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_. . . , . . :_ . .. - <br /> : . . . . <br /> 1 <br /> =--= =— Above Ground P.o. Box 1350 <br /> � .� �� . --� , <br />' - - ..,t/t-. �:...;:��:;, -;..;.�=� <br />' , � �''����'� -'�:-"=;,:� '-���� -`'' Largo, Florida 33779-1350 <br />� _. v�� v ,Sprinkle� Piping <br />' CONIIII�RCIAL FIRE (`.727)-530-4521 50901100012004 " ' <br /> & COMMUNICATIONS SITE#: <br />�t. <br /> Contractor's Material �and Test Certificate for Aboveground Piping ,= <br /> PROCEDURE r� � z"`' <br /> Upon completion of work,inspections and fests shall be made by the contractor's representative and witnessed by an owner's representative. All <br /> defects shall be corrected and system left in service before contractor's personnel finally leave the job. <br /> A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities,owners and contractor It is <br /> understood that the owner's representative's signature in no way prejudices any claim against contractor for faulty material,poor workmanship or failure <br /> , to com I with a rovin authori 's re uirements or local ordinances. �,�'`� �r,;i <br /> - Property Name � /f ����� �OU t`� Date��� a��� ' <br /> �,� f <br />, Property Address �U / I � ������_� ;"'� �`� <br /> s � i l� <br /> Accepted by approving authorities(n�mes) � <br /> , Address <br /> , Plans Installation conforms to accepted plans ``0..Yes ❑ No <br /> ' Equipment used is approved `�'q Yes ❑ No � <br /> If no, explain deviations <br /> "" Has person in charge of fire equipment been instructed as '�,Yes ❑ No, �� .� - <br /> ,. to location of control valves and care and maintenance ' <br /> -- of this new equipment? <br /> If no,explain <br /> Instructions <br /> Have copies of the following been left on the premises? ❑ Yes 0. No <br /> � �'1. System components instructions ❑ Yes �[^�], No <br /> ". s� 2. Care and maintenance instructions ❑ Yes �� No <br /> •� 3. NFPA 25 ❑ Yes �� No <br /> Location of Supplies buildings <br /> s stem <br /> - Year of Orifice Temperature <br /> Make Model manufacture size Quantit ratin <br /> ! LJ _r� L��.4.` "�C�/.� R�_'' � /S�'�' <br /> Sprinklers � � � � � <br /> � Pipe and Type of pipe Jc <br /> fittin s T e of fittin s �'�-'� � / A Ca.� <br />, ' Maximum time to operate <br /> Alarm valve Alarm device throu h test connection <br /> or flow T e Make Model Minutes Seconds <br /> indicator <br /> D valve Q.O.D. � � <br /> Make Model Serial no. Make Model Serial no. <br />' ' Time to trip Time water Alarm " <br /> Dry pipe through test Water Air Trip point reached operated <br />� operating connection� ressure ressure air ressure test outlet� ro erl <br />� ��est Minutes Seconds si si si Minutes Seconds Yes No <br /> ' � Without � � <br /> N/ � Q.O.D. <br />� _ With • � � , <br /> Q.O.D <br /> If no explain <br /> 1 Measured from time inspector's test connection is opened <br />'�_F __ _ _ -" _ _ _. � . - <br />