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� � f � FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION - j To be cornpleted by the system irastallation contrnctor at tlae time of system acceptance and approval. � It s{aal!be per-rnitted/o naod�this form as needed to provide a more complete and/or clear recor�d. � Insert N/A in al[z�nused lines. , Attach additional sheets,data, or calculatio�zs as laecessary to pi•ovide a cornplete record. I 1. PROPERTY INFORMATIOfV Nameofproperty: G�'..�=� ' %_..r:�-..��.r;��S—,�.J�?f�:_f—�f�.'�-�� C� i �1. _7_C.� ,- --------------- Address. /2_�� j �4 .Si •�w.4.1,'`!� �-"� 1�.z1.�_,�.__�_ I `��_._ /_�t�..- � L'� / c Descri�ition of property• �%g �_;;,��4� __ _--- _-_-_-_ ---__- --_-__- ,. �1 : OccupancY tYPe� _��.��=-�-�------------ - ., Naine�f property representative: �a'.•`�r f,��-_ �'� c_. ��-:Z.``l. � . ,-- -�.,.. r'.tr_<.c_ L_c..----�--- - �----. ._._. .----�-�-----�----._..__.._..._..----- �' i - Addres's: � �C, �� ' � � - ----- -------- S�— --�'_�-�- -`----�-��---.i �ry��;_'z__//1��',��`:�� . ---._._ W...._. � Phone:' — • -- ` i - , ;°��. • .��'.S �! � Fax. E-ma�l. r�'/r �� °` !�,' c�_ _,_�o_:c�� -�-�4---� =---------�-.5�_.._. __�- ----- -----__ __ ___ ,f.. .c�_=�_�.� .._---u<1.��_ r.-_�.�_ , t Autliori havin 'unsdiction over this ro e '`J` ��C E lCC j'��.' ,h' g J P P rtY' l',� r��_._ 11�^` ��:i^�v,��:�f�._«I_ .._..------------- - � Phone:� �(=�_t,�� _�� Fax. E-mail. ____ ;; � c__� �i J,,�- '----- ---- - - - - - ---- . i --- ----- =� 2. IfVST�LLATION, SERVICE,AND TESTING CONTRACTOR INFORMATION , � Installa'tion contractor for this equipment: ��r�,�Z�;�'�_.�.^_.�;�,r_�a��3.[_Ct._t�_�______—`__ � � ------ -- I __. Address: � � D f ij : �- '_ �,� r •��: � .� ' __ - I --�._�.--0---------�--��-�-�----'�=� -�-�.I�1 f.L_�._ . .f_.L- ---------------- --- License or certification number: �,F'"��(/��`�________ ___________ __ _ _ ___ _ ____ -� -- - --- �,.�� - . � _ . ,-- . Phone:; a( :�.;r_,-_,�ti c'f`�-�' Fax. 4}'1..5 i 7�/` U / 7 E-ma�l: --- ---- - ----- c`` �_�i..�!. _. _. ._. ---- -- -- Service�organization for this equipment: �_ __ Address: -------------------------_ ----- --- - ------- -- --- —-- i License or certification number: Phone:; Fax: / E-mail: ___.___ __ —7 - -- A contract for test and inspection in accordance with NFPA standards is in effect as of: � -----�__._ _—__-------- _ , Contracted testing company• �: i -------------- - ------------ — Address: � _____._. _.._------------- -------- -- - --- --------- ------------------- ---- - ---------- Phone•�I � Fax. E-mail. � ----_ ___ _____- --- --. .. _--- ------- -- ---------_ -- -----------.._._..-- - ----- '- Contract expires. Contract number• __ Frequency of routine inspections: : I - - -- ._. _ _.__. _. _---.- 3. DESCRIPTION OF SYSTEM OR SERVICE � - ❑Fire alarm system(nonvoice) i ❑Fire alarni with in-building fire einergency voice alarm communication system(EVACS) - I ❑Mass notification system(MNS) i ❑Combination system,with the following components: ❑Fire alann ❑EVACS ❑MNS ❑Two-way,in-building,emergency communication system ��Othei(specify): _�_y%c %._..._ �' r�!=�f�_!1�._a.__-- - ------- �.--------- - --- ---..._.._.. ... .---------___ __ � NFPA 72, �ig 10.18.2.1 1 (p 1 of 12} Copyright OO 2009 National Fire Proteclion Association;for individual use,not to be commercially produced or distributed.