**THIS FORM MUST BE SUBMITTED WITHIN 30 DAYS FROM THE DATE OF INSPECTION TO THE OCEAN CITY FIRE
MARSHALS OFFICE **
Rev. 10/7/2008
TOWN OF OCEAN CITY - OFFICE OF THE FIRE MARSHAL
P.O. Box 158 Ocean City, MD 21843
Phone # 410-289-8780 Fax # 410-289-8767
CERTIFICATE OF INSPECTION
Standpipe System
Annual Certificate of Inspection in Accordance with NFPA 25
Non-Annual Certificate of Inspection in Accordance with NFPA 25
Deficiencies: YES NO
Protected Property:
Building Name:________________________________ Exact Physical Address:__________________________________________
Contact Person:________________________________ Bill To:_______________________________________________________
Contact Phone #:_______________________________ Billing Address:________________________________________________
Standpipe System Testing Company:
Inspector/Technician:___________________________ Company:_______________________________________________
Phone Number:________________________________ Address:_________________________________________________
Date System Tested:____________________________ _________________________________________________
Standpipe System Owner’s Notification:
The owner and/or the owner’s representative of the system was notified on
of all deficiencies?
PRIOR TO TESTING, OCEAN CITY COMMUNICATIONS SHALL BE NOTIFIED!
PHONE # 410-723-6620
(Failure to do so will result in the full provisions of the Town of Ocean City Fire Prevention and Protection Code to be invoked.)
Dispatcher Name/Number:_____________________________ Time:__________________
System Type:
Wet Standpipe Dry Standpipe Manual Semi-Automatic Automatic Other
Pressure Restricting Devices / Valves (PRV’s):
Are PRV’s provided? Yes No
Deficiencies Identified During Inspection:
System Out Service FDC Obstructed
Fire Hose Connection Damaged Cap(s) Missing on FDC
Valve Handle Missing Valves Do Not Operate Smoothly
Hose Connections / Valve Leaking Pressure Restricting Device Not Functioning Properly
Damaged Pipe Control Valve(s) Damaged
FDC Sign Missing / Obstructed Fire Hose Connection Obstructed
Control Valves Not Supervised Horizontal and/or Vertical Pipes Not Supported Properly
Other: List Below
Comments / Deficiency Description:
(Attach an “Additional Information Form” if more room is needed.)
___________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
FOR INTERNAL USE ONLY:
Data Entry Date:__________ FM Assigned:__________ Date FM Assigned:__________ Date Inspected/Contacted:__________
No Deficiencies Found Deficiencies Verified
QV #:__________ Date of Violation:__________ Date of Compliance:__________
