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HomeMy WebLinkAboutStandpipe NFPA 13 AGMTF CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR /'"'1BOVEGROUND PIPING Additional copies of this form are Loss Prevention Publicalions-Training Resource Cenler available to insureds from: Faclory Mulual Engineering and Research,1151 Boslon-- Providence Turnpike,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.All defects shall be corrected and system left in service before contractors personnel finally leave the job. A certificate shall 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 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 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 LEFT ON PREMISES? IF NO,EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM Fire Standpipe Flow Test MAKE MODEL YEAR OF pRIFICE SIZE QUANTITY TEMPERATURE RATING MANUFACTURE 0 SPRINKLERS o 0 0 a PIPE CONFORMS TO N.F.P.A.#13 STANDARD � YES ❑ NO PIPE AND FITTINGS FITTINGS 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 ALARM VALVE VIKING F-1 DRY VALVE Q.O.D. MAKE MODE� SERIALNUMBER MAKE MODEL SERIALNUMBER TIME TO TRIP THRU AIR TRIP POINT AIR Time Watar qlarm Operated DRY PIPE TEST PIPE WATER PRESSURE pRESSURE PRESSURE Reached Tast properly Outlat 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 FACILITY IN EACH CIRCUIT FOR TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Does each circuit operete supervision Does each circuit operata velve Meximum time to operete MAKE MODEL loss alerm7 releases9 release YES NO YES NO MIN. SEC. HYDROSTATIC:Hydros�atic lests shall be made al not less lhan 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 prevenl damage.All TEST DESCRIPTION aboveground piping leakage shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop which shall no�exceed 1-1/2 psi(0.1 bars)in 24 hours.Tesl pressure tanks ai normal water level and air pressure and measure air pressure drop which shall not exceed 1-1/2 psi(0.1 bars)in 24 hours. ALL PIPING PNEUMATICALLY TESTED AT '100 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 pSl OPEN WIDE PSI Underground meins end lead-in connections to system risers shell ba flushed before connection made to sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER 85B? ❑ 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 SPRINK�ER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR3? CI YES ❑ NO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS�UALIFIED IN COMPLIANCE WITH THE REOUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR-3? Q YES ❑ NO DO YOU CERTIFY THAT WELDING WAS CARRIEO OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY C(�NTRnI PR(�CFfIURF TO INSI IRF THAT AI I IIIRCS ARF RFTRIFVFfI THAT OPFNINGS IN PIPING ARE SMOOTH.THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED.AND THAT INTERNAL DIAMEfERS OF PIPING ARE NOT PENETRATED7 [�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 NTRAC7AR( gned) TITLE . '` DATE .�..�"'..,�.�- /�,����-✓� /�`� ;.,J •� ��L�;�, � -I Z� ADDITIONAL EXPLANATION AND NOTES: _ / ������1,��s ���'�/� �'°'6 .' , �'-1,�� 77 C�� � /`%`C?%� CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR/`1BOVEGROUND PIPING Addffional copies of this(orm are Loss Pre�enlion Publicalions-Training Resource Center availa6/e to insureds fivm: Factory Mutual Engineering and Research,1151 Boston— ProHdence 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.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 shail 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 authoritys requirements or locai ordinances. PROPERN NAME �A� SOLARIS PROJECT 3/512010 PROPERN ADORESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED BYAPPROVING AUTHOR(TY(S)NAMES VAIL FIRE DEPT ADDRESS 42 W.Meadow Drive Vail Colorado 81657 P�S INSTALLATION CONFORMS TO ACCEPTED PLANS [JJ 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 lHE CARE AND MAINTENANCE OF THIS NEW IF NO.EXPLAIN: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCT70NS AND CARE AND MAINTENANCE CHARTS BEEN Q YES ❑ NO LEFf ON PREMISES? IF NO,EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE PARKING LEVEL SOUTH GREEN BAYS DP-1 MAKE MODEL YEAR OF ORIFICE SI� aua,rmrr TEMPERANRE RATING MANUFACTURE VIKING VK124 2008 1/2" 551 155° SPRINKLERS VIKING VK122 2008 1/2" 1 155° VIKING VK446 2008 1/2" 2 155° 0 0 PIPE CONFORMS TO N.F.P.A.#13 STANDARD Q YES ❑ NO PIPE AND FITTINGS FffT1NGS 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 MODEL SERIAL NUMBER VIKING F-1 VIKING D-2 TIME TO TRIP THRU AIR TRIP POINT AIR T�^�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 wiTM o.o.�. 6 130 40 30 16 IF NO,EXPLAIN: OPERAl10N ❑ pNEUMAIIC ❑ ELECTAIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MED�A SUPERVISED? � yES ❑ NO DOES THE VAIVE OPERATE FROM THE MANUAL TfiIP ANDlOR REMOTE CONTROL? ❑ YES ❑ NO IS Tl-IERE AN ACCESSIBLE FACILITY IN EACH CIRCUR FOR TESTING? ❑ YES ❑ NO OELUGE& IF NO.EXPLAIN: PREACTION VALVES Does esch circuit operate supervisfon Does each circuit operate valve Maximum tlme to operate MAKE MODEL ioss alerm? relesses? release YES NO YES NO MIN. SEC. HYDROSTATIC:HydrostaGc tests shall be made at not less than 200 psi(13.6 bars)for two hours ar 50 psi(3.4 bars�above static pressure in excess of 150 psi(10.3 bars)for twu haurs.Oifferentlal dry-pipe val�,e ciappers shail be left open during test to prevent damage.All TEST DESCRIPTION �0�round piping Ieakx�e shall be stopped. PNEUMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed i-7/2 psi(0.1 hars)in 24 haurs.Test pressure tanks at normal water le�e�and air pressure and measure air pressura drop which shall not e�eed t-1/2 psi(0.t bars)in 24 haurs. ALL PIPING PNEUMATICALLY TESTED AT 1t(� PSI FOR `z Hrs. IF NO,STATE REASON DRY PIPING PNEUMATICALLY iESTED? yEg ❑ NO EDUIPMENT OPERATES PROPERLY? � YES ❑ NO TESTS READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE W ITH VALVE IN TEST PIPE: DRAINTEST PS� OPENWIDE PSI UrMerground meins and lead-in connectlons to system rtsers shall ba 8ushed before connectlon made to sprinkler piping. VERIFIED BY COPY OF'tHE FORM NUMBER 85B? ❑ YES ❑ NO OT}iER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPR�NKLER PIPING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDED PIPING? � YES ❑ NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CON7AACTOR THAT W ELDING PROCEDURES COMPLY W ITH T}iE REQUIREMENTS OF AT LEAST AWS D10.9,IEVEL AR-3? �YES ❑ NO WELDING DO YOU CERTIFY THAT THE W ELDING W AS PERFORMED 8Y W ELDERS QUALIFIED IN COMPLIANCE W RH THE REOUIREMENTS OF AT LEAST AWS 010.9.LEVEL AR-3? �YES ❑ NO DO YOU CERTIFY THAT W ELDING W AS CARRIED OUT IN COMPLIANCE W ITH A DOCUMENIED QUALITY CONTROL PROCEDI IRE TA INSI IRE THAT ALL DIRCS ARE RETAIEVED.THAT APENIN(,S IN PIPINC; ARE SA�OTH.THAT SLAG AND OTHER W EL�ING RESIDUE ARE REMOVED.AND THAT IN7ERNAL DIAMETERS OF PIPING ARE NOT PENEiRATED? �YES ❑ NO NAMEPLA7E PROVIDED? �YES ❑ NO HYDRAULIC DATA IF NO,ExPi.aiN: NAMEPLATE DATE LEFT IN SERVICE W ITH ALL CONTROL VA�VES OPEN: REMARKS NAME OF INSTALLING CONTRACTOR Frontier Fire Protection, Inc. TESTS WRNESSED BY SIGNATURES FOR PROPERN OWNER(Signed) 7�E DATE FOR INSTALLING CONTRACTOR(Signed) 7'(n E DATE ADDt110NAL EXPLANATION AND NOTES: CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING Addffional copies of Utis form aie Loss Prevention Publications-Training Resource Center available ro insureds(rom: Factory Mutual Engineering and Research,1151 Boston— Pro�dence Tumpike,PO Box 9102,Norwood,MA 02062 PROCEDURE: Upon completion of work,inspection and tests shali be made by the contractor's representative and witnessed by an owner's representative.All defects shali be corrected and system left in service before contractor's personnel ftnally 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 representatives signature in no way prejudices any claim against the contractor for faulry material,poor workmanship, or failure to comply with approving authorit�/s requirements or local ordinances. PROPERTY NAME pA� 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 Colo�ado 81657 PLANS �NSTALLATION 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 E�UIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROI 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,EXPLA�N: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE PARKING LEVEL NORTH ORANGE AND YELLOW BAYS DP-2 MAKE MODEL YEAR OF ORIFICE SI� pUANTITY TEMPERATURE RATiNG MANUFACTURE VIKING VK124 2008 1/2" 192 155° SPRINKLERS VIKING VK104 2008 1/2" 6 155° VIKING VK150 2008 1/2" 256 l55° 0 0 PIPE CONFORMS TO N.F.P.A.#�3 STANDARD Q YES ❑ NO PIPE AND fiTTINGS FITTINGS CONFORM TO N.F.P.A.#�3 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 2 DRY VALVE Q.O.D. MAKE MODEL SERIALNUMBER MAKE MO�EL SERIALNUMBER ViKiNG F-1 VIKING D-2 TIME TO TRIP THRU AIR TRIP POINT AIR T�'�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. Nnniour O.O.D vuirH a.o.o. 12 125 41 39 12 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 CONTAOL? ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOH TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Does each circuit operete supervision Does each circuit operete valve Maximum tlme to operete MAKE MODEL loss alerm? releases? release YES NO YES NO MIN. SEC. HYOROSTATIC:Hydrostatic tests shall be made at not less�an 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.DiHerentlai dry-pipe valve clappers shall be left open during test to pre�nent damage.All TEST DESCRIPTION �O�round piping leakage shail be stopped. PNEUMATIC:Esta6lish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed t-7/2 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 eueed 1-1/2 psi(0.1 bars)in 24 hours. ALL PIPING PNEUMATICALLY TESTED AT '200 PSI FOR 2 Hrs. �F NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED? �YES ❑ NO EQUIPMENTOPERATES PROPERLY? � YES ❑ NO TESTS READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: AESIDUAL PFESSURE W ITH VALVE IN TEST PIPE: DRAIN TEST PSI OPEN W IDE PSI Underground meins and lead-in connectfons to system risers shall be Bushed before connectio�mede to sprinkler piping. VERIFIED BY COPY OF iHE FORM NUMBER 858? � �S ❑ NO OTHER EXPLAIN PLUSHED BY INSTALLER OF UNOERGROUND SPFiINKIER PIPING? ❑YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDEDPIPING? � YES ❑ NO IF YES... 00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT W ELD�NG PROCEDURES COMPLY W ITH THE RE4lJIREMENTS OF AT LEASTAWS D10.9,LEVEI AR-3? 