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HomeMy WebLinkAboutF2021-0369 - Misc (4)CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR A BOVEGROUND PIPING 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. rnImcn �., nnnl- Date UPTOWN NEfWPORT RESIDENCE- BUILDING #3 1 06/26/2024 PROPERTY ADDRESS q_J ti 1 42<9 UPTOWN NFIWPORT nR. NF.WPORT RF.Ar f-L f A ACCEPTED BY APPROVING AUTHORITY('S) NAMES ADDRESE PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS EQUIPMENT USED IS APPROVED IF NO, EXPLAIN DEVIATIONS ® YES ❑ NO ® YES ❑ NO HAS PERSON IN CHARGE OF FIRE ECUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT) IF NO. EXPLAIN ® YES ❑ NO INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES' I. SYSTEM COMPONENTS INSTRUCTIONS 2 CARE AND MAINTENANCE INSTRUCTIONS a. NFP,A25 Q YES ❑ NO ® YES ❑ NO DYES ❑ NO LOCATION OF SYSTEM SJPPLIES BUILDING. MAKE MODEL YEAR OF MANUFACTURE ORIFICE SIZE QUANTITY TEMPERATURE RATING SEND 1/2" 163 2050 VIKING VK462 MIRAGE 1 2" 23 1750 SPRINKLERS V` " NG V6530 EL 3'4" 47 2000 VIKING VK3021 XT1 1/2" 23 2000 VIKING VK3001 XTi 1/2" 6 2000 PIPE AND FITTINGS Type of Pipe: Schd. 40 Lightwall Type of Fittings; Cast iron f 25# and Grooved ALARM DEVICE MAXIMUM TIME TO OPERATE THRU TEST CONNECTION ALARM VALVE 'TYPE MAKE MODEL MIN SEC. OR FLOW INDICATOR DRY VALUE O O D MAKE MODEL SERIAL NO, MAKE MODEL SERIAL NO. Y P TIME TO TRIP ILou TEST CONNECTION' WATER PRESSURE AIR PRESSURE TRIP POINT AIR PRESSURE TIME WATER REACHED TEST OUTLET' ALARM OPERATED PROPERLY MIN. SEC. PSI PSI PSI MIN SEC. YES NO OPE ING ES Vvithout GOD. ❑ With 0 O.D. ❑ IY.OVS; MON ONV NOIIVNVIdX--IV'NOWCCV 3lVn 31111 (03NOIS) JOlOVd1NO3 831NNIJdS d0J ___ S321n1VNOlS 31VCI Mill. (03NOIS) N3NMO.A1J3dOJd 80J AIR 03SS31N11M SIS31 uoipojoad eaij pien!D up -NO10'V8INO-0 F1317114IJdS JO 31AWN SNMVW3ki "N3dO S3/l.1V,1 lOJINOJ "1"IV H1IM 3Dpl83S NI 1,131 31V0 ON ❑ S3A ® 31Vld3WVN VIVO NIVId,G ON J'!. 030V•,Odd 31Vld 3WVN OIInVJOAH ON ❑ RDA Er' iO3A31813J 3JV (SOSIC) SlnOinO S3SIO 11V iVHI 38nSN301.3JI11V3,f IOUiNOO V' 3AVH(IOA 1V'H1Ijud3O nOA 00 Sinolno ON ❑ S3A Z i031VJ13N3d ION 3NV ONldld JO S8313W'di0' VNI43INI 9H1 1VHI (INV Q3AOW3J 3JV 3nQIS36 ONIOl3M 831410 0NV OVIS 1VHJ. 'Hi00WS 38V ONidid NI S9NIN3dO 1VH1 '03A31813J 38V SOSIO 11V 1VH13HnW 0138!103OOdd 1081NOO Alli'dn0 0311,13MD00 V H11M 3DNVIldWO0 NI C !IIMVD SW ONIC113M 1VH1 AJ11d30 f10A 00 ONIO'13M ON D SAA ® tf-8V 13A31 "E"0l0 SAW 1 SV31 1V d0 9IN3W38ln03d 3111 HIM 3ONVIldW00 NI 031dl-'VOO SJ3013,M IS C3VN8OJJ3d SVM ON1019AA 3H11VFI1 AJIld30 nOA. 00 ON ❑ S3/. ® IC'JV 13A31'6 OtO SMV 1SV311V JO SIN311436V`103d 3H1 H11M AldlNOO S3dH03308d SMOI3AA 1VH1 JOI0VdiNO3 d3-NN[IdS AH1 SV AJLLJ]0 nOA 00 RAA dl ON SAA DNldid CBOI3.M S SI O RJ 31 C13AOW38 dAMM -SNOIJ.V3O1 03sn 839WnN wl ON ❑ 33),[] ONldld 831NMJdS ONnOJO -83ONn JO J3llV1SNl AS 03HSMJ ON ❑ S3A ❑ So ON, WJOJ n 3H1 JO AdOO AS 031JI83A NIVld X3 d3H10 ONid Id 83-NNIdd6 013CVW N01103 N N 03 3J0 A3S 03 HSniJ 3J3S1H N1313 AS Ol SNOIl"_13N NOO NI OV31 ONV NIVW ONnO60830 IN ISd Z9 30IM N3dO 1`40II03NN03 f9d L-N01133NNOO 1531 1S31 NI 3AIV'A H11M 3NnSS3dd lb ^OIS3d is3i Aiddns J31VM dV3N 031VO01 3`0VIJ JO ONICIV3d = ON ❑ 33A ❑ S1831 tVI ElNlddOJ.S JO SW3ISAS SNJi 3 JOJ O38n LON 3N3M+$IVDIW3HO 3+ASOJJOD 83H1O 80 '3M66 '31VD11.3 MOOS 3O S3A71'VAIN3O J031V.