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Contractor's Material & Test Certificate For Underground ion-
rang
Upon cornipietirm
by
work, inspection chseben laavna
F�Csentative. Ail defects ai be eted and syrn left in servicefore contactor's personnel fiery
the Job-
'k certificate sham be filled out and signed by both representatives. Copies shall be prepared for approving 5u tiinstes'
con urn • and conyat:tor. Ir is understood the owner's representative's signature in no way prejudices any clam a or
for faulty material., poor workmanship, or failure to comply with approving authority's requirement' or lel
ordinances.
)PERTY NAME kowisovSF .# I
}PERTY ADDRESS 3 a 3 c,o f E g-E e 14Q)z. *1] VAI C, DATE•
r'
S7
ACCEPTED BY APPROVING AUTHORITIES(NAMES)
■ oro D0.iG - s A6.4- LLrG, .rArspL 4 .cAfizz f' t,..'
YS ADDRESS
3 ,r i , . 0/.1 vi Art=, c o 4,16 C 7
INSTALLATION CONFORMS TO ACCEPTED PLANS #tigkEs ❑ NO
EQUIPMENT USED IS APPROVED S NO
IF NO,STATE DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT B Ei Ai INSTRUCTED AS TO LOCATION OF
CONTROL VALVES AND CARE&MAINTENANCE OF THIS NEW EQU PM T?
)yEs NO
IF NO EXPLAIN
a
UCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE&MAINTENANCE CHARTS
BEEN LEFT ON PREMISES? n YES NO
IF NO,EXPLAIN G A T ex,.,+lr rF' -7lr0 r
ION SUPPLIES BUILDINGS
g-010-1ittj
PIPE TYPES AND CLASS - TYPE JOINT-
;ROUND PIPE CONFORMS TO 5 P A �° STANDARD SYES a NO
VD FITTINGS CONFORM TO tis►a. 64 co STANDARD %YES n NO
IF NO,EXPLAIN
JOINTS NEEDING ANCHORAGE CLAMPED,STRAPPED, OR a YES NO
BLOCKED IN ACCORDANCE WITH STANDARD
IF NO,EXPLAIN tr Q J O 1E PITS ? P
CION as per 10-2.2 of NFPA
Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags
^la as hydrants and blow-offs. Flush at flows not less than 39OGPM(I476IfmM)for a 4"pipe, 830 GPM
for 6"p0e, 1560 GPM(5905 IJ,nin)for 8"pipe, 2440GFM(923511mm)for 10"pipe, and 3520GPM (1331
"pipe. Wizen supply cannot produce stipulated flow rates, obtain maximum available.
7C: Hydrostatic tests shall be made at not less than 200 psi (13,Sbars)for two hours or 50psi (3.4 ban
,ensure in excess of 15Opsi(10.3 bars)for two hours.
Vey pipe laid with rubber gasket joints shag if the workmanship is satisfactory, have little or no leakage
amount of leakage at the joints shall not exceed 2gts. Per hr. (1.89,moi)per 100 joints irrespective of pi
leakage shall be distributed over alljoints. If such leakage occurs atal few joints, the installation shall
rxrrfir r al^fnr., and lorolleIl�rtl mini T min ■Intl 1 r/MrilJNf Jif drildiutrdilc, IMI,Strffilfri7 CT,JVtay na4 rrlarY% A., feeant*
� f T
r .
NEW UNDERGoRU ING FLUSHED ACCORDING [
TO _fa CCl --r�4 .0 STANDARD BY YES c NO [
(COMPANY) dEA •.nr CxC� vA:.Z -'
IF NO,EXPLAIN
FLUSIx7NG
TESTS
HOW FLUSHING FLOW WAS OBTAINED?
'PUBLIC WATER ci TANK OR RESERVOIR o FIRE PUMP
THROUGH WHAT TYPE OPENING?
t ) .
ALL NEW UNDERGROUND PIPING HYDROSTATICALLY
ROSIATIC TESTED AT PSI FOR ,HOURS
YDEST jowrS COVERED: Ai/.A a YES a NO
Y TOTAL AMOUNT OF LEAKAGE MEASURED-
GALS. HOURS
h1."AA -- ,3O i.0 TN pz-PAS
AKAGE TEST ALLOWABLE LEAKAGE
GALS. HOURS
NUMBER INSTALLED: Q TYPE AND MAKE:
►RAI TS � e
ALL OPERATE SATISFACTORILY
WATER CONTROL VALVES LEF '' CEDE OPENci YES %NO
IF NO,STATE REASON: ry 0 ..41 �rTL ,r,eSTI! C)
['RdL HOSE THREAD OF FIRE DEPARTMENT CONNECTIONS
F5 AND HYDRANTS LNTERCHANGEABLE WITH THOSE OF FIRE
DEPT.ANSWERING ALARM ++,,t/A YTS rs
NO
DATE LEFT IN SERVICE
NAME OF INSTALLING CONTRACTOR
TESTS WITNESSED BY:
U5
FOR IOP' ' r �., : �'
(SIGNED) .�.���. :_ TITLE: ig d p SAT
FOR LNSTALLING ONTRACTOR
(SIGNED)64414) TITLE: 5')?e ,,rrt1%v"r_
DATE: 3 /
IAL EXPLANATION AND NOTES:
■
STATE OF COLORADO
Division of Fire Prevention and Control
-- vtiyy k,
i}l �i
18-U-.O4 i69
Be 1t Known That
Beaumont Excavating, Inc.
Jeff Beaumont-Principal
`was Successfully Completed CC‘Requirements
to Become Registered
Fire Suppression Systems Contractor - Underground
'Issued On
January 1, 2018
Expiring On, `finless Earlier '.evoked
December 31, 2018
In Accordance With
S CCR 1507-11
.Yr
•
Air
&Life Safety Section
CDPS
inion ofFire Prevention&Control
Kipling Street,Suite 4100 4 *Se°
ver, CO 80215 te.:
Mike Morgan,DirectorCO I
•