Report (74) Northwest Fire 'I .� S o w
Suppressions S
Inc.
FIRE ALARM/SUPPRESSION SYSTEM RECORD OF
Protected Premise: COMPLETION
Tigard Apartments Building 7 Owner's Re. &Phone:
13215 SW Hawks Beard St
Tigard, OR.
Permit#FPS2017-00072
This system was designed by, and equipment supplied by:
Northwest Fire Suppression,Inc., 1800 NW 169th
Beaverton, OR 97006 Phone: 503.6447720 Fax Site C 00
1 {s) of System or Service 03 644-8289
Control Unit Manufacturer: Notifier
Other
Model Number:
.-■ Fire Alarm �w'100
u ■�
T�.e of Communication: ■� I� Othe S bee
11�I DAC with Cell ■
Monitoring provided$ ; Other S.eci i"s N/A
Alarm Center Inc,
Account Number:
Alarm Code S le:
Phone Line 1 Number:
Phone Line 2 Number:
11111111111111111111111111111111111111111111111111111. .11 —11111111111111 1111111111111
2 System Power Su lies
(a)Fire Alarm Control Panel:
Nominal Volta:e: 120VAC
Breaker Location: Cutxent Rating: 20 Am s
(b) Secondary(standby):
Sealed Lead Acid Batteries 8 AH Provid' ::
Soft24 Hours Of Backu
3_Systemware
Panel Firmware Rev#:
A.•lication Software: PS-Tools
Rev Completed By: Name
Corn'any
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4. Notification Devices
Quantity Device Type
1 Bells
Horns
Horn/Strobes
Strobes
Speakers
Annunciators
Other(Specify)
5.Initiating Devices
Quantity Device Type
1 Fire Alarm Pullstations
Suppression Manual Release Station
Ion Detectors
Photo Detectors
Duct Detectors I Type:
Heat Detectors
2 Waterflow Switches/Pressure Switches
Abort Switches
2 Tamper Switches
1 Low Air Switches
1 High Air Switches
Other(Specify)
6. Record of System Installation
This system has been installed in accordance with the National Electric Code, and
meets all requirements of Article 760 as a Power Limited Fire Alarm system.
After all device installation was complete (except control equipment final
terminations), all initiation, signal and control circuit wiring was tested and found to
be free of opens, shorts and ground faults.
The entire system was installed per the AHJ approved plans, and complete, accurate
"as built"notations have been provided to Northwest Fire Suppression,Inc.
Installing Contractor: 4-er6 e el 1e-
Responsible Journeyman: Er,'C '� ',4 y License#: Ter/*7 3
Signature: Date:
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h A..
7. Record of System Operation
All operational functions and features of this system were tested and found to be
working properly in accordance with the approved plans,per NFPA 70,National
Electric Code, Article 760,per NFPA 72, Chapters 1, 3, 4, 5, 6 and 7,and per the
manufacturer's instructions.
I have reviewed the"as built"drawings and find that they are accurate and complete.
Certifying Contractor: Northwest Fire Suppression Inc.
Responsible Journeyman: Kevin Hood License#: 4751LEA
Signature: //
Date:
ck 6/6h'7
8. Acceptance Testing Statements
Commissioning Technician:
I have tested and witnessed satisfactory performance of all system devices and control
functions, and/or have noted any exceptions on this Record of Completion.
Name: 14e_v Ho ej _ Representing: N {'�a rs
Signature: '
SDate:__--e__ - C. ,' 6W/ 7
Local Authority(or Authorities)Having Jurisdiction:
This system has been inspected and is accepted for the jurisdiction I represent.
Name: Representing:
Signature: Date:
9. Comments
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Contractor's Material and Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work,inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative.
All defects shall be corrected and system left in service before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and
contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material,
poor workmanship,or failure to comply with approving authority's requirements or local ordinances.
PROPERTY NAME: . di *'Mem Is S @ lacth A- SG v LIS -7
PROPERTY ADDRESS: '. S }{p t-z--5 + A,d 54. .ry.ed 17605 DATE: is.31•17
ACCEPTED BY APPROVING AUTHORITIES(NAMES)/;\ _ _ p 4.;�� J�
PLANS ir� aT ,,p �J
ADDRESS 131p6 5� (' (3`2 d. "r;�D•t IDk Q& Gfl 3
INSTALLATION CONFORMS TO ACCEPTED PLANS V YES 0 NO
EQUIPMENT USED IS APPROVED IES 0 NO
IF NO,EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS PES 0 NO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
IF NO,EXPLAIN
INSTRUCTIONS
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES?
1.SYSTEM COMPONENTS INSTRUCTIONS YES 0 NO
2.CARE AND MAINTENANCE INSTRUCTIONS YES 0 NO
3.NFPA 25 YES ❑NO
LOCATION SUPPLIES BUILDINGS A l( -
OF SYSTEM
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SIZE
QUANTITY RATING
12.a‘tinbLe_ lit.A r64 a-otI ( " a ty�.
SPRINKLERS ti__, COQ C' Kai
3 ' " t i .
Zito:
' a t
vu.�l.0 W7yo a-0I-7 t j a 30`l 15°°.
PIPE AND TYPE OF PIPE C."P.V.c. I $ 1 b d- 4 0 A
FITTINGS TYPE OF FITTINGS C..Q.u,C I d- 0-.co O-l
ALARM MAXIMUM TIME TO OPERATE
ALARM DEVICE THROUGH TEST CONNECTION
VALVE
OR FLOW TYPE MAKF. MODEL MIN
INDICATOR SEC
X00 Sys , o7r 0 (D--
DRY VALVE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODELI SERIAL NO.
ViC.�l*$ L I WY/lb(
TIME TO TRIP TIME WATER ALARM
THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
DRY PIPE CONECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PROPERLY
OPERATING MIN SEC PSI PSI PSI MIN SEC YES NO
TEST WITHOUT Q U
O.O.D. O t 3 u / 1 (0 "I O a? )(
WITH
O.O.D.
IF NO,EXPLAIN
DELUGE OPERATION 0 PNEUMATIC 0 ELECTRIC 0 HYDRALIC
PREACTION SUPERVISED 0 YES 0 NO DETECTING MEDIA SUPERVISED 0 YES IF •
VALVES
DOES VALVE OP FROM THE MANUAL TRIP,REMOTE,OR BOTH IT 0 NO
CONTROL STATIONS
IS THERE AN ACCESSIBLE FACILITY IN E' I'CUIT -,EEXPLAIN
FOR TESTING 0 YES 0 NO
DO - - CIRCUIT OPERATE DOES I'CULT MAXIMUM TIME TO
MAKE MOD •'ERVISION LOSS ALARM? OPERATE VAL ' ASE OPERATE RELEASE
YES NO YES i NI MIN SEC
Page 1 of 2 �..
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w
LOCAT
SETTING STATIC PRESSURE REM FLOW RATE
PRESSURE &FLOOR MODEL (FLOWING)
REDUCINGINLET(PSI)(OUTLET(PSI) FLOW(GPM)
VALVE TEST IL
—
..r
HYDROSTATIC: i,drostatic tests shall be made at not less than 200 PSI(13.6 bars)for 2 hours or 50 PSI(3.4 bars)
TEST ..• - ' . ire in excess of 150 PSI(10.2 bars)for 2 hours. Differential dry-pipe valve clappers shall be left
DESCRIPTION open during the test to prevent damage. All aboveground leakage shall be stopped.
PNEUMATIC:Establish 40 PSI(2.7 bars)air pressure and measure drop,which shall not exceed 11/2 PSI(0.1 bars)
In 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop,which shall
not exceed 1' PSI(0.1 bars)in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT SI BARS FOR _ IRSI IF NO,STATE REASON
DRY PIPING PNEUMATICALLY TESTED YES 0 NO
EQUIPMENT OPERATES PROPERLY 0 YES 0 NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,
SODIUM SILICATE OR DERIVITIVES OF SODIUM SILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS
WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?
rit YES ❑ NO
R RESIDUAL PRESSURE ��
TESTS DRAIN SUPPLY TEST COF AGE NNEII�,; TE SR( BARS) CONNECTION OPEN WIDE 1. SI(VE�ST IN
BARS)
7 '—_
UNDERGROUND MAINS AND LEAD — ')NS TO SYSTEM RISERS FLUSHED BEFORE
CONNECTION MADE TO SPRINKLE(____
VERIFIED BY COPY OF THE U FORM NO.85B $ YES 0 NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER- sh YES 0 NO
GROUND SPRINKLER PIPING 110
IF POWDER-DRIVEN FASTENERS ARE USED IN 0 YES 0 NO IF NO,EXPLAIN
CONCRETE,HAS REPRESENTATIVE SAMPLE
TESTING BEEN SATISFACTORILY COMPLETED? NUMBER REMOVED
BLANK TESTING NUMBER USED I LOCATIONS
GASKETS
WELDED PIPING V.YES ❑'NO
IF YES....
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING yr YES 0 NO
PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST
AWS D10.9,LEVEL AR-3?
WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS A YES 0 NO
QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST
AWS D10.9,LEVEL AR-3?
• DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE
WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE �y 0ES NO
THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE
SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,
AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED?
• CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO til YES 0 NO
(DISCS) ENSURE THAT ALL CUTOUTS(DISCS)ARE RETRIEVED?
HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN
DATA g], YES ❑ NO
NAMEPLATE
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN
REMARKS
43'31.-1.1
NAME OF SPRINKL R CO CTOR
TEST DATE
WITNESSED FO ROPER ER(SIG.ED) TITLE DATE y'
BY ..41, 1
'' I KLE t • TRACTO .IGNED) TITLE DATE
-r�n,W‘o•v\i 6 wfilc+f `$ '61- 17
ADDITIONAL EXPLAN• ire NOT1
4 4307
�aiiir 1
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