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MacGregor Pl Test Certifications.pdf�ET�g DRY SYSTEM CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING SMITH FIRE SYSTEMS, INC. 3813 - 168th Street NE • Suite 1 Arlington, WA 98223 BUS (360) 651-7701 k� FAX (360) 651-2419 Contr. Reg. No. SMITHFS1360T PROJECT NAME PROJECT ADDRESS 5TH & WALNUT MIXED USE 437 5TH AVENUE SOUTH EDMONDS. WASHINGTON 98020 SYSTEM NO. 1 1 PROCEDURE AUTHORITY HAVING JURISDICTION SERVES PARKING LEVEL JOB NO. N1 k - 159 Upon completion of work, inspection and tests shall be made by the contractors representatives and witnessed by an AHJ and/or owner's representative. All defects shall be corrected and systems left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor„ It is understood that owner's representative's signature in no way prejudices any claim, against contractor for faulty material, poor workmanship, or failure to m N with a rovi�n authont "s� requirements or local ordinances. CITY OF EDMONDS 121 5TH AVE. NO., EDMONDS, WA. 98020 PIPE AND ... PIPE CONFORMS TO NFPA 13 - 1996 STANDARD ®YES ❑ NO FITTINGS FITTINGS CONFORM TO NFPA 13 - 1996 STANDARD YES ❑I NO WELDED Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least Q YES ❑ NO AWS D10,9, level AR -3? PIPING Cf) Do you certify that the welding was performed by welders qualified in compliance with the requirements of at ®YES ❑ NO >_ least AWS D10 9, level AR -3? YES ❑ NO Do you certify that welding was carried out in compliance with a documented quality control procedure to YES ❑ NO ensure 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? HYDROSTATIC TEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi for two hours or 50 psi above static pressure in excess of 150psi for two hours. Differential dry -pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS? 0 YES ❑ NO IF NO, STATE REASON TEST WITNESSED BY r FOR O D SIGNATURE � ® TITLE 'F-'Vr„ M f '.�i 1 DATE 1 l U 7 PNEUMATIC TEST PNEUMATIC: Establis40 psi air pr „sure and easure drop which shall not exceed 1 '/ psi in 24 hours. Test pressure tanks at normal water level and air pressure and m1air pressure drop w ich shall not exceed 1 'Y2 psi in 24 hours, DRY PIPING PNEUMATICALLY TESTED? M YES ❑ NO IF NO, STATE REASON FOR (WW ER SIGNATURE C a S /d TEST WITNESSED BY TITLE I °✓ DATE / FLUSHING Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping. VERIFICATION VERIFIED BY COPY OF UNDERGROUND PIPING TEST CERTIFICATE? N YES ❑ NO FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING? ® YES ❑ NO ❑ OTHER -EXPLAIN ADDITIVE AND DO YOU CERTIFYAS THE SPRINKLER CONTRACTOR THATADDITIVES AND CORROSIVE CHEMICALS, CORROSIVE CHEM- SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS ®YES [I NO ICAL VERIFICATION WERE NOT USED FOR TESTING SYSTEM OR STOPPING LEAKS? BLANK TEST GASKETS Number Used: 0 Locations Number Rernoved: 0 YROf` TEMP. MANUFACTURER TYPE MODEL MFG. K -FACTOR RATING°Fi QUANTITY RELIABLE SSU G 2002 5.6 165° 125 RELIABLE HSW G 2002 1 5.6 165° 1 ..... - .M RELIABLE DRY SSP G3-2002 5.6 165° 12 SPRINKLERS TOTAL 1 138 ALARM