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Report Fire Alarm System O Record of Completion stio “\c>5(:). crud S� Name of Protected Property: Ti and Recovery Center Address: 10362 SW McDonald Street Representative of Protected Property(Name/Phone) Authority Having Jurisdiction: City Of Tigard Address/Telephone Number: 13125 SW Hall Boulevard Ti.and OR 97123 Organization Name/Phone Representative Name/Phone Installer: Steele Electric 503 268-1311 R an Reiber 503 268-1311 Supplier: DTS S stems 503-643-3127 Drexel White 503-643-3127 Service Organization: DTS S stems 503-643-3127 Scott Aut 503-799-0619 Location of Record (As-Built) Drawings. Document Box/ DTS Systems Inc. Location of Operation &Maintenance Manual(s). Document Box/ DTS Systems, Inc. Location of Test Reports: Document Box/ DTS Systems,Inc. A Contract for Test&Inspection in Accordance with NFPA standards: Contract No(s): Effective Date: Expiration Date System Software: a.Operating system(executive)software revision level(s): b. Site-Specific software revision date: c. Revision completed by: ,,,,,,, Name Fir 1.Type(s)of System or Service: NFPA 72, Chapter 6- Local If alarm is transmitted to location(s) off premises, list where received: NFPA 72, Chapter 8 - Remote Station: Telephone numbers of the organization receiving alarm: Alarm: Trouble: Supervisory: if alarms are transmitted to public fire service communications centers or others, indicate location and telephone numbers of the organization receiving alarm Indicate how alarm is transmitted NFPA 72, Chapter 8 - Proprietary: Telephone numbers of the organization receiving alarm: Alarm: Trouble: Supervisory: if alarms are transmitted to public fire service communications centers or others, indicate location and telephone numbers of the organization receiving alarm Indicate how alarm is transmitted X NFPA 72, Chapter 8 - Central Station: Prime Contractor: Metro Central Station Location: Estacada Means of transmission of signals from protected premises to the central station: McCulloh Two-Way Radio © Digital Alarm Communicator LLI One-Way Radio III Multiplex Others Means of transmission to the public fire service communications center: a. b. System Location: NFPA 72, Chapter 9-Auxilliary: Type of connection: Local energy Shunt Parallel telephone Location of telephone number for receipt of signals: 2. Record of System Installation: (Fill out after installation is complete and wiring is checked for opens, shorts,ground faults,and improl branching, but prior to conducting operational acceptance tests). This system has been installed in accordance with the NFPA standards as shown below, was inspected Drexel White on, 8/4/2017 , includes the devices shown in 5 and 6, and has been in service since A-4- . X NFPA 72,Chapters: 1 2 3 4 5 6 7 9 10 11 (circle all that apply) X NFPA 70, National Electrical Code,Article 760 X Manufacturer's Instructions. Other(s,ecify): 1 Signed: Date: 8/4/2017 Organization: DTS Systems 3. Record of System Operation: Documentation in accordance with Inspection Testing Form, is attached , All operational features and functions of this system were tested by Drexel White Date:8/4/2017 and found to be operating properly in accordance with the requirements of: X NFPA 72, Chapters: 1 2 3 4 5 6 7 8 9 10 11 (circle all that apply) X NFPA 70, National Electrical Code, Article 760 X Manufacturer's Instructions. Other pecify): Signed: Date: g4—/ Organization: TS Systems 4. Signaling Line Circuits: Quantity and class of signaling line circuits connected to system( see NFPA 72,Table 6.6.1): Quantity: 1 Style: 4 Class: s 5.Alarm Initiating Devices&Circuits: Quantity and class of Initiating Device circuits ( see NFPA 72,Table 6.5): Quantity: Style: Class: Manual (a) Manual Stations Noncoded Transmitters Coded Addressable 1 (b) Combination manual fire alarm&guard's tour coded stations: Automatic Coverage: Complete X Partial Selective Nonrequired (a) Smoke Detectors: Ionization Photelectric Addressable 20 (b) Duct Detectors: Ionization Photelectric Addressable (c) Heat Detectors: FT RR RC Coded Addressable 2 (d) Sprinkler Waterflow indicators: Coded Noncoded 1 Transmitters Addressable (d) The alarm verification feature is disabled X or enabled ,changed from seconds to seconds. (f) Other(list) 6. Supervisory Signal-initiating devices&circuits(use blanks to indicate device quantity) Guard's Tour (a) Coded Stations (b) Noncoded Stations (c) Compulsory guard's tour system comprised of transmitter stations&intermediate stations. Note:Combination devices are recorded under 5(b), Manual,and 6(a),Guard's Tour. Sprinkler System Check if provided (a) 1 Valve supervisory switches (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 a) Fire pump running Engine-Driven Generator (a) Selector in auto position (b) Control panel trouble (c) transfer switches (d) Engine running Other supervisory function(s)(specify): 7.Annunciators Number: 1 Type: LCD Location: Entry 100 8.Alarm Notification Appliances and Circuits NFPA 72, Chapter 6-Emergency Voice/Alarm Service Quantity of voice/alarm channels Single Multiple Quantity of speakers installed Quantity of speaker zones Quantity of telephones or telephonejacks included in system Quantity and the class of notification appliance circuits connected to system(see NFPA 72,Table 6.7): Quantity 4 Style Y Class B Types&Quantities of Notification Appliances Installed: (a)Bells with visible (b)Speakers with visible (c)Horns with visible 9 (d)Chimes with visible (e)Other (11) Low Frequency Sounders with visible (f)Visible appliances without audible 6 9.System Power Supplies (a)Fire Alarm Control Panel: Nominal Voltage: 120vac Current Rating 1r 3,5 Overcurrent Protection Type Breaker Current Rating 20 Location: House Panel Breaker (b)Secondary(standby) Storage Battery 2 Amp-hour rating 8 Calculated capacity to drive system, in hours 24 Engine driven generator dedicated to fire alarm system: Location of fuel storage: (c) Emergency system used as backup to primary power supply: Emergency system desribed in NFPA 70,Article 700 10. Comments Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): none System Deviations from the referenced NFPA standard(s)are: none (signed)for installation contractor/supplier Title (date) (signed)f.'alar ice company Title (date) (signed)for central station Title (date) Upon completion of the system(s)satisfactory test(s)witnessed(if required by the Authority Having Jurisdiction): (sighed)representative of the Authority Having Jurisdiction Title (date)