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Home My WebLink About0128379-ElectricElectric Permit Work Card Job Address 631 HAZEL ST Permit Number 128379 Create Date 1/7/2008 Owner HEALTH CARE REIT INC Contractor SUBURBAN ELECTRICAL ENGINEERING Service New ~ ChangeQ Temp Q N/A Type Q Overhead ~ Underground Q N/A Volts 480!277 Circuits 2200 Luminaires 1700 Value $1,266,000.00 Amps 2500 Switches 1400 Receptacles 2000 Use/Nature 31 -Residential-New Multi-Family Wiring Wire 111 independent living units, kitchen, restaurant and spa of Work Inspections: Date 05/22/2008 Type Service Inspector Kevin Benner approved w/cond. FP Test conducted 5/21/8 5 KAIC MCB upplemental grounding not connected & the lug for the GEC to be replaced axed to WPS 5/23/8 Date/Time requested: 05/21/2008 08:19 AM Notice Type: Ready Date/Time: 05/22/2008 08:19 AM Access: Requested by: SUBURBAN ELECTRICAL ENGINEERING Q Reinspect Fee Q Fee Wavied ^ Reinspect Fee Paid --------------------------------------------------------------------------------- Phone Number: 841-7096 Scott Electric Permit Work Card Job Address 631 HAZEL ST Permit Number 128379 Create Date 1/7/2008 Owner HEALTH CARE REIT INC Contractor SUBURBAN ELECTRICAL ENGINEERING Service New ~ Change ~ Temp ~ N/A Type 0 Overhead ~ Underground ~ N/A Volts 480/277 Circuits 2200 Luminaires 1700 Amps 2500 Switches 1400 Receptacles 2000 Value $1,266,000.00 Use/Nature 31 -Residential-New Multi-Family Wiring Wire 111 independant living units, kitchen, restaurant and spa. of Work Inspections: Date 09/08/2008 _ Type Re Service Inspector Kevin Benner _ approved PS work #242737 -- axed to WPS 9/8/8 DatelTime nequested: 09/05/2008 11:08 AM Notice Type: Access: Requested by: SUBURBAN ELECTRICAL ENGINEERING Q Reinspect Fee ~ Fee Wavied ^ Reinspect Fee Paid Ready Date/Time: 09/05/2008 11:08 AM Phone Number: 920-841-7096 Scott Square D®Se~vices Electrical Equipment Test Report BELLA VISTA GFP TEST 24312080-046 sa ~~.~ Schneider Electric i11Pc~~ q .~'lre- ~-k~ i rii [RFvS~d September 5, 2008 BELLA VISTA SCOTT WESTPHAL -SUBURBAN ELECTRIC 631 HAZEL STREET OSHKOSH, WI 54904 Customer PO.: 087-671661 Project: 24312080-046 Subject: Ground Fault Testing Report Dear SCOTT WESTPHAL -SUBURBAN ELECTRIC, Enclosed please find the project documentation for the work performed by Square D Services at Bella Vista inr Oskosh on 09/05/2008. In addition to this summary letter I-have included the test report. Scope of Work Summary Secondary Injection Test: This test is used to ensure proper calibration of all functions of the solid state trip unit. Primary injection Test: this test is used to test the proper operation of the ground fault system. Recommendations /Conclusions All of the equipment passed both the visual/mechanical inspections and the electrical tests performed. The equipment was found to be operational and within applicable standards and manufacturer s tolerances. Thank you for allowing Square D Services to meet the electrical needs of Suburban Electric and Bella Vista. If you have any questions or concerns regarding the enclosed test reports or work performed please feel free to contact me anytime at: (920) 757-1057. Thank you for allowing Square D Services to meet the electrical needs of Suburban Electric and Bella Vista. If you have any questions or concerns regarding the enclosed test reports or work performed please feel free to contact me anytime at: (920) 757-1057. Respectfully, Jeff Witthuhn FSR cc: Robert Fulton, Square D Services RUEGSEGGER TOM, Square D Services File a ~~~ Sci~n~ider Electric P~ ,z ,k-~; fin ,rr- t~~.~ Services Division LV Circuit Breaker (Manually Operated) 1-888-778-2733 REFERENCE INFORMATION Contact Name: KONG 920-841-7096 FSR: Jeff Witthuhn Job No: 24312080-046 Customer Site: BELLA VISTA 631 HAZEL STRE Customer Ref No: 087-671661 DBID: 21-218140 ET OSHKOSH, WI 54904 Date: Se tember 5, 2008 P IDENTIFICATION Sub Station Location: Main Customer Asset ID• Sub ID: Main Circuit ID: 1200a Main NAMEPLATE DATA Manufacture: Square D Manufacture Date: 0843 Serial No: 06408405790001 Type: Powerpact RJ1200 Frame Size: 1200 Amps Rated Amps: 1200 Amps Sensor Rating: 1200 Amps Rating Plug: 1200 Amps Fuse Type: Fuse Manufacture: N/A Fuse Model/Catalog No: Fuse Rating: Trip Unit Type: Micrologic 6.OA Trip Curve No: Interrupt Rating: 65 KA Mounting: Fixed Number of Operations: Number of Operations: INSPECTION CHECKLIST ITEM AS LEFT ITEM AS LEFT Blown Fuse Indicator (BFI): Not Applicable Switch Condition: Acceptable Interlocks: Not Applicable Primary Disconnects: Not Applicable Over-Travel Stops: Not Applicable Secondary Disconnects: Not Applicable Mechanical Wear: Acceptable Ground Contacts: Acceptable Mechanical Lubrication: Acceptable Main Contacts: Acceptable Intermediate Contacts: Not Applicable Arcing Contacts: Acceptable Trip Free Test: Acceptable Pri.Current Path Lubrication: Not Applicable Manual Close Test: Acceptable Arc Chutes: Acceptable Spring Discharge: Acceptable Interphase Barriers: Not Applicable Insulated Linkages/Bracing: Acceptable Gap !Wipe Settings: Not Applicable Contact Alignment / Sequence: Acceptable Test Repoli, 24312080 - 046 4. OVER CURRENT PROTECTfQN - TRIP UNIT. DATA Test Equipment ID: FFTS-JW Calibration Date: 1-08 FSR: 2165 Manufacture: Square D Trip Device Serial #: - Style: Micro 6.OA Battery Status As Found: Pass As Left: Pass Settings CT Coil Ratings: CT Tap Ratings: Rating Plug: As Found Setting As Tested Setting As Left Setting I"2T ON As Found Setting As Tested Setting As Left Setting 1'2T ON Long Time Pickup 1 1 1 Instantaneous Pickup 2 2 2 Long Time Delay .5 .5 .5 Ground Fault Pickup A-.2(240) A-.2(240) A-.2(240) Short Time Pickup 1.5 1.5 1.5 Ground Fault Delay .1 .1 .1 Yes Short Time Delay .1 .1 .1 Yes TRIP UNIT TIMING T EST (measured in Seconds) Trip Device Function Test Current Amps Specified Range Phase A Phase B Phase C Amp Range Minimum Maximum As Found As Left As Found As Left As Found As Left Long Time 1,600 ~ 14.72 Short Time 2,100 5.11 Instantaneous 3,000 0.036 Ground Fault 480 0.653 NOTES The ground fault system was primary injected with 1000 amps and tripped within the acceptable operating range. Test Report, 24312080 - 046 5. ~- P 5 w ~~ 24-237 ~~ Schr~tid~r ~~~~ LV Circuit Breaker as x~ a~ (Manually Operated) Services Division 1-800-634-2003 -- REFER Contact Name: gcatf GJc~ ~~ FSR: Customer Site: Qa ll4 Urs+~ Ass' s~{ed ~ ~i Customer R Sub Station: Sub ID: ~"' Manufacture: ~c?tbq~e ~ Manufacture Date: o y3 Frame Size: Amps J Z o v Rated Amps: ) 2 0 0 Fuse Type: N~ Fuse Manuf~~re: Trip Unit Type: ~ t [,u ~ G ~. G A Trtp Curve No: ~.- Number of Operations: As Found Number of Operations: As Left ~NSi'E( ITEM AS FOUND AS LEFT Condition: ~ Disconnects: ~' Ground Contacts: ~ ~ _. Main Contacts: Intermediate Contacts: -- Arcing Contacts: -' Pri.Current Path Lubrication / Arc Chutes: Interphase Barriers: Gap /Wipe Settings: i , -mss ~,~~ ~ -~ G'~iECKLt$'r - `~ ~ ~ ~ ~` ITEM AS FOUND AS LEFT interlocks: "` Over-Travel Stops: Mechanical Wear: / Mechanical Lubrication: Control Wiring: Control Relay: Trip Free Test: ,/ Manual Close Test: / Spring Discharge: _ Insulated LinkagesBracing Contact Alignment / Sequence: -~'~ SEP 0 5 2008 DEPttRTf~'EEid°i" Gi= COi~I~iUNITY DEVELO~~~ENT INSPECTION SERVICES DIVISION NCE iNFQRMAT#ON . ~ ~' L~ c~ ~ 1..,~ Job No: ~ `'~3 ~ Z, O $ 0 - U~ b f No: DBID: Date: ~N~'IFiC!#T10N Customer Asset ID: Circuit ID: /hq,~ i~¢kc+' D~ c. ~' G~~-w~-r ~I~ S VI~A DATA Serial No: 05~ PyoS7~Oda~ Type: /2oc'J Sensor Rating: 1 Lov Rating Plug: 1 Z~b Model /Catalog No: N Rating: ~~ Interrupt Rating: ~5. ~~ E C-~ o ~ Mounting: ~° ~~ M INSULATION R~SISTANC EST Test Equipment Id: Calibratio ate: FSR: Test Voltage: Tests are perfomned wit reaker CLOSED .and all unenergized grounded Tests are performed with breaker OPEN and all unenergized poles grounded AS FOUND AS LEFT AS FOUND AS LEFT A To B 52 ALINE TO LOAD S2 SZ A To C S2 S2 B LINE TO LOAD S2 !Z B To C S2 S2 CLINE TO LOAD S2 S2 A TO GROUND S2 52 B TO GROUND S2 S2 MPERATURE C TO GROUND S2 S2 HU ITY -. CONTROL WIRING ST . . Test Voltage: 0 null volts As Found: 0 null volts As Left: 0 null volts ," , OVER C , RENT PROTECTION -TRIP UNIT DATA AND T~S~ ~ 4 ~r }y As F~un~! Test Equipment ki: Cali tion Date: FSR: Manufacture: Trip Devi Serial #: Style: Battery tus ound: As Left: Settings " CT Coil Ratings: CT Tap Rat i s: Rating Plug: As Found Setting As Tes Se ng As Left Setting As Found Setting As Tested Setting As Left Setting Long Time Pickup Instan us Pickup Long Time Delay Ground Fa Pickup Short Time Pickup Ground Fault ay short rime Delay OVER CURRENT PROTECTION -TRIP UNIT DATA ANQ TESTr ~': As Left Test Equipment Id: ~ K Calibration Date: j - o $ FSR: j„~~ ~. ~ ~, ~ Manufacture: S~ .D Trip Device Serial #: ~ Style: /h,uo to ~ ~.d Battery Status As Found: As Left: Settings. CT Coil Ratings: ~-- CT Tap Ratings: --- Rating Plug: % 2 a a As Found Setting As Tested Setting As Left Setting As Found Setting As Tested Setting As Left Setting Long Time Pickup ~ Instantaneous Pickup Z 2 ~ Long Tlme Delay ~ $ - S Ground Fault Pickup A • . Z~ zy~ Short Time Pickup ~ , S ~. S ~, S Ground Fault Delay , I 0 ~.- a ,,., ,] 6 shore Time Delay o ,~ - I s _ I n ~ CONTACT RES ISTA E TEST Test Equipment kl: libration Date: THROUGH PRIMARY DISCONNECT FI RS AND /OR YPASS PRIMARY FUSES (IF APPLICABLE) (OR NO PRIMARY FSR: DISCONNECT FINGERS AND/OR FUSES DISCONNECT FINGERS AND/OR FUSES) AS FOUND A E AS FOUND AS LEFT PHASE A micro S2 cr PHASE A micro S2 micro Q PHASE B micro S2 micro SI PHASE B micro O micro O PHASE C micro S2 micro S2 PHASE C micro Q micro Q r INSULATION HI-POT TEST As Found Test Equipment Id: Calib on Date: FSR: Type of HI-POT: Test Volta KV mperature: Humidity: Measurement iMilltamps for AC , Microamps for DC Test Tests are Pertom~ed with Breaks Open and All Unenergized Poles Grou Tests are Pertom'ted wirii Breakers Closed and All Unenergized Phases Grounded Current s /Fail Current Pass / FaU Phase A: Top (front) pace A Phase A: Bottom (rear) Phase B Phase B: Top (front) pace C Phase B: Bottom (Rear) Phase C: Top (front) Phase C: Bottom (rear) S~ILATION 1-~1-POT TEST As Left Test Equipment kJ: Calibrat(on Date: FSR: Type of HI-POT: Test Voltage: KV Temperature: Humidity: Measurement in Miiliamp or AC est , Microamps for DC Test Tests are Pertomied with Breakers Open and AIi Unenergized Poles Grounded Tests are Perfom~ed with Breakers Closed and Ail Unenergized `PhasesGrounded Current Pas /Fail Current Pass /Fail Phase A: Top (front) hase A Phase A: Bottom (rear) P ass B Phase B: Top (front) Phase C Phase B: Bottom (Rear) Phase C: Top (front) Phase C: Bottom (rear) CO ROL CIRC TEST Test Equipment Id: Calib on Date: FSR: Control Pickup Volt PI up oltage Results Voltage AC/DC Spec. previou Found Left Under Voltage Drop-out Test Trip Circuit Drop-out Volt Spec: Close Circuit As Found: Charging Motor As Left Drop-out: PIC KUP T S T Trip Device Function Specified Range Phase A Phase B Phase C Minimum Maximum As Fou As Left As Found As Left As Found As Left Long Time short Time Instantaneous Ground Fault TIMING TEST (measured in Seconds) Trip Device Function Test Current Amps Specffied Range Phase A Phase B phase C Amp Range Minimum Maximum As Found As Left As Found As Left As Found As Left . TIMING TEST (measured in Sec,gn~r) ., ~. ,.. Long Time V D U 1/ 1 ~ .7 Z < jSa~d snort Time ~ I V U S, ~ I~ 4~rmd instantaneous v v 0 , 0 3~ ~ ~~ Ground Fault y 0 ~ $.3 h'r ~~ ~~+C~. ~(~' ~p ~/N~T' ~~.J.SQ.~ R,~ ~ !3~ ~eG6r,.a ..ry INJeG.~I b./ ~~s~s , V ~~ v ~ /D L ~ b `t~ a~rlJ I ~N J ca Ci~' v ~ ca... S"~ ~~d~ ~/' , V 4Z~-5 ~. , (nJ <-S ~j C, e4 G,c ~~+.~s ~s 0.- rac~S~. ~ ~y ~~ ~~g ~-~~~~,~ fb S~~ lv~.rf~~til ~~~~ ~~ R ~~ z~~ ~~ ~ _~~vR ~