2022 Annual FLS Testing Report Cottage 2475.pdf
PDF 205 KB Posted
- Solicitation number
- S-44300-00005148
- Issued by
- Union County, Oregon
About this file
This document is an NFPA 72 report for the fire protection system at the Oregon Health Authority's Pendleton Cottage 75 facility. The report details the inspection and testing of the fire alarm control panel, notification appliances, initiating devices, and related system components conducted by Siemens Industry, Inc. on September 20, 2022. All equipment was found to be functioning properly, with no deficiencies or impairments identified.
The related state and local contract opportunity is an RFP issued by the Oregon State Hospital to contract with a qualified firm to perform fire protection system maintenance upgrades at three buildings located at 2585 Westgate in Pendleton, Oregon. The project scope involves replacing detection devices and system equipment with like-for-like components to bring the current fire protection system up to code. The contract will be awarded to serve the Umatilla County jurisdiction.
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Text version
NFPA 72 REPORT
© Siemens Industry, Inc., Smart Infrastructure Division, 2009-2022. All rights reserved.
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 1 of 7
SYSTEM RECORD OF INSPECTION AND TESTING
System Name: OHA PENDLETON SYSTEM 3 Cottage 75 Panel Name: 01 - System 3 Cottage 75
Inspection/Test Start Date/Time: 20 Sep 2022 0700 Inspection/Test Completion Date/Time: 20 Sep 2022 1500
Contract Info: OR1P-FIS-OSH Pendleton (2600114256) Notification Number: 5102303440
Supplemental Form(s) Attached: Yes
1. PROPERTY INFORMATION
Name of property: Oregon Health Authority 2585 Westgate (4433-97801-00014)
Address: 2585 Westgate Pendleton Or. 97801 Cottage 75
Description of property:
Name of property representative: OREGON HEALTH AUTHORITY (30581098), None
Address: 2585 WESTGATE, PENDLETON, OR 97801
Phone: None Fax: None E-mail: None
2. TESTING AND MONITORING INFORMATION
Testing organization: SIEMENS
Address: 9755 SW Barnes Rd, Suite 205, Portland, OR 97225
Phone: 503 207 1900 Fax: 503 207 1901 E-mail: NA
Monitoring organization: Moon Security 541-276-0295
Address: NA
Phone: 541-276-0295 Fax: NA E-mail: NA
Account number: 2585 Phone line 1: NA Phone line 2: NA
Means of transmission: Parallel Phone
Entity to which alarms are retransmitted: NA Phone: NA
3. DOCUMENTATION
On-site location of the required record documents and site-specific software: NA
4. DESCRIPTION OF SYSTEM OR SERVICE
4.1 Control Unit
System Name: OHA PENDLETON SYSTEM 3 Cottage 75 Panel Name: 01 - System 3 Cottage 75
Panel Location and Address: Fire Panel Room, Cottage 75 2585 Westgate, Pendleton Or. 97801
Manufacturer: Siemens Model number: System 3
4.2 Software and Firmware
Firmware revision number: NA
4.3 System Power
4.3.1 Primary (Main) Power
Nominal voltage: 120v Amps: 20a Location: Fire Panel Room
Overcurrent protection type: Breaker Amps: 20a
Disconnecting means location: House Panel
4.3.2 Secondary Power
Type: Storage Battery Location: Fire Panel Room
Battery type (if applicable): Sealed Lead Acid Manufactured Date: 01 Sep 2022
Calculated capacity of batteries to drive the system:
In standby mode (hours): 24 In alarm mode (minutes): 5
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 2 of 7
4.4 Notification Appliance Power Extender Panels
4.4.1 Primary Power
ID Location Input Volts
Panel Amps
Over-current Type
Over-current Amps
Primary Supply Location Disconnect Location
01:Bldg 75 FACP Room 120v Breaker House Panel
4.4.2 Secondary Power
ID Location Battery Type
Manufactured Date
Voltage Rating
Amp Rating
Standby Hours
Alarm Minutes
01:Bldg 75 FACP Room SLA Sep 1 2021 8ah 24 5
5. NOTIFICATIONS MADE PRIOR TO TESTING
Monitoring organization Contact: Moon Security 541-276-0295 Time: 0700
Building management Contact: NA Time: NA
Building occupants Contact: Aaron Williams 541-310-0103 Time: 0700
Authority having jurisdiction (AHJ) Contact: NA Time: NA
Other, if required Contact: NA Time: NA
6. TESTING RESULTS
6.1 Control Unit and Related Equipment
Description Visual Inspection or Functional Test Comments
Control unit Functional None
Disconnect switches Functional None
Fuses Functional None
Ground-fault monitoring Functional None
Interface Equipment Functional None
Lamps/LEDs/LCDs Functional None
Local annunciator Functional n/a
Primary Power Functional None
Remote annunciators Functional N/A
Remote power panels Functional N/A
Supervision Functional None
Trouble signals Functional None
6.2 Secondary Power
Description Visual Inspection or Functional Test Comments
Battery condition Functional None
Charger test Functional None
Discharge test Functional None
Load voltage Functional None
Remote panel batteries Functional N/A
6.3 Notification Appliance Power Extender Panels Secondary Power
ID Location Battery Voltage
Battery Amps
Test Method
Pass/ Fail
01:Bldg 75 FACP Room Functional Pass
6.4 Alarm and Supervisory Alarm Initiating Device
Attach supplementary device test sheets for all initiating devices.
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 3 of 7
6.5 Notification Appliances
Attach supplementary appliance test sheets for all notification appliances.
6.6 Interface Equipment
Attach supplementary interface component test sheets for all interface components.
6.7 Supervising Station Monitoring
Description Received Time / Elapsed
Time Pass/Fail Comments
Alarm signal Yes NA / NA Pass None
Alarm restoration Yes NA / NA Pass None
Trouble signal Yes NA / NA Pass None
Trouble restoration Yes NA / NA Pass None
Supervisory signal Yes NA / NA Pass None
Supervisory restoration Yes NA / NA Pass None
6.8 Public Emergency Alarm Reporting System
Description Yes No Time Comments
Alarm signal NA NA
Alarm restoration NA NA
Trouble signal NA NA
Trouble restoration NA NA
Supervisory signal NA NA
Supervisory restoration NA NA
7. NOTIFICATIONS THAT TESTING IS COMPLETE
Monitoring organization Contact: Moon Security 541-276-0295 Time: 1500
Building management Contact: NA Time: NA
Building occupants Contact: Aaron Williams 541-310-0103 Time: 1500
Authority having jurisdiction (AHJ) Contact: NA Time: NA
Other, if required Contact: NA Time: NA
8. SYSTEM RESTORED TO NORMAL OPERATION
Date: 20 Sep 2022 Time: 1500
9. CERTIFICATION
This Testing Was Performed in Accordance with Applicable NFPA Standards.
Signed: Jason Carpenter Nicet # 141882 Date: 09/20/2022
Printed name: Jason Carpenter Title: Technician License No.: Nicet # 141882
Organization: SIEMENS Phone: 503 207 1900
Qualifications (refer to NFPA 72, Section 10.5.3): Inspection, Testing, Service, Programming
10. SUMMARY OF EQUIPMENT MARKED AS FAILED WHEN INSPECTED OR TESTED
11. ACCEPTANCE BY OWNER OR OWNER’S REPRESENTATIVE
The undersigned accepted the test report for the system as specified herein:
Signed: Printed name: Aaron Williams 541-310-0103 Date:
Organization: OREGON HEALTH AUTHORITY (30581098) Phone: None
Pursuant to applicable codes and standards, the owner or designated representative is responsible for proper maintenance and care of the system(s) identified in this report. During the site inspection, if Siemens has identified code deficiencies or impairments, Siemens will recommend certain corrective actions contained in this report. In the event the
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 4 of 7 owner fails to correct such deficiencies or impairments within the required time period per the code, Siemens may be required to report such deficiencies or impairments to the Local AHJ or Fire Marshall per regulatory requirements.
Customer shall hold Siemens harmless and releases Siemens of any and all liability due to Customer’s failure to correct such deficiencies or impairments.
12. OTHER
12.1 Special Procedures
Sensitivity test performed on all smoke detectors. Pass.
12.2 Comments
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 5 of 7
NOTIFICATION APPLIANCE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING
1. PROPERTY INFORMATION
Name of property: Oregon Health Authority 2585 Westgate (4433-97801-00014)
Address: 2585 Westgate Pendleton Or. 97801 Cottage 75
2. NOTIFICATION APPLIANCE TEST RESULTS
2.1 Notification Appliances Equipment Summary by Type
Total Qty
ALL
Functionally Tested Qty
ALL
Functionally Tested %
100%
Visually Tested
Qty
Visually Tested %
Failed Qty
Failed %
0%
Device or System Type
Horn / Strobes
2.2 Notification Appliances Testing Results by Type
See main System Record of Inspection and Testing for additional information, certifications, and approvals.
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 6 of 7
INITIATING DEVICE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING
1. PROPERTY INFORMATION
Name of property: Oregon Health Authority 2585 Westgate (4433-97801-00014)
Address: 2585 Westgate Pendleton Or. 97801 Cottage 75
2. INITIATING DEVICE TEST RESULTS
2.1 Initiating Devices Equipment Summary by Type
Total Qty Functionally Tested Qty
Functionally Tested %
Visually Tested
Qty
Visually Tested %
Failed Qty Failed % Device or System Type
1 1 100% 0 0% 0 0% Control Valve Switches
23 23 100% 0 0% 0 0% System Smoke Detectors (P)
1 1 100% 0 0% 0 0% Waterflow Devices
2.2 Initiating Devices Testing Results by Type
Control Valve Switches
Row Date Dev.# Location Visual/ Functional
Pass/
1 12/30/22 01-100-028 TAMPER COTTAGE 75 Functional Pass
System Smoke Detectors (P)
Functional
Pass/ Fail
1 12/30/22 01-100-001 ENTRY PULL STATION COTTAGE 75 Functional Pass
2 12/30/22 01-100-002 LIVING ROOM SMOKE COTTAGE 75 Functional Pass
3 12/30/22 01-100-003 DINING ROOM SMOKE COTTAGE 75 Functional Pass
4 12/30/22 01-100-004 DINING ROOM HEAT COTTAGE 75 Functional Pass
5 12/30/22 01-100-005 WEST HALL SMOKE COTTAGE 75 Functional Pass
6 12/30/22 01-100-006 WEST HALL PULL STATION COTTAGE 75 Functional Pass
7 12/30/22 01-100-007 WEST WING BEDROOM SMOKE COTTAGE 75 Functional Pass
8 12/30/22 01-100-008 WEST WING BEDROOM SMOKE COTTAGE 75 Functional Pass
9 12/30/22 01-100-009 WEST WING BEDROOM SMOKE COTTAGE 75 Functional Pass
10 12/30/22 01-100-010 WEST WING BEDROOM SMOKE COTTAGE 75 Functional Pass
11 12/30/22 01-100-011 WEST HALL SMOKE COTTAGE 75 Functional Pass
12 12/30/22 01-100-012 NORTH HALL PULL STATION COTTAGE 75 Functional Pass
13 12/30/22 01-100-013 KITCHEN HEAT COTTAGE 75 Functional Pass
14 12/30/22 01-100-014 FURNACE ROOM HEAT COTTAGE 75 Functional Pass
15 12/30/22 01-100-015 MIDDLE HALL PULL STATION COTTAGE 75 Functional Pass
16 12/30/22 01-100-016 HALL BY FACP SMOKE COTTAGE 75 Functional Pass
17 12/30/22 01-100-017 MAIN HALL SMOKE COTTAGE 75 Functional Pass
18 12/30/22 01-100-018 MAIN HALL SMOKE COTTAGE 75 Functional Pass
19 12/30/22 01-100-019 MIDDLE HALL PULL STATION COTTAGE 75 Functional Pass
20 12/30/22 01-100-020 N.E. WING BEDROOM SMOKE COTTAGE 75 Functional Pass
21 12/30/22 01-100-024 N.E. WING BEDROOM SMOKE COTTAGE 75 Functional Pass
22 12/30/22 01-100-025 N.E. WING BEDROOM SMOKE COTTAGE 75 Functional Pass
23 12/30/22 01-100-026 N.E. WING BEDROOM SMOKE COTTAGE 75 Functional Pass
Waterflow Devices
Functional
Pass/
1 12/30/22 01-100-027 WATER FLOW COTTAGE 75 Functional Pass
This report was created by TechAdvance+™, a service of Siemens Industry, Inc. Page 7 of 7
See main System Record of Inspection and Testing for additional information, certifications, and approvals.
File details come from the government source that posted it. Updated .