Ground 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 #: 184334

Site: System Inspected: Area: Site Contact:

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

System # 66-079006 Type: Kitchen Panel:

Kitchen/Hood 1 Floor: Ground Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch KPGEA breaker#4 by double doors

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

Renovation N/A

Recharge N/A

Fuel Shutdown

NO SHUNT TRIP SYSTEM INSTALLED

Electric YES

Gas YES

Last Hydro Test Date

How many tanks

Size of Tank 1 3 gallon

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove Microwave. Conveyor toaster

Fryer N/A

Griddle N/A

All appliances properly covered w/ proper nozzles YES

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

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

Inspector: SEMI-ANNUAL Inspection Date: December 28, 2022 Service Ticket #: 184334

Site: System Inspected: Area: Site Contact:

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

System # 66-079007 Type: Kitchen Panel:

Kitchen/Hood 2 Floor: Ground Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch KPGEA breaker #4 by double doors

Date Fusible Links Replaced 12/28/2022 (3)360. (1)Mechanical Pull Station

Renovation N/A

Recharge N/A

Fuel Shutdown N/A

Electric YES

Gas YES

Last Hydro Test Date

How many tanks

Size of Tank 1 3 gallon

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove N/A

Fryer N/A

Griddle N/A

All appliances properly covered w/ proper nozzles YES

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

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

Inspector: SEMI-ANNUAL Inspection Date: December 28, 2022 Service Ticket #: 184334

Site: System Inspected: Area: Site Contact:

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

System # 66-079008 Type: Kitchen Panel:

Kitchen/Hood 3 Floor: Ground Building:

NOT_DISPLAY

Location of Kitchen Shunt Switch KPGEA breaker #4 by double doors

Date Fusible Links Replaced 12/28/2022 (3)360. (1)Mechanical Pull Station.

Renovation N/A

Recharge N/A

Fuel Shutdown

Electric YES

Gas YES

Last Hydro Test Date

How many tanks 4 (3)gallon

COOKING APPLIANCE LOCATIONS FROM LEFT TO RIGHT:

Stove Burner, Stove top

All appliances properly covered w/ proper nozzles YES

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 YES

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

Check cartridge weight (if applicable) YES

Hydrostatic test date YES

6 years maintenance date YES

UNITED FIRE PROTECTION CORP.

Work Ticket Delivery Date: December 28, 2022 Ticket #: 184334.12282022

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: Call

Point of contact:

Scope of Work: Perform Semi Annual Kitchen inspection.

TO BE PERFORMED:

Site Act # Frequency Ctrl Panl

System Area Building Str# Str Fl City St

66-079006 Semi Annual

Kitchen Kitchen/ Hood 1

130 West Kingsbridge Road

Ground Bronx NY

66-079007 Semi Annual

Kitchen Kitchen/ Hood 2

130 West Kingsbridge Road

Ground Bronx NY

66-079008 Semi Annual

Kitchen Kitchen/ Hood 3

130 West Kingsbridge Road

Ground Bronx NY

Description of Work Performed:

Performed Semi-Annual Inspection and Maintenance of (3) Kitchen Systems Protecting Ground Level Kitchen Prep.

All Systems Left Normal and in Full Service.

Follow-up Required:

Kitchen Kitchen/Hood2 -Between 1st and 2nd Link Housing, conduit needs to be supported.

Kitchen Kitchen/Hood3 -Discharge Nozzle are not aligned with appliances.

Material Used:

Qty Make Model Description

NA

Technicians Actual Time for the Job: