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I:1'.N IJf AI. INI I)N MA'I If'N 11 9 <br /> CONTRACTOR'S MATERIAL&TEST CERTIFICATE FOR ABOVEGROUND PIPING <br /> PROCEDURE ' <br /> Upon completion of work.Inspection end teats shall be merle by the contractor's rapreMntative and witnessed by en owner's representative. All <br /> defects shell he corrected end system left In service before connector's personnel finally leave the lob. <br /> A certificate shell be filled out and signed by both representatives. Copies shill be prepared for approving euthoritles,owners and contractor, <br /> It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material,poor workmanship, <br /> or failure to comply with approving authority's requirements or local ordinances. <br /> PROPERTY NAME r� ,w _ ` '1I,,� r }'� 1DATE (�� <br /> PROPERTY ADDRESS Vv)j-M l A L G Y'fI2N I Nv l ca t L -7-TJ-el 1 <br /> e$1, )F T (-4-iIA -ATV4_ Th.vb Coo Vu r-) <br /> ACCEPTED BY APPROVING AUT ORITYI'S)NAMES <br /> - - G-/7_. r i S_c <br /> ADltrtrSt -- —_ <br /> PLANS <br /> INSTALLATION CONFORMS TO ACCEPTED PLANS [!ft/ES 0 NO <br /> EQUIPMENT USED IS APPROVED Ef S D NO <br /> IF NO,EXPLAIN DEVIATIONS <br /> HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION [S ENO <br /> OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT <br /> IF NO,EXPLAIN <br /> INSTRUCTIONS ,------ ' <br /> HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS u 'LS L.)NO <br /> AND NEPA t3A BEEN LEFT ON PREMISES <br /> IF NO,EXPLAIN <br /> • <br /> LOCATION SUPPLIES BLDGS. <br /> OF SYSTEM -- g,..,1..l 17 rr <br /> MAKE MODEL YEAR OF ORIFI,E QUANTITY TEMPERATURE <br /> MANUFACTURE SIZE RATING <br /> c."_r LYT.V 01, d -.2Q M a�.._ <br /> SPRINKLERS - __... <br /> • <br /> PIPE CONFORMS TO AJ,/74�,13 STANDARD E4ES 0NO <br /> PIPE AND FITTINGS CONFORM TO I`-frey 'it STANDARD N-YES ENO <br /> ' FITTINGS IF NO,EXPLAIN <br /> ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE <br /> ALARM - -.__._.—_-T.- ---._....__._-.---._ ---- '-'-------- -----_._. .------- <br /> VALVE TYPE MAKE MUUEL MIN, SEC, <br /> OR FLOW Uul �w iia fst , Itch Ft F R. -u—) ,-- `i <br /> INDICATOR <br /> DRY VALVE _ QO.D. <br /> MAKE MODEL SERIAL NO, MAKE MODEL SERIAL NO. <br /> TIME TO TRIP-S WATER <br /> THRU TEST PIPE .PR SSURE AIR TRIP POINT <br /> PRESSURE AIR PRESSURE TIME WATER <br /> REACHED ALARM <br /> OPERATED <br /> TEST OUTLET* PFERLY <br /> MIN. <br /> DRY PIPE - .._—. V -- <br /> MIN. SEC, PSI _,,,_PLI•w�'^^" PSI" ,M�Mr_- ?[C__'� YES NO <br /> OPERATING -----_ ___--_-- _—_---- .---_.—' <br /> TEST Without - -� <br /> O.O.D. <br /> y <br /> With .. .� <br /> �'' � <br /> O.O.D. .,`` <br /> IF NO,EXPLAIN "',,,�` <br /> 'MEASURED FROM TIME INSPECTOR'S TEST PIPE IS OPENED. (OVER) <br /> I)SA 00.00) PRINTED IN USA <br /> Contractor's Material& Test Certificate for,boveground Piping <br />