20111222095651559.pdfL. D i
Letter of Transmittal
December 22, 2011
Washington State Department of
nealth
Construction Review Services
310 Israel Rd. SE
Tumwater, WA 98501
PO Box 47852
Olympia, Washington 98504-7852
www.doh.wa.gov/crs
tel. 360-236-2944
fax. 360-236-2901
Contact: Maurice Santillanes Contact: N/A
Swedish Edmonds Hospital
X. X.
Maurice. Santillanes@swedish.org
Copies To:
®
Local AHJ: City of Edmonds
❑
Project Info:
®
Architect / Engineer: Collins Woerman
CRS# 60260351
Project
21601 76th Ave W
Swedish Edmonds Hospital
location:
Edmonds, WA 98026-7507
Chapter 246-320 WAC Hospitals
Consultant: N/A
❑
MRI Replacement
Local Permit #:
Contact: Maurice Santillanes
Key People:
Aging & Adult Services Admin.
❑
Assigned DOH Mina Zarelli
®
L&I, Bill Eckroth, Electrical Section
Reviewer: mina.zarelli@doh.wa.gov
ElL&I,
Facility Swedish Edmonds Hospital
Facility Contact:
Same as Administrator
Administrator: Stephan Rehnfeldt
21601 76th Ave W
Edmonds, WA 98026-7507
(425) 640-4211 x.
X.
stephan.rehnfeldt@swedish.org
Architect / Collins Woerman
Local AHJ:
City of Edmonds
Engineer: Scott Rice
Leif Bjorback
7102 nd Ave Ste 1400
121 5th Avenue North
Seattle, WA 98104
Edmonds, WA 98020
(206) 245-2100 x.
(425) 771-0220 x.
srice@collinswoerman.com
Bjorback@ci.edmonds.wa.us
Consultant: N/A
Consultant:
N/A
Contact: Maurice Santillanes Contact: N/A
Swedish Edmonds Hospital
X. X.
Maurice. Santillanes@swedish.org
Copies To:
®
Local AHJ: City of Edmonds
❑
DOH Child Birth Center Licensing
®
Architect / Engineer: Collins Woerman
❑
DOH Office of Accommodations & Res. Care Survey
❑
Consultant: N/A
®
DOH Office of Investigations & Inspections
❑
Consultant: N/A
❑
DSHS, Div. Of Alcohol & Substance Abuse
®
Contact: Maurice Santillanes
ElDSHS,
Aging & Adult Services Admin.
❑
Contact: N/A
®
L&I, Bill Eckroth, Electrical Section
ElL&I,
John Harvey, Factory Assembled Structures
®
CRS File
Page 1 of 5 Plan Review Comments for Project #60260351
Facilitv Data Certificate:
Facility Name: Swedish Edmonds Hospital
Site Address: 21601 76th Ave W
Edmonds, WA 98026-7507
Estimated Date of Occupancy: currently occupied
Licensee UBI#: 602997735
Critical Access Facility: ❑ Yes ❑ No
Replacement of existing MRI equipment. This project includes removal of existing finishes, new shielding, new
finishes and casework.
i
�I
The data above is based on the information presented to CRS. Any change in the facility or facility program that
causes the above information to be incorrect is subject to review by CRS. Approval for construction is not
approval for licensure. A copy of the facility data certificate will be sent to the licensing agency.
Page 2 of 5 Plan Review Comments for Project #60260351
Occupancy I-2
Construction
1-A
O
Applicable Code:
2000 NFPA 101
Maximum allowable licensable beds:
Group:
Type:
2009 IBC
2010 FGI Guidelines
Number of Current:
Added:
Removed:
Total:
HBeds:
y
Automatic Fire Sprinkler System: ® Yes
❑ No
Type
dAutomatic
Fire Alarm System:
® Yes
❑ No
ot
Compartmentation req'd:
❑Yes
®No
Smoke Control System Provided: ❑ Yes ❑No
Pk
Special Delayed Egress Control:
❑ Yes
❑No
Location:
Certificate of Need Required:
❑ Yes
❑No
CON Approval Granted:
❑ Yes ❑No
CON Number:
Replacement of existing MRI equipment. This project includes removal of existing finishes, new shielding, new
finishes and casework.
i
�I
The data above is based on the information presented to CRS. Any change in the facility or facility program that
causes the above information to be incorrect is subject to review by CRS. Approval for construction is not
approval for licensure. A copy of the facility data certificate will be sent to the licensing agency.
Page 2 of 5 Plan Review Comments for Project #60260351
Number of units: Private occupancy: Two person occupancy:
aBased
on size of rooms used for sleeping Residents
O
Based on size of common rooms Residents
z �
Maximum allowable licensable beds:
Qualifies for Assisted Living Funding Program ❑ Yes ❑No Number of qualifying units:
Replacement of existing MRI equipment. This project includes removal of existing finishes, new shielding, new
finishes and casework.
i
�I
The data above is based on the information presented to CRS. Any change in the facility or facility program that
causes the above information to be incorrect is subject to review by CRS. Approval for construction is not
approval for licensure. A copy of the facility data certificate will be sent to the licensing agency.
Page 2 of 5 Plan Review Comments for Project #60260351
Swedish Edmonds Hospital
Chapter 246-320 WAC Hospitals
MRI Replacement
Project Status:
0
- Authorized to Begin Construction a
11,317, =�• llf
This project is not approved for use or licensure. The construction documents have been reviewed and
construction can begin, subject to construction permitting from the local building official.
This project will not be approved until the comments labeled as "not approved" have been resolved by
providing a written response to each of the comments. When referencing drawings or attached materials,
provide sheet or page #, revision # and date as applicable. Additional comments may follow based on design
team response and site inspections may be required to verify compliance.
Please note the following:
® The stamped "Authorization to Begin Construction" drawings will be delivered to the Facility
Administrator. These shall be kept available on site for inspection during construction and post
occupancy survey.
Any changes/deviations (incl. change orders or addenda) from the approved documents must be
submitted to the Department for review and approval.
Beginning construction prior to resolving the attached comments will constitute facility
acknowledgement that you are proceeding at your own risk.
Please include your CRS number on all communications to Construction Review Services,
PROJECT CLOSE-OUT REQUIREMENTS You must notify the department when construction is
complete by completing the following steps:
V Verify that you have resolved all of the comments on this form and have submitted any revisions
v' Complete the Notification of Construction Completed at:
1!1tjj: Hstatic. dolt, ard,lifin
�pink g
............
V Email or fax the assigned reviewer (see page 1) a copy of the approval from the local building
department (final permit approval or certificate of occupancy); and
V Email or fax the assigned reviewer a floor plan showing the scope of work.
Contact the DOH Office of Customer Service (360-236-4700) for help with revising _your license _Lo
You can monitor project status at
Page 3 of 5 Plan Review Comments for Project # 60260351
Swedish Edmonds Hospital
Chapter 246-320 WAC Hospitals
MRI Replacement
Plan Review Comments:
� b
Q
U d Z
Preliminary Conference —11/17/11
Attendees:
Mina Zarelli (mina.zarelli@doh.wa.gov) — Department of Health
Stefan Rehnfeldt — Swedish Edmonds
Maurice Santillanes — Swedish Edmonds
0 Provide a copy of the facility's Infection Control Risk Assessment (ICRA) for this
project. The assessment shall identify risks and describe provisions for infection control
and safety of the facility's occupants during this project. The ICRA must be individually
tailored to fit each area of the project and must be signed and dated by the Hospital
Infection Control Manager. The design professional shall incorporate the specific
construction -related requirements of the ICRA into the contract documents, and include
the locations of temporary barriers, anterooms, negative pressure outlets, contractor
access, covered materials transport and debris removal, etc.
WAC 246-320-505(2)(c)(i)(C) & 2010 FGI 1.2-3
Approved 11/23/11— Based on ICRA received 11/23/11
2 0 Provide an interim life safety measures plan (ILSM) to ensure the health and safety of all
occupants adjacent to the work area during construction. Indicate the exiting paths to be
used during construction and materials used as temporary construction barriers.
Combustible materials, such as plastic sheeting, that do not meet the requirements of
NFPA 701 shall not be used as barriers. The ILSM must be included in the contract
documents and the contractor must implement these requirements during construction.
WAC 246-320-505(2)(c)(i)(B) & 2009 IFC Chapter 14.
Approved 11/23/11— Based on ILSM received 11/23/11
3 0 Provide manufacturer plans identifying the 5 gauss line. 2010 FGI 2.2-3.4.4
4 0 Verify sprinkler heads will not be blocked by the new equipment or casework. If heads
must be relocated as part of this project, provide a revised plan for review.
0 Provide final testing report from the manufacturer to verify existing utilities (electrical,
mechanical) are provided and meet the requirements for the new equipment. 2010 FGI
2.2-3.4.4.7
Page 4 of 5 Plan Review Comments for Project # 60260351
Swedish Edmonds Hospital
Chapter 246-320 WAC Hospitals
MRI Replacement
6 0 Provide a functional program for this project if the use of the MRI equipment will change
with the new equipment. Will the MRI equipment be used for image guided biopsies or
procedures? 2010 FGI 1.2-2
Compliance with the comments above provided by the Department of Health, Construction Review Services, are necessary for this facility to meet
the requirements of the applicable licensing regulations found in the Washington State Administrative Code and associated references. These
comments do not relieve the facility from the responsibility to meet the requirements of any other applicable federal, state or local regulations.
In the event of conflicts between other jurisdictions and these written comments, the most stringent shall apply.
Page 5 of 5 Plan Review Comments for Project # 60260351