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19607 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY Bwldln rm an Identlllcation I A P���ts .0 � PERh(]TNO. �. eoudyg Aaam»: e . NIO 1960f" 22900 Cristo Rey Drive, .Los Altos, CA 94024 one. Forum Life Care CITY OF CUPERTINO-BUILDING DIVISION ' 1 —�G��O Contna" Name: Lk.N. APPLICATION / PERMIT �+ l Vikin Electric Inc. C10-386973 ' BUIIOING-EDCRICALPLUMBINGM LAICAL CATEGORY CON7ROLa ' - ®/ ArohXecx/Englnnr. Llc No: ' HKI 6 T 5383 - BUILDING PERMIT INFO Q ELECTRIC PERMIT FEE Add. 553 Mission Street San Fra 1 PERSITTISUANCE LICENSED CONTRACTORS DECLARATION Ihereley affirm that l am Ikanxxdurder p.1sione of Chapter 9(mmmeac APPLIANCES-RESIDENTIAL JOB DESCRIPTION ingwlth Sedfon7000)af DtAM.3ofthe Buarrvand Pr feWor.C-ode,and Ilmrmetslafnur aeffed. PANELS LFORUM/APARTMENTS ken&e Close `�1� Lk.. 386973 Dae Codndor ARCHITECPsnECLARAnoN 311-1000 pZ I unAeraand my pbmahaBbe uwd as public res, x OVFR1 SQ.FT.FLOOR AREA $/SQ.Fr. Licensed Prdesslonut < OWNER-BUILDER ZO FO,r� ]herey a(OrOWNER-BUI,LDEroRm nthEeCCLAAILAnION sa folbw( bm tt ] ,Bushs and o bOstia;Mla,wy dryer FM 'untywhkhmNquapetndaltsr,mpwede=lbhorr aRyrowMpbtoltsuarceabrequrheapprmtfosuNpemt0 S.IQPEC{rIAML FlER��TA1_T�+G�LSC L■1It a\ aJ� fits ned.agY u,ne,ot that he b Bamsed pursuant to the provbbru d the POWER DEVICES Contradori Lleense law(Chapter 9(mmmme ng with Section 7000)of Dlv4 SWQhNG POOL ELECTRIC ab oaand onrthaexempt lhef a VALU rhebasinsfn-thealleged<.empti : AnyvidabnofSebyany appBantfora pemdt sebjectsthe applicant toa dull peraftydnot morethan OUTLEISSWITCFEESFD(7URF5 'oy"4a nv undred dollars MM. ..�„ 1,as owner of the property,or my employees with wages u thelr sole NLW RI5mQJ77AL ELECTR SQ Fr. STORIES TYPE CONSTRUCTIONC7� orkamb oempeneadon,willdotte w ,andthewrennt Intended or offered for 5 ❑ salebee70N,Bu&low.rd P,of.br Code:The Conorad.e.these Law - (jSR damns.pplytoa .owfpmpertywhohrlldaorlmprwnthereogand OCC GROUP RES.UNITS fi whodoeveuchworkhinmel(orthrough hbownemployeee,prwlded thet.vch Improvements are riot Intended oroHered fatale.If,however,the bullding or TOTAL i,340. 0 Improvement bold wdhln orsyearolmmplalarR tie owner-bullderwW lave UILklolm of proving that he dM not wild or Improve for purpose of sale.). QTY. PLUMBING PERMIT -FEE Lf L as owner of the property,am eulualvely contracting wtth IkeruM FLOOD ZONE APN nuactaa to mat nrua the prefect 7044,Bwlnesa and Profmaktrs Code: PERMIT ISSUANCE The Contrsdori Lberue Law does net apply to to owner of property who ALTER-DAMN k VFM-WATER(F.V wild,or Improve thereon,and who eormam for suds pTokm with offasete,(s)Barred pursuant to the Contndor&License Law. - FEE SUMMARY IJI am exempt under Sec B k P C for thla recon BACKFLOW PROTEGE.DEVICE Qvrsr Dae DRAINS FLOOR ROOF,AREA,WND. SANITARY Y_ N_ WORKMAN COMPENSATION DECLARATION icacf:fp�a ❑I hereby afMn that I have a anlllate of consent to self-Insure,or a, FD(TURES PER TRAIa SOTOOL TAX Y N_ .� adNate dWorkeri wsunora s mnifled copy thereof(Sec. RFLEIPI'a 380,Lab GAS EA.SYSTEM.]INC-4 OUTLETS PARK FEE Y_ N_ PaRyo WP8040$194 RECEIPT/ cum y fireman _Hes_ GAS EA.SYSTFAI-0VER4(PA) BUILDING DIVISION FEES �Cenlfled ropy le hereby fumlahed. pCPlir`--nNed mpybflled with the dty Wpectlon dfWslon. GREASE/WDUSIRL WASTE INTERCEPTOR PLANCHECK FEE CERTIFICATE OF E3(EMYT[ON FROM WORKERS' GREASE 7RM PAID COMPENSATIONINSURA.sIfo SEWER.gANITARY-STORM EA mR;E Date Reoel t# CE (ITtsettlbn need seabENSATI Bt he SURApermibfororc hundred dollars ($I W)or lav) WATER HEATER w/vFNT/E].Ecrtt ENE RGY FEE Y N I anrythut In the performance d the work for whleh thin permit to Issued, I null not employ any person N any manner an as to become ubjee to the WATIR SYSTEM/'IRFAnNG Worker Compenutlon laws of allfomm.Dae PAID PP Z p N'OnCETO APPLICANT:If,after making site Certificate NEW RF_SiDEN7IAL PLMB.ate or Exe ption,You SQFr. Date Recei t# Mould become subjectto the Workers'CompemaLaver lan prevalent of the TOTAL: ~ N Code,you mostlothwrh comply with sect,provbbru or this pemtlt&hall be Wj deemed revoked. BUILDING CONSTRUCTION LENDING AGENCY SEISC tl MI IXercbyafarm that thea Lsamrutrodlon krdingagercyfortheperfonn- 7 Z ance of the work(or which thla permit 097 dt is led(Sec.3 ,CN.C.) TOTAL ELECTRIC FEE C) O Lender&Name PLUMBING FEE LL ~ Lender.Addrers QTY. MECHANICAL PERMIT FEE MECHANICAL FEE O W Imdiflt,ul tuveread thbappllatbnaM atatethrtthe above lnfomutlon bmneet.Iagreetocomply with all dtyand muntyordiunmland gaelaws PERMIT ISSUANCE FEES PAID-. >. SIn rclating towlWing mrstrudlon,aM hereby authaiu rcprr:ntstho olthb Z dtyto enter upon the above-mentioned property fawp Han purposesAM�FL . ALTERORDDTO (We)agree to save,hdemntly in d keep harmless the Cry of Cu penin - Date Receipt# W agat BabWmaa tlee,Judgments, aard ses expenwhkh 19ayln .