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Report (3) -r-Nd95 2O) , --- cDn/2, ( FIRE ALARM SYSTEM RECORD OF COMPLETION Name of protected property: Regal Cinemas Bridgeport Village Address: 7329 SW Bridgeport Road 97224 Representative of protected property(name/phone): Joe Atchley 503-968-7675 gm652 ac regalcinemas.com Authority having jurisdiction: City of Tigard CD Address/telephone number: 13125 SW Hall Blvd. 97223 Organization name/phone Representative name/phone Installer: Performance Systems/503-641-2222 Jason Wells 503-713-3689 Supplier: PSI Service organization: PSI Location of record(as-built)drawings: FACP doc box Location of operation and maintenance manuals: FACP doc box Location of test reports: FACP doc box A contract for test and inspection in accordance with NFPA standard(s) 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) (firm) 1.Type(s)of System or Service ❑ NFPA 72,Capter 6 and 8-Unmonitored Protected Premises If alarm is transmitted to location(s)off premises, list where received: • NFPA 72,Chapter 8-Central Station Telephone numbers of the organization receiving alarm: Alarm: EM24 800-877-3624 Supervisory: EM24 800-877-3624 Trouble: EM24 800-877-3624 ❑ NFPA 72,Chapter 8-Proprietary Telephone numbers of the organization receiving alarm: Alarm: Supervisory: Trouble: If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone Location: Phone: Location: Phone: Location: Phone: PF&R 300.91B 01/14 dh Fire Alarm Record of Completion Page 1 of 4 Means of transmission of signals from the protected premises 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: (a) (b) System location: ❑ NFPA 72,Chapter 9—Auxillajy Indicate 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 improper branching, but prior to conducting operational acceptance tests.) This system has been installed in accordance with the NFPA standards as shown below,was inspected by Jason Wells on 8/22/2019 , includes the devices shown in 5 and 6, and has been in service since 8/22/2019 © NFPA 72, Chapters 1 ❑ 2❑ 3❑ 4❑ 5❑ 6❑ 7❑ 8❑ 9❑ 10❑ 11 ❑ (check all that apply) • NFPA 70, National Electrical/Code,Article 750 • Manufacturer's instructions ❑ Other(specify): Signed: Date: 10/15/2019 Organization: PSI 3.Record of System Operation Documentation in accordance with Inspection Testing Form, Figure 10.6.2.3, is attached All operational features and functions of this system were tested by Jason Wells Date 8/22/2019 and found to be operating properly in accordance with the requirements of: • NFPA 72,Chapters 1 ❑ 2❑ 3❑ 4❑ 5❑ 6❑ 7❑ 8❑ 9❑ 10❑ 11 ❑ (check all that apply) [Z] NFPA 70, National Electrical Code,Article 750 171 Manufacturer's instructions ❑ Other(specify): Signed: Date: 10/15/2019 Organization: PSI 4.Signaling Line Circuits Quantity and class of signaling line circuits connected to system (see NFPA 72, Table 6.6.1). Quantity: 1 Style: Class B Class: Class 3 PF&R 300.918 01/14 dh Fire Alarm Record of Completion Page 2 of 4 5.Alarm-Initiating Devices and Circuits Quantity and class of initiating device circuits(see NFPA 72, Table 6.5): Quantity: Style: Class: MANUAL (a)Manual stations: Non-coded Transmitters Code Addressable (b)Combination Manual fire alarm and guard's tour coded stations AUTOMATIC Coverage: Complete Partial Selective Nonrequired (a)Smoke detectors Ion Photo 9 Addressable 9 (b)Duct detectors Ion Photo Addressable (c)Heat detectors FT RR FT/RR RC Addressable (d)Sprinkler waterfiow indicators:Transmitters Noncoded Coded Addressable (e)The alarm verification feature is❑disabled ❑enabled,change from seconds to seconds (f)Other(list): 6.Supervisory Signal-Initiating Device and Circuits Guard's Tour(indicate quantity of devices) (a) Coded stations (b) Noncoded stations (c) Compulsory guard's tour system comprised of transmitter stations and intermediate stations Note: Combination devices are recorded under 5(b), Manual,and 6(a), Guard's Tour. Sprinkler System (a) ❑ Valve supervisory switches (b) ❑ Building temperature points (c) ❑ Site water temperature points (d) ❑ Site water supply level points Electric fire pump (a) ❑ Fire pump power (b) ❑ Fire pump running (c) ❑ Phase reversal Engine-driven fire pump (a) ❑ Selector in auto position (b) ❑ Engine or control panel trouble (c) ❑ 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): PF&R 300.91B 01/14 dh Fire Alarm Record of Completion Page 3 of 4 7.Annunciator(s) Number: Type: Location: 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 or zones: Quantity of telephones or telephone jacks included in system: Quantuty and the dass of notification appliance cir cuits connected to system(NFPA 72, Table 6.7) Quantity: Style: Class: Types and quanties of notification appliances installed: (a)Bells With Visible (b)Speakers With Visible (c)Horns With Visible (d)Chimes With Visible (d)Other With Visible (f) Visible appliances without audible: 9.System Power Supplies (a)Fire Alarm Control Panel: Nominal Voltage: Current Rating: Overcurrent protection: Type: Current rating: Location: (b)Secondary(standby): Storage battery: Amp-hour ratings: Calculated capacity to drive system, in hours: Engine-driven generator dedicated to fire alarm system: Locaton of fuel storage: (c)Emergency system used as backup to primary power supply: Emergency system described in NFPA 70,Article 700: 10.Comments 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: —4I111 , LEA 10/15/2019 (signed)'or install. . contr. for/: pp.er (tine) (date) LEA 10/15/2019 (signed)for.erm servi - c• pa (title) (date) LEA 10/15/2019 (signed)'Or centra station (title) (date) Upon o ,ple f .f the sy••f(s)satisfactory test(s)witnessed(if required by the authority having jurisdiction): 41 C (re Ic' IC ! /� 10/15/2019 (signed re le•- tative of the authority having jurisdiction (title) ! (date) PF&R 300.918 01/14 dh Fire Alarm Record of Completion Page 4 of 4