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HomeMy WebLinkAbout2600 Tamarack Ave - Life Safety Syste Contractor's Material & Test Certificate for Aboveground Piping F ai Additional printed copies of this form are available to insureds from: Customer Services,FM Global,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 authority's requirements or local ordinances. Property I.D. Property Name: Date: 12--2 Property Location: Plans: Accepted By Approving Authority's Name(s) re,L. pu i t►in,l v� Address: Installation Conforms to Plans JKYes ❑ 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 ❑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? Yes ❑No If no,explain: Location: Supplies Buildings: S rinklers: Sprinkler Identification Year of Temperature Make Number(SIN) Manufacture K Factor Quantity Rating 1 o 0 0 0 Pipe and Fittings: Pipe conforms to IVFP,4J3 Standard Yes ❑No Fittings conform to � .� J� Standard Yes ❑No If no,explain: Alarm Valve or Flow Indicator: Alarm Device Maximum Time to Operate Through Test Pipe Type Make Model Min. Sec. R t� Dry Pipe Operating Test Dry Valve Q.O.D. Make Model Serial Number Make Model Serial Number Dry Pipe Operating Test(Continued) Time to Trip Trip Point Air Time Water Reached Alarm Operated Through Test Pipe I Water Pressure I Air Pressure I Pressure Test Outlet Properly 02003 Factory Mutual Insurance Company X85A ENGINEERING 9/2003 Contractor's Material & Test Certificate for Aboveground Piping �i al 7Min. Sec. PSI PSI PSI Min. Sec. Min. Sec.Without Q.O.D. With Q.O.D. If no,explain: Deluge and Pre-action Valves: O eration: ❑Pneumatic ❑Electric ❑H draulic Pi in Supervised? ❑Yes ❑No Detectin Media Su ervised? ❑Yes ❑No I Does valve operate from manual tri and/or remote control?Is there an accessible facility in each circuit for testing? p ❑Yes ❑No If no,explain: 9• ❑Yes ❑No Does each circuit operate Does each circuit operate Maximum time to operate Make Model supervision loss alarm? valve release? 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(10.3 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: All i in h drostaticall tested at psi for hrs. D i inpneumaticallytested? ❑Yes ❑No Equipment operates properly? Yes ❑No If no,reason: Drain Test Reading of gage located near water supply test pipe: Residual pressure with valve in test pipe wide open? psi. Under round mains and lead-in connections to system risers shall be flushed before connection made to sprinklerpiping, Verified by copy of 856? ❑Yes ❑No Other: Flushed by installer of underground sprinkler piping? ❑Yes ❑No Blank Testing Gaskets: Explain: Number Used: Locations: Welding: Number Removed: Welded Piping?�IeastrA ❑No Do you certify as kler contractor threquirements of aWS D10.9,Level AR-3? ❑No Do you certify that the welding was performed by welders qualified in compliance Yes with the requirements of at least AWS D10.9,Level AR-3? ❑No Do you certify that welding was carried out in compliance with a documented quality 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? Do you certify that all field cut pipe cutouts(discs/coupons)have been retrieved from Yes ❑No sprinkler system piping? Hydraulic Data Nameplate: Nameplate provided? Yes ❑No if no,explain: Remarks(Date left in service with all control valves open): Signatures: Name of Installing Contractor: For Property Owner(Signed : - Title: n9 ' fate: For In I i e ©2003 Factory Mutual Insurance Company �� �� ��dl�wf f Z Z-11 X85A ENGINEERING 9/2003