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Home My WebLink AboutFire Inspection Reports _~n Hood Fire System Inspection & Maintenance Report I A,M, I PM I I RENOVATION I NOTE: NON CO. ',' l'"'' '~ ~ W'...n,.lA.iV.IIVWJRlL.l\IUPPRESS A FIRE. n. '~-"'_ 0' " ."","'O'f1tt'C~.1I1 Mtt.', I CURRENT U,L, .300 STANDARDS AND MAY NOT PRO PERL Y EXTl/iG.IlISI!A.. ' 'l -8 MOllERN COOKING OIL I AND APPLIANCES. I IS ' RECOMM RliPlAGE:AlP8RAfll! rOUfl SUPPhESSION SYSTEM ITH A.U.L. -300 APPRIIVED WET CHEMICAL S ftfI'- EVENT OF A ceaKING AREA FIRE .~ YES ];Q WI\ 20, Check travel of cable nuts! S-nooKs' 10 10 Jd ~1 ,Piging&, <;9nduitse<;UI'!l'Y brayk!lteQ '.. " .0., 10 10 22, Proper separation between fryers & flame jZJ 10 10 23, Proper clearance-flame to fi~ers 2J 10 10 24. Exhaust fan in operating order ;;5 10 10 25. All fi~ers replaced jZJ 10 10 26, Fuel shut-off in on posrtion ~ 10 10 27, Manual & remote set/seals in place f!f 10 10 28, Replace systems covers fl/ 10 10 29, System operational & seals in place ;;r 10 10 30, Slave system operational 10 10 2J J:;f 10 10 31, Clean cylinder & mount ;zJ 10 10 JZJ 10 10 32, Fan warning sign on hood ;;r'1O 10 9f 10 10 33, Proper signage and personnel instructed in manual Rf 10 10 operation of system j2f 10 10 9f 10 10 34, Proper hand portable extinguishers ~ 10 10 2f 10 10 35, K class fire extinguisher in cooking area j:?J' 10 10 J:;f 10 10 36, Portable extinguishers properly serviced %' 10 10 ~IO 10 37, Service & Certification tag on system f3 10 0 )0 10 10 38. Safety chains on all gas appliances attached and secured 10 ,cr'1O )?"IO 10 NOTE DISCREPANCIES OR DEFICINCIES BELOW /10 10 10 ;1 // -/ IJ L., ~r"Y'~ r, fr'101"";'I-1 (/"q (" Ii ,-. / PI-5-!-/' <-:;-/.;!- /1//,I,*r) Northland --. Fire & Secu~ Your Life Safety Specialists 4445 W. nth St., Suite 125, Minneapolis, MN 55435 (952) 893.0905 Name J3u rJ ( d'2.J tr 4//2;;:' Address,"5 ().z: f') / (> r' :/.. . "51. .,5, F City J-~/n... j ok" fr1~ "5"') ~ 72 Telephone(~ :?~ _) L/ 1/7...3.3/ Z Store No, Owner or Manaaer A r--r 'I MOl r1 S I - COOKING APPLIANCE LOCATIONS & SIZES: LEFT TO RIGHT hVN -hyn :((-v (' y :(;"vr( 1 YES];Q~ 1, System interlocked w~h building fire alann 10 10 ji!J 2. Duct and planum covered w~h correct.no~les, A! P, 10 '., ' :3. Check pos~ioning of all nozzles )If 10 10 4, System installed per U.L. 300 standard & meets manufacturers U.L. listing & N,F.P.A standards 10 r;J 10 5. Hood/duct penetrations sealed w~h weld or UL device % b 10 6, Check if seals intact, evidence of tarnpering .9f 10 10 7. If system has been discharged, report same 10 ;:r 10 8, Pressure gauge in proper range Of gauged) 10 10 i!f 9, Check cartridge weight (if applicable) Rf 10 10 10, Dry system 6 year maintenance date! wet system 12 year hydro-test date 11, Inspect cylinder and mount 12, Operate system from terminal link 13, Test for, proper operation from remote 14, Check operation of micro sw~ch 15, Check operation of gas valve 16, Clean nozzles 17, Proper nozzle covers in piace 18, Check fuse links and clean 19. Replaced fuse links COMMENTS: c/~/ .5/t,)I. J30 Ii n , " . 