Report - SYSTEM ACCEPTANCE 13 -63
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Contractor's Material and Test Certificate for Aboveground Piping
PROCEDURE
Upon•completion of work inspection and tests shall be made by the contractors representative and witnessed by an owner's
representative. All defects shall be corrected and system left in service before contractors 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 owners 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 b4.9 e cblo DATE 9
5/, �
PROPERTY ADDRESS 59 da 5 I - eb „ci /Y A� ( ( / "]
ACCEPTED BYAPPfil LAG ,2
ADDRESS RI�IF,S E) J /
(�'' 1 �( ��
PLANS '
INSTALLATION CONFORMS TO ACCEPTED PLANS j' YES . C] NO
EQUIPMENT USED IS APPROVED A YES C] NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS YES C] NO
TO LOCATION 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: `- ►� YES C] NO
1. SYSTEM COMPONENTS INSTRUCTIONS IN YES C] NO
2. CARE AND MAINTENANCE INSTRUCTIONS . A YES C] NO
3. NFPA25 C] YES C] NO
LOCATION SUPPLIES BUILDINGS
OF SYSTEM
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
✓lerfruCIL VZ'7 "ZOO 61 . 1/2" _ VI I%
SPRINKLERS TYCO Si b & .4 U 2 d n (o IrZ 3 1 t
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PIPE AND Type of Pipe 4 C/ , 10 t < t L )K 4 Flo to
FITTINGS Type of Fittings S' C r 4e00Vr-8 1 WC LJ) a
ALARM MAXIMUM TIME TO OPERATE '.
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VALVE ALARM DEVICE THROUGH TEST CONNECTION
OR FLOW TYPE MAKE MODEL MIN. SEC.
INDICATOR W4 IM) Porn Z Et• Wily C, 23
.DRY VALVE • Q. O. D.
MAKE MODEL SERIAL NO. MAKE , L • SERIAL NO.
. DRY PIPE TIME TO T' • TIME WATER ALARM
OPERATING THROUGH TEST AIR RIP POINT REACHED OPERATED
' TEST CONNECTION' PRESSURE - - S - '- AIR PRESSURE TEST OUTLET' PROPERLY
MIN. SEC. PSI •SI �---...„ PSI MIN. • SEC. YES NO
Without
Q.O.D. •
With - -.. 7..........: ,
Q.O.D. .
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IF NO, EXP
'MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED.
Figure 8 - 1(a).
1994 Edition
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13 -64 INSTALLATION OF SPRINKLER SYSTEMS
OPERATION
❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPER : • ❑ YES ❑ NO
DOE • • _ • PERATE FROM THE MANUAL TRIP AND /OR REMOT ❑ YES ❑ NO
CONTROL STATIO 1
DELUGE &
PREACTION IS THERE AN ACCESSIBLE FACILI ' • CH CIRCU IF NO, EXPLAIN
VALVES FOR TESTING
I YES ❑ NO
DOES EACH C ' IT OPERATE DOES E • - : CULT MAXIMUM TIME TO
MAKE MODEL SUPERVI s LOSS ALARM OPERATE VALVE - - - SE OPERATE RELEASE
S NO YES NO MIN. SEC.
LOCATION • • E & SETTING STATIC PRESSURE RESIDUAL PRESSURE FL01N RATE
PRESSURE & FLOOR MODEL (FLOWING)
REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM)
VALVE TEST
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars)
• above static pressure in excess 01150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be left
TEST open during test to prevent damage. All aboveground piping leakage shall be stopped.
DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1 -1/2 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- 1/2.psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT 2 ° 0 PSI FOR is HRS. IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED ❑ YES n NO
EQUIPMENT OPERATES PROPERLY ❑ YES (I 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?
tgf YES ❑ NO
DRAIN READING OF GAGE LOCATED NEAR WATER J RESIDUAL PRESSURE WITH VALV E (TEST
TESTS TEST SUPPLY TEST CONNECTION: 9 PSI I 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. 85B ,mil YES ❑ NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING X YES ❑ NO
IF POWDER DRIVEN FASTENERS ARE USED IN ❑ YES ❑ NO IF NO, EXPLAIN
CONCRETE, HAS REPRESENTATIVE SAMPLE
TESTING BEEN SATISFACTORILY COMPLETED? -
BLANK TESTING NUM: R USED LOCATIONS NUMBER REMOVED
GASKETS A 04e'
WELDED PIPING . �1 YES ❑ NO - .
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING
PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST 4 YES ❑ NO
AWS D10.9, LEVELAR -3?
WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS •
QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST 21 YES ❑ NO
AWS D10.9, LEVEL AR-3?
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DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPUANCE
WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE
THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE YES ❑ NO
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 [YES ❑ NO
(DISCS) ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? ,,
Figure 8 -1(a) (cont). •
1994 Edition • -
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SYSTEM ACCEPTANCE 13 -65
J .
HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN
DATA YES 0 NO
NAMEPLATE i
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: I /q I t>7
REMARKS
NAME OF SPRINKLER CONTRACTOR n i �J
g (1
h
SIGNATURES TESTS WITNESSED BY
FOR PREM OWNER SIGNED) TITLE DATE '
FOR PRINKLER CO TOR (SIGNED) TIT ,no DATE I/ 2S 7
�C e-C i i O
ADDITIONAL EXPLANATIIII AND NOTES
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