HomeMy WebLinkAbout14-15075 . CITY OF ZEPHYRHILLS
5335-8TH STREET f''
� � • �si3>�so-oo20 1507,��
FIRE STANDPIPES PERMIT '�
Permit Number: 15075 Address: 38361 CR 54
Permit Type: FIRE HOOD SUPPRESSION SYS ZEPHYRHILLS, FL.
Class of Work: FIRE-HOOD SUPPRESSION SYS Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 02-26-21-001 B-00000-0050
Improv. Cost: 1,700.00
Date Issued: 3/25/2014 Name: FOTOPOULOS WILLIAM & FILAX, JOHN
Total Fees: 160.00 Address: PO BOX 1999
Amount Paid: 160.00 LAND O LAKES FL 34639-1999
Date Paid: 3/25/2014 Phone:
Work Desc: INSTALLATION SUPPRESSION SYSTEM BLACKSTONE
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FIRE INSPECTION FEES 30.00 CONTRACTOR CERTIFICATE 30.00
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Chapter 633, Florida Statutes,authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review,administrative fees,and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of$100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR 14N ATTORNE EFORE
RECORDING YOUR NOTICE OF COMMEI� MEN'1�' �, ;; ;�
Y�..
CO CTOR SIGNATURE PERMIT OFFICER
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOURS NOTICE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT- 813-780-0041
s�a-�so-oo2o City of Zephyrhilis Fire Fax-813-780-0021
Permit Application
Date Received 1j— �� � Phone Contact for Permft r 352� 5 7 7340
Owner's Name Blackstones Restaurant owners Pnone Number 813 82 1623
owner's Address 38361 CR 54E
Fee Simple Titlehoider Name Titletalder Ptrone Number � � ��
Fee Simple Titleholder Address
Job Address Lot# �
Sub Division ���#
� Bio-Hazard Waste Storage-ANNUAL a Fumigation Tent
o Comm Exhaust Kitchen Hood/Duct a Hazardous Material(Trer I{or RQ Facility)ANNUAL
� Controlled Bum a Hood installation
� Emergency Generator<3p kw � LP/Nahxal Gas-Instai{aUon
� Emergency Generator>30 kw � LPMatural Gas-ANNUAL Sale
� Fire Protection Maintenance-ANNUAL o Places of Assembly/1NNUAt �
�y m� �n r �
Sprinkier � ❑ O D � Recreational Bum /�
Fire Alarm � ❑ ❑ � � � Sperkiers �r
Hood Cleaning � ❑ ❑ � � � SprinklerSystem fnstallations /�
Hood Suppression a ❑ ❑ ❑ New � Standpipes(Sprinkler Sys) ��`� c��f'�'`1��
� T/
� Fire Alarm instatiation � Torch Roofinglfar Kettle �t.
Fre Pumps o Waste Tire 5torage ANNUAL �
Fire Works
Flammable Application-ANNUAL 17 0 0.0 0 -, Valuation of Project
Fuel Tanks
[� Other.
Contractor ��^Y
g�9��� Registered Y!N Fee Current Y/N
Address License#
ELECTRICfAN Company
Signature � Registered Y/N Fee Current Y!N
qdd�� Licertse#
PLUMBER Company
Signature Registered Y 1 N Fee Cunent Y/N
Address License#
MECHANICA ��►�Pa�Y
Signature Registered Y/N Fee Curtent Y I N
Address License#
OTHER Company Securit Fire E ui ment LLC
Signature ��� Registered Y/N Fee Curtent Y/N
Address 18330 Lawrence Rd License#
Directions
Fill out appiication compietety.
Owner 8 Corrtractor sign badc af application,notarized(Or,copy of signed corrtract with owner)
If over$2500,a Notice of Commencement is required(Mechanical work over 35000)
Supply Mro(2)sets of drewings with applicable documentation
Atlow 10.14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(hMpJ/appraiser.pascogov.com)
NOTICE OF DEED RESTRICTiONS: The undersigned understands thet fhis permit may be subject to"deed'restrictlons'
' which mey,be more restrictive than Counry regulations. The undersigned assumes responsibilfty for compliance with any
appticabie deed rastrictbns.
