Specifications (2) CONTRACTOR'S MATERIAL & TEST CERTIFICATE
SPRINKLER SYSTEMS — WATER SPRAY SYSTEMS
PART "A" GENERAL
PROCE o JmI
UPON COMPLETION OF WORK INSPECTION AND TESTS SHOULD BE MADE BY CONTRACTOR'S REPRESENTATIVE AND WITNESSED BY AN OWNER'S REPRESENTATIVE.
ALL DEPICTS SHOULD BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S MEN FINALLY LEAVE THE JOB.
A CERTIFICATE SHOULD BE FILLED OUT AND SIGNED BY BOTH REPRESENTATIVES. COPIES SHOULD BE PREPARED FOR INSPECTING AUTHORITIES, OWNER AND
CONTRACTOR. IT IS UNDERSTOOD THE OWNER'S REPRESENTATIVE'S SIGNATURE IN NO WAY PREJUDICES ANY CLAIM AGAINST CONTRACTOR FOR FAULTY
MATIRIAL, POOR WORKMANSHIP OA FAILURE TO COMPLY WITH INSPECTING AUTHORITY'S REQUIREMENTS OR LOCAL ORDINANCES.
PROPERTY NAME
((�� Q n DATE
l"' ACA or C rocks IM 4 51 1 L x1 C -II t— 9/20194
PROPERTY ADDRESS
( 0 9 7 n • Sc. 72 ' A(d Sn2 n elf ,
ACCEPTED BY INSPECTION AUTHORITYI'SI NAMES
ADDRESS
PLANS
INSTALLATION CONFORMS TO ACCEPTED PLANS YES ❑ NO ❑
EOUIPMENT USED IS APPROVED YES ❑ NO ❑
IF NO. STATE DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL
VALVES AND CARE OF THIS NEW EQUIPMENT YES ❑ NO ❑
IF NO. EXPLAIN
INSTRUC-
TIONS FF S CO P OOIF INSTRUCTION AND MAINTENANCE CHART BEEN LEFT AT PLANT YES ❑ NO ❑
FLUSHING: Flow the r.vu rata unto mans are clear as indicated by no collection of foreign material in burlap bags at outlets such as hydrants and blow-offs.
Flush at haws rot less than 750 GPM for 6-inch pipe and smaller. 1000 GPM for 8-Inch. 1500 GPM for 10-inch, 2000 GPM for 12 -inch. Where supply cannot
produce stipulated how rate. obtain rnm.mum wadeable by using properly sired discharge devices.
HYDROSTATIC Hydrostatic test should be made it not less than 200 PSI for two hours or 50 PSI above static pressure in excess of 150 PSI. Differential dry-
woe Tatra ctesspers should be Hitt Open during test to prevent damage All above Wound piping leakage should be stopped.
TEST LEAKAGE. New woe laid with rubber gasketed IO,nts should. If the workmanship is satgfectory. have no leakage at the joints. Unsatisfactory amounts of leakage
usually result Itom twnsted wnched or cut gaskets. However. tome leakage might result from small amounts of grit or small imperfections. The amount of leakage
DESCRIPTION at t■ terms mould not exceed 2 quarts per hour per 100 lo,nts irrespectively of pipe diameter. The leakage should be distributed over all joints. If such leakage
occurs et • her to the , nstallation Mould bir considered unsatisfactory and necessity repairs made. New pipe laid with caulked lead or lead substitute joints
should. the we.kmansh.p .5 saints/glory. hays I,Itle or no leakage at the mints. Any font having leakage or more than a "slight drip" or "weeping" should be re-
paired Looker should not ••card 1 or Il measure) per hour per inch of pipe diameter per Joint. The leakage should be distributed over all joints. If such
Weeps occurs aamOst *ewe's at a few lo the installation should be considered unsatisfactory and necessary repairs made.
PNEUMATIC Estabbl•sh 40 PSI a. pressure and measure pasture drop which should not exceed 1% PSI in 24 hours. Test pressure tanks at normal water level
and or pnsur., and measure or pressure drop wench should not exceed 1 PSI in 24 hours.
