oshpd preapproval of manufacturer's certification … mailing address: 1111 broadway suite...
TRANSCRIPT
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 12/16/15) Page 1 of 2
APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER’S CERTIFICATION (OPM)
OFFICE USE ONLY
APPLICATION #: OPM-0406-13
OSHPD Preapproval of Manufacturer’s Certification (OPM)
Type: New Renewal Update to Pre-CBC 2013 OPA Number: OPA-2617-10
Manufacturer Information
Manufacturer: ARxIUM, Inc.
Manufacturer’s Technical Representative: Wally Eliuk
Mailing Address: 1400 Busch Parkway, Buffalo Grove, IL. 60089
Telephone: (204) 925-6252 Email: [email protected]
Product Information
Product Name: MedSelect Flex Dispensing Cabinets
Product Type: Other electrical and mechanical components
Product Model Number: Varies
General Description:The MedSelect Flex dispensing cabinets provide hospitals and long-term care providers with safe and accurate means for dispensing medical supplies.
Applicant Information
Applicant Company Name: ARxIUM, Inc.
Contact Person: Wally Eliuk
Mailing Address: 1400 Busch Parkway, Buffalo Grove, IL. 60089
Telephone: (204) 925-6252 Email: [email protected]
I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, 2016.
Signature of Applicant: Date:
Title: Senior System Designer Company Name: ARxIUM, Inc.
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William Staehlin
OPM-0406-13
08/08/2017dispensing medicadispensing medica08/08/2017
08/08/2017 OPM-0406-13: Reviewed for Code Compliance by William Staehlin Page 1 of 10
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 12/16/15) Page 2 of 2
Registered Design Professional Preparing Engineering Recommendations
Company Name: Biggs Cardosa Associates
Name: Dan Devlin California License Number: S3116
Mailing Address: 1111 Broadway Suite 1510, Oakland, CA 94607
Telephone: (510) 625-9900 ext 1136 Email: [email protected]
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 AC156 FM 1950-16
Other* (Please Specify):
*Use of criteria other than those adopted by the California Building Standards Code, 2016 (CBSC 2016) for component supports and attachments are not permitted. For distribution system, interior partition wall, and suspended ceiling seismic bracings, test criteria other than those adopted in the CBSC 2016 may be used when approved by OSHPD prior to testing.
Analysis
Experience Data
Combination of Testing, Analysis, and/or Experience Data (Please Specify):
List of Attachments Supporting the Manufacturer’s Certification
Test Report Drawings Calculations Manufacturer’s Catalog
Other(s) (Please Specify):
OFFICE USE ONLY – OSHPD APPROVAL VALID FOR CBC 2016 & ALL PRE-2016 CODE BASED PROJECTS
Signature: Date: 08-08-2017
Print Name: William Staehlin
Title: SSE
Condition of Approval (if applicable):
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William Staehlinliam Staehlim Stam Staeliam Staehli
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William Staehlin
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William StaehlintaehliSt
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William Staehlin
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William Staehlin
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William Staehlin
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