HomeMy WebLinkAboutFAI15-0047 AHI 2023 Fire Suppression System Distributor Certificate of
installation
To be Completed by Regional Office
Job Name meN\cR /41— ,JETgM Js HALL Job Number Z2o
Job Address 131 `1 'atDoiag , [��,�Na a , c Type of System: Ansul hY
1.5q33 Pyrochem 0
Other
To be Completed by Fire System Distributor
Company Name F rrri-li" I F PiL TerTioNI, //Jr, • System Model 12-Tro2-•
Address i 7c EK-MA r''f'• cN r�� << ii
F ['� Serial Number 35�9c0
'7 S 7 '
Fuel/Energy Shut Off Device Gas Valve: Mechanical M Electrical 0 Size 1'
Installed. Tested on o7.114�`.' Electric Equipment Shut-down Tested: gYes Q No
Date
This Fire Suppression System is installed in accordance with the Manufacturer's instructions and
drawings, NFPA 96 and 17 (current issues)and all applicable state and local codes. All electrical
work or work performed by others to complete the installation of this system has been completed.
Exceptions to the above are noted below. (Use back of sheet if necessary)
.1:.iL s7MTrcrf [ Ecc yi-t'dINl /c ' FP-eAA %lei b, (`kN,7 ,eipp/e.c. f )
Installer's Name W1c,,�P-C-Ar.J D . OLsc-r..1
Signature �//i`,,.. Date b: /«A ev3
•
To be Completed by Owner or Owner's Representative
I have received a copy of the Fire Suppression System Owner's Manual and I understand it. I also •
understand that it is the recommendation of the National Fire Protection Association (NFPA) that
the system be ins cted eve six months to maintain its reliability.
Signature . Date ;a- ro o'oz3
To be Completed by the Authority Having Jurisdiction
Functional tests have b en witnessed and the system performs as designed.ar
Signature Date a//'O /1'42S
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