DEVICE ALARM DEVICE MAX. TO OPERATE THRU TEST PIPE TYPE MAKE MODEL MIN, SEC. PRESSURE SWITCH POTTER ELECTRIC PS10-2 1� DRY VALVE O.O.D. DRY PIPE OPERATING MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO, TEST VICTAULIC [7:5:6 NIA7AIRPRESSURE NIA N/A NIA TIME WATER ALARM TIME TO TRIP' WATER TRIP POINT REACHED OPERATED PRESSURE AIR TEST OUTLET, PROPERLY PRESSUREMIN.SEC. PSI SI PSI MIN. SEC. YES NO Without Q.O.D. With Q.O.D. IF NO, EXPLAIN `MEASURED FROM THE TIME THE INSPECTOR'S TEST CONNECTION VALVE IS OPENED. EQUIPMENT EQUIPMENT OPERATES PROPERLY EM YES ❑ NO OPERATION IF NO, EXPLAIN INSTRUCTIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES JJYES ❑ NO AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES? 1. SYSTEM COMPONENTS INSTRUCTIONS ® YES []NO 2. CARE AND MAINTENANCE INSTRUCTIONS DYES ❑ NO 3. NFPA 25 ❑ YES 0 NO HYDRAULIC DATA NAME PLATE PROVIDED YES ❑ NO NAMEPLATE IF NO, EXPLAIN CUT OUT (DISC) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUT OUTS (DISCS) ARE 0 YES ❑ NO RETRIEVED? CERTIFICATION IF NO, EXPLAIN LOCATION MAKE & PRESSURE MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RA'T'E REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVEINSTALLED ❑ YES NO EN STUDS ARE USED IN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN ❑ YES ❑ NO POWDER DRIVEN SATISFACTORILY COMPLETED? STUD INSTALLED IF NO, EXPLAIN ❑ YES EM NO IN-SERVICE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN 57-1—A DATE —/_ MAIN DRAIN READING GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE RESIDUAL PRESSURE WITH VA4VES IN TEST PIPE TEST STATIC PRES RE ; Q [ Sl OPEN WIDE: �/T (�L) PSI FINAL ACCEPTANCE FOR l , F SIGNATURE ? "` J" TITLE- DATE S /7-41 TEST WITNESSED BY H FIR6 FOR VMS DAATITLE 1n, �AjDATE SIGNATURE CERTIFICATION I CERTIFY THAT THE INFORMATION HEREIN IS TRUE AND THAT THIS SPRINKLER SYSTEM WAS INSTALLED IN ACCORDANCE WITH RCE 16-160 AND THE RULES ADOPTED BY THE mow. Inc. WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY ct"Ille r r THE STATE FIRE MARSHALL. or TOM HINTON A `" 3 1-11< NAME OF CERTIFICATE OF COMPETENCY HOLDER If PRINT OR YPE;) .�d�• Am'- J-jo �__ --- _tEC:V HOLDFR CIf_NATI IRF (1F f � IA,� "e^�j";'•. olig'lNi MCI" CERTIFICATE REGISTRATION # 391-11-2369 PERMIT# 2002-0235 DATE 3 �9TH WET SYSTEM CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING SMITH FIRE SYSTEMS, INC. 3813 - 168th Street NE • Suite 1 Arlington, WA 98223 uuIlopy BUS (360) 651-7701 FAX (360) 651-2419 Contr. Reg. No. SMITHFS1360T PROJECT" NAME 5TH & WALNUT MIXED USE JOB NO, N1 t 159 PROJECT ADDRESS 437 5TH AVENUE SOUTH EDMONDS, WASHINGTON 98020 SYSTEM NO. 2 SERVES FIRST FLOOR PROCEDURE Upon completion of work„ Inspection and tests shall be made by the contractor's representatives and witnessed by an AhIJ and/or owner's representative Ali defectis shall be corrected and systems left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor. It is understood that owners representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to I com pivwith approving authority's requirements or local ordinances. AUTHORITY" HAVING CITY OF EDMONDS JURISDICTION 121 5TH AVE. NO, EDMONDS, WA. 98020 PIPE AND PIPE CONFORMS TO NFPA 13 - 1996 STANDARD YES ❑ NO FITTINGS Fii1iNGS CONFORM TO IN FPA 13 -1996 STANDARD ® YES ❑ NO WELDED PIPING Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at ® YES ❑ NO least AWS D10.9, level AR -3? 