5Y'5I~/T' /L/; Y' I DATE OF 5ERVI~E i / I TIME 17-/ZZ'(~ IANNUAL ' l SE I-~~NUAL l RECHARGE I ILOCATION OF SYSTEM CYLINDERS H~rr ") IMANUF~U;EUR ( I MODEL NUMBER WET //1'....., IZ-jC-'L X CYLINDER SIZEZSTER I CYLINDER SIZE SLAVE I ,',-J q()/'c,n . FU~NKS 360" F FUSE LINKS 4SO" F I FUSJKS SOO" F FUEL SHUT.OFF ELECTRIC j GAS . V.~:?UMBER y ~ HYDRO Tr.i~l (liP INSTALLATION I DRY CHEMICAL CYLINDER SIZE SLAVE OTHER SIZE LAST RECHARGE DATE MANUFACTURER'S MANUAL REFERENCE On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17, 1-7A, 96"aRd~ manufacturer's manual and was operated according to these procedures with results indicated above. X /4 / / ,/? I I I I I i(/ SER'ilICE 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, "I !' , WHITE - CUSTOMER . YELLOW - DISTRIBUTOR . PINK - AUTHORITY HAVING JURISDICTION Hood Fire System Inspection & Maintenance Report I A.M. I P.M. I I RENOVATION I I ~_...en I DATE OF ;ZCEZZly/ I TIME IANNUAL ~EMI~;AL J RECHARGE I ILOCATION OF SYSTEM CYLINDERS J3ro d~ r IMANUFAC~RER I MODEL NUMBER /ln~1 ,Z-/OZ. ICYU~~EA SI,ZE ~;lEA I CYLINDER SIZE SLAVE \.. -) gtl IF' ;7 FusuiNKS 360' F FUSE LINKS 460' F I FUSE LiS 500' F FUEL SHUT-OFF ELECTRIC j GAS I V/'...5 ]/1"..,7 ~I-t"'f , SERIAL NUMBER 'LAST 96TEST DATE MANUFACTURER'S MANUAL REFERENCE INSTALLATION Northland --. Fire & Secu~ Your Life Safety Specialists 4445 W. nth St., Suite 125, Minneapolis, MN 55435 (952) 893.0905 v- I I DAY CHEMICAL CYLINDER SIZE SLAVE WET Name J3- n:j"'Y' .da..-t L/I 7. :7 Address -5c..:ZO /~[,~!- -5/. .5,r City Pin 1'" .t.c. j{ p. /VI ^/ 55 =-r77 Telephone (. L5d) '1~7 ---33/ Z Store No. LAST RECHARGE DATE . NOTE, NON"FIIlII~r..qI"'~.&\lerRl_"fiIll!l!9lE" A FIRE. CURRENT U,L, -300 STANDARDS AND MAY NOT PROPERLY EXTINGUISH A COOKING AREA FIRE DUE TO MUUC"NII;UUI\INIi OILS ANIl APPLIANCES. IT IS ! RECOMMENDED THAT YOU REPlACEJUPGRADE YOU 5UPPRES~ON SYSTEM WITH ~.U.L. -300 APPROVED WET CHEMIC L SYSTEM AND MI"MAL LIABILITY IN T E YES till lliA ~ ~NT OF A C.K1NG AREA FIRE, 1. System interlocked w~h buiiding fire alarm 0 o;;y 20. Check travel of cable nuts! S-hooks .",~:~~::"n~~~:~~l1c~;:~~:s correct"nll.~les_ '"'""f-g-~--i}~~r~~~fl:k, ~~~~~~~r-flame 4. System installed per UL 300 standard & meets 23. Proper clearance-flame to fiijers manufacturers UL listing & N.F.P.A standards 0 (:Y 0 24. Exhaust fan in operating order 5. Hood/duct penetrations sealed w~h weld or UL device flJ 0 0 25. All filters replaced 6. Check ~ seals intact, evidence of tampering P' 0 0 26. Fuel shut-off in on pos~ion 7. If system has been discharged, report same 0 JZf 0 27. Manual & remote set/seals in place 8. Pressure gauge in proper range (~ gauged) 0 0 it 28. Replace systems covers 9. Check cartridge weight (if applicable) 9' 0 0 29. System operational & seals in place 10. Dry system 6 year maintenance date/wet system 12 30. Slave system operational year hydro-test