UNLICENSED CONTRACTURS AND CONTRACTOR RESPONSIBiLfT1ES: If the owner has hir�l a cantractor or
corrtractors to undertake woric,lhey may be requ'rced to be licensed in acco►dance with state and local regulations. lf the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violatton
under state law. ff the owner or irrtended contractor are uncertain as to what licensing requirements may appiy for the
intended wmk,they are advised to contact the Pasco County Bu�lding Inspection Division—Licensing Sectb�at 727-847-
8009. Furthertnore, if the owner has hired a contrector or corrtracto►s, he is edviaed to have the conhactor(s) sign
portions of the'cor�trector Blodc"of this applicaGon for which they wNl be responsible. H you,as the owner sign as the
contractor, that may be an indicallon that he is not properiy licensed and is not endtled to permitting privlieges in Pasco
County.
TRANSPORTATION IMPACTNTILITIES IMPACT AND RESOURCE RECOVERY FEE3: The undersigned undetstands
that Transportation Impact Fees and Recourse Recovery Fees may appiy to the oonshuction of new buildings,change of
use in existing buifdings, or expansion of existing buHd'mas,as specified in Pasco Courriy Ordlnance number 89-07 and
90-07,as amended. The undersigned also understands,that such fees,as may be due,vh11 be idenii8ed at ihe time of
permitting. it is further understood that Transporfation lmpact Fees and Resairce Recovery Fees must be paid prior to
receNtng a'certiRcate oi occupancy'or final power releese. N the proJect dces not invdve a oertiflcate of occupancy or
final power release,the fees must be paid prior to permft issuance. Furthermore, M Pasco CouMy WaterlSewer Impact
fees are due,they must be paid prior to permtt Issuan�in a�coMance with applicable Pasco CouMy ordinances.
CONSTRUCTION l.IEN LAW(Chapter 713,Fiafda Statules,as amended): If valuation of work is 32,500.00 or more,I
certify that I, the appUcant, have been provided with e �py of the 'Florida Construction Lien Law--Homeowner's
Protection Guide'prepared by the Florida Dep�tment of Agriculture and Consumer Affsirs. If the applicant fs someone
other than the'owner',1 certlFy that!have obtained a c�py of the above described documeM and promise in good fatth to
deliver ft to the`owner"prior to commencement.
CONTRACTOR'SJOWNER'3 AFFIDAVIT: f certNy thet al)the i�fortnaUon in lhfs application is accurate and that all work
wiil be done in compliance wtth ali appticable laws reguladng construction,zoning and land development. ApplicaUon is
hereby made to obtain a permft to do work and installatlon as indicated. I certify tfiat no worlc or instaflation has
c�mmenced prior to issuarn�oF a pemiit and that eli work urNl be pertormed to meet atandards of ail lanvs regulatlng
construction, County and City codes, zontng regulations, and land development reguletlons in the jurisdiction. I elso
certHy thaf I urnierstand that the regulations af ather govemment egencies may apply io the irrtended work,and that ft is
my responsibqity to identlfy�actions 1 must take to be in compliance. Such agencles indude birt�e r►ot Iknfted to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmenteily Sensitive
Lands,Wat�/Wastewater Treatrnenk
- 5outhwest Ftorida Water Management District-Wefls, Cypress Bayheads, WeUand Areas, Aftering
Watercourses.
- Artny Cwps of Engmeers�eawaqs,Docks,NavigaWe Watetways.
- Department of Health 8� Rehabiikative Servic�slEnvironmentai Heatth Unit-WeNs, Wastewater 7reatment,
Septic Tanks.
- US Environmerrtal Protectfon Agency-Asbestos abatement.
- Federal Aviation Authaity-Runways.
I understand that fhe following restricdons apply to the uae of iNt:
- Use of fdl is not allowed in Flood Zone'V'uMess expressly permit�ed.
- tf the flA materisi is to be used in Flood Zaie 'A', it is understood that a drair�ge plan addressing a
°compensatlng volume'wiil be submit�d at time of perrnttting which is prepared by e professfonal engineer
Ifcensad by the Stete of Florida.
- If the flil mater�! Es to be used in Flood Zone'A"in connedion wkh a permitted building using stem waq
construcUon,I certlfy fhat ftll wiN be t�ed only to fill the�ea wlthhi the stem wail.
- If flll material is to be used in arry area, 1 certt(y tMat use of such fill wili not adv�sely atfect adjaoent
propertfes. I#uae of fidl is found to adversey affect adJaceM Pr'nPerUas�the owner rtreY be dbed ior vblating
the condkiais of the building pertnit issued under tlie attached pertnfl application,fw lots less than one(1)
acre which are elevated by fpl.an en8fneered drainage pan is rev�kad.