91 YES ❑ NOW Do you certify that the welding was performed by welders qualified in compliance with the requirements fR YES ❑ NO 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 IH YES ❑ NO to ensure 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? HYDROSTATIC TEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi for two hours or 50 psi above static pressure in excess of 150psi for two hours. Differential dry -pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS? ® YES ❑ NO IF NO, STATE REASON r' , TEST WITNESSED BY FOR F' SIGNATURE TITLE DATE _51 7 FLUSHING rg nd ma s and lea -in connections to system risers flushed before connection made to sprinkler piping. 9 VERIFIED BY COnd UNDER ROUND P ING TEST CERTIFICATE? U ® YES ❑ NO FLUSHED BY INS LLER OF UNDEI 'ND SPRINKLER PIPING? ® YES ❑ NO OTHER — EXPLAIN ADDITIVE ,AND DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM CORROSIVE CHEM- SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT ® YES ❑ NO ICAL VERIFICATION USED FOR TESTING SYSTEM OR STOPPING LEAKS? BLANK TEST GASKETS Number Used 0 Locations Number Removed 0 YR. OF TEMP. MANUFACTURER TYPE MODEL MFG, K - FACTOR RATING °F OUANTIT RELIABLE SSU G 2002 5.6 165° 4 RELIABLE SSP F1FR 2002 5.6 155° 95 RELIABLE HSW F1 FR 2002 5.6 155° 11 RELIABLE I DRY HSW G3A 2002 5.6 165° 4 SPRINKLERS TOTAL 1 114 ALARM DEVICE . TO OPERATE THRU TEST' PIPE ALARM DEVICE TYPE MAKE MODEL MIN. SEC. WATERFLOW SWITCH POTTER ELECTRIC VSR-F m g YES NO EQUIPMENT EQUIPMENT OPERATES PROPERLY OPERATION IF NO, EXPLAIN HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES YES ❑ NO AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES? YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS 2. CARE AND MAINTENANCE INSTRUCTIONS YES ❑ NO 3. NFPA 25 [ YES NO YES ❑ NO HYDRAULIC DATA NAME PLATE PROVIDED NAMEPLATE IF NO, EXPLAIN DO YOU CERTlrY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THATALL CUT OUTS (C1SCS) ARE ® YES ❑ NO CUT OUT (DISC) RETRIEVED? CERTIFICATION IF NO, EXPLAIN PRESSURE LOCATION & FLOOR MAKE & MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING _ INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM VALVEINSTALLED ❑ YES ® NO IF POWDER DRIVEN STUDS ARE USED IN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN ❑ YES ❑ NO POWDER DRIVEN SATISFACTORILY COMPLETED? STUD INSTALLED IF NO, EXPLAIN ❑ YES NO ® IN-SERVICE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN DATE MAIN DRAIN READING GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE RESIDUAL PRESSURE WITH VALVES IN TEST PIPE TEST STATIC PRESSURE: r� , v n PSI OPEN WIDE PSI o FINAL ACCEPTANCE FOR O Eft SIGNATURE r TITLE DATE QiJ TEST WITNESSED BY FOR S I H Fl E Y TEMS SIGNATURE TITLE r DATE CERTIFICATION I CERTIFY THAT THE INFORMATION