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Report 1 " IR �� Contractor's Material and Test Certificate for Aboveground Piping . it E PROTECTION. INC • ° . • PROCEDURE Upon completion of work :inspection and tests 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 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 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 - - D t . Triangle Point iI \S \'► o Property Address ' 13333 SW 68th Pkwy Accepted by Approving Authorities (names) City of Tigard . • Address Plans • 0 Yes ❑ No Installation conforms to .accepted, plans • Equipment used is approved N Yes ❑ No • If no, explain deviations ' Has person in charge of fire equipment been instructed as to location ❑ Yes ❑ No ' of control valves and care and maintenance of this new equipment? . 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 • ❑ Yes ❑ No 3. NFPA 25 0 Yes ❑ No - Location Supplies Building System No. ' of System Whole - All Year of Orifice Temperature . • Make Model Manufacture Size Quantity Rating . Reliable F1 FR 2010 5.6 155 • Tyco EC11 • 2010 . 11.2 155 • Pipe and Type of Pipe Sch -10 / Flow / Sch-40 . Fittings Type of Fittings Grooved / Threaded . • Alarm Device Maximum time to operate through test connection Alarm Valve or Type Make .Model Minutes Seconds Flow Indicator Flow Switch. Potter VSR - . Dry Valve ' Quick Opening Device ' Make . Model Serial No. - Make - Model Serial No. • " N/A - Time to trip • Alarm . - through test Water Air Trip Point Time water reached operated • - connection (1,2) Pressure Pressure Air Pressure test outlet (1,2) properly Minutes Seconds PSI PSI PSI Minutes Seconds Yes No Dry Pipe Wthout ❑ ❑ Operating Test Q.O.D. - • With • - ❑ ❑ • Q.O.D. . . . If no, explain - - • • • . - (1) Measured from time inspector's test connection is opened ' (2) - NFPA 13 only requires the 60- second limitation in specific sections • . ! , . Operation - ' Pneumatic ' ❑ Electric ❑ Hydraulic ' Piping supervised X11 Yes ❑ No Detecting media supervised `ll Yes ❑ No - Jeluge and Does valve operate from the manual trip, remote, or both control stations? ' Yes ❑ No • Preaction Is there an accessible facility in each circuit for ❑ Yes ❑ No If no, explain Valves ' testing? Make Model Does each circuit operate Does each circuit operate Maximum time to supervision loss alarm? valve release? operate. release N/A Yes No Yes - -No • Minutes - Seconds ❑ ❑ • ❑ ❑ Location and Make and Setting - Static Pressure Residual Pressure (Flowing) Flow Rate Pressure Reducing Floor Model Inlet (PSI) - Outlet (PSI) . Inlet (PSI) Outlet (PSI) Flow (GPM) Valve Test N/A Hydrostatic: Hydrostatic tests shall be made at not less than 200 PSI (13.6 bar) for 2 hours or 50 PSI,(3.4 bar) above static pressure in excess of 150 PSI (10.2 bar) Test for 2 hours. Differential dry-pipe valve clappers shall be left open during the test to prevent damage. All aboveground piping leakage shall be stopped. Description . Pneumatic: Establish 40 PSI (2.7 bar) air pressure and measure drop, which shall not exceed 1'4 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 135 PSI (0.1 bar) in 24 hours. All piping hydrostatically tested at 70 0 PSI for 2 hours If no, state reason Dry piping pneumatically tested . ❑ Yes ' ❑ No Equipment operates properly ❑ Yes ❑ No • Do 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 stopping leaks? -© Yes ❑ No Tests Drain Reading of gauge located near water supply test connection: Residual pressure with valve in lest connection wide open: Test Static Pressure ' \ \ S ' PSI \f 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. 85B ❑ Yes ❑ No Other Explain , Flushed by installer underground sprinkler piping ❑ Yes ❑ No If powder- driven fasteners are used in concrete, , • has representative sample testing been If no explain . satisfactorily completed? ❑ Yes ❑ No Blank Testing ' Number Used Locations Number Removed ' Gaskets - Welded Piping ❑ Yes - ❑ No . • • . If yes... . Do you certify as'the sprinkler.contractor that welding procedures comply with the requirements of at least AWS ❑X Yes ❑ No B2 :1? Welding Do you certify that the welding was performed by welders qualified in compliance with the requirements of at least x❑ Yes ❑ No AWS B2.1? • Do you certify that the welding was carried out in compliance with a documented quality control'procedure to - x❑ Yes ❑ No 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? CUtOUtS Do you certify that you have a control feature to ensure that all cutouts (disks) are retrieved? ' I 1 Yes ❑ No (Disks) • Hydraulic Data • - Nameplate provided If no, explain Nameplate • 4 Yes ❑ No - ' • Date left in service with all control valves open - - Remarks • - • A S. \lO - • Name of sprinkler contractor - Contractor's License No. . Patriot Fire Protection, Inc. PATRIFP099CF • • Tests witnessed by For roperty owner (signed) Title Date Signatures z� s ! ,- --C •-- __. -4._9 L - � J. // / { 1 /.'% • For s rinkier coritfactor (si ned \ Title Dade ' • F r (proving authority n Title / I ate i ! t.c I / U � i •