**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
Hood Fire Suppression System
Annual Certificate of Inspection in Accordance with NFPA 96
Non-Annual Certificate of Inspection in Accordance with NFPA 96
Deficiencies: YES NO
Protected Property:
Building Name:________________________________ Exact Physical Address:__________________________________________
Contact Person:________________________________ Bill To:_______________________________________________________
Contact Phone #:________________________________ Billing Address: ________________________________________________
Hood Fire Suppression System Testing Company:
Inspector/Technician:___________________________ Company:_______________________________________________
Phone Number:________________________________ Address:________________________________________________
Date System Tested:____________________________ ________________________________________________
Hood Fire Suppression 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 Chemical Dry Chemical Other
Deficiencies Identified During Inspection:
System Out of Service/ Impaired Exhaust System Out of Service
Unprotected Appliance Missing Filters
Nozzle Blocked / Obstructed Grease Laden Filters / Hood / Duct Area
Failure of Gas or Electric Shut Off Agent / Expellant Gas Levels Inadequate
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:__________