*.Y.mrue AIR HANDLING UNIT 8010,000 CFM) - SUBTOTAL: agalrst Citybmnseeporm,d thegnaingd Ipc AIR HANDLING UNTr(OVER 10,00ocFAD CONSTRUCTION TAX �� %�-y reornppramt/Canm.na Date oaiAUSTHOOD(W/DICT) CONSTRUCTION TAX PAID: =RnOUSMATEltDISCLOSURE WllltheappBantafuwmw0ding pa ntaoneorhardlehandous HEATING UMTODI OD,000 BTU). Date RCCei t# material as defined by the Cupenln Murddpal Code,Chapter 9.17,and the Ikarh ant Safety Cade,�a—SS�ection 25537 W ER 7 HEATING UNTF(OV100,00D BTU) TOTAL: qyes No Ill the ippllont or future w0ding otapant use equipment or devkaa VENTILATION FAN(SINGLE REQ) ISSUANCE DATE which cmlt harardou&ab cmiuNrunts as defined by the Bay Area Nr Illy Management District? BOILER-COMP QEIPGRtaB,aa B"Iles Yn No a h.Ufw= dthe leahh ty Cwe Srtom25remsunder Chapter G95 of BOILER-COMP(OVER 10DODO BTU the allfomla}Lea LLh k Salery Coda SMlots 755 W,75513 and 75534. I n underetaMthat ilthewOdNgdant note requirements tenant lust b bony NEW RESIDEN77ALMECH. SAFE. rsporo hithytrim.to naBythe oate of dtherequbemeaswhich nus be met prior to lsuarccdaCenlOats of Oc parcy. �llJ;ot, f'.nnarn o 6Il9 Owner or authoaud agent Date 70TH I.: 111 ISSUEDB' OFFICE COPY M'A `r - 1 4 - 9 1 TUE •3 = 3S AFP A R A TU S U11LT D _ R _ ® 1 R ARATUS D�� NUMITED • MAY 8516 rv>�civlC.oL 8516 Fruitridge Road Sacramento. 95826 (916) 383.4-4986 MDB, INSPECTION DEPARTWU Fax (916) 383.3480 �+. r✓'� FAX TRANSMISSION SHEET COMPANY: y 1. 1 cc) 0 Ctn 1_C_ FROM: -3\EY\ �Uk ATTENTION: DATE: 61 I_4 FAX NO: ��I q�Aol'��15 I TIME: )n:440 PAGE I OF QQ PLEASE CALL AND CONFIRM COMMENTS: =f O W ,2-t PqWiT THANK YOU. • r . au 9 .� 6 A F F �'l R F T U S U N �y 'I tl F . ® 4 � � 1 � LOW VOLTAGE CIRCUIT BREAKER TEST PORT �t �J y,",% NUMITcD i MAY 4fL-C-^aIC�� r' �.i6C-+.1NIGL. • CLIENT ps_ . imecF .rinm nFPARTMFMT � y�.Cl�'�°BJLiOrIIQE�Rl9✓ LOCATION (DATE a �rI r . S IT EAR 75lGNATI N F GOER IDENTIFICATION I@ I E ` MUF CTURER TY STYL6ISERIAL NUMBER FRAME SIZE I ERRUPTING RATIN `�IG TRIP UNIT.SENSOR RATING TgIP UNIT TYPE CHARACTERISTIC CURVE I OWN C UR SIZEIPHASB lAeb TRIP UNIT AVAILABLE SETTINGS FUNCTIONS RANGES AS FOUND AS LEFT A 8 C A B LONG TIME PICKUP C O LONG TIME OELAY Jrl Ad SHORT TIME PICKUP SHORT TIME DELAY INSTANTANEOUS PICKUP GROUND FAULT PICKUP GROUNO FAULT DELAY