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Report
SYSTEM RECORD OF COMPLETION(continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible l 4.1/ Combination Audible and Visible 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers N /4 Door Unlocking Elevator Recall Elevator Shunt Trip 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: �/ -Z .-- Printed name: '11) r v, Date: / 1.3 /1 -7 Organization: ?o i r o n i t Title: ? . .ti,'c ' Phone: 7—d t 6 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: 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.