HomeMy WebLinkAbout07-6451
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
6451
Permit Number: 6451
Permit Type: FIRE PROTECTION
Class of Work: FIRE SPRINKLER
Proposed Use: COMMERCIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 6215 ABB STATION DR 107-108
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: SILVER OAKS VILLAGE
Parcel Number:
10,000.00
2/09/2007
120.00
120.00
2/09/2007 Phone:
INSTALL PARTIAL FIRE SPRINKLER SYSTEM
Name:
Address:
CERVALLOS JUAN
6215 ABBOTT STATION DR (107-108)
ZEPHYRHILLS, FL. 33542
813 788-6257
FIRE PERMIT FEES
rl f1o..lo-d)
.:31 dOl
l (O...v-.
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
NO OCCUPANCY BEFORE C.O.
~ ~.
CONTRA NATURE , PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813.780.0020
City of Zephyrhills Permit App'
Building Department
Date Received
Phone Contact for Permitting
Owner's Name
,;l. v) I {)
PASco ~lON~ M~'btC.
111100 Fl". ~\,J'" ~~.
Owner's Address
Fee Simple Titleholder Name I
Fee Simple Titleholder Address I
Co 'l,.. \ ~
'trm~~~ONAl:-,
-:('mPleteFire ' ION INc.
ProtectJon (" . lYWw.candoifp
jef1/1ce" .COm
.Wayne Le .
DIstrict D . nlgan
3~1; <: eSlgn Manager
Lak uite 101
8 7-048 33811
863-57;'-0486 Fax Cell: 863-
W/enigan@ 89.9-9071
24-HOUR EMERGe. candoifp.com
NCy SERVICE
LOT # I IDle -\ (.;f:>
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JOB ADDRESS
PARCEL 10# I
SUBDIVISION
WORK PROPOSED
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VALUATION OF TOTAL CONSTRue TION
WR.E.C,
NEW CONSTR
INSTALL
ADD/AL T
REPAIR
PROPOSED USE
TYPE OF CONSTRUCTION
SFR
BLOCK
COMM
FRAME
DESCRIPTION OF WORK
BUILDING SIZE
SQ FOOTAGE I
(OBTAINED FROM PROPERTY TAX NOTICE)
o
~ OTHEF 1t',,,,E; '"'it"l"'~
o STEEL D OTHER I
F,~ .c~,,~..J~ ~~~
I HEIGHT I I
.
SIGN
D
DEMOLISH
MOVE 0
D
1$
D ELECTRICAL 1$
D PLUMBING 1$
I 0) OC,>C">
D MECHANICAL 1$
D GAS 0
FINISHED FLOOR ELEVATIONS I
BUILDING
I
1
1
I
D
I
AMP SERVICE
D
D
PROGRESS ENERGY
OTHER
C= YES
NOC-
G.~.~ O?a. dD
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f=JQo tE:CTL6,.J
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ROOFING
VALUATION OF MECHANICAL INSl AI.LATION
SPECIALTY 0
FLOOD ZONE AREA
DNO
BUILDER
SIGNATURE
COMPANY
REGISTERED
License #
COMPANY L;;]
REGISTERED FEE CURRENT
License #
COMPANY ~
REGISTEREO FEE CURRENT
License #
COMPANY C;;;;
REGISTERED FEE CURRENT
Address
ELECTRICIAN I
SIGNATURE ,
Address I
PLUMBER I
SIGNA TURE
I
Add ress
MECHANICAL I
SIGNATURE
Address
OTHER
~\ C. \-riGNATURE
PL. '3~S\:> Address
RESIDENTIAL
FEE CURRENT
~
~
~
~
Jcense # I
Ix,J n;''''IIIAT\OJ~ ~
~ J FEE CURRENT Y / N
Ucense # I
COMMERCIAL
.
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms
Minimum ten (10) working days after submittal date, Required onsite. Construction Plens, Sanitary Facilities & 1 dumpster
Attach (3) sets of Building Plans; (1) set of Energy Forms,
Minimum ten (10) working days after submittal date, Required onsite, Construction Plens, Sanitary Facilities & 1 dumpster
All commercial requirements must meet compliance,
Attach (2) sets of Engineered Plans,
""PROPERTY SURVEY required for all NEW construction,
SIGN PERMIT
.
Directions:
Fill out application completely,
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A/C upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC
Driveways.Not over Counter if on public roadways..needs ROW
Fences (PloVSurvey/Footage)
Fire Chief Robert Hartwig
~
ZEPHYRHILLS FIRE DEPARTMENT
6907 Dairy Road, Zephyrhills, FL 33542
Bus (813) 780-0041 Fax (813) 780-0044
Occupancy No.:
Plan No.: Q7- o~
Business Name: ~, JI..
BusinessAddress: {.~~
Business Phone No.:
Business Fax No.:
Contact:
FIRE SERVICE U~~~~ n .
Q,,~ :::J.M. ~ \C",-b:.\;w,
Billing Address: ~ .' ~~'<. ~~3
Billing Phone No.: gr!> -"04-/383
Billing Fa1S-i:
Contact: ~Yl ~
PERMIT FEE
PLAN REVIEW FEES
~ Site Plan N/C
Building Plans ,04 sf
Revision ,06 sf
STANDPIPE SYSTEM
o Per Riser $25
~ SPRINKLERt;'
- 25 Heads 30
26 plus Heads 0
FIRE PUMP
o Per Pump $100
FIRE ALARM SYSTEM
o 0 - 25 Devices $30
o 26 plus Devices $60
SUPPRESSION SYSTEMS
~ Wet $35
Dry $35
C02 $35
Other $35
GREASENENTILATlON
o Hood/Ducts $35
,0
PLANS TOTAL ~
Comments:
INSPECTION FEES
Annual N/C
1 st Re-inspection $25
2nd Re-inspection $50
3rd Re-inspection $125
4th Re-inspection $250
5th Re-Inspection $500
Construction $15
Commercial $25
SPRINKLER SYSTEMS
Hydro Undergrof'f,ds $45
HYdrostaffc~Yste~'.~
Wet Acceptance ~
Dry Acceptance $45
Hydrant Flow $25
Hood / Booth $30
Grease Duct $15
FIRE ALARM SYSTEM
o System Acceptance $50
D Recall Acceptance $50
OTHER
Fire Wall/Smoke Wall $15
LP Gas $25
Natural Gas $25
Fuel Tanks $25
Tent $15
INSPECTION TOTA~
GRAND TOTAL
FtJ SPRINKLER ~MS
tpJ Automatic ~
FIRE PUMP
D Fire Pump $15
FIRE ALARM SYSTEM
o Detection $15
OTHER
~ LP Gas
Natural Gas
Fire Works
Fuel Tanks
$45
$45
$25
$45
FALSE ALARM FEE
1 st Alarm N/C
2nd Alarm N/C
3rd Alarm N/C
4th Alarm $25
5th Alarm $50
6th Alarm $75
7th Alarm $100
8th Alarm $150
9th Alarm $200
10th Alarm $250
Non Compliance $150
"Affidavit of Service/Repair"
FALSE ALARM I
TOTAL
GREASENENTILATION
n Hood/Ducts $15
D Kitchen suppreSSio~ . $ ~
PERMIT TOTAL~
I~~
2/~4J:-
It ""'I ~4 - Pi
f
Date:
Inspector:
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations, The undersigned assumes responsibility for compliance with any
applicable deed restrictions,
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law, If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible, If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County,
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended, The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting, It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances,
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs, If the applicant is someone
other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated, I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction, I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions I must take to be in compliance, Such agencies include but are not limited to:
Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses,
Army Corps of Engineers-Seawalls, Docks, Navigable Waterways,
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks,
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida,
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction, I understand that a separate permit may be required for electrical work,
plumbing, signs. wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF C M CEMENT.
FLORIDA JURAT (F,S, 117,03)
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
by
Who is/are personally known to me or has/have produced
as identification.
'qor-.
Commission No.
Commission No.
Notary Public
~.1 "'-r---
Name of Notary typed, printed or stamped
Feb, 5. 2007 3:29PM INTERNATIONAL FIRE PROTECTION
No. 8045 P. 1
@ MAiTHEW JONES LICENSE #56212700012005
11COMPLETE FIRE PROTECTION SERVICEn ,
1402 MERCANTU.JE COURT OO~.
PLANT CITY, FL. 33563-1151 ~~ ~
PHONE: 813-754-1383 ~e .. ~
FAX: 813-754-1638 C~\\O
NU"8ER OF PAGES SENT ;st 30NClUOING THIS GOvER SHEET) \..0
IF YOU DO NOT RECEIVE A~S, PLEASE CALL ABOVE NUMBER.
To: X C'-~("-- \'Y\ l~\\~
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INTERNA TIONAL
FIRE PRO-rECTION, INC,
Company:
From:
Date:
Re:
Messoge:
Original: 0 Will Be Sent Via: 0 US Mail 0 UPS 0 FedEx
o Will Not Be Sent 0 Unless Requested
cc:
;_; eFeb. 5. 20070 3:29PM3525:INTERNATIONAL FIRE PROTECTIONNGINEERING
.
..
...
.:- Fax Cover Sheet
No. 8045 p, 2: Ell
PASCO REGIONAL MEDICAL CENTER
ENGINEERING DEPARTMENT
13100 FORT KING ROAD
DADE CIlY, FlORIDA 33525
PHONE: 352.52M 12.
FAX: 352-62.1-1542
, CONFIDENTIAL HEALTH INFORMA 119N NOTS
Thla Fill( may contain ~nftdentl.1 health care Information that Ie peraonaland ..n.lliv. In'onru.t1on. It.. beln"
faxed to you after appropriate authorization frotn the patient or Linder droum..nce. that do not requIre patient
authortzatlon. You, the recipient, may be obligated under Federal or State Law to maintain the Inronnatlon In a
u'o, IOCU", and confide"UaI manner. R.4IeeI0$1I" without addltlorMll ,...ent pennl"'on or .. otherwise
pennltted by law may be prohIbited. Unauthorized re-d1.et08ure or h1l1ura to maintain confldentwllty could
.ubject you to penalties under Federal or State Law
TOI
International Fire Protection. Inc,
,_ Bob R...." by CheIyI ~
Plsnt Operations
Dat., JanuElry 31.2007
,... 813-754-1638
p.._: 2. Including cover
R.:
Purchase Order
ee2
o urv...t 0 For RevlelW 0 '1.... Co"'....nt 0 Pl.... -.ply 0 '1... Recycl.
-Cammont.:
Good Moming!
Following is our Purchase Order 851-C152271 a for tho inr;tall.Uo" of a fire sprinkler system st the PRMC Center for
Wound Haaling and Hyperbaric MedIclne In ZephyrhUls.
IMPORTANT WARNING: This message Is intended for the U8e of the person or entity to which Ills addressed and
,"8Y contain (n~tlon that. Is privileged end confidential, the dlaclosLn of which is g0V8nled by #,lpplleeble law. If
the rmtder of thIS message IS not lhe Intended redpienl. or the employee or agent relponslble 10 deliver it to the
intended recipient, you are hereby notified that any dissemination, dlstnbution or copying of 'his Infonnetion is
STRICTlY PROHIBI1CD. If you h.w received this message in enor. please nodfy lIS Immediately and destroy the
related message.
R ec e i ve d Tim e Jan. 31, 9: 37 AM
Feb. 5. 2007 3:29PM
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State of
r':i ,NOTICE OF COMMENCEMENT .. ~W~~~IW"JII"I"II1I11I1I"IIIIII""I"1
r lo {;\. ~ County of PC( ~ CO ' ;
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,
and in accordance with Chapter 713, Florida St:,ltutes, the following information is provided in
this Notice of Commencement:
1. Description of Property: ParcelNo. 0> -~,-~I ~"~Q:) -OC)~oO-OOO
J if - <P,c:>.e~ c;~I\~1\.A.1 €,-Nlu' K,,~,' ~ I S- '-'~Olt- S"''kbl'- j)r, 'Zefkyr k'-;ls~
(Legal description of the property and eet address if available) F-L ~ ~ S-'f~
2. General Description of Improvement f= i lie. S p'\"-\' ill, -e. ("' So ,y5t-e.v'1..
" \"\ ~ P e. ~\n 0- \\,' L C k'V\. ~ R_O)l"..) ,.....,
R'
3. OwnerInfonnation:Name A-s~...^ ~~t-, t-[C .
Address_PO gOY 4tl City -r~felL State PL 33~C;1
Interest in Property: Ow ,,,tor /~...r
Name of Fee Simple TItlehOlder:' - .: ""-. \-<> '" ~ ~ ~ . L [(
(If other than owner) l.,)
Address City State
Contractor: Name -;::{t~~'o~ (\",e:.. ~\O~c-\-1\o fI. I "]:1"\'--
Address 5)1 / ~~ g l u ,.l. Ste-fityJ2,i:A ~e b~State F L '338] J
5. Surety: Name
Address
Amount of Bond: $
6. Lender: Name
Address
City
State
Rcpt: 1072838 Rec: 10.00
DS: 0.00 IT: 0.00
02/09/07 Dpty Clerk
State
City
7. Persons within the State of Florida designated by Owner upon whom notices or other
documents may be served as provided by Section 713.13 (1) (a) (7), Florida Statutes:
Name
Address
City
State
8. In addition to himself, Owner designates
of to receive a copy of the Lienor's Notice as
provided in Section 713.13 (1) (b), Florida Statutes.
9. Expiration date of Notice of Commencement (the expiration date is 1 year from the date
of recording unless a different date isrecified.) ,
~ JED PITTnAN4 PASCO COUNTY CLERK
l I I 02/09/07 0 : llpm 1 of 1
Signature of Owner: ~ ~q OR BK 7383 PG 87
swOmIOand}U~~befRemethis~aYOf ~, ,20J[j.
Notary Public:~ l \l (1, .\J... ~
My Commission Expires: 5.-
PC93053048/A r-p(-l1l\.e.,\ fT ad.. 'rvt. ~
~D\<33l{~7
t: J ' , Noc.y ~.i State of Florida
\;4 j My ~IOII Expires May 6. 2007
. ".1..",,,~ Ccimmisslon # 00183477
.."", Bonded B .
., National Notary Assn.
May, 23. 2007 12:06PM INTERNATIONAL FIRE PROTECTION
To:
Company:
From:
Date:
Re:
Message:
No.0341 P. 1
NTERNA TONAL
FIRE PROTECTION, INC.
8 MATTHEW JONES LICENSE #56212700012005
"COMPLETE FIRE PROTECTION SERVICE" "oot!
1402 MERCANTILE COURT V
PLANT CITY, FL. 33563-1151 "I n,(,4J
PHONE: 813-754-1383 ~ l~u
FAX: 813-754-1638
E-MAIL: wlenigan@candoifp.com
NUMBER OF PAGES SENT __,]_ (INCLUDING THIS COVER SHEET)
IF YOU DO NOT RECEIVE ALL PAGES, PLEASE CALL ABOVE NUMBER.
tiott
~oClo;
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- ~. L,t:>~__. 'b~:l:...._
Wayne Lenigan, District Design Manager
S/1,1 OJ'
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...~ --. ,....-- .--,...._..~~
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Original: 0 Will Be Sent Via: 0 US Moil 0 UPS 0 FedEx
~ Not Be Sent ~ess Requested
cc:
May. 23. 2007 12: 06PM
INTERNATIONAL FIRE PROTECTION
No, 0341
P. 2
International Fire Protection, Inc.
1402 Mercantile Court
Plant City, FL 33563
Contractors 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 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 u"derstood the owner's representative's sig"ature 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 NAME: DIVERSIFIED THERAPY
PROPERTY ADDRESS; 6215 ABBOTT STATION DRIVE, ZEPHYRHILLS, FL Permit #:
ACCEPTED BY APPROVING AUTHORITIES (NAMES) : CITY OF ZEPHYRHILLS
PLANS ADDRESS: ZEPHYRHILLS, FLORIDA
INSTALLATION CONFORMS TO ACCEPTED PLANS DYES DNO
EQUIPMENT USeD IS APPROVED DYES DNO
IF NO. EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS DYES DNO
TO L.OCATlON OF CONTROL VALVES AND CARE AND MAINTENANCE
OFTHIS NEW EQUIPMENT
INSTRUCTIONS IF NO, EXPLAIN
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: DYES DNO
1 SYSTEM COMPONENTS INSTRUCTIONS DYES DNO
2 CARE AND MAINTENANCE INSTRUCTIONS DYES DNO
3 NFPA 25 DYES DNO
LOCATION Supplies Building(s); New Warehouse with Office
- vn,'rlvl: ._,
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
VIKING MIRAGE it:UUIl K"'8 9 155 F
SPRINKLERS
PIPE AND Type of Pipe: CPVC & 5ch 10 & 40 Galv Steel Pips
FITTINGS Type of Fillings: CPVC & Threaded Cast Iron & Grooved Ductile Iron
11M!: I U u..t:KA I t:
ALARM VAL.Ve ALARM DEVICE THROUGH TEST CONNECTION
OR FLOW TYPE I MAI\t: I MODEL MIN. I SEC.
INDICATOR Flow I I I
Tamper I I I
DRY VALVE I \,I.U,D,
MAKt: MuDEL I SERIAL NU. I IVIAI\!: I MUUt:L ~eRIAL NO.
N1A I I I
TIME TO TRIP TIMt: VW\/t:K ALAKM
THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
DRY PIPE CONNtC1ION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET" PROPERLY
OPERATING MIN, ::;~{;. P::;I PSi ,....1 MIN. ;;it:~. YI:::> NO
TEST WlTIIOUT
0,0.0.
WITH
a.o,u,
IIF NO, EXPLAIN:
OPERATION:
DPNEUMATIC DELECTRIC DHYDRAULIC
N/A PIPING SUPERVISED YES LTI NO DETECTING MEDIA SUPERVISED DYES CJNO
DOES VALVE OPERATE FROM THE MANUAL TRIP, REMOTE. OR BOTH DYES DNO
DELUGE AND CONTROL STATIONS
PREACTION IS THERE AN ACCE$SI61.E FACILITY IN EACH CIRCUIT IF NO, EXPLAIN:
VALVES FOR TESTING DYES DNO
DOES EACH CIRCUIT OPC:RATt: DOl'S FACH CIRClIlT OI'ERA 1'1, MAl\IMUM liME 10
MAKE MODEL SUPERVISION LOSS ALARM '1 VN.VF RF.LF.A$F? OPI=RATF RFI.I::ASF
YE~ I NO yt:~ I NU I
I I 1
May. 23. 2007 12:06PM
/ I
SIGNATURES PROPI::RTY OWN .
(SIGNEDBY) /~rf~
SPRINKLER OR -
(SIGNED BY) ~~. 'CJ.M
ADDITIONAL EXPLANATION AND NOTES:
IFP ProjGCl #12C07020
N/A
PRESSURE
ReOUCING
VALVE TEST
TEST
DESCRIPTION
TESTS
BLANK
TI::STING
GASKETS
WELDING
CUTOUTS
(DISCS)
HYURAUlIC DATA
NAMEPLATE
REMARKS
INTERNATIONAL FIRE PROTECTION
No. 0341
P. 3
International Fire Protection, Inc.
1402 Mercantile Court
Plant City, FL 33563
MAKE & Sr::ll,...ul
MODEL
:s I A II~ PRe~~URE
FLOW RA I t:
(FLOWING)
INLt: I (t'~I) I UU I Lt:T (P~I) INLET (PSI)! oUTLt: I .
I I
.HYDRO~ 'A Lj:, HyarostatlC lests shall be make at not less lnan LUU pSI (13.6 Dars) for 2 hours or 50 pSI (3.4 Dars)
above static pressure in excess of 150 psi (102 bars) far 2 hours. Differential dry-pipe valve clappers shall be left
open during the lest to prevent damage. All aboveground piping leakage shall be stopped.
PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop. which shall not exceed 11/2 psi (0.1 bars)
in 24 hours. Test pressure tanks at nonnal water level and air pressure and measure air pressure drop, which shall
not exceed 11/2 psi (0,1 bars) in 24 hours.
All piping hydrostatically tested at Dsi oveL!tliltic for hrs,
Dry piping pneumatically tested DYES DNO
Equipment operates properly []]YES DNO
Do you certify as the Sprinkler Contractor that additives and corrosive chemicals.
sodium silicate or derivatives of sodium silicat., brine, or other corrosive chemicals
were not used for testing systems or stopping leaks? [!]YES DNO
DRAIN I Reading of gaug.'ocated near water I Residual pressure with valve in test
TEST I supply test connection: _ psi ~bars) lconnection open wide: _ psi ~ bars)
Underground mains and lead in connections to system risers flushed before OTHER - EXPLAIN
connection made to sprinkler piping.
Verified by copy ofthe U form no. 85B
Flushed by installer of underground
sprinkler piping
If powder driven fasteners are used in
concrete, has representative sample DYES
testing been satisfactorily completed'?
NUMBER USED
M)
IF NO, STATE REASON
DYES
DYES
DNO
DNO
DNO
IF NO, 8CPLAIN
LOCATIONS
NUMBER REMOVED
WELDED PIPING
DYI::S
DNO
IF YES
Do you certiry as the Sprinkler Contractor that welding procedures comply
with the requiremenlS or at least AWS 010.9. level AR-3 ?
Do you certify that the welding was performed by welders qualified in
compliance with the requirements of at least AWS 010.9, level AR-3 .,
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 diameters of piping are not penetrated?
Do you certify that you have a control reature to ensure that all
cutouts (discs) are retrieved?
DYI::S
DYES
DNO
DNO
DYES
DNO
DYES DNO
IF NO. EXPLAIN
NAMEPLATE PROVIDI::D
YES
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN
NAME OF SPRINKLER CONTRACTOR
INTERNATIONAL FIRE PROTECTION. INC.
.,
TESTS WITNESSED BY
. vVI~ST_ SUPT. OR PROJECT MJR.
A
,- TITL.1.. .Q. II DA IFf I
)...'/v lS/, /d?
TITLE DATE/ ,
FOReMAN 3/ ( 1~7
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