Report 12/04/2006 14:22 FAX 5032892208 Fire Systems West, Inc. 001/004
Fire Systems stems West /Precision Alarm
Vancouver. Washin3ton 98661 • 3 6 x 93-9906
600 3c Maritime Avenue. suite 300
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12/04/2006 14:22 FAX 5032892208 Fire Systems West. Inc. Q002/004
SYSTEM ACCEPTANCE • 13 -63
Co Material and Test Certificate for Above Piping
PROCEDURE
U
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pon completion of work inspection and tests shad be made by the contractors representative and witnessed by an owners
representative. Act defects shall be Careced and system left in service before canuacefs personnel finally leave the job.
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A certificate shall be :sled out and signed by both representatives. Copies shall be prepared for approving authorities, owners. and
contractor. It is understood ine owners representatives signature in no way prerydit;es any daim against contractor for faulty material, poor
workmanship, : r 'allure to comply :With approving authority's requirements or focal ordinances.
PROPERTY NAME - • ; DATE
/2 l%
PROPERTY ADDRESS A /
• • .• /rlo'gS'' St..a 7.Z.Mt,1 /VZ)t ---
ACCEPTED &' APPROVING AUTHORITIES (NAMES)
ADORES.E
, �y df f f
` PLANS ' • •
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INSTA _AAION CONFORMS TO ACCEPTED PLANS V YES Fir
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EQUIPMENT USED IS APPROVED ( 'YES fS NO
IF NO, EXPLAIN DEVIATIONS ( .
'
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HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS YES ;._ j NO
TO LOCATION OF CONTROL VALVES AND CARE ANO MAINTENANCE
OF THIS NEW EQUIPMENT?
IF NO. EXPLAIN
INSTRUCTIONS
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES; YES L NO
1. SYSTEM COMPONENTS INSTRUCTIONS YES C) NO
2. CARE AND MAINTENANCE INSTRUCTIONS YES 0 NO
3. NFPA 25 YES U NO ••
LOCATION ( SUPPLIES 3UlLOINGS
OF SYSTEM
,e /A 6/( YEAR OF ORIFICE • I T EMPr= ATUO.E
MAKE MODEL MANUFACTURE SIZE QUA TIT'r j RATING
w:.. ... WtrZ- `l.111111,'
SPRINKLERS I 1 1
l
1 .5
1 !
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PIPE ANO Type of Pipe f3AcA Si.. c /
FITTINGS Type of Finings
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• MAXIMUM TIME TO OPERATE
ALARM ALARM OEVICE THROUGH TEST CONNECTION
VALVE
OR FLOW I TYPE MAKE T MODEL- M IN. ; SEC.
• . DRY VALVE l O. O O
. MAKE MODEL SERIAL NO. MAKE 1 MCCEL SERIAL NO.
-
. .. 1
ORY PIPE TIME TO TRIP T T1ME'NA0 At_4RM
OPERATING THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
TEST CONNECTION' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET PROPERLY
MIN. SEC. PSI r • PSt 1 PSI l MIN. 1 SEC. 1 - YES 1 NC
Without r ' j
0.0.0. •
With j l I
• • •
IF NO. EXPLAIN
'MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED.
/‘
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12/04/2006 14:23 FAX 5032892208 Fire Systems West, Inc. 2003 /004
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13-64 tNSTALLAT1CN OF SPRINKLER SYSTEMS
OPERATION
G PNEUMATIC ❑ :ELECTRIC 0 HYDRAULIC
PIPING SUPERVISED G YES ❑ NO ` OE i ECT<NG MEDIA SUPERVISED ❑ YES ❑ NO
DOES VALVE OPERATE '+RCMTHE MANUAL TRIP AND/OR REMOTE ❑ YES ❑ NC
CONTROL STA T IONS
DELUGE &
PREACTIOM IS THERE AN ACCESSIBLE FACILITY IN Fble CRi� CUIT I IF NO. EYPLAIN
VALVES ❑ Y ES ❑ No
DOES EACH CIRCUIT OPERATE I 00E5 H CIRCUIT MAXIMUM TIME TO
MAKE MCOEL 1 SUPERVISICN LOSSALARAI 1 OPERATE v RELEEASc I OPERATE RELEASE
YES F NO 1 YES 1 _,..., 1 MIN 1 SEC.
I 1 1 1 1 I 1 1 --- . 1
FOR
LOCATION TESTI NG MAKE & SETTING STATIC PRESSURE ` �ESIOUAL PRESSURE ! FLOW RATE
PRESSURE a FLOOR I MCOEL al (FLOWING) `
REDUCING ` I INLET (PSI) I OU1UT (PSI) I INLET (PSI) I OUTLET" (P511I FLOW (G ?u)
VALVE TEST 1 1 I 1 I
HYDROSTATIC: Hydrostatic Tests shall be made at not less than 200 psi (13.6 bars) for wra hours or 50 psi (3.4 bars)
• above static pressure in excess of 150 psi (10.2 bars) for two hours D(ffetenhal dry -ape `eve sappers shat be left
open during Test to ;revere damage. At aboveground piping leakage shat be.stoPPe.
TEST whim' s not exceed 1 Si (0 -1 bars)
DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 ban) air pressure and measure drop.
1 in 24 hours. Test pressure tanks at normal water level and air ;tenure and measure al?`pr \ tire drop. which snail
not exceed t t2 as' (0.1 (0 -I bars) in 24 Wow
I
ALL PIPING HYDROSTATICALLY T Es c0 AT PSI FOR __ HRS. 1 IF NO. STATE REASON
DRY PIPING PNEUMATICALLY TESTED ❑ YES ❑ NO \
ECUIPMENT OPERATES ?RCP ❑ YES ❑ NO 1
00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES ANO CORROSIVE CHEMICALS.
SODIUM SILICATE FOR 0 E SYSTEMS OR IIVATI S'OPPIN LEAKS OR OTHER CORROSIVE CHEMICALS
WERE NOT
❑ YE33 ❑ NO
DRAIN IRE/WING OF GAGE LOCATED NEAR wAT P ' RESIDUAL PRESSURE WITH VALVE IN TEST
TESTS ! TEST SUPPLY TEST CONNECTION: 1 PS1 CONNECTICN OPEN WIDE _ P51
UNDERGROUND MAINS ANO LEAD IN CONNECTIONS 70 SYSTEM RISERS FLUSHED 3EFCRE
I CONNECTION MADE TO SPRINKLER PIPING. NO OTHER EX�,+�IN
VERIFIED BY COPY OF THE U FORM NO. 858 ❑ YES ❑
I FLUSHED 8Y :NSTAL CF UNDER• _ __ — ...... •
1 GROUNO SPRINKLER PIPING ❑ YES ❑ NO
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I IF POWDER DRIVEN FASTENERS ARE USED IN ❑ YES
❑ NC IF NO. E.CPle11N
CONCRETE. HAS REPRESENTATIVE S
TESTING BEEN SArISFACTCRI Y C
i NUMBER REMOVED
BLANK TESTING NUMBER USED LOCATIONS GASKETS I
WELDED PIPING 0 YES G NO
IF YES...
I
00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR 711AT WELDING [] YES ❑ NO
• PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST
j , AWS 010.9. LEVEL
I 00 YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS ❑ YES ❑ NO
WELDING 1 OUAUFIE0 IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST
I AWS 010.9. LEVELAR -3?
1 00 YOU CERTIFY THAT WELDING WAS CARRIED CUT IN COMPLIANCE
WITH A COC JMENTEO QUALITY CONTROL PROCEDURE TO INSURE ❑ YES ❑ NO
1 THAT ALL DISCS ARE RETRIEVED. THAT OPENINGS IN PIPING ARE
f SMOOTH. THAT SLAG ANO OTHER WELDING RESIOUE ARE REMOVED.
I
ANO THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED?
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CUTOUTS • 00 YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO 1:3 YES ❑ NC
(DISCS) I ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED?
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Figure 94(a) (conq.
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12/04/2006 14:23 FAX 5032892208 Fire Systems West, Inc. 41004 /004
SYSTEM ACCEPTANCE 13-
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NYORAULJC NAMEPLATE PROVIOEO IF NO, EXPLAIN
DATA
NAMEPLATE It YES ❑ NO
OATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REMARKS
ii
IIP/ I NAME OF SPRINKLER CONTRACTOR
SIGNATURES TESTS • ESSED SY
FOR Pfie TY O ER (SIGNED) TITLE ATE
q-zo6L
FOR SPRI TRACTOR (SIGNED) TITLE DATE
ril r fi r p G
ADDITIONAL EXPLANATION AND NOTES
F .
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