Fire Department inspection report form

NYC 9/11 Public Portal Document

A-468 (5/90) H1-901S26-5-.117 FIRE DEPARTMENT • CITY OF NEW YORK Bureau of Fire Prevention RANGE HOOD EXTINGUISHING SYSTEM REPORT

Folder No_ ^/

Batt. No.. Boro._y^^X^ _ Zip /S ' Premises Address.

Name of Establishment ---- _____________________________

Installer’s Name.

Address

Name of System. B.S. of A. No. <S'2 -S/y Z2-

Model No.. 2,__ _________Container Size^xz4.^.^5^^l./lbs., No. of /4/__

Type of Extinguishing Agent,

Location of System(s). 7^

Remote Manual Release: Location

Automatic Fuel Shut-off Yes □ No Type; □ Gas Electric I *■ -I-'’ Pipe Sizes: From Supply _ dS ir _, Between Nozzles_ ~K-

Detection: Fusible Links: Number ot 5^ , Temp. Setting _

Other___

Hood Dimensions A). Duct Dimensions A).

Bl 'X B)

Blower Shut Down: □ Yes X No Damp^ Close: □ Yes/^Z& No BSA of^A No._ B. S. of A. Grease Filters: RYes □ No, Pi2i^No./<>^£±L?^Z6 / Installation Conforms with Plan: Yes □ No, System Tested: Automatically XYes □ No, Results „

Manually 'XsYes □ No, Results _ lie Diagrams and Signs Posted: SfYes □ No, V. O. Issued.

Recommendations: ■ 0 A239 □ D-2 Issued F. D. Tag No.. '22/ Remarks:

Inspector (print) .

Inspector (sign)

Date of Test____

NYC-WTC_000166089