CITY MANAGEMENT

Fire Detection Isolation Permit

All Permits Must Be E-mailed to tenant.fitout@kafd.sa

Permit to be submitted 3 working days before commencement of works

KAFD Unique Isolation Number: KAFD BUILDING NO 3.05 16 TH FLOOR

Date of Permit Application: 4-12-2022

Associated GA Permit Number:

Declaration

KAFD DMC’s representative issues this isolation permits for the execution of work by the contractor named below. The contractor must liaise with the KAFD’s Fit-Out
Coordinator before work commences. All works must be strictly controlled to reduce any risk of injury or damage to property. The contractor must comply with the KAFD
Health and Safety Policy (copies of which are distributed at the Contractor’s Induction meeting) and current legislation, including relevant Codes of Practice. Isolations are
made on a case-by-case basis. Tampering with any isolation and or locking device by anyone other than an approved and appointed competent person (appointed by KAFD
DMC), will be ground for immediate removal from the working environment.
Project Reference: modify the locations of the smoke Exact Location: B 3.05 16 TH FLOOR
detector

Contractor Name: TAMAM OMER ALANAZYI EST Tenant Name: King Salman Park EST

Requestor: OTHMAN MOHAMMEDEEN Requestor Signature:

Details of Isolation Required

Nature of Work The project is to modify the locations of the smoke detector and sprinkler at the headquarters of the King Salman Park EST

Isolation From (Date/Time) 4-12-2022 6 PM Isolation To (Date/Time 4-12-2022 12 AM

Comments
Details of Isolation Date & Time Normal Position Revised Position
(e.g. logged in fire log)
Must be emptied 16th floor
B 3.05 16 TH FLOOR 4-12-2022 6 PM modify the locations of the smoke detector
water s of firefighting net
Is Contractor Competent Fire Watch in Is Building Security Notified of Requirement Is the insurance company
Y/N Y/N Y/N
Place for Extra Patrol? notified

DECLARATION BY LANDLORD’S COMPETENT PERSON

I declare that the isolations made above are in place, have been confirmed as effective, and tamper 3-12-2022
resistant, and have requested that alternative fire watches are implemented. Signature and Date

DECLARATION BY CONTRACTOR COMPETENT PERSON

I declare that the isolations made above are suitable for the agreed works under the General Access 3-12-2022
permit and that I will not alter or tamper with the isolations. Signature and Date

DECLARATION BY CONTRACTOR COMPETENT PERSON

I declare that the works have been completed and that all affected systems have been tested and it is 3-12-2022
safe to reinstate the affected system. Signature and Date

DECLARATION BY LANDLORD’S COMPETENT PERSON

I confirm that the isolations made have been removed and systems restored to normal operational 3-12-2022
lineup and declare this permit cancelled Signature and Date

KAFD-LF-NSP-00000-KFD-OPE-TMP-00065_R00
City Management