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Hamburger Harry NFPA 72 - 6-26-19.pdfSYSTEM 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: 6/26/2019 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Hamburger Harry's / Gravity Address: 605 5th Ave. S. Edmonds, WA 98020 Description of property: Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Security Solutions NW Address: 22121 17th Ave. SE Suite 223, Bothell, WA 98021 Phone: 360-734-4940 Fax: E-mail: Service organization: N/A Address: Phone: Fax: E-mail: Testing organization: N/A Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Guradian Security Address: 1743 1 st Ave S., Seattle, WA 98134 Phone: 206-323-2400 Fax: E-mail: Account number: 75770255 Phone line 1: Phone line 2: Means of transmission: AES Radio Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION On -site location of the required record documents and site -specific software: FACP 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ® New system ❑ Modification to existing system Permit number: NFPA 72 edition: 4.1 Control Unit Manufacturer: Silent Knight Model number: 6808 4.2 Software and Firmware Firmware revision number: N/A 4.3 Alarm Verification ® This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for 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. (p. 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: 120VAC Overcurrent protection: Type: Fused Branch circuit disconnecting means location: Suite E panel Control panel amps: 5 Amps: 20 Number: Breaker #21 5.1.2 Secondary Power Type of secondary power: Battery Location, if remote from the plant: FACP 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 1 B 2hr Device Power Initiating Device Notification Appliance 1 B 2hr Other (specify): 7. REMOTE ANNUNCIATORS Type Location 8. INITIATING DEVICES Type Quantity Addressable or Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 1 A A Switch Smoke Detectors 10 A A Photo Duct Smoke Detectors 0 Heat Detectors 0 Gas Detectors 0 Waterflow Switches 1 C A Kitchen Hood Tamper Switches 0 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 Visible Combination Audible and Visible 10 horn strobes 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold -Open Door Releasing Devices NA HVAC Shutdown NA Fire/Smoke Dampers NA Door Unlocking NA Elevator Recall NA Elevator Shunt Trip NA 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: Cameron Sipos Printed name: Cameron Sipos Date: Organization: Security Solutions NW Title: Technician Phone: 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Cameron Sipos Printed name: Cameron Sipos Organization: Security Solutions NW Title: Technician 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: 6-26-19 7:30am Nelson Electric Solutions 6-26-2019 Zan 71A _noon Date: 6-26-2019 Phone: 360-734-4940 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. 3 of 3)