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Report (9) 6d0 -.x.56 r Form 2a Project Name: Tigard Triangle Commons Bldg. 1 RE P 1 SUMMARY �� �� Project 1. Project Name Tigard Triangle Commons BIgh'1�� ?//lib 2. Project Address 68th and Dartmouth �U !LD I N G + i �'HNti 3. City/Town Tigard - i 1 , 5. County ash . 4. Building, Gross Area (ft2) *8 , 647 -six). rr, 6. No. of Floors I 2 7. Construction Site Elevation A • • x ,000 ft? ❑ YES EN0 Attached Chapter ID Description Attach Forms and Building Envelope Form 3a Building Envelope - General El Worksheets 3b Prescriptive Path - All Climate Zones El • CodeComp Report for Simplified Trade -off ❑ * In lieu of 3b • Floppy disc with .occ CodeComp file ❑ Check boxes to indicate attached Worksheet 3a Wall U- factor El forms and 3b Roof U- factor ❑ worksheets 3c Floor U- factor ❑ S Y ���� 3d Window /Skylight Schedule ❑ 4a Systems - General ❑ 4b Complex Systems ❑ MAY 1 20Norksheet 4a Unitary Air Conditioners - Air Cooled ❑ 4b Unitary Air Cond. - Water & Evap Cooled ❑ (SITY OF TIGARD 4c Unitary Heat Pump - Air Cooled ❑ BUILDING DIVISION 4d Unitary Heat Pump - Water Cooled ❑ 4e Packaged Terminal A.C. - Air Cooled ❑ 4f Packaged Terminal Heat Pump - Air Cooled ❑ 4g Water Chilling Pkgs - Water & Air Cooled ❑ 4h Heat Rejection Equipment ❑ 4i Boiler - Gas -Fired and Oil -Fired ❑ 4j Furnace & Unit Heaters - Gas and Oil -Fired ❑ 4k Simultaneous Heating and Cooling ❑ 41 Air Transport Energy ❑ 4m Natural Ventilation ❑ Lighting Form 5a Lighting - General El 5b Interior Lighting Power - Tenant Method El 5c Int. Ltng. Power - Space -by -Space Method ❑ Worksheet 5a Lighting Schedule El 5b Interior Lighting Power El Applicant 7. Name Dan Vasquez 10. Telephone 503 - 244 -0552 8. Company Mildren Design Group 11. Date SA/ 1 o b 9. Signature , Attached No. of Pages Description of Documentation Document- ation Compliance with OSSC, effective 01/01/05 Form 3a Project Name: Tigard Triangle Commons Bldg 1 Page: 1 BUILDING ENVELOPE - GENERAL Check all boxes 1. Exceptions (Section 1312) that apply. ❑ No Envelope Components. The building plans do not call for new or altered building envelope components, e.g., walls, floors or roof /ceilings. ❑ A Non - conditioned Building. The proposed structure has no spaces heated or cooled by an HVAC system. Exceptions ❑ Exception. All new or altered building envelope components do not comply with the Discussion of qualifying requirements, Section 1312, but qualify for Exception: 0-1 0-2 0-3 0-4 ❑ -s exceptions in Portions of the building that qualify: instructions section. Plans /Specs Show compliance by The plans/specs show compliance in the following locations: including a drawing sheet, detail number, 2 Air Leakage specification section (Section 1312.1.1) and/or subparagraph. 0 Complies. Plans require penetrations in building envelope are sealed and windows and doors are caulked, gasketed or weatherstripped. The plans /specs show compliance in the following locations: A4.1, A4.2, A4.3 3. Suspended Ceiling (Section 1312.1.2.1) O Complies. Building plans do not show suspended ceilings used to separate conditioned space from unconditioned space. No exceptions permitted. 4. Recessed Light Fixtures (Section 1312.1.2.2) O Complies. The building plans do not show recessed light fixtures installed in ceilings separating conditioned spaces from unconditioned spaces. O Exception. The building plans require that fixtures installed in direct contact with insulation be insulation coverage (IC) rated. The plans /specs show compliance in the following locations: 5. Moisture Control (Section 1312.1.4) O Complies. A one -perm vapor retarder is installed on the warm side (in winter) of all exterior floors, walls and ceilings, and a ground cover installed in the crawl space of both new and existing buildings where insulation is installed. The plans /specs show compliance in the following locations: O Exception. All new or altered building envelope components do not comply with the vapor retarder requirements of the code, but qualify for an exception. Note applicable exception. Section 1312.1.4, Exception: ❑ -t 0 -2 Portions of the building that comply: Slab on grade floor Climate 6. Climate Zones Zones 0 Zone 1 - A building site is in Climate Zone 1 if its elevation is less than 3000 feet above sea level and it is in one of the following counties: Benton, Columbia, Clackamas, Clatsop, Coos, Curry, Douglas, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Yamhill, or Washington. ?:, ❑ Zone 2 - Building sites not in Zone 1, or where construction site elevation is 3000 feet or ` =D • ++ higher in Zone 1, are in Zone 2. 3 -1 Compliance with OSSC, effective 01/01/05 Form 3b Project Name: Tigard Triangle Commons Bldg 1 Page: 2 PRESCRIPTIVE PATH Part 1 of 4 CLIMATE ZONE 1 Exterior Wall Window Area Area Glazing Maximum Glazing (total rough frame ft2) (gross ft2) % Fraction Complies Glazing Conditioned I Percent Space I 7,773 1 + 23,859 X 100 = 32.6% Yes r Calc- ulation Semi - Conditioned + X 100 = 0.0% Yes See instruction Space section for a Cont(itloned 1 discussion of glazing percent Mechanical + X 100 = 0.0% Yes calculation. Penthouse Windows Window Max Minimum Shading Window Minimum From Work- (from Worksheet 3d) U- Factor' Assembly (from worksheet 30) Coefficient Assembly 3d place wA N/A ., the highest ❑ N/A WA p Overall Window U -Value Complies N/A U - factor and SC Complies N/A highest Center Required Double-glazed w/0.5 inch 1/4" thick glass, low of - Glass SC. Or Minimum argon -filled space, low-e Required Minimum emissivity coating not greater check minimum Assembly (Fixed coating < 0.05, thermally Assembly than assembly and Windows) broken frame 0.05, tinted outdoor pane. identify window. Required Mini- mum Assembly (Operable • Only use Max U- Factor Windows and Curtalnwall) The plans/specs show window compliance in the following locations: Notes ''From Worksheet 3d, place the highest Overall Window U- factor or check (Minimum Assembly). See 'Window Requirements' in table on the following page for specific MA requirements. Excel version will automatically insert minimum assembly requirements or greatest U -value from Worksheet 3d. 2 From Worksheet 3d, place the highest 'center-of-glass' shading coefficient (SC) for glass or check MA (Minimum Assembly). See - Window Require- ments' in following table for specific MA requirements. Excel version will automatically insert minimum assembly requirements or greatest SC from Worksheet 3d. Shading Coefficient (SC) can be calculated from Solar Heat Gain Coefficient using the equation: SC = SHGC + 0.87. Manufacturers data may also be used to document SC. Walls R -Value Wall / insulation T I. - Insulation Only U- Factor' See instructions Masonry or concrete, w/interior insulation fora discussion 11 or of wall require — — — — ents. or m or or — s or 9 or Below- R - Value Grade Walls Insulation Only U- Factor' See instructions Below -Grade Walls Min. R -7.5 ( R-7.5) (Max. 0.11) for a discussion of � - 4., requirements. or h..`` n32 to eil. i1 v a • ' Notes s Submit Worksheet 3a for each calculated assembly U- factor � 3-2 Compliance with OSSC, effective 01/01/05 • Form 3b Project Name: Tigard Triangle Commons Bldg 1 Page:13 • PRESCRIPTIVE PATH Part 2 of 4 Code Requirements - Zone 1 Discussion of these requirements in the instruction section. ZONE 1 Wall Requirements Window Requirements Max. Glazing Max. 4 R -Value Shading Fraction Wall / Insulation Type InsulationOny U- Factor Max. U- Factor Coefficient Up to 15% CMU 'Masonry' w/integral loose fill insulation N/A or 0.300 7 Masonry or concrete w /cont. exterior insulation 1.4 or 0.300 0.540 0.57 CMU Masonry w/integral rigid fill insulation N/A or 0.210 Masonry or concrete wlnterior insulation 11 or 0.130 Up to 30% Masonry or concrete w /cont. exterior insulation 2.8 or 0.210 0.540' 0.57 Frame (wood or metal framing) 13 or 0.130 Other (provide short description) 13 or 0.130 CMU Masonry w /integral rigid fill insulation N/A or 0.210 Masonry or concrete w/interior insulation 11 or 0.130 Up to 40% Masonry or concrete w /cont. exterior insulation 2.8 or 0.210 0.370 10 0.35 Frame (wood or metal framing) 13 or 0.130 Other (provide short description) 13 or 0.130 Code Requirements - Zone 2 Discussion of these requirements in the instruction section. ZONE 2 Wall_ Requirements _ Window Requirements Wall / Insulation Type Max. Max. Glazing R -Value U- Factor Max. U- Factor Shading Fraction Insulation only Coefficient Up to 15% CMU 'Masonry w/integral loose fill insulation N/A or 0.300 1, t t Masonry or concrete w /cont. exterior insulation 1.8 or 0.270 0.500 0.57 CMU Masonry w /integral rigid fill insulation N/A or 0.160 Masonry or concrete wfunterior insulation 13 or 0.090 Up to 25% Masonry or concrete w /cont. exterior insulation 4.3 or 0.160 0.500 0.57" Frame (wood or metal framing) 19 or 0.090 Other (provide short description) 19 or 0.090 CMU Masonry w/integral rigid fill insulation N/A or 0.160 Masonry or concrete wfinterior insulation 13 or 0.090 Up to 33% Masonry or concrete w /cont. exterior insulation 4.3 or 0.160 0.370 0.43 Frame (wood or metal framing) 19 or 0.090 Other (provide short description) 19 or 0.090 Notes 4 The Simplified Trade -off Approach must be used if glaz fraction exceeds allowable percentages. 5 Minimum weight of masonry and concrete walls = 45 Ib/ft2 of wall face area a All cores to be filled. At least 50% of cores must be filled with vermiculite or equivalent fill insulation. 7 Prescriptive MA (Minimum Assembly) - For Fixed Windows: double -glazed window with a 0.5 inch air space, low-e coating and aluminum frame. MA shading coefficient description is a tinted outboard pane of glass. For Operable Windows or Curtalnwall: double - glazed window with a 0.5 Inch air space, bw-e coating and thermally broken frame. MA shading coefficient description is a tinted outboard pane of glass. a All cores except bond beams must contain rigid insulation inserts approved for use in reinforced masonry walls e Batt insulation installed in metal or wood frame walls shag be Insulated to the full depth of the cavity, up to 8 inches in depth. to Prescriptive MA (Minimum Assembly) - For Fixed Windows: double -glazed window with a 0.5 inch argon filled space, low -e coating (e<= 0.05) and thermal break frame. For Operable Windows or Curtalnwall: only use Max U- Factor. MA shading coefficient description is a 0.25 -inch thick glass with low-e coating (e <= 0.05) with a timed outboard pane. 1 t Prescriptive MA (Minimum Assembly) - For Fixed Windows: double -glazed window with a 0.5 inch air space, low-e dating and aluminum frame. For Operable Windows or Curtalnwall: double -glazed window with a 0.5 itch as space, bw-e coating (e <= 0.1) and thermally broken frame. MA maximum shading coefficient description is a tinted outboard pane of glass. 12 Prescriptive MA (Minimum Assembly) - For Fixed Windows, a double - glazed window with a 0.5 inch argon filled space, low-e coating (e <= 0.05) and thermal break frame. For Operable Windows or Curtainwall, only use Max U- Factor. MA shading coefficient description is a 0.25-inch thick glass M. : s. ? with low-e coating (e <= 0.05). 3 -3 Compliance with OSSC, effective 01/01/05 . Form 3b Project Name:,Tigard Triangle Commons Bldg 1 Page: 4 PRESCRIPTIVE PATH Part 3 of 4 Roofs/ R -Value d Insulation Only U - Factor C e in ions Roof / Ceiling" (Min. R -19) (Max 0.050) fora dicussion of (Framed roof with rigid insulation R -19 or 1 roofs/ceilings. Notes 11 Write -in a short description for assembly with the lowest insulation R -value or the highest assembly U- factor. 12 Submit Worksheet 3b for each calculated roof /ceiling assembly U- factor. - _ Skylight Area Roof Area Skylight Maximum Skylight (total rough frame ft2) (gross ft2) ,5613 Fraction Complies Skylights Conditioned Includes glazed SpBOe + X 100 = N/A smoke vents. See instructions Semi for a dicussion of Conditioned + X 100 = N/A skylights. Space Conditioned Mechanical + X 100 = N/A Penthouse Skylight Area Roof/Ceiling Area Skylight (total rough (gross ff2) frame ft2) Percent Skylights Skylights Max Minimum Shading Minimum From Worksheet 14 Skylights 3d, place highest (from Worksheet 3d) . U= Factor Assembly prom Worksheet Coefficient' Assembly Overall Vertical #WA - ❑ #WIA - N/A Window U factor . and highest U - Value Complies Yes SC Complies Yes Center - of - Glass SC. Required Required Minimum Minimum N/A Assembly N/A (must use SC) Assembly Y The plans /specs show window compliance in the following locations: Code Compliance Thermal Performance Shading Coefficient Require- O ption Overall vertical u Factor Center of Glass SC Perfor U - 1.230 for overall assembly in overhead plane SC -0.47 center -of -glass • meats MIn. Assembly (MA) Double glazed, 0.5 -inch airspace N/A Notes 13 Skylight percentage area is based on total skylight and smoke vent rough frame area divided by total conditioned roof area. Percentage must not exceed 6 percent of total roof/ceiling area in conditioned building space. The Simplified Trade-off Approach must be used if glaring fraction exceeds allowable percentages. 14 From Worksheet 3d, place the highest Overall Vertical 11-factor or write -In MA (Minimum Assembly). See "Skylight Requirements' in table above for specific MA requirements. 15 From Worksheet 3e, place the highest 'center-of-glass" shading coefficient (SC) for glass. See 'Skylight Requirements' in table above for specific MA requirements. Shading Coefficient (SC) can be calculated from the Solar Heat Gain Coefficient using the equation: SC = SHGC 0.87. Manufacturers data may also be used to document SC. b .' if. tr 3 - 4 Compliance with OSSC, effective 01/01/05 i . . ' • Form 3b Project Name: Tigard Triangle Commons Bldg 1 Page:l5 PRESCRIPTIVE PATH Part 4 of 4 Floors See instructions R - Value for a dicussion Floors over Unconditioned Spaces Insulation Only U Factor of floors. or Heated Concrete Slab Edge R -Value .. - Insulation Ony Heated Slab -on -Grade (Section 1312.1.2.4) ❑ Complies. Building plans show insulation extending downward from the top of the slab a minimum distance of 24 inches or downward and under the slab for a combined minimum distance of 24 inches or to the bottom of the thickened edge of the of slabs used as a foundation. The plans /specs show compliance in the following locations: Notes 16 Write -in a short description for assembly with the lowest insulation R -value or the highest assembly U- factor. 17 Submit Worksheet 3c for each calculated floor assembly U- factor. 18 Write -in a short description for Heated Slab, which has heat, Integrated into slab such as hydronic heat. If more than one floor type, enter the lowest insulation R -value or the highest component U- factor of any floor. Code Compliance Options Require- Min. R -Value Max. U- ments Component Insulation Only Factor Floor over Unconditioned Spaces 1 11 I or I • 0.070 Climate Climate Component Zone 1 Zone 2 Heated Concrete`Slab'Edge, Min. R =Value i 7.5 1 or 1 10.0 Doors See instructions 19 R -Value U- Factor for a dicussion of Doors insulation Only Center -of -Panel doors opaque,•whh leaf width greater than 4' (Min. R -5) (Max. 0.20) I 1 H Notes 19 Write -in a short description for Doors. If more than one door type, enter the lowest insulation R -value or the highest center -of- panel U- factor of any door. The following doors are exempt from door and window U- factor and shading coefficlent requirement . . . 3 -5 Compliance with OSSC, effective 01/01/05 {?2oo6. S6 MATERIAL & TEST CERTIFICATE ABOVEGROUND CASCADE FIE PROTECTIum up. PROCEDURE f '" ii i Upon completion of work, inspection and test shall be made by the contractor's repre F= ° - Zessed by an owner's representative. All defects shall be corrected and system left in service before ca Jct2r perso el finally leave the job. air CU(); BU P ° 11G A certificate shall be filled out and signed by both representatives. Copies shall be p ovin authorities, owners, and contractor. It is understood the owner's representative's signature in no way preju I 4ly claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME DATE ®����� COp PROPERTY ADDRESS I 5o i e.� �-� 7 = �/_� �,�e 1 7 07 ACCEPTED BY APPROVING AUTHOR IES (NAME) .:_ 1 o f `B Sc . 1 a e-tz-to g.TT ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES ❑ NO EQUIPMENT USED IS APPROVED AYES ❑ NO IF NO, EXPLAIN DEVIATION HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTOL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES ZINO IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS YES ❑ NO ' 2. CARE AND MAINTENANCE INSTRUCTIONS erYES 0 NO : 3. NFPA 25 ❑ YES ❑ NO LOCATION SUPPLIES BUILDINGS OF SYSTEM - - - - MAKE MODEL YEAR OF ORIFICE SIZE QUANTITY TEMPERATURE RATING MANUFACTURE • SPRINKLERS TYPE OF PIPE PIPE AND F F-LecAJ FITTINGS TYPE OF FITTINGS tered ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION • TYPE MAKE MODEL MINUTES SECONDS ALARM VALVE OR FLOW INDICATOR P P,1- A (�, -,vim S ,a -r��J PTA DRY VALVE QUICK OPENING DEVICE MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP TRIP POINT TIME WATER WATER ALARM OPERATED THRU TEST AIR PRESSURE AIR REACH ..T ST PRESSURE }- - PROPERLY DRY PIPE CONNECTION PRESSURE 0 r mot - O PERATING TEST MIN SEC PSI PSI PSI MIN L. i tpf"ez NO WITHOUT // / WITH C, A -, j , J Q.O.D. e im ly yr i IF NO, EXPL t)ifit/G (q8 � ifr � S, 0 OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC ',! PIPING SUPERVISED ❑ YES ❑ NO I DETECTING MEDIA SUPERVISED ❑ YES ❑ NO ' DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS? �j( j � NO DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? IF NO, EXPLAIN Y' CE PREACTION ❑ YES ❑ NO l., up 1 VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPERATE MAKE MODEL SUPERVISION LOSS ALARM? VALVE RELEASE? RELEASE YES NO YES NO YES NO HYDROSTATIC: Hydrostatic levels shall be made at not less that 200 psi (13.8 bars) for two hours of 50 psi (3.4 bars) above static pressure in TEST 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 DESCRIPTION piping leakage shall be stopped. PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop which shall not exceed 1 % psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1 % psi (0.1 bars) in 24 hours ALL PIPING HYDROSTATICALLY TESTED AT 2 7 FOR 2 HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED ❑ YES ❑ NO EQUIPMENT OPERATES PROPERLY RYES ❑ NO DO YOU CERTIFY AS THE SPRINKLER SYSTEM 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 STOPPING LEAKS? ZJ/ES ❑ NO DRAIN READING F GAGE LOCATED NEAR WATER SUPPLY TEST I RESIDULE PRESSURE WITH VALVE IN TEST TESTS TEST CONNECTION: PSI CONNECTION OPEN WIDE: PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO 858 ❑ YES ❑ NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING ❑ YES ❑ NO IF NO, EXPLAIN BLANK TESTIN NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 1 ti A WELDED PIPING ❑ YES ❑ NO IF YES, COMPLETE BELOW ' 4 DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3? ❑ YES ❑ NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR -3? ❑ YES ❑ NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE 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? _ ❑ YES ❑ NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL (DISCS) CUTOUTS (DISCS) ARE RETRIEVED? ❑ YES ❑ NO FUNCTIONAL a DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? ❑ YES ❑ NO FLOW TEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? ❑ YES ❑ NO HYDRAULIC IF NO, EXPLAIN NAME PLATE PROVIDED ❑ YES ❑ NO DATA NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR CONTRACTOR LICENSE # DATE '-4 fr( ka J girra 6 WA = CASCAFP203MW OR = 89096 g• 7 TESTS WITNESSED BY SIGNATURES PROP OWNER OR REPRESENTATIVE TITLE DATE I -- T '..'• ITY HAVING `II — • TITLE DATE �, 8 z c 2 „ ._._........_ ..... .. 9ug 31 2007 5:58PM Cascade Fire Protection C 503 541 -8768 p.2 9,,o O • ,. a MATERIAL & TEST CERTIFICATE ABOVEGROUND CASCADE F PIETECTION CCL PROCEDURE Upon completion of work, inspection and test 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 befone:contractor's 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 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 local ordinances. . PROPERTY NAME DATE " rzcc , e - Zo 1 1 FI-N COW) /VI- ' g - a 2, -a ? PROPER TY ADDRESS y-� ca //O ACCEPTED B Y A ZROVING A U T H O R I T I E S (NAME) / . t i e Q, ; 9' 7 2 3 • ,C=7 0 ''. /..-e...fie.0 ( Cl/x/ e A-, e _ itd 1 /; ) ADDRESS PLANS • • INSTALLATION CONFORMS TO ACCEPTED PLANS YES 0 NO / j � EQUIPMENT USED IS APPROVED �L:ES 0 NO 1; V'� 1i- . IF NO, EXPLAIN DEVIATION r C HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN L^ r INSTRUCTED AS TO LOCATION OF CONTOL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES 1$NO �;. . . IF NO, EXPLAIN INSTRUCTIONS • . HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: gg 1. • _ - SYSTEM COMPONENTS INSTRUCTIONS YES 0 NO : P -' - ` - •:,:: , .r -,A:' .__; ;•-• .; • • 2. CARE AND MAINTENANCE INSTRUCTIONS • YES 0 NO ;j, *% a - .ice`` • 3. N PA 25 C O NO , :- : %.a: LOCATION SUPPLIES BUILDINGS 4 - -;'` = - • OF SYSTEM MAKE MODEL YEAR OF . MANUFAC7tJRE ORIFICE SIZE • QUANTITY TEMPERATURE RATING , 79e ,A6 7 2" 7 A '. y LI P, %5 %yco 7 t e0 -- i r3, 3 I -2 bo ? a Al 3 24:56 - SPRINKLERS. • T yco , Ty- C115 tril 333 / Z 4 ' 1 °1 '` .• • : Sr? . TYPE OF PIPE PIPE AND • D YiF�4 ni REhll O IBS R. /C�au) FITTINGS TYPE OF FITTINGS . CA-sr .40240 4..astne -i.r c S ALARM DEVICE • !MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION TYPE Q MAKE �) MODEL 1 4UTI£S S€ os. ALARAI FLOW INDICATOR OR r-L 4� 1 O W! e- V 5 r, - r • ii • a 1 , • \ ._ :.. ..... .... .. .- .. .. .._._ __ ..� .. _. .. _ -. -. r-_. _..,.�_ I • 111 - -.. ... . . .._. Aug 31 2007 5:58PM Cascade Fire Protection C 503 541 -8768 p.3 " ( 'pow VALVE • QUICK OPENING DEVICE MAKE MODEL SERIAL N0. MAKE ? MODEL SERIAL NO. i • TIME T07iIP WATER TRIP POINT i TIME WATER ALARM OPERATED ' " THRU T $T AIR PRESSURE AIR REACHED TEST PROPERLY DRY PIPE _ CONNECTO0N PRESSURE PRESSURE OUTLET OPERATING TEST MIN i SEC PSI PSI PSI 'MIN SEC YES NO WITHOUT Q.O.D. WITH Q.O.D. • • • IF NO, EXPLAIN OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑: HYDRAULIC Will PIPING SUPERVISED ❑ YES ❑ NO I DETECTING MEDIA SUPERVSED ❑ YES Q NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS? O YES ❑ NO DELUGE 8 IS THERE AN ACCESSIBLE : FACILITY IN EACH CIRCUIT FOR TESTING? IF NO, EXPLAIN PREACTION i ❑ YES ❑ NO VALVES ? DOES EACH CIRCUIT OPERATE - DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPERATE MAKE MODEL ; SUPERVISION LOSS ALARM? VALVE RELEASE' RELEASE i • YES NO YES *0 YES . NO HYDROSTATIC: Hydrosta levels shall be made at not leas Chet 200 psi (13.6 bars) for two hours ad SO psi (3.4 bars) above static Pressure In TEST mss d 150 ps1(10.2 bars ; two hours. Differential dry -pipe valve dappers shell be Celt open during test b prevent damage. All aboveground DESCRIPTION ' piping leakage shall be stodted. PNEUMATIC: Establish 40' Psi (2.7 bars) air pressure end measure drop vAkti shad not exceed 1 Si psi (0.1 bars) in 24 tours. Test pressure tanks at normal water level end air pressure and measure alr pressured which shell not exceed +! IS pd (D. ) In 24 hours • ALL PIPING HYDROSTATICALLY TESTED AT A 00 FOR . , HRS IF N0, ST N DRY PIPING PNEEUMATICAILLYTESTED 0 YES ❑ NO EQUIPMENT OPERATES pROPERLY ❑ YES C] NO 00 YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS. o % N • • SILICATE OR DERIVATIVES OF SO SILICATE, BRINE OR OTHER CORROSIVE CHEMICALS TESTING ICALS WERE NO! USED FOR TEST : • OR. STOPPING LEAKS? .YES CI NO f DRAIN READING O ;.AGE LOCATED NEAR WATER SUPPLY,TEST I C L PRESSURE OR WIT VALVE � T ' I,.. . TESTS TEST I CONNECTIOI•: PSI UNDERGROUND MAINS ,AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. i . VERIFIED BY COPY OF Tfi E U FORM NO 868 RTES ❑ P40 _ FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING © YES ❑ NO IF NO, EXPLAIN • BLANK TESTING NUMBER USED ' LOCATIONS NUI4SER REMOVED GASKETS 0j' i v WELDED PIPING ❑ YES MO IF YES, COMPLETE BELOW •• 00 YOU CERTIFY AS THE'SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMELY WITH THE REQUIREMENTS OF AT LEAST AWS 010.9. LEVEL AR3? ❑ YES ❑ N0 I, WELDING DO YOU CERTIFY THAT!)1E WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.8, LEVEL AR-3? ❑ YES ❑ NO • DO YOU CERTIFY THAT lPJELDNG WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED. THAT OPYENINGS IN PIPING ARE SMOOTH THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, ANL) THAT • THE INTERNAL D1AAAETERS OF PIPING ARE NOT PENETRATED? ❑ YES ❑ NO CUTOUTS DO YOU CERTIFY THAT. 10U HAVEA CONTROL FEATURE TO ENSURE THAT ALL YES ❑ (DISCS) CUTOUTS (DISCS) ARE PJ TR1l1/ED? No FUNCTIONAL DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS?. AYES 0 N FLOW TE YES ❑ NO WERE FUNCTIONAL FL 4TESTRESULTSSATISFACTORY? , HYDRAULIC IF NO, EXPLAIN • DATA NAMEPLATE NAME PLATE PROVIDED : YES ❑ NO • REMARKS DATE LEFT N SERVICEWETH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER COINTRACTOR CONTRACTOR LICENSE'S DATE WA = CASCAFP203 IIW OR = 89096 EZ)312, 7 i TESTS WITNESSED BY SIGNATURES TY OWNER OR RE THE TITLE DATE • • • ••- TTY HAVI -- .- - ' DICTION TITLE DATE /, i� .- - _ • 111 Slug 31 2007 5:58PM Cascade Fire Protection C 503 541 -8768 p.4 • ( 411; MATERIAL. & TEST CERTIFICATE ABOVEGROUND CASCADE R ON CQ PROCEDURE , Upon completion of work, inspection and test shall be made by the contractor's representative and witnessed by an owners representative. All defects shall be corrected and system left in service before contractor's 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 owner's representative's signature in not way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. . • PROPERTY NAME - DATE 8 - _18 - 07 ' PROPERTY ADDRESS 1 i 8 60 LA) 6 7 � . / . An ewe. 9 7,2 23 ACCEPTED APPR G RUTH -e (NAME) • C-s• o P `rsc tam C,Ns p Q,a e- ugT7 ADDRE8S , PLANS - INSTALLATION CONFORMS TO ACCEPTED PLANS WES 0 NO EQUIPMENT USED IS APPROVED YES 0 NO IF NO, EXPLAIN DEVIATION HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN orr� INSTRUCTED AS TO LOCATION OF CONTOL VALVE AND c ®p y CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? YES ErNO IF NO, EXPLAIN i OiSTRtICTIONB HAVE COPES OF THE FOLLOWING BEEN LEFT ON THE • : I PREMISES 1. SYSTEM COMPONENTS INSTRUCTIONS ES 0 NO '., ' :.' - F .: `' 2. CARE AND MAINTENANCE INSTRUCTIONS S ONO i- gg S 3. NFPA 25 ❑YES ❑ NO F LOCATION SUPPLIES BUILDINGS ' OF SYSTEM - MAKE MODEL MANUFACTURE ORIFICE SIZE QUANTITY TEMPERATURE RATING I 7 p It 1 I 