**THIS FORM MUST BE SUBMITTED WITHIN 30 DAYS FROM THE DATE OF INSPECTION TO THE OCEAN CITY FIRE
MARSHALS OFFICE **
Rev. 1/13/2011
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
Sprinkler System
Annual Certificate of Inspection in Accordance with NFPA 25
Non-Annual Certificate of Inspection in Accordance with NFPA 25
Deficiencies: YES NO
Is system provided with a fire pump?: YES NO Fire pump test date:
Protected Property:
Building Name:________________________________ Exact Physical Address:__________________________________________
Contact Person:________________________________ Bill To:_______________________________________________________
Contact Phone #:_______________________________ Billing Address:________________________________________________
Sprinkler System Testing Company:
Inspector/Technician:___________________________ Company:_______________________________________________
Phone Number:________________________________ Address:_________________________________________________
Date System Tested:____________________________ _________________________________________________
Sprinkler 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(s): Wet Sprinkler Dry Sprinkler Pre-Action Deluge Water Spray Other
System Monitoring:
Is this system monitored off site? Yes No Have appropriate authorities been notified prior to testing? Yes No
If yes, provide name, location, and phone number of monitoring station:________________________________________________
_________________________________________________________________________________________________________
Deficiencies Identified During Inspection:
System out of Service/ Impaired Fire Pump / Jockey Pump Inoperative
Unprotected Areas Improper Design of Sprinkler System
Closed Control Valve Quick Opening Device Inoperative
Dry Pipe System Tripped FDC Sign Obstructed or Missing
FDC Obstructions Other Comment 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:__________