date r;t 0 0 31. Clean cylinder & mount 11. Inspect cylinder and mount .c;r 0 0 32. Fan warning sign on hood 12. Operate system from terminal link 2: 0 0 33. Proper signage and personnel instructed in manual 13. Test for proper operation from remote Jz!: 0 0 operation of system 14. Check operation of micro switch ADO 34. Proper hand portable extinguishers 15. Check operation of gas valve ::.a' 0 0 35. K ciass fire extinguisher in cooking area 16. Clean nozzles f! 0 0 36. Portable extinguishers properly serviced 17. Proper nozzle covers in place j::J" 0 0 37. Service & Certification tag on system 18. Check fuse links and clean ):i!fJ 0 38. Safety chains on all gas appliances attached and secured 19. Replaced fuse links % 0 0 NOTE DISCREPANCIES OR DEFICINCI~S BELOW <X>.!"1MEWS: ~-<y~j-,(Y7 /lC/ IlL', =5r:t) (",,'c- />"1,0,1-:,/;/ //k/1f;,j- / -:;/;/A' [5&1#1' " M)y'1 J?'~kn .5I;,k ";:;>Qp,):,kr / V Owner or Manager. /10 ... (" V jV1 0 I (\ ~ COOKING APPLIANCE LOCATIONS & SIZES: LEFT TO RIGHT ,t7/'n,lor OTHER I I I I I I I SIZE YEStill~ OO~ ._-.g'g% ' ;;y j'I 0 fl". 0 0 :ar: 0 0 %00 ~OO C;r'00 (700 00yr' ~OO ~OO ~gg ~OO ~g 0;0 0 000 On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 1~, J7A'J6'!fn~e manufacturer's manu~1 and was operated according to these procedures with resu.lts indicated above. X //t:-A j /;:.~ I I I I kill, \ \,., SERVICE 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 . . I I ..dlll Hood Fire System Inspection & Maintenance Report ~ "'---.:J I DATE OF SERVI.CE, l TIME;: I A M I P.M. I ~ tl'J~U f- \ IANNuLI I cr~~ANNUAL I RECHARGE I INSTALLATION I RENOVATION O....h.and ~' - ILOC. ,~:'~N OF SYSTEM CYLINDERS "-&1 '4 ' f' i l \,}I.L. ire & Secu . I~ANUF;~:URER rODEIL,,"~MBER > WET Your Life Safety Specialists !CYLlNDE,.R SIZE M", ASTER I CYLINDER SIZE SLAVE 4445 W. 77th ~t. Su;le125, Minneapolis, MN 55435 (952) 893.0905 / lit I FUSE LINKS 360" F FUSE LINKS 450" F I FUSE UN, KS 500" F I I : , \:.. Itis'> It)), i" I r rW C~\ <:, ~ . IFUELSHUT'OFF ;.L;C;RIC j h ;A~ C SERIAL NUMBER LAST HYDRO TEST DATE Name Address Citv i i L [,'kf /'/,1 5(117) Telephone -:':)';' i7- ~?:!~ Store No. OwnerorManag," ; ;;c. f/f\.".)'::, COOKING APPL. ANCE L.OCATIONS & SIZES: L.EFT TO RIGHT 1. System interlo :ked with building fire alarm 2. Duct and plen Jm covered with correct nozzles 3. Check positiolling of all nozzles ,4, System installed per U.L. 300 standard & meets manufacture~ U.L. listing & N.F.P.A standards 0 a 0 5. Hood/duct pe letrations sealed w~h weld or UL device gOO 6. Check if seals intact, evidence of tampering c:J 0 0 7. n system has lean discharged, report same 0 0;0 8. Pressure gaU( e in proper range Of gauged) 0 O;E;! 