CV-22 07 00 – Plumbing Insulation Equipment Identification/Tag: _______ Location: _________________________ PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping clean, dry, pressure tested and approved prior to application of insulation. Type and thickness of insulation complies with listed specification requirements for given system and pipe size. Insulation installed with smooth and even surfaces, without the use of filler in voids. Butt joints and longitudinal seams closed tightly with a minimum of 2” lap on jacket seams and 2” tape on butt joints. Staples along seams and butt joints provided with vapor barrier mastic provided for staples on systems requiring vapor barrier. Full-length material used as possible, with no scrap piecing or stretching of insulation utilized. Insulation continuous through sleeves and openings with vapor barriers continuous through all penetrations. Complete vapor barrier provided for all cold water, storm water and piping systems with surface temperatures below 65ºF. Exposed fiberglass insulation covered and sealed at all permanent terminations and at end of work day. Piping and direction of flow is labeled per specification requirements.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) VALVE, FITTING & EQUIPMENT INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Fittings, valves, unions, flanges, couplings and specialties insulated with factory molded or built up insulation of the same thickness as adjoining insulation. Insulated fittings, valves, unions, flanges, couplings and specialties covered with fabric reinforcing and mastic or where temperatures do not exceed 150F, PVC fitting covers. PVC fitting covers secured with tack fasteners and 1-1/2” band of mastic over ends, throat, seams or penetrations or for systems requiring vapor barrier, vapor barrier mastic. Group/ Item
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) GENERAL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Pipe hanger spacing complies with specification requirements. All equipment requiring maintenance is accessible (valves, etc.). Group/ Item
Piping allows access to equipment that is part of this system or another system. Piping is not run through any plenums rated for ventilation. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) FUEL OIL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Double or triple swing joints provided in the pipe lines connected to underground fuel oil tanks, except straight fill lines and test wells, to permit the tanks to settle without Group/ Item
YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All exposed piping which passes through a wall, ceiling or floor is provided with escutcheon plates. Piping labels and direction of flow is provided per specification requirements. All penetrations through fire rated wall assemblies have been sealed per specification requirements. All penetrations through non-rated wall assemblies have been sealed per specification requirements for given space type. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO Group/ Item
CV-22 11 00 – Facility Water Distribution Equipment Identification/Tag: _______ Location: _________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, etc. are clean and free of damage prior to installation. Temporary protective coating is provided on cast iron and steel valves during storage. Temporary end caps are provided on piping and fittings until installation.
Pipe hanger spacing complies with specification requirements. All equipment requiring maintenance is accessible (valves, strainers, etc.). Piping allows access to equipment that is part of this system or another system. Water piping not installed within exterior walls. Open pipe ends capped at completion of work day. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) UNDERGROUND PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/ Item
Question Details Exterior water piping installed below predicted frost level in accordance with SPS Table 382.30-6, but in no case less than 6' bury depth to top of pipe. Minimum of 8' horizontal distance maintained between 2-1/2" and larger water piping and sanitary sewer piping. Minimum of 30" horizontal and 12" vertical distance, water on top, maintained between 2" and smaller water piping and sanitary sewer piping. Where water piping crosses a sanitary sewer, minimum 18" vertical clearance add waterproof PVC water pipe sleeve (reference sanitary sewer materials) sealed at both ends for distance of 10' from sewer in both directions provided. Thrust restraints provided for 3" and larger exterior water piping joints, hydrants, caps, plugs, fittings and bends of 22-1/2 degrees or more. Excavation and backfill meet specification requirements. Underground warning tape installed 6"-12" below finished grade above all exterior below ground piping. Pipe and fittings encased in a polyethylene wrap per specification. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) VALVE & FITTING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO Group/ Item
YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All exposed piping which passes through a wall, ceiling or floor is provided with escutcheon plates. Piping labels and direction of flow is provided per specification requirements. All penetrations through fire rated wall assemblies have been sealed per specification requirements. All penetrations through non-rated wall assemblies have been sealed per specification requirements for given space type. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO
CV-22 13 00 – Facility Sanitary Sewerage Equipment Identification/Tag: _______ Location: _________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping meets ASTM standards and specifications. All piping, etc. is clean and free of damage prior to installation. Temporary protective covering is provided on pipe and fittings during storage.
B) GENERAL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Piping is installed with sufficient pitch and arranged in a manner to ensure drainage of entire system. Interior piping pitched to drain at minimum slope of 1/4" per foot where possible and in no case less than 1/8" per foot for piping 3" and larger. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Pipe hanger spacing complies with specification requirements. All equipment requiring maintenance is accessible (valves, strainers, etc.). Drains and cleanouts level and plumb to finished floor, roof or finished wall. Minimum clearance of 18” provided for all cleanouts and backwater valves. Open pipe ends capped at completion of work day.
ends for distance of 10' from sewer in both directions provided. Excavation and backfill procedures meet specification requirements. Piping bedding and backfill materials meet specification requirements. Underground warning tape installed 6"-12" below finished grade above all exterior below ground piping. Non-metallic piping has tracer wire installed per Wisconsin Administrative Plumbing Codes. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) TESTING & FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
CV-22 14 00 – Facility Storm Drainage Equipment Identification/Tag: _______ Location: _________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping materials meet specified ASTM standards and the specifications. All piping, etc. is clean and free of damage prior to installation. Temporary protective covering is provided on pipe and fittings during storage.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) GENERAL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Piping is installed in a manner to ensure that insulation will not contact adjacent surfaces. Piping is installed with sufficient pitch and arranged in a manner to ensure drainage of entire system. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Connections between dissimilar pipe materials are made with approved fittings.
Pipe hanger spacing complies with specification requirements. All equipment requiring maintenance is accessible. Piping allows access to equipment that is part of this system or another system. Minimum clearance of 18” provided for all cleanouts. Open pipe ends capped at completion of work day. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) UNDERGROUND PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
Question Details Exterior piping installed below predicted frost level, but in no case less than 5' bury depth to top of pipe. Excavation and backfill procedures meet specification requirements. Bedding and backfill material meet specifications. Tracer wire is installed on non-metallic piping. Underground warning tape installed 6"-12" below finished grade above all exterior below ground piping. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) TESTING & FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
22 15 13 – General Service Compressed Air Piping Equipment Identification/Tag: _______ Location: _________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All pipe materials and fittings meet the specifications. All piping, valves, etc. are clean and free of damage prior to installation. Temporary protective coating is provided on steel valves during storage. Temporary end caps are provided on piping and fittings until installation.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is secured to assure damage to hangers, joints, or the building structure does not take place. Piping is installed with sufficient pitch and arranged in a manner to ensure drainage of entire system. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. 4" minimum depth dirt leg installed at the bottom of each vertical run and at each outlet connection with shutoff valve at bottom of dirt leg. Pipe hanger spacing complies with specification requirements.
All valves are in an upright vertical position with handles in a horizontal position and fully operated without removal or alteration of handle. Isolation valves provided at all equipment connections, main branches and sub-branches, “T” connections, and as necessary for repairing the system as specified in contract documents. Vibration isolation is installed where identified in the contract documents. Open pipe ends capped at completion of work day. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO E) TESTING & FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
22 30 00 – Sewage Elector Pumps Equipment Identification/Tag: _______ Location: _________________________ Group/Item Group/Task Description Submitted Delivered A MODEL VERIFICATION 1 Manufacturer 2 Model 3 Serial Number 4 Impeller Diameter (in) 5 Outlet Size (in) 6 Capacity / Head (gpm / ft w.g.) / / 7 Motor Speed / Power (rpm / hp) / / 8 Voltage / Phase / Frequency (V / - /Hz) / / / / CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response B PHYSICAL CHECKS 1 Unit is free from physical damage. YES NO 2 Openings are sealed with plastic. YES NO 3 All components and accessories present. YES NO 4 Installation and startup manual provided. YES NO 5 Unit tags affixed. YES NO 6 Manufacturer’s ratings readable/accurate YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: C INSTALLATION 1 Unit secured as required by manufacturer and specifications. YES NO 2 Adequate clearance around unit for service. YES NO 3 All components accessible for maintenance. YES NO 4 Unit labeled and is easy to see. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: E PIPING 1 All piping components have been installed (in the correct order) as required by contract document or manufacturer. YES NO 2 Piping arranged for ease of unit removal. YES NO 3 Piping supported as required by specifications. YES NO 4 Piping is clean. YES NO 5 Mix-flush valve installed per manufacturer instructions. YES NO 6 Unit connected to drain piping using unions or flanges and isolation valves. YES NO 7 Piping and valves properly checked and free of leaks. YES NO 8 All valves and test ports are easily accessible. YES NO 9 Valve tags attached. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: E ELECTRICAL 1 Local disconnect installed in accessible and visible location. YES NO 2 Motor rotation in the proper direction. YES NO 3 All electrical connections are tight. YES NO 4 All electrical components are grounded. YES NO 5 Electrical conduit and conductor penetrations of sump are air and water tight. YES NO 6 Electrical connections in sump are water tight. YES NO
CV-22 30 00 – Water Heaters (Electric) Equipment Identification/Tag: _______ Location: _________________________ Group/Item Group/Task Description Submitted Delivered A MODEL VERIFICATION 1 Manufacturer 2 Model 3 Serial Number 4 Heating Input (kW) 5 Voltage / Phase / Frequency (V / - / Hz) 6 Storage Capacity (gal.) 7 Recovery capacity at 100 deg. F rise (gph) CHECKLIST GROUP COMPLETE INITIALS: DATE: Group/Item Group/Task Description Response B PHYSICAL CHECKS 1 Unit is free from physical damage. YES NO 2 Water and gas openings are sealed with plastic plugs. YES NO 3 All components present. YES NO 4 Installation and startup manual provided. YES NO 5 Unit tags affixed. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: C INSTALLATION 1 Unit secured as required by manufacturer and specifications. YES NO 2 Equipment location coordinated with piping, ductwork, conduit and equipment of other trades to allow sufficient clearances. YES NO 3 Unit is set on concrete housekeeping pad and is level (commercial units ONLY). YES NO 4 Adequate clearance around unit for service. YES NO 5 All components accessible for maintenance. YES NO 6 Drain pan installed and piped to an adequate drain. YES NO 7 Proper clearances from combustible surfaces maintained per manufacturer’s instructions and applicable codes. YES NO 8 Unit labeled and is easy to see. YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: D WATER PIPING 1 All piping components have been installed (in the correct order) as required by contract document or manufacturer. YES NO 2 Piping arranged for ease of unit removal. YES NO 3 Piping supported as required by specifications. YES NO 4 Piping is clean. YES NO 5 Unit connected to water supply and return/make-up piping using unions or flanges and isolation valves. YES NO 6 Dielectric fittings installed to isolate dissimilar pipe materials. YES NO 7 Piping and valves properly checked and free of leaks. YES NO 8 Thermometers and pressure gauges supplied on supply and return lines. YES NO 9 Piping insulation is complete and installed as per specifications. YES NO 10 All valves and test ports are easily accessible. YES NO 11 Valve tags attached. YES NO
CV-22 42 00 – Commercial Plumbing Fixtures Equipment Identification/Tag: _______ Location: _________________________ A) INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Fixture traps and service stops easily accessible for service. Fixture and carriers secured per manufacturer requirements and level and plumb to finished surface. Pipe penetrations covered with escutcheons. Openings between walls, floors and fixtures sealed with mildew-resistant silicone sealant same color as fixture. Fixtures tested and fully operational. Fixture valves adjusted for intended water flow rate to fixtures to eliminate splashing, noise or overflow Self-closing lavatory faucets adjusted to 15 second cycle. Shower valve temperature limit stops set to 110 degree maximum outlet temperature. Fixtures and trim cleaned using manufacturer's recommended cleaning methods and materials.
CV-22 50 00 – Pool, Aquarium, and Fountain Plumbing Systems Equipment Identification/Tag: _______ Location: _________________________ A) GENERAL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, etc. are clean and free of damage prior to installation. Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Piping is installed with sufficient pitch and arranged in a manner to ensure drainage of entire system. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Pipe hanger spacing complies with specification requirements. All equipment requiring maintenance is accessible (valves, strainers, etc.). All valves are in an upright vertical position with handles in a horizontal position. All valves can be fully operated without removal or alteration of handle, including provisions for specified insulation thickness of piping. Isolation valves provided at all equipment connections, main branches and sub-branches, “T” connections, and as necessary for repairing the system as specified in contract documents.
CV-22 60 00 – Laboratory and Medical Gas and Vacuum Piping Equipment Identification/Tag: _______ Location: _________________________ A) PRE-INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details All piping, valves, etc. are packaged and plugged, and free of damage prior to installation. All installers are “Certified Installers” per manufacturer of piping systems. Temporary end caps are provided on piping and fittings until installation.
Piping allows access to equipment that is part of this system or another system. All pipe joints are silver brazed per specification. Nitrogen purging was use continuously during the brazing process. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) NATURAL GAS AND LP PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping tested at specified pressure and duration as per specification. All leaks identified during testing have been repaired and test re-done to meet specifications. Entire testing procedure witnessed by DFD representative. Test conducted with all piping of tested system or section visible during testing. All exposed piping which passes through a wall, ceiling or floor is provided with escutcheon plates. Piping labels and direction of flow is provided per specification requirements. All penetrations through fire rated wall assemblies have been sealed per specification requirements. All penetrations through non-rated wall assemblies have been sealed per specification requirements for given space type. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) COMPRESSED AIR AND VACUUM PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) COMPRESSED AIR AND VACUUM TESTING & FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping preliminarily tested utilizing nitrogen at specified pressure and duration as per specification. All leaks identified during preliminary testing have been repaired and test re-done until no leaks are present. Piping tested utilizing nitrogen at specified pressure and duration as per specification. Entire testing procedures have been witnessed by DSF representative.
Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO B) GENERAL PIPING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) 7) 8) 9) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping is free to expand and contract without noise or damage to hangers, joints, or the building. Piping is installed in a manner to ensure that insulation will not contact adjacent surfaces. Piping is installed with sufficient pitch and arranged in a manner to ensure drainage of entire system. Changes in pipe sizes are made with the proper size reducing fittings, reducing elbow or reducing tees, and no bushings are utilized. Pipe hanger spacing complies with specification requirements.
All equipment requiring maintenance is accessible (valves, strainers, etc.). Piping allows access to equipment that is part of this system or another system. Water piping not installed within exterior walls. Open pipe ends capped at completion of work day. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO C) VALVE & FITTING INSTALLATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE:
Question Details All valves are in an upright vertical position with handles in a horizontal position. All valves can be fully operated without removal or alteration of handle, including provisions for specified insulation thickness of piping. Drainage valves provided at all low points and downstream of riser isolation valves. Isolation valves provided at all equipment connections, main branches and sub-branches, “T” connections, and as necessary for repairing the system as specified in contract documents. Riser shutoff valve and a capped hose thread drain valve at the bottom of each riser provided. All strainers in piping system have ball valves installed at the tapped screen retainer. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO D) TESTING CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) 5) 6) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO
YES NO YES NO YES NO YES NO YES NO YES NO CHECKLIST GROUP COMPLETE INITIALS: DATE: Question Details Piping tested utilizing distilled water at specified pressure and duration as per specification. All leaks identified during testing have been repaired and test re-done until no leaks are present. Test conducted with all piping of tested system or section visible during testing. Entire testing procedure witnessed by DFD representative. After pressure testing system filled and disinfected with solution of distilled or RO water and hydrogen peroxide per manufacturer directions. Following initial disinfection system flushed with distilled or RO water until no trace of hydrogen peroxide evident by potassium permanganate test. Negative Responses Date Found Found By Location Reason for Negative Response Resolved Date Resolved Resolution YES / NO YES / NO YES / NO YES / NO YES / NO E) FINALIZATION CHECKS Date Description of Work Performed % Complete Initials Questions (See details below) 1) 2) 3) 4) YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO YES NO