Report 09/13/2005 TUE 14:11 FAX 503 620 2748 ACS TESTING INC ��61_ 7 CO [x]0021002
44!
7409 SW Tech Center Dr. Ste. 145
Tigard, OR 97223
Ph: 503443 -3799 Fax: 503 -620 -2748
.1111 WAY
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NO
SPECIAL INSPECTION
FINAL REPORT
DATE: 09 /13/2005
PROJECT: Oak Tree II Apartments
PERMITS: 2004 - 004 - 04,61,62,63,. ' •6
•
ADDRESS: SW 108th
CITY: Tualatin STATE: Oregon
JURISDICTION: City of Tualatin
CITY: Tualatin STATE: Oregon
ZIP: 97062
Re: Final Letter
To Whom It May Concern:
ACS Testing, Inc. attest that all inspections for Reinforced Concrete, Anchors and Welding was
performed to the best of our knowledge on the above referenced project, in accordance with approved
plans, specifications, RFI's and the applicable codes and standards of section 1701 of the Oregon State
Structural Specialty Code.
•
Approved
Bob Brown
President
r Jun 01 05 08:06a H Tech 360 256 17 p.2
CAP 2004 -- -, 6 ,
WASHINGTON STATE FIRE MARSHAL'S OFFICE FIRE SPRINKLER ADVIS BOARD
C ONTRACTORS MATERIAL & TEST REPORT FOR ABOVEGROUND PIPING HYDRO TECH FIRE PR OT!_CTION INC
P.O. BOX 40
._......_.... _.
BRUSH PRAIRIE, WA 98606
PROCEDURE
Upon completion of work, Inspection and teats shall be made by the contractor's representative and witnessed by an owner's representative. All defects
shall be corrected and ttystem left In service before contractor's 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 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.
PROPERTY NAME �� "t iL `. DAT
VA-4 N om. APA ►�F.N1 (r=te) f -
PROPERTY ADDRESS n Rb '
EPTED BY APP OVINE 1U7 RrTIES (N)
ADDRES , D
I ( v-
INSTALLATION NFO T ACCEPTED PLANS YES NO
PLANS EQUIPMENT USED IS APPROVED YES 0 NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ¢AYES LINO
OF CONTROL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: h4 YES NO
INSTRUCTIONS I. SYSTEM COMPONENTS INSTRUCTIONS ES ONO
2. CARE AND MAINTENANCE INSTRUCTIONS. ES ONO
3. NFPA 13A 7 ES ❑ NO
LOCATION
OF SYSTEM Ip . 4 13 SuJ icet
) in i ce jc;ir..r�ikiC "C,
SUPPLIES BUILDINGS
YEAR OF OR IFICE TEM
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
SPRINKLERS '—
PIPE AND TYPE OF PIPE G,PV
FITTINGS TYPE OF FITTINGS LV
ALARM ALARM DEVICE MAXIMUM TIME TO OPERATE _.
VALVE THROUGH TEST CONNECTION
OR FLOW TYPE MAKE MODEL MIN SEC.
INDICATOR �" I rrr4. S c.4J 4 F' Qirj 1 5C. -- Sr •
•
DRY VALVE 0.0D.
MAKE MODEL 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 PROPERLY
TEST MIN. SEC. _ PSI PSI PSI MIN. SEC. YES NO
kI /A WITHOUT '
Q.O.D.
WRH
Q.O.D.
IF NO, EXPLAIN
• MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED
85A (OVER)
v Jun 01 05 08:06a H Tech 360 256 2817 p -
6
■
•PERATION'
❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC
DELUGE E PIPING SUPERVISED • YES • NO DETECTING MEDIA SUPERVISED • YES • NO
PAEACTTON DOES VALVE OPERATE FROM THE MANUAL. TRIP ANDIOR REMOTE CONTROL STATIONS YES
VALVES IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO, EXPLAIN NO
❑ YES 0 NO
N /\ MAKE MODEL EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
/ SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE
TEST el.. . • N v.l arW tb m
ydraac teem 1 ade of tot fa.. Ulan 200 W (I» r _ 5bdic DESCRIPTIO taus. •r*r• W dmp1l» r.M. c ehasnail b. I.H op.n a rt 1.a n pn�ont daJflaa PION 1.
