HomeMy WebLinkAboutCERTIFICATE 500 Big Thompson Ave Aboveground Piping 2006/
Contractor’s Material and Test Certificate for ]boveground Piping
A.Procedure (Conforms to NFPA 13-1994)
Upon completion of work,inspection and tests shall be made by the
contracto?s representative and witnessed by an owners 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 authori
ties,owners and contractor.It is understood the owners 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.All ‘No’answers shall be explained in
the Comments portion of this form.
Property Name:)t’)&AJ c’f’FAk_V26ihJi M)&),(MiI
Property Address:óZ’626 --‘?9V Date:_______
B.Plans 2’/9&c?c3 )-J7
1.Accepted by Approving Authorities (Names):’ô
2.Address:S9 ‘G?JA/3’?L.35 1j’,u’9
3.Installation conforms to accepted plans U Yes U No ‘
4.Equipment used is approved U Yes U No
C.Instructions
1.Has person in charge of fire equipment been
instructed as to location of control valves and
care and maintenance of this new equipment U Yes U No
2.Have copies of the following been left on the premises:
a.System components instructions
b.Care and maintenance instructions
c.NFPA 25
D.Location of system -Supplies building:
E.Sprinklers
Make Model Year Made Orifice Quantity Temperature
t/7 114
2tc F(t &‘5 yz 1-1C771fi
l1L 1 ,)(.3 .‘c 21#,41
F.Pipe and Fittings
/--
1.Type of Pipe:2((i()J Ai %t4i2 30 LI
2.TypeofFittings:CA’T tO
G.Alarm Valve or Flow Indicator
Type Make Model Max.Time to Operate Through Insp.Test
H.Dry-Pipe Valve
1.Make and Model:
___________________________________
2.Serial Number:
___________________________________________
I.Quick Opening Device (Q.O.D.)
1.Make and Model:
_____________________________________
2.Serial Number:
___________________________________________
J.Dry-Pipe System Operating Test Without Q.O.D.
1.Time to trip through test connection4:
_______________________
2.Water pressure psi.Air pressure psi.
3.Trip point air pressure psi.
4.Time water reached test outlet4:
____________________________
5.Alarm operated properly U Yes U No
K.Dry-Pipe System Operating Test With Q.O.D.
1.Time to trip through test connection4:
_______________________
2.Water pressure psi.Air pressure psi.
3.Trip point air pressure psi.
4.Time water reached test outlet4:
5.Alarm operated properly U Yes U No
L.Deluge and Preaction Valves
1.Make and Model:
_____________________________________
2.Operation:U Pneumatic U Electric U Hydraulic
3.Piping and detecting media supervised U Yes U No
4.Does valve operate from manual trip andlor
remote control stations U Yes U No
5.Is there an accessible facility in each circuit
for testing U Yes U No
6.Does each circuit operate supervision loss alarm U Yes U No
7.Does each circuit operate valve release U Yes U No
8.Maximum time to operate release:
__________________________
M.Pressure Reducing Valv
1.Location and Floor:/“.t-’Y
2.Make and Model:(.1 L’(&jf5 Z..IA)I.O
3.Setting:V7 0 ‘5l.
4.Static Pressure:In1et(2’)psi,-Outjt (7 C)psi
5.Residual Pressure (Flowing):Inlet 7’(j psi,Outiet,LVpsi
6.Flow Rate:l50(’)gpm
4measured from time inspectors test connection is opened
N.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 1.5 psi (0.1 bars)in 24 hrs.Test pressure tanks at
normal water level and air pressure and measure air pressure drop,which
shall not exceed 1.5 psi (0.1 bars)in 24 hrs.
0.Tests
1.All piping hydrostatically tested atLL)C psi for,hours
2.Dry piping pneumatically tested U Yes U No
3.Equipment operates properly U Yes U No
‘4.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?U Yes
5.Drain Test:
a.Static pressure reading of gage located near
water supply connection ,CiO psi.
b.Residual pressure with valve in test connection
open wide i()psi.
6.Underground mains and lead in connections to
risers flushed before connection made to sprinkler
piping and verified by copy of form No.13-U U Yes
7.Flushed by installer of underground piping U Yes
8.If powder driven fasteners are used in concrete,
2 has representative sample testing been
M1’-’satisfactorily completed?U Yes
P.Blank Testing Gaskets
1.Number used:
________
2.Locations:
3.Number removed:________
Q.Welded Piping -If welded piping was used in the system,
complete the following:
1.Do you certify as the sprinkler contractor that
welding procedures comply with the require
ments of at least AWS D10.9,Level AR-3 U Yes U No
2.Do you certify that the weldir’g was performed
by welders qualified in compliance with the re
quirements of at least AWS D10.9,Level AR-3 U Yes U No
3.Do you certify that welding was carried out in
compliance with a documented quality control
procedure to insure that all discs are retrieved,
openings in the pipe are smooth,slag and other
welding residue are removed,and the internal
diameters of piping are not penetrated U Yes U No
R.Cutouts (Disks)
Do you certify that you have a control feature to
ensure that all cutouts (disks)are retrieved?U Yes U No
S.Hydraulic Data Nameplate Provided U Yes U No
T.Date left in service (with all control valves open):2 3 ‘-
U.Signatures Front Range Fire Protectiofl
I.Name of sprinkler contractor:4007 S.Lincoln,Ste.460
2.Tests witnessed by:.f7 Loeland,(JO &)537
For propqrty owIwr (Signed):J’<’/‘
Title:‘2-’•ate:25.
For sprinkle c ntractor (Signed):-
Title:c9i2’/)/44/Date:
V.Comments (This section is for additional explanation an no es.
All “No”answers must be explained here.)
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U Check here if comments continue on reverse side of this form
U Yes
U Yes
U Yes
UNo
UNo
UNo
U No
U No
U No
U No
()199 National Nre Sprrnlcler Association,P.O.Box 1000,Patterson,NY 12303,(l4i)W/-4200 Form 13-A Page 1 of 1