Report (100) FTS z_( oQQ' 217
Contractor's Material and Test Certificate for Aboveground Piping
PROCEDURE
Upon completion 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 job.
A certificate shall be filled out and signed by both representatives.Copies shall be prepared for approving authorities,owners,and contractor.It is
understood 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 Met Center I DATE 8-10-15
PROPERTY ADDRESS 10330 SW Scholls Ferry RD Tigard OR 97223
ACCEPTED BY APPROVING AUTHORITIES(NAMES)City of Tigard
ADDRESS
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ®YES 0 NO
EQUIPMENT USED IS APPROVED ®YES 0 NO
IF NO,EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION Z YES 0 NO
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT?
IF NO,EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES ®YES 0 NO
1. SYSTEM COMPONENTS INSTRUCTIONS ®YES 0 NO
2. CARE AND MAINTENANCE INSTRUCTIONS Z YES 0 NO
3. NFPA 25 ®YES 0 NO
LOCATION SUPPLIES BUILDINGS Entre Buildina
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
SPRINKLERS Tyco T`j ffi 2015 1 I 1 C5
Tyco ry F!'(f 2015 '/ l_ 37' 155
Tyco 2015
Tyco 2015
PIPE AND TYPE OF PIPE SCH 10&SCH 40
FITTINGS TYPE OF FITTINGS grooved
MAXIMUM TIME TO OPERATE
ALARM VALVE ALARM DEVICE THROUGH TEST CONNECTION
OR TYPE MAKE MODEL MIN SEC
FLOW flow POTTER VSF-R I 0 90
INDICATOR
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
TIME TO TRIP TIME WATER ALARM
DRY PIPE THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
OPERATING CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PROPERLY
TEST MIN SEC PSI _ PS) PSI MIN SEC YES NO
WITH
Q.O.D.
W/O
Q.O.D. 0
IF NO,EXPLAIN
•
OPERATION f PNEUMATIC f ELECTRIC f HYDRAULIC
PIPING SUPERVISED n YES 0 NO DETECTING MEDIA SUPERVISED n YES n NO
DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE
DELUGE& CONTROL STATIONS n YES n NO
PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN
VALVES FOR TESTING? n YES n NO
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE
YES NO YES NO MIN SEC
N/A
PRESSURE LOCATION MAKE& SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE
REDUCING &FLOOR MODEL (FLOWING)
VALVE TEST INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM)
N/A
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static
TEST pressure in excess of 150 psi(10.2 bars)for two hours.Differential dry-pipe valve clappers shall be left open during test to prevent
DESCRIPTION damage.All aboveground piping leakage shall be stopped.
PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 1%psi(0.1 bars)in 24 hours.Test
pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1%psi in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT 200 FOR 2 HOURS IF NO,STATE REASON N/A
DRY PIPING PNEUMATICALLY TESTED ®YES 0 NO
EQUIPMENT OPERATES PROPERLY 6a YES f NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE
OR DERIVATIVES OF SODIUM SILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING
SYSTEMS OR STOPPING LEAKS? ®YES f l NO
DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST
TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI
UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE
CONNECTION MADE TO SPRINKLER PIPING.
VERIFIED BY COPY OF THE U FORM NO.858 ®YES 0 NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND
SPRINKER PIPING Rl YES fNO
IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO,EXPLAIN
HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? f YES f NO
BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS 1 1 1
WELDED PIPING 6d YES f NO
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES 0 NO
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE
WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 3? ®YES 0 NO
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED
QUALITY CONTROL PROCEDURE TO INSURE 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? II YES f NO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS)
(DISCS) ARE RETRIEVED? ®YES f NO
HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN
DATA ®YES 0 NO
NAMEPLATE
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN.
REMARKS
NAME OF SPRINKER CONTRACTOR:
FP STEMS INC. Anthon Braaten
SIGNATURES { TESTS WITNESSED BY T> 2-CQ
F•: PR. ERTY OWNE SIGNED TITLE
DAI
F' �'INKLER 'ONTRACTOR(SIGNED) TITLE DATE
ADDITIONAL EXPLANATIONS AND NOTES: