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Home My WebLink AboutF2021-0487 - MiscrZoy(- Cy-f`67 Contractor's Material and Test Certificate for Aboveground Piping 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 representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY ADDRESS 880 IRVINE AVE ADU CONVERSION ACCEPTED BY APPROVING AUTHORITIES (NAMES) NEWPORT BEACH FIRE DEPT. ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS EQUIPMENT USED IS APPROVED IF NO, EXPLAIN DEVIATIONS ® YES ® YES ❑ NO ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION ® YES OF CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT? IF NO, EXPLAIN ❑ NO INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES 1. SYSTEM COMPONENTS INSTRUCTIONS 2. CARE AND MAINTENANCE INSTRUCTIONS 3. NFPA 25 ® YES ® YES ® YES ® YES ❑ NO ❑ NO ❑ NO ❑ NO MAKE MODEL YEAR OF MANUFACTURE ORIFICE SIZE QUANTITY TEMPERATURE RATING SPRINKLERS VICTAULIC FL- R V2704 2022 112 40 200 VICTAULIC FL -OR V2708 2022 112 93 200 VICTAULIC FL-RES/C V4906 2022 112 80 155 PIPE AND FITTINGS TYPE OF PIPE DYNA THREAD I BLAZEMASTER TYPE OF FITTINGS CAST ALARM VALVE ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION OR TYPE MAKE I MODEL MIN SEC FLOW NIA 1 NIA N/A N/A NIA INDICATOR MAKE MODEL I SERIAL NO. MAKE MODEL SERIAL NO. IA NIA I NIA NIA NIA NIA DRY PIPE OPERATING TIME TO TRIP THROUGH TEST CONNECTION WATER PRESSURE AIR rRIP PRESSURE POINT AIR PRESSURE TIME WATER REACHED TEST OUTLET ALARM OPERATED PROPERLY TEST MIN SEC PSI PSI PSI MIN I SEC YES NO WITH O.O.D. W/O Q.O.D. IF NO, EXPLAIN OPERATION rl PNEUMATIC f1 ELECTRIC rl HYDRAULIC PIPING SUPERVISED rl YES n NO DETECTING MEDIA SUPERVISED 11 YES rl NO DELUGE & DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS rl YES rl NO PREACTION VALVES IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN MIA FOR TESTING? El YES r 1 NO MAKE MODE DOES EACH CIRCUIT OPERATE SUPERVISIONLOSS ALARM DOES EACH CIRCUIT OPERATE ALVE RELEASE MAXIMUM TIME TO OPE TE RELEASE N/A N/A YE NO I YES NO MIN SEC PRESSURE I LOCATION MAKE & SETTING STATIC PRESSURE RFSIDIIAI PRFSSIIRF FI OW RATE REDUCING VALVETEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static TEST pressure in excess of 150 psi (10.2 bars) for two hours. Differential dry -pipe valve clappers shall be left open during test to prevent DESCRIPTION damage. All aboveground piping leakage shall be stopped. PNEUMATIC Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed I'' psi (0.1 bars) in 24 hours. Test r)ressure tanks at n rmal water level and air pressure and measure air Pressure droo which shall not exceed 1'h psi in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 FOR 2 HOURS IF NO, STATE REASON NO, NOT REQUIRED DRY PIPING PNEUMATICALLY TESTED ❑ YES ® NO EQUIPMENT OPERATES PROPERLY 0 YES I —I NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? M YES Fl NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TESTS TEST_ SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 858 ❑ YES []NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND NIA SPRINKER PIPING Fl YES FIND IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE IF NO, EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? FJYES NO NIA BLANK TEST NUMBER USED LOCATIONS NUMBER REMOVED GASKETS NIA NIA NIA WELDED PIPING El YES M 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 DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D70.9. LEVEL AR 3? ❑ YES ® NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETER PIPING ARE NOT PENETRATED) 0 YES M NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) DISCS ARE RETRIEVED? YES R NO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA ® YES ❑ NO NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN. REMARKS 7-20.202 NAME OF SPRINKER CONTRACTOR: APEX FIRE SYSTEMS INC. SIGNATURES TESTS WITNESSED BY • FOR PROPERTY 0 NER (SIGNF.C11 TITLE DATE n' . FOR SPRINK hM R.K�.Tnr�tS M TITI P nnTF EXPLANATIONS AND