FINAL CONST CONT DOC Final Construction Control Document
To be submitted at completion of construction by a
rer
If
w; Registered Design Professional
for work per the 8th edition of the
a�M—sye�.
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Dr. Bolen dental offices Tenant Fit-out Date: 12/02/2019 Permit No.
Property Address: 100 Highland Avenue, Salem, MA 01970
Project: Check (x) one or both as applicable: [ ] New construction [X] Existing Construction
Project description: Interior Tenant renovation of existing dental offices. Remove selected non-load bearing
walls in reception area, erect new walls for offices and make minor layout modifications. Upgrade sprinkler
head locations per plan and update emergency egress lighting as required. New paint and minor flooring
patchwork throughout.
I Douglas Shoop, MA Registration Number: 7967 Expiration date: August 2020, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning:
[X] Architectural [ ] Structural [ ] Mechanical
[X] Fire Protection [ ] Electrical [ ] Other: Describe
for the above named project, I, or my designee, have performed the necessary professional services and was
present at the construction site on a regular and periodic basis.To the best of my knowledge, information, and
belief the work proceeded in accordance with the requirements of 780 CMR and the design documents
approved as part of the building permit and that I or my designee:
1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and
other submittals by the contractor in accordance with the requirements of the construction documents.
2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Have been present at intervals appropriate to the stage of construction to become generally familiar
with the progress and quality of the work and to determine if the work was performed in a manner
consistent with the construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
Enter in the space to the right a "wet" or co
electronic signature and seal: ���' � s W. ���
; 1i B ° No.7967 -°
CAMBRIDGE,
MA
4 OF Mp`55P
Phone number: 781.391.1939 Email: doug@dsaarchitects.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
Contractor's Material and Test Certificate for Aboveground Piping
PR{)CEDURE
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 system left in service before contractor's pe:sonnel 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 tnderstwd the owner's representative's sigiratuo., in no war, prejudices any claim against wut,ut.tor for faulty material,
poor workmanship,or failure to comply with approving authority's requireme>its or local ordinances.
PROPERTY NAME: _
PROPERTY ADDRESS: i Q_a _,14L�L_h_./d ,iQ, DATE: �C—Lf 20/�j
__._._ %�/ C _
ACCEPTED BY APPROVING AUTHORITIES(NAMES) J/ tpWt ri✓� , p J441r6
PLANS r// 7
ADDRESS
—
INSTALLATION CONFORMS TO ACCEPTED PLANS 1( 'yES 0 NO
EQUIPMENT USED IS APPROVED YES []NO
IF NO,EXPLAIN DEVIATIONS
—_ ------
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INS ERUCTED AS „, 'ES Tj NO
TO LOCATION OF CONTROL VALVES AND CARE AND Me dINTENANCE
IF NO,EXPLAIN
INSTR UC:PION S
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE..P 2EMISES? _/ .�—�
1.SYSTEM COMPONENTS INSTRUCTIONS �i P' 0 NO
2.CAVE AND MAINTENANCE INSTRUCTIONS is r... CI NO
3.NFPA 25 It 0 NO
LOCATION SUPPLIES BUILDINGS
OF SYSTEM N'e- I.
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SILL QUANTITY RATING
SPRINKLERS - �,
Lei ~_ "
PIPE ARID TYPE OF PIPE -1-2-e ' .t
FITTINGS TYPE OF L^1 r"I INGS CC/S/-.�0�Al
ALARMALARM DEVI MAXIMUM TIME TO OPERATE
VALVE S.F �_ _..T1;1134,1�(^'H. NILG.`11011.r
OR FLOW y
—I.Y MAKE 1y1Q1)AI._ MIN SFC
INDICATOR ----
u) LK I; t
Yt I {� A- I 'J__.____ — DRY VALVEO.D. /
MAKE MO-I DEL SERA O. MAKE MODEL. SERIAL NO.
—.. TIME TO TRIP H TIME WATER ALARM
THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
DRY PIPE 0 -, IN P' ' ' • P' • SURE .1 AIR PRESSUR;-? , T UTLET RQP IRLY
OPERATING 3>� '_L__� PSI NO
TEST WITHOUT
WITH --- ---� .—.—.
,41
E4r IF NO,EXPLAIN
OPERATION Cl PNEUMATIC El ELECTRIC — 0 HYDRALIC
DELUGE AND
PREACTION PIPING SUPERVISED 0 YES 0 NO 1>ETECTING MEDIA SUPERVISED 0 YES ❑NO
VALVF,S
IDES VALVE OPERATE FROM THE MANUAL TRIP,REMOTI OR BOTH �� 0 YES 0 NO ___
CONTROL STATIONS •
IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO,EXPLAIN ._.FOR TESTING CI YES 0 NO
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM? OPERATE VALVE RELEASE OPERATE RELEASE
YES NO YES NO _MIN
r. DSystem\1h1-arid FormstBailding\CormactolsAbovegronndPiping,doc _SEC
ge I of 2
rLOCATION MAKE& SETTING S"ATIC PRESSURE RESIDUAL PRESSURE FWW RATE__—
PRESSURE ,_ )DEL '-S .._.._
REDUCING LET(PSI) OUTLET(PSI INLET(PSI) OUTLET(PSI) FLOW 4GPM)—
VALVE TEST ----
HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 PSI(13.6 bars)for 2 hours or 50 PSI(3.4 bars) ---
TEST above static pressure in excess of 150 PSI(10.2 bars)for 2 hours. Differential dry-pipe valve clappers shall be left
DESCRIPTION open during the test to prevent damage. All abovegrc and leakage shall be stopped.
PNEUMATIC:Establish 40 PSI(2.7 bars)air presst re and measure drop,which shall not exceed 1' PSI(0.1 bars)
In 24 hours. Test-pressure tanks at not ma!water leve I and air pressure and measure air pressure drop,which shall
_ not exceed 1' PSI(0.1 bars)in 24 hours. __ ___,
ALL PIPING HYDROSTATICALLY TESTED A' PSI_ BARS FOR :it HRS IF NO,STATE REASON
DRY PIPING PNEUMATICALLY TESTED/1r& 0 YES 0 NO
EQUIPMENT OPERATES PROPERLY j' YES a NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACT OR THAT ADDITIVES AND CORROSIVE CHEMICALS,
SODIUM SILICATE OR DERIVTTTVES OF SODIUM 5 ILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS
WERE OT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?
._ YES 0 NO — _..
TESTS DRAIN READING OF GUAGE LOCATE NEA WATER RESIDUAL PRESSURE WITH VALVE TEST IN
TEST SUPPLY TEST CONNECTION.' (UPS ( BARS) CONNECTION OPEN WIDE:57 PSI(_._._BARS)
UNDERGROUND MAINS AND LEAD IN CONNECTI DNS TO SYSTEM RISERS FLUSHED BEFORE
CONNECTION MADE TO SPRINKLER PIPING
VERIFIED BY COPY OF THE U FORM NO.85B 0 YES 0 NO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDER-
GROUND SPRINKLER PIPING A) A 0 YES ❑ NO p t I yt
IF POWDER-DRIVEN FASTENERS ARE USED IN YES III NO IF N/O,EXP-
LAIN
CONCRETE,HAS REPRESENTATIVE SAMPLE
TESTING BEEN SATISFACTORILY COMPLETED? /VA
BLANK TESTING NUMBER USED LOCATIONS NUMI3ER REMOVED
GASKETS �. C) -� �_....,. �
WELDED PIPING 0 YES "NO
IF YES...,
DO YOU CERTIFY AS THE SPRINKLER CONTRACT OR THAT WELDING 0 YES 0 NO
PROCEDURES COMPLY WITH THE REQUIREMENT'S OF AT LEAST
AWS D10.9,LEVEL AR-3?
WELDING DO YOU CERTIFY THAT THE WELDING WAS PER FORMED BY WELDERS 0 YES 0 NO
QUALIFIED IN COMPLIANCE WITH THE REQUIRE 4ENTS OP AT LEAST
AWS D10,9,LEVEL AR-3?
DO YOU CERTIFY THAT WELDING WAS CARRIED our TN COMPLIANCE
WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE
THAT ALL DISCS ARE RETRIEVED,THAT OPENIN 3S IN PIPING ARE 0 YES 0 NO
SMOOTH,THAT SLAG AND OTHER WELDING RES II)UE ARE REMOVED,
AND THAT THE INTERNAL DIAMETERS OF PIPING r ARE NOT PENETRATED?
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL I EATURE TO Oit YES 0 NO ____
(DISCS) ENSURE THAT ALL CUTOUTS(DISCS)ARE RETRI WED?
. �
HYDRAULIC NAMEPLATE PROVIDED } IF NO,EXPLAIN - -���
DATA 0 YES VI..NO NAMEPLATE _ e X l J/1
1) r.
DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN r _,�
REMARKS .-..-_—
NAME OF SPRINKLER CONTRACTOR I I ,{_ —
TEST �. _.e Me- t U e V1 Fife. 2C 4-16 r ,._.a--
WITNESSED MR PROPERTY• ER(SIGNED) TITLE pIrJ(DATE
_____.__.._._......BY r �. / 7"1 %9
,
FOR SPRINKLER C NTRACTOR(SIGNED) = TITLE DATE
orcla,-(Pc. , 6-J2b4.4-
pbrAowl _ ......
ADDITIONAL EXPLANATION AND NOTES
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