Loading...
HomeMy WebLinkAboutNFPA 13 3 17 10 CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR/`1BOVEGROUND PIPING Additlonal capies of this/orm are Loss Pre�ntion Publications-Training Resource Center available ro insureds from: Factory Mutual Engineering and Research,1151 Boston— ProHdence Tumpike,PO Box 9702,Norwood,MA 02062 PROCEDURE: Upon completion of work,inspection and tests shall be made by the conVactor'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 fiiled out and signed by both representatives.Copies shali be prepared for approving authorities,owner's and contractor. It is understood the owner's representatives signature in no way prejudices any claim against the conVactor for faulty material,poor workmanship, or faiiure to comply with approving authoritys requirements or local ordinances. PROPERTY NAME DATE SOLARIS PROJECT 3!5/2010 PROPERN ADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED BY APPROVING AUTHORtTY(S)NAMES VAIL FIRE DEPT ADDRESS 42 W.Meadow Drive Vail Colorado 81657 P�S INSTALLATION CONFORMS TO ACCEPTED PLANS 0 YES ❑ NO EQUIPMENT USED IS APPROVED(IF NO.STATE DEVIATIONS BELOW) [Jf YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL Q YES ❑ NO VALVES AND THE CARE AND MAINTENANCE OF THIS NEW IF NO.EXPLAIN: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTtONS AND CARE AND MAINTENANCE CHARTS BEEN Q YES ❑ NO LEFTON PREMISES? IF NO,EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE PARKING LEVEL SOUTH GREEN BAYS DP-1 MAKE MODEL YEAR OF ORIFICE St� QUANTITY TEMPERATURE RATING MANUFACTURE VIKING VK124 2008 1/2" 551 155° SPRINKLERS VIKING VK122 2008 1/2" 1 155° VIKING VK446 2008 1/2" 2 I55° 0 0 PIPE CONFORMS TO N.F.P.A.#�3 STANDARD Q YES ❑ NO PIPE AND fITTINGS FI1'TINGS CONFORM TO N.F.P.A.#�3 STANDARD Q YES ❑ NO IF NO,EXPLAIN: ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOR DRY VALVE VIKING F-1 3 DRY VALVE Q.O.D. MAKE MODEL SERIALNUMBER MAKE MOOEL SERIALNUMBER VIKING F-1 VIKING D-2 Time water TIME TO TRIP THRU AIR TRIP POINT AIR Alarm Operated TEST PIPE WATER PRESSURE pRESSURE PRESSURE Reached Test property DRY PIPE ounec OPERATING TEST MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. WITHOUT �.O.D �TM a.o.o. 6 130 40 30 16 IF NO,EXPLAIN: OPERATION ❑ pNEUMATIC ❑ ELECTAIC ❑ HYDiiAUUC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED? � YES ❑ NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP ANDlOR REMOTE CONTROL? ❑ YES ❑ NO IS 1}1ERE AN ACCESSIBLE FACILIIY IN EACH CIRCUR FOR TESTING? ❑ YES ❑ NO DELUGE 8� IF NO.EXPLAIN: PREACTION VALVES Does each circuit operete supervision Uaes each circuit aperete vaive Maximum tlme to aperate MAKE MODEL loss alarm? releases? reiease YES NO YES NO MIN. SEC. HYDROSTATIC:HydrostaGc tests shall be made at not lass than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static pressure in excess ol 150 psi(10.3 bars)for twn hours.Differentlal dry-pipe valoe clappers shall be leR open during test to prevent damaga.All TEST DESCRIPTION �oveground piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 6ars)air pressure and measure drop which shatl not exceed 1-7/2 psi(0.1 6ars?in 24 hours.Test pressure tanks at normal water level and air pressure and measure air pressura drop which shall not exceed t-1l2 psi(0.i bars)in 24 hours. ALL PIPING PNEUMATICALLY TESTED AT 2� PSI FOR 2 Hrs. IF NO,STATE REASON DRY PIP�NG PNEUMAi1CALLY TESTED? YES ❑ NO EQUIPMENT OPERATES PROPERLY? � YES ❑ NO TESTS READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE W ITH VALVE IN TEST PIPE: DRAIN TEST PSI OPEN W IDE PSI U�erground mains and lead-in connectlons to system risers shall be flushed before connectlon made to sprinkler piping. VEHIFIED BY COPY OF T}iE FORM NUMBER 85B? ❑ YES ❑ NO OTHEFi EXPLAIN FLUSHED 8Y INSTALLER OF UNDERGROUND SPRINKLER PiPING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDED PIPINC,? � YES ❑ NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT W ELDING PROCEDURES COMPLY W ITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? �YES ❑ NO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS�UALIFIED IN COMPLIANCE W tTH THE REOUIREMENTS OF AT LEAST AWS D70.9.LEVEL AR-3? �VES ❑ N� DO YOU CERTIFY THAT W ELDING W AS CARRIED OUT IN COMPLIANCE W ITH A DOCUMENTED QUALITY CONTROL PROC:EDURE TA INSI IFiE THAT ALL DIRCS ARE FETRIEVFD.THAT OPENIN[,S IN PIPIN(; ARE SMOOTH.THAT SLAG AND OTHER WELDfNG RESIDUE ARE REMOVED.AND 1}1AT INIERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? �YES ❑ NO NAMEPLATE PROVIDED? Q YES ❑ NO NYDRAULIC DATA IF NO,EXPUIIN: NAMEPLATE �ATE IEFT IN SERVICE W ITH ALL CONTROL VALVES OPEN: REMARKS NAME OF INSTALIING CONTRACTOR Frontier Fire Protection, Inc. TESTS WRNESSED BY SIGNATURES FORPROPERTVOWNER(Signedy 7�nE DAiE FOR INSTALLING CONTRACTOR(Signed) n7�,E DATE ADDfT10NAL EXPLANATION AND NOTES: CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING Additlonal copies offhis lorm aie Loss Prevention Publications-Training Resource Center availa6/e to insureds from: Factory Mutual Engineering and Research,1151 Boston— Providence Tumpike,PO 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.Ail defects shall be corrected and system lek in service before contractor's personnel finaily leave the job. A certificate shali be filled out and signed by both representatives.Copies shall be prepared for approving authorities,owner's and contractor. It is understood the owner's representatives signature in no way prejudices any claim against the contractor for faulty materiai,poor workmanship, or failure to comply with approving authorit�/s requirements or local ordinances. PROPERN NAME pA� SOLARIS PROJECT 3/5I2010 PROPERN ADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED 8Y APPROVING AUTHORITY(S)NAMES VAIL FIRE DEPT ADDRESS 42 W.Meadow Drive Vaii Colorado 81657 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS Q YES ❑ NO EQUIPMENT USED IS APPROVED(IF N0,STATE DEVIATIONS BELOW) Q YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONIROL Q YES ❑ NO VALVES AND tHE CARE AND MAINiENANCE OF THIS NEW IF NO,EXPLAIN: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN Q YES ❑ NO LEFTON PREMISES? IF NO,EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE PARKING LEVEL NORTH ORANGE AND YELLOW BAYS DP-2 MAKE MODEL YEAR OF pRIFICE SI� Qua,rinrr TEMPERATURE RATING MANUFACNRE VIKING VK124 2008 1/2" 192 155° SPRINKLERS VIKING VK104 2008 1/2" 6 I55° VIKING VK150 2008 1/2" 256 l55° 0 0 PIPE CONFORMS TO N.F.P.A.��I3 STANDARD Q YES ❑ NO PIPE AND FITTINGS FPiTINGS CONFORM TO N.F.P.A. #13 STANDARD � YES ❑ NO IF NO,EXPLAIN: ALARM DEYICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOR DRY VALVE VIKING F-1 2 DRY VALVE Q.O.D. MAKE MO�EL SERIALNUMBER MAKE MODEL SERIALNUMBER VIKING F-1 VIKING D-2 TIME TO TRIP THRU AIR TRIP POINT AIR Time Water p�arm Operated DRY PIPE TEST PIPE WATER PRESSURE pRESSURE PRESSURE Reached Test property OPERATING TEST Outlet MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. WITHOUT O.O.D uvirH a.o.o. 12 125 41 39 12 IF NO,EXPLAIN: OPERATION ❑ PNEUMAl1C ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED? � YES ❑ NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL? ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACILITV IN EACH CIHCUR FOR TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Doas each circuH operate superviston Does each cfrcult operate valve Maximum ilme to aperate MAKE MODEL loss alarm? releasesT release YES NO YES NO MIN. SEC. HYDROSTATIC:Hydrostatic tests shall be made at nat less than 200 psi(13.6 bars)for twa hours or 50 psi(3.4 bars�above static pressure in e�ess of 150 psi(10.3 bars)tor two hours.Differentlal dry-pipe valve ciappers shall be lek open during test to prevent damage.All TEST DESCRIPTION aboveground piping leakage shali be stopped. PNEUMATIC:Establish 40 psi(2.7 bais)air pressure and measure drop which shall not ezceed t-t/2 psi(0.1 bars)in 24 haurs.Test pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1-t/2 psi(0.t bars)in 24 hours. ALL PIPING PNEUMATICALLY 7ESTED AT 200 PSI FOR '2 Hrs. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED? �YES ❑ NO E�UIPMENTOPERATES PROPEALY? � YES ❑ NO TESTS READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE W ITH VALVE IN TEST PIPE: DRAINTEST pSl OPENWIDE PSI Underground meins and lead-in connections to system risers shall be flushed before connectlon made to sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER 858? ❑ YES ❑ NO 011iER EXPLAIN FLUSHED BY INSTAI�ER OF UNDERGROUND SPqINKLER PIPING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDED PIPING? � YES ❑ NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONIAACTOR THAT W ELDING PROCEDURES COMPLY W ITH THE RE�UIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? �YES ❑ NO WELDING 00 YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE W ITH THE HEOUIREMENTS OF AT LEAST AW S 010.9.LEVEL AR-3? �YES ❑ NO DO YOU CERTIFY THAT W ELDING WAS CARRIED OUT IN COMPLIANCE W ITH A DOCUMENTED�UALITY CONTROL PROCE�URE TO WRURE THAT ALL DI4CS ARE RETRIEVED.THAT OPENMCdS IN PIPIN(; ARE SMOOTH.THAT SLAG AND OTHEH W ELDING RESIDUE ARE REMOVED.AND THAT INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? �YES ❑ NO NAMEPLATE PROViDED? �YES ❑ NO HYDFiAULIC DATA IF NO,EXPI.AIN: NAMEPLATE DATE LEFT IN SERVICE W ITH ALL CONTROL VALVES OPEN: REMARKS NAME OF INSTAILING CONTRACTOR Frontier Fire P�otection, Inc. TESTS WITNESSED BY SIGNATURES FOR PROPERTY OW NER(Signed) 7(nE DATE FOR INSTALLING CONTFiACTOR(Signed) TI'RE DATE ADDfiIONAI EXPLANATION AND NOTES: CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR/''1BOVEGROUND PIPING Additlonal copies of this iorm are Loss Preuantion Publications-Training Resource Cenier avaitable to insureds finm: Factory Mutual Engineering and Research,1151 Boston— ProHdence Tumpike,PO 8ox 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.Ali defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall he fllled out and signed by both representatives.Copies shail be prepared for approving authorities,owner's and contractor. It is understood the owner's representatives signature in no way prejudices any ciaim against the contractor for faulty material,poor workmanship, or failure to comply with approving authoritys requirements or local ordinances. PROPERTY NAME DATE SOLARIS PROJECT 3/5/2010 PROPERN ADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPlEO BY APPROV WG AUTHORITY(S)NAMES VAIL FIRE DEPT ADDRESS 42 W.Meadow Drive Vail Colorado 81657 PLANS INSTALLAl10N CONFORMS TO ACCEPTED PLANS 0 YES ❑ NO EQUIPMENTUSED IS APPROVED(IF NO,STATE DEVIAl10NS BELOW) [�YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRIlCTED AS TO IOCAl10N OF CONTROL Q YES ❑ NO VALVES AND THE CARE AND MAINTENANCE OF THIS NEW IF NO,EXPLAIN: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN � yE$ � NO LEFTON PREMISES? IF NO.EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE PARKING LEVEL MIDDI.E ORANGE BAY DP-3 MAKE MODEL YEAR OF ORIFICE SI� nuarmTr TEMPERATURE RATING MANUFACTURE VIKING VK124 2008 1/2" 415 I55° SPRINKLERS VIKING VK104 2008 1/2" 1 155° 0 0 0 PIPE CONFORMS TO N.F.P.A.#13 STANDARD Q YES ❑ NO PIPE AND FITTINCaS FfTfINGS CONFORM TO N.F.P.A.#13 STANDARD � YES ❑ NO IF NO,EXPLAIN: ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOR DRY VALVE VIKING F-1 3 DRY VALVE Q.O.D. MAKE MODEL SERIAL NUMBER MAKE MOOEL SERIAL NUMBER VIKING F-1 VIKING D-2 TIME TO TRIP THRU AIR TRIP POINT AIR Time Water ,q�arm Operated DRY PIPE TEST PIPE wATER PRESSURE pRESSURE PRESSURE Reached Test properly OPERATING TEST outlet MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. Hnniour �.O.D �TM a.o.o. 12 125 40 37 32 IF NO,EXPLAIN: OPERATION ❑ PNEUMATIC ❑ ELECIRiC ❑ HYDRAULIC PIPING SUPEflVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED? � YES ❑ NO DOES THE VALVE OPERATE FFiOM THE MANUAL TRIP AND/OR REMOTE CON7AOl? ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUR FOR TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Dces each circuit operate supervisfon Does each circWt operete valve Maximum tlme to operete MAKE MODEL loss alarmT releases? release YES NO VES NO MIN. SEC. HYDROSTATIC:Hydrosta6c tests shall be made at not less than Z00 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static pressure in ewCess oF 150 psi(10.3 bats)for two hours.DiHerenNal dry-pipe�ralve clappers shall be Iak opan during test to pravant damage.All TEST DESCRIPTION �O�round piping leakage shall 6e stopped. PNEUMAl1C:Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed t-t/2 psi(0.1 bars)in 24 hours.Tes[pressure tanks at normal water level and air pressure and measure air pressure drop which shall not euceed 1-1/2 psi(0.1 bars)in 24 hours. ALL PIPING PNEUMATICALLY TESTED AT 20� PSI FOR 2 Hrs. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED? �yES ❑ NO EQUIPMENTOPERATESPROPERLY? � YES ❑ NO READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE W ITH VALVE IN TEST PIPE: TESTS ORAIN TEST pSl OPEN W IDE PSI U�erground meins and lesd-in canrectlons to system risers shall be flushed before connection mede to sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER 858? ❑ YES ❑ NO OlHER EXPLAIN FIUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDEDPIPING? � yES ❑ NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT W ELDING PROCEDURES COMPLY W ITH THE REOUIREMENTS OF AT LEAST AW S D10.9,LEVEL AR-3? �YES ❑ NO WELDING DO YOU CERTIFY'fHAT THE W ELDING WAS PERFOHMED BY W ELDERS WALIFIED IN COMPLUINCE W tTH THE FEQUIREMENTS OF AT LEAST AW S D10.9.LEVEL AR-3? 0 YES ❑ NO DO YOU CERTIFY THAT W ELDING W AS CARRIED OUT IN COMPLIANCE W ITH A DOCUMENTED QUALITY CONiAOI PR(H',EDURE TO INRURE THAT ALL DI,SCS ARE RETRIEVED.THAT APENINCS IN PIPIN(i ARE SMOOTH.THAT SLAG AND OTHER W ELDING RESIDUE ARE REMOVED.AND THAT INTERNAL DIAMElERS OF PIPING ARE NOT PENETRATED? �YES ❑ NO NAMEPLAiE PROVIDED? YES ❑ NO MYDRAULiC DATA IF NO,EXPIAIN: NAMEPLATE DATE LEFT IN SERVICE W ITH ALL CONTROI VALVES OPEN: REMARKS NAME OF INSTALLING CONTRACTOfl Frontier Fire Protection, Inc. TESTS WITNESSED BY SIGNATURES FOR PROPERTY OW NER(Signed) 7(nE DAiE � FOR INSTALLING CONTRACTOA(Signed) 7�E DATE AODfT10NAL EXPLANATbN AND NOTES: CONTRACTOR'S MATERIAL 8� TEST CERTIFICATE FOR MBOVEGROUND PIPING Additlonal copies of this(orm are Loss Prevention Publications-Training Resource Center availab/e ro insureds from: Factory Mutual Engineering and Research,1157 Boston— Providence Tumpike,PO Box 9102,Norwood,MA 02062 PROCEDURE: Upon completion of work,inspection and tests shail 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 finaily leave the job. A certificate shall be fiiled out and signed by both representatives.Copies shall be prepared for approving authorities,owner's and contractor. it is understood the owner's representatives signature in no way prejudices any claim against the conVactor for faulty material,poor workmanship, or failure to comply with approving authoritys requirements or local ordinances. PROPERN NAME 0A7E SOLARIS PROJECT 3/5/2010 PROPERTY ADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED BY APPROVING AUTHORITY(S)NAMES VAIL FIRE DEPT AD�RESS 42 W.Meadow Drive Vail Colorado 81657 PLANS �NSTALLATION CONFORMS TO ACCEPTED PLANS 0 YES ❑ NO E�UIPMENT USED IS APPROVED(IF NO,STATE DEVIATIONS BELOW) Q YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL Q YES ❑ NO VALVES AND THE CARE AND MAINTENANCE OF THIS NEW IF NO.EXPLAIN: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN Q YES ❑ NO LEFf ON PREMISES? IF NO.EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE TO LEVEL 1 PARKING YELLOW AND RED BAYS DP-4 MAKE MODEI YEAR OF ORIFICE SI� nua,rinrr TEMPERATURE RATING MANUFACTURE VIKING VK124 2008 1/2" 21 155° SPRINKIERS VIKING VK463 2008 1/2" 23 155° VIKING VK150 2008 1/2" 261 155° 0 a PIPE CONFORMS TO N.F.P.A.#13 STANDARD � YES ❑ NO PIPE AND FITTINGS F�NGS CONFORM TO N.F.P.A.#13 STANDARD � YES ❑ NO IF NO,EXPLAIN: ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOR DRY VALVE VIKING F-1 Z DRY YALVE Q.O.D. MAKE MODEL SERIALNUMBER MAKE MODEL SERIALNUMBER VIKING F-1 VIKING D-2 TiME TO TRIP THRU AIR TRIP POINT AIR Time Water Alarm Operated ORY PIPE TEST PIPE WATER PRESSURE pRESSURE PRESSURE Reached Test properly Outlet OPERATING TEST MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. vwn+our Q.O.D �TM o.o.o. 4 125 40 39 22 IF NO,EXPIAIN: OPERAl10N ❑ PNEUMAl1C ❑ ELECIRIC ❑ HYDRAULIC PIPING SUPERVISED Q YES ❑ NO DETECl1NG MEDIA SUPERVISED? ❑ YES ❑ NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CON7ROL? ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUfT FOR TESTiNG? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Does each cfrcuit operele supervisian Daes each circuit operate valve Meximum tlme to operate MAKE MODEL loss alarm9 releases? release YES NO YES NO MIN. SEC. HYDROSTATIC:Hydrostatic tests shall be made at not Iess than 200 psi(13.6 bars)for two hours or 50 psi(3.4 barsj above static pressure in excess of 150 psi(10.3 bars)for two hours.OiHerentlal dry-pipe valve clappers shall be lek open during test to prevent damage.All TEST DESCRIPTION �oveground piping Ieakage shall be stopped. PNEUMATIC:Establfsh 40 psi(2.7 bars)air pressure and measure drop which shall not exceed 1-1/2 psi(0.t bars)in 24 hours.Test pressure tanks at normal water le�.el and air pressure and measure air pressure drop which shall not exceed 1-t/2 psi(0.1 bars)in 24 hours. ALL PIPING PNEUMATICALLY TESTED AT 2� PSI FOR '1 Hrs. IF NO,STATE REASON DRY PIPING PNEUMATiCALLY TESTED? �,YES ❑ NO EDUIPMENTOPERATES PROPERLY? � YES ❑ NO READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE W ITH VALVE IN TEST PIPE: TESTS DRAINTEST PSI OPENWIOE PSI Underground meina and Iead-in connectfons to system risers shail he 8ushed before connectlon mede to sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER BSB? ❑ YES ❑ NO OTHER EXPLAIN FWSHED BY INSTALLER OF UNDERGROUND SPRINKLEfi PIPING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDEDPIPING? � yES ❑ NO IF YES... DO VOU CEATIFY AS 1}1E SPRINKLER CONTAACTOR THAT W ELDING PROCEDURES COMPLY W ITH THE REOUIREMENTS OF AT LEAST AW S D10.9,LEVEL AR-3? �YES ❑ NO WELDING DO YOU CERTIFY T}IAT THE W ELDING WAS PERFORMED BY W ELDERS QUALIFIED IN COMPLIANCE W fTH THE REQUIREMENTS OF AT LEAST AW S D10.9.LEVEL AR-3? �YES ❑ N� DO YOU CERTIFY THAT W EL�ING W AS CARRIED OUT IN COMPLIANCE W ITH A OOCUMENTED QUALIN GONTROL PqCICEDIIRE TO INRIIRE THAT ALL DI.SC.S ARE RETRIEVED.T-IAT OPENMC,R IN PIPINC; AAE SMOOTH.THAT SLAG AND OTHER WELDING RESIDUE AFiE REMOVED.AND THAT INTERNAL DIAMEIERS OF PIPING ARE NOT PENETRATED? �YES ❑ NO NAMEPLAlE PROVIDED? �YES ❑ NO HYDRAULIC OATA IF NO,EXPLAIN: NAMEPLATE DATE LEFT IN SERVICE W ITH ALL CONTFiOL YALVES OPEN: REMARKS NAME OF WSTALLING CONTRACTOR Frontier Fi�e Protection, Inc. TESTS WITNESSED BY SIGNATURES FOH PROPERTYOWNER(Signed) 7mE DATE FOR INSTALLING CONTRACTOR(Signetl) 7�7LE DATE ADDITIONAL EXPLANATION AND NOTES: CONTRACTOR'S MATERIAL 8� TEST CERTIFICATE FOR ABOVEGROUND PIPING Additlortal copies of this lorm are Loss Prevention Publications-Training Resource Center avaiia6le ro insureds 6om: Factory Mutual Engineering and Research,1151 Boston— Providence Tumpike,PO 8ox 9102,Norvvood,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.Ali defects shall be corrected and system left in service before contractor's personnei finally leave the job. A certificate shall be filied out and signed by both representatives.Copies shall be prepared for approving authorities,owner's and contractor. It is understood the owner's representaUves signature in no way prejudices any claim against the contractor for faulty materiai,poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERlV NAME pq7E SOLARIS PROJECT 3/5/2010 PROPERIY ADDRESS 141 EAST MEADOW DRIVE VAII., CO ACCEPTED BY APPROVING AUTHORITY(S1 NAMES VAIL FIRE DEPT ADDRESS 42 W.Meadow Drive Vail Colorado 81657 PIANS INSTALLATION CONFORMS TO ACCEPTED PLANS [�YES ❑ NO EQUIPMENT USED IS APPROVED(IF NO,STATE DEVIATIONS BELOW) Q YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROI Q YES ❑ NO VALVES AND THE CARE AND MA�NTENANCE OF THIS NEW IF NO.EXPlA1N: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN Q YES ❑ NO LEFT ON PREMISES? IF NO.EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM LEVEL 1 -2 PARKING BLUE BAY DP-5 MAKE MOOEI YEAR OF pRIFICE SI� OUANTITY TEMPERATURE RATING MANUFACTURE VIKING VK124 2008 1/2" 180 155° SPRINKLERS ° 0 0 0 PIPE CONFORMS TO N.F.P.A.