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Home My WebLink About2012-Certificate of Occupancy AHERN Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work,inspection and tests shall be made by the contractor's representative and witnessed by the property owner or their authorized agent. All defects shall be corrected and system left in service before contractor's 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 owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship,or failure to comply with approving authorit 's requirements or local ordinances. PROPERTY NAME Evco Plastics AFP Contract# 491196 DATE: June 21, 2012 PROPERTY ADDRESS 450 Ripple Avenue Oshkosh, WI 54902 ACCEPTED BY APPROVING AUTHORITIES (NAMES) 1. Oshkosh Fire Department (Battalion Chief—Mike Augsburger) 2. City of Oshkosh (Building Inspector—Brian Noe) 3. CNA Insurance (Mr. Scott J. MacPherson) 4. ADDRESS Plans 1. 101 Court Street - Oshkosh, WI 54901 2. 215 Church Avenue - PO Box 1130 -Oshkosh, WI 54901 3. 13845 Bishops Drive, Suite 100- Brookfield, WI 53005 4. INSTALLATION CONFORMS TO ACCEPTED PLANS 91 YES ❑ NO EQUIPMENT USED IS APPROVED ❑YES ❑N O IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION 49rYES ❑N O OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? INSTRUCTIONS IF NO, EXPLAIN HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: Item No.'s 2&3 will 1. SYSTEM COMPONENTS INSTRUCTIONS RYES ❑N O be forwarded by AFP at closeout time. 2 CARE AND MAINTENANCE INSTRUCTIONS ®'YES ❑N,O 3. NFPA 25 FrYES ❑NO LOCATION OF SUPPLIES BUILDINGS SYSTEM System 4 (Revised) MAKE MODEL YEAR OF K- QUANTITY TEMPERATURE MANUFACTURE FACTOR RATING Viking Micromatic VK200 Upright 3/4"Brass 2012 8.0 142 286 Deg. Reliable JL-17 RA1914 Pendent 3/4"Brass 2012 16.8 210 165 Dea. SPRINKLERS PIPE AND TYPE OF PIPE Schedule 7; Schedule 30; Black FITTINGS TYPE OF FITTINGS Grooved;Threaded;Welded Outlets FLOW ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION TYPE MAKE MODEL MINUTES SECONDS Water Flow Detector System Sensor WFD N/A EXPLAIN ANY ALARM PROBLEMS: ALARM DEVICES LOW AIR ALARM DEVICE ALARM OPERATED PRESSURE TYPE MAKE MODEL PROPERLY N/A SETTING PSI YES NO EXPLAIN ANY ALARM PROBLEMS: Ahern CENTRAL MONITORING SIGNALS RECEIVED ALARM SERVICE LOCATION(S) TYPE OR PRESSURE NAME OF'REMOTE WATERFLOW SWITCH LOW—AIR OTHER SERVICE DETECTOR FLOW SUPERVISORY SUPERVISING LOCATION(S)- STATI(ON-SITE) ¢ r l REMOTE NAME OF SERVICE: REMOTE MONITORING ALRMSERVICE SIGNALING (OFF—SITE) PHONE: , .3 OTHER: LOCATION(S): EXPLAIN ANY ALARM SIGNALING PROBLEMS: DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. DRY PIPE TIME TO TRIP TIME WATER ALARM OPERATING WATER TRIP POINT AIR THROUGH TEST AIR PRESSURE REACHED TEST OPERATED CONNECTIONab PRESSURE PRESSURE , TEST OUTLETa 'PROPERLY MIN. SEC. PSI PSI PSI MIN. SEC. YES NO WITHOUT Q.O.D. WITH Q.O.D. IF NO, EXPLAIN: OPERATION: ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑YES ❑ NO DETECTING MEDIA SUPERVISED ❑YES El NO DOES VALVE OPERATE FROM THE MANUAL TRIP, REMOTE, OR BOTH CONTROL STATIONS? ❑YES ❑NO IS THERE AN ACCESSIBLE FACILITY IN EACH IF NO, EXPLAIN DELUGE& CIRCUIT FOR TESTING? PREACTION ❑YES ❑NO VALVES DOES EACH CIRCUIT DOES EACH CIRCUIT MAXIMUM TIME TO OPERATE SUPERVISION OPERATE VALVE OPERATE RELEASE MAKE MODEL LOSS ALARM? RELEASE? YES NO YES NO MINUTES SECONDS LOCATION & MAKE&MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE PRESSURE FLOOR (FLOWING) REDUCING INLET OUTLET INLET OUTLET FLOW VALVE TEST (PSI) (PSI) (PSI) (PSI) (GPM) a MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED. NFPA 13 ONLY REQUIRES THE 60-SECOND LIMITATION IN SPECIFIC SECTIONS. 2 Ahern HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi(13.6 bar)for two(2)hours or 50 psi(3.4 bar)above static pressure in excess of 150 psi(10.2 bar)for two(2)hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All TEST aboveground piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40-psi(2.7 bar)air pressure and measure drop,which shall not exceed 1-1/2 psi(0.1 bar)in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop,which shall not exceed 1-1/2 psi(0.1 bar) in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT PSI (_Bar)for HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED YES f'NO EQUIPMENT OPERATES PROPERLY jjrYES ❑ NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OR SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? YES ❑NO DRAIN I READING OF GAUGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST TEST SUPPLY TEST CONNECTIO 3 PSI ( Bar) CONNECTION OPEN WIDE: PSI (_Bar) TESTS UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISER(S)TO OTHER EXPLAIN BE FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE CONTRACTOR'S MATERIAL AND TEST CERTIFICATE FOR UNDERGROUND PIPING. ❑YES R NO Ei FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING ❑YES NO IF POWDER-DRIVEN FASTENERS ARE USED IN CONCRETE, HAS IF NO, EXPLAIN REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? ❑YES WNO BLANK NUMBER USED LOCATIONS NUMBER REMOVED TESTING GASKETS _WELDEDPIPING NYES ❑ NO IF YES... Do you certify as the sprinkler contractor that welding procedures used complied with the minimum requirements of AWS 132.1,ASME Section IX Welding and Brazing Qualifications, or other applicable YES ❑N O qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators qualified in accordance SKYES ❑ NO WELDING with the minimum requirements of AWS 132.1,ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that the welding was conducted in compliance with a documented quality control procedure to ensure that(1)all discs are retrieved;(2)that openings in piping are smooth,that slag ZWYES ❑ NO and other welding residue are removed; (3)the internal diameters of piping are not penetrated;(4) completed welds are free from cracks,incomplete fusion,surface porosity greater than 1/16 inch diameter, undercut deeper than the lesser of 25%of the wall thickness or 1/32 inch;and(5)completed circumferential butt weld reinforcement does not exceed 3/32 inch? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL ES ❑ NO DISCS CUTOUTS DISCS ARE RETRIEVED? HYDRAULIC NAMEPLATE P_ROVDED IF NO, EXPLAIN DATA YES ❑NO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: f NAME OF SPRINKLER CONTRACTOR AHERN, 855 MORRIS STREET—FOND DU LAC,WI 54935 TESTS WITNESSED BY AUTHORITIES HAVING JURISDICTION (SIGNED) TITLE DATE SIGNATURES (� � 4-Q-2`2010 TH OPERTY OWN4 THEIR AUTHORIZED AGENT(SIGNED) TITLE �TE ,a: PRINKLE 0 TOR( NED) TITL DATE ADDITIONAL E)PLANA] ONS AND N TES: 3