CHECK POINT NOTES CHECK POINT NOTES ARC CHUTES TRIP LATCH CONTACT CONOITION PRIMARY STAGS CONTACTS@QUENCE CONTROL CONTACTS CONTACT ADJUSTMENT A CEI I /CRADLE CONDITION ELECTRICAL OPERATOR INTERLOCKS TRIP BAR ADJUSTMENT OPERATING MECHANISM aim AS FOUND AS LEFT MFCL A B C q g C MIW NOTES CONTACT RESISTANCE III AMPS IN MV ♦,� '} 1 t, LONG TIME PICKUPOOp L. T. DELAY %RATING I lDt)n AMPS) I (I SHORT TIME PICKUP k3 1A S. T, OCL) y %RATING I AMPS) INSTANTANEOUS PICKUP GROUND FAULT PICKUP G. P. DELAY® AMPS SHUNT TRIP PICKUP IJNOGRVOLTAGE P.U. 0.0. CLOSED Gq EAKER OPEN MEGGER TEST BREAKER A-GNO G- N° , VOLTS C-GND A-8G-C C-A A g C c 41 ID I ( /otl0 LMO NOTES. `CONOITION A-AGC6PTAGLE R-NEEDS REPAIR, REPLACEMENT,OR ADJUSTMENT C-CORRECT613 NA-NOT APPLICAELE 1�-rut 9 = 3 r A F P A R A T U S U N L- T L - F 0 3 LOW VOLTAGE CIRCUIT BREAKER TEST REPORT NL!M!TE-M CLIENT IJCS NO. II LOCATION_ DA 'f] v SWI'QH EA DESI ATION KEDER IDENTIFICATION ENGINE 1111 • • BREAK Eii' MA UPACTURER TYPE STYLE/SERIAL NUMBER FRAME SIZ INTERRUPTING RATING 1 1"106 TRIP UNIT:SENSOR RATING TRIP UNIT TYPE CHARACTERISTIC CURVE CONDUCTOR SIZEIPHASE TRIP UNIT AVAILABLE AS FOUND SETTINGSAS LEFT FUNCTIONS RANGES A B C A B C LONG TIME PICKUP 'o A LONG TIME DELAY SHORT TIME PICKUP SHORT TIME DELAY INSTANTANEOUS PICKUP GROUND PAULT PICKUP GROUND FAULT DELAY CHECK POINT NOTES • CHECK POINT NDiES ARC CHUTESTRIP LATCH CONTACT CONDITION Aft PRIMARY STABS CON7ACTSEQUENCE CONTROL CONTACTS CONTACT ADJUSTMENT CELUCRAOLE CONDITION ELECTR[CAL OPERATOR INTERLOCKS TRIP BAR AOJUSTMENT OPERATING MECHANISM AS FOUND ( AS LEFT MI A B c A B c MIN/Nm NOTES CONTACT RESISTANCE(Il 3�Q AMPS IN MV 6 o LONGTIME PICKUP L. T. DELAY %RATING I AMPSI I.fQ SHORT TIME PICKUP S. T. OELAY E %RATING I AMPS) INSTANTANEOUS PICKUP vl ,L V) � GROUND FAULT PICKUP 1>10 G. F. DELAY AMPS SHUNT TRIP PICKUP UNOERVOLTAGE P.U. 0,0. BREAKER CLOSED BREAKER OPEN MEGGER TEST A--GNO I B-G D I C-GND LTS A-B 8-C C-A A 8 C VO • a 1 /a / I O NOTES, -CONDITION A-ACCEPTABLE R-NB606 gSPAIR, REPLACEMENT,OR AUJUSTMENT C-CORR8CTE0 NA-NOTAPPLICASLE T U E 'D - Z; 7 A F F A R A T U C IJ " L T D . F OG LOW VOLTAGE CIRCUIT BREAKER TEST REPORT LJ NL!MITc-., -I enc ; n lulu w.u�i . t r` ® CLIENT IJOB NO. LOCATttN DATE 2 SVjs} 6 T34GBA O SIGN TION 4 IDENTIFICATION i MAIJ�:�5�C TURER TYPE STYLEUSERIAL NUMBER IFR MM I INTERRUPTING RATING .SLI' r/1 TRIPTISENSOR RATING TRIP UNIT TY E HARACTERISTIC CURVE CONDUCTOR SIZEIPHASCI) TRIP UNIT AVAILABLE SETTINGS AS FOUND AS LEFT FUNCTIONS RANGES A B C A B C LONG TIME PICKUP LONG TIME DELAY SHORT TIME PICKUP I zd.4 It VRIAI SHORT TIME DELAY INSTANTANEOUS PICKUP GROUNO FAULT PICKUP A I GROUND FgULT DELAY INSPECTION CHECK POINT NOTfSI CHECK POINT NOiD • ARC CHUTES A I I TRIP LATCH CONTACT CONDITION PRIMARY STABS CONTACT SEQUENCE CONTROL CONTACTS CONTACT ADJUSTMENT CELLJCRAOLE CONDITION ELECTRICAL OPERATOR INTERLOCKS TRIP BAR AOJUSTMENT OPERATING MECHANISM ELELrRICAL TESTS AS FOUND AS LEFTq NOTE 8 C A B C CONTACT RESISTANCE bL AMPS IN MV q LONG TIME PICKUP BC) tnb aev L.T. DELAY(F 'T %RATING 1 AMPS) 131 S W>.� SHORT TIME PICKUP Qlo S. T. DELAY® % ATING I AMPS) INSTANTANEOUS PICKUP ic 4910 c GROUND FAULT PICKUP G. F, DELA v @ MPS SHUNT TRIP PICKUP UNOERVOLTAGE P.U, Q D.O. BREAKER CLOSED BREAKER OPEN MEGGER TEST A GNDB-GNO C-GND A-B B-C C-A A 8qplp- C Pd t TS JJ/YO 1 /ri[.0 /A ,Q NOTES. J 'CONDITION A-ACCEPTABLE R-NEEDS REPAIR, REPLACEMENT, OR ADJUSTMENT C-CORRECTED NA-NOT APPLICABLE GROUND FAULT SYSTEM TEST REPORT CUSTOMER / A-Ar dmk 14 JOB, NO. LOCATION T " ( DATE 3111. 41 GR. DESIGNATION 1 (,1� p ENGR, 1 FIELD DATA: MAIN OVERR�CURRR+ENT DEVICEIRCUIT BREAKER FUSED SWITCH R MFGR. 1 M- ,/ . F TYPE A & MDDEL/CAT. NO 'vS�. PO F Glz) CURRENT RATING 1,200 VOLTAGE RATING fn� GROUND FAULT SYSTEM NEUT.-GRD. ZERO-SEQ. RESIDUAL _ CRD. 0 MFCR. T 1 MODEL .�s CAT. NO. (*(CL PICK-UP RANGE d-/� y tj TIME RANGE - A6E- SENSOR/C.T. AS 'FOUND SETTING: p/ PICKUP CURRENT TIME AS LEFT SETTING: O PICKUP CURRENT _312c,? TIME In , INSPECTION: CHECK INSPECTION POINT! REMARKS NEUT.-GRD. LOCATION PARALLEL NEUT.-GRD. SHUNTS ✓ CONTROL POWER MONITOR OR TEST PNL OPERATION OTHER ELECTRICAL TESTS: 1. PICK UP CURRENT -107. eN ( /atl \)- O TRIP O TRIP 2. PICK UP CURRENT +107. (a_& A.) STRIP ONO TRIP 3. SHUNT TRIP COIL PICK-UP VOLTAGE !q VOLTS 4. SYSTEM NEUTRAL INSULATION RESISTANCE TO GRD.- M1L 5. TDO CHARACTERISTIC TESTS: PRIMARY CURRENT % TOTAL RT RELAY MFGR. AMPERE-TURNS PICKUP TIME TIME TOLERANCE .}pD d 0 ,0O A REMARKS WITNESSED BY: • GROUND FAULT SYSTEM TEST REPORT CUSTOMER ir JOB. NO. n LOCATION r I ap DATE I .*-WGR. DESIGNATION (!1 ENCR. FIELD DATA: �12rU/ dZ MAIN OVERCURRENT DEVICE C CUIT BREAKER FUSED SWITCH MFGR. Z •T F• TYPE L - o MODEL/CAT. N0. CURRENT RATING !v29t9 VOLTAGE RATING 1✓J3V GROUND FFA"ULT SYSTEM NEUT.