HomeMy WebLinkAboutFP 2004-00354 Above Ground Piping Test Certificate t
cp a 004 - o0 3s
C ONTRACTORS MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING
5'7f0 fu cti)
PROCEDURE:
Upon completion or work, inspection and tests shall be made by the contractors representative and witnessed by an owners representative. All defects shall
be left in service before contractors personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood
the owners representative's signature in no way prejudices any claim for faulty material, poor workmanship, or failure to comply with approving authority's
r, uirements or local ordinances.
PROPERTY NAME: r Q iliaI - S 4c." K Gs DATE: 5- 3
PROPERTY ADDRESS: 5910 Neil Avenue North "
ACC BY APPROVING AUTHORITIES ( NAMES)
•
City of Oak Park Heights
PLANS ADDRESS:
INSTALLATION CONFORMS TO ACCEPTED PLANS ® YES U NO
EQUIPMENT USED IS APPROVED YES ❑ NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT [ZI YES ❑ NO
IF NO, EXPLAIN
INSTRUCTIONS
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 0 YES 0 NO
1. SYSTEM COMPONENTS INSTRUCTIONS CO YES ❑ NO
2. CARE AND MAINTENANCE INSTRUCTIONS I1 YES ❑ NO
3. NFPA 13 f' YES ❑ NO
LOCATION OF SUPPLIES BUILDINGS
SYSTEM ENTIRE BUILDING
DESCRIPTION MODEL YEAR ORIFICE SIZE TEMPERATURE QUANTITY
Reliable Chrome Pend F1FR 2004 1/2" 155 Ali[
Reliable Chrome Dry Pend F3QR 2004 _ 1/2" 155• 4 -
SPRINKLERS
•
PIPE B F ITT INGS / J� L I CI n i_ d- y nc P eel
(Le 4- k (r" 01 :( f��K2( C30o if) `a- MG/Ieckble !/O:. -" 6!'00:ec9
ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST
ALARM VALVE CONNECTION
OR FLOW TYPE MAKE MODE MINUTES SECONDS
INDICATOR IA le flr^}i -e/ i / <, .r -- f
DRY VALVE
Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO
TIME TO TRIP • WATER AIR TRIP POINT TIME WATER REACHED ALARM OPERATED
THROUGH TEST CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET • PROPERLY
MINUTES SECONDS PSI PSI PSI MINUTES SECONDS YES NO
DRY PIPE WITHOUT
OPERATING Q.O.D.
TEST WITH
Q.O.D.
IF NO, EXPLAIN
MEASURED FROM THE TIME THE INSPECTORS TEST CONNECTION IS OPENED.
OPERATION
0 PNEUMATIC 01 ELECTRIC El HYDRAULIC
..i .. •
n
PIPING SUPERVISED Q YES Q NO DETECTING MEDIA SUPERVISED
DELUGE Q YES Q NO
& PREATION DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS
VALVES IS THERE AN ACCESSIBLE FACILITY IN EACH CURCUIT FOR TESTING IF NO EXPLAIN Q YES Q NO
Q YES Q NO
MAKE MODEL DOES EACH CURCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO OPERATE
SUPERVISION LOSS ALARM OPERATE VALVE RELEASE RELEASE
YES I NO YES I NO MINUTES SECONDS
HYDROSTATIC: HYDROSTATIC TEST SHALL BE MADE AT NOT LESS - 1 . 60 PSI /116 BAR) FOR TWO HOURS OR 50 PSI (3.4 BAR) ABOVE
STATIC PRESSURE IN EXCESS OF 150 PSI (10.2 BAR) FOR TWO HOURS. DIFFERENTIAL DRY -PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DURING TEST TO
TEST PREVENT DAMAGE. All ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED.
DESCRIPTION PNEUMATIC: ESTABLISH 40 PSI (2.78AR) AIR PRESSURE AND MEASURE DROP WHICH SHALL NOT EXCEED 1 -1/2 PSI (0.1 BAR) IN 24 HOURS.
TEST PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1 -1/2 PSI (0.1 BAR)
IN 24 HOURS.
ALL PIPING HYDROSTATICALLY TESTED AT D PSI FOR c� HRS. IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED Al Q YES Q NO
EQUIPMENT OPERATES PROPERLY ICI YES Q NO
TESTS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OR
SODIUM SILICATES, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?
0 YES Q NO
DRAIN TEST t READING OF GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE:
(RESIDUAL PRESSURE WITH VALVE IN TEST PIPE OPEN WIDE
STATIC PRESSURE: PSI
PSI
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFOR CONNECTION MADE TO SPRINKLER PIPING.
VERIFIED BY COPY OF THE U FORM NO. 85B Q YES Q NO OTHER
EXPLAIN:
FLUSHED BY INSTALLATER OF UNDERGROUND Q YES Q NO
SPRINKLER PIPING
BLANK TESTING NUMBER USED LOCATIONS
GASKETS I r NUMBER REMOVED
WELDED PIPING D YES f:p NO
IF YES........
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 Q YES 0 NO
WELDING
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED
IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR -3 Q YES Q NO
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED QUALITY CONTROL. PROCEDURE TO INSURE THAT ALL DISCS ARE Q YES Q NO
RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER
WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF
PIPING ARE NOT PENETRATED.
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS
(DISKS) (DISKS) ARE RETRIEVED pa YES Q NO
HYDRAULIC NAMEPLATE PROVIDE< ) IF NO, EXPLAIN
DATA I
NAMEPLATES p YES Q NO
REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: 7.. / - O 1
NAME OF SPRINKLER CONTRACTOR: SUMMIT FIRE PROTECTION
SIGNATURES
TEST WITNESSED BY ` S(
,�/ PERTY • • ER (S D) TITLE DATE: 2.,..._
j summit
7
FIRM ("R
OR S INK R CONTRACTOR ( SIGNED) TITLE DAT .
- (1"14 atl f . r of - z, -'ct`