Report SYSTEM RECORD OF COMPLETION
This form is to be completed by the system installation contractor at the time of system acceptance and approval.
It shall be permitted to modem 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: 11-13-19 Supplemental Pages Attached: 0
1. PROPERTY INFORMATION
Name of property: Bridgeport Center
—Jr Address: 7632 SW Durham Rd,Suite300
Description of property: Commercial low rise
Name of property representative:
Address:
Phone: Fax: E-mail:
2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION
Installation contractor: Point Monitor
Address: 5863 Lakeview Blvd
Phone: 503-627-0100 Fax: E-mail:
Service organization: Unchanged
Address:
Phone: Fax: E-mail:
Testing organization: Point Monitor
Address:
Phone: Fax: E-mail:
Effective date for test and inspection contract: Unchanged
Monitoring organization: Unchanged
Address:
Phone: Fax: E-mail:
Account number: Unchanged Phone line 1: Phone line 2:
Means of transmission: Unchanged
Entity to which alarms are retransmitted: Phone:
3. DOCUMENTATION
On-site location of the required record documents and site-specific software: Building Engineer
4. DESCRIPTION OF SYSTEM OR SERVICE
This is a: ❑New system ®Modification to existing system Permit number: FPS2019-00129
NFPA 72 edition: 2019
4.1 Control Unit
Manufacturer: FCI Model number:
4.2 Software and Firmware
Firmware revision number: Unchanged
4.3 Alarm Verification ®This system does not incorporate alarm verification.
Number of devices subject to alarm verification: Alarm verification set for seconds
Copyrights 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.
s
SYSTEM RECORD OF COMPLETION (continued)
5. SYSTEM POWER
5.1 Control Unit
5.1.1 Primary Power
Input voltage of control panel: 120 VAC Control panel amps: 8
Overcurrent protection: Type: Breaker Amps: 20
Branch circuit disconnecting means location: Number:
5.1.2 Secondary Power
Type of secondary power: Battery
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 2 B 0
Other(specify):
7. REMOTE ANNUNCIATORS
Type Location
Unchanged
8. INITIATING DEVICES
Addressable or
Type Quantity Conventional Alarm or Supervisory Sensing Technology
Manual Pull Stations Unchanged
Smoke Detectors Unchanged
Duct Smoke Detectors Unchanged
Heat Detectors Unchanged
Gas Detectors Unchanged
Waterflow Switches Unchanged
Tamper Switches Unchanged
Copyrights 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 5 Strobes
Combination Audible and Visible 11 Horn Strobes
10. SYSTEM CONTROL FUNCTIONS
Type Quantity
Hold-Open Door Releasing Devices Unchanged
HVAC Shutdown Unchanged
Fire/Smoke Dampers Unchanged
Door Unlocking Unchanged
Elevator Recall Unchanged
Elevator Shunt Trip Unchanged
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 specified herein has been installed according to all NFPA standards cited herein.
Signed: Printed name: Brian Date: 11-13-19
Organization: Point Monitor Title: Tech Phone:
12.2 System Operational Test
This system as specified herein has tested according to all NFPA standards cited herein.
Signed: Printed name: Brian Date: 11-13-19
Organization: Point Monitor Title: Tech Phone:
12.3 Acceptance Test
Date and time of acceptance test:
Installing contractor representative:
Testing contractor representative:
Property representative: •AHJ representative: +-�j I'/(c�. ' 4 C-; I t- L Ie//� !9
Copyright n 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.