PART "B" — UNDERGROUND PIPING
FEEDS BLOCS
LOCATION (S PIPE TYPE AND CLASS D �t ( ' TYPE JOINT
UNDER. _
GROUND CONFORMS TO STANDARD YES ❑ NO ❑
IF NO, EXPLAIN
PIPES
ANO JOINTS NEEDING ANCHO LAMPEO. STRAPPED OR BACKED IN ACCORDANCE YES ❑ NO ❑
JOINTS WITH STANDARD
IF NO. EX' '
•
TESTS FLUSHING HYDROSTATIC LEAKAGE
REQUIRED
NEW UNDERGROUND PIPING FLUSHED ACCORDING TO STANDARD YES ❑
BY 'COMPANY)
HOW WAS FLUSHING FLOW OBTAINED
PUBLIC WATER ❑ TANK OR S VOIR ❑ - - PUMP ❑
THROUGH WHAT TYPE OPENING
FLUSHING HYD. BUTT. • OPEN PIPE ❑
LEAD INS FLUSHED ACCORDING TO T NDARO YES ❑
TESTS BY (COMPANY)
HOW WAS FLUSHING FLOW OBTAINED
PUBLIC WATER ❑ TANK OR RESERVOIR ❑ FIRE PUMP ❑
THROUGH WHAT TYPE OPENING
Y CONN. TO FLANGE & SPIGOT ❑ OPEN PIPED
ALL NEW UNOERGROUN ING HYDROSTATICALLY TESTED AT
HYDROSTATIC P.S.I. FOR HOURS
LEAKAGE TOTAL AMO OF LEAKAGE MEASURED
GALS. HOURS
TESTS ALLOWABLE LEAKAGE
GALS. HOURS
69Ca -o&
NUMBER INSTALLED TYPE AND MAKE
HYDRANTS ALL OPERATE SATISFACTORILY
YES ❑ NO ❑
HOSE THREADS OF FIRE DEPARTMENT CONNECTIONS AND HYDRANTS INTERCHANGEABLE WITH
THOSE OF FIRE DEPARTMENT ANSWERING ALARM? /ES ❑ NO ❑
CONTROL WATER CONTROL VALVES LEFT WIDE OPEN A1
VALVES IF NO, STATE REASON t " i YES ❑ NO ❑
DATE LEFT IN SERVICE
REMARKS `
PARTS A & B NAME OF SPRINKLER CONTR • •R FOR PROPERTY OWNER (SIGNED) TITLE
FOR SPRINKL • ONTRACTOR (SIGNED) DATE
SIGNATURES
PART "C" - SPRINKLER & WATER SPRAY ABOVE GROUND PIPING (FILL OUT SEPARATE PART "C" FOR EACH RISER)
SERVES BLOCS.
a oCATION
TESTS 1 HYDROSTATIC TEST OF ALL PIPING
2 PNEUMATIC TEST OF ALL DRY PIPING
REQUIRED 3 EQUIPMENT OPERATION TESTS OF ALL EQUIPMENT
SPRINKLERS MAKE MODEL SIZE QUANTITY TEMPERATURE RATING
OR (j-Cw. ■\ OP A Q tc. f/7 2 /S r
SPRAY 6-f K.- i /' Pl / /["r ~
NOZZLES
04_, ✓)f1 ( �U [ s // 1.
PIPE AND MATERIAL AND KIND CONFORMS TO P A i 3 STANDARD •
FITTINGS IF NONE, EXPLAIN
ALARM VALVE ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE
OR FLOW TYPE MAKE MODEL MIN. SEC.
INDICATOR
•
OPERATING TEST RESULTS
TIME TO TRIP TIME
THROUGH TEST PIPE WATER ALARM
DRY MAKE MODEL SERIAL NO. WATER AIR POINT R EACHED OPERATED
PRESS. SS. AIR TEST PROPERLY
PIPE WITHOUT WITH PRESS
.. . 0 ..0. OUTLET
VALVES e
MIN. M N. S EC. P,SI. P , S . I . P , S , I . MIN, I SEC. YES I NO
IF NO, EXPLAIN �/ I
OPERATION (3E1ATIC ELECTRIC ❑ HYDRAULIC ❑
PIPING SUPERVISED YES ❑ NO ❑ I DETECTING MEDIA SUPERVISED YES ❑ NO ❑
DELUGE DOES VALVE OPERATE FR HE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS YES ❑ NO ❑
& IS THERE AN ACCE LE FACILITY IN EACH CIRCUIT FOR TESTING YES ❑ NO ❑
IF N0, EXPLAI
PREACTION
® VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM VALVE RELEASE OPERATE RELEASE
YES NO YES NO MIN. SEC.
