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Home My WebLink About001-210-025 CF ArchiveCONTRACT'OR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING Factory Additional copies of this form are Loss Prevemion Publications - Training Resource Center Mutual System available to insured from: Factory Mutual Engineering and Research. 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, r►r faiitiro to n^mnly tx:;th nnnrnvina ;k1Ahnr;1-v'c rennin-ment¢ or lncal ordinances - W1 144.. Yi V ..V vv...v. l .. .... -I-V. v . ...cz . . --; , . - J --------- - - - - - - - PROPERTY NAME: ENGSTORM WAREHOUSE/PACKING SHED JOB# 05212 DATE: SEPT. 15, 2006 PROPERTY ADDRESS: 8TH STREET, BIGGS, CA PLANS ACCEPTED BY APPROVING AUTIHORITY'(S) NAMES: BUTTE COUNTY- BUILDING DIVISION ADDRESS: 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 INSTALLATION CONFORMS TO ACCEPTED PLANS YES X NO EQt'IPMENT L►'SED 1S APPROVED (IF NO, STATE DEVIATIONS BELOW) YES X NO — -_--- -- - INSTRUCTIONS VIAS PERSON-,-C41ARG.E--OF FIZE Et�I,::�';',L1''I' tIEE ' INS; RL CTE D -AS TO LOCATION OF-CON-TROL_ - - AND. - - - --- VALVES THE CARE AND MAINTENANCE OF THIS NEW EQUIPNIENT? YES X NO IF NO, EXPLAIN: H. -%%*E COPIES OF APPROPRIATE INSTRLICTIONS AND CARE AND MAINTENANCE CHARTS BEEN LEFT ON YES X I NO PREZ'IISES? IF NO, EXPLAIN: LOCATION OF SYSTEM SL:PPLIES BUILDINGS SYSTEM #1 SPRINKLERS MAKE TYCO MODEL YEAR OF ORIFICE SIZE MANUFACTURE I QUANTITY TEMPERATURE RATING VIKING PEND. V K500 2006 3/4" 360 2050 PENDENT TY -FRB 2006 '/2'' 4 1550 PENDENT TY -FRB 2006 3/4" 4 2000 PIPE & FITTINGS PIPE CONFORM` TO N FPA # 13 STANDARD FITTINGS CONFORM TO _ NFPA # 13 STANDARD YES X NO YES X NO ALARM VALVE OR FLOW INDICATOR ALARM DEVICE MAXINIU-M TIME TO OPERATE THROUGH TEST PIPE TYPE MAKE MODEL MIN. SEC. WATERFLOW swiTCH POTTER VSR-F 0 60 DRY PIPE OPERATING TEST DRY VALVE Q.O.D. MAKE 'MODEL SERIAL NO. MAKE MODEL SERIALNO. TIME TO TRIP THRI 1 TEST PIPE WATER PRESSURE AIR PRESSURE TRIP POINT AIR PRESSURE TIME WATER REACHED OUT. ALARM OPER- ATED PROPERLY MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. WITHOUT ' Q.O.D. WITH Q.O.D. IF NO, EXPLAIN: OPERATION I PNEUMATIC J ELECTRIC HYDRAULIC PIPING SUPERVISED YES I NO I DETECTING MEDIA YES NO SUPERVISED? _ DOES THE VALVE OPERATE FROM THE '1IANUAL TRIP AND/OR REMOTE CONTROL? YES NO DELUGE AND PREACTION IS THERE AN ACCESSIBLE- FACILITY IN EACH CIRCUIT FOR TESTING? YES NO VALVES IF NO, EXPLAIN: DOES EACI4 CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODEL SLPERV ISIO`I LOSS ALARM? OPERATE VALVE RELEASE? OPERATE RELEASE YES NO YES NO MIN. SEC. HYDROSTATIC: HYDROSTATIC TESTS SHALL BE MADE AT NOT LESS THAN 200 PSI (13.6 BARS) ABOVE STATIC PRESSURE IN EXCESS OF 150 PSI (10.3 BARS) FOR TWO HOURS. -DIFFERENTIAL DRY- TEST PIPE, VALVE CLAPPERS SMALL BE LEFT OPEN DURING TEST TO PREVENT DAMAGE. ALL ABOVE-GROUND PIPING LEAKAGE SHALT. BE STOPPED. DESCRIPTION PNEUMATIC: ES'rL ABl.1S'H 40 PSI (2.7 BARS) AIR PRESSURE AND MEASURE DROP WHICH SHALL NOT EXCEED 1-1/2 PSI (0.1 BARS) IN PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRI-,SSURE DROP WHICH SHALL NOT EXCEED 1-1/2 PSI (0.1 BARS) IN 24 HRS. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR-2 HRS. IF NO, STATE REASON: DRQ' PIPING PNEU.NlATICALLV TESTED? YES NO EQUIPMENT OPERATES PROPERLY? YES NO DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIDUAL PRESSURE WITH VALVE IN TESTS PIPE. TES- 200 PSI TEST PIPE OPEN WIDE 200 PSI r UNDERGROUND MAINS AND LEADAN CONNECTIONS TO SYSTEM RISERS SHALL BE FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF'I'nE FORM # 85B? YES NO OTHER EXPLAIN FlAiSHED BY INSTALLER OF ONDERGROUND YES NO SPRINKLER PIPING? BLANK TESTINGNL-NIBER L!SED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING`' x YES NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING YES x NO PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9. LEVEL AR-3? WELDINGDO YOU CERTIFY THAT T HE WELDING WAS PERFORMED BY WELDERS QUALIFIED YES X NO IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10"9, LEVEL AR-3? DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A YES x NO 13�)C'L�MEN"I-ED QC:ALITY CONTROL. PROCEDURE TO INSURE THAT ALL DISCS ARE RFTI'<IEVED. THAT OPE NC_:S IN PIPING ARE SMOOTH. THAT SLAG AND OTHER WE7LDING RESIDUE ARE RF%iOVED. AND THAT INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? HYDRAULIC NAMEPLATE PROVIDED? YES X NO DATA-NAMEPLATE IF N'O, EXPLAIN: DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN.- PEN:REMARKS REMARKS t N.ANIE OF INSTALLING CONTRACTOR: CEN-CAL FIRE SYSTEMS, INC. TESTS WITNESSED BY FOR AUTHORITl'HAVING .IIAISDICTION (Signed) TITLE DATE SIGNATURES I. L 'G CION 'i ed) TITLE DATE In --"-- ADDITIONAL EXPL. f ON AN N S: CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING ]Factory Additional copies of this form are Loss Prevention Publications - Training Resource Center Mutual System available to insured from: Factory Mutual Engineering and Research, 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 NAME: ENGSTORM WAREHOUSE/PACKING SHED JOB# 05212 DATE: SEPT. 15, 2006 PROPERTY ADDRESS: 8T" STREET, BIGGS, CA ACCEPTED BY APPROVING AUTHORITY'(S) NAMES: BUTTE COUNTY -- BUILDING DIVISION ADDRESS: 7 COUNTY CENTER DRIVE, OROVILLE, CA 95965 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES X NO EQUIPMENT USED IS APPROVED (IF NO, STATE DEVIATIONS BELOW) YES X NO -� -` INSTRUCTIONS _ HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES THE CARE AND MAINTENANCE OF THIS NEW EQUIPMENT`' IF NO, EXPLAIN: AND YES X NO HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN LEFT ON PREMISES' IF NO, EXPLAIN: YES X NO LOCATION OF SYSTEM SUPPLIES BUILDINGS SYSTEM #2 SPRINKLERS MAKE TYCO MODEL YEAR OF ORIFICE SIZE MANUFACTURE QUANTITY TEMPERATURE RATING VIKING PEND.VK500 2006 3/4" 167 2050 VIKING UPRIG. VK520 2006 3�4" 72 2050 UPRIGHT TY -FRB 2006 '/z" 18 2000 PENDENT TY -FRB 2006 '/2" 16 1550 PENDENT TY -FRB 2006 3/4" 15 2000 PIPE & FITTINGS PIPE CONFORMS TO NFPA #13 STANDARD FITTINGS CONFORM TO NFPA #13 STANDARD YES X NO YES X NO ALARM VALVE OR FLOW INDICATOR DRY