HEREIN IS TRUE AND THAT THIS SPRINKLER SYSTEM WAS INSTALLED IN ACCORDANCE WITH RCE 18-160 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY THE STATE FIRE MARSHALL. a lac S CVc TONT HINTON °�6 NAME OF CERTIFICATE OF COMPETENCY HOLDER T+ulmy IEl tan 39I•tk,21 (PRINT OR TYPE) , SIGNATURE OF CERTIFICATE OF COMPETENCY HOLDER 0418 ccc rug CERTIFICATE REGISTRATION# 391-11-2369 / PERMIT# 2002-0235 DATE +/++ 3 mow WET SYSTEM CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING SMITH FIRE SYSTEMS, INC. 3813 - 168th Street NE • Suite 1 Arlington, WA 98223 ("N '11) 11) BUS (360) 651-7701 FAX (360) 651-2419 Contr. Reg. No. SMITHFS1360T SYSTEM NO. JURISDICTION FITTINGS WELDED PIPING ® YES ❑ NO H'YDROST'ATIC TEST TEST WITNESSED BY FLUSHING VERIFICATION ADDITIVE AND CORROSIVE CHEM- ICAL VERIFICATION BLAND TEST GASKETS SPRINKLERS 5` & WALNUT MIXED USE ------------ — _... 4 --- 437 5THAVENUE SOUTH EDMONDS, WA. 98020 3 SERVES SECOND FLOOR N1 - 159 Upon completion of work, lnspection and tests shall be made by the contractor's representatives and witnessed by an AHJ and/or owners representative All defects shall be corrected and systems left in service before contractors personnel finally leaves the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor. It is understood that owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to CITY OF EDMONDS 121 5T" AVE. NO., EDMONDS, WA. 98020 PIPE CONFORMS TO NFPA 13 - 1996 nrTTINMA r:nnrr=raRM TO NFPA 13 - 1996 STANDARD WYES u NO STANDARD ® YES ❑ NO ---- Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS D10.9, level AR -3? ® YES ❑ NO WDo you certify that the welding was performed by welders qualified in compliance with the requirements } of at least AWS D10.9, level AR -3? Do you certify that welding was carted out in compliance with a documented quality control procedure YES ❑ NO EYES ❑ NO to ensure 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? HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi for two hours or 50 psi above static pressure in excess of 150psi for two hours. Differential dry -pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS? ® YES ❑ NO IF NO, STATE REASON 41 FOR F D a O S T ' f SIGNA URE TITLE �i(�MHI%L. DATE 9rQ UndoGROUND ound! mai and loadIn connections to system risers flushed before connection made to sprinkler piping. VERIFIED BY COPY C UNDERPIP G TEST CERTIFICATE? FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING? ® YES ❑ NO ® YES '❑ NO OTHER — EXPLAIN DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEM OR STOPPING LEAKS?- + YES ❑ NO,, Number Used 0 Locations Number Removed 0 YR. OF TEMP. MANUFACTURER TYPE MODEL MFG. K -FACTOR RATING °F QUANTIT RELIABLE RECESSED SSP F1/RES 18 2002 3.9 155° 142 RELIABLE DRY HSW G3A 2002 5.6 165° 9 TOTAL 151 ALARM DEVICE ALARM DEVICE MAX. TO OPERATE THRU TEST PIPE TYPE MAKE MODEL MIN. SEC. WATERFLOW SWITCH POTTER ELECTRIC VSR-F A il EQUIPMENT EQUIPMENT OPERATES PROPERLY ® YES ❑ NO OPERATION IF NO, EXPLAIN HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES ® YES ❑ NO AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES? 1. SYSTEM COMPONENTS INSTRUCTIONS ® YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ® YES ❑ NO 3. NFPA 25 ❑ YES NO HYDRAULIC DATA NAME PLATE PROVIDED 0 YES ❑ NO NAMEPLATE IF NO, EXPLAIN CUT OUT (DISC) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUT OUTS (DISCS) ARE YES ❑ NO RETRIEVED? CERTIFICATION IF NO, EXPLAIN LOCATION & MAKE & PRESSURE FLOOR MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVEINSTALLED� ❑ YES NO IF POWDER DRIVEN STUDS ARE USED IN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN [I YES El NO POWDER DRIVEN SATISFACTORILY COMPLETED? STUD INSTALLED IF NO, EXPLAIN ❑ YES ® NO IN-SERVICE DATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN ,5 / -9 l o3 MAIN DRAIN READING GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE RESIDUAL PRESSURE WITH VALVES IN TEST PIPE TEST STATIC PRESSURE: 11 Q PSI OPEN WIDE 0 PSI FINAL ACCEPTANCE FOR OI" SIGNATURE / , TITLE S4-tL DATE TEST WITNESSED BY I FOR ITH ESfSTEMS SIGNATURE TITLE DATE CERTIFICATION I CERTIFY THAT THE INFORMATION HEREIN IS TRUE.AND THAT THIS SPRINKLER SYSTEM WAS INSTALLED IN ACCORDANCE WITH RCE 18-160 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY 'A6016 lot. THE STATE FIRE MARSHALL. t Cm TOM HINTON -' � T4MW1G.l9Y) Illrproar NAME OF CERTIFICATE OF COMPETENCY HOLDER 391-11-?,469 (PRINT OR TYPE) q. 4N Slkp-w— sp SIGNATURE OF CERTIFICATE OF COMPETENCY HOLDER CERTIFICATE REGISTRATION # 391-11-2369 k%I// l/� PERMIT# 2002-0235 J2Q DATE u/!5/1✓ �9TH WET SYSTEM CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING SMITH FIRE SYSTEMS, INC. 3813 - 168th Street NE - Suite 1 Arlington, WA 98223 ("Opy BUS (360) 651-7701 d FAX (360) 651-2419 Contr. Reg. No. SMITHFS1360T SYSTEM NO. FITTINGS WELDED PIPING IM YES ❑ NO 5TH & WALNUT MIXED USE 437 5TH AVENUE SOUTH EDMONDS, WA. 98020 JOB NO. N1 — 159 4 SERVES THIRD FLOOR Upon completion of work, Inspection and tests shall be made by the contractor's representatives and witnessed by an AHJ and/or owner's representative All defects shall be corrected and systems left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor. It is understood that owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to compli with a2proving author s re ultements or local ordinances. CITY OF EDMONDS 121 STH AVE. NO., EDMONDS, WA. 98020 PIPE CONFORMS TO NFPA 13 - 1996 STANDARD YES ❑ NO ® YES ❑ NO FITTINGS CONFORM TO NFPA 13 -1996 STANDARD Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at ® YES ❑ NO least AWS D10.9, level AR -3? wDo you certify that the welding was performed by welders qualified in compliance with the requirements ®YES ❑ NO } of at least AWS D10.9, level AR -3? LL Do you certify that welding was carried out in compliance with a documented quality control procedure M YES ❑ NO to ensure 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? HYDROSTATIC TEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi for two hours or bu psi above static pressure in excess or i oupsi ror two nuws. Differential dry -pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS? 91 YES ❑ NO IF NO, STATE REASON TEST WITNESSED BY FOR a ttlll'w C. SIGNATURE TITLE r• P-15 DATE -5—h/013 FLUSHING Un er0,round Mains and ead-In connections to system risers flushed VERIFICATION VERIFIED BY CO OF'UN'DERGROUN PIPING TEST CERTIFICATE? FLUSHED BY INSTALLER OF LINDERGR UND SPRINKLER PIPING? OTHER — EXPLAIN ADDITIVE AND DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM CORROSIVE CHEM- SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT ICAL VERIFICATION USED FOR TESTING SYSTEM OR STOPPING LEAKS?` BLANK TEST GASKETS Number Used 0 Locations SPRINKLERS r piping. ® YES ❑ NO ® YES ❑ NO ® YES ❑ NO, Munitugr Removed 0 MANUFACTURER TYPE MODEL MFG. K -FACTOR RATING °F QUANTIT RELIABLE RECESSED SSP F1/RES18 1 2002 1 3.9 155°142 TOTAL 1 142 ALARM DEVICE ALARM DEVICE MAX. TO OPERATE THRU TEST PIPE TYPE MAKE MODEL MIN. SEC. WATREFLOW SWITCH POTTER ELECTRIC VSR-F EQUIPMENT EQUIPMENT OPERATES PROPERLY ® YES ❑ NO OPERATION IF NO, EXPLAIN HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES YES ❑ NO AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES? 1„ SYSTEM COMPONENTS INSTRUCTIONS YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS YES ❑ NO 3. NFPA 25 ❑ YES ® NO HYDRAULIC DATA NAME PLATE PROVIDED ® YES ❑ NO NAMEPLATE IF NO, EXPLAIN CUT OUT (DISC) DO YOU CERTIFY THAT YOJ HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUT OUTS (DISCS) ARE E YES ❑ NO RETRIEVED? CERTIFICATION IF NO, EXPLAIN LOCATION & MAKE & PRESSURE FLOOR MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVEINSTALLED ❑ YES E NO IF POWDER DRIVEN STUDSARE USED IN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN [I YES El NO POWDER DRIVEN SATISFACTORILY COMPLETED? STUD INSTALLED IF NO, EXPLAIN ❑ YES ® NO IN-SERVICE DATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN MAIN DRAIN I READING GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE RESIDUAL PRESSURE WITH VALVES IN TEST PIPE TEST STATIC PRESSURE: n PSI OPEN WIDE D PSI FINAL ACCEPTANCE FOR S SIGNATURE a. TITLE�1 ^A �--�.4tL- DATE� TEST WITNESSED BY FOR 0111TH I STEMS t SIGNATURE TITLE^ DATE CERTIFICATION I CERTIFY THAT THE INFORMATION HEREIN IS TRUEAND THAT THIS SPRINKLER SYSTEM WAS INSTALLED IN ACCORDANCE WITH RCE 18-160 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY too. 1sr THE STATE FIRE MARSHALL. o1"►p TOM HINTON T+omm I Hinton NAME OF CERTIFICATE OF COMPETENCY HOLDER 391-[1-2 ma (PRINT OR TYPE) µTy SIGNATURE"CCE FICA OF COMPETENCY HOLDER P914 CERTIFICATE REGISTRATION # 391-11-2369 ffll,54S PERMIT # 2002-0235 DATE Ammw SMITH FIRE SYSTEMS, INC. ( ��) BUS (360) 651-7701 �9TAS 3813 Street NE 168th S 1 FAX (360) 651-2419 Arlington, WA 98223 Contr. Reg. No. SMITHFS1360T FIRE SPRINKLER SUPPLY LINE CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR UNDERGROUND PIPING PROJECTNAME S FIFTH & WALNUT BUILDING JOB NO. N1 - 159 437 Fifth Avenue Edmonds Washington Upon completion of work, inspection and tests shall be made by the contractor's representatives and witnessed by an AHJ and/or owner's representative. All defects shall be corrected and systems