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HomeMy WebLinkAbout5600 AVENIDA ENCINAS; ; AS150030; Permit9/27/22, 3:05 PM AS150030 Permit Data City of Carlsbad Sprinkler Permit 5600 AVENIDA Job Address: ENCINAS Permit Type: SPRINK Parcel No: 2100905000 Lot #: 0 Permit No: AS150030 Status: ISSUED Applied 2/19/2015 Approved: 2/23/2015 Reference No.: Issued: 2/23/2015 PC #: Inspector: Project Title: AVENIDA ENCINAS GYM STE 100 STE 100: INSTALL NEW TENANT PIPING AND SPRINKLERS AS SHOWN ON THE DRAWINGS. NEW SPRINKLERS TO BE SUPPLIED FROM EXISTING 1" OUTLETS AND/OR EXISTING SPRINKLER PIPING. Applicant: INDUSTRIAL FIRE SPRINKLER CO INC 3845 IMPERIAL AV SAN DIEGO CA 619-266-6030 619-266-6035 Owner: MART-CARLSBAD L L C 221 15TH ST DEL MAR CA Fees ($) Add'I Fees ($) Total ($) Balance ($) 210 0 210 about:blank 1/1 'I Contractor's Material and Test Certificate for Aboveground Piping WICNIN IIWIJ[ Ii Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shalt 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 authority's requirements or local ordinances. Property name AVENIDA ENCINAS Date 4-30-15 Property address 5600 AVENIDA ENCINAS CARLSBAD CA. Accepted by approving authorities (names) CARLSBAD FIRE DEPT. Address 2560 ORION WAY CARLSBAD CA. 92010 Plans Installation conforms to accepted plans 0 Yes 0 No Equipment used is approved Z Yes 0 No• If no, state deviations Has person in charge of fire equipment been instructed as to location of 0 Yes 0 No control valves and care and maintenance of this new equipment? If no, explain Have copies of the following been left on the premises? Instructions System components instructions 0 Yes 0 No Care and maintenance instructions N Yes 0 No 3.NFPA25 EYes 0 N 4. With whom copies GENERAL _have _the _been _left? _CONTRACTOR Location of AVENIDA ENCINAS system Year of Make Model manufacture Orifice size Quantity Temperature rating GLOBE GL5615 2015 3,4 Sprinklers Pipes and Type of pipe fittings Type of fittings Maximum time to operate through test Alarm valve or flow Alarm device connection Type Make Model Minutes Seconds VANE TYPE FLOW POTTER VSR indicator 1 30 For individual use. No other reproduction or transmission in any form permitted. 1 of 3 Contractor's Material and Test Certificate for Aboveground Piping Dry valve - Q.0.D Make Model Serial No. Make Model Serial No. Dry pipe Time to trip throuq1 test connection Water pressure Air pressure Trip point air pressure Time water reached test outlet Alarm operated properly rating ope test Minutes psi psi psi Minutes Yes No Without O.O.D. ____ _Seconds ______ _Seconds With I i Q.O.D. If no, explain Operation 0 Pneumatic 0Electric 0Hydraulics Piping supervised 0 Yes 0 No J_ Detecting media supervised 0 Yes 0 No Doesvalveoperatefromthemanualtrip,remote,or bothcontrolstations? Yes No Is there an accessible facility in each circuit for testing? If no, explain Deluge and preaction valves ) Yes 0 No Does each circuit operate Does each circuit operate Maximum time to operate Make Model supervision lossalarm? valverelease? release Yes No Yes No Minutes Seconds - Location and Make and Pressure- floor model Setting Static pressure Residualpressure(flowing) Flowrate Flow reducing valve test Inlet(psi) Outlet(psi) Inlet(psi) Outlet(psi) (gpm) Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for 2 hours. Differential dry pipe valve clappers shall be left Test open during the test to prevent damage. All aboveground piping leakage shall be stopped. description Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 11/2 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 1½ psi (0.1 bar) in 24 hours. All piping hydrostatically tested at 200 psi ( bar) for 2 hours If no, state reason Dry piping pneumatically tested 0 Yes 0 No Equipment operates properly 0 Yes 0 No 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 systems or stopping leaks? Yes [I No Drain Reading of gauge located near water supply I Residual pressure with valve in test connection I Tests t test connection psi( bar) open wide psi( bar) Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material and Test Yes No Other Explain Certificate for Underground Piping. Flushed by installer of underground sprinkler piping Yes 0No If powder-driven fasteners are used in concrete, has Yes 0 No If no, explain representative sample testing been satisfactorily completed? Measured from time inspector's test connection is opened. b NFPA 13 only requires the 60-second limitation in specific sections. For individual use. No other reproduction or transmission in any form permitted. 2 of 3 Contractor's Material and Test Certificate for Aboveground Piping Blank testing Number used Locations Number removed gaskets Welding piping Yes 0 No If yes... Do you certify as the sprinkler contractor that welding procedures used complied with the minimum requirements of AWS B2.1, ASME Section IX Welding and Brazing Qualifications, Q Yes 0 No or other applicable qualification standard as required by the AHJ? Welding Do you certify that all welding was performed by welders or welding operators qualified in accordance with the minimum requirements of AWS B2.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Yes 0 No Do you certify that the welding was conducted in compliance with a documented quality 0 Yes 0 No control procedure to ensure that (1) all discs are retrieved; (2) that openings in piping are smooth, that slag and other welding residue are removed; (3) the internal diameters of piping are not penetrated; completed welds are free from cracks, incomplete fusion, surface porosity greater than /16 in. diameter, undercut deeper than the lesser of 259/0 of the wall thickness or /32 in.; and (5) completed circumferential butt weld reinforcement does not exceed /32 in.? Cutouts (discs) Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved? 0 Yes 0 No Hydraulic data Nameplate provided If no, explain nameplate 0 Yes 0 No Sprinkler contractor removed all caps and straps? 0 Yes 0 No Remarks Date left in service with all control valves open Name of sprinkler contractor INDUSTRIAL FIRE SPRINKLER CO. INC. 3845 IMPERIAL AVE SAN DIEGO CA 92113 (619) 266-6030 Tests witnessed Signatures The pro pe owne or their authorized agent (signed) Title Date For sprinkler contractor (signed) Title Date Additional explanation and notes For individual use. No other reproduction or transmission in any form permitted. 3 of 3 Contractor's Material and Test Certificate for Aboveground Piping 11 E C U11! 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 shalt be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. Ills 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 authority's requirements or local ordinances. Property name AVENIDA ENCINAS f Date 4-30-15 Property address 5600 AVENIDA ENCINAS CARLSBAD CA. Accepted by approving authorities (names) CARLSBAD FIRE DEPT. Address 2560 ORION WAY CARLSBAD CA. 92010 Plans Installation conforms to accepted plans 0 Yes 0 No Equipment used is approved 0 Yes 0 No If no, state deviations Instructions Has person in charge of fire equipment been instructed as to location of 0 Yes 0 No control valves and care and maintenance of this new equipment? If no, explain Have copies of the following been left on the premises? System components instructions 10 Yes 0 No Care and maintenance instructions 10 Yes 0 No 3.NFPA25 0 Yes No 4. With whom copies been GENERAL _have _the _left? _CONTRACTOR Location of AVENIDA ENCINAS system Sprinklers Make Model Year of manufacture Orifice size 2015 Quantity Temperature rating GLOBE GL5615 eej 0L Pipes and fittings Type of pipe Type of fittings Alarm valve or flow indicator Alarm device Maximum time to operate through test connection Type Make Model Minutes 1 Seconds - 30 VANE TYPE FLOW POTTER VSR Yi Contractor's Material and Test Certificate for Aboveground Piping I E= =Rhk~ For individual use. No other reproduction or transmission in any form permitted. 1 of 3 Contractor's Material and Test Certificate for Aboveground Piping Dry valve Q.O.D Make Model Serial No. Make Model Serial No. I t Dry pipe Time to trip throu9h test connection a,pressure Water Air pressure Trip point air pressure Time water reahed test outlet a,b Alarm operated properly operating test Minutes Seconds psi psi psi Minutes Seconds Yes No Without Q.O.D. With O.O.D. If no, explain Operation 0 Pneumatic 0 Electric 0 Hydraulics Piping supervised 0 Yes 0 No J Detecting media supervised 0 Yes 0 No Does valve operate from the manual trip, remote, or both control stations? 0 Yes 0 No Is there an accessible facility in each circuit for testing? If no, explan Deluge and preaction valves o Yes 0 No Does each circuit operate Does each circuit operate Maximum time to operate Make Model supervision loss alarm? j valve release? release Yes No Yes No Minutes Seconds Location and Make and Pressure- floor model Setting Static ssure Residual pressure (flowing) Flow rate Flow reducing valve test Inlet (psi) Outlet (psi) Inlet (psi) Outlet (psi) (gpm) Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (102 bar) for 2 hours. Differential dry pipe valve clappers shall be left Test open during the test to prevent damage. All aboveground piping leakage shall be stopped. description Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop; which shall not exceed 1½ 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 1½ psi (0.1 bar) in 24 hours. All piping hydrostatically tested at 200 psi ( bar) for 2 hours If no, state reason Dry piping pneumatically tested 0 Yes 0 No Equipment operates properly 0 Yes 0 No 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 systems or stopping leaks? DYes No Drain Reading of gauge located nearwater supply Residual pressure with valve in test connection Tests test test connection psi( bar) open wide psi( bar) Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material and Test Yes o No Other Explain Certificate for Underground Piping. Flushed by installer of underground sprinkler piping ED Yes 0 No If powder-driven fasteners are used in concrete, has 0 Yes 0 No If no, explain representative sample testing been satisfactorily completed? d Measured from time inspector's test connection is opened. b NFPA 13 only requires the 60-second limitation in specific sections. For individual use. No other reproduction or transmission in any form permitted. 2 of 3 Contractor's Material and Test Certificate for Aboveground Piping Blank testing Number used Locations Number removed gaskets Welding piping D Yes 0 No If yes... Do you certify as the sprinkler contractor that welding procedures used complied with the Yes 0 No minimum requirements of AWS B2.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators qualified in Yes 0 No Welding accordance with the minimum requirements of AWS B2.1, 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 Yes 0 No control procedure to ensure that (1) all discs are retrieved; (2) that openings in piping are smooth, that slag 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 /16 in. diameter, undercut deeper than the lesser of 250% of the wall thickness or /32 in.; and (5) completed circumferential butt weld reinforcement does not exceed /32 in.? Cutouts (discs) Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved? 0 Yes 0 No Hydraulic Nameplate provided If no, explain data nameplate ED Yes 0 No Sprinkler contractor removed all caps and straps? 0 Yes 0 No Remarks Date left in service with all control valves open Name of sprinkler contractor INDUSTRIAL FIRE SPRINKLER CO. INC. 3845 IMPERIAL AVE SAN DIEGO CA 92113 (619) 266-6030 Tests witnessed The property owner or ther authofl$d agent (signed) Title Date Signatures Sqp S, or sprinkler côntractor(signtid): TWO" Date Adt !TeaaPn and notes For individual use. No other reproduction or transmission in any form permitted. 3 of 3 Contractor's Material and Test Certificate for Aboveground Piping Jjj 11 RE FflLE C©Y 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 authority's requirements or local ordinances. Property name AVENIDA ENCINAS Date 4-30-15 Property address 5600 AVENIDA ENCINAS CARLSBAD CA. Accepted by approving authorities (names) CARLSBAD FIRE DEPT. Address 2560 ORION WAY CARLSBAD CA. 92010 Plans Installation conforms to accepted plans I@ Yes 0 No Equipment used is approved 10 Yes 0 No If no, state deviations Has person in charge of fire equipment been instructed as to location of Z Yes 0 No control valves and care and maintenance of this new equipment? If no, explain Have copies of the following been left on the premises? Instructions System components instructions 0 Yes 0 No Care and maintenance instructions 0 Yes 0 No NFPA 25 0 Yes 0 No With whom have the copies been left? GENERAL CONTRACTOR Location of AVENIDA ENCINAS Year of I Make I Model manufacture I Orifice size Quantity Temperature rating GLOBE GL5615 2015 1 •'-. IDO 1W Sprinklers 1772 \ 4 ° Pipes and Type of pipe fittings Type of fittings Maximum time to operate through test Alarm valve Alarm device connection I or flow Type I Make i Model Minutes Seconds L - indicator VANE TYPE FLOW I POTTER I VSR I 1 30 For individual use. No other reproduction or transmission in any form permitted. 1 of 3 Contractor's Material and Test Certificate for Aboveground Piping Dry valve 0.0.0 Make Model Serial No. Make Model Serial No. Dry pipe Time to trip throuh test connection a, Water pressure Air pressure Trip point air pressure Time water reached test outlet a, Alarm operated properly operating test Minutes Seconds psi psi psi Minutes Seconds Yes No Without Q.O.D. With O.O.D. If no, explain I Operation 0 Pneumatic 0 Electric 0 Hydraulics Piping supervised 0 Yes 0 No I Detecting media supervised 0 Yes 0 No Does valve operate from the manual trip, remote, or both control stations? 0 Yes 0 No Is there an accessible facility in each circuit for testing? If no, explain Deluge and preaction valves C Yes 0 No Does each circuit operate Does each circuit operate Maximum time to operate Make Model supervision loss alarm? valve release? release Yes No Yes No Minutes Seconds Location and Make and Pressure- floor model Setting Static pressure Residual pressure (flowing) Flow rate Flow reducing valve test Inlet (psi) Outlet (psi) Inlet (psi) Outlet (psi) (gpm) Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for 2 hours. Differential dry pipe valve clappers shall be left Test open during the test to prevent damage. All aboveground piping leakage shall be stopped. description Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1½ psi (0j bar) in 24 hours. Test pressure tanks at normal water level and air pressureand measure air pressure drop, which shall not exceed 11/2 psi (0.1 bar) in 24 hours. All piping hydrostatically tested at 200 psi ( bar) for 2 hours If no, state reason Dry piping pneumatically tested 0 Yes 0 No Equipment operates properly 0 Yes 0 No 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 systems or stopping leaks? DYes [I No Drain I Reading of gauge located near water supply Residual pressure with valve in test connection I Tests test connection: psi( bar) open wide: psi( bar) Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material and Test S Yes No Other Explain Certificate for Underground Piping. Flushed by installer of underground sprinkler piping 0 Yes 0 No If powder-driven fasteners are used in concrete, has Yes 0 No If no, explain representative sample testing been satisfactorily completed? d Measured from time inspectors test connection is opened. b NFPA 13 only requires the 60-second limitation in specific sections. For individual use. No other reproduction or transmission in any form permitted. 2 of 3 Contractor's Material and Test Certificate for Aboveground Piping Blank testing Number used Locations Number removed gaskets Welding piping Yes 0 No If yes... Do you certify as the sprinkler contractor that welding procedures used complied with the Yes 0 No minimum requirements of AWS B2.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators qualified in Yes 0 No Welding accordance with the minimum requirements of AWS B2.1, 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 0 Yes 0 No control procedure to ensure that (1) all discs are retrieved; (2) that openings in piping are smooth, that slag and other welding residue are removed; (3) the internal diameters of piping are not penetrated; completed welds are free from cracks, incomplete fusion, surface porosity greater than /16 in. diameter, undercut deeper than the lesser of 25% of the wall thickness or 1/32 in.; and (5) completed circumferential butt weld reinforcement does not exceed /32 in.? Cutouts (discs) Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved? Yes 0 No Hydraulic Nameplate provided If no, explain data nameplate 0 Yes 0 No Sprinkler contractor removed all caps and straps? 0 Yes 0 No Remarks Date left in service with all control valves open Name of sprinkler contractor INDUSTRIAL FIRE SPRINKLER CO. INC. 3845 IMPERIAL AVE SAN DIEGO CA 92113 (619) 266-6030 Tests witnessed The property owner or their authorized agent (signed) Title Date Ig- Signatures For sprinkler dontracYor (signed) Title Date Additional explanation and notes For individual use. No other reproduction or transmission in any form permitted. 3 of 3 L'flLE rnnPS 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 authority's requirements or local ordinances. Property name AVENIDA ENCINAS Date 4-30-15 Property address 5600 AVENIDA ENCINAS CARLSBAD CA. Accepted by approving authorities (names) CARLSBAD FIRE DEPT. Address 2560 ORION WAY CARLSBAD CA. 92010 Plans Installation conforms to accepted plans 0 Yes 0 No Equipment used is approved 0 Yes 0 No If no, state deviations Has person in charge of lire equipment been instructed as to location of 0 Yes 0 No control valves and care and maintenance of this new equipment? If no, explain Have copies of the following been left on the premises? System components instructions 0 Yes 0 No Instructions Care and maintenance instructions 0 Yes 0 No NFPA 25 0 Yes 0 No With whom have the copies been left? GENERAL CONTRACTOR Location of AVENIDA ENCINAS system Year of Make Model manufacture Orifice size Quantity Temperature rating GLOBE GL5615 2015 . joo Im —2400 JUL q Sprinklers ~ -2 o Pipes and Type of pipe fittings Type of fittings Maximum time to operate through test Alarm valve or flow Alarm device connection Type Make Model Minutes Seconds - VANE TYPE FLOW POTTER VSR indicator 1 30 11 Contractor's Material and Test Certificate for Aboveground Piping For individual use. No other reproduction or transmission in any form permitted. 1 of 3 Contractor's Material and Test Certificate for Aboveground Piping Dry valve Q.O.D Make Model Serial No. Make Model Serial No. Dry pipe operating test Time to trip throuh test connection Water pressure Air pressure Trip point air pressure Time water reached test outlet a,b Alarm operated properly Minutes Seconds psi psi psi Minutes Seconds Yes No Without Q.O.D. With Q.O.D. If no, explain Operation 0 Pneumatic 0 Electric 0 Hydraulics Piping supervised 0 Yes 0 No I Detecting media supervised 0 Yes 0 No Does valve operate from the manual trip, remote, or both control stations? 0 Yes 0 No Is there an accessible facility in each circuit for testing? If no, explain Deluge and preaction valves 0 Yes 0 No Make Model Does each circuit operate supervision loss alarm? Does each circuit operate valve release? Maximum time to operate release Yes No Yes No Minutes Seconds Location and Make and Pressure- floor model Setting Static ssure Residual pressure (flowing) Flow rate Inlet (psi) Outlet (psi) Inlet (psi) Outlet (psi) Flow (gpm) reducing valve test Test Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for 2 hours. Differential dry pipe valve clappers shall be left open during the test to prevent damage. All aboveground piping leakage shall be stopped. description Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1½ 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 1½ psi (0.1 bar) in 24 hours. All piping hydrostatically tested at 200 psi ( bar) for 2 hours If no, state reason Dry piping pneumatically tested 0 Yes 0 No Equipment operates properly 0 Yes 0 No 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 systems or stopping leaks? NYes No Tests Drain test Reading of gauge located near water supply test connection psi( bar) RrduaI pressure with valve in test connection open wide psi( bar) Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material and Test Yes No Other Explain Certificate for Underground Piping. Flushed by installer of underground sprinkler piping Yes 0 No If powder-driven fasteners are used in concrete, has Yes 0 No If no, explain representative sample testing been satisfactorily completed? Measured from time inspector's test connection is opened. b NFPA 13 only requires the 60-second limitation in specific sections. For individual use. No other reproduction or transmission in any form permitted. 2 of 3 Contractor's Material and Test Certificate for Aboveground Piping Blank testing Number used Locations Number removed gaskets Welding piping Yes 0 No If yes... Do you certify as the sprinkler contractor that welding procedures used complied with the 0 Yes 0 No minimum requirements of AWS 82.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators qualified in 0 Yes 0 No Welding accordance with the minimum requirements of AWS B2.1, 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 0 Yes 0 No control procedure to ensure that (1) all discs are retrieved; (2) that openings in piping are smooth, that slag and other welding residue are removed; (3) the internal diameters of piping are not penetrated; completed welds are free from cracks, incomplete fusion, surface porosity greater than /16 in. diameter, undercut deeper than the lesser of 250% of the wall thickness or /32 in.; and (5) completed circumferential butt weld reinforcement does not exceed /32 in.? Cutouts (discs) Do you certify that you have a control feature to ensure that all cutouts (discs) are retrieved? 0 Yes 0 No Hydraulic Nameplate provided If no, explain data nameplate Yes 0 No Sprinkler contractor removed all caps and straps? 0 Yes 0 No Remarks Date left in service with all control valves open Name of sprinkler contractor INDUSTRIAL FIRE SPRINKLER Co. INC. 3845 IMPERIAL AVE SAN DIEGO CA 92113 (619) 2666030 Tests witnessed Signatures The property owner or their authorized agent (signed) Title Date -i - For sprinkler contractor (signed) itlé 41, Vxpj at~orj and notes For individual use. No other reproduction or transmission in any form permitted. 3 of 3