H I am the AGENT FOR THE OWNER,I prcxnise tn good faith to iMorm the aRmer of the pem►itUng conditlons set forth in
this affidavit prtor to aommencing constructia�. 1 understand that a seperete permit may be required for electricel work,
plumbfng, signs,wells, pools, air c�ondid�ing, gas, or oiher kiatalfetions not specHiwly induded fn the applicatfon. A
penntt issued shail be c�nehued to be a I�ense to proceed wNh the wo►k and not as authority to.vidate,cancel,alter,or
set aside a�ry proviabns ofi the technk�l codes,nor shall issuance of a permit prevent the 9uNdirig Official from thereeftaf
requiring a correction af errars in plans.aor►structfon or violatlons of�ry codes. Eveiy permit issued shall become imalid
unless the work authorized by such permR�e�mmenc�d wtthfn six morrths of permB issuance,or N wrnic authorized by
the permit is suspended or�andoned for a perlod af six(8)manths after the thne lhe wodc is commenced. An exte�afon
may be requested, in writing,irom the Building Oflicial for a period not to eacceed r►inety(90)days and will demonsirate
justifiabie cause for the extensior►. If work ceeses for Mnety(90}conaecuHve days,the�b is cor�sidered abandorred.
WARNiNG TO OWWER: YOUR FAILURE TO RECORD A NOTiCE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING 7WICE FOR IMPROVEINENTS TO YOUR PROPERTY. �YOU MITEND TO OBTAqd FlNANCING,CON$ULT
WITH YOUR LFND�R OR AN ATTQRNEY BEFORE RECORDMG YQUR NQTIC�QF COMMENCEMENT
�.oRroa,n�ar�:s.�».oa)
Subecribed a�to(nr arthmed)be(me ma Bis Subaabed a�id awwn in(a atflmiad)6e(ae me 1f�
W►w islae Persone�N kram�to ma or heNheve produced Who Isfare ps uNy Imown to me or hadF�ave produced
as�wi. es�entl�ca�.
Pbtary P�c Notary PubBc
Commisslon No. Commbsb^No.
Meme of Notary ryped.P�rned ar sternpad Name of Nohry typed.Prin►ed or s►empad
ZEPHYR�ILL� FIRE DEP/�F�T!`�E[�T
6907 Dairy Road, Zephyrhills, FL 33542
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: Contractor:
Business Name: Billing Address:
Business Address:
Business Phone No.: Billing Phone No.:
Business Fax No.: Billing Fax No.:
Contact: �����
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
Site Plan WC Mnual WC Sprinkler S50 1 st Alarm N/C
Multi-Family/Commercial .06 sf 1st Re-inspection WC Standpipes E50 2nd Alarm N/C
(Minimum Charge 325.00 2nd Re-inspection 5100 Fire Pump 550 3rd AIaRn N/C
� Plan Revis'ions DBL 3rd Re-inspection 5250 Hoods S50 4th Alann a100
4th Re-Inspection �500 fire Alartn S50 5th Alarm a150
SPRINKLER SYSTEMS (Business dosed until LP Gas $50 6th Alartn s200
8 0-25 Heads S50 viola�o�s coReded) Natural Gas S50 r+oN co��w�c� 5150
26 plus Heads 5100 SPRINKLER SYSTEMS Fuei Tanks- Per�rc $50
STANDPIPE SYSTEIiA Hydro Undergrounds S45 Spa�lclers 5100
� Per Riser S50 Hydrostabc Test $65 per system Fire Works 5500
FIRE PUMP Acceptance Test $45 per system Camp Fire , ... .._ __�25
� Per Pump 5100 Hydrant Flow $75 \
FIRE ALJIRM SYSTEM �d �� '
0-25 Devices S50 FIRE ALARM SYSTEM �+�
26 plus Devices 5100 System Acxeptance $50 Fire Protectio� S25
SUPPRESSION SYSTEMS Recall Acceptance 550 FlammaWe�ppl�cation S50 nrnuai
Wet SSO OTHER Waste Trce Storage S50 �nnuai
Dry S50 Flre WalllSmoke Watl a15 per wail Gerlerator<KW 5100
CO2 �50 LP Gas $25 per tank Generator>30 KW 150
Other a Natural Gas �25 per syseem Bio-HazaM Waste 5100 �
KIT DCHAUST � Fumigation Tenting �50
� ucts 50 Tent 10k10'or greater S15 Per ee�n Torch PoUApplied S50
OTHE FKe Pump Haz.Materials E100 �
tbn per tank a50 Fire Suppression �30 �
Fuei Tank Instaltation S50 System Acoeptano�
(Per Tank) S50 E�aust Hood/Duct S30
�Nawral Gas InstaNation S50 Re-insped'an DBl
(Per System) (other than annual)
�Spray Booth $50 � Inspection scheduled DBL a
and cancelled less than
24 hours
Construction Insp. N/C
Emerc,�ency Vehicle A� �50 FALSE ALARM
_-------PL�4idS�t�T�Ai --�iSPE�TI9N-fiOT74i ---- - -PtiftMii-i� --��fiAt---- _ __.__-
------ __
� --- - -----
GRAND TOTAL
Comments:
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Chapter 3—System Design
Large Wok(High Mount�Vozzle)
Compulsory Nozzle NL2H
Flow Points Per Nozzle 2(Two)
Number of Nozzles Required 1 (One)
Maximum Area of Protection Greater than 24 inches diameter to 30 inches in diameter and 8 inches maximum depth.