left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by both representativ,)s. Copies shall be prepared for approving authorities, owners and contractor. It is understood that owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. AUTHORITY FOR Edmonds Fire Department HAVING JURISDICTION PIPE AND FITTINGS PIPE CONFORMS TO NFPA 13 & 24 STANDARD ❑ YES ❑ NO (. t FITTINGS CONFORM TO NFPA 13 & 24 STANDARD ❑ YES El NO - • "". TYPE & CLASS OF PIPE USED: Ductile Iron - Class 52 JOINT TYPES USED: Mega -lug / Mechanical Joint J'hIN REST, AINTS ALL PIPE JOINTS ARE RESTRAINED WITH Meaa-lua or Flanged Fiitinas IN ACCORDANCE WITH NFPA 13 & 24 ❑ YES []NO IF NO, EXPLAIN FLUSHING Flow the required rate until water is clear as 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 -inch pipe, 880 GPM for 6 -inch pipe, 2440 GPM for 10 -inch pipe, and 3250 GPM for 12 -inch pipe. When supply cannot produce stipulated flow rates, obtain maximum available. UNDERGROUND PIPING WAS FLUSHED IN ACCORDANCE WITH NFPA 13 & 24 STANDARD ® YES ❑ NO IF NO, EXPLAIN WATER FLOW FOR FLUSHING WAS OBTAINED BY ® PUBLIC WATER MAIN ❑ TANK OR RESERVOIR ❑ FIRE PUMP FLUSHING Fnn Edmonds Fire DPnartment WITNESSED BY '--7:715L SIGNATURE —= C 2 TITLE/� / DATE /CI—i{—i-2 HYDROSTATIC TEST Hydrostatic test shall be made at not less than 200 psi for two hours or at 50 psi above the static pressure in excess of 150 psi for two hours. UNDERGROUND PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HOURS EYES ❑ NO IF NO, EXPLAIN JOINTS COVERED AT TIME OF TEST YES ❑ NO IF YES, EXPLAIN r =:C & ud 12 g FOR Edmonds Fire Department HYDROSTATIC TEST WITNESSED BY SIGNATURE TITLE//L �� I%yjl��[ ! ��Z DATE 'L(riJZ LEAKAGE TEST REQUIRED YES ❑ NO LEAKAGE: NEW PIPE LAID WITH RUBBER GASKETED JOINTS SHALL, IF THE WORKMANSHIP IS SATISFACTORY, HAVE LI I I LE UR NO LEAKAGE AT THE JOINTS, THE AMOUNT OF LEAKAGE AT THE JOINTS SHALL NOT EXCEED2 QTS. PER HOUR PER 100 JOINTS IRRESPECTIVE OF PIPE DIAMETER, THE LEAKAGE SHALL BE DISTRIBUTED OVER ALL JOINTS. IF SUCH LEAKAGE OCCURS AT A FEW JOINTS, THE INSTALLATION SHALL BE CONSIDERED UNSATISFACTORY AND NECESSARY REPAIRS MADE. THE AMOUNT OF ALLOWABLE LEAKAGE SPECIFIED ABOVE MAY BE INCREASE 1 FL. OZ. PER INCH OF VALVE DIAMETER, PER HOUR, FOR EACH METAL SEATED VALVE ISOLATING THE TEST SECTION, IF DRY BARREL HYDRANTS ARE TESTED WITH THE MAIN VALVE OPEN, SO THE HYDRANTS ARE UNDER PRESSURE, AN ADDITIONAL 5 FL'. OZ. PER MINUTE LEAKAGE IS PERMITTED FOR EACH HYDRANT, TOTAL AMOUNT OF LEAKAGE MEASURED ALLOWABLE LEAKAGE QTS PER HOUR QTS PER HOUR HYDRANTS NUMBER OF HYDRANTS INSTALLED ALL 0 .. PERATED PROPERLY LJ YES LI NO INSTALLED MANUFACTURER MODEL MODEL T E [I YES NO N j HYDRANT HOSE THREADS ARE INTERCHANGEABLE WITH YES NO THOSE OF FIRE DEPARTMENT ANSWERING ALARM CONTROL VALVES WATER CONTROL VALVES LEFT WIDE OPEN fflYES ❑ NO IF NO, EXPLAIN IN SERVICE DATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN FOREMAN SIGNATURE—.4 DATE k REMARKS FINAL ACCEPTANCE FOR SMIT FIRE SIGNATURE FOR Ecitycls SIGNATURE I � EMS CONTRACTOR'S REGI 136 TRATION NO. SMITHFST . . .... _TITLE, DATE nt v I CERTIFY THAT TI INFORMtnON IT 1 .REIN IS TRUE AND THA THIS UNDERGROt :0 SPRINK ER TEM SUPPLY PIPING WAS INSTALLED IN ACCORDANCE I H RCW 18-160 AND THE I� RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY THE STATE FIRE MARSHAL. TOM HINTON NAME OF CERTIFICATE OF COMPETENCY HOLDER /I (PRINT OR TYPE) SIGNATURE OF CERTIFICATE OF COMPETENCY HOLDER CERTIFICATE REGISTRATION # 391-11-2369 DATE PERMIT # Ag 0.2 -010.Z 441, -A�,�w DATE 5-1 -1 /C SMITH FIRE SYSTEMS, INC. BUS (360) 651-7701 3813 -168th Street E - Suite 1('Opy FAX (360) 651-2419 Ar Arlington, WA Contr. Reg. No. SMITHFS1360T FIRE DEPARTMENT CONNECTION LINE CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR UNDERGROUND PIPIN9 PROJECT NAME FIFTH & WALNUT BUILDING Joe NO. N1 - 159 PROJECT ADDRESS 437 Fifth Avenue Edmonds Washin tan PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representatives and witnessed by an AHJ and/or owner's representative. All defects shall be corrected and systems left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor. It is understood that owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. AUTHORITY FOR Edmonds Fire Department HAVING JURISDICTION PIPE AND FITTINGS PIPE CONFORMS TO NFPA 13 & 24 FITTINGS CONFORM TO NFPA 13 & 24 ® YES ❑ NO TYPE & CLASS OF PIPE USED: Ductile Iron - Class 52 & Galvanized Schedule 40 Steel Pipe JOINT TYPES USED: Mega -lug & fainged JOINT FLUSHING FLUSHING WITNESSED BY ATIC TEST HYDROSTATIC TEST WITNESSED BY CONNECTION FINAL ACCEPTANCE AI 1 PIPF ,10INTR ARF RFRTRAINPn WITH Mena - Ii in R Pinnnad IN ACCORDANCE WITH NFPA 13 & 24 YES [:]NO IF NO, EXPLAIN Flow the required rate until water is clear as 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 -inch pipe, 880 GPM for 6 -inch pipe, 2440 GPM for 10 -inch pipe, and 3250 GPM for 12 -inch pipe. When supply cannot produce stipulated flow rates, obtain maximum available. UNDERGROUND PIPING WAS FLUSHED IN ACCORDANCE WITH NFPA 13 & 24 YES NO IF NO, EXPLAIN WATER FLOW FOR FILU'SH'ING W&S OBT IkJ� BY , PUBLIC WATER MAIN ❑, TANK OR RESERVOIR ❑ FIRE PUMP SIGNATURE Hydrostatic test -hall be psi for two hour UNDERGROUND PIPING F IF NO, EXPLAIN atatno! less than 200 JOINTS COVERED AT TIME OF TEST IF YES, EXPLAIN /' N FOR Ed SIGNATURE J FIRF r'Ir=PARTMF'NFIRF r nN�N TI@R"9"F@R WITH THOSE OF F RE DEPARVENT A FOR SMIT FIRE 1 SIGNATURE FOR Ed SIGNATURE Tq 0 LL �,'�.,��NZr vl ' 1 L DATE i+ two hours or at 50 psi above the static pressure in excess of 1 0 YTESTED AT 200 PSI FOR 2 HOURS ® YES ❑ NO ❑ YES /N0 nt TITLEDATE . d�r 4t)r, ARF INTFRRHANr;FARI F YFR I 1 Nn SWERING ALARM nt NO. SMITHF S1360T 44- DATE °rrrLE4 � DATE S % i � TION I CERTIFY THAT THE INFORMATION HEREIN IS TRUE AND THAT THIS UNDERGROUND SPRINKLER SYSTEM SUPPLY PIPING WAS INSTALLED IN ACCORDANCE WITH RCW 18-160 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY THE STATE FIRE MARSHAL. NAME OF CERTIFICATE OF COMPETENCY HOLDER (PRINT OR TYPE) L"IC'AJTEOF SIGNATURE OF CERTIPETENCY HOLDER DATE WI V o 3 PERMIT # a b0 a P) 0 oZ 004 I' lee, l3I v CerrQdf'ri 'iva�wmy 6[u�3 391.,111"61'r