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� � �/ �v�� <br /> ti <br /> Contractors Material and Test Certificate for Aboveground Piping <br /> PROCEDURE <br /> Upon completion of work.InspecUon and test shall be made by the contractors representative and witnessed by an owners representaWe <br /> All defects shall be corrected and system lett in service before contractors personel Rnally leave the job. <br /> A certiflcate shall be filled out and signed by both repreaeMatives.Copies shall be prepared for approving authoritiss,owners,and <br /> contractor.It is understood the owner's represeMative'a slgnature in no way prejudices any clain agalnst contractor for faully materlal,poor <br /> workmanahip,or failure to comply with approving authority'a requirements or local ordinances. <br /> Properly name Panera Date <br /> Properly address 7242 Gall Blvd <br /> Accepted by approving authorities City of Zephyrhills <br /> Address <br /> Plans Installatlon confortns to accepted plans �X Yes � No <br /> Equipment used is approved OX Yes � No <br /> If no,explain deviations <br /> Has person in charge of flre equpiment been instructed as �X Yes � No <br /> to Iceatlon of control valvea and care and mafntenance <br /> of this new equipment7 <br /> If no,explain? <br /> Instructlons <br /> Have copies of the following been left on the premises? �X Yes � No <br /> 1 System components insWction �X Yes � No <br /> 2 Care and maintenance instrucUons �X Yes � No <br /> 3 NFPA 25 �X Yes � No <br /> Lceation of aystem Supplies building See Site Plan <br /> ear o ce empe re <br /> a e e manu re a ze uan ng <br /> Sprinklers <br /> pe an ype o p pe na ow c u e <br /> flttinga Type of fittings roov an rea ngs <br /> ax�mum me o ope <br /> Alarm Alarm device through test connectlon <br /> valve or ype a e e nu scon s <br /> flow ow ys m nsor <br /> Indicator <br /> ry va e <br /> Make Model Serlal no. Make Model Serial no. <br /> Dry pipe me o p me w r arm <br /> operating through test Water Air Trip pioM reached operated <br /> test connection pressure pressure air pressure best outlet properly <br /> Minutes Seconda psi psi psi Minutes Seconds Yes No <br /> 0 <br /> no,exp a n <br /> pe on <br /> �Pneumatic � Electric � Hydraulics <br /> Piping supervised Yes No Detectlng media aupervised Yes No <br /> Does valve operate from the manual Vip,remote,or both �Yes �No <br /> Deluge and control statlons? <br /> preactlon s ere an assess e c n eac c rcu ne,exp a n <br /> valves forteating <br /> OYes �No <br /> oes eac c rcu ope oes eac c rcu ope ax mum me o <br /> Make Model supervision loss alarm� valve release? operate release <br /> Yes No Yes No Minutea Seconds <br />