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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 modify 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: 12/16/2019 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: BiAmp-Cascade Address: 10575 Sw Cascade Ave#100 Beaverton,OR Description of property: Manufacturing Name of property representative: Icon Owner Pool 3 West LLC by Indoor Properties Address: 2 North Riverside Plaza#235 Chicago, IL 60606 Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Point Monitor Corp Address: 5863 Lakeview Blvd Phone: 503-627-0100 Fax: 503-627-0110 E-mail: benbreit@pointmonitor.com Service organization: Address: Phone: Fax: E-mail: Testing organization: Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: 4jes- 'EQ0 ^'vs- Address: l3$ L(Q Gigs 5't Svc 15 000 CrVI Phone: 5p%-(j,S 1 -6155 Fax: E-mail: Account number: P O9 ' out& Phone line 1: Phone line 2: Means of transmission: Ge LL Entity to which alarms are retransmitted: VjtSZE'.Fl '4 0 1.•Y 1 0(Z 1 oi(T Phone: t 7 -3 - 9151 3. DOCUMENTATION On-site location of the required record documents and site-specific FA�p software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system ®Modification to existing system Permit number: FPS2019-00128 NFPA 72 edition: 2019 4.1 Control Unit Manufacturer: Silent Knight Model number: 5808 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: 0 Alarm verification set for 0 seconds Copyright©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. ip 1 of 3) SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120V Control panel amps: 3.25 Overcurrent protection: Type: Fuse Amps: 20 Branch circuit disconnecting means location: Number: LV 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 X B Other(specify): 7. REMOTE ANNUNCIATORS Type Location 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations Smoke Detectors Duct Smoke Detectors Heat Detectors Gas Detectors Waterfiow Switches Tamper Switches Copyright©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. (p 2 of 3) SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible 0 Visible 0 Combination Audible and Visible 10-Existing Ceiling Mount 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices 0 HVAC Shutdown 0 Fire/Smoke Dampers 0 Door Unlocking 0 Elevator Recall 0 Elevator Shunt Trip 0 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 ecified herei as been installed according to all NFPA standards cited herein. Signed: _ ,,,..- Printed name: Jeremy Speer Date: 12/16/2019 Organiz on/ Pint Monitor Title: Technician Phone: 503-997-8200 12.2 System Operational Test This system as ecified herei as tested according to all NFPA standards cited herein. Signed: Printed name: Jeremy Speer Date: 12/16/2019 Organiz on P int onitor Title: Technician Phone: 503-997-8200 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: Copyright 02012 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. (p. 3 of 3)