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Permit l �f 4 `} CITY OF TIGARD BUILDING PERMIT ii . PERMIT #:' BUP2008 -00196 COMMUNITY DEVELOPMENT DATE ISSUED: 6/16/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 126CA - 00900 SITE ADDRESS: 09009 SW HALL BLVD 200 ZONING: C - SUBDIVISION: WASHINGTON CIRCLE PLAZA LOT: JURISDICTION: TIG PROJECT: MACY'S FURNITURE GALLERY Project Description: Fire alarm. REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: FPS FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 2N : sf N: S: E: W: OCCUPANCY GRP: M TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 1,328 BASEMENT: sf AREA SEP. RATED: STOR: 3 HT: ft GARAGE: sf OCCU SEP. RATED: BSMT ?: Y MEZZ ?: N REQD SETBACKS REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:Y DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : U HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 41,000.00 Owner: Contractor: MACY'S NORTHWEST OREGON ELECTRIC GROUP 7 W SEVENTH ST. 1010 SE 11TH AVE CIO TOM HOWARD PORTLAND, OR 97214 CINCINNATI, OH 45202 Phone: (206)506 Contact #: FAX 503- 234 -1001 PRI 503 - 234 - 9900 Reg #: LIC 203 FEES Description Date Amount REQUIRED ITEMS AND REPORTS [BUILD] Permit Fee 6/6/2008 $316.39 [TAX] 12% State Surch 6/6/2008 $37.97 [FLS] FLS Pin Rv 6/6/2008 $126.56 Total $480.92 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of thes - • -s • .'rec •uestions to OUNC by calling 503.246.6699 or 1.800.332.2344. Iss ed By: / . ,, /���, A _,,, Permittee Signature: /"-- e _,c��� Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building ermit Application F ,. 1 .,% rrotection System FOR OFFICE USE O LY City of Tigard VECEN Received 1 ermo.: Date /B �� ' it N = , / . {fir 13125 SW Hall Blvd., Tigard, OR 972 Plan Review j C o �. Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 O 5 20 0 Date /B : J`- ' /��I. T I t R p Inspection Line: 503.639.4175 SUN Date Rea'': y: Juriao ® See Page 2 for Internet: www.tigard - or.gov MO Notified/Method: /) R" Supplemental Information CITY OFTI U . IS1n <—.0.S �1 „ . �" max_- _� TI' PE. OF- ; t ` , RE(�L7IRED� AND 2- E AMILYrnwEl,iuvel'. ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the „, .wr ,,„ °U" e - 4 indicated on this application. ;� ^ CATEGORY;;OF GONSTRUC;TION, �: v � ;_,,;, wor ❑ 1- and 2- family dwelling ® Commercial/industrial Valuation: $ q/, oGO . to ❑ Accessory building ❑ Multi- family Number of bedrooms: ❑ Master builder El Other: Number of bathrooms: 40i3 STl'E3INFORMATIO LOCATION= Total number of floors: Job site address 9009 ew uan ur.,a New dwelling area: square feet City /State /ZIP: Tigard, OR 97223 pi ri r I t grt dert Garage /carport area: square feet Suite/bldg. /apt. no.: Project natltg;ligsp'S wA Sq Ptre Alarm Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet ;: ;REQUIRED,= DATA :,COMMERCIAL -USE. CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. • Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all ,;,;.,,.. - ,<, ,M, .,,: .,; ,... .; -,, • •,�,..