ALL PIPING HYDROSTATICALLY TESTED AT ICTInt PSI FOR _HOURS . ? /A
DRY PIPING PNEUMATICALLY TESTED YES ❑ NO PJ �1
EQUIPMENT OPERATE PROPERLY YES NO ❑
TESTS IF NO, STATE REASON
DRAIN TEST: READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE WITH VALVE IN TEST PIPE OPEN WIDE:
STATIC PRESSURE PSI PSI
BLANK NUMBER USED LOCATIONS NUMBER REMOVED
TESTING
GASKETS
WELDED OR BRAZED PIPING YES ❑ NO ❑ IF YES, DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT THE WELDER
OR GRAZERS ARE QUALIFIED FOR WELDING OR BRAZING IN ACCORDANCE WITH THE REQUIREMENTS OF ASME BOILE a. ..
VESSEL CODE, SECTION IX, QUALIFICATION STANDARD FOR WELDING AND BRAZING PROC • r - , - , : •AZERS, AND
WELDING WELDINGS AND BRAZING OPERATORS — 1968 EDITION YES ❑ NO ❑
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN.
REMARKS
NAME OF SPRINKLER CONTRACTOR II FOR PROPERTY OWNER (SIGNED) TITLE
PART"C" 5 • F .'f L 1 3� l�L
SIGNATURES Foa
s
boo 96 - U 6 6 17 0
gLDc —‘)€. -bi � `e ;s
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ENGINEERING PERMIT DATE ISSUED: 09/25/96 By: il
PERMIT # • ENG96 -0056
PRIM. PERMIT #.: SDR93 -0017 .� ++.. PARCEL: 2S113AD -01700
SITE ADDRESS...: 16920 SW 72ND AVE — $jw4 ‹:Ve ZONING:C -G
SUBDIVISION • ROSEWOOD ACRE TRACTS
BLOCK LOT •30
PERMIT TYPE..: SOP PUBLIC IMPRV : QUANT. (LIN FT) VALUE
AGREEMENT DATE: / / GRAD /EROS - * * *- $
ASSURANCE EXPIRATION - -- STREET 11 $
PERFORMANCE: / / SAN SEW 11 $
MAINTENANCE: / / STM SEW II $
PATHWAYS 11 $
ALL OTHER - * * *- $ ii
TOTAL $
Remarks: STREET OPENING, TO INSTALL TRAFFIC CONTROL DEVICES (TRAFFIC SIGNAL
EQUIPT, PAVEMENT MARKINGS AND PEDESTRIAN APPURTANCES).
C — 14eurgea.■ es IA. (- s- IDJOArVa.wk RI . i "7 Z_"=- AQ e_ ..
Permittee: FEES
HAMILTON PROPERTIES, INC. type amount by date recpt
3939 NW ST HELENS RD OPEN $ 1600.00 JMH 09/25/96 96- 284363
PORTLAND OR 97210
Phone #: 224 -2676
Engineer: 1
MACKENZIE ENGINEERING, INC.
0690 SW BANCROFT ST. $ 1600.00 TOTAL
PORTLAND OR 97201 -0039
Phone #: 224 -9560
REQUIRED INSPECTIONS --- -- - - --
Permittee 'Agent /Signature: -- -STORM SEWER -- STREET-- -
� 4<2,:,1 ---, M.H. & C.B. CRB LINE & GRADE
i PIPE LN & GRD SUBGRADE
/
BCKFLL & CMPCT BASE ROCK
AIR & TV TEST LEVEL COURSE
City of Tigard, Oregon WEARING COURSE
13125 S.W. Hall Blvd. -- -SAN. SEWER - -- TRAFF & PED CONT
P.O. Box 23397 M.H. & C.O. MONUMENTATION
Tigard, Oregon 97223 PIPE LN & GRD STREETLIGHTING
Phone #: 639 -4171 BCKFLL & CMPCT WALK /APRON /RAMP
AIR & TV TEST
FOR INSPECTION, CONTACT: - - -- GRADING
Letha Thomas #639 -4171 (office) -- REPR'S /ADJ,S -- CONTOURS
#780 -2647 (mobile) DRAINAGE
- - -- PATHWAYS - - -- EROSION CNTL.
OCT 11 '95 01' :01PM CHECKPOINT 3 -P1p�{ 7 � P.1 /2
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10/11/96 \
A L. L. A C T I V I T Y R E P U R 7
BORDERS! BOOKSHOP PAVE: i
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BORDERS BOOKS te MUSIC #0167 001826' .
16920 SW 72ND AVENUE, ! Account: er BDR
FIRE SYSTEM Dealer: pR
TIGARD, OR 97223 From 10/11/96 To 10/11/96
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DATE TIME SIGNAL !
INFORMATION
10/11/96 FRI I .
00:01:23 = => *L T T* LATE TO TEST
10:18:28 = => TESTING OF ENTIRE SYSTEM =` ADDED ASH
FROM FRI 10/11/96 AT 1018 TO FRI 10/11/96 AT 1700 ASH
REASON: 50600
10:20:35 =da FIRE-ALARM ROOF TOP SMOKE DETECTOR #1 ASH
SIGNAL RECEIVED: (RAD F) Fill
DIS
10:20:37 ==3 FIRE ALARM ROOF TOP SMOKE DETECTOR 04
SIGNAL RECEIVED: (RAD F) F114 DIS
10:20: 38- __? FIRE TROUBLE ROOF TOP SMOKE DETECTOR 05 '
SIGNAL RECEIVED: (RAD G) G115 DIS
10:20:39 Qe} FIRE. ALARM ROOF TOP. SMOKE DETECTOR #48
SIGNAL RECEIVED: (RAD F) F1L8 DIS
10:44 ;48 =_> TROUBLE SPARE ' .
SIGNAL RECEIVED (RAD T) T006 DIS :
ph.> FIRE ALARM ROOF TOP SMOKE DETECTOR #1
SIGNAL RECEIVED: (RAD F) F111 DIS
10:44 ;52 = =) FIRE ALARM ROOF TOP SMOKE DETECTOR 04 DIS
SIGNAL. RECEIVED; (RAD F) .F114
10:44:53 = = >.FIRE TROUBLE ROOF TOP SMQKE.DETECTOR #5
SIGNAL (RAD G) 0115 DIS
=> FIRE ALARM ROOF' TOP SMOKE DETECTOR 08 • SIGNAL RECEIVED: (RAD F) File DIS
10:44:94 =,> TROUBLE "SPARE
SIGNAL RECEIVED; (RAD T) 7007 BIS
10:44:58 =6.> TROUBLE MAIN PANEL TAMPER
SIGNAL RECEIVED: (RAD T) T008 D "iS
10 :46:17 = => FIRE TROUBLE GATE VALVE TAMPER
SIGNAL RECEIVED; (RAD 0) G077 DIS
10:46:18 =_} FIRE RESTORE 'GATE VALVE TAMPER
SIGNAL RECEIVED: (RAD H) H077 DIE
30:48:05 =.=> FIRE ALARM WATERFLQW RISER
' SIGNAL RECEIVED:, (RAD F) F'076 DIS
10:48:07==> FIRE RESTORE WAYERFLOW RISER • SIGNAL RECEIVED: (RAD H) H076 1 DIS
10 :4S :10. = FIRE '
,TROUBLE ROOF TOP SMOKE'DETECTOR #1
SIGNAL RECEIVED: (RAD 0)•01.11 DIG
= =3 FIRE ALARM ROOF TOP SMOKE DETECTOR #1
SIGNAL RECEIVED :..(RAD F) F111 DIS
•
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