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Report (46) FPS Z-e), _ © o i 3 IzFt FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem acceptance and approval. 1. Protected Property Information Name of property: KRONOS Address: 11850 SW 67TH AVE.STE.200 TIGARD OR. 97233 Description of property: OFFICE BLDG. Occupancy type: Name of property representative: PNWP. LLC Address: 6600 SW 105TH AVE.STE. 175 BEAVERTON OR 97008 Phone: 503 Fax: E-mail: Authority having jurisdiction over this property: Phone: Fax: E-mail: 2. Fire Alarm System Installation,Service,and Testing Information Installation contractor for this equipment: ERTELL'S ELECTRIC Address: PO BOX 279 FOREST GROVE OR 97116 Phone: 503-841-4511 Fax: E-mail: Service organization for this equipment: PRO-TECH Address: Phone: Fax: E-mail: Location of as-built drawings: IN PANEL DOOR Location of Historical Test Reports: Location of system operation and maintenance manuals: A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. Type of Fire Alarm System or Service NFPA 72®, Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers(if applicable): Alarm: Phone: Supervisory: Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: NFPA 72 Fig 4.5.2., 1r-, . of 5) i Copyright©2009 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. If Chapter 8,note the means of transmission from the protected premises to the central station: ®Digital alarm communicator 0 McCulloh 0 Multiplex 0 2-way radio 0 1-way radio 0 N/A If Chapter 9,note the type of connection: 0 Local energy 0 Shunt ❑N/A 3.1 System Software Operating system(executive)software revision level: Site-specific software revision date: Revision completed by: 4. Signaling Line Circuits Characteristics of signaling line circuits connected to this system(see NFPA 72%, Table 6.6.1): Quantity: Style: Class: 5. Alarm-Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system(see NFPA 724', Table 6.5): Quantity: Style: Class: 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: 0 Complete area 0 Partial area 0 Nonrequired partial area 0 N/A Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: 0 Addressable ❑Conventional 0 Coded 0 Transmitter ❑N/A Type of smoke detector sensing technology: 0 Ionization 0 Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: 0 Complete area 0 Partial area 0 Nonrequired partial area 0 N/A Type of devices: 0 Addressable 0 Conventional ❑Coded 0 Transmitter 0 N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: 0 Addressable 0 Conventional 0 Coded ❑Transmitter 0 N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is:❑Enabled 0 Disabled 0 Set for seconds 6. Supervisory Signal-Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A Alr-PA 72, F rl. ) L Copyright®2009 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. 6.2 Fire Pump Type of fire pump: 0 Electric ❑Diesel Type of fire pump supervisory devices: 0 Addressable D Conventional 0 Coded 0 Transmitter 0 N/A Fire Pump Functions Supervised ❑Fire pump power ❑Fire pump running ❑Fire pump phase reversal 0 Selector switch not in auto ❑Engine or control panel trouble 0 Low fuel Other: 6.3 Engine-Driven Generator Type of generator supervisory devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A ❑Engine or control panel trouble ❑Generator running 0 Selector switch not in auto 0 Low fuel Other: 7. Annunciators 7.1 Annunciator 1 0 Local ❑Remote Type:o Addressable 0 Directory 0 Graphic ❑N/A Location: 7.2 Annunciator 2 0 Local 0 Remote Type: o Addressable 0 Directory 0 Graphic 0 N/A Location: 7.3 Annunciator 3 0 Local ❑Remote Type:0 Addressable ❑Directory 0 Graphic 0 N/A Location: 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker zones: 8.2 Telephone Jacks Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑Electrically powered ❑Sound powered 0 N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system(see NFPA 724, Table 6.5): Quantity: Style: Class: 8.4es and Quantities of Nonvoice Notification Appliances Installed N� S ��1 5 T`S'P P t tkCA Bells: With visual device: Horns: X With visual device: 8 Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: Other(describe): iVt:PA 72 Flg. 4 5.2 , (i of 5 Copyright 02009 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. 9. Emergency Control Functions Activated ❑Hold-open door releasing devices 0 Smoke management or smoke control ❑Door unlocking 0 Elevator recall 0 Other 10.System Power Supply 10.1 Primary Power Nominal voltage: 120 VAC Amps: 20 Overcurrent protection: Type: BREAKER Amps: 20 Location(of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: PANEL Type: SEALED LEAD Nominal voltage: Current rating: ACID BATT. Number of standby batteries: 2 Amp hour rating: 7 AH EACH Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 24 HRS In alarm mode: 5 MIN 11.Record of System Installation Fill out after all installation is complete and wiring has been checked for opens,shorts,ground faults, and improper branching,but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards:(Note any or all that apply.) NFPA 72t ®NFPA 701',Article 760 ®Manufacturer's published instructions 0 Other(please specify): System deviations from referenced NFPA standards: �.. Signed: Printed nameek\k`�� ate: Organization: Title: "�> Phon : .� 12. Record of System Operation All operational features and functions of this system were tested by or in the presence of the signer shown below,on the date shown below,and were found to be operating properly in accordance with the requirements of: NFPA 728 ®NFPA 701',Article 760 Manufacturer's published instructions 0 Other(please specify): Docu entation in accordance with Inspection and Testing Form(Figure 10.6.2.3 of NFPA 721)is attached Signed: Printed name: Date\ Organization: Title: Phone: NFPA 1:;,,), ` 2 +* 4 5) 13.Certifications and Approvals 13.1 System Installation Contractor This syste s specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Date: 0 2••. \ ,3 Organization: Title: Phone: 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: N/A Date: Organization: Title: Phone: 133 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: N/A Date: Organization: Title: Phone: 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.5 Authority Raving Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications,its approved sequence of operations,and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NF-P4 72, Fig 4 5.2 1 tp 5 of F''l Copyright®2009 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.