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NATIONAL Contr - tors Material and Test Certificate for boveground Piping F�� �� 'A.Procedure Upon completion of work,inspection and tests shall be made by th�contractor's representative and 'O'��1ON'�"` 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.All "No"answers shall be explained in the Comments portion of this form. Property Name: F�.a"bo� �a��Wc �b Address: SA3� �(Q-11 �$\ Date: � O.Tests B.Plans 1 All piping hydrostatically tested at z0� psi for z hours 1.Accepted by Approving Authorities(Names):(�',a,��„�n�� 2. Dry piping pneumatically tested C�Yes ❑No 2.Address: � 3.Equipment operates properly r�Yes ❑No 3.Installation conforms to accepted plans r,l1'es ❑No 4.Do you certify as the sprinkler contractor that additives and 4 EGuipment used is approved r�Yes ❑No corrosive chemicals,sodium silicate or derivatives of sodium C.Instructions silicate,brine,or other corrosive chemicals were not used for 1.Has person in charge of fire equipment been testing systems or stopping leaks? �Yes ❑No instructed as to location of control valves and � care and maintenance of this new equipment uYes ❑No 5.Drain Test: a.Static pressure reading of gage 2.Have copies of the following been left on the premises: located near water supply connection � psi. a.System components instructions u�Yes ❑No b.Residual pressure with b.Care and maintenance instructions [�es ❑No valve in test connection open wide ss psi. c.NFPA 25 [�Yes ❑No 6.Underground mains and lead in connections to D.Location of system-Supplies building(s): risers flushed before connection made to sprinkler E.S rinklers piping and verified by copy of form No. 13-U �Yes ❑No Make Model Year Made Orifice Quantity Temperature 7,Flushed by installer of underground piping O Yes ❑No 8.If powder driven fasteners are used in concrete, � has representative sample testing been satisfactorily / �L S(9�S Zb�z �1. �2a 2�a dYes ❑No completed? P.Blank Testing Gaskets 1 Number used: 2.Locations: 3.Number removed: Q.Welded Piping-If welded piping was used in the system, F.Pipe and Fittings complete the following: 1.Type of Pipe: `S3�V- SC�4 y� 1.As the sprinkler contractor,were welding procedures in 2.Type of Fittings: �c� W lrl. -M�� compliance with the requirements of at least AWS B2. G.Alarm Valve or Flow Indicator ASME Section IX or other required standards Yes ❑No 2.Was welding performed by welders qualified in (�� compliance with the requirements of at least AWS B2J, � \�L ASME Section IX or other required standards I�Yes ❑No H.Dry-Pipe Valve 3.Do you certify that welding was carried out in compliance Make,Model and Serial Number: with a documented quality control procedure to insure that all discs are retrieved,openings in pipe are smooth,slag and I.Quick Opening Device(Q.O.D.) other welding residue are removed,the intemal diameters of Make,Model and Serial Number: piping are not penetrated,completed welds are free from cracks, J.Dry-Pipe System Operating Test Without Q.O.D. incomplete fusion,surface porosity greater than 1/16 inch in 1.Time to trip through test connection*: diameter,undercut deeper than the lesser of 25%of the wall 2.Water pressure psi. Air pressure psi. thickness or 1/32 inch,and the completed circumferen�al 3.Trip point air pressure psi. 4.Time water reached test outlet*: butt weld reinforcement does not exceed 3/32 inch?�Yes ❑No 5.Alann operated properly ❑Yes ❑No R.Cutouts(Disks) K.Dry-Pipe System Operating Test With Q.O.D. Do you certify that you have a control feature to 1.Time to trip through test connection*: ensure that all cutouts(disks)are retrieved? �Yes ❑No 2.Water pressure psi. Air pressure psi. S.Hydraulic Data Nameplate Provided C�Yes ❑No 3.Trip point air pressure psi. T.Date left in service(with all control valves open): 4.Time water reached test outlet*: U.Signatures 5.Alarm operated properly ❑Yes ❑No 1 Name of sprinkler contractor:��^Q\ �� o��`�?'� L.Deluge and Preaction Valves 2.Tests witnessed by 1.Make&Model: For property owner(Signed): Title: Date: 2.Operation: ❑Pneumatic ❑Electric ❑Hydraulic For sprinkler contractor(Signed): 3.Piping and detecting media supervised ❑Y.es ❑No Title: Date: 4.Does valve operate from manual trip and/or V.Comments(This section is for additional explanation and notes. All remote control stations ❑Yes ❑No "No"answers must be explained here.) 5.Is there an accessible facility in each circuit for testing OYes ❑No 6.Does each circuit operate supervision loss alarm OYes ❑No 7.Does each circuit operate valve release ❑Yes ❑No 8.Maximum time to operate release: M.Pressure Reducing Valve 1.Location and Floor: 1 2.Make and Model: 3.Setting: Static Pressure: Inlet _psi, Outlet _�si 4.Residual Pressure(Flowing):Inlet psi, Outlet psi 5 Flow Rate: gpm N.Test Description j�Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi for two hours or 50 psi above static pressure in excess of 150 psi for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage.All aboveground piping leakage shall be stopped. Pneumatic: Establish 40 psi air pressure and measure drop. Test pressure tanks at normal water level and air pressure and measure air pressure drop. In both cases,the pressure drop shall not exceed 1'/�psi in 24 hrs. *Measured from the time the inspector's test connection is opened ❑Check here if comments continue on the reverse side of this form 02007 National Fire Sprinkler Association,40 Jon Barrett Road Patterson,NY 12563(845)878-4200 Form 13-A,Page 1 of 1