APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER S CERTIFICATION (OPM)

Transcription

1 OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER S CERTIFICATION (OPM) OFFICE USE ONLY APPLICATION #: OSHPD Preapproval of Manufacturer s Certification (OPM) New Type: Renewal Update to Pre-CBC 2013 OPA Number: Manufacturer Information Manufacturer: Pentair Equipment Protection Manufacturer s Technical Representative: Mailing Address: Telephone: Nate Westby 2100 Hoffman Way, Anoka, MN (763) Emai mail: il: Nate.west Na Nate.westby@pentair.com west Product Information Product Name: Product Type: Cabinet Rack Communication Equipment uipmen u pmen nt Product Model Number: General Description: ENC217S, 7 S, S ENC219S, S, EN ENC219S, ENC21710S, ENC21712S S Jeffre Y. Jeffrey Y Kikumoto Kik moto entair nta Cabinet Cab Ca abi binet inet net et Closed Cl o os sed frame frame LAN LAN rack rack iss designed designe de designe ned to hold h Hoffman Pentair electronic equipment in communication attion on data ata at ta centers c t and d telecommunication t l i ti rooms. rro rooms ooms / / Applicant Information Applicant Company Name: EASE Co. Contact Person: Jonathan Roberson, S.E. Mailing Address: 577 Pine Ave. Suite 210, Chino Hills, CA Telephone: (909) J.Roberson@EASECo.com I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, Signature of Applicant: Title: Principal Engineer Date: Company Name: 3/12/15 EASE Co. Access to Safe, Quality Healthcare Environments that Meet California s Diverse and Dynamic Needs STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY OSH-FD-700 (REV 1/24/13) : Reviewed for Code Compliance by Jeffrey Kikumoto Page 1 of 2 Page 1 of 10 CERT A

2 OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION Registered Design Professional Preparing Engineering Recommendations Company Name: EASE Co. Name: Jonathan Roberson, S.E. California License Number: S4197 Mailing Address: 577 Pine Ave. Suite 210, Chino Hills, CA Telephone: OSHPD Special Seismic Certification Preapproval (OSP) Special Seismic Certification is preapproved under OSP- (Separate application for OSP is required) Special Seismic Certification is not preapproved Certification Method(s) Testing in accordance with: ICC-ES C-ES AC156 FM Other* (Please Specify): *Use of test criteria other than those adopted d by the California Building Standards a d Code, 2013 (CBSC 2013) for component supports and attachments ts are not permitted. t e For distribution i ti system, s interior partition wall, and suspended ceiling seismic bracings, test criteria ia other than those adopted d in the CBSC C 2013 may be used when approved by OSHPD prior to testing. Analysis Experience Data Combination of Testing, Analysis, s, and/or Experience e e Data a (Please e Specify): List of Attachments Supporting the Manufacturer s u rscer r s Certification i ion Test Report Drawings Calculations Manufacturer s Catalog Other(s) (Please Specify): OFFICE USE ONLY OSHPD APPROVAL VALID FOR CBC 2013 ONLY Signature: Date: Print Name: Jeffrey Kikumoto Title: SSE Condition of Approval (if applicable): Access to Safe, Quality Healthcare Environments that Meet California s Diverse and Dynamic Needs STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY OSH-FD-700 (REV 1/24/13) Page 2 of 2 : Reviewed for Code Compliance by Jeffrey Kikumoto Page 2 of 10

3 O PM 0200 PM Jeffrey y Y. Kikumoto 0 /0/201 : Reviewed for Code Compliance by Jeffrey Kikumoto Page 3 of 10

4 2 OPM M Jeffrey y Y. Kikumoto : Reviewed for Code Compliance by Jeffrey Kikumoto Page 4 of 10

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8 6 M /0/ /201 1 : Reviewed for Code Compliance by Jeffrey Kikumoto Page of 10

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10 Jeffrey Y. Kikumoto : Reviewed for Code Compliance by Jeffrey Kikumoto Page 10 of 10