Report -- _ . SYSTEM ACCEPTANCE C/ r a 00 _ /� /'� � . .
co a. _
Contractor's Material and Test Certificate forAboveground Piping
,
PROCEDURE
Upon completion of work. inspection ana t ests s hall be matl by the contractor's representative and witnessed by an owner's
representative. All detects shall be corrected and system left in service before contractor's personnel finally leave the job. •
si 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 aporoving authorityjrequirements or local ordinances.
PROPERTY NAME ----- � +
_ D�_■ 4� 1V ��IiJ1 C_ enL f DATE
PROPERTY ADDRESS -- ` — ( %. 7 . l 4 ' ,e
-------- - - -._— C M fin. ■\ . f 4t alTi fa
j ACCEPTED BY APPROVING AUTHORITIES (NAMES) ,r ----
di_ c._. i L'N c,F \ lr..
ADDRESS ��
PLANS
INSTALLATION CONFORMS TO ACCEPTED PLANS
EQUIPMEENT.t'JSED IS APPROVED „r YES U NC
IF NO, EXPLAIN DEVIATIONS 2 YES Ei NO
I HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE YES Ell NO
I OF THIS NEW EQUIPMENT? �`
IF NO, EXPLAIN f ' '
INSTRUCTIONS L
6i.
HAVE COPIES OF THE FOLLOWING BEEN ON THE PREMISES?
I. SYSTEM COMPONENTS INSTRUCTIONS I YES n NO
2. CARE AND MAINTENANCE INSTRUCTIONS YES L NO
___ 3. NFPA 25 I YES El NO
LOCATION — 2 YES ) I NO
OF SYSTEM SUPPLIES Bl1ILDINGS —
•
LI MAKE YEAR OF ORIFICE —
MODEL MANUFACTURE J SIZE TEMPERATURE
�~ QUAN RATING
ITC. V A
2
SPRINKLERS ° �r� 11
_— —
_
. PIPE AND /Type of Pipe °C.41 4 , --- ck► 1 A
•
FITTINGS Type of Fittings
i --- — — CO-06 ea a
ALARM
VALVE ALARM DEVICE MAXIMUM TIME TO OPERATE
OR FLOW TYPE THROUGH TEST CONNECTION
MAKE —
• INDICATOR n"—MODEL MIN
4).k,\/ L .�,iiI �'�r SEC
•
, _ DRY VALVE '
•
MAKE —r— Q. O. D.
MODEL SERIAL NO MAKE f
I_ MODEL SERIA .. •
DRY PIPE + TIME TO TRIP _ i
OPERATING THROUGH TEST J WATER I AIR MfE REACHED
ALARM
TRIP POINT I REACHED
PRESSURE I PRESSURE Al- - l OPERATED
TEST CONNECTlONt
� MIN SEC
PSI i PS SU_ RE TEST OUTLETt J PROPERLY A (Wthout PSI f MIN SEC YES NO
i O. D
With + — I �TL -
. ,- -- r--
Q.Q.D.! I + � _
•
IF NO, EXPL4Y. —
1 MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED.
Figure 8 - 1(a) Part 1.
1996 Edition
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13 - INSTALLATION OF SPRINKLER SYSTEMS
OPERATION
f_i PNEUMATIC h ELECTRIC
Li HYDRAULIC
PIPING SUPERVISED . YES El NO I DETECTING MEDIA SUPERVISED YES El NO
I DOES VALVE OPERATE FROM THE MANUAL TRIP, REMOTE, OR BOThi--- F YES LI NO
L CONTROL STATIONS
DELUGE AND I _
PRFAC T !ON IS THERE AN ACCESSIBLE FACILITY IN EACH CI,5QU IF NO EXPLAIN
VALVES ; FOR TESTING
YES 'i a
I I
1 I DO - ACH CIRCUIT OPERATE DOES EACH CIRCUIT. MAXIMUM TIME TO
^a ! MAKE I MODEL I PERViSION LOSS ALARM? I OPERATE VALVE RELEASE? OPERATE RELEASE
YES J NO , YES I NO 1 MIN SEC
1 I _
1
N Ip LOCATION I MAKE & I SE I I ING 1 STATIC PRESSURE • AL PRESSURE FLOW RATE •
PRESSURE & FLOOR I MODEL I (FLOWING)
REDUCING
VALVE TEST �- INLET (PSI) OUTLET•(PSI) I INLET (PSI) ? OUTLET (PSI) FLOW (GPM)
I HYDROSTATIC. Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for 2 hours or 50 psi (3.4 bars)
above static pressure in excess of 150 psi (10.2 bars) for 2 hours. Differential dry-pipe
open during the test to prevent damage. All aboveground piping leakage shall be stopedve clappers shall be left
TEST
DESCRIPTION' 1 PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 11/2 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 tat. PSI STATE
DRY PIPING PNEUMATICALLY TESTED Y ES NO w I to
BARS) FOR _ HRS i iF NG REASON
EQUIPMENT OPERATES PROPERLY ;
ES Ii NO I l
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? -, '
L 1 ✓YES i l NO
I1 DRAIN /READING OF GAUGE LOCATED NEAR WATER j RESIDUAL PRESSURE WITH VALVE IN TEST
TESTS LTEST 1 SUPPLY TEST CONNECTION: PSI (__BARS) I CONNECTION OPEN WIDE:
PSI (_BARS)
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 IT YES El NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING /
—_ L✓ YES ❑ NO
IF POWDER - DRIVEN FASTENERS ARE USED IN '
• CONCRETE. HAS REPRESENTATIVE SAMPLE U YE S L NO IF NO, EXPLAIN
. TESTING BEEN SATISFACTORILY COMPLETED ?• I
f
BLANK TESTING NUMBER SED LOCATIONS NUMBER REMOVED
GASKETS 0 V A-
WELDED PIPING r YES ) I NO
_
• IF YES...
DC YOU CERTIFY AS THE SPRINKLER CONTRACTOR. THAT WELDING
PROCEDURES COMPLY WITH THEREQUIREMENTS OF AT LEAST — YES I I NO
AWS D10.9, LEVEL AR -3?
WELDING II DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS
QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST NO
• AWE Di 0.9, LEVELAR -3? YES
3
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, YES ( I NO i i
AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED?
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO . ,/
(DISCS) ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? ! J YES U NO
•
Figure S -1(a) Parr 2.
:996 Edition •
• .• SYSTEM ACCEPTANCE - 13-7:
•
' HYDRAULIC i NAMEPLATE PROVIDED 1 IF NO, EXPLAIN
• DATA
ZrYES NO
NAMEPLATE i •
•
• I DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN a. • y. 4
REMARKS )
NAME OF SPRINKLER CONTRACTOR
F
SIGNATURES „ . . • '' • " • TESTS WITNESSED BY
. . .
P • E '1(15•E?) , ' TITLE DATE
000k Lb Z
_. •
-ff pE CONTR • 'TOR (SIG ' z i;D • ,.0
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ADDITIONAL EXPLANATION AND NOTES
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