-CRD. ZERO-SEQ. RESIDUAL _ GRD. MFGR. ` MODEL CAT. NO. PICK-UP RANGE /fiM'��Q7 TIME RANGE _..SENSOR/C.T. AS FOUND SETTING: ® PICKUP CURRENT T AS LEFT SETTING: PICKUP CURRENT /9,0 TIME INSPECTION: CHECK INSPECTION POINT REMARKS NEUT.-GRD. LOCATION PARALLEL NEUT.-CRD. SHUNTS CONTROL POWER MONITOR OR TEST PNL OPERATION OTHER ELECTRICAL TESTS: 1. PICK UP CURRENT -107. A.) LJNO TRIP C TRIP 2. PICK UP CURRENT +10% c alo A.) "IP ❑ NO TRIP 3. SHUNT TRIP COIL PICK-UP VOLTAGE VOLT 4. SYSTEM NEUTRAL INSULATION RESISTANCE M GRD.. MR 5. TIME CHARACTERISTIC TESTS: PRIMARY CURRENT % TOTAL RT RELAY MFGR. AMPERE-TURNS PICKUP TIME TIME TOLERAN o ,. 6 o 0 /bui - 5L0 /i1g5 WITNESSED BY: GROUND FAULT SYSTEM TEST REPORT CUSTOMER ! / JOB. NO. r d . LOCATION DATE .RGR. DESIGNATION ' GR_ FIELD DATA: MAIN OVERCURRENT DEVICEIRCUIT BREAl • FUSED SWITCH MFGR. x. T. E.a• TYPE w MODEL/CAT. N0. L CURRENT RATING IyVQ VOLTAGE RATING GROUND FAULT SYSTEM NEUT.-GRD. RQ-SEQ, RESIDUAL _ GRD. MFGR. �. • MODEL 2' `— CAT. NO. / � }- 6D PICK-UP RANGE TIME RANGE SENSOR/C.T. AS FOUND SETTING.0 PICKUP CURRENT /n TIME AS LEFT SETTING: 1�� PICKUP CURRENT TIME L INSPECTION: CHECK INSPECTION POINT REMARKS NEUT.-CRD. LOCATION Y/ PARALLEL NEUT.-CRD. SHUNTS CONTROL POWER MONITOR OR TEST PNL OPERATION OTHER ELECTRICAL TESTS: I. PICK UP CURRENT -107. ( -A,) CS'NO TRIP ❑ TRIP 2. PICK UP CURRENT +107. c 6 G A.) Mt IP ❑ NO TRIP 3. SHUNT TRIP COIL PICK-UP VOLTAGE VOLTS 4. SYSTEM NEUTRAL INSULATION RESISTANCE TO• GRD.. JJ�%Q mn 5. TIME CHARACTERISTIC TESTS: —I PRIMARY CURRENT % TOTAL RT RELAY MFGR. AMPERE-TURNS PICKUP TIME TIME TOLERANCT O OA IGS o� proo • 5P i� WITNESSED Y: • GROUND FAULT SYSTEM TEST REPORT CUSTOMER 01 JOB. NO. LOCATION Peuo DATE P � l*WGR. DESIGNATION 4ENCR. FIELD DATA: raw- MAIN OVERCURRENT DEVICEC IIntCU//IT BREAKER FUSED SWITCH + MFGR. 1.T F. . TYPE �►/ l0 MODEL/CAT. NO. � CURRENT RATING VOLTAGE RATING GROUND FAULT SYSTEM NEUT.-GRD. 0-SE RESIDUAL _ GRD. MFGR. �. T• MODEL CAT. NO. 7l F L PICK-UP RANGE SFO` I�OOA TIME RANGE SENSOR/C.T. Cv AS FOUND SETTING: PICKUP CURRENT TIME AS LEFT SETTING: PICKUP CURRENT �/D �� TIME INSPECTION: CHECK INSPECTION POINT REMARKS NEUT.-CRD. LOCATION ,AJ li4 PARALLEL NEUT.