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FIRE PROTECTION BUREAU —PLAN REVIEW
PO Box 42642 5 No 11111111111116,
Olympia WA 98504-2642
(360) 596-3900 FAX: (360) 596-3934 War
CONTRACTORS' MATERIALS AND TEST CERTIFICATE
FOR PRIVATE FIRE SERVICE MAINS
PROCEDURE
Upon completion of work, inspection and test shall be made by the contractor's representative and witnessed by an owner's
representative. All defects shall be corrected and system left in service before contractors personnel finally leave 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 the owners representative's signature in no way prejudices any claim against contractor for
faulty material, poor workmanship,or failure to comply with approving authority's re uiremenIS or local ordinances.
PROPERTY NAME
DATE
Dougs Lynnwood Hyundai
19/28/2020
PROPERTY ADDRESS
22130 WA-99
ACCEPTED BY APPROVING AUTHORITIES (NAMES)
City of Edmonds
ADDRESS
PLANS
121 5th Ave N. Edmonds, WA. 98020
INSTALLATION CONFORMS TO ACCEPTED PLANS ❑✓ YES ONO
EQUIPMENT USED IS APPROVED [DYES ❑ NO
IF NO, STATE DEVIATIONS:
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES
AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? (DYES ❑ NO
INSTRUCTIONS
IF NO, EXPLAIN:
SUPPLIES BUILDINGS Yes
LOCATION
PIPE TYPES AND CLASS 6" DI Class 52
TYPE JOINT Tyton Joint
PIPE CONFORMS TO City of Edmonds STANDARD ❑ YES ❑ NO
FITTINGS CONFORM TO City of Edmonds STANDARD [D YES ❑ NO
IF NO, EXPLAIN:
PIPES AND JOINTS
BURIED JOINTS NEEDING ANCHORAGE CLAMPED,
STRAPPED OR BLOCKED IN ACCORDANCE WITH City of Edmonds STANDARD ❑✓ YES ❑ NO
IF NO, EXPLAIN
FLUSHING: Flow the required rate until water is dear 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 (1476 Umin) for 4-inch pipe, 610 gpm (2309 Umin) for 5-inch pipe, 8W gpm (3331 Umin) for
6-inch pipe, 1560 gpm (5905 Unim) for 8-inch pipe, 2440 gpm (9235 Umin) for 10-inch pipe, and 3520 gpm (13323 Umin) for 12-inch pipe. When
supply cannot produce stipulated flow rate, obtain maximum available.
TEST
HYDROSTATIC- Hydrostatic tests shall be made at not less than 200 psi (13.8 bars) for two hours or 50 psi (3.4 bars) above static pressure in
DESCRIPTION
excess of 150 psi (10.3 bars) for two hours.
LEAKAGE: New pipe laid with rubber gasketed joints shall, if the workmanship is satisfactory, have little or no leakage at the joints. The amount
of leakage at the joints shall not exceed 2 qts. per hr. (1.89 Uh) per 100 joints, irrespective of pipe diameter_ The amount of allowable leakage
spedW above may be increased by 14 oz_ per in. valve diameter per Iv. (30 mL125 mmfh) for each metal -seated valve isolating the test section.
If dry barrel hydrants are tested with We main valve open so the hydrants are under pressure, an additional 5 oz- per minute (150 mL/min)
leakage is pennitted for each hydrant
NEW PIPING FLUSHED ACCORDING TO City of Edmond STANDARD BY Grade Inc. (company) a YES ❑ NO
IF NO, EXPLAIN:
HOW FLUSHING FLOW WAS OBTAINED
THROUGH WHAT TYPE OPENING:
✓❑ PUBLIC WATER
❑✓ HYDRANT BUTT
❑ TANK OR RESERVOIR
❑ OPEN PIPE
FLUSHING TESTS
❑ FIRE PUMP
LEAD-INS FLUSHED ACCORDING TO STANDARD 0 YES ❑ NO
HOW FLUSHING FLOW WAS OBTAINED-
THROUGH WHAT TYPE OPENING
❑✓ PUBLIC WATER
❑ Y CONNECTION TO FLANGE & SPIGOT
❑ TANK OR RESERVOIR
❑✓ OPEN PIPE
FIRE PUMP
3000-420-242 (R 8/15) Page 1
JOINT COVERED
HYDROSTATIC
TEST
ALL NEW PIPING HYDROSTATICALLY TESTED AT 2550 PSI FOR 2
ALL
HOURS
❑✓ YES ❑ NO
TOTAL AMOUNT OF LEAKAGE MEASURE 0 2
LEAKAGE
NO LEAKAGE ALLOWED FOR VISIBLE JOINTS GALS.
HOURS
TEST
ALLOWABLE LEAKAGE (BURIED) 0 2
NO LEAKAGE ALLOWED FOR VISIBLE JOINTS GALS.
HOURS
NUMBER INSTALLED
TYPE AND MAKE
ALL OPERATED SATISFACTORILY
HYDRANTS
0
N/A
❑ YES ❑ NO
WATER CONTROL VALVES LEFT WIDE OPEN ❑✓ YES ❑ NO
IF NO, STATE REASON:
CONTROL VALVES
HOSE THREADS OF FIRE DEPARTMENT CONNECTION AND HYDRANTS INTERCHANGEABLE WITH THOSE YES ❑ NO
OF FIRE DEPARTMENT ANSWERING ALARM
DATE LEFT IN SERVICE 9/28/2020
REMARKS
ADDITIONAL COMMENTS
NAME OF INSTALLING CONTRACTOR
Grade Inc.
TESTS
WITNESSED BY
SIGNATURES
FOR PROPERTY OWNER (SIGNED)
TITLE
DATE
FO I ALLING CONTRACTOR (SIGNED)
TITLE
DATE
Presideint
9/28/2020
t.
ADDITIONAL EXPLANMhON
AND N
......................... . .
' WASHINGTON STATE
' CERTIFICATE OF COMPETENCY
FIRE PROTECTION SPRINKLER SYSTEMS ;
Krep P. Oveson
4909-0519-D Level try ;
c.
'A
1Z1p4
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3000-420-242 (R 8/15) Page 2