HomeMy WebLinkAbout1999 - sprinkler systems -66 INSTALLATION OF SPRINKLER SYSTEMS
CONTRACTOR'S MATERIAL&TEST CERTIFICATE FOR ABOVEGROUND PIPING
# 4i'37
PROCEDURE
Upon correlation d work.Inspection and tests hail be made by the contractors reoresentative and witnessed by an owners representative.All detects shall be corrected and
system left In service before contractors personnel finally leave the lob.
A certificate shalt be filled out and signed by both representatives.Copies shall be prepared fa approving authontles,owners,and contractor.It is understood the owners reo-
resentanve's signature in no way pretudices any claim against contractor for faulty material•poor workmanship,Of failure to comply with approving authority's requirements or
local aroinances.
PROPERTY NAME DATE
Hew 13 L06, ...�E,eV I CE 8 oo (DETAIL./ o FF1G E l 9- 99
PROPERTY ADDRESS Z1 0 w, WAy ZArPS BLVO, � O O I-W) N 1-4 r 55"39 I
ACCEPTED BY APPROVING AUTHORITIES(NAMES)
C ice/ of OR•ONb , ��$ PECTLo/
ADDRESS //
PLANS Pr O. BOX e 6 1 ca,(>M
7AL..BAy1 14.f$ .3z3
INSTALLATION CONFORMS TO ACCEPTED PLANS ...XES ❑NO
ECUIPMENT USED IS APPROVED YES 0 NO
IF NO.EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE ECUIPMENT BEEN INSTRUCTED AS TO LOCATION �Q't ES 0 NO
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW ECUIPMENT? /1
IF NO.EXPLAIN
INSTRUCTIONS
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: ( YES 0 NO
1. SYSTEM COMPONENTS INSTRUCTIONS ES O NO
2. CARE ANO MAINTENANCE INSTRUCTIONS ES 0 NO
3. NFPA 13A ES ONO
LCCA'IGN
OF SYSTEM SUPPLIES BUILDINGS 8-/4 7-14 E /)S roky g ` )5-8 0
OpO0 Jr w6-7-5-isrgJi
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
CExT L"GB'Icr��euME Pip /99,9 1/zt1 k s.6 /00 1SS°
SPRINKLERS 1
PIPE AND Type of POe //Ai/Mf Sc�. J o / —/Nc X L
FITTINGS Type of Fittings c ,Q..Q a V t� /WELD FD /�kf?Eco ED
` MAXIMUM TIME TO OPERATE
ALARM ALARM DEVICE THROUGH TEST CONNECTION
VALVE TYPE MAKE MODEL MIN. SEC.
OR FLOW
INDICATOR /%r ictoe PA IN rCeitc, fwii7G-I
DRY VALVE O.O.D.
MAKE I MODEL SERIAL NO. MAKE MODEL II SERIAL NO.
NUS C I L
TIME TO TRIP TIME WATER ALARM
THRU TEST WATER AIR TRIP POINT REACHED OPERATED
DRY PIPE CONNECTION' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' PROPERLY
OPERATING • MIN. SEC. PSI PSI I PSI MIN. I SEC. YES I NO
TEST
Without
0.0.0.
With
0.0.0.
IF NO.EXPLAIN
•uC AC1 icc^Cart/TtUC IUCD cPTrro•o TC CT r•r1NNcr•TIruu iC nommen
OPERATION
O PNEUMATIC 0 ELECTRIC O HYDRAULIC
PIPING SUPERVISED OYES ONO DETECTING MEDIA SUPERVISED 0 YES 0 NO
DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS O YES ONO
DELUGE& I AN ACC SIL CIL/ IN AC CIRCUI 0• S ING I NO, XPLAIN
PPEACTION
VALVES 0 YES O NO
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE
YES NO YES 1 NO - MIN. SEC.
HYDROSTATIC_Hydrostatic tests shall be made at not teas than 200 pal(17.8 bars)for two hours or 50 pel(3.4 bars)above static pressure In excess
at 150 psi(10.2 bars)for two hours,Differential dry-pipe valve dacpers shall be lett open during teat to prevent damage.All aboveground piping leakage
TEST shall be stopped.
DESCRIPTION
PNFLJMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop which shad not exceed 1.1/2 psI(0.1 bars)in 24 hours.Test pressure
tans at normal water level and air pressure and measure air pressure arm wrier)shad not exceed 1-1/2 pal(0.1 bars)In 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT'Z.UO PSI FOR Z,,HRS. IF NO,STATE REASON
DRY PIPING PNEUMATICALLY TESTED O YES O NO
ECUIPMENT OPERATES PROPERLY O YES O NO
CO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS.SODIUM SILICATE OR
DERIVATIVES OF SODIUM SILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR
TESTS STOPPING LEAKS? RYES 0 NO
DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST
TEST SUPPLY TEST CONNECTION: PSI CONNECTION OPEN WIDE PSI
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MACE TO SPRINKLER PIPING,
VERIFIED BY COPY OF THE U FORM NO.858 ❑ YES O NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING ES 0 NO
BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS NONE
WELDED PIPING YES O NO
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE RECUIREMENTS OF AT LEAST AWS D'^9.LFVFI..AR-3 YES O NO
WELDING CO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS CUALIFIED IN
COMPLIANCE WITH THE RECUIREMENTS OF AT LEAST AWS D10.17,LEVEL AR-3 YES O NO
CO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED DUALITY 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
PIPING ARE NOT PENETRATED IES 0 NO
CUTOUTS CO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
(DISCS) CUTOUTS(DISCS)ARE RETRIEVED? .ES 0 NO
HYDRAUUC NAME PLATE PROVIDED IF NO,EXPLAIN
DATA
NAMEPLATE YES O NO
DATE LEFT IN SER V/ICEIWITH ALL CONTROL VALVES OPEN:
REMARKS
NAME OF SPRINKLER CONTRACTOR
OLSEN FIRE PRGrFrrTC N TNC_
TESTS WITNESSED BY
SIGNATURES FOR PROP,ERTY OWNER(SIGNED) ITITLE m�v S / 1
CATE /0/`o�
FOR PRI KL R CON OR( NE TITLE i DATE !
ADDITIONAL EXPLANATION AND NOTES
—41 6LQ.1X1, 1 a/ 1014-e id Sall)
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