Outage End Date: Outage End Time: Explanation of outage/service interruption: Project Superintendent: Contract: Telephone #: Location of Piping, Wiring, Etc.: Size of Piping: Number of Connections: Is Pipe Insulated? Yes No Asbestos? Yes No ☐ ☐ ☐ ☐ Estimated Hours to Perform Work: Subcontractor Name: Regular Time or Premium Time Estimated Cost: $ ☐ ☐ Contractor’s Requested Date: Request Approved By: C.C. Assistant Director of Maintenance and Engineering & Facilities Tech Fire Alarms – Date: Step 2 Street Closure – Type of Outage: Planned Limited Notice ☐ ☐ Explain nature of limited notice notification: Planned– An interruption in services, which can be foreseen and includes all projects with enough lead time (preferably 10 or more business days) to allow them to be accomplished on a non-emergency basis. Limited Notice– An interruption in services which cannot be foreseen and includes outages which must be accomplished within a short time frame to safeguard property, research and occupant health. This form must be submitted by the Planner/Project Manager and sent to the Facilities Operations Supervisor in accordance with the following: outside contractors/Capital Projects that may be involved with or affected by the Energy Control Procedures must submit their procedures to the FO Building Technician and the FO Supervisor prior to approval
Outage End Date: Outage End Time: Explanation of outage/service interruption: Project Superintendent: Contract: Telephone #: Location of Piping, Wiring, Etc.: Size of Piping: Number of Connections: Is Pipe Insulated? Yes ☐ No ☐ Asbestos? Yes ☐ No ☐ Estimated Hours to Perform Work: Subcontractor Name: Regular Time ☐ or Premium Time ☐ Estimated Cost: $ Contractor’s Requested Date: Request Approved By: C.C. Assistant Director of Maintenance and Engineering & Facilities Tech – Fire Alarms Date: Step 2 – Street Closure Type of Outage: Planned ☐ Limited Notice ☐ Explain nature of limited notice notification: Planned– An interruption in services, which can be foreseen and includes all projects with enough lead time (preferably 10 or more business days) to allow them to be accomplished on a non-emergency basis. Limited Notice– An interruption in services which cannot be foreseen and includes outages which must be accomplished within a short time frame to safeguard property, research and occupant health. This form must be submitted by the Planner/Project Manager and sent to the Facilities Operations Supervisor in accordance with the following: outside contractors/Capital Projects that may be involved with or affected by the Energy Control Procedures must submit their procedures to the FO Building Technician and the FO Supervisor prior to approval
Contractor-Request-For-Shutdown-or-Street-Closure-Form.docx