Report Oct 13 05 11:47a Hydro Tech 360 256 2817 p.10
Jun 01 05 08:06a Hydro Tech 360 256 2817 p.2 r.'
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WASHINGTON STATE FIRE MARSHAL'S OFFICE FIRE SPRINKLER ADVISORY BOARD a-P E
CONTRACTORS MATERIAL & TEST REPORT FOR ABOVEGROUND PIPING HYDRO TECH FIRE PROTECTION IN C P.O. 80X 40
BRUSH PRAIRIE, WA 98608
annt.----•
PROCEDURE
Upondempletion 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 lob.
A certificate shall be Bled out and signed by both representatives. Copies shall be prepared for approving authorities, ownets, and contractor. II Is under-
stood 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.
. . _
Cil4k T.i%. 41 CE )80 it-DOki G I ( C o tiAlV es
PROPERTY ADDFIESS
C9 a.%)1ceflarr\.;
• - •T5D By APPROVIs • UWORITIE ( 1 )
4. t-fr•H I & Z. d _.
ADDRESS--..
I i i ) a
INSTALIATIONCONFO TO ACCEPTED PLANS OYES U NO
PLANS EQUIPMENT USED IS APPROVED 113 YES 0 NO
IF NO. DCPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION XY ES U NO
OF CONTROL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, DCPLA1N
•
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES ES U NO
1. SYSTEM COMPONENTS INSTRUCTIONS ES EiN0
INSTRUCTIONS
2. CARE AND MAINTENANCE INSTRUCTIONS. ES ONO
3. NEPA I3A J ONO
LOCATION
OF SYSTEM I O st„) nAi-liNn 't:. - tkm.zolG 'E
SUPPLIES BUILDINGS
YEAR OF' ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE WEE OUANTITY RATING
_ 'a ..._ - - ._. * ),..- IA ...... 0, C.
SPRINKLERS
. _
•
'
PIPE AND TYPE OF PIPE crvfc
FITTINGS TYPE OF FITTINGS
•
ALARM ALARM DEVICE MAXIMUM TIME TO OPERATE —.
VALVE THROUGH TEST CONNECTION
OR FLOW TYPE • K E MODEL MIN SEC.
INDICATOR . . 4. r".,:lc , ,:,-, .1,0 -. 0
DRY VALVE 0.00.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
• TIME TO TRIP • TIME WATER ALARM
DRY PIPE THRU TEST WATER AIR TRIP POINT I REACHED OPERATED
OPERATING CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PROPERLY
TEST ,
, MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
. ,
0 /A WITHOUT
0.0.0.
WITH
0.0.0.
IF NO. EXPLAIN _
----.----..---.----.
• MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED
ESA (OVER)
Oct 13 05 11:47a Hydro Tech 360 256 2817 p. 11
„Jun 01 05 08:06a Hydro 'Tech 360 256 2817 p.3 ,6\
. .n
• • - - M
El PNEUMATIC O ELECTRIC O HYDRAULIC
DELUGE & PIPING SUPERVISED • YES • NO DETECTING MEDIA SUPERVISED II YES • NO
PR FACTION DOES VALVE OPERATE FROM THE MANUAL RIP AND/OR REMOTE CONTROL STATIONS N yES N NO
VALVES S THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO. EXPLAIN
OYES ONO
N/ A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
M MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE Ile nude el lul •
•IIIIIiIi0...1.01=1111.1.111 MOM
TEST Induce . died m Wed u•N. cell«. left dee 202
0. Idt quo M•o.e bang Draw haws of 60 0 W O.I
134 4 •toY. .wk laulauf. 100 pd n0.2
' ! ' daft 144112 Dear. d.RUpw Al •a0yOIaund NONOV AG• Lr bopped
'- , -., "*. - E+!•hWl 44ld t2.7 ban( air pumas and warm.
w,M wu.d wer•uy. •w.
dap saint, anal nx• 55.., /2 0.1 1 Own► 2e hams Td p.uun tuw4 w17b•.d wnm r . .
• •Ib, shall het l a I i
- 5/2 •.1 fwwe. N 24 hwawa
PIP ' HYD - • - A'•TTlj T OAT Ilk P; F• R H IF N*, -- • •N
DRY PIPING PNEUMATICALLY TESTEDN •kkk y a []NQ
EQUIPMENT OPERATES PROPEPLY BYES ONO
.• • YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS. SODIUM
LICATE OR DERNATNES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TEST-
ING SYSTEMS OR STOPPING LEAKS? F:. YES O NO
•
TESTS ll " - ' 31-1 • err E L• TED N z, . . - T `URE HV a (, TE
SUPPLY TEST CONNECTION; CONNECTION OPEN WIDE LI PSI
' - .c ROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO
- RINKLER PIPING.
AIRED BY COPY OF THE U FORM NO. &SS OYES ONO OTHER EXPLAIN
1- - =+ BY INSTALLER OF UNDER-
a ROUND SPRINKLER PIPING 1! ES ONO
BLANK TESTING . UMBER U ED LOCATIONS NUMBER REMOVED
GASKETS r
"=r a • PIPING NI YES ■ NO
• • • CERTIFY AS THE SPRINKLER __ IF YES .
THE REQUIREMENTS OF AT LEAST AWS 010.9. D T 09, TLEVELG PROCEDURES COMPLY
• OYES 0 N
• • YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 0t0.9. LEVEL AR-3
I T/A DYES ONO
• • YOU CEfCTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED OUA TIY CONTROL PROCEDURE TO INSURE THAT AU. DISCS ARE
- - -' THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER
= • LNG RESIDUE ARE REMOVED. AND THAT THE INTERNAL DIAMETERS OF
- (PING ARE NOT PENETRATED OYES ONO
1 4 CUTOUTS ,.. YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
DISCS •• • S a ARE RETRIEVED? OYES ONO
FUNCTIONAL •. Al-U REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? • YES F' ,•
FLOWTEST - FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? OYES •1 O
• . • -, I • PLATE PROVIDED
DATA NAMEPLATE IF NO, EXPLAIN
►_ ES ONO
REMARKS OATS LEFT IN SERVICE • `� V q�_VfS OPEN
E OF P • ■ • - CO M T • - ' N - TOR LICENSE #
,• 11 a. _L _
TESTS WITNESSED BY
SIGNATURES PI • PROPERTY • 5 NED) TITLE DATE
�g ININ O � �_ ' f �J!� TITLE . TE
CERTIFY THAT THE Ski -4 - • HEREIN IS -T E AND THAT THIS SPRINKLER SYSTEM WAS INSTALLED H ACCORD
• WITH RCW 18-160 AND THE RULES ADOPTED BY THE WASHI TON ADMINISTRAT ODE AS ADMINISTERED BY
CERTIFICATION HE STATE FIRE MARSFIAt_tetit e / t ,r i _
° ([ j i/l_ /
t it � tit y y i.�'L/
K• 5� of 4 , A NAH.fE CERTIFICATE OF HOLDER NPR NT QR TYPE)
A. s e ( a P �
IFICATE • .` a r ► &WNATURE OP CFRRPICAIE OP OOwBITiNOY HHO
•�:�� DATE
ADOROfYR ExPLANAT10N NO NOTES I •r0. - ; -Y • - -- --
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