Report (64) ` tt5 c.Ao --?cc1/4.. 1-- L` S FN Ps 2D&- 00 017
Contractor's Material and Test Triad Fire Protection
ROC319343 CCB#199988 S3DESDL863RZ
Certificate for Above Ground 1927 NE Rodney Avenue
Portland, Oregon 97212
Piping 503.856.6333 Fax 866.766.8862
office@triad-fire.com www.triad-fire.com
Procedure
Upon completion of work,inspection and tests shall be made by the contractor's representative and witnessed by the property owner or their agent. 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 authority's
requirements of local ordinances.
Property Name Natural Grocers
Property Address 13115 SW Pacific Hwy
Accepted by approving authorities(names) City of Tigard
Address 13125 SW Hall Blvd
Plans Installation conforms to accepted plans K Yes No
Equipment used is approved IKI Yes No
If no,explain deviations
Has person in charge of fire equipment been instructed as to location of control k Yes No
valves and care and maintenance of this new equipment?
If no,explain
Instructions Have copies of the following been left on the premises?
1. System components instructions X1 Yes No
2. Care and maintenance instructions Yes I I No
3. NFPA 25
KI Yes No
Location of Supplies buildings Entire Interior
system
Make Model Year of manufacture Orifice size Quantity Temperature rating
Tyco EC-14 Upright 2018 3/4" 63 200
Sprinklers Tyco EC-14 Pendant 2018 3/4" 14 155
Tyco DS-1 2018 3/4" 8 200
Tyco FRB 2018 1/2" 12 155
Pipe and Type of pipe SCH 7 K SCH 10 K SCH 40 CPVC Other:
fittings Type of fittings X Grooved x Welded X Threaded CPVC Other:
Alarm device Maximum time to operate through test connection
Alarm Type Make Model Minutes Seconds
valve or Flow
flow Potter VSR 0 45
indicator
Dry valve Quick opening device
Make Model Serial number Make Model Serial number
Time to trip through test connection Water Air Trip point Time water reached Did alarms operate
Dry pipe pressure pressure air pressure test outlet properly
operating
test Minutes Seconds PSI PSI PSI Minutes Seconds Yes No
Without Q.O.D.
With Q.O.D.
If no,explain
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Operation: Pneumatic Electric Hydraulics
Piping supervised? Yes No Detecting media supervised? Yes No
Deluge Does valve operate from the manual trip,remote,or both control stations? Yes No
and Is there accessible facility in each circuit for testing? Yes No If no,explain
pre-action
valves Does each circuit operate Does each circuit operate valve Maximum time to operate release
Make Model supervision loss alarm? release?
Minutes Seconds
Yes No Yes No
Location and floor Make and model Setting Static Pressure Residual pressure(flowing) Flow rate
Pressure
reducing Inlet(psi) Outlet(psi) Inlet(psi) Outlet(psi) Flow(gpm)
valve test
HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi(13.6 bar)for 2 hours or 50 psi(3.4 bar)above static pressure in excess of
150 psi(10.2 bar)for 2 hours. Differential dry-pipe valve clappers shall be left open during the test to prevent damage. All above ground piping
Test leakage shall be stopped.
description
PNEUMATIC:Establish 40 psi(2.7 bar)air pressure and measure drop,which shall not exceed 1-1/2 psi(0.1 bar)in 24 hours. Test pressure tanks at
normal water level and air pressure and measure air pressure drop,which shall not exceed 1-1/2 psi(0.1 bar)in 24 hours.
All piping hydrostatically tested at 200 psi( bar)for 2 hours If no,state reason
Dry piping pneumatically tested Yes No
Equipment operates properly rt,-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 chemicals were not used for testing systems or stopping leaks? I)I Yes No
Reading of gauge near water supply test connection 65 psi( bar)
Tests Drain test
Residual pressure with valve in test connection open wide 60 psi( bar)
Underground mains and lead-in connection to system risers flushed before connection made to sprinkler piping....
Verified by copy of the Contractor's Material and Test Certificate for Underground Piping x Yes No If no,state reason
Flushed by installer of underground piping I^I Yes ElNo
If powder driven fasteners are used in concrete,has representative sample testing been satisfactorily completed? ri Yes n No
If no,state reason
Blank Number used Locations Number removed
testing
gaskets
Welded piping? KI Yes No
If yes...
Do you certify as the sprinkler contractor that welding procedures used complied with the minimum
requirements of AWS B2.1,ASME Section IX Welding and Brazing Qualifications,or other applicable x Yes No
qualification standard as required by the AHJ?
Welding Do you certify that all welding was performed by welders or welding operators qualified in accordance
with the minimum requirements of AWS B2.1,ASME Section IX Welding and Brazing Qualifications,or x Yes No
other applicable qualification standard as required by the AHJ?
Do you certify that the welding was conducted in compliance with a documented quality control
procedure to ensure that(1)all discs are retrieved;(2)that openings in piping are smooth,that slag
and other residue are removed;(3)the internal diameters of piping are not penetrated;(4)completed x Yes No
welds are free from cracks,incomplete fusion,surface porosity greater than 1/16 in.diameter,undercut
deeper than the lesser of 25%of the wall thickness or 1/32 in.;and(5)completed circumferential butt
weld reinforcement does not exceed 3/32 in.?
Do you certify that you have a control feature in place to retrieve all cutout(disks)? x>Yes No
Misc. Have you provided a hydraulic data plate? x Yes No If no,explain
Date left in service with all control valves left open: 8-1-1 8
Name of Triad Fire Protection representative: Benjamin Esqueda Date: g_1_1 8
Signature of Triad Fire Protection Representative: ‘B04,y. 6,,y,uelG
Signatures
Name of property owner/agent: Title: Date:
Signature of owner/agent:
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• Additional Explanations/Notes:
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