Certificate Of Inspection - Sprinkler System - Ocean City Fire Marshal
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1TOWN 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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