Report Oct 13 05 11:43a Hydro Tech 360 256 2817 p.2
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# Jun 01 05 08:06a H y d r o T ech 360 256 2817 P 2
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147005 SW ic)8 7 71.4vE 13c a6- A
WASHINGTON STATE FIRE MARSHALS OFFICE FIRE SPRINKLER ADVISORY BOARD
/ HYDRO TECH FIRE PROTECTION INC
CONTRACTORS MATERIAL & TEST REPORT FOR ABOVEGROUND PIPING BRUSH P.O. B OX 40
R 98608
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PROCEDURE
Upon completion at work. Inspection and testa 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 oertiflcate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities. owners, and mRtractor. 1 is under.
stood the owner's representative's signature In no way prejudices arty claim against contractor for faulty material, poor workmanship. or Iailure to comply
with approving authority's requirements or local ordinances.
PROPERTY NAME _ _ DATE •
IA zF A' k � 1
PROPERTY ADDRESS \ q b � �fF\ !1 : �' E % r.1 G A 1t D r � A�� ^A
'
ACEAPPROVING a J B AUTHORITIES (NAME)
t Pcof* 1j
c_1 7 l" 1 t
ADDRESS •
INSTALLATION CONFORMS TO ACCEPTED PLANS DYES U NO
PLANS EQUIPMENT USED IS APPROVED RYES 0 NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION BYES U NO
OF CONTROL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: YES NO
1. SYSTEM COMPONENTS INSTRUCTIONS YES ENO
INSTRUCTIONS 2. CARE AND MAINTENANCE INSTRUCTIONS. YES ONO
3. NFPA 13A t'ES O NO
OFSYSTEdA SUPPLIES BUILDINGS 1S -3 ' v 1 � � � l'" � iLb 1 G A
YEAR OF ORIFICE " TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
SPRINKLERS
r
PIPE AND TYPE OF PIPE C 1 V C -
FITTINGS TYPE OF FITTINGS c"Jr-
ALARM ALARM DEVICE MAXIMUM TIME TO OPERATE -.
THROUGH TEST CONNECTION
VALVE MIN SEC.
OR FLOW TYPE MAKE MODEL MI
INDICATOR NJ �rla- VANE. 1='is ) ' - i•VE z 11 ti l` 1 15
DRY VALVE O.OD.
MAKE MODEL 1 SERIAL NO. MAKE MODEL SERIAL NO.
• TIME TO TRIP ' TIME WATER ALARM
DRY PIPE THRU TEST WATER MR TRIP POINT REACHED OPERATED
OPERATING CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PRO PERLY
TEST MIN_ SEC. PSI PSI PSI MIN. SEC. YES NO
WITHOUT _
Ki /Pi O.O.D.
WITH
Q.O.D.
IF NO, EXPLAIN
• MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED (OVER)
85A
Oct 13 05 11:44a Hydro Tech 360 256 2817 p.3
1 360 256 2817 P•
Jun 01 05 08:068 Hydro Tech
• OPERATION'
El PNEUMATIC 0 ELECTRIC 0 HYDRAULIC
DELUGE L PIPING SUPERVISED • YES IA NO DETECTING MEDIA SUPERVISED III YES • NO
PREAC ON DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS L1YES U NO
V • IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO. EXPLAIN
EACH
❑YES
1 \
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAZE MODEL. SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE
.• •• . n -
TEST • maw* [.a .h.0 be msda a na 1.� then 200 pal (tae bani Tor two hewn' 0160 o.l pA MO) •6n'.. stalk pr. SWS 4l mane at 150 poi (102
DESCRIPTION .44.. O4$ 4nrilal dry rs TT
p1p. h.M. cl.pp.1.M b.l.n during uring I..I ta pr.v. "' e.m.p•• A2 .h).1.pw
rrd pldn9 • 1 a 9. .h. *ap
PNA h11TY•• &4.h1.', 40 pJ (27 ham it p..••rss •4414,44.4.4 daep.Nch mall not .hc..d 1.112 pal 10.1 h.I.) In 24 houa. I 13r4 44U44 heft 41 POo .J was.
1.•.I and .0 . ..nd or.ur. .6 • • .. .614.6 44.11 nal •.c..41 1 412 • • 1 • N 24 hours.
ALL' ' IN HYD•••. AT a AT • ` PSI F•R �_ HR . I •, TAT - $T.°iN
DRY PIPING PNEUMATICALLY TESTEDK, • YES •
EOUIP MENT OPERATES PROPERLY aq YES • NO
DO YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM
SILICATE OR ()ERMINES OF SOOIUM SILICATE, BRINE. OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TEST-
ING SYSTEMS OR STOPPING ❑ NO
TESTS 'DRAIN READING OF GAGE LTED WATER RESIDUAL PRESSURE WITH VAL INJEST
TEST 1 SUPPLY TEST CONNECTION: `7 PSI CONNECTION OPEN WIDE 7c PSI
UNDERGRO MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MAO TO
SPRINKLER PIPING. ,
VERIFIED BY COPY OF THE U FORM NO. 85B OYES 0 NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER -
GROUND SPRINKLER PIPING ()RYES ❑ NO
BLANK TESTING NUMBER�USED LOCATIONS NUMBER REMOVED
GASKETS /�
YIELDED PIPING DYES ENO
IF YES.. .
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D 10.9. LEVEL AR-3 OYES ❑ NO
WELDING COMPLIANCE YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS OUAL I LED IN
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9. LEVEL AR-3 O YES 0 NO
N/A 00 YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED QUALITY 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 OYES ONO
K JA CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
(Discs♦ CUTOUTS (DISCS) ARE RETRIEVED? D YES • NO
FUNCTIONAL DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? DYES • s _
FLOWTEST WERE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? DYES .1'NO
HYUHAUUC NAME PLATE PROVIDED ( IF NO EXPLAIN
DATA NAMEPLATE YES ONO
REMARKS DATE LEFT IN SE WITH QOM TROL VALVES OPEN:
NAM OF_ S p CONTRACTOR CONTRACTOR LICENSE M
W 1 a ECM 14`lnkn •
TESTS WITNESSED BY _
SIGNATURES FOR PROPE•TY OWNER (SIGNED) TITLE DATE
I
FOR /• *: • • • v �. IM i > E .
'
AP WING �`Tl1 ► S l O i u
P
TITLE � a • TE
oTil
I CERTIFY THAT E IN -s - TION HEREIN IS TRUE AND THAT THIS SPRINKLER SYSTEM WAS INSTALLED IN ACCORD-
ANCE WITH RCW 16-160 AND THE RULES ADOPTED BY THE WASHIN ON ADMINISTRATIVE C?D4S ADMINISTERED BY
CERTIFICATION THE STATE ARE MARSHAL,':. , / , / J (�
Gr . �� - c ' � 1.. . — NA4 r OF CERTIFICATE Of C I.IPETENCY Iq( P TY
NT OR PEI
CERTIFICATE r mOMATIM Of cFm1FFlCt E OF E7E? Y
mod, • DAT ac
AIM EXPIA44.41t0M /440 NOTES - •• --________---____
4 \.