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2001, 08-03 Material & Test Report for Aboveground Piping w. !r PAuuoT __ FIRE PROTECTION CONTRACTORS MATERIAL&TEST REPORT FOR ABOVEGROUND PIPING PROCEDURE - ." _ 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 Nave the Job. Acertificate shall befilled'out and signed by both representatives. Copies shall be prepared for approving authorities,owners,and contractor. It Is under- stood 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 Vo1 14 0 5e► l AMel 1 cavi e.evi}k v. DATE.. J ( PROPERTY ADDRESSa of es5d!Dil. ' ACCEPTED BY P VINUTFiO IES (NAME) ADDRESS INSTALLATION CONFORMS TO ACCEPTED PLANS UYES UNO PLANS EQUIPMENT USED IS APPROVED OYES 0 N IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION YES NO OF CONTROL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? F NO,EXPLAIN HAVE COPIES OF THE FOLLOWING BEENLEFT ON THE PREMISES: UI YiS U NO INSTRUCTIONS 1. SYSTEM COMPONENTS INSTRUCTIONS OYES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS. OYES 8 NO 3. NFPA 13A ll 1 ��o �� t( OYES(� NO LOCATION SYSTEM * 1 I I 1314 , SERVES: Q�1 C' J 4),A 1)Ia.ten OF SYSTEM �+ — YEAH uE UAW-It., TEMPERATURE �Q4 MAKE MODEL MANUFACTURE SI7�E, QUANTITY RATINGS j r SPRINKLERS " or - S O l ti K fig., 16 it I~ F .e a 1 [ _ I PIPE AND TYPE OF PIPE 1�. C7 Y�C���s. -1 ��I�l'� FITTINGS TYPE OF FITTINGS COL* • I MAXIMUM TIME TO OPERATE �R�j ALARM DEVICE VALVE THROUGH TEST CONNECTION OR FLOW °, TYPE MAKE MODEL MIN SEC. INDICATOR DRY VALVE 0.0D. MAKE MODEL 1 SERIAL NO. MAKE MODEL SERIAL ha • TIME TO TRIP * TIM WATER `--AURM DRY PIPE THRU TEST WATER AIR TRIP POINT REACHED OPERATED OPERATING CONNECTION PRESSURE PRESSURE AIR PRESSURE_ TEST OUTLET PROPERLY TEST MIN. SEC. P�I PSI PSI MIN. SEC. YES NO WITHOUT O.O.D. , WITH ° Q.O.D. ` W NO,EXPLAIN »i. 4 'MEASURED FROM TIME INSPECTORS TEST tQ9NNECTION IS OPENED tar (OVER1 1 pirr , III 1111 OPERATION 0 PNEUMATIC 0 ELECTRIC 0 HYDRAULIC DELUGE i PIPING SUPERVISED DYES U NO f DETECTING MEDIA SUPERVISED DYES U NO PREACTION DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS U YES LINO VALVES IS THERE AN ACCESSIBLE FACIUTY IN EACH CIRCUIT FOR TESTING - IF NO,EXPLAIN ❑YES ❑NO ' DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE YES i____. NO --YES NO FAIN " SEG HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi(13.8 bars) two hours or 50 psi(3.4 bars)above static pressure In excess of 150 gel DESCRIPTION (10 2 bars)for two hours Differential dry.plpe valve clappers shalt be left open during test to prevent damage.All above ground piping leakage shall be Stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed 1.1/2 pet(0.1 bars)In 24 hours.Teel pressure tanka at normal water level and air pressure and measure air pressure drop which shall not exceed 1' psi(0.1 bars)In 24 hours. "II PIPING AT PST FOR I.HRS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTEDIiirYES (]NO OUIPMENT OPERATES PROPERLY ❑YES LOINO ••YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SIUCATE OR DERIVATIVES OF SODIUM SIU TE,BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TEST- ING SYSTEMS OR STOPPING LEAKS? •--' n TESTS . -7 ' -1 d 1 a 'Tc •1 el Ire •c S e N WA - .- a e -T ►r ST SUPPLY TEST CONNECTION: PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE OaRraTioti MADE TO - KLER PIPING. RIFLED BY COPY OF THE U FORM NO.NB DYES ❑NO OTHER EXPLAIN HED BY INSTALLER OF UNDER- c ROUND SPRINKLER PIPING OYES 0 NO BLANK TESTING NUMBER ED LOCATIONS l NU►ABER REMOVED GASKETS LDED PIPING IIEFfES LINO IF YES. . . DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR3 . 5.ES ONO ••YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN WELDING a ..UANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR3S ONO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A ••r MEWED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER 1 a NG RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF 0 NO PING ARE NOT PENETRATED —. ES CUTOUTS DO Y• CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL FUIFilI."TfONAL •' OUTS(DISCS)ARE RETRIEVED? - 4�S NO •• :•AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS? YES NO FLOWTEST FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? AYES NO HYDRAULIC NAME PLATE PROVIDED IF NO,EXPLAIN DATA NAMEPLATE OYES ©NO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKyE1 Liv—v)CrTOF� �J ft 6-W' CONTPATRIOFP099CFSE• r �r `}•'TESTS WISSED BY �L SIGNATURES FOR PROPERTY OWNER(SIGNED) I TITLE + DATE ! I ii FOR SPRIN • CO�#y,� O�(SIG a• I )TLE DA ` -e -• NG ,4 •P•-Ty / TjT r ICE T TH' FORMATION HEREIN RUE AND THAT THIS SP KLER SY TEM AS INSTALLED ZA�F 5)/ E RCW 18-le0 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY CERTIFICATION HE STATE FIRE MARSHAL NAME OF CERTIFICATE OF COMPETENCY HOLDER(PRINT OR NYPE) SIGNATURE OF CERTIFICATE OF COMPETENCY FOLDER CERTIFICATE REGISTRATION# DATE ADDITIONAL EXPLANATION AND NOTES 6311 BACK