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Home My WebLink AboutNFPA 13 3 5 10 (2) CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR /`1BOVEGROUND PIPING Additional copies of this form are Loss Prevenlion Publicalions-Training Resource Center available to insureds from: Factory Mulual Engineering and Research,t 151 Bos�on-- Providence Turnpike,PO Box 9102,Norwood,MA 02062 PROCEDURE: Upon completion oi 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 contractors personnel finally leave the job. A certificate shall be filled ou�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 material,poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME DATE SOLARIS PROJECT 3/17/2010 PROPERTY ADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED BY APPROVING AUTHORITV(S)NAMES VAIL FIRE DEPT ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS Q YES ❑ NO EQUIPMENT USED IS APPROVED(IF NO,STATE DEVIATIONS BELOW) Q YES ❑ NO HAS PERSON IN CHARGE OF FIRE E�UIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL Q YES ❑ NO VALVES AND THE CARE AND MAINTENANCE OF THIS NEW IF NO,EXPLAIN: INSTRUCT�ONS HAVE GOPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANGE GHARTS BEEN Q YES ❑ NO LEFT ON PREMISES? IF NO,EXPLAIN: LOCATION OF SUPPLIES BUILDINGS srsTeM Fire Standpipe Flow Test MAKE MODEL YEAR OF ORIFICE SIZE QUANTITY TEMPERATURE RATING MANUFACTURE 0 SPRINKLERS ° 0 0 0 PIPECONFORMSTO N.F.P.A.#13 STANDARD Q YES ❑ NO PIPE AND FITTINGS FITTINGS CONFORM TO N.F.P.A.#13 STANDARD Q YES ❑ NO IF N0,EXPLAIN: ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST PIPE ALARM VAIVE OR TYPE MAKE MODEL MIN. SEC. FLOW INDICATOR ALARM VALVE VIKING F-1 DRY VALVE Q.O.D. MAKE MODEL SERIAL NUMBER MAKE MODEL SERIAL NUMBER Time Watar TIME TO TRIP THRU AIR TRIP POINT AIR Alerm Operated TEST PIPE WATER PRESSURE pRESSURE PRESSURE Reached Test properly DRY PIPE outiet OPERATING TEST MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. WITHOUT Q.O.D WITH Q.O.D. IF NO,EXPLAIN: OPERATION ❑ PNEUMATIC ❑ 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 CIRCUIT FOR TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Does each circuit operete supervision Does each circuit operate valve Maximum tima to oparete MAKE MODEL loss elerm� releases� release YES NO YES NO MIN. SEC. HYDROSTATIC:Hydroslatic lests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above slatic pressure in excess of 150 psi(10.3 bars)for two hours.Differenlial dry-pipe valve clappers shall be left open during lesl lo prevent damage.All TEST DESCRIPTION aboveground piping leakage shall be stopped. PNEUMATIC:Eslablish 40 psi(2.7 bars)air pressure and measure drop which shall no�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 nof exceed 1-1/2 psi(0.1 bars)in 24 hours. ALL PIPING PNEUMATICALLY TESTED AT 200 PSI FOR '1 Hrs. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED? ❑ YES ❑ NO � EQUIPMENT OPERATES PROPERLY? � YES ❑ NO READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE WITH VALVE IN TEST PIPE: TESTS DRAIN TEST PSI OPEN WIDE PSI Underground mains and lead-in connections to system risers shall be flushed before connection mede to sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER 858? ❑ YES ❑ NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS NONE WELDED PIPING? Q YES ❑ 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 WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REOUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR37 �YES ❑ NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY . CONTROI PR(7CFnI1RF TO INSI IRF THAT AI I nISCR ARF RFTRIFVFfI THAT OPFNINGS IN PIPINC; ARE SMOOTH.THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED.AND THAT INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED7 Q YES ❑ NO NAMEPLATE PROVIDED? Q YES ❑ NO HYDRAULIC DATA IF No,EXPLAIN: NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF INSTALLING CONTRACTOR Frontier Fire Protection, Inc. TESTS WITNESSED BY SIGNATURES FOR PROPERTY OWNER(Signed) TITLE DATE .F.sR-tt�YSTALRFeG NTRAC R( gned) TITLE , ` DATE G�T ,� E' �...,.w � . ��'"��/�. /y � '-�,,J • '✓C.=� � '�� ADDITIONAL EXPLANATION AND NOTES: ,�/�y� / y ��r `�l�� /✓v!�"�/i3 �`6 .-'� �� L�C� , t� ��/�`C��U /' �� / �