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Specifications . t e x ,p ?co y- GOD ci CONTRATOR'S MATERIAL AND TEST CERTIFICATE FOR ABOVERGROUND PIPING PROCEDURE Upon completion of work, inspection and tests shall be made by Ibe contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel leave the job. A certificate shad be tilled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is tmdetstood 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 RANEE Winco Tigard DATE 10 -22 -2008 Plznl rYannRF�.q 07501 S W Darthmouth Street, Tigard, OR ACCEPTED BY APPROVING AUTHORTIIES (NAMES) City of Tigard ADDRESS 13125 SW Hall Blvd, Tigard, OR 97223 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS © YES ❑ NO EQUIPMENT USED IS APPROVED IF NO, EXPLAIN DEVIATIONS © YES ❑ NO HAS PERSON IN CHARGE (WPM EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES © YES ❑ NO AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAINS INSTRUCTIONS HAVE COPIES OF THE FOLIO WINO+ BEEN LEFT ON THE PREMISES? 0 YES 0 NO 1. SYSTEM COMPONENTS INSTURCTIONS v YES 0 NO 2. CARE AND MAINTENANCE INSTRUCTIONS 0 YES 0 NO 3. NFPA 25 Q YES 0 NO LOCATION OF SUPPLIES BU I DINOS SYSTEM YEAR OF ORIFICE QUANTITY TEMPERATURE MAKE MOAEI, MANUFAC IJRE SV.F. R A11 NO _ Tyco TY -FRB 2008 1/2" K5.6 29 155 degree SPRINKLERS Tyco FR0231 B 2008 3/4 K11.2 118 155 degree Tyco DSI 2008 1/2" K5.6 18 165 degree PIPE AND TYPE OF PIPE AS M 53 Steel FTITINO TYPE OF }I rrINGS ast Iron ALARM DEVICE MAXIMUM TIME TO OPERATE ALARM THROUGH TEST CONNECTION VALVE _ OR FLOW TYPE MAKE MODEL MIN SEC INDICATOR - _ _ ._ N/A J DRY VA YE 0.9.11 MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP WATER AIR TRIP POINT TIME WATER ALARM THROUGH TEST PRESSURE PRESSURE AIR PRESSURE REACHED OPERATED le PR c DRY _ rni n.�rrrn 4 r es es r: T ur OPERATDVO PIPE /Toy aana cpn PeT ocr nar ►Jr*r SCG_, tan TEST WITHOUT Q.O.D N/A WITH Q.O.D IF NO, EXPLAIN OPERATION ❑ PNEUMATIC ELECTRIC a HYDRAULIC -- I DELUGE AND PIPING SUPERVISED [DYES oNO ( DETECTING MEDIA SUPERVISED EYES NO PREACTION 1. J VALVES DOES VALVE OPERATE FROM THE MAUALTRIP, OR BOTH ❑ YES ❑ NO CONTROL STATIONS IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN FOR TESTING [� YES ❑ NO N/A MAKE MODEL DOES EACH CIRCUIT ES EACH CIRCUIT MAXIMUM TIME TO OPERATE SUPERVISION OPERATE VALVE OPERATE RELEASE LOSS ALARM? RELEASE? YES NO YES NO MIN SEC PRESSURE LOCATION MAKE SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING & H.DOR MODEL (FIA W1NI01 VALVE TEST INLET OUTLET INLET OUTLET PLOW N/A (PRI) , (PSI) "PS) (PSI) ICtPM1 BYQROSTAT1C: Hydrostatic test ahaf be made at not leas Mat 200 psi (134 bars) for 2 hours or 50 psi (3.4 ban) above wain pressure in excess of 150psi (I0.2bars ) for 2 hour. Differential dry-pipe valve clappers shell be TEST open during the ten to prevail damage. A(1 aboveground piping leakage be stopped. DESCRIPTION PNEUMATIC, Establish 40 psi (2.7 bars) air pressure and measure drop. which shall not exceed 154 psi (0.1 bars) in 24 bouts. Teat pressure tanks at normal water laud and air pressure end measure air pressure drop, which shall not exceed 134 psi (0.1 bate) 11124 boars. ALL Pl IPING HYDROSTATICALLY TESTED AT 200 PSI ( —BARS) FOR 2–HRS IF NO, STATE NEW AREA REASON DRY PIPING PNEUMATICALLY TESTED ❑ YES ❑ NO ONLY EQUIPMENT OPERATES PROPERLY ❑ YES 0 NO FIGUARE 8 -1(a) 2 DO You CERTIFY As THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE SODIUM SILICATE OR DERIVATIVES OR SODIUM SILICATE. BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? TESTS ❑ YES ❑ NO DRAIN READING OF GUAM LOCATED RESIDUAL PRESSURE WITH NEAR WATER VALVE IN TEST CONNECTION TEST SUPPLY TEST OW WIDE CONNECTIONS 110 PSI ( S) y I ( —HAM UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINLER PIPING VERIFTk7] 13Y OOOPY OF THE U FORM NO 8SB n O OTE EXP LAIN FLUSHED BY INSTALLER � - - - � � 1 N UNDERGROUND SPRINKLER PIPING ❑YEStUNo N/A • IF POWDER -DRIVEN FASTENERS ARE USED IN IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE ❑ YES TESTTNO BEEN SATISFACTORILY COMPLETED? N/A BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING fl YES ❑ NO IF YES.... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR ❑ YES ❑ NO N/A THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D109, LEVEL AR 3? DO YOU CERTIFY THAT THE WELDING WAS PERFORMED ❑ YES ❑ NO BY WELDERS QUALIFIED IN COMPLIANCE WITH THE WFIAINO REQUIRMENTS OF AT LEAST AWS D109, LEVEL AR -3? DO YOU CERTIFY THAT WELDING WAS CARRIED OUT III COMPLIANCE WITH A OODU)MENTED QUALITY ❑ YES ❑ NO CONTROL PROCEDURE TO ENDURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE • SMOOTH, THAT SLAG AND OTHER WELDING RESIDUAL ARE REMOVED AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS 170 YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE ( DISCS) TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? ® YEs ❑ NO HYDRAUUC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA NAMEPLATE YES ® NO ❑ EXISTING DATE LEFT IN SERVICE WITH ALLCONTOL VALVES OPEN REMARKS Never left out of service - we completed TI 10 -9 -08 FIGUARE S -1(a) 3 r 7 NAME OF SPRINKLER CONTRACTOR T &L Communications, Inc TESTS WITNESSED BY FOR PROPERTY OWNFA. (SIGNED) TITLE DATE SIGNATURES /7/61e::::,,‘,..„.._ W i O Sailer /o a'Z - -og FOR SPRDIKLER CONTRACTOR (SIGNED) TITLE DATE Larry Bushaw :okCt.; ii vim` President I0 -22 -2008 ADDITIONAL EXPLANATION AND NOTES t e , f..er� e4 '6,,' ae FIGUARE 8 -1(a) 4