^,IlIS Wn100S 'SIVotvGH0 3AI£08JOO ONV S3A11COV 1VH1 JOtOVJINOO N31ANIJd5 3HI 3' A IIIH30 nOA 00 ON ❑ 83A ® Ald3dOdd S31Vd3d01.193WdIn03 V/ N— ON ® S3A ❑ 031531 A11VOIiVWn3Nd ON;dId AHO -NOSV38 3iV1S'ON dl SJH i dOJ ISd OOZ IV 031S31 AllV0ilV1SOJCIAH ONldld llV 'smog h� m isleq Fd) Is Z/L'4 Paaoxa Iqu Ileys ygiym o:p amssW Le ainseaw pue anssa� lie pue larval ia}err. ieuuou F@ 5>Iuel amssa�d Ual smrnl cL u; (sJeq i. 0) fsd 2FL-t paaoxe loJ Ileys 4o!4m dap auissaw pug alnssaid ile (svaq [ Z) [ad 00:#sllge}s3 011VWn3Nd paddols NOIldlMOS30 aq lleys a6e4eal 6uidld punoi6anoge IIV 'e6ewep luananl a} Ise) 6uunp uado Ijai oq Ileys sladdela ante^ adyAp le'loatapio -sing ON uol Ivuq Z pl1 isd 1531 • QS4 )o ssanxa of anssaid ayels anoge (<fgq bC) isd qS lq smog omi ao; (slap g Ell Isd GpZ ueyl ssal tau Ig apgw aq Ileys sisal a;ie{swp6H !lb'1SOJ0 AN '03S "NiW ON s^3A ON 53A 1300W 3NVlN 3SV3138 31VJ3d0 t3SV3l3d 3:`JVA 4lJVIVSSO NOISIAd3dnS 013W11 WnWIXVW 31b'd3dO 1100810 1-IOV3 5300 31Vd3d0 ilnZ dH* HOV3 S3O0 lV CN ❑ San ❑ NO11 341d an NJV'1dX3 ON dI ON11531 dOd mniSD HOV3 Ni AiIIIOVJ 310113SKUV NV 3J3111 Si ON 0 53A ❑ SNOlViS 10811100 310W3d JO/0NV dims IVnNVW 3H1 W0NJ 31Vd3dO 3AIVA S30C ON El 53A 0 03SW63dn5 V!03W ONI103130 ON ❑ 83A ❑ 03SIAN3dnS ONIdId .DMVJCAH ❑ OIJ13313 ❑ 011'YWn3Nd NOI1VJ3dO CONTRACTOR'S MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING Standpipe System NFPA 14 PROCEDURE Upon completion of work, inspection and tests shall be made by the contractors representative and witnessed by an owner's representative. All defects shall be corrected and the system left in service before the 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 that the owner's representative's signature in no way prejudices any claim against the contractor for faulty material, poor workmanship, or failure to comply with the approving authority's requirements or local ordinances. Property name Date 0 6/ 2 6/ 2 0 2 4 UPTOWN NEWPORT RESIDENCE- BUILDING #3 Property address. ;3.2'� ti�-5t 9 UPTOWN NEWPORT DR, NEWPORT BEACH CA Accepted by approving authorities(names) -- Address Plans Installation conforms to accepted plans? b Yes ❑ No Equipment used is approved or listed? 64Yes ❑ No If no, explain deviations. ❑ Automatic dry ❑ Automatic wet ❑ Semiautomatic dry Type of ❑ Manual dry System U Manual wet ❑ Combination standpipe/sprinkler If other, explain. Water Supply -----------------..-..-....._Model Data Used for-------------...--- :'anufactLurer..............-- --._. - ---..............................-----____ Design and As Electric ❑ Diesel Shown on Plans Rated, psi ..—__._.........�._._._ ... Shutoff, psi _.. _. Water supply 3 public waterworks system (gal) U Storage tank - (gal) R Gravity tank - (gal) ❑ Open reservoir (gal) Source Capacity, Gallons ©Other (explain) ------------------------- ff Public Static, psi 78 Residual, psi 62 Flow, 9P m Waterworks _ System: Have Copies of the Following Ci System components instructions M Care and maintenance of system U NFPA 25 Been Provided to 0 Copy of accepted plans 3 Hydraulic data/calculations the Owner or Owner's Representative? Main waterflow shutoff location FS RISER ROOM Supplies Building(s) df bP Number ostandpipe — Pe risers 2 --- Do all standpipe risers have bass of riser shutoff valves? 3Yes ❑ No Valve ZD Locked open O Sealed and tagged M Tamperproof switch ❑ Other Supervision If other, explain. -__._-- ---------------------__---__----- Pipe and Iypeofpipe SCH 10 AND SCH 7 --- --- Fittings Type of fittings RR V C T ..__-.-.-. Hose Hose threads have been verfied for compliance with local fire department ZkYes ❑ No Threads Backflow 3 Double check assembly Size 6 Make and motel WILKINS 450DA Preventor ❑ Reduced -pressure device - - 0 2018 National Fire Protection Association NFPA 14 (p. 1 of 3) (€ to Z A Hl tlddN uo4esoossV uolpaload aJH IeuoilgN 8 WE 0 •ureldxe'ou 11 ON M saA ❑ Lf jadoud poluiedowelsAs uo saAIeA aso4 ptl (!ad) BulAwij I (lad) Bul IWaN 331A3Q 0NIIVVY93H-3kinSS3Hd Isd _— _wnssexi jiy I u011e301 •uleldxe `ou N ON ❑ SfA 0 4Aleadoid palejado aoinap uopmpe 4oe3 ,uleldxo'ou 11 ON ❑ 98A ❑ gpaisal aolAep uo4eAlpg 4oe3 oes --- ulry -- 601Aep u04eA11oe to japow pug wfery Salk 0 ua1"13? ollgwneud sel M uo4 ROR oupa13 saA ❑ uo.pA4ou o!IneJpAW lallno eAlgA esoy alowai payoeaj jeleM swll ®� ulg�dxa `ou 11 oN ❑ SSA ® LApadojd palejado wagltl amssaid jiu lulod dul oas -- - UIN ---_ lallno aAleA asoy 61Owaj payoesj jaleM awlj aunssajd jaleM oes - uiry oiquA espy alowej 46nang dui of ewll 2IHdWVI HS,IM SOL H307H2dI3 331AM 3AIVA10HIN03 Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for 2 hours. Differential dry pipe valve clappers shall be left open during test to Test prevent damage. All aboveground piping leakage shall be stopped. Description Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1'h psi (0.1 bar) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1Y2 psi (0.1 bar) in 24 hours. Hydrostatic Test - Pressure at top of standpipe(s) STP# _l Pressure 2 0 0 (psi) { bar) STP# STP# 2 Pressure 2 0 0 (psi) ( bar) STP# Rreoai ira (PRO ( twr) STP# # p,-essare---(psi)(--bar} All piping hydrostatically tasted at 2 n n psi ( bar) for 2__— fire If no, state reason. Dry piping pneumatically tested? ❑Yes ti) No NOT A DRY SYSTEM Equipment operates properly? 0 Yes U No Do you certify as the standpipe contractor that additives and corrosive chemicals, Tests sodium silicate, or derivatives of sodium silicate, brine, or other corrosive chemicals were not used for testing systems or stopping leaks? td Yes O No Drain Reading of gauge located near water Residual pressure with valve in test test supply test connection _... . ........ -... _ _._. _ psi (------. bar) connection open wide ..................... ... ___-_____. psi ( ._....... _ bar) Underground mains and lead-in connections to system risers flushed before connection made to atandpipe piping. Verified by copy of the underground test form? LA Yes ❑ No ❑ Other (explain) Flushed by installer of underground standpipe piping? �U Yes Lit No m--•�au..�-- �- II most remote standpipe outlet(s). Flow Test Record: Static pressure: psi ( bar) esr bar Nome diameter: in. (—cm) Pilot pressure:. _ . _ _ .- psi ( ------ bar) Total flow: � gpm (-- Umfn) BlankTesting Number used __N/A_ Locations -------- ----.--...-----...._... --------------------- Number removed Weldedpiping LXYes Ll No - If yes ... Do you certify as the standpipe contractor that welding procedures comply with the requirements A Yes a No of at least AWS D10.9, Level AR-3? Welding Do you certify that the welding was performed by waders qualified in compliance with the a Yes ❑ No requirements of at least AWS Of 0.9, Level AR-3? Do you certify that welding was carried out in compliance with a documented quality control 2 Yes - U No procedure to ensure that all discs are retrieved, that openings in piping are smooth, that slag and other welding residue are removed, and that the internal diameters of piping are not penetrated? cutouts Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved? M Yes a No (Discs) Hydraulic Nameplate provided? 0 Yes a No ❑ If no, explain. - - - Data Nameplate Date left in service with all control valves open: 6 / 2-5_/ 2 02 4 Remarks . _------- _-..-.__ Name of Name of contractor ONGUARD FIRE PROTECTION Address118.00 Sterl ng_Ave ,__,Suite LRiverside, CA Sprinkler/ Standpipe Contractor .rsie . _ ... State license number (if applicable) 9 5 0 3 % 8 System Property owner _ Title - wm _ ..,....�_ Date,___ Operating Test Sprinkler/standpipe contractor Title ... __.., ..___.. Data...._ _ ------ Whnessedby Approving authorities Tifle Date Additional Explanation and Notes 0 2018 National Fire Protection Association NFPA 14 (p. 3 of 3)