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PIPER fIRE PROTECTION INC. �j 13075 US Highway 19 North Clearwater,Florida 33764 PHONE: 727-581-9339 FAX: 727-581-8332. CONT CTOR'S MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING .. PR EDURE;' . . - UPON OMPLEfION OF WORK,INS CTION AND TESTS SHALL BE MADE BYTHE CONTRACTOR'S REPRESENTATIVE AND WITNESSED BY OWNER'S REPRESENTATIVE(HEREINAFTER _ DEFINED PROPERTY OWN ALL DEFECTS SHALL BE CORRECTED AND SYSTEM LEFT IN SERVICE BEFORE CONTRACTOR'S PERSONNEL FINALLY LEAVE THE JOB. A CERTIFICA ILLED OUT AND SIGNED BY BOTH REPRESENTATIVES. COPIES SHALL BE PREPARED FOR APPROVING AUTHORITIES,OWNERS AND CONTRACTOR. , IT IS UNDERSTOOD THAT THE PROPERTY OWNER'S AUTHORIZED REPRESENTATIVE IS A LEGAL S16NATORYAND'FULLY REPRESENTATIVE OF THE PROPERTY OWNER AND THAT BY THE PROPERTY OWNER'S OR PROPERTY OWNER'S AUTHORIZED REPRESENTATIVE SIGNATURE,THE PROPERTY OWNER ACCEPTS FULL RESPONSIBILITY FOR THE SYSTEM AS INSTALLED AND AGREES THAT IT.IS IN COMPLIANCE WITH THE APPLICABLE APPROVING AUTHORITY'S REQUIREMENTS 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: IPUBLIX STORE#1245 • — DATE:- ( 09/11'/20" PROPERTY ADDRESS: 17838 GALL BOULEVARD,ZEPHYRHILLS, FLORIDA 33541 ACCEPTED BY APPROVING AUTHORITY('S)NAMES. _ CITY OF ZEPHYRHILLS ADDRESS. - I PLANS.. INSTALLATION CONFORMS TO ACCEPTED PLANS: YES EQUIPMENT USED IS'APPROVED YES I- IF NO,STATE DEVIATIONS HAS PROPERTY OWNER OR PROPERTY OWNER'S AUTHORIZED REPRESENTATIVE BEEN INSTRUCTED AS TO THE LOCATION OF CONTROL VALVES.AND CARE AND MAINTENANCE NO OF THIS NEW EQUIPMENT? EXPLAIN."No"ANSWERS: AT TIME OF CLOSEOUTS A AT INSTRUCTIONS HAVE.COPIES OF THE FOLLOWING BEEN GIVEN TO THE PROPERTY OWNER OR PROPERTY OWNER'S REPRESENTATIVE? 1. SYSTEM'COMPONENTS INSTRUCTIONS NO 2. CARE AND MAINTENANCE INSTRUCTIONS 3. NFPA25 . .. . No No EXPLAIN'NO"ANSWERS: T TIME OF CLOSEOUTS SERVES BUILDINGS.OR PORTIONAF BUILDING:' LOCATION OF — — —-- SYSTEM(S) REMODEL AREAS ONLY MAKE .. MODEL :- SIZE • : --QUANTITY: . TEMPERATURE/.STYLE VIKING SR-VK102 1/2"5.6K 23 155F CHROME RECESSED VIKING SR-VK102 1/2"5.6K 11 155F WHITE 401.SKIRT VIKING SR-VK100 1/2"5.6K 20 155F STANDARD UPRIGHT SPRINKLERS OR VIKING SR-VK532 3/4" 11.2K 17 20OF STANDARD UPRIGHT SPRAY NOZZLES VIKING SR-VK154 1/2"5.6K 4 175F 401-SKIRT W/CAGE HEAD TOTAL 75 . _ _OF.PIPE: TYPE OF FITTINGS:- TYPE Pipe AND FITTINGS SCH 10 GROOVE 8o SCH 40 THREAD Cl, DI& MI THREAD AND GROOVED STEEL _ ..ROUGH-IN INSPECTION:BY TESTING OR PNEUMATIC.TESTING • 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)FOR TWO HOURS. DIFFERENTIAL DRY-PIPE VALVE CLAPPERS_SHALL BE LEFT OPEN DURING THE TEST TO PREVENT DAMAGE.ALL ' TEST DESCRIPTION ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED PNEUMATIC: ESTABLISH 40 PSI(2.7 BAR)AIR PRESSURE AND MEASURE DROP,WHICH SHALL NOT EXCEED:1 1R 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 NO_J IF YES.'.:. DO•YOU:CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY �. WITH THE REQUIREMENTS OF.AT LEAST AWS B2.1? - DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY.W ELDERS QUALIFIED IN WELDING COMPLIANCE WITH.T.HE-REQUIREMENTS OF AT LEAST AWS B2.17 DO YOU'CERTIFYTHAT.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," CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS-ARE RETRIEVED? YES UNDERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLE_R.PIPING . UNDERGROUND _ VERIFIED BY,COPY OF UNDERGROUND TEST FORM YES. OTHER: r V . FLUSHED BY.INSTALLER OF.UNDERGROUND SPRINKLER PIPING YES.= ° I '