance 1 B Other(specify): 7, REMOTE ANNUNCIATORS Type Location 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations - - - - Smoke Detectors - - - - Duct Smoke Detectors - - - - Heat Detectors - - - - Gas Detectors - - - - Waterflow Switches - - - - Tamper Switches - - - - Copyright 0 2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. • SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible - - Visible 10 In Suite 301 Combination Audible and Visible 6 In Suite 301 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices - HVAC Shutdown - Fire/Smoke Dampers - Door Unlocking - Elevator Recall - Elevator Shunt Trip - 11. INTERCONNECTED SYSTEMS ❑ This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specifies herein has been installed according to all NFPA standards cited herein. Signed: 4111, Printed Date: Al , . rt���___' name: V6V1n ti3S151A.v14.- -2,00as Organization: 0.0L-e i to(, ec T G- Title: {&j �` to►v. Phone: ( 3) 3 ft-?Ca/ 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed Ryan Mendoza Date: 7-19-2018 name: Organiz John on Controls Title: Tech Rep Phone: 503-683-9000 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: Copyright 0 2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.