PIPE OPERATING TEST ALARM DEVICE TYPE MAKE MODEL WATERFLOW POTTER VSR-F SWITCH DRY - - — -_ MAKE I MODEL SERIAL NO. MAXIMt1M TIME TO OPERATE THROUGH TEST PIPE MIN. SEC. 0 1 60 MAKE MODEL SERIAL NO. TIME TO TRIP WATER AIR TRIP POINT TIME WATER ALARA'[ OPER- THRUT TEST PRESSURE PRESSURE AIR PRESSURE REACHED OUT. ATED PROPERLY PIPE MIN. SEC. PSI PSI PSI ` MIN. SEC. MIN. SJEC. WITHOUT Q.O.D. WITH Q.O.D. l IF NO, EXPLAIN: A OPERATION I PNEUMATIC ELECTRIC HYDRAULIC PIPING SUPERVISED YES NO DETECTING MEDIA YES NO SUPERVISED? DELUGE AND DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL? YES NO PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? YES NO VALVES IF NO, EXPLAIN: DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO SUPERVISION LOSS ALARM? OPERATE VALVE OPERATE RELEASE MAKE MODEL. RELEASE? YES NO YES NO MIN. SEC. %0.9 11J 1 1JLJ R V HYDROSTATIC: HYDROSTATIC TESTS SHALL BE MADE AT NOT LESS THAN 200 PSI (13.6 BARS) ABOVE X YES NO DRY - 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 TEST PIPING LEAKAGE SHALL, BE STOPPED. DESCRIPTION PNEUMATIC: ESTABI]SM 40 PSI (2.7 BARS) AIR PRESSURE AND MEASURE DROP WHICH SHALL NOT EXCEED 1-1/2 PSI (0.1 BARS) IN PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1-1/2 PSI (0.1 BARS) IN 24 HRS. AI.I_ PIPING HYDROSTATICALLY TESTED .4T 200 PSI FOR 2 HRS. IF NO, STATE REASON: YES X NO DRY PIPING PNEUMATiC.'ALLY TESTED? YES DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A NO Dt�Ct-MENTED QUALITY CGNTROL PROCEDURE TO INSURE THAT ALL DISCS ARE EQUIPMENT OPERATES PROPERLY? YES NO DRAIN READING OF GAGE LOCATED NEAR WATER SUPPLY TEST RESIDUAL PRESSURE WITH VALVE IN TESTS PIPE-. TEST PIPE OPEN WIDE 200 PSI HYDRAULIC TEST 200 PSI YES X UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS SHALL BE FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE FORM # 85B? IF NO, EXPLAIN: YES NO OTHER EXPLAIN DATE LEFT IN SERVICE NNTH ALL CONTROL VALVES OPEN: T FLI.'SHED BY INSTALLER OF I *NDERGROUND YES REMARKS NO NAN'IE OF INSTALLING CONTRACTOR: CEN -CAL FIRE SYSTEMS, INC. SPRINKLER PIPING? TESTS WITNESSED BY t FOR AUTHORITY HAVING KRISDICTION (Signed) TITLE DATE BLANK TESTING ,rN • f, 7lTTC NUMBER USED LOCATIONS NUMBER REMOVED %0.9 11J 1 1JLJ R V WELDED PIPING? X YES NO IF YES... DO YOU CERTIFY AS THF SPRINKLER CONTRACTOR THAT WELDING YES X NO PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? YES X NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A YESX NO Dt�Ct-MENTED QUALITY CGNTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED. THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REN IOVED, AND THAT INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? HYDRAULIC NAMEPLATE PROVIDED? . YES X NO DATA NAMEPLATE IF NO, EXPLAIN: - — DATE LEFT IN SERVICE NNTH ALL CONTROL VALVES OPEN: T REMARKS NAN'IE OF INSTALLING CONTRACTOR: CEN -CAL FIRE SYSTEMS, INC. TESTS WITNESSED BY t FOR AUTHORITY HAVING KRISDICTION (Signed) TITLE DATE SIGNATURES�-- wo-11A 10". FOR I ' 'TAI�aG CON�'i2. R Sig d) TITLE DATE ADDITIONAL EXPLANATION ANMD OTkS: rn