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FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION <br /> To be completed by the system installation contractor at the time of systen:acceptance and approval. <br /> It shall be permitted to modify this form as needed to provide a more complete and/or clear record <br /> Insert N/A in all uni�sed lines. <br /> Attach additiona[sheets,data, or calculations as necessary to provide a complete record. <br /> 1. PROPERTY INFORMATION I <br /> ` �/ C���C�L�(_ /r� , � <br /> . Nameofproperty: �G���S fJ <br /> _ .G_�fl��-_------- -- -----.---- <br /> Address: �c.�S..-C�G ---�I�.D.. ...__ZC�Q/L ��___._..�G.--_.�J., !_�_ � --- --_ <br /> , Description of property: " � II <br /> . � <br /> - -- — -- - ... - -._. ._ _...- - --- --,... .. ....._ ---- - -... _ _ _- - _. _......_ <br /> Occupancy type: ---�._�-.�------- -���C - -- --- ---- ---�- -- _- - — -------�--- -- <br /> - - - - <br /> ` I <br /> Name of property representative: _�it2t1�/�4_ _ � _._•' _ ��ST�!/.�T7_ <br /> � - -- - - - - - <br /> - <br /> --- <br /> �.�.� _r�. ..�- - �_�,Q -�+ -- � - � -- -.�-�/��J_ <br /> Address: , <br /> • q 4 <br /> Phone: .�f 7�_u��� !!�Z_ Fax: �C.il1 u!l2 - O l�/.�ai� ...__ ___- ------------- � . I <br /> � , 1�1�'. ....._- ------- <br />' Authority having jurisdiction over this property: __ _ ,!� ��o�/� ���/� <br /> -'7"`-�7,e1_'(r��-�•'�g-- __ --- ..__. �__---- - <br /> Phone: $1� P' `1g� '-QGZ�Fax: ' E-mail. '— <br /> 2. INSTALLATION, SERVICE,AND TESTING CONTRACTOR INFORMATION <br /> Installation contractor for this equipment: , u �� %��r�_ � <br /> --- °'✓1_ - - -- - --- -- - _ _ <br /> Address: � � ��CGC',�- ��7%��J--��' - �-J_.-�G.-�- - <br /> __�`'_�_�o_ ..�-- - - � --- � - <br /> _ �.-- - - <br /> License or certification mber: ,�� f,34���p�__/ <br /> Q ? q - - - - <br /> ' Phone: O IJ ��Q�,Z�C..... Fax: �L��[�. "��03� E-mail. ,��/1�-�---�C:�?Y/r!L�._r._�01!YI <br /> Service organization for this equipment: <br /> �+ � <br /> Address: <br /> License or certification number: <br /> Phone: Fax: E-mail: <br /> A contract for test and inspection in accordance with NFPA standards is in effect as of: <br /> Contracted testing company: <br /> Address: <br /> Phone: Fax: E-mail: <br /> Contract expires: _ Contract number: Frequency of routine inspections: <br /> 3. DESCRIPTION OF SYSTEM OR SERVICE <br /> Fire alarm system(nonvoice) <br /> ❑Fire alarm with in-building fire emergency voice alarm communication system(EVACS) <br /> ❑Mass notification system(MNS) <br /> ❑Combination system,with the following components: <br /> ❑Fire alarm ❑EVACS ❑MNS ❑Two-way,in-building,emergency communication system <br /> ❑Other(specify): <br /> i NFPA 72, Fig. 10 1$.2 1.1 (p. 1 of 12} <br /> Copyright O 2009 Na6onal Fire Protec6on Association.This form may be copied for individual use olher lhan for resale.It may not be copied for commercial sale or distribution. <br /> • _ I <br />