Above Ceiling Work Permit.pdf

ATTACHMENT A ABOVE-THE-CEILING WORK PERMIT

Building:___________ Floor: ______ Room #: ______ Fire / Smoke Barrier: YES NO (circle one)

Work Coordinator/Supervisor: Name:

Phone # or Extension:

Date(s) Planned for Proposed Work:

Date Permit Submitted:

Yes No

Will the proposed work open or penetrate an existing building structural element, such as a wall or floor, which is smoke-tight or fire-rated?

If YES, complete ILSM if the penetration will not be immediately closed to describe the planned installation to restore the wall or floor to its original smoke-tight or fire-rated condition and then go to #2.

If NO, complete bottom section, numbers 3 through 6 (no approval required)

Will the opening(s) or penetration(s) created by the proposed work be sealed using a UL-approved system? Describe the planned method and attach installation detail sketch.

Fire stop system utilized, list type (must provide documentation proving fire stopping is compatible with other fire stopping in area):

Approved by: Date:

NOTE: - Contact the POC when work is complete or for additional information and assistance.

To be completed by the COR or designated staff:

Yes No

1. The proposed work area has been inspected and the proposed plan is approved.

2. A copy of the approved permit has been provided to the work coordinator/supervisor.

3. Work is complete and every opening, penetration and joint is properly sealed to prevent the escape of fire and smoke.

4. Work is complete and all acoustical ceiling tiles have been replaced.

5. All work has been completed in accordance with industry practice and applicable building fire code requirements.

6. All j-boxes in the area are closed.

Closed by: Date: