CONTRACTOR'S MATERIAL AND TEST CERTIFICATE FOR ABOVEGROUND PIPING ‘Standpipe System NFPA 14 ‘PROCEDURE Upon complation of work, inspection and tests shall be made by the contractors representative and witnessed by an owners representative. All elects shall be carected and the system lin sarica baforo the contactor’ personnel finaly leave the jo. A catificate shall be filed out and signed by bath representatives. Cops shal bo propared for approving auzhories, owners. and contractor, Itis undersood that he ewner’s roprosentatve’s signature in no way prejudices any claim agalnat the corractr for fauly maieria, poor ‘workmanship, or failure to compy with the approving authority's requirements or local rdinances. Property name Dave Property adéress ‘Aesoptod by approving auhatites (names) aes Taio ona crpted pls? aye awe Eadoer sedis opine ied? ave ON Utero ition Tatonate ave fora wt ave Sanita dy ave Beet [Manat ay ayes Manan aves Cenbiaton saneipliner ove omer og ip daa Dausee te, |Manutacee Ma Desinandas |Type: Enc —ODeed a Obwr(einy ‘Shown on Plans |Rated,gom________——sRated,psi_______Shutotf, psi, later SuP0 a Pubiovatervods sytem 9 Storagetark a Greviyienk © Open esonc urge CaPEEHY. | 5 oMner (plain) it Public Waterworks System: Statc,psi___ Residual ph ow gpm Have Copies [0 Sym anpornisiilons _ Gaeandaleranceotepion —_GNFPARB atte Fotewing | «copy oteccenelam Hyde aetna the Premises? Main waterlow chute locaton. eiiztie, [Nomar saree ase Doataundpe tes ars bam ahack ea ae ate ave |B Lecedopen G SuledadioordO Tomprpratavch 5 Sher swpetion | tere opin ye SE TE TE ines | Tp oltre ae ‘Hose threads have been vartied for compliance with local fire department 2 Yes No ee Ce Preventor 1G Reduced-prossure device ‘Size_____ Make and model Som icae sees ae ay FIGURE 11.1.3ta) Sample Contractor's Mater { Piping.‘CONTROL VALVE DEVICE Typo Size Make Modet Time to tip through remote hose valve Min See Water pressure ‘Ale prossure Time water reached remote hoso valve outlat Min ‘See Trippoint air pressure psi Alam operated property? Yes ONO Wnovexpla, Time water reached remote hose valve outlet Min See Hydraulic activation a Yes Eloctic activation a Yes Peumatio activation ayes Make and model of aetvation device Each activation device tested? «Yes No Ito, expla Each activation device operated properly? a Yes No Ino, explain, PRESSURE-REGULATING DEVICE Nentiowing (pei) Flowing (pai) Location & Floor Mode! Inlet Outlet Inlet Outlet sem ‘Allhose valves on system operated property? Yes No tno, explain, ©2006 National Fire Protection Association NFPA 14(9.20f3) FIGURE 11.1.8) ContimedTest Deseription ydrostaic: Hysrostatc tests hallbe made at not lass than 200 psi (19.6 bar) for 2 hours or 50 psi (@.4 bar) above static ‘pressure in excess of 180 psi (10.2 ar) for2 hours iferontal dr pipe valve cappors shal bo Ie open uring test to ‘revenl damage. Al aboveground piping leakage shal be stopped. Pheumate: Establish 40 psi (2.7 bat) ei pressure and measure drop, which shall not excoed {psi (0.1 bas) in 24 hours. ‘Tost pressure tanks at nomal wator level and ae pressure and measure al prosstte drop, which chal nak excoed + Yepsi (0.1 bay) in 28 hous, Tests All piping hydrostalcaly tested al psi(__ bar) for__ rs | ino slate reason, Dry piping preumatcaly tested? Yes ONe | Eauioment operates proporty? Yes a No ‘Do you caity as tho standpipe contactor thal addtves and corrosive chemicals ‘sodium sitcate. or derivatives of sou scat, brine, or other cowosive chemicals ere not used fot testing systems or stopping leaks? a Yes QNo Drain Reading of gauge located near walor Residual prossure with valve in test test _| supply test connection psi(__bay) | conection open wide psi(__ba) Underground mains and lean connections to system risers flushed before connection mada lo stancipe piping, Veriod by copy ofthe Uform no, 85b? Yes No 2 Other (explain). Flushed by instaterof underground stance piping? Yes No Blank Testing Welaing ‘Number used Locations, Number removed, Weldedpiing ci Yes No ives Do you certly as the standpipe contractor that welling procedures comply with he requirements Yes No of al loast AWS D10.9, Level ARS? ‘Do you cory that he welding was pertormed by welders quelfied in comaliance with he ayes ano requiremants of atleast AWS D10.9, Level AF-S? Do you cary that welding was carid out in compliance witha documented qualty canto! OYes ano procedure to ensure tha al ics are reviaved, tht openings in ping are emocth, tal slag and ‘other welding residue are removed, and that the inlemnal diameters of piping are not penetra? ‘Cutouts (Discs) Hydraulic Data Namoplate ‘Do you catty that you have a conto feature to ensure that al cutouts (ses) ae retieved? ayes aN Namoplate provided? GQ Yes. No Hn, oxpain, pee ee ae Eee Dato ft in service with all contra valves open: Remarks Namo of | Name of contractor Snapp | Mose Contractor | State lieonse numbor i aplesbe) System | Property owner tae te. Operating Test | Sprinklevstandpipe contactor Tale at. Witnessed by | approving auras Tale at. Additional Explanation and Notes (©2008 National Fro Protection Association NEPA 14 (9.3013)