Contractors Material And Test Certificate - Fire Alarm And Fire Detection Systems printable pdf download

Contractors Material and Test Certificate

Fire Alarm and Fire Detection Systems

Yes

No – Fire Alarm System is ready for Fire Department acceptance testing. Failure of test will result in

termination of the testing and additional fees will be assessed.

Date: ___________________________________ Permit # _____________________________________________

Installing Company: ____________________________________________________________________________

Installing Contractor’s Address: ___________________________________________________________________

City: ________________________________________ Phone #: _______________________________________

Installers Name (PRINT): ________________________ License and/or Certificate: _________________________

Name of Facility: _______________________________ Address: ______________________________________

City: _________________________ Zip: _______________________ Phone: ____________________________

Occupied As: _______________________________ Owner or Rep: _____________________________________

Authority Having Jurisdiction: Valley Regional Fire Authority

Phone: 253-288-5870 Fax 253-288-5970

General Contractor: _____________________________ Contact Name: _________________________________

Electrical Contractor: ____________________________ Contact Name: _________________________________

FACP Equipment Manufacturer: ___________________ Model #: ______________________________________

This system has been installed, PRE-TESTED and operates in accordance with the standards listed below. This

system was inspected and PRE-TESTED by: __________________ on ____________ and includes the devices

listed below.

_____ NFPA 72, Chapter 1,3,4,5,6,7 (circle all that apply)

_____ NFPA 70, National Electrical Code. Article 760, Manufacturer’s Instructions

_____ Manufacturer’s Instructions

_____ Other (Specify)

The above system is monitored by: ____ Proprietary ____ Remote ____ Central Station. Name of monitoring station is

___________________________ Phone #: __________________ Contact Name: ___________________________

Signed: ______________________________________________________ Date: ___________________________

EQUIPMENT INSTALLED AND TESTED:

Control Panel:

_____ of _____