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-- - �� - � - PIPER FIRE PEZOTECTI.ON INC._ � - - - _ _ ' -- - 13075 US Highway 19 North = __ � - - -- _- : - _ - - Clearwater,Florida 33764 _ _.. -_- _ __-_ - _ _ - = - � -- PHONE: 727-581-9339 FAX: 727-581-8332 _ - - .- = CONTRACTOR'S_MATERIAL AND-TEST CERTIFICATE FOR ABOVEGROUND_PIPING__.- � - PROCEDURE: :.: - - - " - -- - _ _ _ - _ - ° - ---- - UPON COMPLETION OF WORK,INSPECTION AND TESTS SHALL BE MADE BYTHE CONTRACTOR'S REPRESENTATIVE AND WITNESSED BYOWNER'S REPRESENTATNE(HEREINAFfER DEFINED AS PROPERTY OW NER).ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S PERSONNEL FINALLY LEAVE THE J06.� ._ A CERTIFICATE SHALL BE FILLED OUT AND SIGNED BY BOTH REPRESENTATNES. COPIES SHALL BE PREPARED FOR APPROVING AUTHORITIES,OW NERS AND CONTRACTOR IT IS UNDERSTOOD THAT THE PROPERTY OWNER'S AUTHORIZED REPRESENTATNE IS A LEGAL SIGNATORYAND FULLY REPRESENTATNE OF THE PROPERTY OWNER AND THAT BY THE PROPERTY OW NER'S OR PROPERN OW NER'S AUTHORIZED REPRESENTATNE SIGNATURE,THE PROPERTY OW NER ACCEPTS FULL RESPONSIBILITY FOR THE SYSTEM AS INSTALLED AND AGREES THAT IT IS IN COMPLIANCE W ITH THE APPLICABLE APPROVING AUTHORIII"S RE�UIREMENTS AND LOCAL ORDINANCES. NOTE:NFPA 13,10-2.2 MODIFICATIONS AFFECTING 20 OR FEWER SPRINKLERS SHALL NOT REQUIRE TESTING IN EXCESS OF SYSTEM PRESSURE. MODIFICATIONS THAT CANNOT BE ISOLATED,SUCH AS RELOCATED DROPS,SHALL NOT REQUIRE TESTING IN EXCESS OF SYSTEM WORKING PRESSURE. PROPERTY NAME: I BEALL'S OUTLET#542 oATE' _ __ -__-__ _ i PROPERTYADDRESS: C6030 GALL BLVD.ZEPHYRHILLS, FL 33542 ACCEPTED BY APPROVING AOTHORITY('S)NAMES i CITY OF ZEPIiYRFiILLS FIRE IVIARSHAL ADDRESS I Puws 5335 8TH STREET ZEPHYRHILLS FL 33542 INSTALLATION CONFORMS TO ACCEPTED PLANS: EQUIPMENT USED IS APPROVED IF NO,STATE DEVIATIONS r --'_- ----- -._s_ ._----— -___.__-•---- ------------- - ----- —-- --- 1 -- , HAS PROPERTY OWNER OR PROPERTY OWNER'S AUTHORIZED REPRESENTATIVE BEEN INSTRUCTED AS TO THE LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE N� OF THIS NEW EQUIPMENT? __ _i_ _ EXPLAIN"NO"ANSWERS: f V---•---- ---- +- - -------T-- ---- -__.-_ - ------------- - -- ------- -•----- � iAt time of close-outs INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN GIVEN TO THE PROPERTY OWNER OR PROPERTY � OWNER'S REPRESENTATIVE? 1. SYSTEM COMPONENTS INSTRUCTIONS N 2. CARE AND MAINTENANCE INSTRUCTIONS 3. NFPA 25 p EXPLAIN"NO"ANSWERS: iAt t1IT1@ Of CIOS@-OUtS T ` � � - -- _ —__,_a_� _,_ LOCATION OP SERVES BUILDINGS OR PORTION OF BUILDING: SYSTEM(S) Entire Building MAKE MODEL SIZE QUANTITY TEMPERATURE/STYLE TY -L 3211 1 2' PT, 5.6K 165°F 401 DEEP NDENT SPRINKLERS OR SPRAY NOZZLES TYPE OF PIPE: TYPE OF FITTINGS: � -� - - ___ ...��- - - - - -_- _ -_ ,- - - ----- - -- ----- - - F- ---- - - - ---- - PIPE AND FITTINGS SCH 10 GROOVE$SCH 40 THREAD CI, DI 8 MI THREAD AND GROOVED STEEL ROUGH-IN/NSPECT/ON: HYDROSTAT/C TESTING OR PNEUMAT/C TEST/NG HYDROSTATIC: HYDROSTATIC TESTS SHALL BE MADE AT NOT LESS THAN 200 PSI(13.6 BAR)FOR TWO HOURS OR 50 PSI(3.4 BAR)ABOVE STATIC PRESSURE IN EXCESS OF 150 PSI(10.2 BAR)FORTVJO HOURS. DIFFERENTIAL DRY-PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DURING THE TEST TO PREVENT DAMAGE.ALL TEST DESCRIPTION '�OVEGROUND PIPING LEAKAGE SHALL BE STOPPED PNEUMATIC: ESTABLISH 40 PSI(2.7 BAR)AIR PRESSURE AND MEASURE DROP,WHICH SHALL NOT EXCEED 1 1/2 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 1 1/2 PSI(0.1 bar)IN 24 HOURS. WELDED PIPING L_ NO • IF YES.... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY �_ N/A _, W ITH THE REQUIREMENTS OF AT LEAST AWS B2.1? DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN �_ N/A____ WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT.LEAST AWS B2.1? 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 [ _N%A __, INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED. ' CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS ARE RETRIEVED? I YES UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING UNDERGROUND VERIFIED BY COPY OF UNDERGROUND TEST FORM ' N/A , OTHER: FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING I N/A !