PERMITING FOR O'DONNELL FUNERAL HOME ypvc°�,' de Commonwealth of Massachusetts
t City of Salem
'�q ix)
t 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 .�
Return card to Budding Division for Certificate of Occupancy
Permit No. 8-18-771
FEE PAID: $33,000.00
PERMIT TO BUILD
DATE ISSUED: 8/17/2018
This certifies that EIGHTY FOUR WASHINGTON SQUARE EAST, LLC
has permission to erect, alter, or demolish a building 84 WASHINGTON SQUARE EA Map/Lot: 350516-0
as follows: Additions - Commercial ADDITION & RENOVATIONS TO AN EXISTING FUNERAL HOME PER
PLANS & SPECIFICATIONS.
Contractor Name: CLAUDE DWAN
DBA: R C GRIFFIN INC
Contractor License No: CS-078163
(-404. 171 -` 8/17/2018
Building Official Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
HIC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
V C
L_
�V
`°J°`„�, Common" -"alth of Massachusetts
{ �ii*.
3 a * 4 i
y� City of Salem A
4 , P 120 Washington St.3rd Floor Salem MA 01970(978)745-9595 x5641
'�All N}:.��
Return card to Building Division for Certificate of Occupancy
Lir
Structure CITY OF SALEM BUILDING PERMIT ,oNDIT,,N
PERMIT TO BE POSTED IN THE WINDOW t �— a`
Excavation a� ��,
y t
Footing INSPECTION RECORD
Foundation
Framing
Mechanical
Insulation INSPECTION: BY DATE
Chimney/Smoke Cha/mbber j$ Jj �i Q /� ^�, (�� �/� (�
Final 1�1.,1 2" 1 7 _,ate `iJ : 1 o 1' i,� . U t 'dec5c 1, 11' l,Cc i )J2e(� 1V L ee- �1\� � it 4-eX1F,`/W1
e` V
I' , Plumbing/Gas 1dr�
I J D-v..AT oft ,q vi 3 - N C/® ,gP-f'Ttc 'irlG In et2 v:Av< oil rr1(,c .)
Rough:Plumbing L/ //9� 1 /� ed /�Rough: //� / ] liv Me Y eL in 1,6 Z W�fY rjC\0 \'t15 �'1116--q 6A 'ileCS �� - `1
Final // 2//20/ */,..t, O /21i�514 dG�i:�i' ,/ fh /45r441 ak �� .
Laj �
Electrical
Service
Rough
Final
ZS Fire Department
Preliminary ¢
Final /_.�-. .aAC�{-—, /ZI I/1(471
4f Health Department
Preliminary
Final
Certificate Number: B-18-771 Permit Number: B-18-771
Commonwealth of Massachusetts
City of Salem
This is to Certify that the Funeral Building located at
Building Type
84 WASHINGTON SQUARE EA in the City of Salem
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY
O'DONNELL FUNERAL HOME
This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and
expires Not Applicable unless sooner suspended or revoked.
Expiration Date
riergOLIZ
Issued On: Friday, December 20, 2019
Commonwealth of Massachusetts
t 7
nI1111 City of Salem ks
120 Washington St,3rd Floor Salem.MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Permit No. B-19-349 P E RM I T TO B U I L D
FEE PAID: $50.00
DATE ISSUED: 4/9/2019
This certifies that EIGHTY FOUR WASHINGTON SQUARE EAST, LLC
has permission to erect, alter, or demolish a building 84 WASHINGTON SQUARE EA Map/Lot: 350516-0
as follows: Other Building Permit RAZE EXISTING GARAGE ON BACK OF PROPERTY (SHC Expiration
of Demolition Delay Ordinance filed with permit app.)
Contractor Name: CLAUDE DWAN
DBA: R C GRIFFIN INC
Contractor License No: CS-078163 _
4/9/2019
Building Official Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
HIC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
CONiiii-4 4 ; Commonw^1Ith of Massachusetts
a� , City of Salem
C7f
Q.
Fr 120 Washington St.3rd Floor Salem.MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Structure CITY OF SALEM BUILDING PERMIT
PERMIT TO BE POSTED IN THE WINDOW
Excavation
Footing INSPECTION RECORD °
Foundation
Framing
Mechanical
Insulation INSPECTION: BY DATE
Chimney/Sm/oke'Cha>m�b]er
Final I�_1 7 _/ J
Plumbing/Gas
Rough:Plumbing
Rough:Gas
Final
Electrical
Service
Rough 6q
COV 7`
Final
Fire Department
Preliminary
Final
Health Department
Preliminary
Final
" tTA, Commonwealth of Massachusetts
lYv dv
ya �: City of Salem
FFFFy
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x56,11
yg:
Return card to Building Division for Certificate of Occupancy
Permit No. B-19-24 FERIVIIT TO BUiLD
FEE PAID: $4,653.00
DATE ISSUED: 1/9/2019
This certifies that EIGHTY FOUR WASHINGTON SQUARE EAST, LLC
has permission to erect, alter, or demolish a building 84 WASHINGTON SQUARE EA Map/Lot: 350516-0
as follows: Sheet Metal FAN COILS WITH HW & DX COOLING, ASSOCIATED DUCT WORK FOR SIX (6)
UNITS, 1ST & 2NU FLOOR. HOT WATER PIPING NEW BOILERS.
Contractor Name: JOHN R. CAPCNE
DBA: HALL SHEET METAL r,VORKS INC
Contractor License No: 72
1/9/2019
Building Official Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall confcrm to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of:;se of any building and structures shall be in compliance with the local zoning by-Irws and codes.
This permit shall be displayed in a location cisarly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issu ad until all applicable signatures by the Building and Fire Officials are provided on this permit.
H IC#: "Persons contracting with unregistered contractors do not have access to the guars ity fund"(as set forth in MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
/ L
`1 Common' Ith of Massachusetts
o City of Salem
�P 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy
Structure vti,�,c`ownir�nH
CITY OF SALEM BUILDING PERMIT
Excavation PERMIT TO BE POSTED IN THE WINDOW \'.
Footing INSPECTION RECORD
Foundation
Framing
Mechanical
Insulation INSPECTION: BY DATE
Chimney/Smoke Chamber
Final ) / 9
Plumbing/Gas
Rough:Plumbing
Rough:Gas
Final
Li) Electrical
Service
Rough
Final
412 Fire Department
Preliminary
Final
Ctri,I Health Department
Preliminary
Final
Final Construction Control Document
To be submitted at completion of construction by a
akl
r ti; Registered Design Professional
I for work per the 9th edition of the
JZartme
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: O'Donnell Funeral Home Fit-Out—Salem MA Date: 12-11-19
Property Address: 84 Washington Square East Salem, MA 01970
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: Fit-out of an existing three(3)story,approximately 10,000-SF converted home for a proposed
O'Donnell Funeral Home in Salem,MA,as well as a 1,600-sf addition.
I Anthony M.Almonte MA Registration Number: 40412 Expiration date:June 30, 2020,am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
Architectural Structural Mechanical
Fire Protection X Electrical Other: Fire Alarm
for the above named project. I,(or my designee-Avid Engineers),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
electronic signature and seal: �N OF '"
L Mq'5'
•
cr. ANTHONY
Avid Engineers ALMONT
• L
o ELECTRI•'
17 Bridge Street, Suite-201 344 Boylston St, 3rd Fir. No.4041-
Billerica, MA 01821 Boston, MA 02116 �,� /N
/STEP ;�/
ON '�
Phone number: 978-663-5580 ex.304 Email: aalmonte@avidengineers.com �sib /
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
ct
Final Construction Control Document
4'1To be submitted at completion of construction by a
- t t Registered Design Professional
f I < for work per the 9th edition of the
-Arm
sYe�
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: O'Donnell Funeral Home Fit-Out—Salem MA Date: 12-11-19
Property Address: 84 Washington Square East Salem, MA 01970
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: Fit-out of an existing three(3)story,approximately 10,000-SF converted home for a proposed
O'Donnell Funeral Home in Salem,MA,as well as a 1,600-sf addition.
I Robert M. MacCormack,Jr.MA Registration Number:46319 Expiration date: June 30,2020,am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning':
Architectural Structural X Mechanical
X Fire Protection Electrical X Other: Plumbing
for the above named project. I,(or my designee—Avid Engineers),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 MR 107.
ti
Enter in the space to the right a"wet"or .��R �'
electronic signature and seal: fro
ac4nR •CK
MEd ANICAL
Avid Engineers N•. 46319
\
14-15
17 Bridge Street, Suite-201 344 Boylston St, 3rd Flr. Fss/o auE O\s��
Billerica, MA 01821 Boston, MA 02116
Phone number: 978-663-5580 ex.305 Email: rmaccormack@avidengineers.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
Griffin
1 =- ,` Engineering
Group,LLC
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT LOCATION: 84 Washington Square East, Salem, MA
(O'Donnell Funeral Home)
NATURE OF PROJECT: Renovation and expansion of funeral home.
ENGINEER: Griffin Engineering Group,LLC
ADDRESS: 495 Cabot Street, Beverly,MA 01915
TELEPHONE: 978-927-5111
I, Robert H. Griffin,Registration No. 36686,being a registered Professional Engineer,hereby
certify that I have prepared or directly supervised the preparation of design plans,computations
and specifications concerning STRUCTURAL ENGINEERING for the above named project and
that,to the best of my knowledge, such plans,computations and specifications meet the
applicable provisions of the Massachusetts State Building Code, 780 CMR 51.00,all accepted
engineering practices and applicable laws and ordinances for the proposed use and occupancy.To
the best of my knowledge and belief,the work has proceeded in substantial accordance with the
documents approved for the building permit and is substantially complete.
y%.��s
Signature ' Date
roo F41 sy
. ROBERr c.1
c
4 GRIFFIN m K"
-0 r crvsss lt ��Qc�#s
s
ete•
Phone 978-927-5111 Fax 978-927-5103 www.griffineng.com
495 Cabot Street 2nd Floor I Beverly, MA 01915
Final Construction Control Document
;( t• !`.'? To be submitted at completion of construction by a
Registered Design Professional
t
for work per the 8"'edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: O'Donnell Funeral Home Date:12-11-2019 Permit No. B-18-771
Property Address: 84 Washineton Square East;Salem,MA 01970
Project: Check one or both as applicable: New construction(X) Existin2 Construction(X)
Project description: Renovation and new construction of an existing funeral home for the operation of the O'Donnell
Funeral Home—Salem. New accessible entrance added to the rear of the building with elevator serving all floors.
Ground Level to serve as chapels with second floor serving as meeting and office space basement area for preparation
and mechanical/electrical equipment.
Paul R. Durand, MA Registration Number: 8615 Expiration date 8/30/2020 .am a Regisieredl design
professional, and 1 have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning:
I X] Architectural [ ] Structural [ I Mechanical
[ ] Fire Protection [ ] Other:
[] Electrical
for the above named project. I.or my designee.have performed the necessary professional services and was present at the const
ruction 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 for my designee:
I. 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.
.0 ARCH/
Enter in the space to the right a"wet"or eNS�
P' g _
electronic signature and seal: PAUL
'8615 ��'"
Phone number: 978-224-2431 oy . w Email: pdurandra)wsarchitects.com
4011
Building()I licial t se Unl�
Building Official Name. I'ermit No _ Date
\ r,ion 06 I I `MI
1 IL,____:iir:-.-- m, 0 En swot.F• Tr,
12.
SPRINKLER CORPORATION
PROTECTING PROPERTIES SINCE 1903
Fire Protection Contractors
58R Pulaski St.
P.O.Box 3007
Peabody,MA 01960
Tel: (978)532-2907 Fax:(978)531-2433
www.metroswift.com
November 12,2019
RE: Fire Sprinkler Installation
O'Donnell Funeral Home
84 Washington Sq, Salem, MA
Our Project Number 18-17318
Attn:Nikolaus Kennedy
This letter is to confirm that an NFPA 13 fire sprinkler system has been installed at the location indicated above. We want to
inform you as the property owner(or as the property owner's authorized representative to us on this project)that the codes and
adopted standards by which this system was installed—NFPA 13, 14 and 25--specifically state"The responsibility for
properly maintaining a water-based fire protection system shall be that of the owner of the property."
For this reason,we have provided record drawings and instruction as to the location and operation of all newly installed control
valves, along with the care and maintenance of this equipment. Furthermore,we have properly executed the applicable
Contractors'Material and Test Certificate(s), and these have been witnessed by your authorized representative. Finally,we
have provided a copy of NFPA 25 "Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection
Systems"for your future reference. It is very important that this information be passed on to those authorized by the property
owner to maintain this new system.
It is critically important that enough heat to prevent the sprinkler pipe from freezing is maintained throughout all
portions of the property including above ceiling spaces,attic spaces,garage,entry vestibules and crawl spaces.
If there is anything about this system that you do not fully understand,please call us this week and we will be happy to answer
your questions. Otherwise, it will be understood that you are fully aware of your responsibilities.
Sincerely yours; n i/
,7
j/.
ichard DeMichele
Metro-Swift Sprinkler Corp.
I acknowledge that I have been authorized to receive this information on behalf of the owner:
2(C 144110 131;I)4120 Sutr_12 1 l-24-19
Printed Name Signatur Title Date
- INSPECTIONAL SERVICES,FIRE PUMP TESTING,BACKFLOW INSTALLATION,24-HOUR EMERGENCY SERVICE -
Page 1 of 1
�1: Cityof: .
tiSalem,
e-c:,>� Massachusetts
:0 kl r;"�r" "ire Department 1\0 �� 'rd'�
48 Lafayette Street
David W.Cody Salem, Massachusetts 01970-3695
J Chief Sire Prevention
f ?ef. 978-744-1235
978-744-6990 Fax 978 74S 4646 Bureau
dcody@salem.com 9T8 T5-T777
Y
FIRE ALARM & SPRINKLER CERTIFICATION
DATE: 14 Ll
FROM: METRO SWIFT SPRINKLER CORP
9 7 8-5 3 2-2 9 0 7
NAME: TELEPHONE:
ADDRESS: 58R PULASKI STREET
PEABODY, MA
ADDRESS OF PROPERTY; 84 WASHINGTON SQ
I hereby certify that the FIRE ALARM system at the above names property has been inspected and
tested in accordance with the manufacturers recommended practices and is installed in compliance with
all applicable Massa tts St des.
SIGNATURE: , c CERTIFICATE# A /1 O G 7
TYPE OF CERTIFICATE: Electrician ✓Fire Alarm Contractor Sprinkler Contractor
DATE OF INSPECTION/TEST: i; 2c 1/
I hereby certify that the AUTOMATIC SPRINKLER system at the above names property has been
inspected and tested in accordance with the manufacturers recommended practices and is installed in
compliance with all applicable Massachusetts State Codes.
SIGNATURE5 � CERTIFICATE# SC001199
TYPE OF CERTIFICATE: Electrician Fire Alarm Contractor Sprinkler Contractor X
DATE OF INSPECTION/TEST: T 1 1
Form 81 F/B (10/06)
`
Contractor's Material and Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work,ins
pection and tests shall be made by the contractor's representative and witnessed by an owner's representative
(hereinafter defined as property owner). All defects she 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. Copes shall be prepared for approving authorities,owners,and contractor.it is
understood that the property owner's authorized representative is a legal signatory and fully representative of the property owner and that by the
property owner's or property owners authorized representative's signature,the property owner accepts full responsibility for the system as
installed and agrees that it is in compliance with the apolicable approving authority's requirements and local ordinances.
Property Name ODONNELL FUNERAL HOME
Date
Property Address -
Property
84 WASHINGTON SQ, SALEM, MA
Accepted by Approving Authorities(Names)
FIRE DEPT
•
Address
Plans
Installation conforms to accepted Plans pg Yes 0 No
Equipment used is approved (A, Yes 0 No If no,explain deviations •
•
Has the property owner or property owner's authorized representative been
instructed as to the location of control valves and care and maintenance of this
new equipment? Yes
If no,explain El No
Instruction Have copies of the following been given to the property owner or property
owner's authorized representative?
1. System Components Instructions 3 Yes ❑ No
2. Care and Maintenance Instructions 3 Yes 0 No
3. NFPA 25 Yes ❑ No
Location — __ .._---
Otsystem Supplies Buildings ALL AREAS
•
Make Year Temperature
Model of Manufacture Orifice Size Quantity Rating
1.,1 S'1' A"1"1'ALHjU
Sprinklers --
{
1
Pipe and i Type of Pipe BLACK STEEL SCH 40 7 SLH 10
• Fittings • Type of Fittings BCI THREADED / ROLL GROOVED
Alarm Device Maximum time to operate
Alarm Valve ''. through test connection
or Flow Type Make Model
Indicator ^ ! ]1WY�R� Minutes Seconds
Dry Valve Q.O.D.
Make Model Serial No. i Make i Model Serial t:.
Time to • Trip Point Time Water
through test ac Air Air Rea st Alarm Operated Proper,
Dry Pipe connection' Pressure
Operating Min/Sec ure Pres si i Min/Sec
Test �� Yes No
w/o Q.O.D.
with Q.O.D.
I'N m
'measured from time inspectors test opened(NFPA 13 only requires the 60-second limitation in specific sections)
i Operation Piping Supervised ❑® Pneumatic 0 Electric
'�'�-... ❑ Hydraulic
Yes ❑ No ( Detecting Media Supervised ■ Yes p ve operate from the manual trip,remote,or both control stations?
Is there an a ible facility in each circuit for testing? No
9 If no,explain
Deluge 8
Preaction ❑ Yes ❑ No �- --
•
Va ves I Does ircur,operate Do circuit operate valve i Maximum time to operate
Make Mode' I supervision los ? release? release
Yes Yes No 1 Min I Sec
Location I Make and — -
Residual Pressure
Pressure and Floor Setting Static Pressure flowing) Flow Rate
Reducing
Valve Tess f Inlet(psi) Outlet(psi) Inlet(psi) Oufle Flcw
Valve Te L (gpm)
I
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi(13.0 bar)for two hours or 50 psi(3.4 bar)above static
pressure in excess of 150 psi(10.2 bar)for two hours. D fferential dry-pipe valve clappers shal':be left open during the test to prevent
Test damage. All aboveground piping leakage shall be stopped.
Description PNEUMA s a
nd measure dro ,whi in ours. Test
pressure tanks a:normal easure a seed 1 Yi psi(0.1 bar)in 24
All piping hydrostatically tested at 2 Q°psi( bar)for 2 hours if no,state reason
Dry piping pneumatioolly tecicd i 3 Yec ❑ No
Equ!pment operates properly - Yes ❑ No
Do you certify as the sprinkler contractor that additives and corrosive chemicals,sodium silicate or derivatives of sodium silicate,brine,1 or other corrosive chemicals were not used for testing system or stopping leaks?
lEl Yes ❑ No
Drain I Reading of gauge located near water supply test connection 1 3..v sidual pressure with valve in test connection open wide
Tests Test ??psi( oar) I Gpsi( bar)
Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping
Verified by copy of the U Form No.85B ❑ Yes ❑ No Other Explain
Flushed by installer of underground sprinkler piping ❑ Yes ❑ No tIG FLUSHED BY MSSC
• INSTALLATION BY OTHERS
If powder-driven fasteners are used in concrete,has ❑ Yes 0 No If no,explain
representative sample testing been satisfactorily
completed?
Blank Number Used Locations Number Removed
Testing
Gaskets
' WeidedPioing 0 YES g NO If Yes...
Do you certify as the sprinkler contractor that welding procedures comply with the
I i Requirements of at least AWS 82.1?
0 Yes 0 Na
Do you certify that the welding was performed by welders qualified in compliance
Welding With the requirements of at least AWS B2.1? 0 Yes 0 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 I
Smooth,that slag and other welding residue are removed,and that the internal
Diameters of piping are not penetrated? ❑ Yes ❑ No
Cutouts Do you certify that you have a control feature to ensure that all cutouts(discs)are
(Discs) Retrieved? [ Yes 0 No
Hydraulic Nameplate provided [2' Yes ❑ No If nc,explain
Data
Nameplate
Remarks Date left in service with all control valves open
Name ofSprinKlerContractor METRO-SWIFT SPRINKLER CORPORATION
Tests Witnessed by: .s " .`r
Signatures > / ,r''
For property owner(printed name) �— Siggne'ture Title Date
.i
r'e► t-- :►0,r1t.�1 , °' '' rt. n JJC1If61
For sprinkler contractor(printed nary e) Signature Title rDate'
Additional Explanation and Notes: c„
FORWARD FLOW TEST OF DCVA THROUGH FDC
® 3 (1/2",K=5.6) TYCO TY323 155' OR BR PENDENT
t 10 (1/2",K=5.6) TYCO TY3199 CC3 COIN SPKR
® 4 (1/2",K=2.8) TYCO TY1231 1550R SEMI RECESSED WHT
>< 2 (1/2",K=4,2) TYCO TY2180 881 ATTIC SPKR
H 7 (1/2",K=5.6) TYCO TY3180 BB1 ATTIC SPKR
Q 29 (1/2"K=5.6) TYCO TY3131 155'QR BR UPRIGHT
• 49 (1/2"K=5.6) TYCO TY3531 155'QR CONCEALED WHT
® 31 (1/2",K=5.6) TYCO TY3131 200'QR BR UPRIGHT
11 (3/4",K=8.0) TYCO TY4332 135'QR EXT COVER SW
< 17 (1/2",K=5.6) TYCO TY3331 155'QR HSW
<x 7 (1'/2",K=5.8) TYCO DS1 155'0RDRY HSW