Form Osh-Fd-125 Post Approval Document Page 2
Download a blank fillable Form Osh-Fd-125 Post Approval Document in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Osh-Fd-125 Post Approval Document with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT
FACILITIES DEVELOPMENT DIVISION
OFFICE USE ONLY
Project#
Increment #
Post Approval Document
PAD-
Costs
Estimated
Cost Type
Change in Construction Costs
Contract
(excluding fixed equipment, imaging equipment,
Add
design fees, inspection fees, and off-site improvements)
Deduct
$
Note: For SB 1838 projects, this amount must not exceed $50,000
Add
Change in Fixed Equipment Costs
Deduct
$
(sterilizers, chillers, boilers, etc., excluding installation)
Add
Change in Cost of Imaging Equipment
$
Deduct
(X-ray, MRI, CT Scan, etc., excluding installation cost)
Note: See Instructions for Fee Information
Reason
Enclosures
Number
Number of
Enclosure Type
Enclosure Type
of Copies
Copies
Contract Information
Site Data Reports
Design Program
Specifications
Equipment Anchorage Calculations
Structural Calculations
Geotechnical Reports (for Buildings and Additions)
Testing, Inspection and Observation Program (TIO)
Letter of Authorization
Verification of Conformance to Local Codes
Plans
Other _____________________________________
Project Schedule
List all drawing sheets included with submittal:
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
OSH-FD-125 (Rev 11/11/11)
Page 2 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal