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Fire Department Inspection Report form

Machine-extracted title · confidence 90%

Blank FDNY Bureau of Fire Prevention inspection report form for restaurant premises.

NYC-WTC_000166036–000166039
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NYC 9/11 Public Portal Document

A-324R M-931511-9-110 FIRE DEPARTMENT, CITY OF NEW YORK • BUREAU OF FIRE PREVENTION lb' NEW vom INSPECTION REPORT FOLDER NO. ACCOUNT ADM CO START DATE DO. TYPE

[BZEBZIZKIzlZl I I I I I Q.J m RESTAURANT NAME

I I I I I I I PREMISE ADDRESS

AKA: I I Till THEET NUMBER PREFIX -

SUFFIX STREET NAME 11 M 11111 BORO CODE TVPE^ ZIP CODE

BILLING ADDRESS

UP L Dlc-I 1 I I 1 1 1 1 I I THEET NUMBER Eg PREFIX - STREET NAME 'A? 0 TYPE f SUFFIX - ZIP CODE / 5 g BORO COPE -I / I

ENTER HERE IF OUT OF TOWN

STATE- ““ I I I I I I I I I I fli PMA PHf HX INSPECTOR NAME EXAMINER NAME DATE

[TEM CODE ] ITEM SUB CODEJ QTY DESCRIPTION FLOOR NO

1 2 3 f- t 4 S r 6 A 7 8 9 10 11 12 COMMENTS

STATUS - CHECK AND COMPLETE □ INSPECTION DATE INSPECTOR I D

H VIOLATIONS REPORTED HBzTZIZkEIZl ij kioR-iy^/|3|^i 1 VO. ISSUED VO. DISMISSAL / RESCIND NOV. ISSUED C- 6- 5 ?S6 777-7 / z /

FRY =RK. DATE.

NYC-WTC_000166037

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NYC-WTC_000166037Source: NYC Law Department, mirrored locally

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Blank A-324R inspection report form from the FDNY Bureau of Fire Prevention for recording restaurant premises details.

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