#�3 STANDARD Q YES ❑ NO PIPE AND FITTINGS FITTINGS CONFORM TO N.F.P.A.#13 STANDARD Q YES ❑ NO IF N0,EXPLAIN: ALARM DEYICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOR DRY VALVE VIKING F-1 Z DRY VALVE Q.O.D. MAKE MODEL SERIAL NUMBER MAKE MODEL SERIAL NUMBER VIKING F-1 VIKING D-2 TIME TO TRIP THRU AIR TRIP POINT AIR Time Water q�arm Opereted TEST PIPE WATER PRESSURE pRESSURE PRESSURE Reached Test proper�y �RY PIPE Outlet OPERATING TEST MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. v�nn�our Q.O.D �TM Q.o.o. 2 125 41 40 9 IF NO,EXPLAIN: OPERA710N ❑ pNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED? � YES ❑ NO DOES THE VALVE OPERATE FROM THE MANUAI TAIP AND/OR REMOIE CONIROL? ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACI�ITY IN EACH CIRCUIT FOR TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES �ces each c(rcult operate supervlsion Does each circuit operate valve Maxlrmim dme to operate MAKE MODEL loss alarm? releasesT release YES NO YES NO MIN. SEC. HYDtiOSTATIC:Hydrostadc tests shall�made at no[less Ihan 200 psi(13.6 hars)for(wo hours or 50 psi(3.4 bars}abova static pressure in excess of 750 psi(10.3 bars)�or two hours.Differentlal dry-pipe valve clappers shall be left open during test to prevent darnage.All TEST DESCRIPTION �O�round piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed t-1/2 psi(0.1 hars)in 24 haurs.Test pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1-t/2 psi(0.1 bars)in 24 hours. ALL PIPING PNEUMATICALLY TESTED AT '200 PSI FOR 2 Hrs. IF NO,STATE REASON DRY PIPING PNEUMATICALLY 1ESTED? �YES ❑ NO EQUIPMENTOPERATESPROPERLY? � YES ❑ NO READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PfiESSURE W ITH VALVE IN TEST PIPE: TESTS ORAIN TEST PSI OPEN W IDE PSI UiMerground metns and lead-in connectians to system risers shall be Hushed before co�nectlan made to sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER 85B? � ,�S ❑ NO OlHER EXPLAIN F�USHED BY INSTALLER OF UNDERGROUND SPRINKLER P�PING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDEDPIPING? � YES ❑ NO IF YES... DO YOU CERTIFY AS iHE SPRINKLER CONTAACTOR THAT W ELDING PFiOCEDURES COMPLY W ITH THE RE�UIREMENTS OF AT LEAST AW S D10.9,IEVEL AR-3? �YES ❑ NO WELDING DO YOU CERTIFY'(HAT THE W ELDING WAS PERFORMED BY W ELDERS�UALIFIED IN COMPLIANCE W tTH THE REOUIREMENTS OF AT LEAST AW S 010.9.LEVEL AR-3? �YES ❑ NO DO YOU CERTIFY THAT W ELDING W AS CAARIED OUT IN COMPLIANCE W 17H A DOCUMENTED�UALITY CONTROL PA(H:EDURE TO INSI IRE THAT ALL DISCS ARE RETRIEVE�.THAT OPENIN(,S IN PIPINf; ARE SMOOTH.THAT SLAG AND OTHER W ELDING RESIDUE ARE REMOVED.AND THAT INTERNAL DIAMETERS OF PIPING AAE NOT PENETRATED? �YES ❑ NO NAMEPLATE PFOVIDED? �YES ❑NO HYDRAULIC DATA IF NO,EXPtAIN: NAMEPLATE DATE LEFf IN SERVICE W RH ALL CONTROL VALVES OPEN: REMARKS NAME OF INSTALLING CONTRACTOR Frontier Fire Protection, Inc. TESTS WITNESSED BY SIGNATURES FOR PROPERTlOWNER(Signed} 7�T�E DATE FOR INSTALLING CONTRACTOR(Signed) 7�7�E DATE ADDf110NAL EXPLANATION AND NOTES: