Fp 173 Form PDF Details

In the realm of fire prevention and safety, the FP 173 form plays a pivotal role, serving as the Contractor’s Material and Test Certificate for Aboveground Piping. This document is essential after the completion of installation, inspection, and testing of fire suppression systems, wherein it becomes a record of due diligence performed by the contractor’s personnel. It is meticulously filled out and signed to document that all components of the fire suppression system meet the specified standards and requirements, ensuring that the system is left fully functional. The form acts as a bridge of communication between contractors, property owners, and the approving authority, in this case, the Unified Fire Authority’s Fire Prevention Bureau. It details comprehensive tests, such as hydrostatic and pneumatic tests, and verifies whether the installed equipment conforms to the approved plans and is up to the national and local fire safety standards. Furthermore, it includes considerations for the instruction of appropriate personnel in the operation and maintenance of the new equipment, ensuring long-term safety and reliability. With spaces for remarks on equipment, tests witnessed by authorities, and contractor and property owner acknowledgments, the FP 173 form embodies a crucial step in the certification process, helping to maintain high safety standards in fire prevention efforts.

QuestionAnswer
Form NameFp 173 Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesnfpa 24 inspection form, nfpa underground certification form, printable nfpa13 nj form, underground test certificate

Form Preview Example

Unified Fire Authority - Fire Prevention Bureau

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 an owner’s representative. All defects shall be corrected and system left in service before contractor’s personnel leave the job.

This certificate shall be filled out and signed as indicated. 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 the approving authority’s requirements or local ordinances.

Property Name and Address

 

Accepted by approving authorities (names) Unified Fire Authority ____________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

Plans

Address 3380 South 900 West, SLC UT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Installation conforms to accepted plans

 

 

 

Yes

 

 

No

 

 

 

Equipment used is approved

 

 

 

Yes

 

 

No

 

 

 

If no, state deviations

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Has person in charge of fire equipment been instructed as

 

Yes

 

 

No

 

 

 

to location of control valves and care and maintenance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of this new equipment?

 

 

 

 

 

 

 

 

 

 

 

 

 

If no, explain?

 

 

 

 

 

 

 

 

 

 

 

 

Instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have copies of the following been left on the premises?

 

Yes

 

 

No

 

 

 

1. System components instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Care and maintenance instructions

 

 

 

 

 

 

 

 

 

3. NFPA 25

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Location of

Supplies buildings

 

 

 

 

 

 

 

 

 

 

 

 

system

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Make

 

Model

 

 

Year of

Orifice

Quantity

 

Temperature

 

 

 

 

 

 

 

 

Manufacturer

size

 

rating

 

 

 

 

 

 

 

 

 

Sprinklers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pipe and

Type of pipe _______________________________________________________________________________

fittings

Type of fittings _____________________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alarm

 

 

 

 

 

 

 

 

 

 

Maximum time to operate

 

 

 

 

 

 

 

Alarm device

 

 

 

Through test connection

 

 

 

 

 

 

 

 

 

 

 

 

 

Valve or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

flow

 

Type

 

 

Make

Model

 

Minutes

 

 

Seconds

 

 

indicator

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Dry Valve

 

 

 

Q.O.D.

 

 

 

 

Dry pipe

 

 

Make

 

 

Model

 

Serial no.

 

Make

Model

 

 

Serial no.

operating

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Time to trip

Water

 

Air

Trip point

Time water

Alarm

 

 

test

 

 

 

 

 

 

 

through test

pressure

 

pressure

air pressure

Reached

operated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Test outlet

properly

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Min

Sec

psi

 

psi

 

psi

Min

 

Sec

Yes

 

No

 

Without

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Q.O.D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Q.O.D.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If no, explain?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FP 173 Revised 11-04

 

“Signatures on this form are reserved for Contractors and Building Owners only”.

Page 1 of 3

 

Operation

 

 

 

 

 

 

 

Pneumatic

 

 

 

 

 

Electric

 

 

 

 

 

 

Hydraulics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Piping supervised

 

Yes

 

 

No

 

 

 

 

 

Detecting media supervised

Yes

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does valve operate from the manual trip, remote, or both

 

 

Manual

 

 

 

Remote

 

 

 

Both

 

 

Deluge and

Control stations?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

preaction

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there an accessible facility in each circuit

 

 

 

 

 

 

 

 

If no, explain?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

valves

for testing?

 

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does each circuit operate

 

Does each circuit operate

 

 

 

Maximum time to

 

Make

 

Model

 

supervision loss alarm?

 

 

 

valve release?

 

 

 

 

operate release

 

 

 

 

 

 

Yes

 

 

 

 

No

 

 

Yes

 

 

 

 

No

 

 

 

 

Min

 

 

 

Sec

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pressure

Location

 

Make and

 

Setting

 

 

Static pressure

 

 

Residual pressure

 

 

 

 

 

Flow rate

and floor

 

 

model

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(flowing)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

reducing

 

 

 

 

 

 

 

 

 

 

 

 

Inlet

 

Outlet

 

 

 

Inlet

 

Outlet

 

 

 

 

Flow (gpm)

 

 

 

 

 

 

 

 

 

 

 

 

 

psi

 

psi

 

 

 

psi

 

psi

 

 

 

 

 

 

 

 

 

 

 

 

valve test

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hydrostatic: Hydrostatic testes shall be made at not less than 200 psi for 2 hours or 50 psi above static

Test

pressure in excess of 150 psi 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 air pressure and measure drop, which shall not exceed 1 ½ psi 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 in 24 hours.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All piping hydrostatically tested at _____ psi

for _____

hours.

 

 

If no, state reason?

 

 

 

 

 

 

 

 

 

Dry piping pneumatically tested

 

 

Yes

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Equipment operates properly

 

 

Yes

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Were additives, corrosive chemicals, sodium silicate or derivatives of sodium silicate, brine, or other

 

corrosive chemicals or other stop leak devices were used for testing systems or stopping leaks?

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Drain Test

 

Reading of gauge located near water

 

 

Residual pressure with valve test

 

 

supply test connection: _____ psi

 

 

connection open wide: _____

psi

 

 

 

 

 

 

 

 

 

 

 

 

 

Underground mains and lead in connections to system risers were flushed before connection was made to

 

sprinkler piping?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you certify as the sprinkler contractor that welding procedures

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

comply with the requirements of at least AWS B2.1?

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

No

 

 

 

Do you certify that the welding was performed by welders qualified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Welding

in compliance with the requirements of at least AWS B2.1?

 

 

 

 

 

 

Yes

 

 

 

 

 

No

 

 

Do you certify that the welding was carried out in compliance with a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

documented quality control procedure to ensure 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?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cutouts

Do you certify that you have a control feature to ensure that

 

 

(discs)

 

 

 

 

 

 

 

all cutouts (discs) are retrieved?

Yes

No

FP 173 Revised 11-04

“Signatures on this form are reserved for Contractors and Building Owners only”.

Page 2 of 3

Hydraulic

Nameplate provided

Yes

 

 

No

 

 

If no, explain?

 

 

 

 

 

 

 

 

 

Data

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nameplate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Remarks

Date system left in service with all control valves open?

 

 

 

 

 

 

 

 

 

Name of sprinkler contractor?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tests witnessed by

Signatures

 

 

 

 

 

 

 

 

For property owner (signed) _________________________________________

 

 

Title _________________________

Date ___________________

 

 

 

 

For sprinkler contractor (signed)

______________________________________

 

Title ________________________

Date ___________________

 

 

 

 

 

 

 

 

 

Antifreeze Systems Type of Antifreeze Used __________________________________

If the fire sprinkler system contains antifreeze do you certify that the antifreeze is strictly

glycerin, C.P or USP 96.5% grade or propylene glycol?

Yes

No

N/A

Name of person who installed antifreeze _______________________________

Date antifreeze installed ________________________

Temperature or protection _____ below zero

For office use only

Date Information Received:

Received By:

Comments:

Page 3 of 3

FP 173 Revised 11-04 “Signatures on this form are reserved for Contractors and Building Owners only”.

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4. This particular paragraph arrives with all of the following fields to enter your particulars in: Tests, Pneumatic Establish psi air, All piping hydrostatically tested, If no state reason, Dry piping pneumatically tested, Equipment operates properly, Yes, Yes, Were additives corrosive chemicals, Yes, Drain Test, Reading of gauge located near, Residual pressure with valve test, Underground mains and lead in, and Yes.

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