First Floor Kitchen_Redacted.pdf

National Fire Protection Association (NFPA) Kitchen Fire Protection System Form 1 of 3

Report of Automatic Sprinkler Systems Inspection, Testing, and Maintenance of Kitchen Systems

Inspector: SEMI-ANNUAL Inspection Date: December 28, 2022 Service Ticket #: 184110

Site: System Inspected: Area: Site Contact:

James J Peters VA Medical Center 130 West Kingsbridge Road, Bronx, NY, 10468

System # 66-079001 Type: Kitchen Panel:

Kitchen/Hood 1 Floor: 1 Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch Panel C by front serving line

Date Fusible Links Replaced 12/28/22 (6) 360degree. (1)Mechanical Pull Station

Renovation N/A

Recharge N/A

Fuel Shutdown yes

Electric YES

Gas YES

Last Hydro Test Date 2016 refilled after a system release-Tank manufactured in 2010

How many tanks

Size of Tank 1 3 gal

Size of Tank 2 3 gal

Size of Tank 3

NA

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove Appliance

Fryer

NA

Griddle

NA

All appliances properly covered w/ proper nozzles

(2) New Pressure Cooker are NOT properly protected, (4)Discharge Nozzles need to be reconfigured to protected appliances.

NO

Duct & plenum covered w/ correct nozzles YES

Check positioning of all nozzles YES

System installed in accordance w/mfg. UL listing YES

Hood.duct penetration sealed w/weld/UL device YES

Check if seals intact, evidence of tampering YES

If system has been discharge, report same N/A

Pressure gauge in proper range (if gauged) N/A

Check cartridge weight (if applicable) YES

Hydrostatic test date YES

6 years maintenance date YES

Inspect cylinders and mount YES

Operate system from terminal link YES

Test for proper operation from remote YES

Check operation from micro switch YES

Check operation of gas valve YES

Clean nozzles YES

Proper nozzle covers in place YES

Check Fuse Links and clean YES

Replace fuse links YES

Check travel of cable nut/s hooks YES

Piping & Conduit securely bracketed YES

Proper separation between fryers & flame YES

Proper clearance flame to filters YES

Exhaust fan in operating order YES

All filters replaced N/A

Fuel shut-off in on position YES

Manual & remote set seals in place YES

Replace system covers N/A

System operational & seals in place YES

Slave system operational YES

Clean cylinder and mount YES

Fan warning sign on hood YES

Personnel instructed in manual operation YES

20 BC Extinguisher mounted YES

Portable extinguishers properly serviced YES

Service & Certification tag on system YES

Comments

Report of Automatic Sprinkler Systems Inspection, Testing, and Maintenance of Kitchen Systems

Inspector: SEMI-ANNUAL Inspection Date: December 28, 2022 Service Ticket #: 184110

Site: System Inspected: Area: Site Contact:

James J Peters VA Medical Center 130 West Kingsbridge Road, Bronx, NY, 10468

System # 66-079002 Type: Kitchen Panel:

Kitchen/Hood 2 Floor: 1 Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch Panel C by front serving line

Date Fusible Links Replaced 12/28/2022 (2)360degree. (1)Mechanical Pull Station

Renovation N/A

Recharge N/A

Fuel Shutdown gas shut down reset push buttons at system control panel

Electric YES

Gas YES

Last Hydro Test Date 2016 refilled after a system release-Tank manufactured in 2010

