HomeMy WebLinkAbout295 Rye Street - Life Safety System Test Contractor's Material & Test Certificate for Aboveground Piping
Additional printed copies of this form are available to Insureds form:
Corporate Communications,Factory Mutual,1151 Boston Providence Turnpike,P.O.Box 9102,Norwood,MA 02062
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 representatives signature in no way prejudices any claim against the contractor for faulty material,poor
workmanship or failure to comply with approving authorlty's requirements or local ordinances.
Property I.D. !
Property Name: I Date: z / L
Pro erty Location: Z y So 1 av a o e
Plans:
Accepted By Approving Authority's Names , WmJosec. 7EKr C)FELe
Address: / �„¢ '7
Installation Conforms to Plans id Yes No
Equipment Used is Approved(if no,state deviations): Yes ❑No
Instructions:
Has person in charge of fire equipment been Instructed as to the location of control -Yes 0 No
valves and the care and maintenance of this new equipment?
If no,explain:
Have copies of appropriate instructions and care and maintenance charts been left on premises? jR Yes No
If no,explain:
Location:
Supplies Buildings: le ZA Q,6 11V ef-10L EIZ1L
Sprinklers:
Year of Temperature
Make Model Manufacture Orifice•Size Quantity Rating
T . Lf
0
• a
0
o
Pi a and Fittings:
Pipe conforms to 1VF M 4L 3 Standard 5a Yes ❑No
Fittings conform to 1*PA*113 Standard JAYes ❑No
If no,explain:
Alarm Valve or Flow Indicator:
Alarm Device Maximum Time to O orate Through Test Pipe
Type Make Model Min. Sec.
QryPI Operating Test
Dry Valve Q.O.D.
Make Model Serial Number Make Model Serial Number
Dry Pipe Operating Test(Continued)
01998 Factory Mutual Engineering
EMV 85A ENGINEERING
Contractor's Material & Test Certificate for Aboveground Piping
Time to Trip Trip Point Air Time Water Reached Alarm Operatod
Through Test Pie Water Pressure Air pressure Pressure Test Outlet Pro erl
Min. Sec. PSi PSI PSI Min. Sec. Min. Sec.
Without
Q.O.D. Nl
With
O.O.D.
If no,explain:
Deluge and Prea tion Valves:
Operation: W Pneumatic Electric Hydraulic I PIPIng Supervised? es No
Detecting Media Supervised? Yes U No I Does valve operate from manual trip and/or remote control? Wes No
Is there an accessible facility in each circuit for testing? V Yes No
If no,explain:
Does each circuit operate Does each circuit operate Maximum time to operate
Make Model supervision loss alarm? valve release? release
Yes I No I Yes I No Min. I Sec.
u iv 'l frirt otk
—met V
Test Description:
Hydrostatic:Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3A bars)above static pressure in
excess of 150 psi(10.3 bars)for two hours.Differential dry-pipe valve clappers shall 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 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.(0.1 bars)in 24 hours.
Tests: P/peu.M+(_
All piping tested at Psi for • hrs. D piping pneumaticallytested? Yes C1 No
Equipment operates property? JU Yes No If no,reason:
Drain Test I Reading of gage located near water supply test pipe:
Residual pressure with valve in test pipe wide open? psi.
Underground mains and lead4b'connecUoris to system risers shall be flushed before connection made to s rinkler PIPIng.
Verified by copy of 85B?' 0 Yes W No I Other. S A, s
Flushed by installer of underground sprinkler piping? Yes No Explain:
Blank Testing Gaskets:
1.Number Used: I Locations: T Number Removed:
Welding:
Welded Pi in ? as ❑No If yes:
Do you certify as the sprinkler contractor that welding procedures comply with the NTYes No
requirements of at least AWS D10.9,Level AR-3?
Do you certify that the welding was performed by welders qualified in compliance NI Yes 0 No
with the requirements of at least AWS D10.9,Level AR-3?
Do you certify that welding was carried out in compliance with a documented quality 19 Yes ❑No
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 internal diameters
of piping are not penetrated?
Hydraulic Data Nameplate:
.Nameplate provided? &(Yes ❑No If no,explain:
Remarks(Date left in service with all control valves open): l �y//2—
Signatures:
Name of Installing Contractor.Smith AutoTo er
For Property Owner(Signed): Title: � f jr� Date:
For Installing Co�Signed: Title Date:
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01998 Factory Mutual Engineering
EMV 85A ENGINYERING