HomeMy WebLinkAbout9 Cliffwood Drive - Life Safety System T (2) CONTRACTOR'S MATERIAL TEST CERTIFICATE FOR ABOVEGROUND 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 property owner's authorized representative is a legal signatory and fully representitive of the property owner and that by the property
owner's or property owner's authorized representitive's signature,the property owner accepts full responsibility for the system as installed and agrees
that it is in compliance with the applicable approving authoritiy's requirements and local ordinances.
PROPERTY NAME Chubb# DATE
9 Cliffwood Drive Group Home 1786100 10/3/2011
PROPERTY ADDRESS
9 Cliffwood Drive South Windsor, CT
ACCEPTED BY APPROVING AUTHORITY('S)NAMES
AHJ
ADDRESS
PLANS
INS TALLATI N CONFORMS TO ACCEPTED PLANS x YES NO
EQUIPMENT USED IS APPROVED x YES NO
IF NO,EXPLAIN DEVIATIONS
HAS PROPERTY OWNER OR PROPERTY OWNER'S AUTHORIZED REPRESENTITVE i x YES NO
BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT
IF NO,EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN GIVEN TO THE PROPERTY OWNER OR
PROPERTY OWNER'S AUTHORIZED REPRESENTITIVE:
1.SYSTEM COMPONENTS INTRUCTIONS X YES NO
2.CARE AND MAINTENANCE INSTRUCTIONS: _X YES _NO
3. NFPA 25: x YES NO
LOCATION OF SUPPLIES BLDGS.
SYSTEM Entire Home According to NFPA 13D
MAKE MODEL YEAR OF ORIFICE SIZE QUANTITY TEMPERATURE RATING in
MANUFACTURE degrees
SPRINKLERS Reliabe RFC43/pnd 2011 1/2" 34 165
Reliabe F1RES44 2011 1/2" 19 165
Reliabe F3QR 2011 1/2" 4 165
PIPE CONFORMS TO NFPA#13D STANDARD X YES M NO
PIPE AND FITTINGS CONFORM TO NFPA#13D STANDARD X YES NO
FITTINGS IF NO,EXPLAIN
ALARM DEVISE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE
ALARM VALVE OR TYPE MAKE MODEL MIN. SEC.
FLOW INDICATOR Flow wr - ��
DRY VALVE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
NA
DRY PIPE TIME WATER
TIME TO TRIP WATER AIR PRESSURE TRIP POINT AIR REACHED TEST ALARM OPERATED
OPERATING TEST THRU TEST PIPE PRESSURE PRESSURE OUTLET PROPERLY
MIN. SEC. PSI. PSI. PSI. MIN. I SEC. YES NO
Without
Q.O.D.
With
Q.O.D
IF NO,EXPLAIN
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DELUGE& OPERATION PNEUMATIC I ELECTRIC I HYDRAULIC
PREACTION PIPING SUPERVISED YES NO I DETECTING MEDIA SUPERVISED YES NO
VALVES DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATION YES NO
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO,EXPLAIN
YES r NO
DOES EACH CIRCUIT DOES EACH CIRCUIT MAXIMUM TIME TO
OPERATE SUPERVISION
NA MAKE MODEL LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE
YES NO YES NO YES NO
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.
TEST FLUSHING: Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags at outlets such as
DESCRIPTION hydrants and blow-offs. Flush at flows not less than 400 GPM(1514 Umin)for 4-inch pipe,600 GPM(2271 Umin)for 5-inch pipe,750
GPM(2839 Umin)for 12-inch pipe.When supply cannot produce stipulated flow rates,obtain maximum available.
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 /00 PSI FOR HRS. IF NO,STATE REASON
DRY PIPING PNEUMATICALLY TESTED YES N
EQUIPMENT OPERATES PROPERLY YES NO
READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE. RESIDUAL PRESSURE WITH VALVE IN TEST
TESTS DRAIN TEST STATIC PRESSURE: 0 PSI PIPE OPEN WIDE 60 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 BY INSTALLER OF UNDER GROUND Work by others
SPRINKLER PIPING YES X NO
TANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED
AND GASKETS 0
WELDING PIPING IYES1 X I NO
IF YES........
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
WELDING 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
HYDRAULIC DATA NAMEPLATE PROVIDED IF NO,EXPLAIN
NAMEPLATE 0 YES= NO
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REMARKS
NAME OF SPRINKLER CONTRACTOR
Chubb Fire&Security,LLC 66 Robinson Ave.Orange,CT 06460
TESTS WITNESSED BY
SIGNATURES F P OPERTYOWNER(S D) TIT DATE
FOR SPRINKLER CONT CTOR(SINGED) TITLE DATE
ADDITIONAL EXPLANATION AND NOTES
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