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UniSpec II Store Planning 072514
SECTION 13900 - FIRE SUPPRESSION
PART 1 - GENERAL
1.1 SUMMARY
A. Section Includes:
1. Automatic sprinkler systems.
2. Fire protection sprinkler piping work with feed and cross main piping, branch line piping, test valves, test
connections, and sprinklers.
3. Flow indicators, valves, gauges, alarms, drain piping, and supervisory switches.
4. System design, installation and certification.
B. Related Sections:
1. Section 02510 - Water Distribution Systems.
2. Section 09900 - Paints and Coatings.
1.2 REFERENCES
A. ASTM International (ASTM):
1. ASTM A 47 - Ferritic Malleable Iron Castings
2. ASTM A 53 - Pipe, Steel, Black And Hot-Dipped, Zinc-Coated, Welded And Seamless
3. ASTM A 135 - Electric-Resistance-Welded Steel Pipe
4. ASTM A 234 - Piping Fittings Of Wrought Carbon Steel and Alloy Steel For Moderate And High
Temperature Service
5. ASTM A 536 - Ductile Iron Castings
6. ASTM A 795 - Black And Hot-Dipped Zinc-Coated (Galvanized) Welded And Seamless Steel Pipe For
Fire Protection Use
7. ASTM A 865 - Threaded Couplings, Steel, Black Or Zinc-Coated (Galvanized) Welded Or Seamless, For
Use In Steel Pipe joints
B. American Society of Mechanical Engineers (ASME):
1. ASME B 16.1 - Cast Iron Pipe Flanges And Flanged Fittings
2. ASME B 16.3 - Malleable Iron Threaded Fittings
3. ASME B 16.4 - Gray Iron Threaded Fittings
4. ASME B 16.5 - Pipe Flanges And Flanged Fittings NPS 1/2 Through NPS 24 Metric/Inch Standard
5. ASME B 16.9 - Factory-Made Wrought Buttwelding Fittings
6. ASME B 16.11 - Forged Fittings, Socket-Welding And Threaded
C. Factory Mutual System (FM):
1. Approval Guide, Latest edition.
D. National Fire Protection Association (NFPA):
1. NFPA 13, 2007Edition - Installation of Sprinkler Systems.
2. NFPA 24, 2007 Edition - Standard for the Installation of Private Fire Service Mains and their
Appurtenances.
3. NFPA 70, 2008 Edition - National Electrical Code.
E. Underwriters Laboratory (UL):
1. UL Fire Protection Directory – Latest Edition.
1.3 SUBMITTALS
A. Authorities Having Jurisdiction (AHJ)
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1. Provide Deferred Submittals to AHJ per requirements of 01330. Drawings and calculations have not been
submitted to the AHJ for code compliance by Owner's Fire Protection Consultant.
a. Submit the following:
1) Product data.
2) Shop drawings.
3) Additional data as may be required by NFPA 13 and Owner’s Fire Protection Consultant.
B. Submittal Procedure:
1. Reference Section 01330 for general submittal procedures. Conform to provisions of Section 01330 unless
otherwise specified herein.
2. Within 21 days after award of prime contract, send submittals to Wal-Mart’s Fire Protection Consultant as
specified Section 01330. Allow 15 day turn-around on submittals sent to Wal-Mart’s Fire Protection
Consultant.
a. Fire Protection Consultant’s electronic drawing files (i.e., DWG, DWF, PDF, etc.) will not be
provided to the Contractor for the purpose of submittals nor will the Fire Protection Consultant
assist with production of submittal information including shop drawings and material data.
b. If the Contractor fails to submit a complete Fire Suppression submittal package within 21 days after
award of contract, the Contractor shall pay the Owner $250.00 per day as liquidated damages and
not as a penalty, until the fully completed Fire Suppression submittal package is received by Wal-
Mart’s Fire Protection Consultant.
c. Send a copy of the Letter of Transmittal sent with the submittals to the Architect indicating date of
and content of transmittal.
3. Fire Protection Consultant will review electronic file submittal as an alternate to requirements of Section
01330. Obtain the electronic submittal procedure from Owner’s Fire Protection Consultant during the Pre-
Construction Conference Call.
4. Within 21 days after Award of Contract by Wal-Mart to Contractor, submit two copies of complete
submittals to Authorities Having Jurisdiction if required by Wal-Mart’s Fire Protection Consultant.
Coordinate submittal with Wal-Mart’s Fire Protection Consultant. Submit additional copies if required
5. Submittals shall be complete, accurate, and in full compliance with contract requirements for proper and
timely approval.
6. Contractor shall respond to shop drawing review comments within 7 days of receipt.
7. Maintain two copies of approved documents on site.
C. Submittal Rejection:
1. Wal-Mart’s Fire Protection Consultant will reject submittals which do not comply with Contract
Documents. If submittal is rejected by Wal-Mart’s Fire Protection Consultant for any reason, Wal-Mart
Stores, Inc., will back-charge the Contractor $200.00 via Change Order, to cover the processing costs of
each subsequent review until submittal is approved. Submittal rejections include, but are not limited to, the
following reasons:
a. Design Issues: Incorrect densities, design areas, equipment sprinkler spacing, hose station missing,
incomplete system design, etc. No changes in design area, number of sprinklers operating, pipe
sizes, number of branch lines, number of mains or deviation of water supply from that shown on the
Contract Documents shall be approved by Wal-Mart’s Fire Protection Consultant. This is not
intended to limit the Contractor from making minor modifications to system design for coordination
purposes.
b. Incorrect Water Test: Failure to use Wal-Mart water test found on project fire protection
Construction Documents. No other water test data is permitted for system design submittals to Wal-
Mart’s Fire Protection Consultant.
c. Incorrect Material: Do not propose pipe, sprinklers or backflow preventers not indicated in
Contract Documents. Products not specified in contract documents are cause for rejection.
d. Incorrect Valves: Do not propose OS&Y valves when wall PIV's are indicated in the Contract
Documents.
2. Rejected submittals shall be revised and resubmitted until approved. Extension of time will not be allowed
for rejected submittals.
a. The Fire Suppression subcontractor shall revise and resubmit rejected submittals within 7 days of
receipt of rejected submittals.
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b. The Contractor shall verify that the Fire Suppression subcontractor has addressed all required
revisions in the resubmittal.
1.4 Contract Closeout Submittals:
A. Submit the following under provisions of Section 01770.
1. Maintenance Data: Include components of system, servicing requirements, inspection data, and owners
manuals.
2. Training Requirements: Provide operational training to Wal-Mart. Include system control operation, Fire
Pump (if provided) manual and abort functions, trouble procedures, auxiliary functions and emergency
procedures.
3. Contractors Material Test Certificates: Provide Copies of completed Underground, Overhead, and Fire
Pump (if applicable) Contractor’s Material Test Certificates.
4. As-Built shop drawings indicating installed location of components, including all piping, sprinklers,
hangers, valving, inspector's test stations, auxiliary drains, and hose stations (if required).
B. At Project completion, present to the Store Manager the As built Drawings enclosed in a plastic pipe tube (fixed
cap at one end and a threaded-cap on the other end) for storage in the Riser Room.
C. In addition to the copies of Documents delivered to the Store Manager, distribute additional copies of documents
as indicated below:
a. Contractor shall deliver copies of the As-Built shop drawings for Fire Suppression and Contractor’s
Material Test Certificates (Underground, Overhead, and Fire Pump) in both hard copy and
electronic form (*.pdf or *.plt) to Wal-Mart’s Fire Protection Consultant.
1.5 SYSTEM DESCRIPTION
A. System shall provide coverage for all existing and new building and expansion areas including, but not limited to,
areas scheduled in this Section. Contract Documents have been prepared in accordance with NFPA 13 (working
plans) except for fabrication information. The Contract Documents are prepared to a level consistent with that
level required by the Authorities Having Jurisdiction to gain plan check approval. No changes in design area,
number of sprinklers operating, pipe sizes, number of branch lines, number of mains or deviation of water supply
from that shown on the drawings shall be approved by Fire Protection Consultant. This is not intended to limit
the Contractor from making minor modifications to system design for coordination purposes. The Contractor
shall review the Contract Documents for completeness and to ensure that the Construction Documents meet all
Authorities Having Jurisdiction requirements. Discrepancies with NFPA or Authorities Having Jurisdiction
requirements shall be brought to the attention of the Fire Protection Consultant prior to bid. The Contractor shall
complete the fire protection Contract Documents to provide all final required detail such as fabrication details,
final pipe cuts, hanger cuts, and other miscellaneous details not required by the Authority Having Jurisdiction for
approval. Contractor is responsible to coordinate design with all trades and disciplines.
