1860_001.pdfCONTRACTOR'S MATERIAL TEST CERTIFICATEABOVEGROUND PIPING
VIKING AUTOMATIC SPRINKLER
3434 FIRST AVENUE SOUTH
SEATTLE, WA 98134
PROCEDURE
Upon completion of work. Inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative.
All deferAs shall be corrected and system left in service before contractors personnel finally leave the job
A certificate shall be filled out by and signed by both representatIves Copies shall be prepared for approving authorities, owners and contractor.
It is understood the ownes representative's signature in no way prejudices any claim contractor for faulty material, poor workmanship, or
failure to comply with approving authority's requirements or local ordinances.
EDMOND RECOVERY CENTER
7416 212TH ST SW, EDMONDS, WA 98026
PLANS
ACCEPTED BY APPROVING AUTHORITIES (NAMES)
CITY OF EDMONDS
ADMESS
121 STH AVE N. EDMONDS, WA 98020
INSTALLATION CONFORMS TO ACCEPTED PLANS
EQUIPMENT USED IS APPROVED
IF NO EXPLAIN DEVICES
no YES F-INO
EYES F-1 NO
INSTRUCTIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
EYES 7 NO
LOCATION
OF SYSTEM
ENTIRE BUILDING
SPRINKLERS
MAKE
MODEL
YEAR OF
MANUFACTURER
ORIFICE
SIZE
QUANTITY
TEMPERATURE
RATING
VIKING
QR SSP
2018
112"
160
155'F
VIKING
OR HSW
2019
1/2"
1
286*F
VIKING
QR DRY SSP
2018
11.
2
155*F
TYCO
DS-1 HSW
2018
11.
27
155'F
VIKING
QR SSU
2018
112"
1
286*F
PIPE AND
FITTINGS
Type of Pipe SCH-10, SCHAO BLACK STEEL PIPE
Type of Fittings DUCTILE IRON 300#. BLACK CAST IRON 125#
ALARM VALVE
OR FLOW
INDICATOR
ALARM DEVICE
MAXIMUM TIME TO OPERATE
THROUGH TEST CONNECTION
TYPE
MAKE
-MOCEL
MIN
SEC,
FLOW SWITCH
POTTER
VSR-F
DRY PIPE
OPERATING
TEST
NOT APPL
DRYVALVE
MAKE
MODEL
SERIAL NO
MAKE
MODEL
SERIAL NO
TIME TO TRIP
THRU TEST
CONNECTION
WATER
PRE85URE
AIR
PRESSURE
TRIP POINT
AIR PRESSURE
TIME WATER
REACHED
TEST OUTLET
ALARM
OPERATED
PROPERLY
WITHOUT
Q O.D,
MIN SEC
PSI
PSI
PSI
MIN. SEC
YES
NO
WITH
QOD
IF NO, EXPLAIN
'MEASURED FROM TIME INSPECTOR'S TEST CONNECTION 19 OPENED
OPERATION
12 PNEUMATIC 10 ELECTRIC 171 HYDRAULIC
PIPING SUPERVISED
0 YES 0 NO
DETECTING MEDIA SUPERVISED YES [:]NO
DELUGE &
DOES VALVE OPERATE FROM THE MANUAL TRIP ANDIOR REMOTE CONTROL STATUS YES [::]NO
PREACTION
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING
JFNO,EXPLAIN
VALVES
0 YES LI NO I
DOES EACH CIRCUIT OPERATE
DOES EACH CIRCUIT
MAXIMUM TIME TO
NOT APPLY
MAKE
MODEL
SUPERVISION LOSS ALARM
OPERATE VALVE RELEASE
OPERATE RELEASE
HYDROSTATIC: Hydrostatic test shall be at not less than 200 psi (13 6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess
of 150 psi (10.2 bars) for hvo hours. Different dry -pipe valve clappers shall be left open during test to prevent damage All aboveground piping
TEST
leakage shall be stopped
DESCRIPTION
PNEUMATIC Establish 40 psi (2 7 bars) air pressure and measure drop which shall not exceed 1-1/2 psi (0.1 bare) In 24 hours Test pressure
tanks at normal water level and air pressure drop which shall not exceed 1-112 psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TEST AT 200 PSI FOR2HRS. IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED 13 YES 0 NO
EQUIPMENT OPERATES PROPERLY Im YES 13 NO
30 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR
TESTS
DERIVATIVES OF SODIUM SILICATE. BRINE OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR
STOPPING LEAKS? EM YES Cl NO
DRAIN
READING OF GAGE LOCATED NEAR WATER TRESIDUAL
ISUPPLY
PRESSURE WITH VALVE IN TEST
TEST
TEST CONNECTION
23
CO
CONNECTION OPEN NDE :5s
ERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING
VERIFIED BY COPY OF THE U FORM NO 656 1@ YES 12 NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND
SPRINKLER PIPING IZ YES LJ NO
BLANK TESTING
NUMBER USED
I
LOCATIONS
NUMBER REMOVED
GASKETS
None
WELDEDPIPING 0 YES 0 NO
IF YES_
00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMP�y
NTH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3 SYES F—INO
WELDING
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN DYES ONO
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
RETRIEVED. THAT OPENING.S IN PIPING ARE SMOOTH. THAT SLAG AND OTHER
WELDING RESIDUE ARE REMOVED. AND THAT THE INTERNAL DIAMETERS OF
PIPING ARE NOT PENETRATED MYES El No
CUTOUTS
DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS)
(DISCS)
ARE RETRIEVEDI MYES El N�O
HYDRAULIC
NAME PLATE PROVIDED
_�XPLAIN
DATA
]IF
NAMEPLATE
0 YES 0 NO
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REMARKS
15�hl h�q
4 __4
NAME OF SPRINKLER CONTRACTOR Viking Automatic SprFinkler Co. Lic.# VIKINAS373 Nr
3434 FIRST AVENUE S. SFEATTLE, WA
TEST WITNESSED BY
SIGNATURES
FOR PROPERTY OWN I AGENT (SIGNED)
TITLE
DATE
FOR SP I L T R (SIGNED)
TITLE &
DATE
JFQ�R
ATHORIKTY25L, TION (SIGNED)
T'O
TITLE
DATE
CERTIFICATION
This is to certify that this automatic sprinkler sygtern has been installed in accordance with the standards adopted by the
Washington State Frie Marshal and N.F.P.A. Standard 13.
Name of Firm: Viking Automatic Sprinkler Co.
Mailing Address: 3434 FIRST AVE. S. SEATTLE, WA
Name: LUCIA FUNG Title DESIGNER Date:
WHEN ALL APPLICABLE ITEMS THROUGH 15 HAVE BEEN COMPLETED
THIS ORIGINAL FORM SHALL BE RETURNED TO TO THE STATE FIRE MARSHAL'S OFF
16 CONFIRMATION OF SPRINKLER SYSTEM INSTALLATION
Name: Title: Date:
Acceptable: E]YES ONO
17 COMMENTS. -
ADDITIONAL EXPLANATION AND NOTES