HomeMy WebLinkAboutALL DOCS - 12-00288 - Madison Central High School - Fire Suppression04112t2010 1033 citv of Rexhrg (233se3022 \l A^r-w
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Rexburg -Modiso n C oYlff
EmergencY Sewlces
Phone: 200.359 'n20 *?26
Fo* 208'359'30?4
APPLICATION: "CONSTRU CTION PERMIT"-ibNsrnucTloN PERMIT #'--
PERMIT APPROVED' YES7 NO SSO'OO F:EE PND:
APPROVED BY:
Office Phone Number:
the Wotk:ffih"". #L&.);71-/tt,Contractor
Contact Petaon:
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Contact Person:
Phone Number:
Cell # (3
PLEASECHECKTHETYPEoFPERMIT(S)YoUAREAPPLYINGFoR:
K auto},IATIc FIRE-DCTINGUISHING SYSTEMS
H ;l#ffiffiffH**oN sysrEMS Ar{D REr-arED EQUTPMENIT
N FIRE T,UTITPS END REI.ATED EQUIPMENT
D HAI\{MABLE ANID COMMBUSTIBLE LIQUIDS
D T{AZARDOUS MATERIALS
D INDUSTRIAL O\TENS
D LP.GAS
D PRIVATE FIRE I{YDRA}-ITS
tr SPRAYING OR DIPPING
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Contractot's Sifnature
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Business Name:
FIRE Kitchen Hood Fire system Inspection & Maintenance Report
SERVIC Phone t-800-866-3640
Fax 1-208-232-0449
Locally Owned & Operatedof IDAHO, I
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MODEL & TYPE
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LOCATTON OF SYqTEM
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7. Pressuregauge in properrange
8. Checked cartridge
9. Cylinder hydrostatic test date
10. Inspect cylinder and mount
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1 1 . Checked travel of cable and link position .^... , u
12. Fusibte tinks 360 _ OUO , UOO
13. Replaced fusible links, manufacture date: / ) A
14. Checked manual release
15. Ghecked micro-switch i'16. Checked gas valve mech. -.-_.- electric
1 7. Pipingr,/conduit securely bracketed
COOKING APPLTANCE LOCATTONS: LEFT TO RtcHT
18. Nozzles cleaned / Clear of Blockage
19. Proper nozzle caps / covers in place
20. Proper separation between fryers and open flame
21. Exhaustfan in operating order
22. Remote manual release seals in place
23. System cartridge replaced / safety pins removed
24. System operational and armed
25. Fan warning sign on hood
26. K-class fire extinguisher in cooking area
27. Proper ABC fire extinguisher for other areas
28. Fire extinguishers properly serviced
29. Personnel instructed in manual operation of system
30. Personnel instructed on required monthly insp. of sys.
31. Personnel instructed on use offire extinguishers
32. Service and certification tag on system
33. ls the system as currenfly configured
a UL 300 compliant system?
YES NO N/A
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1. All seals intact, no evidence of tampering
2. All appliances properly covered dcorect nozzles
3. Duct and plenum covered w/corect nozzles
4. Check positioning of all nozzles
5. Hood/duct penetrations sealed
6. Grease accumulation ! Excessive D Heavy pModerate
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NOTE:NoTE:Noncomp|iancesystemsmayfai|toeXtinguish/suppreSs'ire
COMMENTS / NON COMPLIAA"',
ire
adopted editions of NFpA 12, 1TA,96 and the manu_
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l'e above service technician certifies that the system was personaily inspected
AM PM CUSTOMER'S AUTHORIZED STGNATURE
conditions to be as indicated on this report.
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120028,8
Madison Central Hlgh School - Fire Suppression
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