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Report Received: Sep 7 2010 10:37am 09- 07 -`10 09:15 FROM -Town & Country Heat 3602565886 T -627 P003/006 F -730 • 7 5 Se 6tiz& $ FP5 7_001 — 000 9 Contractor's Material and Test Certificate for Underground 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 tautly material, poor . workmanship, or failure to comply with approving authority's requirements or local ordinances. Property name — - 1 daCy1 e-e v► Date • Property address -t 1 ©1 -3-- / 1 h(AC , S�Jo1��t�Ctr 5�, c.0 �t� I Accepted by approving authorities (names) Address Plans-- — — - .- .._._... -._,. �- Installation conforms to accepted plans ' • Yes I._. , No • • Equipment used is approved j Yes [] No Si no, state deviations Has person in charge of fire equipment been instructed as to location of [ t1'Yes t 1 No i • control valves and care and maintenance of this new equipment? • if no, explain • Instructions Have copies of appropriate instructions and care and maintenance P (Yes 11 .1 No charts been left on premises? If no, explain • Location Supplies buildings • , Pipe types and class Typ joint D - :� GL4ss. 5Z I . of>v Pipe conforms to _ /Vie:} 13,_ standard C '"Yes U] No Fittings conform to Ai FP!3. -II_ _ standard - U , Underground If no, explain r .�!' 1es No pipes and joints Joints needed anchorage clamped, strapped, or blocked in 1 ..kles El No • accordance with _ /. _ standard If no, explain iglus in : Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags at outlets such as hydrants and blow -offs. Flush at flows not less than 390 gpm (1476 Umin) for 4 -in. pipe, 800 gpm (3331 Umin) for 6 -in. pipe, 1560 gpm (5905 Umin) for 8 -in, pipe, 2440 gpm (9235 Umin) for 10 -in. pipe, and 352.0 gpm (13,323 1 . Umin) for 12 -in. pipe. When supply cannot produce stipulated flow rates, obtain maximum available. Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.8 bar) for 2 hours or 50 psi (3.4 bar) above Test static pressure in excess 01 150 psi (10.3 bar) for 2 hours. • description Leakage: New pipe laid with rubber gasketed joints shall, if the workmanship is satisfactory, have little or no leakage at the joints. The amount of leakage at the joints shall not exceed 2 quarts per hour (1.89 Uhr) per 100 joints irrespective . of pipe diameter. The leakage shall be distributed over all joints. If such leakage occurs at a few joints, the installation shall be considered unsatisfactory and necessary repairs made. The amount of allowable leakage specified above can • be increased by 1 fluid ounce per inch valve diameter per hr. (30 mU25 mm /hr) for each metal seated valve isolating the test section. If dry barrel hydrants are tested with the main valve open so the hydrants are under pressure, an additional 5 ounces per minute (150 mUmin) leakage is permitted for each hydrant. , • • New underground piping flushed according to j YYes 0 No FP// ! 3 standard by (company) If no, explain j How lushing flow was obtained Through what type opening Flushing ILK Public water (, _.; Tank or reservoir j.1 Fire pump i_ii hydrant butt (. 1 Open pipe tests -- - . — — Lead -ins flushed according to _ _ , -Ai ?-,_LS standard by (company) j.-Ts j-. -: No If no, explain Ho ushing flow was obtained Through what type open • l Public water ; _. Tank or reservoir Fire pump ni Y connection to flange r -` Open pipo and spigot Reprinted with permission from NFPA 13, Instaiiation of Sprinkler Systems, Copyright © 2002, National Fire Protection Association, Quincy, MA 02269. This reprinted material Is not the complete and official postion of the National Fire Protection Association, on the referenced subject which is represented only by the standard in its entirety. American Fire Sprinkler Association 9696 Skillman Street, Suite 300, Daltas,Texas 75243 AFSA Form #AF064 Received: Sep 7 2010 10:37am 09-07-10 09:15 FROM-Town & Country Heat 3602565886 T-627 P004/006 F-730 . . • • All new underground piping hydrostatically tested at l Joints covered Hydrostatic 2- 0 ps ! 71 yes ViN. , test 0 psi for ___...Z hours __L_ ( _ _— Total amount of leakage measured • b 0 . Leakage gallons _..... _ — hours . test Allowable leakage gallons ... ..... _... hours I i;-.) / Number installed Type and make All operate satisfactorily Hydrants Li Yes ( .. J No - Water control valves left wide open 4.1 [7] No If no, state reason Control valves Hose threads of lire department connections and hydrants interchangeable with [t 1. 1 No those of fire department answering alarm . . . . . . Dale left in service /z / / 0 . . Remarks • . . . . Name of installing contractor (._ , i . • mvpo Ffrei Sprix/klei-s . • . - — Tests witnessed by Signatures For property owner (signed) Title Date ... . For installing cont actor (signe , , Title Date, ..... ..._ Additional explanation and notes Contractor's Material and Test Certificate for Underground Piping Received: Sep 7 2010 10:37am - 09- 07 -`10 09,15 FROM -Town & Country Heat 3602565886 T -627 P005/006 F -730 '_j • .. .a....v.v. v ......•w ....... ........ u....e ..v. e...v. -i .v. .�wvawa�.vww .rs..0 4 CEDURE ..,.. ...- ..- ..- ...,......e.._� -.__ 3 �._ ' completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owners representative. All defects be corrected and system left in service before contractor's personnel finally leave the job r xl rtificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is rstood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to tF •ly with approving authority's requirements or local ordinances. vy , Name Date amette Dental -- Tigard Office, 09CS -006 1 412(2010 _ rty Address -- — — -___.....- -- - — - -- 5 SW Gonaga Street, Ti and OR. S. Accepted by Approving Authorities (names) =' City of Tigard : Address . -- Plans 13125 SW Hall Blvd. -- — — — — — Installation conforms to accepted plans (] Yes 0 No i. E ui ment used is approved x El No .- 4 p Pp ❑ Yes If no explain deviations t•r •; It. Has person in charge of fire equipment been instructed as to location Yes ❑ No , k of control valves and care and maintenance of this new equipment? ;a -i If no, explain. ' Building owner has all information from original installation. V t f- Instructions — — — - -- Have copies of the following been left on the premises? 1. System components instructions I1 Yes ❑ No 2. Care and maintenance instructions El Yes I I No . '1 3. NFPA 25 ❑ Yes El No ' 4 2" . , Location Supplies Building System No. 0,_ of System Supplied Southside Middle of Building • <fi Year of Orifice Temperature , ::"L Make — Model _ Manufacture _ Size Quantity Rating t RELIABLE F1 FR 2009 '/z" _ 130 155 <.;r+',. RELIABLE F1FR 2009 Y2 1 20 200 , � ' Sprinklers %,, ,, ,, RELIABLE DS -1 2009 6 200 is rre,, -4,. Pipe and Type of Pipe Sch40 black / Sch7 "flow" pipe ° ;; Fittings Type of Fittings C.I. screwed, grooved and Flexhead drops ',= V ' , j , Alarm Device Maximum time to operate through test connection 4 • - Alarm Valve or - Type Make Model Minutes Seconds ±` _ q ,:,Flow Indicator FLOW SWITCH System WFD 0 45 i' ` ,' � Sensor ;r i -' -- -- - - r ' " "'; Dry Valve Quick Opening Device _ ' s■r q) . -,' Make Model Serial No. Make Model Serial No. • '.t Time to trip ` -- Alarm t through test Water Air Trip Point Time water reached operated s connection (1,2) Pressure Pressure Air Pressure _ test outlet (1,2) properly ` ',ai, Minutes Seconds PSI PSI PSI Minutes Seconds Yes No t - 4--,.., Dry Pipe — - • perating Test Without ❑ ❑ ea' '`' p g Q.O.D. -- — - -- ' r With :1 ❑ ❑ '.. % Q.O.D. — —_ ,.` If no explain E• d . , (1) Measured from time inspector's test connection is opened a ia; (2) NFPA 13 only requires the 60- second limitation in specific sections --- VI . c . 3 Received: Sea 7 2010 10:38am I 09- 07 -`10 09:16 FROM -Town & Country Heat 3602565886 T -627 P006 /006 F -736 *. ., vr,m 0..011 ❑ Pneumatic ❑ Electric ❑ Hydraulic . , Piping supervised ❑ Yes ❑ No Detecting media supervised ❑ Yes ❑ No Deluge and Does valve operate from the manual trip, remote, or both control stations? ❑ Yes 0 No Preaction Is there an accessible facility in each circuit for 0 Yes ❑ No If no, explain • it testing? Valves Make Model Does each circuit operate Does each circuit operate Maximum time to supervision loss alarm? valve release? operate release Yes No Yes No Minutes Seconds ❑ 0 0 0 :1 Location and Make and Setting Static Pressure Residual Pressure (Flowing) Flow Rate v, • ressure Reducing Floor Model Inlet (PSI) Outlet (PSI) Inlet (PSI) Outlet (PSI) . Flow (GPM) t 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) . Test for 2 hours. Differential dry-pipe valve clappers shall be left open during the lest to prevent damage All aboveground piping leakage shall be stopped. A Description Pneumatic: Establish 40 PSI (21 bar) air pressure and measure drop, which shall not exceed 114 PSI (0.1 bar) in 24 hours. Test pressure tanks at normal water level and air . essure and measure air ,ressure dim., which shall not exceed 11 PSI 0.1 bar in 24 hours. All piping hydrostatically tested at 200 PSI for 2 hours If no, state reason Dry piping pneumatically tested ❑ Yes ❑ No Equipment operates properly ❑ 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? ❑x Yes ❑ No za Reading of gauge located near water supply test connection: Residual pressure with valve in test connection wide open: Tests Drain Test , Static Pressure 110 PSI 90 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. 85B El Yes ❑ No Other Explain 1 i Flushed by installer of underground sprinkler piping 0 Yes ❑ No It powder - driven fasteners are used in concrete, If no, explain 5_ has representative sample testing been satisfactorily com eted? O Yes ❑ No i y = Blank Testing Number Used Locations Number Removed y Gaskets 0 Welded Piping ❑✓ Yes 0 No x, If yes... Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS RI Yes ❑ No ° °_k 82.1? ' `- Welding 1 Do you certify that the welding was performed by welders qualified incompliance with the requirements of at least EI Yes ❑ No AWS B2.1? .4' Do you certify that the welding was carried out in compliance with a documented quality control procedure to El Yes ❑ No ensure that all discs are retrieved, that openings in piping are smooth, that slag and other welding residue are I . removed, and that the internal diameters of piping are not penetrated? Cutouts Do you certify that you have a control feature to ensure that all cutouts (disks) are retrieved? R1 Yes ❑ No .' (Disks) Hydraulic Data Nameplate provided If no, explain :3? Nameplate D Yes [1 No „.., i'% Date left in service with all control valves open . t ' 4/2(2010 `4 Remarks Q,s Name of sprinkler contractor Contractor's License No. Vanport Fire Sprinklers, Inc. VANPOFSI8OPF � . Tests witnessed by t s For property owner (signed) r. Signatures Title Dale fo x r sp ter contra for (sgned) Title y ._ Date / . For approving aut ily (signed) Title Date Additional explanations and notes - Hydrostatic Test 1/29/10 (Passed) 10 :00 am to 12:00 p. noon. • 1 State Certification d' , z Y