Investigation of Complaint Report Form, n.d.

NYC 9/11 Public Portal Document

A-268 (4/69) OFFICE BUILDING INSPECTION FORM

DIV, BATT. CO. BLOCK NO,

1 I A. 1. Address 3 C _____________ 2. Name of Owner or Agent , lOf (LS vC z a/ feopf Height in Stories^ 4. Area<4^ 5. Date of erection \ | 6 Certificate of Occupancy posted _{A8--6 or SP.- See Instruct. Sheet) 7. Enter the number of the Certificate of Occupancy —f ---------------------------------

B. Permits, Certificates, Records. 1. Fuel Oil permit S' SfeArt (A234) 2 Fuel Oil C. of F. # . ' — -------- (F.0.1) 3. Sprinkler C. of F. number (C32) 4. Standpipe Certificate of (Qualification number 1 (C33) 5. Written records of monthly sprinkler tests_____ 1^ x _________ __£FP52) ■6. Written records of monthly standpipe tests _______ (FP43) 7. Refrigeration Certificate of (jhalification number iLQ, ~ ( 1 7________ _(C31) 8. Other required permits or certificates, enter type and the number of the permit XA234)

C. Cellar or sub cellar, state which _ Oil Butner 1. Ceiling overhead fire gytayfed / (F09) 2. Pails of sand or extinguisher provided____ (F02) 3. Movable combustiole material at lekaZ 5’ fn6m l/e3iing surfaces or fire retarded(F03) 4. Remote control properly labelled (FO8) 7 Flue pipes in good condidon(SP29)

D. Housekeeping Conditions. (Apply to etui re building) 1. All areas clear of rubbish (FP12) yZ 2. Properly coveted fire proof receptacles f or rubbish ______ 3- Fire proof receptacles with self chz^ng covers for oily waste (FP6) 4. Aisle space, minimum 3’___Z~S_______ (FP27) 5. Ceiling clearance 18” (FP'13) 6. Cellar ceilings, walls, floors in good condition, nz 'holes ________________ (SP26- A8-10) 7. Chemicals. V.T.O. paints properlvz^ored (FpX 22. 23. 24. SP-42) 8. All empty container s of flamma^trfe liquids remov^ (FPM) 9. No Smoking sigp s cx;;(FPll) 10. All electrical wiring in conduit or BX /(SP64.^1) 11. Electrical switches, junction boxes equipped with ws (SP65) 12. Only one attachment to an electrical outlet 13. Electric motors clean, free from dust and lint and with pre combustible material, (SP66,67) 14. Grease Ducts; a. Non-combustible FiltZrs or Extinguish System __vz_______ (A8-^ b. Hoods, ducts, flues and filters Clean and Record of (ZJieuning Kept (EP12A-12B) c. Where/fextinguishing system present- Control valves labelled (SP-1) Annj ^Test Record (A 8)

E. 1. Correct number of extinguishenZand o^fire pails 1FP1,3) 2. Proper date^dn tag (FP4; 3- Nozzle unobstructed \z (SP) 4. Hosegood condition _____ 5. Properly charged and placed (FP4. 5) 6/^ire pails filled, properly placed XFP2, 5)

F. Standpipe Systems. 1. Siamese caps painted red < (FP41) 2. Siamese swivel serviceable iSP46) 3. Conditions at hose outlets satisfactory x iFP42)

G. Sprinklers If no sprinklers, see instruction sheet. . t 1. Type of sprinklerjjjau^matl^^on-automaticx^^ dry AgATTJ/Y/VT I C xzY C. ________ ___________ 2. Extent of building protected Sign posted (FP50) 3. City main shut oHXabelled^d clear of*gt)structions (SP58.59) 4. Control valve^.Zealed open and labelled (FPJ^) 5. Access ladder provided for ^.efrtrol valves (over 7’^^z<.z^ (A8-43),/^ 6. Heads in place (SP53) 7. JZ'ob.structed <^^(FP55, 58) 8. FreXof paint or dirt ie<(SP52, 54) 9. Stock 18” below sprinklers ,Cz^ (FP55) 10. F.xtrazKeads (6) (FP54Y" 11. Sprinkler Siamese connecdon - automatic spripJfler, caps painted green _xz__ (FP5 1) Labelled (FP50) Swivel serviceable \ z^ (SP56) 12. Non automatic or perforated pipe I Property capped (FP53) / Painted Aluminum fU (SP60) Labelled (FP50) Swivel serviceable (SP46)

NYC-WTC_000169195