0 YES ❑ NO WELDING DO YOU CERTIFY THAT THE W ELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE W ITH THE RE�UIREMENTS OF AT LEAST AW S D10.9.LEVEL AR-3? �YES ❑ NO DO YOU CERTIFY THAT W ELDING WAS CARRIED OUT IN COMPLIANCE W ITH A DOCUMENTED OUALITY CONTAOL PRO(:EDURE TO IN811RE THAT ALL DISCR AFE RETRIEVED.THAT APENM(,S IN PIPIN(; ARE SMOO7H.THAT SLAG AND OTHER WELDING fiESIDUE ARE REMOVED.AND THAT INTERNAL DUIMETERS OF PIPING ARE NOT PENETAATEO? �YES ❑ NO NAMEPLAIE PROVIDED? �YES ❑ NO HYDRAULIC DATA iF NO,ExPLniN: NAMEPLATE DATE LEFT IN SERVICE W I71-I ALL CONTROL VALVES OPEN: REMARKS NAME OF INSTALLING CONTAACTOR Frontier Fire Protection, Inc. TESTS WITNESSED BY SIGNATURES FOR PROPERTYOWNER(Signed) n'(�E DATE FOR INSTALLING CONTRACTOR(Signed) 7�7�E DATE ADOITIONAL EXPLANATION AND NOTES: CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR /`1BOVEGROUND PIPING AddiNonal copies of this form are Loss Preuention Puhlications-Training Resource Center avai(ab(e to insureds lrom: 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.All defects shall be corrected and system left in service before conVactor's personnel finaily leave the job. A certificate shal�be 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 conVactor for faulty material,poor workmanship, or failure to complywith approving authorit7ls requirements or local ordinances. PROPERTY NAME DATE SOLARIS PROJECT 3/5/2010 PROPERT(ADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED BY APPROVING AUTHORITY(S)NAMES VAIL FIRE DEPT AODRESS 42 W.Meadow Drive Vail Colorado 81657 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS 0 YES ❑ NO EQUIPMENT USED IS APPROVED(IF NO,STATE DEVIATIONS BELOW) Q YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRl1CTED AS TO LOCATION OF CONTROL 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 � YES ❑ NO LEFf ON PREMISES? IF NO,EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE PARKING LEVEL MIDDIE ORANGE BAY DP-3 MAKE MODEL YEAR OF ORIFICE SI� QUANTITY TEMPERATURE RATING MANUFACTURE VIKING VK124 2008 1/2" 415 155° SPRINKLERS VIKING VK104 2008 1/2" 1 155° 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 �S ❑ 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 MODEL SERIALNUMBER 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 ouuet MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. WITHOUT �.O.D uvirH o.o.n. 12 125 40 37 32 �F NO,EXPLAIN: OPERATION ❑ PNEUMATIC ❑ ELECTAIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED? � YES ❑ NO DOES T}IE VALVE OPERATE FROM THE MANUAL TRfP ANO/OR REMOTE CONTAOL? ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACII.RY IN EACH CIRCUIT FOR TESTING? ❑ YES ❑ NO DELUGE& �F NO.ExPLA1N: PREACTION VALVES Does each circult operete supervision Dces each circuit operate valve Maximum time to operate MAKE MODEL Ioss alarm? releases? release YES NO YES NO MIN. SEC. HVDROSTATIC:Hydrostatic tests shall be made at no[less ihan 200 psi(13.6 bars�for two hours or 50 psi(3.4 bars)above static pressure in excess ot 150 psi(10.3 bars)(or two hours.DifferenNal dry-pipe valve clappars shall be lek open during test to pievent damage.All TEST DESCRIPTION abovaground piping leakage shall be stopped. PNEUMAl1C:Establish 40 psi(2.7 bars)air pressure and measu�s drop which shall not excaed 1-1/2 psi(0.1 bars)in 24 hours.Test pressure tanks at normal water le�,el and air pressure and measure air pressure drop which shall not exceed i-1/2 psi(0.1 bars)in 24 hours. AlL PIPING PNEUMATICALLY TESTED AT 200 PSI FOR '2 Hrs. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED? �yES ❑ NO EWIPMENTOPERATESPROPERIY? � YES ❑ NO READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE W ITH VALVE IN TEST PIPE: TESTS DRAIN TEST pSl OPEN W IDE PSI U�Merground mal�s and lead-in connectlons to system risers shell be flushed before connection mede ta sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER 858? ❑ YES ❑ NO OTHER EXPLAIN Fl.USHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING? ❑ YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDED PIPING? � yES ❑ NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTAACTOR THAT W ELDING PROCEDURES COMPIY W ITH THE REQUIREMENTS OF AT�EAST AW S D10.9,IEVEL AR-3? �YES ❑ NO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY W ELDERS�UALIFIED IN COMPLIANCE W ITH THE RE�UIREMENTS OF AT LEAST AW S D70.9.LEVEL AR-3? 0 YES ❑ NO DO YOU CERTIFY iHAT W ELDING W AS CARRIED OUT IN COMPLIANCE W ITH A DOCUMENTED�UALITY CnNTRnL PRCH:EDlIAE TA INSIIRE THAT ALL DIS(;S ARE RETRIEVED.h1AT nPENIN(;R IN PIPIN[9 ARE SMOOTH.THAT SLAG AND OTHER W ELDING RESIDUE ARE REMOVED.AND THAT INTERNA� DIAMETERS OF PIPING ARE NOT PENETRATED? �YES ❑ NO NAMEPLA7E PROVIDED? �YES ❑ NO HYDRAULIC DATA IF NO,EXPLAIN: NAMEPLATE DA1E LEFT IN SERVICE W ITH ALL CONTROL VALVES OPEN: REMARKS NAME OF INSTA�LING CONTRACTOR Frontier Fire Protection, inc. TESTS WITNESSED BY SIGNATURES FOR PROPERTY OW NER(Signed) 7mE DATE � FOR INSTAILING CON7AACTOR(Signed) 7(7�E DATE ADOITIONAL EXPLANATbN AND NOTES: CONTRACTOR'S MATERIAL 8� TEST CERTIFIGATE FOR f'1BOVEGROUND PIPING Additional copies of U�is form are Loss Prevention Publ(cations-Training Resource Center availab(e ro insureds hom: Factory Mutual Engineering and Research,1151 Boston— Pro�idence Tumpike,PO Box 9102,Norwood,MA 02062 PROCEDURE: Upon completion of work,inspection and tests shafi 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 personnei finally leave the job. A certificate shall be filled out and signed by 6oth 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 authority's requirements or local ordinances. PROPERTY NAME pq� SOLARIS PROJECT 3/5/2010 PROPERTYADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED BY APPROVING AUTHORIiY(S)NAMES VAIL FIRE DEPT ADORESS 42 W.Meadow Drive Vail Colorado 81657 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS Q YES ❑ NO EQUIPMENT USED IS APPROVED(IF NO,STATE DEVIATIONS BELOW) [�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 LEFT ON PREMISES? IF NO.EXPLAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM GARAGE TO LEVEL 1 PARKING YELLOW AND RED BAYS DP-4 MAKE MODEL YEAR OF pRIFICE SI� QUANTITY TEMPERATURE RATING MANUFACTURE VIKING VK124 2008 1/2" 21 155° SPRINKLERS VIKING VK463 2008 1/Z" 23 I55° VIKING VK150 2008 1/2" 261 155° a 0 PIPE CONFORMS TO N.F.P.A.#13 STANDARD Q YES ❑ NO PIPE AND FITTINGS F�NGS CONFORM TO N.F.P.A.#�3 STANDARD Q YES ❑ NO IF N0,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 2 DRY VALVE Q.O.D. MAKE MODEL SERIALNUMBER MAKE MODEL SERIALNUMBER VIKING F-1 VIKING D-2 T1ME TO TRIP THRU AIR TRIP POtNT AIR Time Water Alartn Operated DRY PIPE TEST PIPE wATER PRESSURE pRESSURE PRESSURE Reached Test properly Outlet OPERATING TEST MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. NnrHOUr O.O.D 'M'� 4 125 40 39 22 �.O.D. IF NO,EXPLAIN: OPERAT�ON ❑ PNEUMAl1C ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECl1NG MEDIA SUPERVISED? � YES ❑ NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OH REMOTE CONTAOL? ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUR FOR TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Does each circuit operate supervision Dces each circuit operate velve Maxlmum Nme to oparate MAKE MODEL loss alarm9 releasesT release YES NO YES NO MIN. SEC. HYDROSTATIC:Hydrostadc 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 a�ess of 150 psi(10.3 bars)for two haurs.Diflerential dry-pipe valve clappers shall be left open during test to prevent damage.All TEST DESCRIPTION �oveground piping leakage shall 6e 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 haurs.Test pressure tanks at normal water le�sl and air pressure and measure air pressure drop which shail not exceed 1-t/2 psi(0.7 bars)in 24 hours. ALL PIPING PNEUMATICALLV TESTED AT 2� pSl FOR '1 Hrs. IF NO,STATE REASON ORY PIPING PNEUMATICALLY 1ESTED? �,YES ❑ NO E�UIPMENTOPERATES PROPERLY? � yES ❑ NO READING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PFESSUAE W ITH VALVE IN TEST PIPE: TESTS ORAIN TESi PSI OPEN W IDE PSI Underground meins and lead-in connections to system risers shail be flushed before connecUon mede to sprinkier piping. VERIFIED 8Y COPY OF THE FOAM NUMBER 85B? ❑ YES ❑ NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPHINKLER PIPING? ❑YES ❑ NO NUMBER USED LOCATIONS NUMBER REMOVED BLANK TESTING GASKETS WELDED PIPING? � yES ❑ NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CON1FtACTOR THAT W ELDING PROCEDURES COMPLY W ITH THE RE�UIfiEMENTS OF AT LEAST AW S D10.9,LEVEL AR-3? �YES ❑ NO WELDING DO YOU CERTIFY THAT THE W ELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPL�ANCE W RH THE FiEQUIPEMENTS OF AT LEAST AW S D70.9.LEVEL AR-3? 0 YES ❑ Na DO YOU CERTIFV THAT W ELDING W AS CARf11ED OUT IN COMPLIANCE W ITH A DOCUMENTED QUALITY C:nNTRnI PR()(:EDIIRE Tn INRtIRE THAT A�L DIR(:S ARE RETRIEVED.THAT APENINC,S IN PIPINC, ARE SMOOTH.THAT SLAG AND OTHER W ELDING RESIDUE ARE REMOVED.AND THAT INTERNAL DU1MElERS OF PIPING ARE NOT PENETRATED? �YES ❑ NO NAMEPLAIE PpOVIDED? �YES ❑ NO HYDRAUIIC DATA iF NO,EXPLAIN: NAMEPLATE DATE LEF�IN SERVICE W ITH ALL CONTROI VALVES OPEN: REMARKS NAME OF INSTALLING CONTAACTOR Frontier Fire Protection, Inc. TESTS WRNESSED BY SIGNATURES FOR PHOPEFiTY OW NER(Signed) 7�7�E DATE FOR INSTALLING CONTAACTOR(Signed) 7�7LE DATE A�DITIONAL EXPLANATION AND NOTES: CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR /`1BOVEGROUND PIPING AddN/onal copies of this(orm are Loss Prevention Publications-Training Resource Center availab/e ro irtsureds lrom: Factory Mutual Engineering and Research,1151 Boston— ProHdence Tumpike,PO Box 9102,Norvvood,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.Ail defects shall be corrected and system left in service before contractor's personnel fi�aliy 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 representatives signature in no way prejudices any ciaim against the conVactor for faulty material,poor workmanship, or failure to comply with approving authoritys requirements or local ordinances. PROPERTY NAME pA� SOLARIS PROJECT 3/5/2010 PROPERN ADDRESS 141 EAST MEADOW DRIVE VAIL, CO ACCEPTED BY APPROVING AUTHORITY(Sl NAMES