HomeMy WebLinkAboutMaterial & Test Certifcate for Aboveground Piping -
Contractor's Material & Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractor s representative and aritnessed by an owner's representative. All defects sha{I be
cosrected and system left in service before contractor's personnel finally leave the job.
A cert�cate shall be filled out and signed by both represeMatives. Copies shall be prepared for approving authorities, owners, and corrtractor. It is understood
the owner's representative's signature in no way prejudices any claim against contr�tor for fauky material, poor workmanship, or failure to comply with
approving auttrority's requirements w local ordinances.
PROPERTY NAME: JEFFERS POND DATE -- I 9.-1 Z
PROPERTY ADDRESS: 14358 PARKSIDE GOURT
ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY
ADDRESS:
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS �YES ❑NO
EQUIPMENT USED IS APPROVED �YES ❑NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE E�UIPMENT BEEN INSTRUCTED AS �YES ❑NO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
OF THIS NEW EQUIPMENT?
IF NO, EXPIAIN
1NSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: �YES ❑NO
�. SYSTEM COMPONENTSINSTRUCTIONS �YES
❑NO
2. CARE AND MAINTENANCE INSTRUCTIONS �YES ❑NO
3. NFPA25 �YES ❑NO
LOCATION ENTIRE BULDING
YEAR OF TEMPERATURE
MAKE MqDEL MANUFACTURE SIZE QTY. RATING
RELIABLE RES 49 2011 1/2 10 155 �
SPRINKLERS RELIABLE RES 44HSW 2011 12 13 155
RELIABLE F3QR 2011 1I2 1 155
PIPE AND Type of Pipe BLAZEMASTER
FITTINGS Type of Fitting CPVC
M/WMUM TtME TO OPERATE
ALARM DEVICE THROUGH TEST CONNECTION
ALARM VALVE OR
FLOW INDICATOR TYPE MAKE MODEL MIN SEC
FLOW INDICATOR POTTER VSR-F
DRY VAWE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
DRY PIPE TIME TO TRIP TIME WATER ALARM
OPERATING TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
CONNNEC710N' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' PROPERLY
MIN SEC PSI PSI PSI MIN SEC YES NO
W!O
Q.O.D.
W ITH
Q.O.D.
IF N0, EXPLAIN
LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE
& FLOOR MODEL FLOWING
PRESSURE
REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM)
VALVE TEST
N/A
OPERATION: ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC
PIPING SUPERVISED ❑YES ❑NO OETACHING MEDIA SUPERVISED ❑YES ❑NO
DOES VALVE OPERATE FROM THE MANUAI TRIP AND/OR REMOTE DYES ❑NO
CONTROL STATIONS
DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN
PREACTION FOR TESTING
VALVES OYES ❑NO
N/A
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
YES NO YES NO MIN SEC
HYDROSTATIC: Hydrosimic test sha11 be mede at nd less men 200 psi (13.6 be�s) ta lwo hours d 50 psi (3A bers) ahove s1aNc pressure
�� � a�so ���o.z ��> ro. n� na,�. o��i a�� �an� ae� snan na �� a�,�� � w P��� aam�e. ai
Aboveground piping lealmge shell ba sropped.
TEST
DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bers) air pressure and rt�easure drop, which shell nd e�xeed 1-1/2 pei (0.1 bars) in 24 houts. Test
pressure tenks at nortnal weter level ami air pressure and rt�ure air pressure drop, which she11 not e�meed 7-12 pai (0.7 bers) in 24 houra.
ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HRS IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED �YES �NO
EQUIPMENT OPERATES PROPERLY �YES ❑NO N/A
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM
SILICATE OR DERIVATNES OF SODIUM SILICATE, BRINE, OR OTHER CORROSNE CHEMICALS WERE NOT USED FOR
TESTING SYSTEMS OR STOPPING LEAKS?
YES NO
DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VE IN TEST CONNECTION
TESTS TE3T SUPPLY TEST CONNECTION � PSI CONNECTION OPEN WIDE �SI
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE
TO SPRINKLER PIPING.
VERIFIED BY COPY OF THE U FORM NO. 8.56 �YES ❑NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND
SPRINKLER PIPING �YES ❑NO
IF POWDER DRIVEN FASTENERS ARE USED IN �YES ❑NO IF N0, EXPLAIN
CONCRETE, HAS REPRESENTATNE SAMPLE
TESTING BEEN SATISFACTORILY COMPLETED9
BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS 0
WELDED PIPING �YES �NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES
COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR3? �YES ❑NO
WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR3 �YES ❑NO
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED
QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC ARE 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? �YES ❑NO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
CUTOUTS (DISCS) ARE RETRIEVED? �YES ❑NO
HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN
DATA �YES ❑NO
N MEPLATE
REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VAWES OPEN: �—( 9.� �?�
NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES LLC
TEST WITNESSED BY
F�E OWNE (SIG D) TITL� DA�
SIGNATURES ! , r �� � �_
OR SPRINK R C NTRACTO (SIGNED) �� ITLE ATE
✓ ,.�,. -/ 9 � / Z
ADDITIONAL EXPLANATION AND NOTES