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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 BSA BACK