oshpd special seismic certification preapproval (osp) licensed structural engineer responsible for...
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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY OSH-FD-759 (REV 12/16/15) Page 1 of 3
APPLICATION FOR OSHPD SPECIAL SEISMIC CERTIFICATION PREAPPROVAL (OSP)
OFFICE USE ONLY
APPLICATION #: OSP – 0198 – 10
OSHPD Special Seismic Certification Preapproval (OSP)
Type: New Renewal
Manufacturer Information
Manufacturer: Jeron Electronic Systems, Inc.
Manufacturer’s Technical Representative: Matt Chesnul
Mailing Address: 7501 N Natchez Ave., Niles, IL 60714
Telephone: 773-275-1900 Email: [email protected]
Product Information
Product Name: Provider Nurse Call System Cabinets
Product Type: Nurse Call Systems
Product Model Number: Provider 680 in 6888 Main Equipment Cabinet; and Provider 790 in 7988 or 7989 Main Equipment Cabinet (List all unique product identification numbers and/or part numbers)
General Description: Provider nurse call systems consist of equipment cabinets that contain control modules,
network and power supply assemblies.
Mounting Description: Rigid wall mounted.
Applicant Information
Applicant Company Name: TRU Compliance, LLC – A Tobolski Watkins Affiliate
Contact Person: Matthew J. Tobolski, Ph.D., S.E.
Mailing Address: 960 SW Disk Dr. Suite 104, Bend OR 97702
Telephone: 844-878-0200 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: 03/16/2016
Title: President & CEO Company Name: TRU Compliance, LLC
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OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
California Licensed Structural Engineer Responsible for the Engineering and Test Report(s)
Company Name: TRU Compliance, LLC – A Tobolski Watkins Affiliate
Name: Derek J. Manwill, S.E. California License Number: S6266
Mailing Address: 960 SW Disk Dr. Suite 104, Bend OR 97702
Telephone: 844-878-0200 Email: [email protected]
Supports and Attachments Preapproval
Supports and attachments are preapproved under OPM- (Separate application for OSHPD Preapproval of Manufacturer’s Certification (OPM) of Supports and attachments is required)
Supports and attachments are not preapproved
Certification Method
Testing in accordance with: ICC-ES AC156
Other (Please Specify):
Testing Laboratory
Company Name: Environ Laboratories
Contact Name: Kent Erickson
Mailing Address: 9725 Girard Avenue South, Minneapolis MN 55431
Telephone: 952-888-7795 Email: [email protected]
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY OSH-FD-759 (REV 12/16/15) Page 2 of 3
03/22/2016 OSP-0198-10
Page 2 of 8
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY OSH-FD-759 (REV 12/16/15) Page 3 of 3
Seismic Parameters
Design in accordance with ASCE 7-10 Chapter 13: Yes No
Design Basis of Equipment or Components (Fp/Wp) = 1.87
SDS (Design spectral response acceleration at short period, g) = 2.49
ap (In-structure equipment or component amplification factor) = 2.5
Rp (Equipment or component response modification factor) = 6.0
0 (System overstrength factor) = 2.0
Ip (Importance factor) = 1.5
z/h (Height factor ratio) = 1.0
Equipment or Component Natural Frequencies (Hz) = See Attachment A
Overall dimensions and weight (or range thereof) = See Attachment A
Equipment or Components @ grade designed in accordance with ASCE 7-10 Chapter 15: Yes No
Design Basis of Equipment or Components (V/W) =
SDS (Design spectral response acceleration at short period, g) =
SD1 (Design spectral response acceleration at 1 second period, g) =
R (Response modification coefficient ) =
0 (System overstrength factor) =
Cd (Deflection amplification factor) =
Ip (Importance factor) = 1.5
Height to Center of Gravity above base =
Equipment or Component Natural Frequencies (Hz) =
Overall dimensions and weight (or range thereof) =
Tank(s) designed in accordance with ASME BPVC, 2015: Yes No
List of Attachments Supporting Special Seismic Certification
Test Report(s) Drawings Calculations Manufacturer’s Catalog
Other(s) (Please Specify): Attachment A
OSHPD Approval (For Office Use Only) – Approval Expires on December 31, 2022
Signature: Date: March 22, 2016
Print Name: Timothy J. Piland Title: SSE
Special Seismic Certification Valid Up to : SDS (g) = 2.49 z/h = 1
Condition of Approval (if applicable):
03/22/2016 OSP-0198-10
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Depth Width Height
4 18 24 44 1
4 24 30 51 2
SPECIAL SEISMIC CERTIFICATIONCERTIFIED COMPONENT MATRIX
TRU PROJECT NO. 16008
Manufacturer: Jeron Electronic Systems, Inc.TABLE 1Model Line: Provider Nurse Call System Cabinets
Provider680
790
Model Line ModelDimensions (in) Weight
(lb)Notes UUT
Note: Installed mounting configuration must be of similar configuration and equivalent strength and stiffness to those tested.
Building Code: CBC 2016 Seismic Certification Limits: S DS = 2.49g z/h=1.0 I P = 1.5
Certified Product Construction Summary:
16 Ga. carbon steel enclosure.
Certified Options Summary:
No available options.
Mounting Configuration:
Wall mounted - rigid
TRU Compliance, LLC - A Tobolski Watkins Affiliate
844.TRU.0200 | [email protected]
03/22/2016 OSP-0198-10
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Depth Width Height
4 18 24 21
4 24 30 33 2
EnclosuresTABLE 2Model Line: Provider Nurse Call System Cabinets
Building Code: CBC 2016 Seismic Certification Limits: I P = 1.5
SPECIAL SEISMIC CERTIFICATIONCERTIFIED SUBCOMPONENT MATRIX
TRU PROJECT NO. 16008
Manufacturer: Jeron Electronic Systems, Inc. Table Description:
S DS = 2.49g z/h = 1.0
7988 16 Ga. carbon steel
7989 16 Ga. carbon steel
Provider 790
(Jeron)
UUT
Provider 680
(Jeron)
Model Line
(Manufacturer)Model
Dimension (in) Weight
(lb)Material Notes
16888 4 18 24 21 16 Ga. carbon steel
TRU Compliance, LLC - A Tobolski Watkins Affiliate
844.TRU.0200 | [email protected]
03/22/2016 OSP-0198-10
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1
1
2
2
2
1
1
1
1
SPECIAL SEISMIC CERTIFICATIONCERTIFIED SUBCOMPONENT MATRIX
TRU PROJECT NO. 16008
Manufacturer: Jeron Electronic Systems, Inc. Table Description:
Component Type Manufacturer Model Description Notes UUT
Electrical ComponentsTABLE 3Model Line: Provider Nurse Call System Cabinets
Building Code: CBC 2016 Seismic Certification Limits: I P = 1.5S DS = 2.49g z/h = 1.0
Main Control Unit Jeron 6850 Circuit board
Power Supply Jeron 6851 In: 105-132V, Out: 28 VDC @ 100VA
Ehternet Switch Jeron 7991 40V @ 3.9W, aluminum enclosure
Gateway Jeron 7993 40V @ 2.2W, aluminum enclosure
Power Supply Jeron 7995 In: 120VAC, 2A; Out: 40VDC, 100VA
Logic Assembly Jeron 13606 PCB, subassembly of MCU 6850
Audio Assembly Jeron 13605 PCB, subassembly of MCU 6850
Master Assembly Jeron 13419 PCB, subassembly of MCU 6850
Bus Assembly Jeron 13418 PCB, subassembly of MCU 6850
TRU Compliance, LLC - A Tobolski Watkins Affiliate
844.TRU.0200 | [email protected]
03/22/2016 OSP-0198-10
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TRU PROJECT NO. 16008
44
SDS z/h IP AFLX-H ARIG-H AFLX-V ARIG-V
16GA. Carbon steel enclosure.
UNIT UNDER TEST (UUT)SUMMARY SHEET
Manufacturer: Jeron Electronic Systems, Inc.
UUT 1Model Line: Provider Nurse Call System Cabinets
Model Number: Provider 680 Serial Number: N/A
Product Construction Summary:
Options/Subcomponent Summary:
Enclosure - 6888 | Main Control unit - 6850 | Power Supply Unit - 6851 | Logic Assembly - 13606 | Audio Assembly - 13605 | Master
Assembly - 13419 | Bus Assembly - 13418.
UUT Properties
Weight
(lb)
Dimension (in) Lowest Natural Frequency (Hz)
Depth Width Height Front-Back Side-Side Vertical
N/A
UUT Highest Passed Seismic Run Information
Building Code Test Criteria
CBC 2016 ICC-ES AC156
4 18 24 N/A N/A
Rigid wall mounted with (4) ungraded #10-32 pan head sheet metal screws.
Unit maintained structural integrity and remained functional per manufacturer requirement.
Contents were included in testing per operating conditions.
2.49g 1.0 1.5 3.98g 2.99g 1.67g 0.67g
Test Mounting Details:
TRU Compliance, LLC - A Tobolski Watkins Affiliate
844.TRU.0200 | [email protected]
03/22/2016 OSP-0198-10
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TRU PROJECT NO. 16008
51
SDS z/h IP AFLX-H ARIG-H AFLX-V ARIG-V
16GA. Carbon steel enclosure.
UNIT UNDER TEST (UUT)SUMMARY SHEET
Manufacturer: Jeron Electronic Systems, Inc.
UUT 2Model Line: Provider Nurse Call System Cabinets
Model Number: Provider 790 Serial Number: N/A
Product Construction Summary:
Options/Subcomponent Summary:
Enclosure - 7989 | Ethernet Switch - 7991 | Gateway - 7993 | Power Supply Unit - 7995.
UUT Properties
Weight
(lb)
Dimension (in) Lowest Natural Frequency (Hz)
Depth Width Height Front-Back Side-Side Vertical
4 24 30 N/A N/A
Test Mounting Details:
Rigid wall mounted with (4) ungraded #10-32 pan head sheet metal screws.
Unit maintained structural integrity and remained functional per manufacturer requirement.
Contents were included in testing per operating conditions.
N/A
UUT Highest Passed Seismic Run Information
Building Code Test Criteria
CBC 2016 ICC-ES AC156 2.49g 1.0 1.5 3.98g 2.99g 1.67g 0.67g
TRU Compliance, LLC - A Tobolski Watkins Affiliate
844.TRU.0200 | [email protected]
03/22/2016 OSP-0198-10
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