HomeMy WebLinkAboutReport of Inspection 5/5/2011 Kitchen Hood Fire System Inspection & Maintenance Report
DATE OF SERVICE TIME A.M. P.M.
,, €NDAg(.F ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION
v 1 .1F NORTHLAND LOCATION OF SYSTEM CYLINDERS
mo d . , ° F I R E & S E C U R I T Y
4445 W. 77th St., Suite 125
MANUFACTURER MODEL NUMBER WET CHEMICAL DRY CHEMICAL
Minneapolis, MN 55435 .
(952) 893.0905 CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
MANIFOLDED PIRANHA WATERFLOW PRESSURE
❑ YES ❑ NO
Name
FUSE LINKS 360 °F FUSE LINKS 450 °F FUSE LINKS 500 °F OTHER
Address .
MECHANICAL GAS VALVE(S) & SIZE(S) ELECT. GAS VALVE(S) & SIZE(S) MANUAL RESET RELAY
City ❑ YES ❑ NO
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
Telephone Store No.
Owner or Manager ■ MANUFACTURER'S MANUAL REFERENCE
.
NOTE: NON COMPLIANT SYSTEMS MAY FAIL TO EXTINGUISH/ SUPPRESS A FIRE.
COOKING APPLIANCE LOCATIONS & SIZES: LEFT TO RIGHT
•
• YE NO WA YES NO WA
1. System interlocked with building fire alarm ❑ ❑ 20. Proper separation between fryers & flame � ❑ ❑
2. Duct and plenum covered with correct nozzles All ❑ ❑ 21. Proper clearance -flame to filters /`r ❑ ❑
3. Check positioning of alt nozzles ❑ -0 22. Exhaust fan in operating order ❑ ❑
4. System installed per U.L. 300 standard & meets 23. All filters replaced /❑ ❑
manufacturers U.L. listing & N.F.P.A. standards 4' ❑ ❑ 24. Fuel shut -off in on position /d❑ ❑
5. Hood /duct penetrations sealed with weld or UL device .4 ❑ ❑ 25. Manual & remote set /seals in place /do
❑ ❑
6. Check if seals intact, evidence of tampering ❑,,' ❑ 26. Replace system covers � ❑ ❑
7. Pressure gauge in proper range (if gauged) ❑ 0,e 27. System operational & seals in place �❑ ❑,'
^
8. Check cartridge weight (if applicable) A ❑ ❑ 28. Slave system operational ❑ �1An
9. Dry system 6 year maintenance date/ wet system / 29. Clean cylinder & mount❑ ❑
12 year hydro -test date /❑ ❑ ❑ 30. Fan warning sign on hood /❑ ❑
10. Inspect cylinder and mount /❑ ❑ 31. Proper signage and personnel instructed in
11. Operate system from terminal link /❑ ❑ manual operation of system ❑ ❑
12. Test for proper operation from remote /❑ ❑ 32. Proper hand portable extinguishers ❑ ❑
13. Check operation of micro switch /❑ ❑ 33. K class fire extinguisher in cooking area ❑ ❑
14. Check operation of gas valve ❑ 34. Portable extinguishers properly serviced ❑ ❑
15. Clean nozzles ` 0 ❑ 35. Service & Certification tag on system /�❑ ❑
/
16. Proper nozzle covers in place ❑ ❑ 36. Safety chains on all gas appliances attached and secured /❑ ❑ ❑
17. Replaced fuse links / PJ r ❑ ❑ 37. Status of gre se buildup in the hood and duct opening
18. Check travel of cable ❑ ❑ Clean Light ❑ Medium ❑ Heavy CI Excessive /,:
19. Piping & conduit securely bracketed ❑ -3 NOTE DISCREPANCIES OR DEFICIENCIES BELOW
COMMENTS: • -. (F . , i, w,,
,,.: r
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA 17,117A, 98 and the manufacturer's manual and was operated according to these procedures with results indicated above.
i�, .
SERyICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMERS AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
WHITE - CUSTOMER • YELLOW - DISTRIBUTOR • PINK - AUTHORITY HAVING JURISDICTION