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HomeMy WebLinkAbout21-1540 nil nil City Of ZephyrhillS PERMIT NUMBER rr 5335 Eighth Street Zephyrhills, FL 33542 FIRE-001540-2021 Phone: (813)780-0020 Fax: (813)780-0021 Issue Date: 02/24/2021 Permit Type: Fire Property Number Street Address 35 25 21 0010 10500 0000 7050 Gall Boulevard Owner Information Permit Information Contractor Information Name: ADVENTIST HEALTH Permit Type:Fire Contractor:APG ELECTRIC INC. SYSTEM/SUNBELT INC Class of Work:Fire Alarm Address: 7050 Gall Blvd Building Valuation:$20,000.00 ZEPHYRHILLS,FL 33541-1347 Electrical Valuation: / Phone: (813)788-0411 Mechanical Valuation: f G Plumbing Valuation: ( 1 Total Valuation:$20,000.00 Total Fees:$150.00 4 � Amount Paid:$150.00 Date Paid:2/24/2021 3:28:53PM Project Description INSTALLATION FIRE ALARM-ADVENT HEALTH Application Fees Fire Alarm System Plan Review $50.00 System Acceptance Inspection $50.00 Fire Alarm Permit Fee(1-25) $50.00 REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c)the local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or first reinspection,whichever is greater,for each subsequent reinspection. Notice: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permit required from other governmental entities such as water management, state agencies or federal agencies. "Warning to owner: Your failure to record a notice of commencement may result in your paying twice for improvements to your property. If you intend to obtain financing,consult with your lender or an attorney before recording your notice of commencement." Complete Plans,Specifications add fee Must Accompany Application.All work shall be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. r r I J CONTFrC OR SIGNATURE PE IT OFFICE i PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER ACORQ : :. DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE: 12/07/2020 THIS.CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS.UPON THE CERTIFICATE HOLDER:THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND-ORALTERTHE COVERAGE AFFORDED BY:THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE.DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE;OR PRODUCER,AND THE;CERTIFICATE HOLDER..: IMPORTANT- If the certificate holder is an ADDITIONAL INSURED,the policy(ies)'must have ADDITIONAL INSURED provisions or.4e endorsed. If SUBROGATION IS WAIVED;subject to the terms and conditions of the. olic J p y,certain policies may require an endorsement. A statement on this.certificate does not confer rights to the certificate holder In lieu of such endorsement(s). . PRODUCER CONTACT Mia Bush .. ... NAME: Brown,&Brown of Florida,Inc. PHONE (813)226-1337 (FAXAIC No -(813)226-1313• P.O.Boz:1.73086 .. A RIESS: mbush@bbtampa:com .. INSURERS)AFFORDING COVERAGE NAIC# Tampa FL 33672. :. rNsuRERA: Amerisure Insurance Company .19488 INSURED INSURER B: Amerisure Mutual Insurance Company :" 23396 ' APG Electric,Inc. INSURER c 4825:140th Ave N INSURER D: INSURER E Clearwater a FL 33762 INsuRERF: .. . COVERAGES CERTIFICATE NUMBER: 2021 Contractor Licensing REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.-NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION:OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED.OR MAY PERTAIN,THE,INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN.IS SUBJECT TO ALL THE TERMS,. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL5UBK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE" INSD WVD POLICY NUMBER- MM/DD MM/DD - - LIMITS' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ X 1,000,000 G o 1,000,000 CLAIMS-MADE .