Nozzle Location Anywhere on the perimeter of the Wok.
Nozzle Height 24 inches to 48 inches above the top edge of the Wok.
Nozzle Aiming Directly at the center of the inside bottom of the Wok.
Graphic Representation See figure 3-14
_= _ ___-__ __. -- - _=-- -,=;
-- -- -- - __
� Nox.zle must be located anyzubere along the perimeter of the Wok, i
I and aimed at the center o the inside bottom o the Wok.
�, ., . ,_ ___ _ _-_ _ ._ -- _- — -_ _ ---_----� -=- ---��--- --_ — _._ _ ___ _-----�'
�A
�
1 I
� M
�
1 f 1 48�
1 n�," E
��a��
�`�� � ��,
�f
24" '' t, �
MINIMUM
30"
MAXIMUM
Figure 3-14
Page rev.C
UL EX4521 December 13,2005 30 Part#10053
Chapter 3—System Design
Small Gas Radiant Char-Broiler(High 1Vlount Nozzle)
Compulsory Nozzle NL1H
Flow Points Per Nozzle 1 (One)
Number of Nozzles Required 1 (One)
Masimum Area of Protection 624 square inches with a longest side dimension of 26 inches.
Nozzle Location Anywhere over the cooking surface.
Nozzle Height 24 inches to 48 inches above the cooking sUrface.
Nozzle Aiming Aimed at the center of the broiler.
Graphic Representation See figure 3-20
,- -- _ -_- :.__..
, _ _ -- . - -_= -- — _=- -_ - _ -_ . --
q -
' Nozzle must be located anywhere witbin the shaded area and aimed at tbe center of the cooking surface.
;'
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-; ��
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I - �#J�;`.`. . �
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� �� .� �,•^ 1
1 �
� ����
,�
.e�+�� f'��
.'�'
� '
�? :I
pt +
26 °k 624 S UARE
LONGEST � Q.
SIDE INCHES
DIMENSI ON M'`ixIMUM
' ' COOHING
AREA
Figure 3-20
UL EX4521 December 13,2005 Page rev.C
36 Part#10053
Chapter 3—System Design
Small Griddle (High Mount Nozzle)
Compulsory Nozzle NL1H or NL2N
Flow Points Per Nozzle 1 (One)NL1H or 2(Two)NL2H
Number of Nozzles Required 1 (One)NL1H or 1 (One)NL2H
Maximum Area of Protection 1080 square inches with a longest side dimension of 36 inches
Nozzle Location NL1H:Above any corner of the cooking surface.
NL2H:0 to 6 in.from either of the short sides of the cooking surface
Nozzle Height 24 inches to 48 inches above the cooking surface.
Nozzle Aiming NL1H:At a point 12 inches in and 12 inches over from the corner below the nozzle.
NL2H:At the center of the cooking surface
Graphic Representation See figures 3-16a&3-16b
f- __.. _ _ ___ _., ,--. = --=-, ---,-.- _ - -_—
NLIHNoxzle must be located directly above any corner of the cooking surface
and aimed at the intersecting point 12 inches from each side of the corner belo�rv the nozzle.
