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SYSTEM RECORD OF COMPLETION (continued) <br />Audible <br />Visible <br />Combination Audible and Visible <br />10. SYSTEM CONTROL FUNCTIONS <br />Type <br />Quantity <br />Hold -Open Door Releasing Devices <br />2 <br />HVAC Shutdovm <br />N/A <br />Fire/Smoke Dampers <br />N/A <br />Door Unlocking <br />N/A <br />Elevator Recall <br />N/A <br />Elevator Shunt Trip <br />N/A <br />11. INTERCONNECTED SYSTEMS <br />® This system does not have interconnected systems. <br />❑ Interconnected systems are listed on supplementary sheet <br />12. CERTIFICATION AND APPROVALS <br />12.1 System Installation Contractor <br />This system as specified herein has been installed according to all NFPA standards cited herein. <br />Signed: Printed name: BRUCE SIMPSON <br />Organization: PSI Title: TECHNICIAN <br />Date: 10/18/2022 <br />Phone: 253-632-3540 <br />12.2 System Operational Test <br />This system as specified herein has tested according to all NFPA standards cited herein. <br />Signed: Printed name: BRUCE SIMPSON Date: 10/18/2022 <br />Organization: PSI Title: TECHNICIAN Phone: 253-632-3540 <br />12.3 Acceptance Test <br />Date and time of acceptance test: 10/18/2022 <br />Installing contractor representative: BRUCE SIMPSON <br />Testing contractor representative: BRUCE SIMPSON <br />Property representative: STEVEN KRAUSE/ SHAWN FU <br />AHI representative: EVERETT FIRE DEPARTMENT <br />Copyright © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. <br />(p. 3 of 3) <br />