NC State University

(Ex: 11.15.1 or REG 11.15.1)

Facilities Operations

(Word Format)

REQUEST FOR FIRE ALARM SYSTEM DISCONNECT

*NOTE* 

ALL REQUESTS REQUIRE APPROVAL FROM NCSU FIRE PROTECTION

ALL REQUESTS REQUIRE ADVANCE NOTICE FOR SCHEDULING OF OUTAGES

ALL REQUESTS REQUIRE AN FME WORK REQUEST NUMBER ISSUED BY THE CUSTOMER SERVICE CENTER ( 5-2991)

 

REQUESTER INFORMATION:

REQUESTER:

DEPARTMENT:

PHONE #

REQUEST DATE:

FME WORK REQUEST #

 

LOCATION & PURPOSE OF OUTAGE :

BUILDING:

FLOOR(S)

ROOM/AREAS:

 

 

PURPOSE OF OUTAGE:

 

 

 

REQUESTED PERIOD OF DISCONNECT:

From Date:

Time:

Daily:

To Date:

Time:

Extension:

 

FACILITY SPRINKLER SYSTEM INFORMATION  (Check One Box)

SPRINKLER SYSTEM WILL BE OPERATIONAL DURING OUTAGE : box

SPRINKLER SYSTEM WILL NOT BE OPERATIONAL DURING OUTAGE :  box

NCSU FIRE PROTECTION APPROVAL:

INSPECTOR’S NAME:

( This section for use by Electronic Systems only )
COMPLETE: DATE: TIME: TECHNICIAN:

 

Notes: 

 

 

 

Last Revised:  2/01/01