How many tanks

Size of Tank 1 3gal

Size of Tank 2 3gal

Size of Tank 3

NA

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove Yes

Fryer

NA

Griddle

NA

All appliances properly covered w/ proper nozzles YES

System installed in accordance w/mfg. UL listing YES

Hood.duct penetration sealed w/weld/UL device YES

Check if seals intact, evidence of tampering YES

If system has been discharge, report same N/A

Pressure gauge in proper range (if gauged) N/A

Check cartridge weight (if applicable) YES

Hydrostatic test date YES

6 years maintenance date YES

Inspect cylinders and mount YES

Operate system from terminal link YES

Test for proper operation from remote YES

Check operation from micro switch YES

Check operation of gas valve YES

Clean nozzles YES

Proper nozzle covers in place YES

Check Fuse Links and clean YES

Replace fuse links YES

Check travel of cable nut/s hooks YES

Piping & Conduit securely bracketed YES

Proper separation between fryers & flame YES

Proper clearance flame to filters YES

Exhaust fan in operating order YES

All filters replaced N/A

Fuel shut-off in on position YES

Manual & remote set seals in place YES

Replace system covers N/A

System operational & seals in place YES

Slave system operational YES

Clean cylinder and mount YES

Fan warning sign on hood YES

Personnel instructed in manual operation YES

20 BC Extinguisher mounted YES

Portable extinguishers properly serviced YES

Report of Automatic Sprinkler Systems Inspection, Testing, and Maintenance of Kitchen Systems

Inspector: SEMI-ANNUAL Inspection Date: December 28, 2022 Service Ticket #: 184110

Site: System Inspected: Area: Site Contact:

James J Peters VA Medical Center 130 West Kingsbridge Road, Bronx, NY, 10468

System # 66-079003 Type: Kitchen Panel:

Serving Line/Hood 3 Floor: 1 Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch Panel C by front serving line

Date Fusible Links Replaced 12/28/2022 (4)360degree. (1)Mechanical Pull Station

Renovation N/A

Recharge N/A

Fuel Shutdown Gas shut off via pressure line piston reset location behind flat top stove

Electric YES

Gas YES

Last Hydro Test Date 2016 refilled after a system release-Tank manufactured in 2010

How many tanks

Size of Tank 1

3 GAL

Size of Tank 2

NA

Size of Tank 3

NA

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove

NA

Fryer Yes

Griddle Yes

Hood.duct penetration sealed w/weld/UL device YES

Check if seals intact, evidence of tampering YES

If system has been discharge, report same N/A

Pressure gauge in proper range (if gauged) N/A

Check cartridge weight (if applicable) YES

Hydrostatic test date YES

6 years maintenance date YES

Inspect cylinders and mount YES

Operate system from terminal link YES

Test for proper operation from remote YES

Check operation from micro switch YES

Check operation of gas valve YES

Clean nozzles YES

Proper nozzle covers in place YES

Check Fuse Links and clean YES

Replace fuse links YES

Check travel of cable nut/s hooks YES

Piping & Conduit securely bracketed YES

Proper separation between fryers & flame YES

Proper clearance flame to filters YES

Exhaust fan in operating order YES

All filters replaced N/A

Fuel shut-off in on position YES

Manual & remote set seals in place YES

Replace system covers N/A

System operational & seals in place YES

Slave system operational YES

Clean cylinder and mount YES

Fan warning sign on hood YES

Personnel instructed in manual operation YES

20 BC Extinguisher mounted YES

Portable extinguishers properly serviced YES

Report of Automatic Sprinkler Systems Inspection, Testing, and Maintenance of Kitchen Systems

Inspector: SEMI-ANNUAL Inspection Date: December 28, 2022 Service Ticket #: 184110

Site: System Inspected: Area: Site Contact:

James J Peters VA Medical Center 130 West Kingsbridge Road, Bronx, NY, 10468

System # 66-079004 Type: Kitchen Panel:

Serving Line/Hood 4 Floor: 1 Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch Panel C by front serving line

Date Fusible Links Replaced 12/28/2022 (1)360degree. (1)Mechanical Pull Station

Renovation N/A

Recharge N/A

Fuel Shutdown

YES

Electric YES

Gas YES

Last Hydro Test Date 2016 refilled after a system release-Tank manufactured in 2010

How many tanks

Size of Tank 1

3 GAL

Size of Tank 2

NA

Size of Tank 3

NA

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove Oven

Fryer

NA

Griddle

NA

Hood.duct penetration sealed w/weld/UL device YES

Check if seals intact, evidence of tampering YES

If system has been discharge, report same N/A

Pressure gauge in proper range (if gauged) N/A

Check cartridge weight (if applicable) YES

Hydrostatic test date YES

6 years maintenance date YES

Inspect cylinders and mount YES

Operate system from terminal link YES

Test for proper operation from remote YES

Check operation from micro switch YES

Check operation of gas valve YES

Clean nozzles YES

Proper nozzle covers in place YES

Check Fuse Links and clean YES

Replace fuse links YES

Check travel of cable nut/s hooks YES

Piping & Conduit securely bracketed YES

Proper separation between fryers & flame YES

Proper clearance flame to filters YES

Exhaust fan in operating order YES

All filters replaced N/A

Fuel shut-off in on position YES

Manual & remote set seals in place YES

Replace system covers N/A

System operational & seals in place YES

Slave system operational YES

Clean cylinder and mount YES

Fan warning sign on hood YES

Personnel instructed in manual operation YES

20 BC Extinguisher mounted YES

Portable extinguishers properly serviced YES

Report of Automatic Sprinkler Systems Inspection, Testing, and Maintenance of Kitchen Systems