1. Fire Protection Consultant has submitted Contract Documents to Authorities Having Jurisdiction for
review and approval. Contractor shall provide all other documents, qualifications, submittals and
coordination necessary to obtain approval by Authorities Having Jurisdiction. All changes made to the
Contract Documents by the Contractor shall be submitted to the Fire Protection Consultant for approval
prior to fabrication or installation. Refer to Section 01330 for submittal requirements.
B. Base system design on water flow test data shown on the Drawings.
C. Verify actual backflow preventer to ensure correct friction loss is calculated.
D. Provide fire department connections where required by Authorities Having Jurisdiction.
E. Sprinklers in light hazard areas shall be quick response type.
F. Limit each system to 52,000 square feet.
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G. Provide 5 psi safety factor between supply curve and demand point, including hose stream allowance.
H. Provide hangers, supports and earthquake bracing per Contract Documents, NFPA 13, and Authorities Having
Jurisdiction.
I. Interface sprinkler system with fire protection supervisory system.
J. Provide 1-1/2" Fire Department hose valves. Locate as indicated on Contract Documents and per Authorities
Having Jurisdiction. Final location and quantity to be coordinated with Authority Having Jurisdiction and
Engineer of Record.
K. If required by Authority Having Jurisdiction, provide Fire Department lock-box; quantity, size, type and location
as directed
1.6 QUALITY ASSURANCE
A. Guarantee system for a period of one year after completion of work and acceptance by Owner.
B. Qualifications (Installer): Company specializing in performing work of this Section with minimum three years
experience and a minimum of a NICET Certified Engineering Technician (Level III) Fire Sprinkler Designer on
staff responsible for project.
C. Company shall have a sprinkler contractor license issued by the Authorities Having Jurisdiction.
D. Regulatory Requirements: Provide certificate of compliance from Authorities Having Jurisdiction indicating
approval of field acceptance tests.
1.7 EXTRA MATERIALS
A. Provide extra sprinklers under the provisions of NFPA 13. Provide suitable wrenches for each sprinkler type.
Provide sprinklers as needed to meet the requirements listed below. Provide a minimum of 2 spare sprinklers for
new sprinklers being added that do not match existing:
1. 12 Sales Floor Type
2. 4 Dry Pendent
3. 2 each of other type present for a total of 24.
B. If needed, provide sprinkler and sprinkler wrench cabinet per NFPA 13, adjacent to sprinkler risers.
C. Provide hydraulic calculation placard attached to each riser on systems that are modified or added.
1.8 DELIVERY, STORAGE, AND HANDLING
A. Deliver, store, and protect products to site under provisions of Section 01600.
B. Store products in shipping containers and maintain in place until installation. Provide temporary inlet and outlet
caps. Maintain caps in place until installation.
PART 2 - PRODUCTS
2.1 MATERIALS
A. Provide UL Listed (for Fire Protection) or FM Approved (for Fire Protection) materials complying with NFPA
13, unless noted otherwise in Contract Documents.
2.2 FIRE PROTECTION PIPING - ABOVE GROUND
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A. Pipe: Steel pipe, conforming to the applicable requirements of NFPA 13, and ASTM A 53, ASTM A 135, or
ASTM A 795, as applicable.
1. Wet Pipe Systems, Utilizing Threaded Pipe:
a. Schedule 40 black steel pipe.
b. Threadable lightwall sprinkler pipe with corrosion resistance ratio of 1.0 or greater after threading.
c. Use galvanized pipe, zinc coated internally and externally, outdoors, inside coolers and freezers, or
in non-conditioned spaces.
2. Wet Pipe Systems, Utilizing Roll Grooved Pipe.
a. Schedule 10 black steel pipe.
b. Lightwall sprinkler pipe with corrosion resistance ratio of 1.0 or greater.
c. Use galvanized pipe, zinc coated internally and externally, outdoors, inside coolers and freezers, or
in non-conditioned spaces.
3. Dry Pipe Systems: Same as wet pipe systems except pipe shall be galvanized, zinc coated internally and
externally.
B. Fittings: Provide one of the following:
1. Cast-Iron Threaded Flanges: ASME B16.1.
2. Cast-Iron Threaded Fittings: ASME B16.4.
3. Malleable-Iron Threaded Fittings: ASME B16.3.
4. Steel, Threaded Couplings: ASTM A 865.
5. Steel Welding Fittings: ASTM A 234, ASME B16.9, or ASME B16.11.
6. Steel Flanges and Flanged Fittings: ASME B16.5.
7. Steel, Grooved-End Fittings: UL-listed and FM-approved, ASTM A 47, malleable iron or ASTM A 536,
ductile iron; with dimensions matching steel pipe and ends factory grooved according to AWWA C606.
Roll groove only, cut groove unacceptable.
8. Steel Fittings and Cast Iron fittings shall not be used for dry pipe systems.
9. Fitting type shall match pipe. Galvanized fittings shall be used for dry pipe systems and wet pipe systems
located outdoors, inside coolers & freezers, or in non-conditioned spaces.
10. Crimp-type couplings shall not be used.
11. Plain end fittings (socket, FIT, roustabouts, etc) shall not be used.
C. Flexible Piping Systems: At Contractor’s option, UL Listed and FM Approved flexible piping connections to
sprinklers may be used for both acoustical panel and gypsum board ceilings when suitable for their intended use.
1. Description: Connections shall include a fully welded (non-mechanical fittings), leak-tested sprinkler drop
with a minimum internal corrugated hose diameter of 1 inch.
2. Flexible piping lengths shall not exceed 6 feet.
3. Installation shall not exceed the minimum bend radius and maximum allowable bends as specified by the
manufacturer.
4. Change in direction shall be gradual enough to allow flexible piping to bend without crimping, distorting
or reducing internal diameter.
2.3 BACKFLOW PREVENTER ASSEMBLIES (IF NEEDED)
A. Subject to compliance with design and Authority Having Jurisdiction requirements, provide Backflow Preventer
Assembly as follows:
1. 2 Inch Connections and Smaller: If Authorities Having Jurisdiction requires double check, double detector
check, or reduced pressure type devices use ASSE or USC Cross Connection approved device.
2. 2-1/2 Inch Through 10 Inch Connections:
a. Double check type, use model 2000SS by Ames, or use model 350A or 350OSY by Wilkins or use
model 350ADA by Wilkins.
3. Provide backflow preventer assemblies in accordance with manufacturer's recommendations, Authorities
Having Jurisdiction and Contract Documents.
2.4 SPRINKLERS
A. Replace any existing sprinkler that has signs of leakage, paint applied (other than by the sprinkler manufacturer),
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corrosion, damage, or loading; or is installed in the improper orientation. Provide new sprinkler with identical K-
Factor, temperature rating, and response type as the existing.
B. Subject to compliance with requirements, provide UL Listed or FM Approved automatic sprinklers. Provide
sprinklers with nominal K-factor as indicated on Contract Documents. Sidewall sprinklers are not acceptable,
unless noted otherwise. Provide the following sprinkler types:
1. Areas With Exposed Structure Above: Upright or pendent sprinkler, bronze.
2. Areas With Gypsum Board Ceilings: Pendent sprinkler, white, with two-piece white escutcheon plate.
3. Areas With Lay-in Ceilings: Pendent sprinkler, white, with two-piece semi-recessed white escutcheon
plate.
C. Standard Sprinklers: Glass bulb sprinklers are acceptable. Sprinklers with o-rings not permitted.
D. Dry Pendent Sprinklers shall be Concealed type Globe Model GL5681, Tyco Model TY3555, or Victaulic
V3301.
1. Substitutions: Not permitted.
E. Dry Horizontal Sidewall Sprinklers shall be Tyco Model TY3355, TY5339, or Reliable R5734.
1. Tyco Model TY5339 for extended coverage ordinary hazard (ECOH) installations.
2. Substitutions: Not permitted.
2.5 ACCESSORIES
A. Electric Bell: Provide 8 inch diameter, 24 volt AC, electric bell, Model No. PBA248, by Potter Electric Signal of
St. Louis, Missouri. Provide bell on exterior of building. Locate as required by Contract Documents and
Authorities Having Jurisdiction.
B. Control Valve Supervisory Switches:
1. Provide new post indicator valves with tamper switches, Model No. PCVS-2, as manufactured by Potter
Electric Signal of St. Louis, Missouri. Wal-Mart will connect to alarm system.
2. Provide new outside screw and yoke valves with tamper switches, Model No. OSYSU-2 as manufactured
by Potter Electric Signal of St. Louis, Missouri. Wal-Mart will connect to alarm system.
3. Provide new ball type control valves leading to alarm initiating devices, Model No. RBVS, as
manufactured by Potter Electric Signal of St. Louis, Missouri. Wal-Mart will connect to alarm system.
4. All other new valves capable of controlling water to the Fire Protection Sprinkler systems shall have
appropriate tamper switches. Wal-Mart will connect to alarm system.
C. Wire Cage Sprinkler Guards:
1. Provide guards on pendent sprinklers located within 7'-6" of finished floor, except for semi-recessed and
concealed sprinklers.
2. Provide guards on sprinklers located beneath overhead doors.
D. Substitutions: Not permitted.
PART 3 - EXECUTION
3.1 GENERAL INSTALLATION REQUIREMENTS
A. Install system and equipment in accordance with NFPA 13 and manufacturer's instructions.
B. Replace with an identical K-Factor, temperature rating, and response-type any sprinkler that has signs of leakage,
paint applied other than by the sprinkler manufacturer, corrosion, damage, or loading; or is installed in the
improper orientation.
3.2 INSTALLATION - ABOVE GROUND PIPING
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A. Provide piping in accordance with NFPA 13.
B. Locate top beam clamp or thru bolt connection near joist panel points per pipe support detail.
C. Provide piping to conserve building space. Do not interfere with use of building space and other work.
D. Group piping whenever practical at common elevations.
E. Prepare pipe, fittings, supports, and accessories for finish painting. Where pipe support members are welded to
structural building framing, scrape, brush clean, and apply one coat of zinc rich primer to welding. Protect
sprinkler to ensure sprinklers do not receive field paint. Remove protective covering after painting. Replace
sprinklers having paint other than factory finish with new sprinklers. Cleaning and reuse of painted sprinklers is
prohibited.
F. Examine other work indicated on the Drawings and conditions at job site. Coordinate routing of work with other
construction trades to avoid interference with other installations. Do not cut building structural members, beams,
joists, etc. for routing of sprinkler piping.
G. Seal pipe penetrations through fire rated walls or floors to achieve fire resistance equivalent to fire separation
required.
H. Provide wall plates at all penetrations. Provide zinc coated (galvanized) wall plates at exterior penetrations.
I. Provide zinc coated (galvanized) all-thread rod for hanging dry system piping.
J. Provide valves with stems upright or horizontal.
K. Route piping and locate sprinklers as required to avoid building structure, equipment, plumbing piping, heating
and air conditioning piping, ductwork, lighting fixtures, electrical conduits and bus ducts, and similar work.
Locate center of sprinkler a minimum of 6 inches off ceiling grid.
1. Final location of lighting and exposed ductwork shall have priority over pipe routing and final sprinkler
locations.
2. Sprinkler piping in sales area without a ceiling and stockroom shall be located above bottom of joists.
Minimum height of sprinkler piping in areas with ceilings shall be 1’-0” above ceiling.
L. Provide pressure relief valves on gridded wet pipe systems.
M. Provide protection from freezing for sprinkler piping exposed to freezing conditions per Contract Documents and
NFPA 13.
N. Provide valves, backflow prevention devices, check valves, and drains per Contract Documents and Authorities
Having Jurisdiction.
O. Use full lengths of pipe except where needed to accommodate changes in direction or for space limitations.
3.3 FIELD QUALITY CONTROL
A. General: Contractor shall schedule, coordinate and conduct all tests required by Authorities Having Jurisdiction
and Wal-Mart’s Fire Protection Consultant. Contractor shall modify, replace or retest as required by Authorities
Having Jurisdiction and / or Wal-Mart’s Fire Protection Consultant.
B. Flush, test, and inspect sprinkler system according to NFPA 13 "Systems Acceptance" Chapter. Test the systems,
including the underground water mains, and the aboveground piping and components to assure that equipment
and components function as intended. Pressure test the systems in accordance with NFPA 13 and NFPA 24. The
Contractor shall have available copies of as-built drawings.
1. Above Ground Fire Protection Piping:
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a. Test per NFPA 13.
b. Inspect welds and verify welder's qualifications per Authorities Having Jurisdiction.
c. Perform Hydrostatic tests per NFPA 13.
2. Backflow Prevention Assembly Forward Flow Test.
3. Operation of control valves and flowing of inspector's test connections to verify operation of alarm devices
including alarm switches. After operation of control valves has been completed, assure that control valves
are in the open position.
4. Main Drain flow test.
C. Fire Sprinkler System Construction Follow Up: Wal-Mart’s Fire Protection Consultant (as specified in Section
01330) will conduct a Pre Construction Conference Call . The purpose of the Pre Construction Conference call is
to review status of project, notify contractor of status of approvals, and review project expectations.
1. Pre Construction Conference Call: The Contractor shall contact Wal-Mart’s Fire Protection Consultant
within 2 days after Contract Award to schedule the Pre Construction Conference Call with the Contractor,
Fire Sprinkler Contractor, and Fire Pump Vendor (if applicable). The conference call will be held within 7
days after Award. FPAT will be preliminarily scheduled at time of Pre Construction conference call.
2. After installation of all components, provide a Letter of Completion to Wal-Mart’s Fire Protection
Consultant. The Letter must state the date that the installation is in substantial conformance with Contract
Documents and be signed by representatives from the Fire Sprinkler Contractor and Contractor.
Additional documentation must be provided to the Fire Protection Consultant upon request, including
photographs or Certificate of Occupancy.
D. Prior to interior store finishing, test existing and new above ground pressure piping for leakage in presence of
Authority Having Jurisdiction and Owner's representative. Maintain test pressure at the high end for two hours.
Test pressure: 200 psi or 50 psi over normal operating pressure, whichever is greater. Conduct test in accordance
with NFPA 13, Hydrostatic Tests. Submit documentation per Contract Closeout Submittals of this section and
01770.
END OF SECTION
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CONTRACTOR’S MATERIAL AND TEST CERTIFICATE FOR UNDERGROUND PIPING
Store Number:
City, ST:
Date:
Pipe Type and Class: Type Joint :
Underground
Pipes
And
Joints
Pipe conforms to NFPA 13/24: □ Yes □ No
Fittings conform to NFPA 13/ 24: □ Yes □ No
If no explain :
Joints anchored clamped, strapped, or blocked in accordance with NFPA 13/24: □ Yes □ No
If no, explain:
Test Description
Flushing: Flow the required rate until water is clear and indicated by no collection of foreign material
in burlap bags at outlets such as hydrants and blow-offs. Flush at flows not less than 390 gpm for 4 in.
pipe, 880 gpm for 6 in. pipe, 1560 gpm for 8 in. pipe, 2440 gpm for 10 in. pipe, and 3520 gpm for 12
in. pipe. When supply can not produce stipulated flow rates, obtain maximum available.
Hydrostatic: All piping and attached appurtenances subjected to system working pressure shall be
hydrostatically tested at 200 psi or 50 psi in excess of the system working pressure, whichever is
greater, and shall maintain that pressure 5 psi for 2 hours.
Hydrostatic Testing Allowance: Where additional water is added to the system to maintain the test
pressures required by 10.10.2.2.1, the amount of water shall be measured and shall not exceed the
limits of the equation in the Leakage Test section.
Flushing Test
New underground piping and lead in flushed according to NFPA 13/24: □ Yes □ No
If no, explain :
How flushing flow was obtained:
Public water □
Tank or reservoir □
Fire pump □
Through what type opening:
Hydrant butt □
Open pipe □
Hydrostatic Test
All new underground piping hydrostatically
tested at ________ psi for _______ hours.
If no, explain:
Joints Covered: □ Yes □ No
Leakage Test
000,148
PSDL
L= testing allowance, gal per hr
S= length of pipe, ft
D= nominal diameter of pipe, in.
P= Avg test pressure during hydrostatic test, psi
psiinftL000,148
________________________
L= Allowable leakage: ________gal ______hrs
Leakage measured: ________gal ______hrs
Leakage actual< leakage allowed?
□ Yes □ No
Hydrants
Number installed: Manufacturer & Model: All operate satisfactorily:
□ Yes □ No
Water control valves left wide open: □ Yes □ No
If no, explain:
Hose threads of fire department connections and hydrants compatible with AHJ: □ Yes □ No
Signatures
Contractor Firm & Contact Name:
Signature: Title: Date:
AHJ Witness: Representing:
Signature: Title: Date:
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