Report 10/20.05 THU 10:II' , 1 master Fire Control ?XIS a002
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Contractor's i` oteriai and Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of wort 7 Ee ecdon and tests shall be made by the COntrector's repr sentalive and witnessed by an owners
representative. All CefoC:;, ',;,all be corrected and system left in service oelore contractor's personnel finally leave me Loh.
A certificate shall be Idled it and signed by both representatives. Copies shall be prepared for approving authorities. owners. ane
Contractor- It is under F?;' ..' ' owner'S representative's signature in no way pre)udides any Claim against contractor for faulty material, ;For
workmanship. or failure t:i • imoly with approving authority's requirements or local ordinances.
PROPERTY NAME A 1 3 L � A o d F / F ■■•• • DATE /O � O 1 a . 665-- PROPERTY ADORES.. / i 5 0 5c..-9 / 3 2.v e ` i4e4c,L t' j t>1?-- � �4
I. ACC EO BY APPROVING AUThORITIES (NAMES) .
• PLANS - -
r tri ;,- „.ATION CONFORMS TO ACCEPTED PLANS NO
=.i,'r'• .''CNT USED IS APPROVED `I YES ❑ NO
i r,.. . `:PLAIN DEVIATIONS .
: - -1A PSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS = YES O
r I - :A T ION OF CONTROL VALVES AND CARE AND MAINTENANCE
r” 3 NEW EQUIPMENT?
if. r ., EXPLAIN
INSTRUCTIONS , 0(A)/46-45 r/' tZ 4/0 PA i Seg 7 To PATE
1 ;-i : :'i'.= ;:OPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: ) 'YES rI NO
• I. SYSTEM COMPONENTS INSTRUCTIONS � ES E' NO
2 :4RE AND MAINTENANCE INSTRUCTIONS L�r :/YES 71 NO
•
Ti r ✓
dFPA 25 YES E. NO
LOCATION LL;P. :.IES BUILDINGS
OF SYSTEM
YEAR OF ORIFICE I I TEMPERATURE
MAKE MODEL f, MANUFACTURE SIZE QUANTITY I RATING
• SPRINKLERS ' - T _
I I
1
PIPE AND i Pipe ,- ) t F- 0 J',, , SG■ 1 f%0
FITTINGS ' ry "` :rt ^ i .. 4 i llt n
_ I MAXIMUM TIME TO OPERATE
ALARM ALARM DEVICE I THROUGH. T_;_ CONNECTION
TYPE . MAKE MODEL MIN. SEC.
OR FLOW
INDICATOR 1
•
DRY VALVE 0. 0. 5'.
MAKE MODEL i SERIAL NO. I MAKE I MODEL I SERIAL NO.
DRY PIPE i TIME TO TRIP ; • I TIME WATE I ALARM
OPERATING THROUGH TEST WATER I AIR TRIP POINT REAOHED I OPERATED
TEST _ CONNECTION' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' I PROPERLY
MIN SEC. I PSI I PSI - PSI I MIN, i SEC i YES I NO
C '` 0, 6.5 t9 I p I ' ? 5 V '
r l.
,a EXPLAIN
'MEASURED F _ ,_ INSPECTORS TEST CONNECTION IS OPENED.
199A Eolticn
10 /20/05 THU 10:.. • 15n:36560782
Master sire Control X1003
{ in= EATIoN _
PNEUMATIC ELECTRIC HYDRAULIC
r'IfVG SUPERVISED YES l NO DETECTING ECTING MEDIA SUPERVISED 'CJ YES • NO
DOE'S VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE I . YES NO
CONTROL STATIONS
PELAGE & j '_ THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT I IF NO. EXPLAIN
PREAGTION : -.1.P.
VALVES TESTING
_ YES Li NO -
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT I MAXIMUM TIME TO
r +l'KE. . MODEL I SUPERVISION LOSS ALARM OPERATE VALVE RELEASE I OPERATE RELEASE
I _ ! YES NO I YES I NO I MIN I SEC.
1 I I I
^CATION MAKE & I SETTING ST ATIC PRESSURE RESIDUAL PRESSURE , FLOW RATE
PRESSURE DOOR MODEL I I , (FLOWING) .
REDUCING ` —J ' I INLET (PSI) I OUTLET (PSI) 1 INLET (PSI) I OUTLET (PSI) I FLOW (GPM)
VALVE TEST . --
1 1 1 I
'DPi.Ci 2 TIC: Hydrosmtie tests shall be made at not less man 200 psi (13.6 bars) for two hours or 50 es; {3 -4 bars)
:.: static: pressure in excess of 150 psi (102 bars) for two hours- Differential dry -pipe valve ^uppers snail be left
on d "n; rest to prevent damage. All aboveground piping leakage snail be stopped.
TEST l
DESCRIPTION i (AF Li • Esraplish 40 psi (2.7 bars) air pressure and measure drop, whin snail not exceed t - 1!2 psi (0,t bars)
,r. 24 hours. Tess pressure tanks at normal water level and air pressure and measure air pressure•drop, wrnorr shall
:. •t exceed 1 -1/2 psi (0.1 bars) in 24 hour. ��,qq�
., LPIIP 'INOHYDROSTATICALLYTESTEDAT 2.1APSI FOR HRS. l IF NO. STATE REASON
Y r- : , R.Y PIPING PNEUMATICALLY TESTED _ YES 77 NO '
DUiPMENT OPERATES PROPERLY YES _I NO I
O YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,
r:ODfUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE. OR OTHER CORROSIVE CHEMICALS
WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? .
L1 YES rl NO
~ DRAIN I READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE I ' T_ST
TESTS I TEST I SUPPLY TEST CONNECTION: PSI CONNECTION OPEN WIDE PSI
'.;NDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE
CONNECTION MADE TO SPRINKLER PIPING.
.EDIFIED BY COPY OP THE U FORM NO. BEE Z ❑ NO i OTHER EXPLAIN
1 1 _'-!SHED BY INSTALLER OF UNDER- I
.:ROUND SPRINKLER PIPING •_) YES E NC 1
CWDEF DRIVEN FASTENERS ARE USED IN '_' YES a NO 1, IF NO. EXPLAIN
;
_'CRETE, HAS REPRESENTATIVE SAMPLE I
. > i ING BEEN SATISFACTORILY COMPLETED? I
BLANK TESTING ' "Ii1ER USED 1 LOCATIONS 1 NUMBER, REMOVED
GASKETS I '
::_I)ED PIPING I!%' Y ES IE NC
IF YES...
' CU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING NO
EDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST
i 010.9. LEVEL AR -3?
WIELDING - YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS
:•.iC_IEIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST YY _ ES NO
D10.9. LEVEL AR -3?
YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE �
vr i-u, A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE ✓ YEp i NO
I - ,- -:AT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE — —
I000TH. THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,
T' THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENe RATED?
CUTOUTS :. ° DU CERTIFY THAT YOU HAVE A CONTROL FEATURE_ TO i ✓! YES _' NO
{DISCS) -'IRE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED?
•
1 r+t Edlticn •
10/20/05 THIS 10:c • - T. iF. Master Fire Control 1004
HYDRAULIC . LLAT PROVIDED IF NO EXPLAIN
DATA.
NAMFPLATE ES n NO
C IN SERVICr- WITH ALL CONTROL VALVES OPEN;
REMARKS
CPRINKLE CONTRACTOR
SIGNATURES / -7) TESTS WITNESSED BY
C 0y NE01/ TITLE DATE/ /
•
.„ • INflLE:R,NT1ACTO- SIGNEDJ TITLE DATE
— c32 D
ADDITIONAL EXPI ' ' • A.NO NOTES