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PAGE 2 OF 4 <br /> Organization Name/PhoneRepresentative Name/Phone <br /> Installer t C,(z v STY _C-or)-4) v o, (-24 <br /> Supplier C 5 <br /> Service Organization 1 <br /> Loeat1 of Ford (As-Built) Drawings: <br /> (z A7` GSsc f'iv( d,J s- <br /> Location of Owner's Manuals: <br /> rLz 4 - rsc ,A y✓ 5; <br /> Location of Test Reports: <br /> -1-' <br /> rile Af Grrc <br /> A contract, dated , for test and inspection in accordance with NFPA <br /> Standards No.(s) , dated , is in effect. <br /> 2. Record of System Installation. (Fill out after installation is complete and wiring checked for opens, shorts, <br /> ground faults, and improper branching, but prior to conducting operational acceptance tests.) <br /> This syste has been installed in accordance with the NFPA Standards as listed below, was inspected <br /> by on -2- -z a includes the devices listed below and has been in service <br /> since -7- Zoo-0 <br /> NFPA 72, Chapters a) 3 6) a6 Q (circle all that apply) <br /> NFPA 70, National Electrical Code, Article 760 <br /> Manufacturer's Instructions <br /> Other (specify): <br /> Signed: _w� �_— �--- Date: -) - ?-7„o <br /> Organization: C SSC / <br /> 3. Record of System Operation: <br /> All operational features-and functions of this system were tested by �No,• �� a.� <br /> on 7- -Z rend found to be operating properly in accordance with the requirements of: <br /> NFPA 72, Chapters C1) 3 C5J (r)) a (circle all that apply) <br /> >( NFPA 70, National Electrical Code, Article 760 <br /> Manufacturer's Instructions <br /> Other (specify): <br /> Signed: > A ,L Date: - -2- <br /> Organization: (T 5 SC <br /> 4. Alarm Initiating Devices and Circuits (Use blanks to indicate quantity of devices.) <br /> MANUAL <br /> a) Manual Stations 6( Noncoded, Activating Transmitters Coded <br /> b) Combination Manual Fire Alarm and Guard's Tour Coded Stations <br /> AUTOMATIC <br /> Coverage: Complete: Partial: <br /> a) Smoke Detectors Ion Photo <br /> b) Duct Detectors Ion Photo <br /> c) I Heat Detectors FT RR K FT/RR RC <br /> d) 1 Sprinkler Water Flow Switches: Transmitters g Noncoded, Activating Coded <br /> e) Other(list): <br />