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Above Ground Test Certificate-Building E & FAutomatic Sprinkler Systems FORM 2-1 O Contractor's Material and Test Certificate for Aboveground Piping Property Name: Gross Electric Late1/13/23 ty Address: 27 Silver Circle, Queensbury, NY 12804 Procedure Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and the 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 authori- ties, owners, and contractors. It is understood that 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. Plans Accepted by (approving authority's name(s)] Town of Queensbury Address Installation conforms to accepted plans? 0 Yes ❑ No Equipment used is approved? CE Yes ❑ No If no, explain deviations. Instructions Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment? Cl Yes ❑ No If no, explain. Have copies of appropriate instructions and care and maintenance charts and NFPA 13 been left on premises? 0 Yes ❑ No If no, explain. Location of System Supplies building(s) Building F Sprinklers Year of Orifice Temperature Make Model Manufacture Size Quantity Rating Tvco TY153 2023 16.8 160 200 Victaulic V2709 2023 5.6 10 155 Pipe and Fittings Pipe conforms to NFPA 13 standard. r7 Yes ❑ No Fittings conform to NFPA13 standard. 2 Yes ❑ No If no, explain. PAGE 1 of 3 Copyright 0 2000 National Fire Protection Association rx-1 Automatic Sprinkler Systems FORM 2-1 Contractor's Material and Test Certificate for Aboveground Piping (cont.) Alarm Valve or Flow Indicator Alarm Device Maximum Time to Operate Through Test Pipe Type Make Model Min. Sec. Flow Switch Potter VSR Dry Pipe Operating Test Dry Valve Q.O.D. Make Model Serial No. Make Model Serial No. Time to Trip Trip Point Time Water Alarm Through Water Air Air Reached Operated Test Pipe" Pressure Pressure Pressure Test Outlet* Properly Min. Sec. Psi (Bar) Psi (Bar) Psi (Bar) Min. Sec. Yes No Without Q.O.D. With Q.O.D. If no, explain. Deluge and Preaction Valves Operation ❑ Pneumatic ❑ Electric LL Hydraulic Piping supervised? ❑ Yes ❑ No Detecting media supervised? Ll Yes ❑ No Is there an accessible facility in each circuit for testing? ❑ Yes ❑ No If no, explain. Does each circuit operate Does each circuit Maximum Time to supervision loss alarm? operate valve release? Operate Release Yes No Yes No Min. Sec. Make Model Test Description HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for two hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for two hours. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. 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 flaws not less than 400 gpm (1514 L/min) for 4-in. (102-mm) pipe, 600 gpm (2271 L/min) for 5-in. (127-mm) pipe, 750 gpm (2839 L/min) for 6-in. (152-mm) pipe, 1000 gpm (3785 L/min) for 8-in. (203-mm) pipe, 1500 gpm (5678 L/min) for 10-in. (254-mm) pipe and 2000 gpm (7570 L/min) for 12-in. (305-mm) pipe. When supply cannot produce stipulated flow rates, obtain maximum available. *Measured from time inspector's test pipe is opened. PAGE 2 of 3 Copyright O 2000 National Fire Protection Association Automatic Sprinkler Systems FORM 2-J Contractor's Material and Test %91 Certificate for Aboveground Piping (cons.) Test Description (cont.) PNEUMATIC: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1112 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 1112 psi (0.1 bar) in 24 hours. Tests All piping hydrostatically tested at 200 psi(bar)for 2 hrs. Dry piping pneumatically tested? ❑ Yes F No Equipment operates properly? 1 -1 Yes No If no, state reason. Drain test —Reading of gauge located near water supply test pipe: Static pressure: psi (bar) Drain test —Residual pressure with valve in test pipe open wide: psi (bar) Underground mains and lead-in connections to system risers flushed before connections made to sprinkler piping Verified by copy of the U Form No. 85B Yes I I No Other Flushed by installer of underground sprinkler piping Yes ❑ No L . Other If other, explain. Blank Testing Gaskets Number used Locations Number removed Welding Welded piping? Yes 11 No If yes, Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS D10.9, Level AR-3? Yes L7 No Do you certify that the welding was performed by welders qualified in com- pliance with the requirements of at least AWS D10.9, Level AR-3? n Yes I I No Do you certify that welding was carried out in compliance with a documented quality control procedure to insure 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? LI Yes ❑ No Hydraulic Data Nameplate Nameplate provided? I� I Yes ❑ No If no, explain. Remarks Date left in service with all control valves open: 17 2.o Z3 Sprinkler Contractor: Absolute Fire Protection Signatures of Test Witnesse For property owner (signed) Title WMUIu . M6J1 Date 13k '70 •Z For sprinkler contractor (signed) / Title Date L a 2 3 PAGE 3of3 Copyright 0 2000 National Fire Protection Association A Automatic Sprinkler Systems FORM 2-1 V Contractor's Material and Test Certificate for Aboveground Piping Date: 11/13/23 Property Name: Gross Electric Property Address: 27 Silver Circle, Queensbury, NY 12804 Procedure Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and the 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 authori- ties, owners, and contractors. It is understood that 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. Plans Town of Queensbury Accepted by [approving authority's name(s)] Address Installation conforms to accepted plans? PI Yes ❑ No Equipment used is approved? 0 Yes ❑ No If no, explain deviations. Instructions Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment? 0 Yes LJ No If no, explain. Have copies of appropriate instructions and care and maintenance charts and NFPA 13 been left on premises? 0 Yes ❑ No If no, explain. Location of System Supplies building(s) Building E Sprinklers Year of Orifice Temperature Make Model Manufacture Size Quantity Rating Tvco TY153 2023 16.8 160 200 Victaulic V2709 2023 5.6 10 155 Pipe and Fittings Pipe conforms to NFPA 13 standard. E Yes ❑ No Fittings conform to NFPA13 standard. 1,1 Yes ❑ No If no, explain. PAGE 1 of 3 Copyright 0 2000 National Fire Protection Association r� FORM 2-I Automatic Sprinkler Systems Contractor's Material and Test Certificate for Aboveground Piping (coat.) Alarm Valve or Flow Indicator Alarm Device Maximum Time to Operate Through Test Pipe Type Make Model Min. Sec. Flow Switch Potter VSR '�.Q Dry Pipe Operating Test Dry Valve Q.O.D. Make Model Serial No. Make Model Serial No. Time to Trip Trip Point Time Water Alarm Through Water Air Air Reached Operated Test Pipe" Pressure Pressure Pressure Test Cutlet* Properly Min. Sec. Psi (Bar) Psi (Bar) Psi (Bar) Min. Sec. Yes No Without Q.O.D. With Q.O.D. If no, explain. Deluge and Preaction Valves Operation ❑ Pneumatic LI Electric ❑ Hydraulic Piping supervised? L7 Yes ❑ No Detecting media supervised? ❑ Yes ❑ No Is there an accessible facility in each circuit for testing? ❑ Yes ❑ No If no, explain. each circuit operate Does each circuit Maximum Tme to LDoes supervision loss alarm? operate valve release? Operate Release Yes No Yes No Min. Sec. Make Model Test Description HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for two hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for two hours. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. 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 400 gpm (1514 L/min) for 4-in. (102-mm) pipe, 600 gpm (2271 L/min) for 5-in. (127-mm) pipe, 750 gpm (2839 L/min) for &in. (152-mm) pipe, 1000 gpm (3785 L/min) for 8-in. (203-mm) pipe, 1500 gpm (5678 L/min) for 10-in. (254-mm) pipe and 2000 gpm (7570 L/min) for 12-in. (305-mm) pipe. When supply cannot produce stipulated flow rates, obtain maximum available. *Measured from time inspector's test pipe is opened. PAGE 2 of 3 Copyright © 2000 National Fire Protection Association Automatic Sprinkler Systems FORM 2-J Contractor's Material and Test %7 Certificate for Aboveground Piping (cont.) Test Description (cont.) PNEUMATIC: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1112 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 1112 psi (0.1 bar) in 24 hours. Tests All piping hydrostatically tested at 200 psi (bar) for 2 hrs. Dry piping pneumatically tested? ❑ Yes l'_I No Equipment operates properly? 1 1 Yes h: No If no, state reason. Drain test —Reading of gauge located near water supply test pipe: Static pressure: psi (bar) Drain test —Residual pressure with valve in test pipe open wide: psi (bar) Underground mains and lead-in connections to system risers flushed before connections made to sprinkler piping Verified by copy of the U Form No. 85B 1,1 Yes I I No ❑ Other Flushed by installer of underground sprinkler piping 0 Yes ❑ No LJ Other If other, explain. Blank Testing Gaskets Number used Locations Number removed Welding Welded piping? ICI Yes F1 No If yes, Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS D10.9, Level AR-3? I ! Yes F1 No Do you certify that the welding was performed by welders qualified in com- pliance with the requirements of at least AWS D10.9, Level AR-3? C Yes U No Do you certify that welding was carried out in compliance with a documented quality control procedure to insure 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? I . Yes I I No Hydraulic Data Nameplate Nameplate provided? ",-I Yes I I No If no, explain. Remarks Date left in service with all control valves open: I Sprinkler Contractor: Absolute Fire Protection Signatures of Test Witnesse For property owner (signed) • 1 �.J�'� Title �1��5� MN� Date I Y•20 �1 For sprinkler contractor (signed Title Date za Jz.3 AGE 3of3 Copyright © 2000 National Fire Protection Association A ORM 2-I Automatic Sprinkler Systems Contractor's Material and Test Certificate for Aboveground Piping Date: 11/13/23 Property Name: Gross Electric Property Address: 27 Silver Circle, Queensbury, NY 12804 Procedure Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and the 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 authori- ties, owners, and contractors. It is understood that 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. Plans Accepted by [approving authority's name(s)j Town of Queensbury Address Installation conforms to accepted plans? 0 Yes ❑ No Equipment used is approved? I+] Yes L.I No If no, explain deviations. Instructions Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment? Pl Yes ❑ No If no, explain. Have copies of appropriate instructions and care and maintenance charts and NFPA 13 been left on premises? 0 Yes F1 No If no, explain. Location of System Supplies building(,) Building E Dry System Sprinklers Year of Orifice Temperature Make Model Manufacture Size Quantity Rating Victaulic V3402 2023 8.0 24 200 Pipe and Fittings Pipe conforms to NFPA 13 standard. Pl Yes 11 No Fittings conform to NFPA13 standard. 0 Yes ❑ No If no, explain. PAGE 1 of 3 Copyright © 2000 National Fire Protection Association Automatic Sprinkler Systems FORM 2-I o Contractor's Material and Test Certificate for Aboveground Piping (coat.) Alarm Valve or Flow Indicator Alarm Device Maximum rime to Operate Through Test Pipe Type Make Model Min. Sec. Dry Pipe Operating Test Dry Valve Q.O.D. Make Model Serial No. Make Model Serial No. Time to Trip Trip Point Time Water Alarm Through Water Air Air Reached Operated Test Pipe" Pressure Pressure Pressure Test Outlet" Properly Min. Sec. Psi (Bar) Psi (Bar) Psi (Bar) Min. Sec, Yes No Without Q.O.D. Si » r� With Q.O.D. If no, explain. Deluge and Preaction Valves Operation ❑ Pneumatic LJ Electric ❑ Hydraulic Piping supervised? ❑ Yes ❑ No Detecting media supervised? ❑ Yes ❑ No Is there an accessible facility in each circuit for testing? LJ Yes ❑ No If no, explain. Does each circuit operate Does each circuit Maximum Time to supervision loss alarm? operate valve release? Operate Release Yes No Yes No Min. Sec. Make Model Test Description HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for two hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for two hours. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. 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 flaws not less than 400 gpm (1514 L/min) for 4-in. (102-mm) pipe, 600 gpm (2271 L/min) for SAn. (127-mm) pipe, 750 gpm (2839 L/min) for 6-in. (152-mm) pipe, 1000 gpm (3785 L/min) for 8-in. (203-mm) pipe, 1500 gpm (5678 L/min) for 10-in. (254-mm) pipe and 2000 gpm (7570 L/min) for 12-in. (305-mm) pipe. When supply cannot produce stipulated flow rates, obtain maximum available. `Measured from time inspector's test pipe is opened. PAGE 2 of 3 Copyright 0 2000 National Fire Protection Association Automatic Sprinkler Systems FORM 2-J Contractor's Material and Test Certificate for Aboveground Piping (cont.) Test Description (cont.) PNEUMATIC: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 1112 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 1112 psi (0.1 bar) in 24 hours. Tests All piping hydrostatically tested at 200 psi (bar) for 2 hrs. Dry piping pneumatically tested? Ll Yes I°1 No Equipment operates properly? n Yes ❑ No If no, state reason. Drain test —Reading of gauge located near water supply test pipe: Static pressure: psi (bar) Drain test —Residual pressure with valve in test pipe open wide: psi (bar) Underground mains and lead-in connections to system risers flushed before connections made to sprinkler piping Verified by copy of the U Form No. 85B 1-1 Yes I I No Other Flushed by installer of underground sprinkler piping C Yes ❑ No - Other If other, explain. Blank Testing Gaskets Number used Locations Number removed Welding Welded piping? 1-1 Yes No If yes, Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS D10.9, Level AR-3? 1-1 Yes No Do you certify that the welding was performed by welders qualified in com- pliance with the requirements of at least AWS D10.9, Level AR-3? P-1 Yes F' No Do you certify that welding was carried out in compliance with a documented quality control procedure to insure 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? D Yes L i No Hydraulic Data Nameplate Nameplate provided? 1,1 Yes I-! No If no, explain. Remarks Date left in service with all control valves open: i L Zo Z Sprinkler Contractor: Absolute Fire Protection Signatures of Test Witnesses For property owner (signed) •1Y Title N1A04-,y1bU4r k%Date la -20 For sprinkler contractor (signed Title ra....�..1 Date �o Z3 PAGE3of3 Copyright 0 2000 National Fire Protection Association