NL2HNoxxle must be located 0 to 6 inches from either of the short sides o the cookin su ace,
f
$ �
�'I
and aimed at the center of the cooking surfare �
I---- --- - ---_ --_:_ , —
NOZZLE
CAN BE
--. ' MOUNTED
� ; / AT EITHER
i
END
� NOZZLE CAN BE _�
�---- MOUN7'ED ABOVE �
� ANYCORNER � � ' �
,� � i � 1
� � � � ' ! � 1
` ' i
� y �� �`� � 1
48,� �„ �� 1 48" �� �
lZ„ � � �
� �� '�',, I
� 6„
w - , � ,}�
.,,� � � �,��
", , � :
12"� .; a �y� ,�, j �'° .n
,,, .
.. �
. � ..._ .9 �,
.�, los0 SQUARE � `� �-� 6 -F
36" f;' INCHES ' � �' � F>
t�.
LONGEST MAXIMUM 6'"µ
SIDE� COOKING AREA
DIMENSI ON �
�
SHORT
SIDE OF \ �:
COOKING �t,
SURFACE
Figure 3-16a:NL1H No2zle Figure 3-16b:NL2H Nozzle
UL EX4521 December 13,2005 32 Page rev.C
Part#10053
Chapter 3—System Design
Four Burner Range
r —� Compulsory Nozzle NL2L
� Note
Flow Points Per Nozzle 2(Two)
� The range
� cannot be u�sder Number of Nozzles Required 1 (One)
I� a backsbelf Maximum Area of Protection 28 inches x 28 inches
when using '
I
� high mount Nozzle Location Center of the cooking surface only.
' protection. Nozzle Height 34 inches to 48 inches above the cooking surface.
Nozzle Aiming Directly down only.
IGraphic Representation See figure 3-9
iExample:A four burner range has a hazard size of 20 in.(51 cm)in length and 27 in. (69
Icm)in width.Follow down the Range Length column in the Nozzle Positioning Chart until
vou come to 20 in.(51 cm). Continue down this column until the correct width appears in
the width column.When the width of 27 in.(69 cm)is arrived at,read across to the radius
column to determine the size of radius allowed,for positioning of the nozzle,from the hazard
area centerline.In this example,the correct radius is 3 in. (8 cm).The nozzle can be aimed
straight down anywhere within a 3 in. (S cm)radius of the hazard area centerline.
_.
__ _ _ _ -- _ __ . _ _
Noxxle must be located�heigbi�wise�anywhere witbin the shaded area,
'!_ _and centered above the cooking su�ce. I
_. __ _ — – _ _ _ _ _ __ --
R I�
3
�,�.'';"..
� ��
� �
�ka, : a
aa 'a i
`.��,+y � .�. �f ��r
���� � `Y` t �
! � t
� 1 �'' *� �"��,�-�� i
�, �� � �- .
�x t�"� �a���'�� ; '�
` � /r t ' �9 �� 2 ` F . C ��1
Ln� j i�°r��"% " >x � ��p.V a�"e'<i �,�
'�x r� /
F �*} �� �� .'� t �4�
� �....; ; ,/
�c
��� L S p� * . �
� �
� "
Figure 3-9
UL EX4521 December 13,2005 Page rev.C
24 Part#10053
Ch•apter 3-Sysrem Design
Fryers with Drip Board (High Mount Nazzle)
Compulsory Nozzle NL2H
Flow Points Per Nozzle 2(Two)
Number of Nozzles Required 1 (One)
Maximum Area of Protection
Condition 1
Deep Vat Cooking Area 324 square inches with a maximum longest side dimension of 18 inches.
(excludes drip board)
Overall Cooking Area 500 square inches with a maximum longest side dimension of 27-3/4 i�ches.
(includes drip board)
Condition 2
Deep Vat Cooking Area 371 square inches with a maximum longest side dimension of 19-1/2 inches.
(excludes drip board)
Overall Cooking Area 495 square inches with a maximum longest side dimension of 25-3/8 inches.
(includes drip board)
Nozzle Location Anywhere over the cooking surface.
Nozzle Height 24 inches to 48 inches above the cooking surface.
Nozzle Aiming Aimed at the center of the cooking surface.
Graphic Representation See Figure 3-5
- . -- - - - --- _
i -- — - -- : _- .- -:
_ __
� Nozzle must be located anywhere within the shaded area and aimed at the center of the cooking surface.
