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HomeMy WebLinkAbout175 Sullivan Avenue - Life Safety System (2) CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING PROCEDURE UPON COMPLETION OF WORK,INSPECTION&TESTS SHALL BE MADE BY THE CONTRACTOR'S REP.AND WITNESSED BY AN OWNER'S REP. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S PERSONNEL LEAVE THE JOB. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH THE 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 JOB NO. JDATE PROPERTY ADDRESS NEW DISTRIBUTION CENTER FOR VISTAR 201000 LOT 3 175 SULLIVAN AVE., SOUTH WINDSOR,CONNECTICUT 06074 ACCEPTED BY APPROVING AUTHORITIES(NAMES) SOUTH WINDSOR,CT ADDRESS PLANS 1540 SULLIVAN AVE.,SOUTH WINDSOR,CT INSTALLATION CONFORMS TO ACCEPTED PLANS X YES NO YES eN0 EQUIPMENT USED IS APPROVED IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION EYES El OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS X YES NO 2. CARE AND MAINTENANCE INSTRUCTIONS X YES NO 3. NFPA 25 X YES NO LOCATION WET SYSTEM 1 MAKE MODEL YEAR OF MFG. ORIFICE SIZE QUANTITY TEMP. RELIABLE RA1914 2015 K=16.8 441 200 SPRINKLERS PIPE AND TYPE OF PIPE SCHEDULE 7 FITTINGS TYPE OF FITTINGS GROOVED ALARM DEVICE MAX.TIME TO OPERATE THROUGH TEST CONN. ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICAT01 FLOW SWICTH POTTER VSR DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP TIME WATER ALARM THRU TEST WATER AIR TRIP POINT REACHED OPERATED DRY PIPE CONNECTION* PRES. PRES. AIR PRESSURE TEST OUTLET* PROPERLY OPERATING MIN. SEC. PSI PSI PSI MIN. SEC. YES NO TEST WITHOUT Q.O.D. WITH Q.O.D. *MEASURED FROM THE TIME INSPECTOR'S TEST CONNECTION IS OPENED OPERATION PNEUMATIC ELECTRIC HYDRAULIC PIPING SUPERVISED YES �NO DETECTING MEDIA SUPERVISED YES ONO DELUGE& DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROLS STATIONS DYES ONO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO,EXPLAIN VALVES DYES F-lNO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM VALVE RELEASE OPERATE RELEASE YES INO YES NO MIN. SEC. (OVER) LOCATION MAKE& STATIC PRESSURE RESIDUAL PRESSURE(FLOWING) FLOW RATE PRESSURE &FLOOR MODEL SETTING INLET(PSI) JOUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) REDUCING VALVE TEST TEST PRESSURE IN EXCESS OF 150 PSI(10.2 BARS)FOR TWO HOURS. DIFFERENTIAL DRY PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DESCRIPTION DURING TEST TO PREVENT DAMAGE. ALL ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED. 24 HOURS. TEST PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1 '/z PSI(0.1 BARS)IN 24 HOURS. ALL PIPING HYDROSTATICALLY TESTED AT j PSI FOR 2 HRS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED BYES BNO EQUIPMENT OPERATED PROPERLY YES NO 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 TESTS STOPPING LEAKS? ®YES BNO DRAIN I STATIC PRESSURE READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTION TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING, AND VERIFIED BY COPY OF FORM NO.13U BYES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING BYES BNO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE,HAS REPRESENTATIVE SAMPLE BYES BNO NA TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING Number Used Locations Number Removed GASKETS 0 0 WELDED PIPE ®YES BNO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10,9,LEVEL AR-3 ®YES BNO WELDING 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 El NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC 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(DISKS) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE THAT INSURES THAT ALL CUTOUTS(DISCS)ARE RETRIEVED? ®YES BNO HYDRAULIC DATA NAME PLATE PROVIDED IF NO,EXPLAIN NAMEPLATE ®YES BNO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR F.E. Moran Fire Protection,3001 Research Road,Suite A,Champaign, Illinois 61822 TEST WITNESS BY SIGNATURES F6R PRO RTY ER(SIGNED) TITLE DATE ek FelfSEfR,( (SI 'ED) TITLE,/ j DATE ADDITIONAL EXPLANATION AQID TE CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING UPON COMPLETION OF WORK,INSPECTION&TESTS SHALL BE MADE BY THE CONTRACTOR'S REP.AND WITNESSED BY AN OWNER'S REP. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S PERSONNEL LEAVE THE JOB. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH THE 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 JOB NO. DATE PROPERTY ADDRESS NEW DISTRIBUTION CENTER FOR VISTAR 201000 LOT 3 175 SULLIVAN AVE.,SOUTH WINDSOR, CONNECTICUT 06074 ACCEPTED BY APPROVING AUTHORITIES(NAMES) SOUTH WINDSOR,CT ADDRESS PLANS 1540 SULLIVAN AVE., SOUTH WINDSOR, CT INSTALLATION CONFORMS TO ACCEPTED PLANS EYES NO EQUIPMENT USED IS APPROVED )( YES NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION MYES 1:1NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS )( YES NO 2. CARE AND MAINTENANCE INSTRUCTIONS X YES NO 3. NFPA 25 X YES NO LOCATION WET SYSTEM 2 MAKE MODEL YEAR OF MFG. ORIFICE SIZE QUANTITY TEMP. RELIABLE RA1914 2015 K=16.8 539 200 SPRINKLERS PIPE AND TYPE OF PIPE SCHEDULE 7 FITTINGS TYPE OF FITTINGS GROOVED ALARM DEVICE MAX.TIME TO OPERATE THROUGH TEST CONN. ALARM VALVE OR TYPE I MAKE MODEL MIN. SEC. FLOW INDICATOF FLOW SWICTH POTTER VSR DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP TIME WATER ALARM THRU TEST WATER AIR TRIP POINT REACHED OPERATED DRY PIPE CONNECTION PRIES. PRIES. AIR PRESSURE TEST OUTLET` PROPERLY OPERATING MIN. SEC. PSI PSI PSI MIN. SEC. YES NO TEST WITHOUT Q.O.D. WITH Q.O.D. *MEASURED FROM THE TIME INSPECTOR'S TEST CONNECTION IS OPENED OPERATION PNEUMATIC ELECTRIC HYDRAULIC PIPING SUPERVISED YES NO DETECTING MEDIA SUPERVISED YES El NO DELUGE& DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROLS STATIONS YES �NO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO,EXPLAIN VALVES MYES ONO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM VALVE RELEASE OPERATE RELEASE YES NO YES INO MIN. SEC. (OVER) LOCATION MAKE& STATIC PRESSURE RESIDUAL PRESSURE(FLOWING) FLOW RATE PRESSURE &FLOOR MODEL I SETTING INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) REDUCING VALVE TEST TEST PRESSURE IN EXCESS OF 150 PSI(10.2 BARS)FOR TWO HOURS. DIFFERENTIAL DRY PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DESCRIPTION DURING TEST TO PREVENT DAMAGE. ALL ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED. z 24 HOURS. TEST PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1'/2 PSI(0.1 BARS)IN 24 HOURS. ALL PIPING HYDROSTATICALLY TESTED AT Is PSI FOR 2 HRS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED eYES BNO EQUIPMENT OPERATED PROPERLY YES NO 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 TESTS STOPPING LEAKS? ®YES EDNO DRAIN I STATIC PRESSURE READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTION TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING, AND VERIFIED BY COPY OF FORM NO.13U FlYES 0NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES 1:1NO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE,HAS REPRESENTATIVE SAMPLE YES 0NO NA TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING Number Used Locations Number Removed GASKETS 0 1 1 0 WELDED PIPE ®YES 1:1NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10,9,LEVEL AR-3 ®YES 1:1NO WELDING 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 1:1NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC 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(DISKS) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE THAT INSURES THAT ALL CUTOUTS(DISCS)ARE RETRIEVED? ®YES 1:1NO HYDRAULIC DATA NAME PLATE PROVIDED IF NO,EXPLAIN NAMEPLATE ®YES 1-1 NO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR Moran Fire Protection, 3001 Research Road,Suite A,Champaign, Illinois 61822 TEST WITNESS BY SIGNATURE / FOR PROPE TY 9 ER(SIGNED) TITL DATE ` FOR OR GN TITLES DAT ADDITIONAL EXPLA I N N TE CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING PROCEDURE UPON COMPLETION OF WORK,INSPECTION&TESTS SHALL BE MADE BY THE CONTRACTOR'S REP.AND WITNESSED BY AN OWNER'S REP. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S PERSONNEL LEAVE THE JOB. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH THE 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 JOB NO. DATE NEW DISTRIBUTION CENTER FOR VISTAR 201000 PROPERTY ADDRESS LOT 3 175 SULLIVAN AVE.,SOUTH WINDSOR, CONNECTICUT 06074 ACCEPTED BY APPROVING AUTHORITIES(NAMES) SOUTH WINDSOR,CT ADDRESS PLANS 1540 SULLIVAN AVE.,SOUTH WINDSOR,CT INSTALLATION CONFORMS TO ACCEPTED PLANS X YES eNO EQUIPMENT USED IS APPROVED YES NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION YES �NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS EYES YES NO 2. CARE AND MAINTENANCE INSTRUCTIONS YES NO 3. NFPA 25 NO LOCATION WET SYSTEM 3 MAKE MODEL YEAR OF MFG. ORIFICE SIZE QUANTITY TEMP. RELIABLE RA1914 2015 K=16.8 490 200 RELIABLE R4842 2015 K=8.0 17 155 SPRINKLERS PIPE AND TYPE OF PIPE SCHEDULE 7 FITTINGS TYPE OF FITTINGS GROOVED ALARM DEVICE MAX.TIME TO OPERATE THROUGH TEST CONN. ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOI FLOW SWICTH POTTER VSR DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP TIME WATER ALARM THRU TEST WATER AIR TRIP POINT REACHED OPERATED DRY PIPE CONNECTION* PRES. PRES. AIR PRESSURE TEST OUTLET* PROPERLY OPERATING MIN. SEC. PSI PSI PSI MIN. SEC. YES NO TEST WITHOUT Q.O.D. WITH Q.O.D. *MEASURED FROM THE TIME INSPECTOR'S TEST CONNECTION IS OPENED OPERATION PNEUMATIC ELECTRIC HYDRAULIC PIPING SUPERVISED YES �NO DETECTING MEDIA SUPERVISED YES 1:1NO DELUGE& DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROLS STATIONS YES 1:1NO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO,EXPLAIN VALVES DYES FjNO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM VALVE RELEASE OPERATE RELEASE YES NO YES INO MIN. SEC. (OVER) LOCATION MAKE& STATIC PRESSURE RESIDUAL PRESSURE(FLOWING) FLOW RATE PRESSURE &FLOOR MODEL SETTING INLET(PSI) JOUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) REDUCING VALVE TEST TEST PRESSURE IN EXCESS OF 150 PSI(10.2 BARS)FOR TWO HOURS. DIFFERENTIAL DRY PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DESCRIPTION DURING TEST TO PREVENT DAMAGE. ALL ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED. PNEUMATIC: ESTABLISH 40 PSI(2.7 BARS)AIR FRESSURE AND MEASURE DROP WHIGH SHALL NO I EXCEED 1 z 24 HOURS. TEST PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1 '/PSI(0.1 BARS)IN 24 HOURS. ALL PIPING HYDROSTATICALLY TESTED AT 9.)5 PSI FOR 2 HRS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED eYES eNO EQUIPMENT OPERATED PROPERLY YES NO 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 TESTS STOPPING LEAKS? ®YES El NO DRAIN STATIC PRESSURE READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTION TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING, AND VERIFIED BY COPY OF FORM NO.13U YES 1:1NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES 1:1NO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE,HAS REPRESENTATIVE SAMPLE YES 1:1NO NA TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING Number Used Locations Number Removed GASKETS 0 1 1 0 WELDED PIPE ®YES 1:1NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10,9,LEVEL AR-3 ®YES 1:1NO WELDING 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 F-1NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC 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(DISKS) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE THAT INSURES THAT ALL CUTOUTS(DISCS)ARE RETRIEVED? ®YES 1:1NO HYDRAULIC DATA NAME PLATE PROVIDED IF NO,EXPLAIN NAMEPLATE ®YES 1:1No DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME 90f_aFRINKLER CONTRACTOR F.E. oran Fire Protection, 3001 Research Road, Suite A, Champaign, Illinois 61822 TEST WITNESS BY SIGNATURES OR PROPER OWN SIGNED) TIT DATE FOR LE TOR-{S NE TITLE DATE, ADDITIONAL EXPLANATI N NOTESd� �! CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING PROGEDUKh UPON COMPLETION OF WORK,INSPECTION&TESTS SHALL BE MADE BY THE CONTRACTOR'S REP.AND WITNESSED BY AN OWNER'S REP. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S PERSONNEL LEAVE THE JOB. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH THE 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 JOB NO. JDATE NEW DISTRIBUTION CENTER FOR VISTAR 201000 PROPERTYADDRESS LOT 3 175 SULLIVAN AVE.,SOUTH WINDSOR,CONNECTICUT 06074 ACCEPTED BY APPROVING AUTHORITIES(NAMES) SOUTH WINDSOR, CT ADDRESS PLANS 1540 SULLIVAN AVE.,SOUTH WINDSOR,CT INSTALLATION CONFORMS TO ACCEPTED PLANS X YES BNO EQUIPMENT USED IS APPROVED YES NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION EYES 1-1 NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS E YES NO 2. CARE AND MAINTENANCE INSTRUCTIONS YES NO 3. NFPA 25 YES NO LOCATION ,1 , p aG e- WET SYSTEM 4 MAKE MODEL YEAR OF MFG. ORIFICE SIZE QUANTITY TEMP. RELIABLE R3672 2015 K=8.0 23 200 RELIABLE R4842 2015 K=8.0 44 155 SPRINKLERS PIPE AND TYPE OF PIPE SCHEDULE 7 FITTINGS TYPE OF FITTINGS GROOVED ALARM DEVICE MAX.TIME TO OPERATE THROUGH TEST CONN. ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOI FLOW SWICTH POTTER VSR DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP TIME WATER ALARM THRU TEST WATER AIR TRIP POINT REACHED OPERATED DRY PIPE CONNECTION PRES. PRES. AIR PRESSURE TEST OUTLET* PROPERLY OPERATING MIN. I SEC. PSI PSI PSI MIN. SEC. YES NO TEST WITHOUT Q.O.D. WITH Q.O.D. MEASURED FROM THE TIME INSPECTOR'S TEST CONNECTION IS OPENED OPERATION PNEUMATIC ELECTRIC HYDRAULIC PIPING SUPERVISED YES El NO DETECTING MEDIA SUPERVISED YES 1:1NO DELUGE& DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROLS STATIONS YES 1:1NO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO,EXPLAIN VALVES DYES 1:1NO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM VALVE RELEASE OPERATE RELEASE YES NO YES NO MIN. SEC. (OVER) LOCATION MAKE& STATIC PRESSURE RESIDUAL PRESSURE(FLOWING) FLOW RATE PRESSURE &FLOOR MODEL SETTING INLET(PSI) JOUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) REDUCING VALVE TEST TEST PRESSURE IN EXCESS OF 150 PSI(10.2 BARS)FOR TWO HOURS. DIFFERENTIAL DRY PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DESCRIPTION DURING TEST TO PREVENT DAMAGE. ALL ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED. PNEUMAJ IG: ES I ABLISH 40 PSI(2.7 BARS)AIR PRESSURE ANu MEASURE DROP WHICH SHALL NO I LXULLL)1 z PSI(0.1 BAR 24 HOURS. TEST PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1'/z PSI(0.1 BARS)IN 24 HOURS. ALL PIPING HYDROSTATICALLY TESTED AT F PSI FOR 2 HRS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED eYES eNO EQUIPMENT OPERATED PROPERLY YES NO 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 TESTS STOPPING LEAKS? ®YES F 1NO DRAIN I STATIC PRESSURE READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTION TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING, AND VERIFIED BY COPY OF FORM NO.13U YES El NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES 1:1NO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE,HAS REPRESENTATIVE SAMPLE YES 1:1NO NA TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING Number Used Locations Number Removed GASKETS 0 0 WELDED PIPE ®YES 1:1NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10,9,LEVEL AR-3 ®YES El NO WELDING 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 F-1NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC 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(DISKS) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE THAT INSURES THAT ALL CUTOUTS(DISCS)ARE RETRIEVED? ®YES 1:1NO HYDRAULIC DATA NAME PLATE PROVIDED IF NO,EXPLAIN NAMEPLATE ®YES 1:1NO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR F.E. Moran Fire Protection, 3001 Research Road,Suite A,Champaign, Illinois 61822 TEST WITNESS BY SIGNATURES FOR PRO ERT NER(SIGNED) TITLE DATE +, /' 'a/moo/lb K E T TOR SI ) TITLE, — 0 DATE J d�✓�-�ar7 l —f�,ZOl(v ADDITIONAL EXPLANATION17 NOTES CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING PROCEDURE UPON COMPLETION OF WORK,INSPECTION&TESTS SHALL BE MADE BY THE CONTRACTOR'S REP.AND WITNESSED BY AN OWNER'S REP. ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S PERSONNEL LEAVE THE JOB. A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH THE 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 JOB NO. DATE NEW DISTRIBUTION CENTER FOR VISTAR 201000 PROPERTY ADDRESS LOT 3 175 SULLIVAN AVE.,SOUTH WINDSOR,CONNECTICUT 06074 ACCEPTED BY APPROVING AUTHORITIES(NAMES) SOUTH WINDSOR,CT ADDRESS PLANS 1540 SULLIVAN AVE.,SOUTH WINDSOR,CT INSTALLATION CONFORMS TO ACCEPTED PLANS X YES ONO EQUIPMENT USED IS APPROVED YES LJNO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION MYES 1:1NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS X YES NO 2. CARE AND MAINTENANCE INSTRUCTIONS X YES NO 3. NFPA 25 X YES NO LOCATION PRE-ACTION SYSTEM MAKE MODEL YEAR OF MFG. ORIFICE SIZE QUANTITY TEMP. VIKING VK595 2015 K=25.2 238 200 SPRINKLERS PIPE AND TYPE OF PIPE SCHEDULE 7 FITTINGS TYPE OF FITTINGS GROOVED ALARM DEVICE MAX.TIME TO OPERATE THROUGH TEST CONN. ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOF FLOW SWICTH POTTER VSR DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP TIME WATER ALARM THRU TEST WATER AIR TRIP POINT REACHED OPERATED DRY PIPE CONNECTION` PRES. PRES. AIR PRESSURE TEST OUTLET* PROPERLY OPERATING IN. SEC. PSI PSI PSI MIN. SEC. YES NO TEST WITHOUT Q.O.D. WITH Q.O.D. MEASURED FROM THE TIME INSPECTOR'S TEST CONNECTION IS OPENED OPERATION PNEUMATIC ®ELECTRIC El HYDRAULIC PIPING SUPERVISED ®YES 1:1NO DETECTING MEDIA SUPERVISED YES El NO DELUGE& DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROLS STATIONS YES 1:1NO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO,EXPLAIN VALVES YES FJNO DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT OPERATE MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM VALVE RELEASE OPERATE RELEASE YES NO YES NO MIN. SEC. (OVER) LOCATION MAKE& STATIC PRESSURE RESIDUAL PRESSURE(FLOWING) FLOW RATE PRESSURE &FLOOR MODEL SETTING INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) REDUCING VALVE TEST TEST PRESSURE IN EXCESS OF 150 PSI(10.2 BARS)FOR TWO HOURS. DIFFERENTIAL DRY PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DESCRIPTION DURING TEST TO PREVENT DAMAGE. ALL ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED. PNEUMATIU: ESTABLISH 40 P.51(2.7 BARS)AIR PRESSURE AND MEASURE DROP WHICH SHALL NUT z -PSr(U.7MRS)IN 24 HOURS. TEST PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1'/2 PSI(0.1 BARS)IN 24 HOURS. ALL PIPING HYDROSTATICALLY TESTED AT ry 3W PSI FOR 2 HRS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED O_ H YES BNO EQUIPMENT OPERATED PROPERLY YES NO 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 TESTS STOPPING LEAKS? ®YES 1:1NO DRAIN I STATIC PRESSURE READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTION TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING, AND VERIFIED BY COPY OF FORM NO.13U YES 1:1NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES 1:1NO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE,HAS REPRESENTATIVE SAMPLE YES El NO NA TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING Number Used ns Number Removed Locatio GASKETS 0 0 WELDED PIPE ®YES El NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10,9,LEVEL AR-3 ®YES 1:1NO WELDING 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 F_1NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC 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 ONO CUTOUTS(DISKS) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE THAT INSURES THAT ALL CUTOUTS(DISCS)ARE RETRIEVED? ®YES 1-1 NO HYDRAULIC DATA NAME PLATE PROVIDED IF NO,EXPLAIN NAMEPLATE ®YES 1:1NO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR F.E. Moran Fire Protection,3001 Research Road, Suite A, Champaign, Illinois 61822 TEST WITNESS BY SIGNATURES FOR PR ER OWNER(SIGNED) TITLE v e t(C/2 DATE F, S CO (SIGNED.) TITLE DAT � ADDITIONAL EXP A A I- D NO]ES