Certificate Of Inspection - Sprinkler System - Ocean City Fire Marshal

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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:
 Yes  No
 Yes  No
Is this system monitored off site?
Have appropriate authorities been notified prior to testing?
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:__________
**THIS FORM MUST BE SUBMITTED WITHIN 30 DAYS FROM THE DATE OF INSPECTION TO THE OCEAN CITY FIRE
MARSHALS OFFICE **
Rev. 1/13/2011

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