1 - 0 8 at,,j/ • TYPE OF PIPE - � PIPE AND `1 ek �L LA - FITTINGS TYPE OF FI TT IIIG 1� S CI�..a dt= 7 r. ALARM DEVICE MAXIMUM TIME TO OPERATE T7IR000H TEST CONNECTION • - TYPE MAKE MODEL MINUTES SgCONDS. ALARM VALVE OR ,, FLOW INDICATOR , A • pikl .rte Pev R I! {r,~J) s rti.e.crAr Rug 31 2007 5:58PM Cascade Fire Protection C 503 541 -8768 P. l DRY VALVE QUICK OPENING DEVICE MAKE NOOEL SERIAL NO. MALICE . MODEL SERIAL NO. - i' TIME TT. TRIP R TRIP POINT ` " TIME WATER ALARM OPERATED THRUTEST PRESSURE AIR PRESSURE AIR REACHED TEST PROPERLY DRY PIPE CONNECTION PRESSURE OUTLET OPERATING TEST MIN • SEC PSI PSI PSI , MIN SEC YES NO WITHOUT is Q.O.D. N' WITH • Q.O.D. �• IF NO, EXPLAIN I . • r. • OPERATION I. ❑ PNEUMATIC ❑ ELECTRIC 0 HYDRAULIC - ��® PIPING SUPERVISED : 0 YES ❑ NO j DETECTING MEDIA SUPERVISED ❑ YES 0 140 01 DOES VALVE OPERATE F ROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS?; ❑ YES ❑ NO DOGE a IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? IF NOS EXPLAIN PREACTION ❑ YES 0 NO , VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO OPE LATE SUPERVISION LOSS ALARM? VALVE RELEASE? RELEASE MAKE MODEL; YES NO YES :NO YES NO . i HYDROSTATIC: Myd levels shall be made at not lees dud 200 psi (13.0 bars) for two Imre of 50 pal (3.4 bars) above etetle preseure.In TEST • excess of 150 psi (10.2�for two hours. OGRerentlal dry-pipe valve clappers shall be left open dbdng test to prevent damage. M aboveground DESCRIPTION O leakage shall be stopped. - PNEUMATIC: Establish 40 psi (2.7 bars) alr pressure end measure drop which shall not exceed 1 6 pal (0.1 bars) In 24 hours. Teat pressure tanks at normal water leveIand alr pressure and measure alr pressure drop leech shat not axoeed11 %psi (0.1 bars) in 24 hours ALL PIPING HYDROSTATICALLY TESTED AT - A7 FOR ) HRS : l NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED 0 YES ❑ NO EQUIPMENTOPERATES;EROPERLY BYES ❑ NO DO YOU CERTIFY AS T SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS. SOOIUM SILICATE OR DERNATIVES OF SODI SILICATE, BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ' S ❑ 140 DRAIN 1 READING GAGE LOCATED NEAR WATER SUPPLY TEST T RESIDULE PRESSURE WITH VALVE IN TEST TESTS TEST I CONNECTION PSI I CONNI:CTIQN OPEN WIDE: PSI UNDERGROUND MAINS SID LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFCJ E CO 0O MADE TO SPRINKLER PIPING. ) • VERIFIED BY COPY OF THE U FORM 140 85B 0 YES ❑ fit FLUSHED BY IN INSTALLEFi.OF UNDERGROUND SPRINKLER PIPING 0 YES ID No C IF NO, EXPLAIN O . BLANK TESTI NUMBER USED I LOCATIONS NI:403ER REMOVED " GASKETS (} 4 l • • A WELDED PIPING o YES ❑ NO IF YES, COMPLETE BELOW • U 1 1 DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR NAT WELDING PROCEDURES COMPLY • WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR3? ❑ YES. ❑ 140 . i HYELDBNG DO YOU CERTIFY THAT T HE WELDING WAS PERFORMED BY WELDERS QUAUFIED IN . COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3? ❑ YES 0 NO DO YOU CERTIFY THAT MELO(NG WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMEN)rED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED, THAT O1?ENINGS 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 j(OU HAVE A CONTROL FEATURE TO ENSURE THAT ALL (DISCS) CUTOUTS (DISCS) ARE bIEIRJEVED? .. 0 YES ONO FU NCTIONAL P DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? ❑ YES ❑ NO FLOW TEST - WERE FUNCTIONAL. FL. 4VTEST RESULTS SATISFACTORY? " • .0 YES 0 NO HYDRAULIC NAME PLATE PROVIOF.q I I ❑YES ❑ NO j IF NO. EXPLAM • • • DATA NAMEPLATE II f REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR CONTRACTOR LICENSER DRTS 4-6 I . f Pi o i hcT a6 WA = CASCAFP20:WW OR = 89096 - . ' -v7 C; T ESTS WITNESSED BY • • SIGNATURES PROP - OWNER OR • PRESENTATIVE TITLE ,. DATE • • A HAVING' -..:`N TITLE DATE • : 1... . • 1 X 11