HomeMy WebLinkAboutCERTIFICATE3� �NNE(J
Contractors Material and Test Certificate for Aboveground Piping tWE? COU
PROCEDURE
Upon complatbrtaf Walk lnspect m and test$ sha3 be made try N10 COnUaslp'a.repreeenlaGW ilia witnessed by an owner's
fermentative. All defects W11 be odratk and gstsm lefttil "Mcebelare bohbddlofs"personnel Onatly leave the )ab.
A certificate shag be ffied.m and e)gAW by both representatives. Copies shell be prepared rdr ap'proviag autnoritiee, ae4era, and
oonbactor. It is understood Ina owiefs repre5eaW0yes eigherura'"r*waynlsorpreloalces and claim against contrador for faulty material. poor
warkmanSW of fa,7ure to with a i ',Wirod a 'ranekKal ordinances.
PRQPERTYNAME
ROSSER LIBRARY
DATE
'4/11l20t7
2960 S TYAOSSE R
Z950 SW ROBBER BIND
t\ r7
v
ACCEPTED RYAPPROVINGAVTHORITIES (NAMES)
SAINT LUCIE COUNTY FIRE DISTRICT
ADDRESS
5160 NW MILNER DRIVE
APR 19 BE
PLANS
INSTALLATION CONFORMS TO ACCEPTED PLANS
EQUIPMENT USED IS APPROVED
IF NO, EXPLAIN
O YES CIRO
[am 0110
// (/ v`+V
INSTRUCTIONS
HAS'. PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS AYES NO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
Of'THIS NEW EQUIPMENT?
IF NO, EXPLAIN
HAVE COPIES -OF THE FOLLOWING BEEN LEFT ON THE PREMISES: vras UNO
1. SYSTEM COMPONENTS INSTRUCTIONS 171ss ONO
2. CARE AND MAINTENANCE INSTRUOTIONS Ows ❑No
3. NFPA25 @WS CI No
LOCATION
OF SYSTEM
NORTHEAST SIDE OF BUILDING,
MAKE
MODEL
YEAR QF
MANUFACTURE
ORIFICE
SIZE
'
QUANTITY
TEMPERATURE RATING
"TYCO
TY323
.2016
1YY'
'186
155
SPRINKLERS
PIPE AND
T of Pi Confarmsto NFPA13Standards
FITTINGS
Type ofReims Conforms to NFPA 13Standards
ALARM
VALVE
ALARM DEVICE..
MAXIMUM TIME TO OPERATE THOROUGH TEST CONNECTION
TYPE I MAKE
MODEL
MIN.
SEC.
ORFLOW
INDICATOR
FLOW SWITCH POTTERVSRZ.
I
So .
DRY VALVE
C,O.D.
MAKE
MODEL
SERIAL NO.
MAKE
MODEL I
SERLALNO.
DRY PIPE
TIME TO TRIP THROUGH
TEST CONNECTION!
WATER
PRESSURE AIR
PRESSURE
TRIP POINT
AIR PRESSURE
TIME WATER
REACHED
TEST OUTLET•
ALARM
OPERATED
PROPERLY
OPERATING
MIN
SEC'
PSI
Psi
P31
MIN
SEC
YES
NO
TEST
Q:OD. -
NIA
WDt1
0.0.13;
o
Q
IF NO. EXPIAIN
'MEASURED FROM TIME INSPECTORS TEST CONNECTIONS 15 OPENED,
Page 1
Aboveground
OPERATION ❑ PNE@UTIC 'O ELECTRIC ❑ RYDRAWC.
NIA
PIPING SUPERVISED ❑YES ONO pETEC71N6 MEDIA SUPERVISED TES ❑�
DOES VALVE OPERATEFROM THE MANUAL TRIP ANDIOR REMOTE - , Yd ONO
CONTROL STATIONS
DELUGE& 'IS
THEREAN.AGCESBIBLE.FACILITY IN EACH CIRCUIT IF NO. E%PLNN
PRFACTION
FORTESTING
VALVES
YEe No
WES EACH CIRCUIT OPERATE
DOES EACH CIRCUIT
MAXIMUM TIME TO
MAKE'
MODEL.
SUPERV13lON LOSS ALARM
QPEFATE VALVERELEASE
OPERATE RELEASE
YE
NO
-YES
NO
MIN
SEC
0
Q
Q
LOCATION
MAKE:&
SETTING
-STATIC PRESSURE
RE DUAL -PRESSURE
FLOW RATE
REDUCING
VALVE TEST
S FLOOR
MODEL
WA
IN SI OUTLET PSI
FLOWING
INLET PS - -OUTLET PSI
LO GPM
O SEE ANNEX
ANNEX
ANNEX
ANNEX
AN EX
ANNEX ANNEX
ANNEX
abovestaffs pressure in excess of ISO psi(10.2 bare) for two houts. DI(feranAel.tllyplpe valve dappers shall tie loft
TEST
epen+luiin0lestio prai!en Cama,Ae. Allnbeveg=ndpipinglea%apashaAbastoppecE
DESCRIPTION
PNEUMATIC; Establish du psi (2.?Aam).air pressure end messure drop, which shay notexceed 1.1I2 psi (0.16ars)
in 20ows. Test pressure tsn%s atnom e) watec levsland at( pleasure and Measure off pressure dmP. wNdi shell
not exceed 1-112 osl 0.1 bars)in 24 home. -
ALL PIPING TESTED AT 200 PSI 'FOR 2 HRS, IF NO; STATE RFJiSON
DRY'PIPINGPNEUMATICALLY TESTED' QrE@ ONo
EQUIPMENT OPERATES:PROPERLY OYES ❑NO
DO YOU CERTIFY AS THE SPRINKLERCQNTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS.
SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, GRINS; OR OTHER CORROSIVECHEMICALS
WERE NOT USED FOR TESTINGSYSTEMS-OR-STOPPING LEAKS?
O+ 1Ts Q NO.
TESTS
DRAIN READING OF GAUGE LOCATED NEAR WATER
RESIpUAL PRESSURE WITH VALVE IN TEST
TEST PPLY TEST CONNECTION TB PSI
CONNEOTIONOPENWIDE 72 PSI
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERSPLUSHED
BEFORE
CONNECTION MADE TO SPRINKLER PIPING.
VERIFIED BY COPY OF THE U FORM NO.850 ED ns ONO
OTHER EXPINN
FLUSHED BY INSTALLER OF UNDER
GROUND SPRINKLER PIPING ons ONO
IF POWDER DRIVEN FASTENERS ARE USED ONO IN + YFe _ NO
1FFNO. EXPLAIN
CONCRETE,. HAS REPRESENTATIVE SAMPLE
TESTING BEEN TISFA ORILY COMPLETED7'
OLANKTESTING
NUMBER USED
LODATIONS
NUMBER REMOVED'
GASKETS
0
1A
WELDED PIPING Lam -u NO:
IFYES
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING
PROCEDURES COMPLYWITH'THEREQUIREMENTS OF AT LEAST [am CJ NO
AWS,DIU:B, LEVEL AR47
OOYOU CERTIFYTHAT THE.WELOING. WAS PERFORMED BY WELDERS
WELDING
[aYES rjNo
AWS DtO:A, LEVFLAR-37
DOYOU CERTIFYTHAT WELDING WAS CARRIED OUT IN COMPLIANCE
WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE
THAT ALL DISCS ARE,RETRIEYED, THAT OPENINGS IN PIPING ARE p+rES OxO.
SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED.
.
AND THAT THE INTERNAL DIAMETERS OF PIPNOARE OT PENETRATED?
CUTOUTS
DO YOUCERTIFY THATYOU HAVEACONTROL..FEATURNE-TO - Q+YES [I No
DI-
ENSURE THAT ALL CUTOUTS(OISCS) ARE RETRIEVED?
HYDRAULIC
NAMEPLATEPROVIDED
IF NO; EXPLAIN
DATA
.YES' NO
NAMEPLATE
REMARKS
Date leftinseM with all m Irotvalveao n.04.11.2017
NAME OF SPRINKLER CONTRACTOR:
RBK FIRE SYSTEMS INC' STATE LIC NFPC14.000010
2385 VISTA PKWY, STE.10 WEST PALM BEACH. FL 33411
TESTSYWTNESSED BY
SIGNATURE$
FORPROPERT ;OWNE 4 D) -
TITLE ,Off.-J ►�
DATE
I•t♦ ++t -.rs-a.
FOR SPRINKLE ON7 TO
-d Ape N
TITLE
DATE
BASILIO.RIABOU(WA
QUALIFIER
Vi2F2017
ADDITI L P IONANDNOTES
Page 2