700 Diffley Rd - Aboveground piping test cert.Contractor's Material and Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractors 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 EA a x, a, CAI i 4 t,
DATE c 2
PROPERTY ADDRESS 7 t7 0411 tcI
PLANS
ACCEPTED BY APPROVING AUTHORITIES (NAMES) G4
i r>t' elP
ADDRESS
INSTALLATION CONFORMS TO ACCEPTED PLANS ►5 YES NO
EQUIPMENT USED IS APPROVED ►1 YES NO
IF NO, EXPLAIN
DEVIATIONS:
INSTRUCTIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN ►5 YES NO
INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND
CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO,
EXPLAIN:
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES? YES NO
1. SYSTEM COMPONENTS INSTRUCTIONS YES NO
2. CARE AND MAINTENANCE INSTRUCTIONS YES NO
3. NFPA 25 YES NO
LOCATION
OF SYSTEM
SUPPLIES BUILDINGS:
SPRINKLERS
MAKE
MODEL
YEAR OF
MANUFACTURE
ORIFICE
SIZE
QUANTITY
TEMPERATURE
RATING
to
f)S
7oo1
/Z
t to
165
77‘ v
F5,13
7�
4114''
h 6
IS 5
t.
co
weistIr
7ia
ye
O a
ZIZ
PIPE AND
FITTINGS
TYPE OF PIPE:
TYPE OF FITTINGS:
ALARM VALVE
OR FLOW
OR
INDICATOR
ALARM DEVICE
MAXIMUM TIME TO OPERATE
TEST CONNECTION
TYPE
MAKE
MODEL
MIN
SEC
VANE
POTTER
VFR
IP
3 5
DRY PIPE
OPERATING
TEST
N/A
DRY VALVE
Q. O. D.
MAKE
MODEL
SERIAL NO.
MAKE
MODEL
SERIAL NO.
TIME TO TRIP
THROUGH TEST
CONNECTION'
WATER
PRESSURE
AIR
PRESSURE
TRIP POINT
AIR PRESSURE
TIME WATER
REACHED TEST
OUTLET'
ALARM
OPERATED
PROPERLY
without
Q.O.D.
with
Q.O.D.
IF NO, EXPLAIN:
'MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED.
Page 1 of 3
1996 Edition
DELUGE AND
PREACTION
VALVES
N/A
OPERATION PNEUMATIC ELECTRIC HYDRAULIC
PIPING SUPERVISED YES NO
DETECTING MEDIA YES NO
SUPERVISED
DOES VALVE OPERATE FROM THE MANUAL TRIP, REMOTE, OR BOTH YES NO
CONTROL STATIONS?
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR
TESTING?
YES NO
IF NO, EXPLAIN:
MAKE
MODEL
DOES EACH CIRCUIT OPERATE
SUPERVISON LOSS ALARM?
DOES EACH CIRCUIT
OPERATE VALVE RELEASE?
MAXIMUM TIME TO
OPERATE RELEASE
YES
NO
YES
NO
MIN
SEC
PRESSURE
REDUCING
VALVE TEST
N/A
LOCATION
FLOOR
MAKE
MODEL
SETTING
STATIC PRESSURE
RESIDUAL PRESSURE
(FLOWING)
FLOW RATE
INLET
(PSI)
OUTLET
(PSI)
INLET
(PSI)
OUTLET
(PSI)
FLOW RATE
TEST
DESCRIPTION
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for 2 hours or 50 psi (3.4 bars)
above static pressure in excess if 150 psi (10.2 bars) for 2 hours. Differential dry-pipe valve clappers shall be left
open during the test to prevent damage. All aboveground piping leakage shall be stopped.
PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1Y2 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 1Y2 psi (0.1 bars) in 24 hours.
TESTS
ALL PIPING HYDROSTATICALLY TESTED AT:
200 PSI BARS FOR 2 HOURS
IF NO STATE REASON:
WET SYSTEM
DRY PIPING PNEUMATICALLY TESTED QS YES 41 NO
EQUIPMENT OPERATES PROPERLY ►,1 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?
tfl YES NO
DRAIN
TEST
READING OF GAUGE LOCATED NEAR
WATER SUPPLY TEST CONNECTION:
'15 PSI BARS
RESIDUAL PRESSURE WITH VALVE IN TEST
CO NN CTION OPEN WIDE:
6 PSI BARS
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 I YES
FLUSHED BY INSTALLER OF UNDERGROUND 0 YES
SPRINKLER PIPING
NO
NO
OTHER, EXPLAIN:
BLANK
TESTING
GASKETS
NUMBER USED
0
LOCATIONS
NUMBER REMOVED
WELDING
WELDED PIPING ►5 YES NO
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING
PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST YES NO
AWS D10.9, LEVEL AR -3?
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS
QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST YES NO
AWS D10.9, LEVEL AR -3?
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE
WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO
ENSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE YES NO
SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,
AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED?
CUTOUTS
(DISCS)
DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO
ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED?
►5
YES NO
Paae 2 of 3
1996 Edition
HYDRAULIC
DATA
NAMEPLATE
NAMEPLATE PROVIDED
NO
IF NO, EXPLAIN:
►5 YES
REMARKS
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
9 '7, a c
SIGNATURES
NAME OF SPRINKLER CONTRACTOR:
ESCAPE FIRE PROTECTION
TESTS WITNESSED BY
7
PROPERTY OWNER (SIGNED) TITLE DATE
SPRINKLER CONTRACTOR (SIGNED) TITLE DATE
ADDITIONAL EXPLANATION AND NOTES:
Page 3 of 3
1996 Edition