9. Check cartrid~e weight (if applicable) POD 10. Dry system 6 lear maintenance date! wet system 12 year hydro-tE* t date \: 11. Inspect cylind lr and mount 12. Operate syste n from terminal link 13. Test for. prope . operation from remote 14. Check operati )n of micro sw~ch 15. Check operati )n of gas valve 16. Clean nozzles 17. Proper nozzie covers in place 18. Check fuse lir ks and clean 19. Replaced fuSE links COMMENTS: i') :lfA\ 1< f..Uj .L!I.' ;,'7 yg; l'!Q !;LA o 0 aI:: ;fJ00 .oeOO 1300 gOO 1300 .mOO 000 gOO ~OO r;:J00 000 'fJ00 ([IIMTI. I DRY CHEMICAL CYLINDER SIZE SLAVE IIII' . I OTHER SIZE LAST RECHARGE DATE 'II IMANUFACTURER'S MANUAL REFERENCE SION SYSiEM DOES MOT MEET NOTE' NON cOM1~_~.mM'AWiiR~'I:Mi m~ A FIRE. PROPERLY EXTINGUISH A COOKING AREA FIRE DUE TO t I~ RECO MENDED THATYO REPLACEJUPGRADE Y.QUR '," WE" WET C EMICAL SYSTEM A D MINIMAL L1ABILIT' IN THE :"\':I C YES I'IQ I'ILA Oo.g .:>0 0 0 >eOO BOO 800 :000 ~OO -gr00 ~OO :gOO OO-e'l '-kJ 0 0 >000 20. Check travel of cable nuts! S-hooks 21. Piping & condu~ secureiy bracketed 22. Proper separation between ftyers'& flame 23. Proper ciearance-flame to fi~ers 24. Exhaust fan in operating order 25. All fi~ers replaced 26. Fuel shut-off in on position 27. Manual & remote seVseals in place 28. Repiace sysiems covers 29. System operational & seals in place 30. Slave system operational :31. Clean cylinder & mount 32. Fan waming sign on hood 33. Proper signage and personnel instructed in manual operation of system ISl 0 0 34. Proper hand portabie extinguishers 8 0 0 35. K ciass fire extinguisher in cooking area -t"l 0 0 36. Portable extinguishers properly serviced -;0 0 0 37. Service & Certification tag on system '1:1 0 0 38. Safety chains on all gas appliances attached and secured 0 0:0 NOTE DISCREPANCIES OR DEFICINCIES BELOW fJ 0 0 On this date, th l above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17, 17A, '16 and the manufacturer's manual and was operated according to these procedures with results indicated above. 1/(iS'r:d I I IA--I"i l U( CtA f t I () Lkj SERVICE T "CHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMERS AlJTHORIZED AGENT The above servi :e technician certifies that the system was personally inspected and found conditions to be as indicated on this report. x " i/ , WHITE - ~USTOMER . YELLOW - DISTRIBUTOR . PINK - AUTHORITY HAVING JURISDICTION 'v...11 i_ ......... '" i -, Hood Fire System Inspection & Maintenance Report r-:--~ DATE Of SERVICE l TIM!; I A.M. I P.M. \ ,. r ( { I', Ce., \,L!~ ~ ANNUAL I SE~'-ANNUAL J RECHARGE I INSTALLATION I RENOVATION I ILOCATION OF SYSTEM CYLINDERS I i-f".( lJ/1"I IMANUFACTURER MODEL NUMBER WET DRY CHEMICAL I , It (it-. I" ICYLlNDER ~IZE MASTER CYLINDER SIZE SLAVE I n. /tip I FUSE LINKS 360' F FUSE LINKS 450' F I FUS~'NKS 500' F IFUEL SHUT-OFF ELEC~RIC j /\ ~:: f . SERIAL NUMBER LAST HYDRO TEST DATE I ( 1,- ..dn ~\ r~orthland --. 'fire & Secu~ Your Life Safety Specialists 4445 w. 77th 1t , SUite 125, Minneapolis, MN 55435 (952) 893 0905 Name .1 t k. tlU/~' liI~l Address r:-{-, () ',4 r r~ ~). I . Citv ." 'Ih LP Kf ''-''7-' ..." '. ~ ;,) Telephone . I ~ : ') )'- :'j~l\~. Store No. Owner or ~ana9' ~r ,. ('1 " i~ \t ,':) COOKING Xi>f5L IlNCE LOCATIONS & SIZES: LEFT TO RIGHT 1. System inter1c Gked with building fire alann 2",puct and plen Jm covered with correct nozzles C:t-l2:heck pos~io ling of all nozzles (4. System installold per U-L 300 standard & meets - manufacturer! U-L listing & N.F.PA standards 5_ Hood/duct pe letrations seaied w~h weld or UL device 6. Check if seais intact, evidence of tampering 7. If system has Jeen discharged, report same 8. Pressure gau( e in proper range Uf gauged) 9. Check cartrid!ile weight Uf applicable) 10. Dry system 6 rear maintenance date/ wet system 12 year hydro-tel t date ,( 11_ Inspect cylind lr and mount 12. Operate syste n from tenninallink 13. Test for prope . operation from remote 14. Check operation of micro switch 15. Check operatl In of gas valve 16. Clean nozzles 17. Proper nozzle covers in place 18- Check fuse lir ks and clean 19- Repiaced fuSl . links "- COMMENTS: . ': i k. ~"" j i; r ,~'t~~\\l)!df\~ '(f I r:<'{ r C F- 1"1 +\ \.//"1 (-1;:,\/\ YES 00 !UA OO~ ...f'J00 .g. Ll 0 0..61 0 000 aDo DOg o DB: '000 / '. ~ 0 0 BOO .>[J 0 0 ~OO .:fJ00 tJOO flOO 000 ,.e00 @Oo 'i -"f . CYLINDER SIZE SLAVE //11'. I OTHER SIZE LAST RECHARGE DATE MANUFACTURER'S MANUAL REFERENCE NOTE, NON cOMP.]'W1S &1RE~6~iMdlOIi&IIG1iIli&TFIRE. CURRENT U.L. .300 STANDARDS AND MAY NOT PAOPERL Y EXTINGUISH A COOKING AREA FIRE DUE TO ~DEIlN I;OOl\lNli OI~S AND APPLlANI;ES.IIlIS AE MENDED THAT YClu REPLACElUPGRADE ~UR . sO RESSJON SYSTEM NITH A.U.L. .300 APP,OVED WET HEMICAL SYSTEM j ND MINIMAL L1ABIlITtt IN THE EVENT OF A Cl OKlNG AREA FIRE. YES 00 !UA 20. Check travel of cable nuts! S.hooks 0 0 ~. 21. Piping & conduit securely bracketed j;;J 0 0 22. Proper sepal'ation betWeen flyers & flame ;><1 0 0 23. Proper clearance-flame to filters 1'J 0 0 24_ Exhaust fan in operating order ~ 0 0 25. All fi~ers replaced ::a 0 0 26. Fuei shut-off in on position 1"l 0 0 27. Manual & remote seVseals in place ~ 0 0 28. Replace systems covers gOO 29. System operational & seals in place (3 0 0 30. Slave system operational 0 Of' 31. Ciean cylinder & mount .g 0 0 32. Fan warning sign on hood i2I 0 0 33. Proper signage and personnel instructed in manual operation of system 34. Proper hand portable extinguishers 35. K class fire extinguisher In cooking area 36. Portable extinguishers proper1y serviced 37. Service & Certification tag on system 38. Safety chains on all gas appliances attached and secured NOTE DISCREPANCIES OR DEFICINCIES BELOW lFe, ( 'K I" ,:... I (. y..Q. liA1'-- ":,1lJ! ,J.F g-OO "BO 0 gOO t'J00 900 0081 r::J'0 0 1/ f) ;'\I-)() (1IMi1. On this date, th 3 above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17, 17 A, l6 and the manufacturer's manual and was operated according to these procedures with results indicated above. X if Ifl,C;Jid I I IXlv ji-C~C~ ,\ \u,)y::J SERVICE 1 ECHNICIAN PERMiT NO. DATE: TIME: AM PM ~USTOMERS ~UTHORIZED AGENT The above servi ~e technician certifies that the system was personally inspected and found conditions to be as indicated on this report WHITE - ::USTOMER . YELLOW - DISTRIBUTOR . PINK - AUTHORITY HAVING JURISDICTION