�OCCUR PREMISES Ea occurrence $ MED EXP(Anyone person) 1.: $ 10,000 A GL20662281101 01/01/2021 01/01/2022 :PERSONAL SADVINJURY $.1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: - GENERAL AGGREGATE $ 2,000,000 POLICY ❑X ECT 7 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: .. .. .. $ AUTOMOBILE LUIBILITY COMBINED SINGLE LIMIT. $,1,000,000. - Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED CA20662261101 01/01/2021 "01/01/2022. .BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ Personal Injury Protection $ 10,000 - X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000" A EXCESS LIAB CLAIMS-MADE CU20662291101 01/01/2021 01/01/2022 AGGREGATE $ 10,000,000 DED I X1 RETENTION$ O $ WORKERS COMPENSATION PER OTH- X STATUTE ER AND EMPLOYERS',LWBILITY Y/N' ANY PROPRIETOR/PARTNER/EXECUTIVE 1 000,000: A OFFICER/MEMBEREXCLUDED?. '� N/A WC2066230-12 01/01/2021 01/01/2022 E:L.EACHACCIDENT $: � (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes;describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT .$ Installation : Jobsite 2,000,000.- B CPP2066227.1302 0.1/01/2021 . 01/01/2022 Occurrence -10,000,000: DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) License Number.EC0000486 Certificate holder is a General Liability additional insured when required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF.THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Zephyrhills ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 5335 8th Street AUTHORIZED REPRESENTATIVE Zephy'rhills FL 35540 = ©1988-2016 ACORD CORPORATION: All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 813-780-0020 City of Zephyrhills Fire Fax-813-780-01021 Permit Application Date Received MAVPhone Contact for Permit Owner's Name A )57t S ty J vh b� �H Owner's Phone Numb er /3 `� Q /f �. Owners Address `76Sp Fee Simple Titleholder Name Titleholder Phone Nt)Mbbr . Fee Simple Titleholder Add�ss -re .. Job Address /6SQ 29Pa111R 1lZ'_1s . . Lot# Sub Division Parcel# 35' c��7 07/ QO/Q ;l6S� &LILJ Bla)iaz$rdNaste Storage-ANNUAL Fumigation Tent. Comm Exhaust Kitcheh HoodlDuct Hazardous Material(Tier it or RQ Facility)ANNUAL Controlled Bum R Hood Installation ❑ Emergency Generator<30 kw LR/Natural Gas-Iristallatior Emergency Generator>30 K*w ❑ LP/Natural Gas-ANNUAL Sale ❑ Fire Protection Maintenance-ANNUAL ❑ Places of Assembly-ANNUAL ® WeR man] Sprinkler ❑ ❑ ❑ ❑ ❑ Recreational oum 910 Fire Alarm ❑ ❑ ❑. ❑ ❑ ❑ Sparklers Hood Cleaning ❑ ❑ ❑ ❑ Sprinkler System Installations �� H ' ��/ Hood ression ❑ ❑ ❑ ❑ Standpipes(Sprinkler,Sys) ) I& Mrs Alarm Installation ❑ Torch Roofingrrar Kettle ❑ Fire u ❑ Waste Tire Storage.ANNUAL Flammable Application-ANNUAL CY,G Valuation Of Project Fuel Tanks Other: Contractor Company Signature Registered Y,/N . Fee Current aY IN Address License# ELECTRICIAN Company /�. Signature Registered N _ Fee Current > IN- Address 9v75 / w, G it FL-- Y$76j. . License# I �. PLUMBER Company Signature Registered Y/N Fee Current Y/N Address License# MECHANICAL Company Signature Registered Y/N' Fee Current Y/N Address License# OTHER Company Signature Registered Y/N Fee Current Address License# Directions: • Fill out application corePletely. Owner&Contractor sign back of.application,notarized(Or,copy,of signed contract with owner) If over$2500,a Notice of Commencement is required(Mechanical work over$50001, Supply two(2)sets of drawings with applicable documentation Allow 10-14 days for.review after submittal"date. _ Parcel#-obtained from Property Tax Notice(http://appraiser.pascagov.com) NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to°deed°restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable geed restrictions. 