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Home My WebLink AboutFP 2007-00043 Material & Test Certificate CONTRACTOR'S MATERIAL&TEST CERTIFICATE FOR ABOVEGROUND PIPING • PROCEDURE Upon completion of work,Inspection and tern shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left In service before contractor's personnel finally The the lob. A owl/late shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities,owners end contractor, It Is understood the owner's representative's signature In no way prejudices any claim against contractor for faulty material,poor workmanship, or failure to comply with approving authority's requirements or load ordinances. PROPER/ AME E 01- & c,-'S rYSa7 PROPSYARD/ RESS7��`(^! ; ACCEPTED BY APPROVING AUTH0 0 ( NAMES CC BILI ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS.. areLIS 0 NO EQUIPMENT USED IS APPROVED EYES ONO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT SEEN INSTRUCTED AS TO LOCATION p+I'ES 0 NO OP CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT IF NO,EXPLAIN INSTRUCTIONS pOA Ess OFROPRA !ININSTRUCTIONS AND CARE AND MAINTENANCE CHARTS S El NO AND HAVE SEEN "mammas IF NO,EXPLAIN LOCATIONND CARE A/5)00S.�/L y�� /j�yr �e OF SYSTEM V�t LV L i/l/ F14,1441 i+e/ CZ,7 A SIN ig/�c3C�1 T YEAR OF ORIFICE TEMPERATURE MAKE MODEL OUANTITV MANUFACTURE RATING `j'�/e'er £41 ' "TV 22 -. 70v7 r " c3 /,$'-5-a SPRINKLERS jjllf/C&J , 4S i /33 2vv"/ X. " / .5 LSA " PIPE CONFORMS TO, / ee-O, STANDARD see YES 0 NO PIPE AND FITTINGS CONFORM TO r1/f 7' STANDARD j'ES 0 NO FITTINGS IF NO,EXPLAIN ALARM DEVICE MAXIMUM TIME 10 OPERATE THROUGH TEST PIPE ALARM TYPE MAKE MODELzi, MIN. S VALVE OR FLOW i/i41"I S A� Sy cin D Y . 3 INDICATOR S W t re b+ JZ Nv<eYl DRY VALVE • 0 0.0. MAKE. MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP WATER AIR TRIP POINT TI WATER ALARM REACHED OPERATED THRU TEST PIPE' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' PROPERLY DRY PIPE MIN, SEC, PSI PSI PSI MIN. SEC. YES NO OPERATING TEST Without I 0.0.0. t Wren O.O.O. IF NO,EXPLAIN 'MEASURED FROM TIME INSPECTOR'$TEST PIPE IS OPENED. SSA 00101 PRINTED IN USA (OVERI Contractor's Material&Teat Certificate for Aboveground Piping 1 13-10 SPRINKLER SYSTFMS see-- - - - OPERATION ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED ❑YES ONO 'DETECTING MEDIA SUPERVISED ❑YES ONO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS OYES ONO DELUGE Si IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO,EXPLAIN PREACTION ❑YES 0 NO VALVES ,A, MAKE MODEL DOES EACH CIRCUIT OPERATE r DOES EACH CIRCUIT MAXIMUM-wen)iji I/Y\ SUPERVISION LASS ALARM OPERATE VALVE RELEASE OPERATE RELEASE YES l NO YES NO MIN. SEG 1 HYDROISTATIC: Hydrostatic tests shell be made at not less theni200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static pressure in excess of 150 psI(10.2 bars)for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. TEST FL�SHING: Flow the required rate until water is clear as Indicated by no collection of foreign material in burlap bags at outlets such as DESCRIPTION hydrants and blow-offs. Flush at flows not less than 400 GPM(1514 L/min)for 4-inch pipe,600 GPM(2271 L/man)for 5•inch pipe, 750 GPM(2839 L/min)for 6-inch pipe,1000 GPM 13785 L/min)for 8-inch pipe,1500 GPM(5678 L/min)for 104nch pipe and 2000 GPM(7570 L/min)for 12-Inchipe. When supply cannot produce stipulated flow rates,obtain maximum available. PNEUMAT C:Establish 40 psi 12.7 bars)air pressure and measure drop which shall not exceed 144 psi(0.1 bars)in 24 hours. Test pressure tans at normal water level and air pressure and measure air pressure drop which shall not exceed 144 psi(0.1 bars)in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT PSI FOR HAS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED(j'sy ❑YES ❑NO , R EQUIPMENT OPERATES POPERL !!tt OYES ❑NO 13 •4-•/ DRAIN READING OF GAGE LOCAT N WATER SUPPLY TEST PIPE: RESIDUAL WITH VALVE IN TEST PIPE OPEN WIDE TESTS TEST STATIC PRESSURE: PSI PSI Underground mains and le in connections to system risers flushed bef a connection made to sprinkler piping. VERIFIED BY COPY OF THE U FORM NO,15511 ❑YES ONO OTHER EXPLAIN I FLUSHED BY INSTALLER OF UNDER• GROUND SPRINKLER PIPING Dyes ONO BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING ❑YES ONO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS 010.9,LEVEL AR-3 ❑YES ONO 00 YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3 ❑YES 0 NO 00 YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF OYES ONO PIPING ARE NOT PENETRATED HYDRAULIC NAMEPLATE PROVIDE IF NO,EXPLAIN DATA NAMEPLATE YES 0 N DATE LEFT IN SERVICE WIT ALL C NTROL ES OPEN: REMARKS ' ` Q NAME O PRINKLER CONTRACTOR . atad/ r )re-4 1044� c--'r 6cr- '7 e I TESTS WITNESSED BY SIGNATURES FO' PROPERTY OWNER(SIGNED TITLE DATE 1 b.– C 1.4_..t. I -Ftc,f CA-Ctt_ 6611414Q4At I q"S--—t 7 FOR SP .�L_• CONT CTOR(SIGNED) TITLE DATE ` ADDITIONAL EXPLAN•T ON AND NOTES i SSA BACK Contractor's Material&Test Certificate for Aboveground Piping i J