- _ ___ ,, _— ---_ _- -- --- ''
OVERAI,L OVERALL
COOHING ARFA COOKING[1RF..A
LONGEST SIDE S S00 SQUARE LONGEST SIDE \ 495 SQUARE
DIMENSION� /INCHES DIMENSION� INCHES
27 3/4' MAXIMUM 25-3/S" MA7CIMLTM
f� COOKING � f KING
: � ARFA � � AREA
i �� � �
� ::.� - �
j t �
t '�►'� a '.,��� i
� l ,_-! i � < .
J 3 j"`�� I � � 1
� f. ,sw� �`;�„ �. �I
f� �, .... �� _,
r ��, 48° � �r" 1
� 48„
E -''
;. . t
,.� �.
324 SQUAR ` 1 . 371 SQUA =', j ,
INCHES INCHES
MAXIMUM � '
r'�� �rr� MAXIMUM � ` '��y ` s
DEEP VAT t! DEEP VAT � ' +r�
AREA # �` AREA �,.r
f>
18" ', r. 1964"
DRIPBOARD LONGEST D�pgOARD LONGEST
SIDE SIDE
DIMENSION DIMENSION
�DEEP VAT) (DEEP VAT)
Conditio�a 1 Condition 2
Figure 3-S
UL EX4521 December 12,2006 lg Page rev.C
Part#10053
• i
SECURITY IRE EQUIPMENT � '�>>appliances piotected with correct nozzles: � No
1833 Lawrence Rd , 2.Duct&Plenum protected wiUi comect no�les es No '�
Dade ity,FL.33523 3.Position of all nozzles correct es No
(3� )567-7340 4.System installed in accord with Man.–DL listing No
Fire Su res ion S stem Re Ol't 5.Hood–Duct penetrations sealed Y No
��� ,t e ` 6.Has system been dischuged or damaged y� �
Name: ��'��;;� S 7.Wl�at is the cylinder pressure
� —
I Address: �� �j � 8��T1�at is the cartridge weight CQ"►fa
�..J_�r�
` 9.Gas Valve Mechani Electrical
City: State: FL.Zip:�� 10.Hydrostatic test Date
Owner–Manager: �,e 11.Operate system from fusible link No
12.Operate system from remote release Yes No
Phone: �) 7 � �, 13.Did micro-switch function
Yes No
14.Did gas shut-0ffvaive function Ye No
Date uf Sen+ice � Time ,n,hq pM 15.Clear all nozzles
8�}�/ � � . � Y No
J 16.Nozzle covers in place Yes No
Type of Service Semi Annu 1 NeW C�e��g 17.Check&dean fusible links Y� �
� 0 18.Replaced fusible links Qt}__� ye No
Model
Manufacturer /(.1�� � p ��� 19.Piping securely bracketed Yes No
/�#� n� 20.Exhaust fan operating
e No
Slave Cylinder
Master Cylinder � � � ,� � 21.Make up air operating Yes No
� ` 22.A11 grease filters in place Sc clean Yes No
Fype of Link
Link Temp � 23.Personnel instructed on use of system Yes �
,
ML B 24.Exhaust hood–du�t clean es No
Fuel Shut-0ff Valve t�1Ze 25.Alarm Actuation
Yes No
` �
Serial Nbr ��Q 7 �C�1 Comments or discrepazicies: ���Y1 ,� S
� �
ApiJ11111Ces
Len Width liance Nozzle
�� / f't"� _ _ !v _
Z
6
� � v f'� e -�(� On the above date,this system was inspected&tested in accordance with procedures of the
•Z,�..t ''L v L , presenUy adopted editions of NFPA]7,I?q and tLe manufachaer's manual and was ope���
G/ � � according to these pmcedm�es with results indicated above.
� � ` 1 � Disclaimer.
Owner–Mgr undersfands that all discrepancies must be addressed within 16 days of this r�eport
and that this equiprt�ent must be re-inspetted after disaepanaes are corrected,Security Fire
Equipment wiil not be held liable for any pre-engineered fire suppression system faiture.Oxmer–
� �j� Q a N x Z Mgr understands that this is a fire suooression svstem and that operation of this system may not
� e�inguish a fire or a fire may infially be suppressed bui can re-ignite.pymer–Mgrwill be
� `L W responsible for immediately notifying emergency services to respond to these premises in the
Hand Portable Fire Extinguishers event of a fire.Owner–Manager assumes all responsibility for damage and/or injury due to a fire
or fire suppression sysfem failure on these premises
Restaurant Exhaust Hoods Cleaning
Operator Instructed:
Fire Suppression Sy tems
Emergency ighti ng Owner–Mgr:
Batt ries and Bulbs
Service Technician:
All Fire Kelated Products
.
SECURITY FIRE EQIJIPMENT I_All appliances protected with correct nozz]es: esj No
18330 Lawrence Rd 2-Ducc&Ple�um pcocuxed with coaect aozzles es` No
Dade City,FL 33523 3_Posidon of all nozzles coffect es� No
(3 52)567-7340 4.System installed in accoid with Man.–IJL listing 'e No
5.Hood–Duct penetrations sealed �e�,i No
Fire Su�ressifln S ystem Report 6.Has system been dischazged or damaged Yes Io
�T� ..../ f7.Whaz is the cylir►der pmssure �-`�
Name:d � i.wt S .�l��g� ����d 8.�Vhat is the cartrid�e wei�h[
9.Ga�Vatve MecF�u Etecxrical
Address: _ �'?��j �� _��( �tt ST ,...� ,�_
10.Hydrostauc test Date M(�
City: ��p��l.-�u�f��� St3te: FI,.Zip: ��S-��o� 1 i.Operate system from fusible link � No
� 12.Operate system from remote ielease No
Owner–Manager_
13_Did micro-switch funcdon Ye�d No
Phone: (�� �'�—��.�� 14.I1id gas shut-off valve funcrion Y �` No
I 5.Clear all nozztes No
Date of Service T'une AM - M lb.Nozzle covets in place es� No
Z" � `� � l7.Check&clean fusible links Yes No)
Type of Service �� ,�. 3 Repipe - Rechazge
� �°`� 18.Replaced fusibie links Qty� � No
Mannfacturer Model 19.Piping securely brncketed � No
.�
Master G�tinder S ave Cylinder 20.Ezhaust fan operating �'+ No
?l.All grease filters in place&ciean �;e, No
Link Temp Type of '
� " � �_B 22.Personnel insaucted on use of sysrem � No
Fuel Shui-Off Valve Size 23.Exhaust hood–dud clean Y�e,` No
���r �� 24.Alazm Actuation 1'� No
,� ��C'�
i
Comrnents or disciepancies: I
Appliances ,
Len Widih A liance T
le
�J 1i _ �.f Gas - Electric
j r c ,� - Gas - IIectric
� �l
j ` /�' �./° Gas - Elect�ic
y'��k � Gas - II�tric
� `� `� On d�above date,this system waz inspected&tested'm acco�daoce with prnaed�of tBe
�f 4 /v Gas - EleCtrIC P���h•adopted edido�of NFPA 17,17A and the manufacpuer's menoal and was opemted
�� `f j ����` accordin ro these
f! /,�l � 8 P�duies with nsnits i�dica0ed above.
y Cras - IIearic
•3•� S'"'� �'"� - f a7�,�"� Gas - Electric Disdaener:
_ �� ��� Owner–Mgr underslands riat ali discrepancies must be addressed wifiin tU days of this�eport
Gas - Electr;c and fhat this equipment must be rein.specled afEerdiscrepancies are correc�ed.Seqrriiy Fire
� fras - Elecaic EqeipmeM wili not be held�le for any pre-eng6�ee�ed fire suppression sys�m failure.Owr�er–
.;i�a.�► /� Mgr lmderstands U�at this is a fire suonression svstem and fiat opera�ion af tlus system may not
Q r� �,.,7 s: Gas - Elec[ric ext�guish a fire or a fire may in+liaAy be suppressed b�►i can re-ign�e.Oamer–Mgr w1p be
x°Z responsble for Kr�nediately r►otitying e�neryency services to respona��ese prertbs�n u�e
Gas - Eiectric evenf of a fire.Owner–M�ager assianes aA respauib�'6ty for damege and/o1��►jury due�o a fire
or fire suppression system failure ai these prern�es
Date Exhaust System Cleaned:__7 oz 7��
�j\ Operator Instcucted:
Cteaned hy: /'� f��1'�,�
,
Owner-Mgr_
�'���le,� z1r� ��r��' _
Service Technician: �,�_ — �-