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PIPER FIRE PROTECTION.INC. <br /> 13075'US HWY19 NORTH Pi <br /> SYSTEM <br /> CLEARWATER,'FL 33764 <br /> p e r SUPPRESSION* <br /> S TAT EWIDE.(800)$27-7604 .. <br /> PIPERFIRE.COM. <br /> Fire Protection REPORT <br /> ... CUSTOMER NAM E..:-• .. - ,. - - - -- - - - <br /> I NUMBER/WORK ORDER#JC# DATE <br /> Publix#1245 10-30-02127:• 8M 2/2020 <br /> SERVICE ADDRESS -- - <br /> ' - CITY' - -STATE,IZI.P <br /> 7838 Gall Blvd: . <br /> Zephyrhills FL' 33541 <br /> .BILLING ADDRESS cITY. . - . . . . .. I STATE ZIP <br /> . - - <br /> ' <br /> CONTACT,NAME: -- . . : CONTACT TEL'NO.. CONTACT EMAIL- - - <br /> -SYSTEM LOCATION. - MANUFACTURER MODEL# - SERIAL _ - SIZE' - <br /> Kitchen ANSUL R-102 �•�� � 9 GAL <br /> DETECTION TYPE ' - NUMBER. TEMP ". YEAR -MANUAL PULL' "„ ACTUATION CARTRIDGE/,DATE /PSI PRESSURE. MFG DATE/HYDRO TEST.DATE <br /> Fu§e'Link 5 360E 2020 .; Mech Double Tank.Cartridge., 2020 MFG <br /> EQUIPMENT SHUTDOWN. - _ ELECTRICAL' - GAS SHUT OFF.VALVE TYPE/SIZE - • HVAC - <br /> .. _ .. . <br /> Electric/Air M/croSwitch:/Alarm - - None snake Up Air <br /> 2W. - <br /> Hood. ff <br /> Duct:22"x 12":. <br /> 70 , <br /> 1N- :- 1N <br /> ♦ 360 F FUSIBLE LINK <br /> .245 260 260 260. 245 _ <br /> c6mBI-OVEN <br /> FRYER' FRYER FRYER_ <br /> W/o W/O W/O <br /> DRIPBOARD DRIPBOARD. DRIPBOARD <br /> (19"x 19") (19"x 19') (19"x 19") <br /> T. All appliances properly protected w/correct nozzles YES '20..Check travel of cable.nuts)S-hooks YES <br /> 2. Duct and plenum protected w/correct nozzles : YES ,. 21..-Piping and conduit:securely bracketed YES <br /> 3.. Nozzles.position.correctly-over the protected area YES 22: Proper separation between fryer&flame: N/A . <br /> 4.: System installed in accordance w/MNF UL listing YES. 23. Proper clearance of flame to filters YES <br /> . 5. Hood/duct penetration sealed w/weld or UL device YES .24. Exhaust fan.in.operating order YES <br /> 6. Check if seals intact,evidence of tampering YES 25. Listed hood:filters installed YES <br /> 7.: If system has being discharged,'report same .. N/A .26.-Fuel.shut-off in on position YES <br /> 8. Pressure gauge in proper range(if gauged) N/A 27. Manual&.remote set/seals in place. YES <br /> 9. Check.cartridge weight(if applicable) YES 2g. Replace system covers. YES <br /> 10. Hydrostatic test date-checked YES 29. System-operational and seals in place _ YES <br /> 11.6.year maintenance.date checked: N/A :30. Slave system operational YES- . . <br /> 12.Operate-system from terminal link YES 31. Clean cylinder and mount YES <br /> 1'3.Test for.proper operation from:remote YES 32. Fan Warning sign on hood YES <br /> 14.Test for proper operation of the gas valve N/A $3. Personal-instructed on system.bp'ratio'' YES <br /> ." <br /> 15. System-connebted to Fire Alarm Control panel. YES 34. Proper portable extinguisher class K installed . YES <br /> 16, Fire Alarm Control panel monitored YES' : . 35. Portable extinguishers properly serviced YES .. <br /> 17:Proper nozzle covers:in place YES 36:Service and Certification tag on system: " YES <br /> 18.All areas have proper fusible links.detection YES. 37. Does system meet UL'300 Standard " YES' <br /> ,-19: Replaced fusible links.. ' : YES.-• NOTE DISCREPANCIES OR DEFICIENCIES BELOW <br /> COMMENTS: <br /> Fire Final was accepted by the CITY OF ZEPHYRHILLS fire_inspector <br /> Permit#FIRE-000470-2020 . <br /> CHAD COLLINS FEP-19-000400: 8/12/2020 <br /> :'.'SERVICE TECHNICIAN "PERMIT NO. DATE ' TIME - AM PM - CUSTOMERAUTHORIZEDAGENT' <br />