Inspector: SEMI-ANNUAL Inspection Date: December 28, 2022 Service Ticket #: 184110

Site: System Inspected: Area: Site Contact:

James J Peters VA Medical Center 130 West Kingsbridge Road, Bronx, NY, 10468

System # 66-079005 Type: Kitchen Panel:

Serving Line/Hood 5 Floor: 1 Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch Panel C by front serving line

Date Fusible Links Replaced 12/28/2022 (1)360degree. (1)Mechanical Pull Station

Renovation N/A

Recharge N/A

Fuel Shutdown

YES

Electric YES

Gas YES

Last Hydro Test Date 2016 refilled after a system release-Tank manufactured in 2010

How many tanks

Size of Tank 1

3 GAL

Size of Tank 2

NA

Size of Tank 3

NA

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove

NA

Fryer

NA

Griddle Yes

Hood.duct penetration sealed w/weld/UL device YES

Check if seals intact, evidence of tampering YES

If system has been discharge, report same N/A

Pressure gauge in proper range (if gauged) N/A

Check cartridge weight (if applicable) YES

Hydrostatic test date YES

6 years maintenance date YES

Inspect cylinders and mount YES

Operate system from terminal link YES

Test for proper operation from remote YES

Check operation from micro switch YES

Check operation of gas valve YES

Clean nozzles YES

Proper nozzle covers in place YES

Check Fuse Links and clean YES

Replace fuse links YES

Check travel of cable nut/s hooks YES

Piping & Conduit securely bracketed YES

Proper separation between fryers & flame YES

Proper clearance flame to filters YES

Exhaust fan in operating order YES

All filters replaced N/A

Fuel shut-off in on position YES

Manual & remote set seals in place YES

Replace system covers N/A

System operational & seals in place YES

Slave system operational YES

Clean cylinder and mount YES

Fan warning sign on hood YES

Personnel instructed in manual operation YES

20 BC Extinguisher mounted YES

Portable extinguishers properly serviced YES

UNITED FIRE PROTECTION CORP.

Work Ticket Delivery Date: December 28, 2022 Ticket #: 184110.12282022

Account #: 66-07900

PO#

Scheduled by:

Site Name: James J Peters VA Medical Center

Address: 130 West Kingsbridge Road, Bronx, NY, 10468 Building

Site Contact:

Type of Call: Inspection

Work Tickets Notes:

Scope of Work: Perform Semi Annual Kitchen inspection.

TO BE PERFORMED:

Site Act # Frequency Ctrl Panl

System Area Building Str# Str Fl City St

66-079001 Semi Annual Kitchen Kitchen/ Hood 1

130 West Kingsbridge Road

1 Bronx NY

66-079002 Semi Annual Kitchen Kitchen/ Hood 2

130 West Kingsbridge Road

1 Bronx NY

66-079003 Semi Annual Kitchen Serving Line/ Hood 3

130 West Kingsbridge Road

1 Bronx NY

66-079004 Semi Annual Kitchen Serving Line/ Hood 4

130 West Kingsbridge Road

1 Bronx NY

66-079005 Semi Annual Kitchen Serving Line/ Hood 5

130 West Kingsbridge Road

1 Bronx NY

Description of Work Performed:

Performed Annual Inspection and Maintenance of (5)Kitchen Systems Protection 1Flr Kitchen Prep. Area.

System Left Normal and in Full Service.

Follow-up Required:

Kitchen Hood Serving Line 2.

(2) New Pressure Cooker are NOT properly protected, (4)Discharge Nozzles need to be reconfigured to protected appliances.

Material Used:

Qty Make Model Description

NA