990 Lone Oak Rd - Material & Test Cert. above ground pipeWsweLT er (f oR Y
? CONTRACTOR'S MATERIAL & TES7 CSRTIFiCATE FaR AOVEGROUND PIPWG
PROCEDURE
Upon compleupn.of work, inspection and tests shall be made by the contrector's representative and witnessed by an owner's representative. AII
defects shall be corrected and sys2em left in service before contractor's persannel finally leave the job.
A cartificate shall 6e filled out and signed by both representatives. Copies shall 6e prepared for approving authorities, owners and contrettor.
It is understaod the owner's represencative'ssignature in na way prejudices any claim against contreccar for faulty material, poor workmanship,
or failure to comply with approving authority's requirements or local ordinances.
YRVYCtiI T IVHMC - O
AAIm.s T,?otv? I3?sm.eu..s c E,pi r-g
PROPERTY ADORE55
e
ACCEPTEO BY APPROVING AUTHORITY ) NAMES
D ? C/r
AOORESS
PIANS J YQ !/c !t E J O, / 6 ?f7?0 /.t/rvc/l?ou1 `y!s?S.J"Y.??
INSTALLATION CONFORMS TO ACCEPTEO PlANS WYES --[]NO
EQUIPMENTUSEDISAPPROVED ?EYES E]NO
IF NO, EXPL.41N DEVIATIONS
NAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTEO AS TO LOCATION eYES ?NO
OF CONTROL VAI.VES ANp CARE ANO MAINTENANCE OF THIS NEW EQU7PMENT '
IF NO, EXPLAIN -
INSTRUCTIONS
HAVE COPIES OF APPfyOPRIATE INSTRUCTIONS ANO CARE AND MAINTENANCE CHARTS E5j"(ES 0 NO
AND NFPA 13A BEEN LEFT ON PREMISES
IF NO, EXPLAIN
1_OCATION SUPPLIES gLOG . .??yr 3
OF SYSTEM ( J ??? ? 4 sfs++l ? 1 W?? T GEG SrI?E?'f
P?? !
MAKE MODEL YEAFi OF
MANUFACTURE ORIFICE
57ZE QUANTITY TEMPERATURE
flATING
w
y 'z
399,
SPRINKIERS T??? ? p$f ? Zz 212
?? A i J 9 ' 2 ? 5? ?
PIPE ANO
FITTI74GS PIPE CONFORMS TO
zy 44 STAIYOARD C]YES C]NO
FITTINGS CONFORM TO STANDARD 0 YES C]NO
IF NO, EXPLAIN
ALARM ALARM DEVICE MAXIMUMTIMETOOPERATETHAOIK'HTESTPIPE
VA'L V,E 'TYPE MAI(E MOOEL f"S MIN. ? SEC.
oR FLow ANE
INDICATOR
ORY VALVE Q.O.O.
MAKE. MODEL SEAIAL NO. MAKE MODEL SE O.
"
TIME TO TRIP '
pflESSUR AIR
PflESSUflE TAIP POINT
AIR E E WATER
REAC1-IED
TESiOUTLET• ALAFiM
OPERATED
PROPERLY
DRY P1PE MIN.. SEC. PSL P51 P51 MIN, SEC. YES NO
OPERATING
TEST
Without
Q.O.O.
witn
Q.O.D.
*MEASUREO FROM THE TIME INSPECTOR'S TEST CONNECTION VALVE IS OPENED.
BSA 0.080) PqINTED IN THE U.S.A. FOfi NATIONAL FIRE SPRINKLEFi ASSOCIATION, INC., P.O. BOX 1000, PATTERSON, N.Y. 12563
DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACN CIRCUIT FO IF NO, EXPLAIN
PpEACT10N
? YES ? NO
VALVES
DOES E4CH CIRCUIT OPERATE OOES EACH CIRCUIT MAXIMUM TIMETO
MAK MODEL SUPERVISION L?5 AIARM OPERATE VALVE RELEASE OPERATEREl.EASE
YES NO YES NO MIN, SEC.
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 6ars) for two haurs or 50 psi (3.4 bars) above static
pressure in excess of 160 psi (102 bars) for two hours. Oifferential dry-pipe valVe clappers shall 6e left open during test to prevent damage.
All aboveground piping leakage shall be stopped.
SH I
l
F L
G
TEST W
N
: F
ow the required rate until water is clear as indicated bY ao coilection of foreign material in burlap bags at outlets such as
DESCRIPTION hy rants and blowoffs. Fiush at flows not less than 400 GPM (1514 L/min) for 4•inch pipe.600 GPM (2271 Lfmin) for 5•inch pipe,
750 GPM (2839 L/min) for 6-inch pipe, 1000 GPM (3785 L/min) for 8-inch pipe, 1500 GPM (5678 L/min) for 70-inch pipe and 2000
GPM (7570 L/min) tor 12-inch ?ipe. When supply cannot produce stipulaied flow ra[es, obtain maximum available.
PN_EUMqT?C: Establish 40 psi 2.7 bars) air pressure and measure drop which shall not exceed 1-Y,•psi 10.1 barsy in 24 haurs. Test
pressure tan s at normal water level and air pressure and measure air pressure drop which shall not exceed 1?/, psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT PSI FOR HRS. IF NO, STATE REASON
ORV PIPING PNEUMATICALLY TESTED ?YES ?NO
EpUIPMENT OPERATES PROPERLY ? YES ? NO
DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIOUAL PRFSSURE WITH VALVE IN TFST PIPE OPEN W I DE
TESTS TEST STATlC PRESSURE: C pSl ?2 PSI
Underground mains and lead in conoections to system risers flushed before connection made to sprinkler piping.
VERIFIED BV COPV OF TNE V FORM NO. 85B ?YES ? NO OTHER EXPLAIN
FLUSHED BV INSTALLER OF UNDER-
GROUNOSPRINKLERPIPING ?YES QND
BLANKTESTING NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS
WELOEDPIPING CYES ?NO
IF YES...
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELOING PROCEDURES COMPLY
WITHTHEREpUIREMENTSOFATLEASTAWSO30.9,LEVELAR-3 Eg YES ?NO
DO YpU CERTIFY THAT THE WELOIN(i WAS PERFORMEO BV WELDERS QUALIFIED IN
WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3 ?YES ? NO
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMEMTED QUALITY CONTROL PROCEDVRE TO INSURE THAT ALL DISCS ARE
RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTFI, TNAT SLAG AND OTHER
- WELDING RESIDUE ARE REMOVEO, AND TNAT THE INTERNAL OIAMETERS OF 59YES ? NO
PIPING ARE NOT PENETRATED
HYDRAUIIC NAMEPLATE PROVIDEp IF NO, EXPLAIN
OATA
NAMEPLATE
? YES ? NO
DATE FT IN
SERVICE WITN ALL CONTROL VALVES OPEN:
REMARKS n
?'?"11 - Z?9 '
NAME OF SPRINKLER CONTRACTOR
N lI ? !M/
TESTS WITNESSED BY
SIGNATURES
PRO R V OW E 5 NED) TIT ?
?
v
FOR SPRINKLER CONT CTOR ( GN D) TITLE DC
?uuI i wrvtaU enrLsirvraTloN AND NOTES // //
(? !I
85q BACK
/AvSPCCr?' ????
` CON'fRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING
PROCEDURE
Upon compleeon of work, inspectian and tests shall 6e made by the contrector's representetive and witnessed by an owner's representative. AiI
defects shall be corrected and system left in service before contractor's personnel finaily leave the job.
A certifiwte shall be filled ouc and signed by both representatives. Copies shalt be prepared far approving authorities, ownen and con[rector.
It is understood the owner's representative's si9nature in no way prejudices any claim againat convacior for faulty material, poor workmanship, or failure to comply with approving authority's
requirementa or local ordinances. -
A
PLANS
INSTAUCTIONS
ACCEPTEO BY APPROVING AUTHORITYCIS) NAMES
ADOFiE55 ----- - - ._.--
sso ` o K E S o. ,??6oa uf ?i.Vsry )
INSTALLATION CONFORMS TO ACCEPTEO PLANS ? YES .? NO
EQUIPMENT USED IS APPROV ED ? YES ? NO
IF NO, EXPL.41N DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUI
OF CONTROL VALVES AND CARE ANO
IF NO, EXPLAIN
i ir
CE
HAVE COPIES OF APPRpPRIATE IMSTRUCTIONS AND CARE ANO MAI
AND NFPA 13A BEEN LEFT ON PREMi5E5
IF NO, EXPLAIN
CHARTS
YES C:]NO
Inrennn' ISlJPP1 ias wi nr_c
dPSYSTEM ? ? ? mjo? J Y? ? A-
MAKE MODEL YEAR OF
MPNUFACTURE ORIFICE
SIZE QUANTITY TEMPEflATURE
RATING
? z 3
SPRlNKLERS T.2f3?
1-7
198f
/
6
212
<? A i1 Y '2 -6
PIPE AND
PITTINGS PIPE CONFORMS TO STANOARD ? YES ? NO
FITTINGS CONFORM TO 4,11f STANDARD ? YES ? NO
IF NO, EXPL.AIN
ALAFM DEV ICS MAXIMUM TIME TO OPERATE THROUGH TEST PIPE
ALARM
VqLVE TypE MAKE MOOEL "• MIN, SEC.
oa FLow 14 NE D i iE?C Lv O
INOICATOR
DRY VALVE Q.O.D•
MAKE MODEL SEflIALNO. MAKE MOOEt SE O.
TIME TO TRIP'
pRESSUR AIR
PRESSURE TRIP POINT
AIR E E WATER
REACNED ?
TES70UTLET ALARM
OPERATED
PROPERLY
DRV PIPE MIN,. SEC. P51. P51 P51 MIN, SEC. YES NO
OPERATING
TEST
Withoui
Q.O.D.
W itn
Q.O.O.
11 rvv,
•MEASURED FROM THE TIME INSPECTOR'S TEST CONNECTION VAIVE IS OPENED.
SSA (10,80) PRINTED IN THE U.S.A. FOR NATIONAL FIAE SPRINKLER ASSOCIATION, INC., P.O. 80X 1000, PATTERSON. N.Y. 12563 (OVER)
?PNEUMATIC ?ELECTRIC ?HYDRAULIG
?YES ?NO DETECTINGMEDIASUPERVI QYES ?NO
TME MANUAL TRIP ANp/OR REMOTE CONTR 5 (-1 vcc I-I win
DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACM CtRCUIT FO IF NO, EXPLAIN
PREACTION ? YES ? NO
VALVES
DOES EACN GRCUIT OPERATE OOES EqCH CIRCUIT MAXIMUM TIME TO
MAK MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEf?SE OPERATERELEASE
YES NO VES NO MIN. SEC.
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
pressure ?n excess of 150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall 6e left open during test to prevent damage.
All aboveground piping leakage shall be stopped.
TEST FLUSHING: Flow the required rate until water is clear as indicated 6y no collection of foreign material in burlap bags at outlets auch as
DESCRIPTION hy ra? nts and blowoffs. Flush at flows not less than 400 GPM (1514 L/min) for 4-inch pipe, 600 GPM 12271 L/min) for 5•inch pipe,
750 GPM (2839 L/min) for 64nch pipe, 1000 GPM (3785 L/min) for B•inch pipe, 1500 GPM (5678 L/minl for 10-inch pipa and 2000
GPM (7570 L/min) for 12-inch pipe. When supply cannot produce stipulated flow retes, obtain maximum available.
PNEUMATIC: Establish 40 psi 12.7 bars) air pressure and measure drop which shall not exceed 1-1/2psi (0.1 bars) in 24 hours. Test
n
pressure ta s at normal water level and air pressure and measure air pressure drop which shall not exceed 1-1/1 psi (0.7 bars) in 24 hours.
ALL PiPING HYDROSTATICALLY TESTED AT PSI FOR HRS, IF NO, STATE REASON
DRYPIPINGPNEUMATICALLYTESTEO ?YES ?NO
EQUIPMENTOPERATESPROPERLV ?YES ?NO
DRAIN READING OF GAGE LOCATED NEA WATER SUFPLV TEST PIPE: RESIDUAL PRESSURE WITN VALVE IN TEST PIPE OPEN W IDE
?
TESTS TEST STATIC PRESSURE:
PSI 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 ?YES ? NO OTHER EXPLAIN
FLUSHED BV INSTALLER OF UNDER-
GROVNOSPRINKLERPIPING ?YES ?NO
BLANKTESTING NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS
wELDED PIPING ? YES ? NO
IF YES...
DO YOU CERTIFY q5 THE SPRINKLER CONTRACTOR THAT WELDINCa PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3 ? YES ?NO
00 VOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
WELDINO COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3 WYES ? NO
DO YOU GERTIFY THAT WELOING WAS CARRIED OUT IN COMPLIANCE WITH A
OOCUMENTED QUALITY CONTROI PROCEDURE TO INSURE THAT ALL DISCS ARE
RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER
WELOING RESIDUE ARE REMOVED, AND THAT TME INTERNAL OIAMETERS OF EgYE5 ? NO
PIPING ARE NOT PENETRATED
HYDRAULIC NqMEPLATE PROVIDED IF NO, EXPLAIN
DATA
NAMEPLATE
? YES ? NO
DAT
E
LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
?
a
REMARKS /
?
NqME OF SPRINKLER CONTRACTOR
TESTS WITNESSED BY
SIGNATURES ROP T OWN (SIGNE TIT D ? o
Kl \
V'V Q
FO R NKLER CONTFgMTClsk (SI NED) TI LE DATE
.vuUlTlorvAL tXVLANATION AND NOTES
l'/ y
85A BACK
Ii???C, rOtf s' C
COIVTRACTOR'S MATERIAL & TEST CERT{FICATE FOR AOVEGROUND PIPING
PROCEDURE
Upon completon.of work, inspection and tests shalt be made by the eontrectar's representative and witnessed by an owner's representative. All
defects shall be corrected and system left in serviae before contracter's pereonnel finally leave xhe job. „
A certificate shall be fillad out and signed by both represantatives. Capies shall be prepared for approving authorities, owner: and contrector. It is understood the owner's representative's
signawre in no way prejudices any claim against contractor for faulty material, poor workmanship,
or failure to comply with approving authority's requirements or local ordinancas.
AOD
PLANS
INSTAUCT10N5
ACCEPTED BY APPROVING AUTHORITYeS) NAMES
l S(? 96 r- / Ty
AOORE55 .
Cos.s D 1pRK .9vg- S
INSTALLATION CONFORMS TO ACCEPTED PLANS
EQUIPMENT USED IS APPROVED
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CNARGEOF FIRE EQUIPME4VT'
OF CONTROL VALVES AND CARE ANO MAINTE
IF NO, EXPL.41N
0
HAVE CDPIES OF APPROPRIATE INSTRVCTIONS
ANO NFPA 13A BEEN LEFT ON PqEMI5E5
IF NO, eXPLqIN
?
?600 /
;S TO LOCATIG
I EQU1PMENT
?;Wss Y,rj-
? YES r7 NO
?c] YES [] NO
?gYES ONO
CARE ANO MAINTENANCE Ch1ART5
ES
LOCATION SUPPLIES BLDGS.
oF sYS Y r i? A*.. 40 r ' i ?C?., SX,f /?Fs,.
MAKE nnODEI YEAR OF
MPNUFa,CTURE ORIFICE
SIZE QUANTITY TEMPERATURE
RATING
SPRINKLERS
T.eA?
/ 98f
/
Z 2
212
W
PIPE AND
FITTINGS PIPE CONFORMS TO STANOARO ? YES r7 NO
FITTiNGS CONFORM TO /Ulf STANOARO OYES F7NO
IF NG, EXPL.aIN
ALAii AIAFiM DEVICE MAXIMUMTIMETOOPERATETHROIX'HTESfPIPE
M
, VALVE ° TypE MAKE MODEL MIN. SEC.
OR FIOW ANE D F?E,C Lv O .
INDICATOR
ORY VALVE Q.O.D.
MAKE_ MODEL SERIRL NO. MAKE MODEL SE O.
TIMETOTAIP'
PflESSUR
AIR
PAESSUAE
TRIPPOINT
AIR E E WATER
REACHED
TESTOUTLET' ALARM
OPERATED
PROPERLY
DRY PIPE MIN.. SEC. P51. P51 P51 Mliv. SEC. YES NO
OPERATING
TEST
Without
Q.O.O.
With
Q.O.D.
I I I .? , I ..
'MEASVRED FROM THE TIME INSPECTOR'S TEST CONNECTION VALVE IS OPENED.
85A 4L080) PRINTEO IN THE U.S.A. FOR NATIONAL FIRE SPRINKLER ASSOCIATION, INC., P.O. BOX 1000, PATTERSON, N.V. 12563 (OVER)
OPERATION
?PNEUMATIC ?ELECTRIC ?HYDRAULIC
PIPINGSUPERVISED ?yES ?NO DETECTINGMEDIASVPERVI aYES ONO
DOES VALVE OPERATEFROM T7iE MANUAL TR1P AND/OR REMOTE CONTR S ? yE5 D NO
DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH ClRCUIT FO IF NO, EXPLAIN
PREACTIDN
? YES ? NO
VALVES
OOES EACH CIRCUIT OPERATE DOES EqCH CIRCUIT MAXIMUM TIME TO
MAK MODEL SUPERVISION LOSSALARM OPERATE VAWE RELEASE .OfERATERELEASE
YES NO YES NO MIN, SEC.
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi 113.6 bars) for two hours or 50 psi (3.4 bars) above static
pressure in excess af 150 psi (10.2 bars) for two hours. Differential dry{pipe valve clappers shall be left open during test to prevent damage.
All aboveground piping leakage shall be stopped.
FLUSHING
Fl
h
i
d
TEST ow t
e requ
re
:
rate until water is clear as indicated by no collection of foreign material in burlap bags at outlets such as
h
ra? nts a`nd bl
ff
Fl
h
f
DESCRIPTION y
ow-o
s.
us
at
lows not less than 400 GPM (1514 L/min) for 4-inch pipe, 600 GPM 12271 L/min) for 5-inch pipe,
750 GPM (2839 L/min) for 6•inch pipe, 1000 GPM (3785 L/min) for 8-inch pipe, 1500 GPM (5678 L/min) for 10-inch pipe and 2000
GPM (7570 L/min) for 12-inch pipe. When supply cannot produce stipulated flow rates, obiain maximum available.
P UMATIC: Establish 40 psi (2
7 barsl air
ressure and
hich shall
re dr
d 7
%
t
i (0
1 4
24 h
T
t
•
) i
.
p
no
excee
•
measu
op w
ars
n
ours.
es
,
ps
.
pressure tan s at normal water level and air pressure and measure air pressure drop which shall not exceed 7-1/2 psi (OJ bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT PSI FOR HRS. IF NO, STATE REASON
DRV PIPING PNEUMATICALLYTESTED ?YES OND
EqUIPMENT OPERATES PROPERIY ? YES ? NO
DRAIN READING OF GAGE LACqTEp NEAR WATER SUPPLY TEST PI PE: RESIDUAL PRESSURE WITH VALVE IN T6f PIPE OPEN WIOE
TESTS TEST STATIC PRESSURE: PSI PSI
Underground mains and Iead in connections to system risers flushed before connection made to sprinkier piping.
VERIFIEO BV COPY OFTHE U FORMN0.856 ?YES ?NO OTHER EXpLAIN
FLUSHEO 8Y INSTALLER OF UNDER-
GROUNDSPRINKLERPIPING ?YES ?NO
BLANKTESTING NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS
WELDEDPIPING ?YES ?NO
IFYES...
DO YOU CERTIFV AS THE SPRINKLER CONTRACTOR TNAT WELOING PROCEDURES COMPLY
WITH THE REQUIRENIENTS OF fiTLEAST AWS 010.9, LEVEL AR•3 54 YES ? NO
DO YOU CERTIFY THAT THE WELDINCi WAS PERFORMED BY WELDERS qUALIFIED IN
WELOING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3 (;j?YES ? NO
DO YOU CERTIFV TNAT WELDING WAS CARRIED OVT IN COMPLIANCE WITH A
DOCUMENTED QUALITV CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
RETRtEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER
WELDING RESIDVE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF ?ffYES ? NO
PIPING ARE NOT PENETRATE?
HYDRAULIC NAMEPV.ITE PROVIDED IF NO, EJ(PLAIN
DATA
NAMEPLATE
? YES ? NO
DATE LEFT IN
SERVICE WITH AI.L CONTROL VALVES OPEN:
REMAflKS 1
2
NAME OF SPRINKLER CONTRACTOR
AhAeim&
TESTS WITNESSED 8V
SIGNATURES F R P PE NE (SIGNE TITL D E
?n
F SP INKLER ON R SIGNED) TITLE DATE
HUDITIONAL EXPLANATION AfVO NOTES Z/ //
ri
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