I. wnd PION oGe shag mor+oa ( oz
t° In
+w I uW air • . Eqa61Lh App.! R.7 bar.) ak pre..um am. measure drop which shall not .c•W 1-1.2 pal I Imm) In 24 tours- Test Pra.eUr. %an4 of normal rator
'nd m.a.ur. w pnr..u.a dmo which OW tot .ac..d I t!2 ps1 t hart` In 24 hours.
' PIPIN ' HYDROS TATI(;ALLY TESTED A T PSI FOR HRS. IF NO, STATE REA ON
DRY PIPING PNEUMATICALLY TESTEDNJ YE ❑ NO
EQUIPMENT OPERATES PROPERLY ,AYES ❑ NO
a • YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM
SILICATE OR OERNATIVES OF SODIUM SIUCATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TEST-
ING SYSTEMS OR STOPPING LEAKS? AYES ❑ NO
TESTS DRAIN I READING OF GAGE LOCATED NEAR WATER I RESIDUAL PRESSURE WITH VALVE 1N TEST
ST ) SUPPLY TEST CONNECTION: PSI CONNECTION OPEN WIDE
NDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO PSI
SPRINKLER PIPING.
RIAED BY COPY OF THE U FORM NO. 858 OYES 0 NO OTHER
FLUSHED BY INSTALLER OF UNDER - FLUSHED
GROUND SPRINKLER PIPING LIES 0 NO
BLANK TESTING NUMBED i LOCATIONS
GASKETS 1 NUMBER REMOVED
LI*0 PIPING UYES I NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT PROCEDURES COMPLY
THE REQUIREMENTS OF AT LEAST AWS D10.9. LEVEL AR-3 ❑ YES ONO
a • YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3
/ i /f - ❑YES ❑ NO
!! DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
RIEVED, THAT OPENINGS IN PIPING ARE SMOOTH. THAT SLAG AND OTHER
= `NG RESIDUE ARE REMOVED. AND THAT THE INTERNAL DIAMETERS OF
PIPING ARE NOT PENETRATED OYES ONO
14/(A CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
(DISCS) r OUTS (DISCS) ARE RETRIEVED?
FUNCTIONAL DOES Al-U REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? U YES ❑ NO
FLOWTEST RE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? O YES LINO _
HYUHAUUC NAME PLATE PROVIDED ❑ YES ❑ NO
DATA NAMEPLATE IF NO, EXPLAIN
YES ONO
REMARKS DATE LEFT IN SERVICE WIT ALL•CONTROL VALVES OPEN:
NAME OF $P NTC
ALERCORA OR CQNTRACTOR LICENSE #
FOR PROPERTY 0 ER (SIGNED) TESTS WITNESSED BY
SIGNATURES TITLE DATE
FOR yT.• §e1� �. � / / TIT , , .
/
RAPP / VIN , ` 11 `,�i L• 1/'F1 60 F!
�I r�:og /I r ll- � ►.Zi. TITLE a ' 7E
I CERTIFY.THAT THE IN •RMA • HEREIN IS TRUE AND THAT THIS SPRINKLER SYSTEM WAS INSTALLED IN ACCORD -
CE WITH ROW 1B-160 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY
CERTIFICATION HE STATE FIRE MARSHAL
NAME OF CERJIFIGTE OF COMPETENCY HOLDER (PRINT CA TYPE)
ERTIFICATE REGISTRATION I eONAT CF CERTIFICATE OF i r HOL.OEp
DATE
AOOITIGt aL e%PCN Af1CN Argo MOTEH
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