�n,.. overhead, and the p equipment, materials, labor, over e a e ofit for the r - ?f °DESCRIPTION°OF °:WORK work indicated on this application. Fire Alarm Installation Valuation: $$41,000.00 Existing building area: square feet New building area: square feet • - . IPR „1111 . . , . ,;.1 ,® ;TENANT _ - s` Number of stories: Name: Type of construction: Remodel Address: Occupancy groups: • City /State/ZIP: Existing: Phone: ( ) Fax: ( ) New: ,, ; „ . . - ,. ❑. APPL][GANT; :, -- :nC ONTACT 1 RSON;,;"`::. `; r`: . NO TI CE � : ;;:: " Business name: All contractors and subcontractors are required to be Contact name: �^ 2. � licensed with the Oregon Construction Contractors Board coin C V Y� G under ORS 701 and may be required to be licensed in the Address: jurisdiction in which work is being performed. If the City /State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: (93 ) S 3 5 - 0 4, L( / Fax:: ( ) E -mail: Y''E, .1-14, ; CONTRACTOR . o BUILDING PERMIT: °FEES* Business name: Oregon Electric Group ," ate ' • (Pkase,referto•,jee.schedule) ;:.• ;r'� . ./ '" Permit fee: 321.98 Address: 1010 SE 11 Ave State surcharge (12% of permit fee): 38.64 City /State /ZIP: Portland, OR 97214 FLS plan review (40% of permit fee): Phone: (503) 234 -9900 Fax: (503) 234 -1001 (Due upon application.) 128.79 CCB lic.: 203 Total permit fees: 489.41 Authorized signature $01 Amount received: �f�y, This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Mark Wei ' ben l e ' Date: 6 5/08 * Fee methodology set by Tri- County Building Industry Service Board. l: \Building\Permits\ FPS- PermitApp.doc 03/23/06 440- 4613T( I I /02/COM/WEB) CITY OF TIGARD BUILDING DIVISION ,, A PERMIT #: BUP2008-00196 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6116/2000 Phone: (503) 639-4171 _ ,ellyitillt Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 81130008 TIME: 7:00AM PAGE: 26 SITE ADDRESS 09009 SW HALL BLVD 200 CLASS OF WORK: SUBDIVISION wASHINGTON CIRCLE PLAZA LOT #: TYPE OF USE: PROJECT NAME: MACY'S FURNITURE GALLERY DESCRIPTION: Fire alarm. OWNER PHONE NORTHWEST, PHONE #: (206)506.7738 CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503-234-9900 Inspection Request Scheduled For: Date ' 6/13/200a Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 074113-01 503-209-2679 N Corrections/Comments/Instructions: I 0& p g-e k. ail Arje .4 ■ PA S M "ARTIAL APPROVAL 0 CANCEL fl NO ACCESS . .1 . AIL r/A ALL FOR INSPECTION n ADDITIONAL FEES ASSESSED -----) Inspector: Date: 5 t; of Phone #: (503) . . FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. PROTECTED PROPERTY INFORMATION Name of property: /M e , �ti "b\ It � t Address: ? °( 5W I A 11 iV) R ef.VCr On Description of property: VvSietass Occupancy type: C etc-Sc Name of property representative: ■ �{ Address: � L'- 7" S . � 1` r1.0 � n -f 4 + G �� Ssgt• Phone: Fax: E -mail: Authority having jurisdiction over this property: Phone: Fax: E -mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION Installation contractor for this equipment: Cr ` c" Cl C. Address: �v l v S' L 6. { � .e a9 . Phone: 56S ? S - SC 01 Fax: E -mail: Service organization for this equipment: J,' ere Address: C3� S I ncs t ve�. v 6 ter, GStr C A S 4 - Phone: ''9a v Fax: E -mail: Location of as -built drawings: 0 1 - Si - Location of historical test reports: Location of system operation and maintenance manuals: o ci r S A contract for test. and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: E -mail: Contract expires: Contract number: Frequency of routine inspections: 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE NFPA 72 Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers (if applicable): 1 Alarm: \ Phone: / 8 -40 Z�` Z`I Supervisory: ' ' Phone: Trouble: i � Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.1 of 5) NATIONAL FIRE ALARM CODE 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE (continued) If Chapter 8, note the means of transmission from the protected premises to the central station: 0 - Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2 -way radio ❑ 1 -way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: q. ' c ' `( Site - specific software revision date: a, 1 2 'G fr" Revision completed by: C;4 (e n C. A .,e ) 4. SIGNALING LINE CIRCUITS Characteristics of si naling line circuits connected to this system (see NFPA 72, Table 6.6.1): Quantity: Style: Class: 5. ALARM - INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: Style: Class: 5.1 Manual initiating devices • 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: , Z Type of coverage: t'Eomplete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization allotoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization clirhotoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ® area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: - Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: cjilAddressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.2 of 5) FUNDAMENTALS OF'FIRE.ALARM SYSTEMS 6. SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUITS 6.1. Sprinkler System Number of valve supervisory switches: Type of devices: ,Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 6.2 Fire Pump Type of fire pump: ❑ Electrical ❑ Diesel Type of pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. ANNUNCIATORS 7.1 Annunciator 1 ❑ Local ❑ Remote Type: r°Addressable ❑ Directory ❑ Graphic ❑ N/A Location: NA i n Fn \ , - ;A , ,C c- 7.2 Annunciator 2 ❑, Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 8. ALARM NOTIFICATION DEVICES AND CIRCUITS 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker zones: 8.2 Telephone Jacks Number of telephone jacks installed: Number of telephone handsets. stored on site: Type of telephone system installed: ❑ Electrically powered .❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics o otification device circuits connected to this system (see NFPA 72, Tablg 6.5): Quantity: l Style: t/ Class: f Y/ , Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.3 of 5) NATIONAL FIRE.ALARM CODE 8. ALARM NOTIFICATION DEVICES AND CIRCUITS (continued) 8.4 Types and Quantities of Nonvoice Notification Appliances In talled Bells: With visual device Horns: G With visual device: `'71S Chimes: With visual device Bells: With visual device: Visual devices without audible devices: , Z_ Other (describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other • 10. SYSTEM POWER SUPPLY 10.1 Primary Power Nominal voltage ) ZU u Amps 2 0 Overcurrent protection: Type Amps Location (of primary supply panelboard): E( cc>r 07 Disconnecting means location: P C- kty C 10.2 Secondary Power . Location: Type: Nominal voltage: Current rating: Number of standby batteries: Amp hour rating: Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 2 `{ \ e> In alarm mode: S 11. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NEPA standards: (Note any or all that apply.) 'NFPA 72 .NFPA 70, National Electrical Code, Article 760 - janufacturer's published instructions ❑ Other (please specify): System deviat. ns from r ced NFPA standards: / �- Signed: Citiga Printed name: Zev L . • Sze- Date: sir--/3-08 Organization: O,e� 57 fJ? 4;e0 Title: ZOCI -, 4 W Phone: V 12. RECORD OF SYSTEM OPERATION All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of: ?NFPA 72 45—NFPA 70, National Electrical Code, Article 760 ,vIanufacturer's published instructions ['Other (please specify): ❑ Docume• h ;on 'n cc rd. th Inspection and Testing Form (Figure 10.6.2.3) is attached S j Signed : Printed name: � e 1 �� /mil 1`1 c��' Date: r ) -C) Organization: rung • ham' 1 � • Title:, / `)J Phone: Reprinted with permission from t FPA 72, National Fire Alarm Code ®, Copyright ©2002 :National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which. is represented only by the standard in its entirety. © 2007 National Fire Protection Association NFPA 72 (p.4 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS • 13. CERTIFICATIONS AND APPROVALS 13.1 System Installation Contractor This system .s pecified herein is been installed and tested according.to all NFPA standards cited herein. Signed: a• A .c:.' s _ /'Printed name: ZO — �� L • 5 ; 2 42-Date: ? -43 Organization: C -,ch/� .p'�'lC 614 Title:�Gl�r3t9e'i *'44 AM/Phone: �S' - 5 2 ; 3 67 , 13.2 System Service Contractor This system a specified ecified he -'n has been installed and tested according to all NFPA standards cited herein. Signed: � • Printed name: ^ I � � Date: T ° Organization: S r1, J i, C. r .1r'rt � � Title: TcLG L i2t, Phone: 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accord. lice ith its approved plans and specifications, its approved sequence of operations, and with all NFPA standard• c to ;ire Signed , _ , Printed name: 74-/g1-4-71-1Z- �/ Bate: 8/3/6 8 Organization: 1.7 - 1 o i 77 Cz 4 Title: 6 it W (A PJ f '( ? co v e: S --7/6 - yr Reprinted with permission from NFPA 72, National Fire Alarm Code ®, Copyright ©2002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in'its entirety. ©.2007 National Fire Protection Association NFPA 72 (p.5 of 5) • ,�� • s-1 Contractor's Material and Test Certificate for Aboveground piping PROCEDURE Upon con rpleuor of wow, urspecoo), and 1051c s rue roads- oy lire contractor' s representative anO wrlr essed o; an owner's representative All oelacis snail re corrected arid system left io service ualore contractors. personnel fir ally have toe Job /- ceru6ca- snail tie filled out and signed by 0010 represeraalives Copies snail oe prepared lee approving cull■onuec owners and contractor Ic understood Ili- °wirer. reptesenlalive'r. slot alum iii uu wary piejudices any ciairn ayansit contractor to !auk triatenal pool workman sr up, us- lallure- U, Golrloly v iii aprrovIr,g aulllorlr' /'L Iequireinen14. O' local oldllianceS PROPERT ' NAME. DATE 5 - f3 -v5 PROPERTY ADDF<ESS • t - • i C,r OR ACCEPTED by APPRO'VE-IC. AU - I I HOR I IEb (NAMES) S CA- t,(' AUGRESS PLANS INS1 ALLA rIOI -I CONFORMS 10 ACCEPT ED PLANS U YES U NO EQUIPMENT USED IS APPROVED IS YES ❑ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION U YES U ND OF CONTROL VALVES AND CARE AIJD MAINTENANCE OF THIS NEW EQUIPMENT'? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LE-ET ON THE PREMISES U YES LI NO 1 SYSTEM COMPONENTS INSTRUCTIONS 0 YES ❑ NO 2 CARE AND MAINTENANCE INSTRUCTIONS IS YES ❑ NO S NFPA 25 LS YES ❑ NO LOCATION SUPPLIES BUILDINGS OF SYSTEM YEAR OF ORIFICE TEMPERATURE MAKE MODEL MANUFACTURE SIZE QUANTITY RATING Rte P� TY- F6L'3 ttiQItA, Hi 7y -FRS 3o 155 °F „ SPRINKLERS (lF it is y s-1 /SS °F "F °F 1 I uF PIPE AND Type of Pipe FITTINGS Type of Fitting. ALARM MAXIMUM TIME TO OPERATE VALVE ALARM DEVICE THROUGH TEST COI'INECl ION OP. FLOW TYPE _ MAKE MODEL MINI SEC INDICATOR DRY VALVE O O 0 MAKE MODEL SERIAL NO MAKE MODEL SERIAL NO. TIME TO TRIP 1 IME WATER ALARM THROUGH TES1 WATER AIR TRIP POINT REACHED OPERATED CONNECTION' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PROPERLY MIN! SEC PSI PSI PSI MIN SEC YES NO DRY PIPE VVdhoul OPERATING TEST OOD VVtlh 0.0 0 IF NO, EXPLAIN ' - - -- ' MEAS'UR =L' FROM - 111,1,E INSPECT OR's. TES - 1 CONNECTION IS OPENED OPEPAT ION ❑ PNEUMATIC ❑ au:T Y_ ❑ HYDI:AUUL PIPIIW SUPERVISED U YES U ND DETE —.1 C MEDIA SUPERVISED U YES Ll NO DOES. VALVE OPERATE FROM 1'HE MANUAL TRIP AND /OF: REIJO GOI lT R05 50-1 0/NO L YES L I NU DELUDE AND IS THERE AN ACCESSIBLE FACILI1 (IPt EACH CIRCUIT FOR TOSI ING iF hID EXPLAIN PREECT ION VALVES ❑ YES ❑ NO DOES EACH CIRCUIT OPERA.1 E DOES EACH CIRCUIT MAXIMUM TIME 10 MAKE MODEL SUPERVI 51011 LOSS ALARM? OPERATE VALVE RELEASE % OPERATE RELEASE (ES NO YES HO MIN SEC LOCAT ION MAKE SET I IND ST A I IC PRESSURE RESIDUAL PRESSURE FLOW RATE PRESSURE PLOUP MODEL (FLOVN1 REDUCING INLET (PSI) OUILE1 (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVE TE &T 1-1(0R05101 IC Hydrostallc temmm shall be I raae at not Tess Iran SILO psi (1? 0 bar;) lot Iwo Hour. or SU pal (0 4 oats) above static pressure ui excess of 150 psi (10.0 oars) for two hours [Mere-nhal dry -pipe valve clappers shall us RI' open durum TEST lest Is prevent damage. All abovegroung piping leakage shall bs slopped, DES0RIP1ION PNEUMATIC' Establish 40 psi (2 r bars) air pressure and measure drop which shall not exceed 1) psi ( Ut bars) to 24 hours 1 est pressure tanks at normal wafer level and air pressure arid Measure air pressure crap wruch snail riot exceed 15 psi (0.1 bars) in 24 hours ALL PIPING HYDROSTATICALL ( TESTED AT 200 PSI (BARS) FOR 2 HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED IN YES ❑ NO EQUIPMENT OPERATES PROPERLY IS YES ❑ NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE. BRINE, OR OTHER CORROSIVE CHE MICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ID YES ❑ NO DRAIN READING OF GAGE LOCATED HEAR WATER RESIDUAL PRESSURE WIT H VALVE IN TEST TEST TEST SUPPLY TEST CONNECTION PSI (_BARS) CONNECTION OPEN WOE PSI UNDERGROUND MAINS AND LEAD IN CONECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING VERIFIED BY COPT' OF THE U FORM NO. 858 111 YES ❑ NO OTHER. EXPLAIN FLUSHED BY INSTALLER OF UNDER- GROUND SPRINKLER PIPING IS YES ❑ NO IF POWDER- DRIVEN FASTENERS ARE USED IN CONCRETE, HAS REP- IF NO, EXPLAIN RESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? ❑ YES ❑ NO BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING U YES L-I NO IF YES.. DO YOU CERTIF`i AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AVVS D10 9, LEVEL AR -3? Si YES ❑ NO DO YOU CERII IFY THAT THE WELDING WAS PREFORMED BY WELDERS QUALIFIED IN WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 0145, LEVEL AF: -3? ID YES ❑ NO DO YOU CERITIFY 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, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? El YES ❑ NO - CUTOUTS DO YOLI CERITIFY 1 HE YOU HAVE A COIJ1 ROL FEATURE TO ENSURE THAT ALL (DISCS) CUTOUTS (DISCS) ARE RETRIEVED% SI YES ❑ PTO HYDRAULIC NAME PLATE PROVIDED 1E140, EXPLAIN DATA. NAMEPLATE YES ❑ NO DATE LEFT IN SERVICE V147H ALL CONTROL VALVES; OPEN REMARKS — — — -- - - IML - U)- SYI1IHKLE -N7Dhl I HAC I SIMPLEXGRINNELL 1 LS1 s W 1 MESSED BY SIGNATURES FOR P: %PERTY OV'- , 4 - '.:IGICD) 117E DATE 10: D) DATE ADDITIONAL EXPLAH 1 '6IV,yA NOTES