HomeMy WebLinkAboutFire Suppression Documentation_Citadel Flex Building C - Aboveground Test Paper Signed
CONTRACTOR’S MATERIAL & TEST CERTIFICATE FOR A
BOVEGROUND PIPING
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 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 Date
PROPERTY ADDRESS
ACCEPTED BY APPROVING AUTHORITY(‘S) NAMES
ADDRESS:
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES NO
EQUIPMENT USED IS APPROVED YES NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
YES NO
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES:
1. SYSTEM COMPONENTS INSTRUCTIONS YES NO
2. CARE AND MAINTENANCE INSTRUCTIONS YES NO
3. NFPA 25 YES NO
LOCATION
OF SYSTEM
MAKE
MODEL
YEAR OF
MANUFACTURE
ORIFICE
SIZE
QUANTITY
TEMPERATURE
RATING
SPRINKLERS
PIPE AND Type of Pipe:
FITTINGS Type of Fittings:
ALARM DEVICE
MAXIMUM TIME TO OPERATE
THRU TEST CONNECTION
ALARM VALVE TYPE MAKE MODEL MIN. SEC.
OR FLOW
INDICATOR
DRY VALVE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
TIME TO TRIP
THRU TEST
CONNECTION*
WATER PRESSURE
AIR PRESSURE
TRIP POINT
AIR
PRESSURE
TIME WATER
REACHED
TEST OUTLET*
ALARM
OPERATED
PROPERLY
DRY PIPE MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
OPERATING
TEST
Without
Q.O.D.
With
Q.O.D.
IF NO, EXPLAIN:
*MEASURED FROM TIME INSPECTOR’S TEST CONNECTION OPENED. (OVER)
Citadel Flex Building C 7/21/2025
200 Center Drive, Glenwood Springs, CO 81061
Glenwood Springs Fire Department
806 Cooper Avenue, Glenwood Springs, CO 81601
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Riser in SW corner. One Sprinkler zone.
Reliable G5 Concealed pendent 2024 1/2"32 212°F
Reliable 2024 120
Reliable 2024
F1FR Upright
G4XLO Extended Coverage Concealed Pendent
1/2"
3/4"18
200°F
200°F
Schedule 10 and 40 steel
Grooved and threaded
Flow switch Potter Var 0 46
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N/A
OPERATION
PNEUMATIC ELECTRIC HYDRAULIC
PIPING SUPERVISED YES NO DETECTING MEDIA SUPERVISED YES NO
DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS YES NO
DELUGE &
PREACTION
VALVES
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING
YES NO
IF NO, EXPLAIN
MAKE
MODEL
DOES EACH CIRCUIT OPERATE
SUPERVISION LOSS ALARM?
DOES EACH CIRCUIT OPERATE
VALVE RELEASE?
MAXIMUM TIME TO
OPERATE RELEASE
YES NO YES NO MIN. SEC.
TEST
DESCRIPTION
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 in excess of 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.
PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop which shall not exceed 1-1/2 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 1-1/2 psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT ___ PSI FOR ___ HRS.
DRY PIPING PNEUMATICALLY TESTED YES NO
EQUIPMENT OPERATES PROPERLY YES NO
IF NO, STATE REASON:
TESTS
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?
YES NO
DRAIN
TEST
READING OF GAGE LOCATED NEAR WATER SUPPLY TEST
CONNECTION: _________ PSI
RESIDUAL PRESSURE WITH VALVE IN TEST
CONNECTION OPEN WIDE _________ PSI
UNDERGROUND MAIN 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
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING YES NO
OTHER EXPLAIN
BLANK
TESTING
GASKETS
NUMBER USED
LOCATIONS:
NUMBER REMOVED
WELDED PIPING YES NO
IF YES. . .
WELDING
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? YES NO
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
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 DOCUMENTED
QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS
IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT
THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? YES
NO
CUTOUTS
(DISCS)
DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
CUTOUTS (DISCS) ARE RETRIEVED? YES NO
HYDRAULIC
DATA
NAMEPLATE
NAME PLATE PROVIDED
YES NO
IF NO, EXPLAIN:
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REMARKS
NAME OF SPRINKLER CONTRACTOR: Western States Fire Protection Company
TESTS WITNESSED BY
FOR PROPERTY OWNER (SIGNED) TITLE DATE
SIGNATURES
FOR SPRINKLER CONTRACTOR (SIGNED) TITLE DATE
FOR LOCAL FIRE MARSHAL (SIGNED) TITLE DATE
FOR RESPONSIBLE MANAGING EMPLOYEE (SIGNED) TITLE DATE
ADDITIONAL EXPLANATION AND NOTES (BACK)
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200 2
115 105
0
Superintendent 7/21/25
Fitter
Fire Marshal
7/21/25
7/21/25
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N/A
N/A