31B-282 Sprinkler Piping Test 2012-05-15.: ", (4 . tJ It'
Contractor's M'terial. & T,at Certlftcate for Abovegrounln"'flH1~~~~~
'AdditIonal printed cepiN;of.tbls form are avill,blt.to Inauredl form: , .'
Corporate Commant9i~oilt, Faotory Mu'ual, 1~'1 lo.C0'J!/OVIdOllot ruMp/ko. ',0. lox ,102, Norwood, MA 01002
Procedure: Upon cqmpleUon of WOrkl Inlpeotlon and telt. than b6 mlde b~ tht oontl'lotofl ropr ... ntadv •• nd wltn ... td by an owner' •
. representalil1e. All defeots 8hall be oorreOtecl.nd .yattm left In ItNloe afore oontrlotofs pnonnel ftnally !elv. \hi Job.
A certificate shall be filled out and II;nl4 bV both r.pl'tPl\lIUvtI. Qopltllhallbt P/WPIfId for approving luthorltltl, own .. 1 and
. ,conlraCtor. It 1$ und8l1tcOd the ownefl roprtRntaUv .. s'gnatureln no WI':/ prtlucllou Iny ol,lm I;t.lnat the contraotor for faulty m.lI~ll, poor
workma~hlp or faUureto comply wIt~ approYlnu lu\hOritye requirement. or IooIlordlnanoe ••
Installallon
equipment
Location: I Supp!l~ Buildings: " .. our< jl~ or Zone.
ONO
on premises? No
. $ rinldei'a:
-
PIDO'and Flttlnas:
Fittings conform to
If no, explain:
Dry Pipe Operating TefiI-
• Make· .... DIYVatve
. Model .
v'' e:.+, ... , I j t.. ~;I'tl .. ,.l-. NXT
Dry Pipe Operating Test (Continued)
@1998 Factory Mutual Engineering
,j%,u\( Afl:h =Mt'>I"'~"""'."",·
Standard ONe
standard !ifVes ONo
. Q.O.D •
Serial N Make. Model Serial Number
&lio inn':!.£.
, • <
, . r
Contractor's Material & Test Certificate for Abovegrou
. ., I
.' If no, exprain:
<'I
..
. Test Description: . '. . ",
,Hydrostatic:, Hydrostatic testa shall b,e made'at not less ltIan 200 pal (1 a.6 bars) for two houra 9r ISO pil (SA 1:111'1) abeve .tatle pre88Ure In
excess of 15.0 psi (10.3 bars) for'tWo hours. Differential dry-pipe valve olappe!'8.hlll b, 'eft open durlng teet to prevent datmlQl1, All above-
ground plplng,leakage shall be stop~ed~ ,
Pneumatic: establiSh 40 psi (2.7 bars) air pressure and measure drop wh/oh shall not exceed M/2 psi (0.1 bara) In 24 hours. Te8t
pressure tanks ~ nOrmal water level'aAd air pressure and measure air pressure drop wh/oh ehall not exceed 1-112, (0.1 bars) In 24 hours.
Number Removed:
Yes No
Do you certify that the welding was performed by welders quallfled In compliance 0 Y.es 0 No
with the requll'eqlElnta of at least AW,S 010.9, Level AR-3?
Do you certify. that welding was camed out In compliance with a documented quality . 0 Yes b No
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 Intemal diameters
. of piping are not penetrated? ' '
Hydraulic Dilta Nameplate:
Nameplate provIded? 0 Yes 0 No If no, exPlain: '
Re~ark6 (Date left In servIce wml all control'Valves open):
Signatures:
Name of Installing Cootrac;tor: :~~ S~~ / __ " '. •
ForPrope I Own(lr( 'goaa(' ,:.~;/'; >~V11t1e: ftJJ fJ":,'::I t~M.1 oa'_15_1:1.
I' . . ~' ---'-~...;...-:.!..-~~~-c.r--"--------i~~___:...!::L __
9 C tractor (Slgnei:l~: • Title Date:
01998 Factory Mutuat Engineering'
EMV 85A ENGINEERING
SpclG k,4e f. ~t:r" 2-15-12
'Contractor's Mat$tla{ '& t~"t Certlftcate' for Aboveground Piping
Addt/Jooal printed COP/~ oith/, fOrm n av.1IIilt 10 Inaul'ld. ,~;
Corporate Commu"/~St Fa~kuy Mutual, ff'1'o.ton Provldenn Tur'lP'k .. P.o. 10K 0102, Nonyoot4 AtA 08002
Procedure: Upon completion of work, Inspectlen Ind testa than be mlde by 111 contl'lCtor'l reprHlntatlvl 11\4 wltnuHd by an owner'.
representative. All defects ahall be correoted Ind IYIlem toft In IIMot before contraotor'll*lOnnl' finally leav,lhe Job.
A certlflcate ~II be tilled ouf and algned by both repttltntaUvea. IIlIII be prlPlraci for appftWlnQ luthorlUea. owner. anti ,cootrador. It Is understood,the owner's reprteontttlVII algnlwrlln no way anyotalm agalnellhl donIrIolor for 'aully mlttrill. poor
workmanship or failure to comply wll~ apptOVlng authority'. requlrementa or local ordlnanoea. '
Plans' , ,
AOOfJpted ay ApprovlJ:lg AuthorIty'S N~I)
Address:
Installallon Conforms to Plans I¥i Yea .I:t~o
EquIpment Used Is Approved (It no, ataIe deviallOl18~ Vea CJNe ..
of control ' I
I ,~ • •
Location: I suePiles Buildings: lsI ,plpqr IN
sprinklers:
Vearof
Make Model Manufacture Orlftee SIze'
! lI:,.J" ... ll£
Pipe and FIttings:
i=ltt!ngs conform to
If ~, explain:
' "~<Qn.,
Alarm Valve or Flow Indicator' ,
t.t;tl
, ,
Standard bi!Ves
Standard
"z ' ''"",p,
:it , " , ,
"
i
'''\
DNo
ONO
';'.. ~
No
Temperature
Quantity Rating
U.t. IS" 0
0
' <I
0
<I
Alarm Device Maximum Time to Operate Througn Test Pipe Type Make
iT....J. -4 b.. ... : '" ' "'t.:~~. \~"
D 1ry Pipe Operating Test
Dry Valve
Make Moclel
Dry Pipe Operating Test (ContinUed)
01998 Factory Mutual Engi""ring
EMV 86A ENGINEERING
Model
'IU .l ,I. /r....., '4b. 1WU4
"'., , " ,';1
:-foi , . \ ..
Serial Number Make
. Min • Sec,
0 .!1~
',Q.O.D. "
Model Serial Number
"
, ,
Contractor's Material & Test Certlflcaie,for A~~~fgro~O,d P1.plng
If no, explain:
Make Model
Does each clrcu t operatt
supervIsion lola alann?
Yes
Inum Ume'10 operatt
relo ••
Test Description:
Hydrostatic: Hydrostatic tests shall be made at not less Illan 200 psi (13.6 bers) for two hours or 50 psi (3.4 bani) above static pressure In
excess of 160 pSI (10.3 bars),for two hours. Differential dry-plpe valve clappers shan be left open dUllng _to prevent damage. Allabov .. grO~nd piping leakqa sheil' be stopped.
Pneumatic: establish 40 psi (2.7 bars) aIr pressure and meaSure drop which ehall not exceed 1-112 Pfli (0.1 bars) In 2411ours. Test
pressure tanks at nonnal wa~er level and air pressure al}d measure air pressure drop whIC/!l.:s~~tllQ.l 8l1pep.d 1r1l2 (0.1 bars) In 24 hours.
Do you certify that the welding was perfonned by welders qualified In compliance ]lfves
with the requirements of at least AWS D10.9, Level AR·3? '~. .
Do you certify that welding was carried out In compliance with a do(;umented quality j2fVes
control procedure to Insure that all d"1SCS are retrieved, lIlat openings In piping are
smooth, that slag and olller welding residue are removed, and that Internal diameters
of piplng are not penetrated?
Hydraulic Data Nameplate:
Nameplate provided? 0 Yes 0 No If no, explain:
Remarks (Date left In service with all control valves open):
Signatures:
.Name of InstaUing Contractor: Smith Automatic Sprinkler . .
For Properj:y Owner (Signed)~ ~ C:::!!fr~_-. '_Tl_ue_: ..J.F...:f...;.~_·::..-' ...I~::::-~ . .:.:4V'-..;..-e..;..;A-;;;..r ___ Da_te_: _____ ~,J.J...t.JI/:...:/:,;:~;..;;:...-
For Installing Contractor (Signed):
@1998 Factory Mutual Engineering
~MV 85A ENGINEERING
Title Date:
: •• ::f;;.
tI\,~ ~ Contractor's Material & Test Certificate for Aboveground Piping '2... --ri..
. ~t;A.ro.
Add/llonal printed copies of 'his fotm 8RJ avallabl' to Insureds fonn:' ~ 'I ':0"
Corpora(e Communications, Fi'lctoty Mutual, 1161 BosCon Provldonc. rump/ko, P.O. Box 9102, Horwood. NlA 02062 ,..., "'~ V
Pro~dure: Upon completion of work. Inspection and teste ahall be made by 'he contractor'. repre.enlallve and wllnl!llSed by lin owner',
representative. All defects ahall be corrected and .y.tam left In service bafore conlrector'e pemnnel finally lelve Iho lob.
A certificate sha~ be nUed out and slgMd by bolh ropresenlatlvea. Cople, shall be prepared for approving auU,or\Ills. owners and
contractor. It is understood the owner's repreaentatlves signature In no wttI prejudices any ¢!aIm agaInst the contractor for faulty malerlal. poor
workmanship or fanura to comply wllh approving authority'. requlremenl8 or local ordlnanoea.
Plans'
. Accepted By Approving AulhorllY's Namej&
Address:
r
Installation Conforms to Plans ;l!Yes ld No Equipment Used Is Approved (If no. state devlallons): CI Yea CJ No
Instructions:
Has person in charge of fire equipment been Instructed as to tne location or control I.....l Yea 0 No
valves and lhe care and maintenance of this new equipment?
. If no. explaIn:
Have copies of appropriate lns!Ncllons and care and maintenance charts been IaI\ on premises? 0 Yes 0 No
If no. explain:
Location: I Supplies Buildings:
S rinklers~
Pipe' and Fittings:
Pipe confonns to
Fittings conform to
If no. explain;
Alarm Valve or Flow Indrcator: .
Standard tiD Yes DNa
Standard J8't'es DNo
Alarm Device Maximum 'rime to OlJOfate Through Test Pipe
!>'Pe_ Make
V;c.ttl.tI /; C
Dry Pipe Operating T~
Dry Valve
Make· Model
Dry Pipe Operating Test (Continued)
@1998FactoryMutual Engineering
EMV 85A ENGINEERING
Model
11:': .. IA' J. Is",,: .....
Serial Number
Min. Sec.
747 M () ~i.l
Q.O.D.
Make Model. Serial Number
/
Contractor's Material & Test Certificate for Aboveground Piping
If no. explain:
Does each circuit operate Doe. each circuit operate
IUporv1s1on loss alarm? valvo r.I ... ..,
Maximum melOoperate i-eloUe Make Model
No Ye. No Min. Sec.
Tast.Deacrlptlon: •
Hydl'08tadc: Hydrostatic teats shall be made at not tesathan 200 psi (13.6 bars) for two hours or 60 psi t3A bars) above statlc p!eSSU1'e In
elCceA of 150 psi (1 0.3 bars) for two hours. Differential dty-pIpe valve dappers shall be !.eft open during teat to prtvent damage. All above-
ground piping (ealeage shaH be stopped.
Pneumatic:: establish 40 pSi (2.7 bars) 81r pressure and measure drop which shell not exceed 1-112 psi (0.1 bars) In 24 hoUrs. Test
pressure tanks at normal water levet and air pressure and measure air prassure drop which shall not exceed 1-112 (O.1 baIlS) In 24 MUllS.
I Number Removed!
No
Do you certify ttiat the welding was performed by welders qualified In compHance 0 Yes 0 No
with the requirements of at least AWS 010.9. level AR.3?
Do you certify that welding was carried out in compliance with a documented quality . 0 Yes 0 No
control procedure to Insure that an discs .re retrieved. that openings in piping are
smooth. that stag and other welding residue are removed. and that intemal dfameters of pIping are not penetrated? •
HydraullQ Data Nameplate:
~meplate provided? 0 Ves 0 No If no, explain:
Remarks (Date left In Gervlce with all ~ntrot valves open):
Signatures:
Name Of Installing Conttactor: Smith Automatio Sprinkler
~ Ii...fa For Property Owner (Signed): ~7-; Ti~ .. Date'; --=:::;---:::=:::---:-.:~~r-'-~~~~--_Y--a..J,,-'4..-M_/;:...;I!!.a:-.· !'~M=fe:c~__ 't/~t L/~ ~ e · . ~ Fl
For~~~o l"~ had): • T"U .... t _~~ ~~I"tY, ~~(.. uB''''J}_/2 ~/~~;,~-~~~~--------------~~ . L.nt'~~o~
@1998FadosyMutualEnglneerlng
EMV 85A ENGI"'EERING