0 CONTRACTOR$ AND CONTRACTOR(RESPONSIBiL(TIES: If the owner has hired a contractor or contractors to undertake work, they may be required'to be licensed in accordance with state and local"regulations. ff the contractor is not licensed as required bylaw, both the owner and contractor may be cited fora.misdemeanor violation undor state law. if the owner or intended contractor are uneertain as #o what iicensing requirements may apply for.the intended work,they are advised to contact the Pasco Colunty Building Inspection Division—Licensing secttdn at 727-847- 80u9. F6.Metlnore, If the owner has Hired a Contractor or contractors, he is advised to have the c6ntractorts) sign portions of the "contractor Block' of this.application for which they will be responsible. If you,'as the ownef sigri'as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County._ CO3?NSTRUCTION LIEN LAW(Chapter 713,Fiortda-Statutes,as amended): If valuation of work is.$2,50000 or more, I certify that I, the applicant; have_ been provided with a copy of tlae "Florida Construction"Lien_law=Homeowner's Protection Guide° prepared by the Florida Department of Agriculture and Consumer Affairs. if the applicant is someone other than the"owner°, I certify#hat:l Have aptained a copy of the above described document and promise in good faith to deliver it to the owner'prior to commericemo t. CONTRACTOR'51011VER'S AFJDAVIT: I certify that all the information in this application is accurate and that all work will be 'done in:cprrtpliance with all applicable laws regulating eons<tnaction, zoning and land development. Application is herebytimade to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to isSuanoe.Of a permit and that all wdrk'wiil be performed to meet standards of all"laws .regulating construction, County'Antl City,codes, zoning regulations, and land development regulations in the jurisdiction: I also certify that I understand that the regulatiions of other government agencies may apply to the intended work,and that it is my iosponsibility to idei5tify what actions I must take.to be in compliance. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter,or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall become invalid unless the work auihoriized by such.permit is oorrimenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a,period'of six(6)-months after:the.time the work is..commenc+ed. An extension maybe requested;"in writing,from the Building Official for a period not to exceed ninety(90) days and will demonstrate justifiable cause for the extension. If work ceases'for ninety(90)consecutive days,the job is considered abandoned. WARNING TO.OWNER: YOUR FAILURE TO RECORD.A NOTICE.OF CO..MMI NCfMENT MAY RESULT IN YOUR PAYING TWICE`FOR IMPRQVMENTS TO YOUR PRORrfi;TY. iF YOU INTEND TO 08TAiN€1t�ANCING,CONSULT WITH YOUR iLENDER.OR AN•:ATTORNEY BEFORE.RECORDING YOUR NOTICE OF COMMF-NOEMENT. FLPRIDA JURAT(F.S.117.03) oWNJER OR AGENT. CONTRACTOR JAn1 C S S L)44cjl2 Subscribed and sworn to(or affirmed)-before me this Subscribed and sworn to(or affirmed)before me this by 2-11612-1�-by Nn_cy,S. Who is/are personally known to me or has/have'produced Who isW /are personal ivlcno to me or has/have produced as identification, as identification. Notary Public Notary Public Commission No. mnin s on No.�-� C14�1�3 t0 �raca nrinrr+.n$o Name of Notary typed,printed or stamped Name o-fNotary typed,printed or stamped tp�► SARACOCHRANE MY COMMISSION#HH 047636 �`` EXPIRES:January 2 .29 026 BOMed ThN Notary Public Un/er 0,.rs ELECTRIC _ENGINEERING TEC LIFE SAFETY HNOLOGv LIFE:SAFETY- SECURITY February 16,2021 City of Zephyrhills Plans Examiner. City.of Zephyrhills Building Department 5335 8tn Street Zephyrhills, FL 33542 _ Re: Advent Health Zephyrhills Kitchen Renovations Phase I 7050 Gall Blvd. _. Ze;phyrhills, FL 33541: Permit-Fire-001178-20.20 To whom it may concern; This submission reflects the changes in the fire alarm scope for the Advent Health Zephyrhills Hospital Renovation for.Kitchen & Dietary Area, Phase I, Permit# FIRE-001178-2020 Due to the Hospital's budget restraints for this phase,the scope has been modified to add only the followin One:(1) addressable:smoke detector, One (1) addressable Pull Station to the existing Fire System'sSLC circuit. Three (3)Visual,and one (1) Audio Visual•devices to the Fire.Alarm System's existing circuits. The other devices that are not currently being.installed were to set the.infrastructure for additional phases that have now been put on hold indefinitely._ Please.see attached drawings with mark-ups. Contact me with any questions or concerns:., james.sutton@apg.company 727-482-6062 Thank you,. James Sutton. Life Safety Project Manager Contractors EC0000486 I Engineers CA5947 1 4825 140th Avenue North I Clearwater, Florida 33762 1 T 727.530.0077 IF 727L30.0045 I www,apg.corripany ELECTRIC. ' ENGINEERING . TECHNOLOGY LIFE SAFETY'. SECURITY February 3, 2021 City of Zephry"hills 5335 81h St toot "- Zephryhills, FL 33540. ,, RE: ELECTRICAL PERMITS . The,fallowing pers ons.are hereby authorized"to take out.electrical permits under the name APG Electric, lnc: PCCLB #I-EC0000486 h State License #EC0000486 " Bruce Lyle Pete Hynema.n. James Sutton Sara;Cachrane Brian Worley . Elizabeth Herman. SherryTew Eric Brockmeier Meoi Plummer Erick Sheppard Joseph Rimes : . Clarice Frye Please remove all other: names from our listing. Until further-notification,these people are the only personnel authorized,to perform the above referenced actions on behalf of APG Electric, Inc. -This-letter supercedes all previously submitted letters regarding personnel authorized to perform the above mentioned functions. o n R. Kavula Chairman and CEO. . State Certified#EC0000486 STATE OF FLORIDA COUNTY OF PINELLAS Subscribed and sworn before me on 3rd - day of February, 2021. $RITTNEY O'8FilEN Notary Public" t ,= �� Sulk-AtAte of Finr. • '8 Commissvon N GG 974434 nixta.� My Commissian"Expires" October 14, 2022 Contractors EC0000486 I Engineers CA5947 1 4825 140th Avenue North.1.Clearwater, Florida 33762. 1 T 727.530.0077 1 F 727,530.0045 t wmapg,co.mpany Wit City o Zephyrililis . R PERIUIIT.t UMBE 5336Ir!§hth Street :.. . Zephyrhi�ls, FC.33542 ---FIRE- I Phone. (I313)780-0g21)> (� Usire Date-'02143t2021_' ? Fak!,(813).78 0021,. --. Permit,T e.,Fire est Address �.� �r s ,:r•,%rty.. _ _ •,� .,, _ -- - r 35 25 21 0010 10500 0000 7050 Gall Boulevard] ` . . I lnfairiti�litii C.critractormInformation Cwnertforrattow ' a R �• ' Nsrne; ADVJrNTIST�hiEALTN' ! Perrttli Type; {te Contractor:APG ELECTRIC INC. SYSTEMISUNBELT INC .Gass of Work:Fire-AlaFm ' Address: 7050 GO Blvd, i B81ldfixl,Vahi6tlon:320.000,00 ' ZEPHYRHiLLS}FL 3.3541-1347 Etectrieal Valuation. Phone. i813)788-041.1 i Mechanical Valuation: P-luntbJng Valuation: ; r •Total Valuation:520,000 i}0 Total Gees:S200.00 Amount Paid:S200.6D, Date Paid:21a1ZQ21 <8-26,03AM Project Description r REPLACEMENT FIRE ALARM,FOR DIETARY AREAL&SERVING- - - App1ieation;Fees - .." " „<..,... y; u . 'F Fire Alarm Pei6ilt F66(1-25)- - r_.. 550.007 Ire Alarm Permlt•Fee(1-25) SyQ0:40' .- S9stem,Acceptarice,ln5pection• S50.00. REINSPECTION FEES:(c),Wiih respe046o Relitspectioii fees will comply.;with,Florida.,Sfatute,553:8p(2)(c)the: •Iccal governrt Brit shall impose a fee offourtimes the amount bf thbifee inlposedffor the initial inspeiitionior first reI&pectibn;Whichever is•greater,for each subsequent,reinspection. Notice:In.additidh to the,rouirdni6hts,of thi; p&mit;there may`06 additid6al resttictiahs applicable to this property.that. ..., relay be`found ry..the public.466eds of-thi's cocinty;•aiti =#tieie rrtay be-addittor ai permit required.from tithe governmental eritities'sucii as water management;state:agencies or,federal`agencies, "Warming to owner: Yotsr'�failure"to teci3rd a;notice of;comtrlencertterit may result`in your paying twice for iovemehtsito,ydur prgperty.-If your 4tend10 6btain:fihancing;consult with your Ierfder or ail attorney: .before recording your,notice oVcammencementY 'Complete Plans, Spedifications add fee Mist Accom0rlly Application.All work shall:lie performed in act orctan-die with City Codes and Ordinances.NO OCCUPANCY:BEFORE C.O; NO OCCUPANCY BEFORE,C.O. r 0.TtTaAcraR S1GNATURi = _ ► tier ' PERMIT EXPIRES IN fi MONTHS WITHOUT APPROVED,INSPECTIQtti ,' ��� `CALL FOR INSPECTION �8HOUR NQ�f DICE`REQUIRED k PROTECT CARD.FROM WEATHER ELECTRIC: :: ENGINEERING . LIFE SAFETY QWA TECHNOLOGY AUTOMATION LIFE SAFETY 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: Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Advent Health.Zephyrhills Address: 7050 Gall Blvd. Ze h rhills FL 33541 ". P Y Hos ital Description of property> P Name of property representative: Address: . . . Phone: Fax: E-mail: 2. INSTALLATION,SERVICE,TESTING,AND MONITORING INFORMATION Installation contractor: APG Electric, Inc. Address: 4825 140th Ave. North,St.Petersburg, FL 33762 Phone: 727-530-0077 Fax: E-mail: :. .. . . Service organization: . Address: Phone: . .. Fax: E-mail:. ... .. .... Testing organization: : APG Electric, Inc. Address: . 4825 140th Ave.North,St. Petersburg, FL 33762: Phone: Fax: E-mail: Effective date for test and inspection contract:. Monitoring organization: Address: Phone: Fax: E-mail: Accountnumber: Phone line 1: = Phone"line 2: -Means of transmission:.. . Entity to which alarms are retransmitted: Phone:. 3. DOCUMENTATION On-site location of.the.required record documents and site-specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system ❑■ Modification to.existing system Permit number: FIRE-001540-2021 Contractors EC0000486 I Engineers CA5947 1 4825 140th Avenue North I Clearwater, Florida 33762 1 T 727.530.0077 1 F 727.530.0045 1 www.apg.company ELECTRIC. ENGINEERING i . LIFE SAFETY TECHNOLOGY AUTOMATION LIFE SAFETY NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: simplex.: .. Model number: 41.00 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: Alarm verification set for seconds 5. SYSTEMP ER 5.1 Control Unit 5.1.1 Primary Power . Input voltage of control panel: Control panel amps: Ovemurrent protection: Type: Amps:. Branch circuit disconnecting means location:. Number: 5.1.2 Secondary Power Type of secondary power: Location,if remote from the plant: Calculated capacity of secondary power to;drive the system: In standby mode(hours): : .. . In alarm mode(minutes): 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 Other(specify): 7. REMOTE ANNUNCIATORS Type Location Contractors EC0000486 I Engineers CA5947 1,4825 140th Avenue North I Clearwater, Florida 33762 1 T 727.530.0077 1 F 727.530.0045 1 www.apg.company . LE TRIG. - ENGINEERING. LIFE SAFETY- TECHNOLOGY AUTOMATION LIFE SAFETY 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology. Manual Pull Stations 1 Addressable Alarm Smoke Detectors ' 1 Addressable Alarm Photo Duct Smoke Detectors Heat Detectors Gas Detectors Waterflow Switches Tamper Switches CO Detectors 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible 3 Strobes Combination Audible and Visible'' 1 Speaker/Strobe 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown. Fire/Smoke Dampers .: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: Printed name: Date: Organization: Title: Phone: 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Date:. Contractors EC0000.486 I Engineers CA5947 1 4825 140th Avenue North I Clearwater, Florida 33762 1 T 727.530.0077 1 F 727.530.0045 1 www.apg.corrpany ELECTRIC.: : . ENGINEE RING G QWA&V� LIFE SAFETY. ::. TECHNOLOGY AUTOMATION LIFE SAFETY Organization: Title: Phone: -12.3 Acceptance Test. Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: "Contractors EC0000486 I Engineers CA5947 1 4825 140th Avenue North I Clearwater, Florida 33762 1 T 727.530.0077 1 F 727.530.0045 1 www.apg.company