HomeMy WebLinkAboutContractor's Material and Test Certificate for Aboveground PipingContractor's Material and Test eertificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contraclor's Íepresênlâtive and witnqssed by an owner's
reprêsentatlve. All defects shalì be corrected and system lett in service before conlractor's personnel finally leave the.iot).
A certilicate shall be filled-out and signed by both representatives. Copies shall be prepared for approving authorilies, owners, and
cotlttaulut. lt ís unüerstood tlìË owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor
workmanship, or failure tc comply with approving authorily's requiremenls or local ordinances.
7¡
Property nam€fr1in¿ llnæ' Ð
Properly âddress
6etPlans
No
t_l No
Address #w
ffi ves
ttô ves
lnstallalion conforms to accepted plans
Ëquipmenl used is approved
lf no, explain deviation$
Has person in chatge of fire equipmenl been instructed as
to localion of control valvês and care and mâintenance
of this new equ¡pment?
ll no, explain
Have copies of the lollowing been left on the prenises?
1. Sysl€m components instrucl¡ons
2. Care and mainlenance ìnslructions
3. NFPA25
lnstruclions
lX ves fl ruo
Yes
Yes
Yes
Yes
E]Fm
l--.1 ruo
f-l t¡o
[]ruo
l--l ruo
l.-ocation Õl iSupplies building$system
Ouânl¡lv
Temp6raturo
ratingMoclel
Year of
manufâcture
u1 IT{ 4¡7\t - {{;--*
Or¡fice
size
YY \:7.1Ç '-tt; 7
)?,-u_iz_.-l1zï_E{3*3i
Make
Spr¡nklers
Pipe and
fittings Type oi fittings
Type of pipe
Maximum time to operate
through tesl connectionAlârm device
Minutes ; $econdsTypeMakeModel
þ,r
Alarm
valve or
flow
indicator
Serial no.Serial no.
trip
tesl Trip point
valve o.
Make Make Model
operaÌed
ptessure
]lm6 to
through
Time waterDry pípe
operaling
test
lf no, explain
Yes NoMinutesSecondsSecondsPst
Measured from time inspector's tesl connection is opened
NFPA 13 only requíres the 60-second lim¡tation in specilic set:tions
; ;ot the complete and official postion of the Nat¡onal FÍre Protection Association, on the reterenced subiect which is rapresenled only by the stôndard in its ontlrety'
,merican Fire Sprlnkler Asgociåtion
696 Skillman Strëet, Suite 300, Ðallãs, Texas 75243 AFSA Form #4F063
ll no, sxpla¡n
FYgl I-l ¡ro
Maximun t¡nê lo
fives
operâto
alarm?Mñhe Model
Operation
Preumalic
:l No I Dclqotíng media ouperv¡sodPipÌog supervls9d
i'-l tto
Dos6 êach circuil
lo66
Does sach circuil operate
valvô r6loa6e?
lB thoro an acco6sible lacility in each o¡rouit
for t$tino?
Does valvo operale from the manual trip, remole, or bolh
conlrol 6lalions?
^83 ves [] ¡to
ûeluge and
preåclion
valves
R€s¡dual presêur€FIN râ16
2:get*€
Mâkê ând Sëtl¡ng
I/Outlet (psí)outlet Froy !gqrì. . .
Location
and floorPressure
redrc¡ñg
Vaìve tost
lest
desorÌption
Hyû9-ñlaltc; Hydrostaliçlosleshallbsmadcalnollessthan200psi{13.6bar)for2hours0rS0psi(3.4bar)
abovestaticpressur6in€xcêssof150psj{10,2bar)for2hours. D¡fê¡entialdry-p¡pevalv€clappersshallb€lstl
open during the tesl to prevent damage. Al¡ arrovgground piping leâkage sha.ll be ôlopped.
Fjgufltlic: Eslâlrlish 40 ps¡ {2.7 bâr) air prÊssur€ aôd m€ssure drop, which shall not exceed 1 y, psl (0.1 bar)
i¡ 24 hours. Têst pr€Gsurô tanks at normal wålor lov€l and âir pressul€ and m€8sure â¡r pressure dlop, wh¡ch shall
nol exceed 'l% psi (0.1 Itar) in 24 hours.
Dra¡n
lssl
Ðo you cerl¡fy as ths spr¡nklsrcontraclor lhat addilives ancJ corËsive chemcals, sodum s¡l¡cale or derivatives
of sodlum s¡ficate, brìno, or olhor aorrosive chemical6 wore ¡ol used tor teslilìg syslems orslopping leaks?
ilbves f--i ¡lo
I
U¡derground ma¡ns and lead-in connêclìons lo system risers tlushgd beloro conneclion ñade
spr¡nkler piping :
verifiod by copv ol {he Conrractols Matcr¡ıl and fcst X""" i-]l No j Oil u.
Csrtil¡cató for Underground Piping. r
Flushed by inslallôr ol underg.ound sprinklor piping lffvu" I I ¡lo
lfpowder.drivân l66t€ners are used in concrete, i] Yes lF.
"ohas ropresentaÌlve samplè tesling been
satielactorily empleled?
lf no, slate roaçon
¡,-
L;
lest
Tesls
Explain
ú+'r(
bar) for ---- hourg
Residual prossure
connecl¡on opon
ll no. €xplalô
ol çãu0e
conneclion:
al -.-..*-(-
Yes
Yês
No
No
All pip¡ng hydrostâlically tested
Dry piping pneumatjcally tested
Égulpment operates ProPerl'J
Locations Number removedBlsnk losting
gãskets
Nriñberilsed
Dô you cerlily lhat lhe wêldlng w8s ca(i€d out iñ compligncè wllh a
documonted quality control pmedure to €nsure ihàt all discs ârê rotrlâvêd, lhâl
opeilings ¡n p¡ping â¡e smoolh, lhåt slag ând otherwolding residuê are
removed, ¿nd thal thg inte.nal diameters ól pip¡ng are not peDetrated?
ffi ves I ¡¡o
L.Þ Yes L-; No
fi ves iI No
lf y6s,
corlify as lh€ sprlnkle. conlÞctor lhaf weldìng p¡ocedùres comply
requiremenß of a{ leasl AWS 82.1?
pip¡ng
W€ld¡ng
Yos [ ] ¡lo
Do you
wilh the
Do yôu certify lhat lho welding wa6 performed by wetders qualllisd i¡
comp¡rance wtlh the tequiremenls of al leasl AWS 82.1?
Culouts
(discs)
I Do you cerlify lhal you lrave å conlrol laälure lo ßnsure lhal
I all cutouls (diss) are r€triwed?l.-j(, ves fl wo
Nameplatê p.ovidsd
fÉ ve" [_ì uo
lf no. explârnHydraulic
data
nameplal€
R6marks
Date lefl in sÊrvicö w¡lh 6¡l conko¡ volves open
Name ot sp¡inklêr
Tèeis witnessed by
ç I(¡
'fìtlê
Signalures For
Additìmal 6xplanatiôn6 and noles I'J
Contractofs Material and Test Certificate lor Aboveground Piping