-CRD. SHUNTS CONTROL POkER 9 • '� MONITOR OR TEST PUL OPERATION OTHER ELECTRICAL TESTS: 1. PICK UP CURRENT -107. c 90 A.) B140 TRIP ❑ TRIP 2. PICK UP CURRENT +10% C //O A.) Q-tRIP ❑ NO TRIP 3. SHUNT TRIP COIL PICK-UP VOLTAGE VOLTS 4. SYSTEM NEUTRAL INSULATION RESISTANCE TO• CRD.. mil 5. TIME CHARACTERISTIC TESTS: PRIMARY CURRENT % TOTAL RT RELAY MFGR. AMPERE-TURNS PICKUP TIME TIME TOLERANCT O / In pC FIITNESSED : GROUND FAULT SYSTEM 'LEST REPORT CUSTOMERIN( �yj IC JOB. NO. CATION 1 DATE S1/7 SWGR. DESIGNATION ice. FIELD DATA: Mui MAIN OVERCURRENT DEVICE caUIT BREAKER FUSED SWITCH hIIrGR, �.��. TYPEF D - k MODEL/CAT. NO. is Ci 3 S71 CURRENT RATING /150 VOLTAGE RATING _ —64" GROUND FAULT SYSTEM NEUT.-GRD. 0-SE . RESIDUAL _ GRD. MECR• _r• f'r MODEL CAT, N0, L J PICK-UP RANCE S- �8 e4 TIME RANGE - SENSOR/ .T. L- 3a�T— AS FOUND SETTING: /1 PICKUP CURRENT [�D /4� TIME _ -ra SY' . AS 'LEFT SETTING: PICKUP CURRENT /%JfQ TIME C-/• INSPECTION: CHECK INSPECTION POINT REMARKS "4� NEUT.-GRD. LOCATION 'v// PARALLEL NEUT.-GRD. SHUNTS _ �� - CONTROL POWER 92 MONITOR OR TEST PNL OPERATION OTHER ELECTRICAL TESTS: 1. PICK UP CURRENT -107. ( 3 A.) RNO TRIP ❑ TRIP 2. PICK UP CURRENT +107. ( `,[/ A,) a fRlp ❑ NO TRIP 3. SHUNT TRIP COIL. PICK-UP VOLTAGE VOLTS 4. SYSTEM NEUTRAL INSULATION RESISTANCE TO• GRD.- M1L 5. TIME CHARACTERISTIC TESTS: PRIMARY CURRENT % TOTAL RT RELAY MFGR. AMPERE-TURNS PICKUP TIME TIME TOLERANCE D 3 UMARKS �o >/ wrnirssED BY• GROUND FAULT SYSTEM TEST REPORT CUSTOMER JOB. NO. CATION DATE / CR. DESIGNATION n,If 0 ENCR. FIELD DATA: ��l U I MAIN OVERCURRENT DEVICE CIRCUIT BREAKER FUSED SWITCH MFGR. S• T• Lam• TYPE dr. - y MODEL/CAT. NO. CURRENT RATING -9;0 VOLTAGE RATING y�O GROUND FAULT SYSTEM NEUT--GRD. ZERO-SEQ. RESIDUAL GRD. MPGR. .2. T. -7:_ MODEL / CAT. NO. &):F/_ _� ?L - 4 e PICK-UP RANGE < - 6o Ii TIME RANGE Sf - AeSENSOR/C.T. L AS FOUND SETTING: Q PICKUP CURRENT _/ TIME L� AS 'LEFT SETTING: PICKUP CURRENT /S TIME INSPECTION: CHECK INSPECTION POINT REMARKS NEUT.-GRD. LOCATION 0Z PARALLEL NEUT.-GRD. SHUNTS N ho CONTROL P0UER —K- MONITOR OR TEST PNL OPERATION OTHER ELECTRICAL TESTS: 1. PICK UP CURRENT -107 ( /TA.) 2tl�O TRIP O TRIP 2. PICK UP CURRENT +107. (A,. 'A.) M-61P ❑ NO TRIP 9. SHUNT TRIP COIL PICK-UP VOLTAGE VOLTS 4. SYSTEM NEUTRAL INSULATION RESISTANCE TO GRD.. Mn 5. TIME CHARACTERISTIC TESTS: PRIMARY CURRENT % TOTAL RT RELAY MPGR. AMPERE-TURNS PICKUP TIME TIME TOLERANCI A) REMARKS d / 0 O� of I af-00L�vl WITNESSED BY: