BATU HIJAU PROJECT

SUMBAWA, NTB
PT Effrensindo Kencana

Berita Acara Pemasangan

Nomor : BA-001/IV/-22
Paket Pekerjaan : Fire Protection Container Data Center
Area : AMMAN Batu Hijau - Sumbawa

Pada hari ini ……………….... , tanggal ……..……... bulan …………………... tahun Dua Ribu Duapuluh Dua
Kami yang bertanda tangan dibawah ini :

1. Client : PT. MUSTIKA MEMADATA

2. Kontraktor : PT. EFFRENSINDO KENCANA

Secara bersama - sama telah mengadakan pemeriksaan, pengetesan fungsi sistem terhadap hasil pekerjaan sebagai berikut :

- Fire Suppression Inergen

- Fire Alarm System
- Vesda Aspirating Smoke Detector

Note :
- Terlampir hasil check list dan dokumentasi

Demikian Berita Acara ini dibuat dan di tanda tangani pada tanggal tersebut
diatas oleh pihak - pihak yang berkepentingan untuk dapat dipergunakan sebagaimana mestinya.

Disetujui, Dibuat,
PT MUSTIKA MEMADATA PT EFFRENSINDO KENCANA

( ) ( )
 CHECK LIST INSTALASI
Client : PT MUSTIKA MEMADATA Date :
Project : BATU HIJAU PROJECT, SUMBAWA - NTB Ref No : BA-002/IV/-22
SOW : Fire Protection Container Data Center

No. Description Brand Qty Unit Status

Fire Suppression system Inergen ( IG-541)

1 Inergen Installation Local 1 Set

- Piping Installation c/w fitting class 3000 ( Seamless Sch 40)

- Support Cylinder (UNP Local)

- Hanger & Support Pipe (UNP Local)

Fire Alarm System
1 Fire Alarm Installation Local
- Kabel Power 220 VAC (NYM 3 x 2.5 mm) 1 Ea
- Smoke Detector (STP AWG # 18 in EMT Conduit) 4 Ea
- Manual Release (STP AWG # 18 in EMT Conduit) 2 Ea
- Abort Switch (STP AWG # 18 in EMT Conduit) 2 Ea
- Disconnect Switch (STP AWG # 18 in EMT Conduit) 1 Ea
- Horn Strobe (STP AWG # 18 in EMT Conduit) 2 Ea
- " EVACUATE AREA " Sign Lamp (STP AWG # 18 in EMT Conduit) 1 Ea
- " GAS DISCHARGE " Sign Lamp (STP AWG # 18 in EMT Conduit) 1 Ea
Interface Connection
- Pressure Switch (STP AWG # 18 in EMT Conduit) 1 Ea
- Selenoid to Pilot Valve N2 (STP AWG # 18 in EMT Conduit) 1 Ea
- Low Pressure Switch (STP AWG # 18 in EMT Conduit) 1 Ea
- Placement Indocator Switch (STP AWG # 18 in EMT Conduit) 1 Ea
- Interconnection to vesda (STP AWG # 18 in EMT Conduit) 4 Ea

VESDA Aspirating Smoke Detector

1 Vesda Installation
- Kabel Power 220 VAC (NYM 3 x 2.5 mm) 1 Ea
- Pipe Installation c/w support & fitting ( UPVC Dia. 25 mm) 2 Set
- Sampling Point Label 7 Ea

NOTE :

Approved by Prepared by :
PT MUSTIKA MEMADATA PT EFFRENSINDO KENCANA

(………………………………………………………………………) (………………………………………………………………………)

Confidential 09/28/2022 Page 2

 CHECK LIST EQUIPMENT
Client : PT MUSTIKA MEMADATA Date :
Project : BATU HIJAU PROJECT, SUMBAWA - NTB Ref No : BA-003/IV/-22
SOW : Fire Protection Container Data Center

No. Description Brand P/N Qty Unit Status

Fire Suppression system Inergen ( IG-541)

1 80 litre container, 300 bar iFLOW, IG-541, 23 cu.m, w/contacted pressure gauge LPG 73130006 2 Ea
ACTUATION PILOT
- 3 litre N2 100 bar pilot container, w/contact pressure gauge, solenoid, manual release LPG 70100075 1 Ea

- Placement indicator - pilot container LPG 441872 1 Ea

2 DISCHARGE HOSE ASSEMBLY c/w Accesories

- Pneumatic Cone c/w inert needle LPG 30027201 2 Ea

- Tee for Pneumatic cone (3 ways,1/4" blind cap) LPG 35116429 2 Ea

- Actuation hose, 1/4" x 580 mm LPG 30506014 2 Ea

- Hose, 350 mm, 3/4" BSP male x 3/4" BSP swivel female-Flexible discharge Hose LPG 91116026 2 Ea
- Check valve, i-flow LPG 21114011 2 Ea

- Decompression screw, short LPG-UL LPG 30027301 1 Ea

- Bleed valve, 1/4" LPG 20007047 1 Ea

- Dowty seal 3/4" LPG 95108010 1 Ea

- Blind cap M 3/4" LPG 30390160 1 Ea

3 AGENT CONTAINER BRACKETS

- Set of bolts (2pc) (bolt of root set) LPG 36116292 2 Ea

- Rail set for I Flow fittings (2pc) (nut set) LPG 36116291 2 Ea
- i-flow bracket LPG 36116293 4 Ea
4 Pressure switch, on manifold LPG 30330010 1 Ea
5 3/4" Acoustic Nozzle c/w NPT Orifice Assembly LPG 448417 3 Ea

Fire Alarm System

1 Fire Alarm Panel (4007-9201) 4007ES 1 Ea
- Batterry 12 Volt - 12 AH 12V-12Ah 2 Ea
2 Suppression Release Peripheral 4090-9005 1 Ea
3 2 AMP Coil Supervisory Module 2081-9046 1 Ea
4 Addressable Photo electric smoke detector 4098-9714 4 Ea
5 Addressable Manual push & Pull Station 4099-9006 2 Ea
6 Suppression Abort Station c/w module 2080-9056M 2 Ea
7 Maintenance Switch Disconnect 2080-9069 1 Ea
8 Horn & Strobe 4906-9127 4 Ea
9 " EVACUATE AREA " Sign Lamp BL 2430-LED-SMT-EAI 2 Ea
10 " GAS DISCHARGE " Sign Lamp BL 2430-LED-SMT-GD 2 Ea
11 Junction Box Fire Alarm TBFA-C 1 Ea
12 6 Point IDNET 2 I/O 4090-9120 1 Ea
13 Input module 4090-9001 2 Ea
14 Relay/Control Module 4090-9002 2 Ea

VESDA Aspirating Smoke Detector

1 VESDA-E VEP DET 3.5" DISP VEP-A10-P 1 Ea

2 ASD PSU STYLE-E 14AH 0.5AMP VPS-220-E5 1 Ea
- Batterry 12 Volt - 12 AH 12V-12Ah 2 Ea
3 ASD SPL PT DECAL E700-SP-DCL 1 Ea

NOTE :

Confidential 09/28/2022 Page 3

 No. Description Brand P/N Qty Unit Status

Approved by Prepared by :
PT MUSTIKA MEMADATA PT EFFRENSINDO KENCANA

(………………………………………………………………………) (………………………………………………………………………)

Confidential 09/28/2022 Page 4