VAIL FIRE DEPT ADDRESS 42 W.Meadow Drive Vail Colorado 81657 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS CJJ YES ❑ NO EQUIPMENT USED IS APPROVED(IF NO,STATE DEVWTIONS BELOW) Q YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL Q YES ❑ NO VA�VES AND THE CARE AND MAINTENANCE OF THIS NEW IF NO.EXPLAIN: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN Q yEg � NO LEFT ON PREMISES? IF NO.EXPIAIN: LOCATION OF SUPPLIES BUILDINGS SYSTEM LEVEL 1 -2 PARKING BLUE BAY DP-5 MAKE MOOEL YEAR OF ORIFICE SI� QUANT7TY TEMPERATURE RATING MANUFACTURE VIKING VK124 2008 1/2" 180 155° SPRINKLERS o 0 0 0 PIPE CONFORMS TO N.F.P.A.#�I3 STANDARD � YES ❑ NO PIPE AND FITTINGS FftTINGS 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 2 DRY VALVE Q.O.D. MAKE MODEL SERIALNUMBER MAKE MODEI SERIALNUMBER VIKING F-1 VIKING D-2 TIME TO TRIP THRU AIR TRIP POINT AIR T��Wa�� Alarm Operated TEST PIPE WA�R PRESSURE pRESSURE PRESSURE Reached Test P� DRY PIPE OuNet °���y OPERATING TEST MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. HnrE+our Q.O.D �TM a.o.o. 2 125 41 40 9 IF NO,EXPLAIN: OPERATION ❑ pNEUMA"tiC ❑ ELECTAIC ❑ HYDRAUIIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPEAVISED? � YES ❑ NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTAOI? ❑ YES ❑ NO IS THEAE AN ACCESSIBLE FACILITY�N EACH CIRCUR FOR TESTING? ❑ YES ❑ NO DELUGE& IF NO.EXPLAIN: PREACTION VALVES Does each clrcuit operate supervlsio� Does each clrcuit operate valve Maxl�m Ume to operete MAKE MODEL loss alarm? releases? release YES NO YES NO MIN. SEC. HYDROSTATIC:HydrostaUc tests shall be made at not less Ihan 200 psi(13.6 bars)for two hours ar 50 psi(3.4 bars)above static pressure in e�ess of 150 psi(10.3 bars)tor two hours.Differentlai dry-pipe valve clappers shall be left open during test[o prevent darnage.All TEST DESCRIPTION �oveground piping leakage shall be stopped. PNEUMATIC:Estahlish 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 shail not exceed i-t!2 psi(0.1 bars)in 24 hours. ALL PIPING PNEUMATICAILY TESTED AT 'Z00 pSl FOR 2 Hrs. IF NO,STATE REASON DRY PIPING PNEUMATICALLY iESTED? �YES ❑ NO EQUIPMENT OPERATES PROPERLY? � YES ❑ NO TESTS READING OF GAGE LOCATEO NEAR WATER SUPPLY TEST PIPE: fiESIDUAI PRESSURE W ITH VA�VE IN TEST PIPE: ORAIN TE5T PSI OPEN W IDE PSI UrWerground mains and lead-In cannections to system rlsers shall be fluahed betore connectlon made to sp�inkler piping. VERIFIED BY COPY OF THE FORM NUMBER 85B? � �S ❑ NO OTHER EXPLAIN FLUSHED 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 CONTRACTOft THAT W ELDING PROCEDURES COMPLY W I7H THE REQUIREMENTS OF AT LEASTAWS D10.9,LEVEL AR•3? EI YES ❑ NO WELDING OO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY W ELDERS QUALIFIE�IN COMPLIANCE W ITH THE HE�UIREMENTS OF AT LEAST AW S�t 0.9.LEVEL AR-3? �YES ❑NO DO YOU CERTIFY THAT W ELDING W AS CARRIED OUT IN COMPLIANCE W ITH A DOCUMENTED QUALIIY CONTROL PH(H:EDtIRE TO INRIIRE THAT ALL DI4CR ARE RETRIEVE�.THAT OPENINGS IN PIPINA ARE SMOOTH.THAT SLAG AND OTHER W ELDING RESIDUE ARE REMOVED.AND THAT INTERNAL OIAMETERS OF PIPING ARE NOT PENETRA'fED? �YES ❑ NO NAMEPLATE PROVIDED? �YES ❑NO HYDRAULIC DATA IF r�,EXPLAIN: NAMEPLATE DATE LEFT IN SERVICE W ITFI ALL CONTROL VALVES OPEN: REMARKS NAME OF INSTALLING CONTRACTOR Frontier Fire Protection, Inc. TESTS WRNESSED BY SIGNATURES FOR PROPERTY OWNER(Signed) 7�TLE DATE FOFi INSTALLING CONlRACTOR(Signed) 7�7�E DATE ADDRIONAL EXPLANATION AND NOTES: