20120823124111816.pdfLetter ®f Transmittal
August 23, 2012
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RECEIVED
AiKj' 23 2012
Healthl!
Construction Review Services
310 Israel Rd. SE
Tumwater, WA 98501
PO Box 47852
Olympia, Washington 98504-7852
DFV11'J,0[1MEN1 SERVI 1'=S www.doh.wa.gov/crs
(301J N`R- tel. 360-236-2944
fax. 360-236-2901
Project Info: �t
CRS# 60302419 Project 21701u3rd Ave W, Ste 200
University of Washington Medical Center location: Edmonds, WA 98026
Chapter 246-320 WAC Hospitals
Licensure/TI of Heart Center Local Permit #:
Key People:
Assigned DOH Mina Zarelli
Reviewer: mina.zarelli@doh.wa.gov
Facility University of Washington Medical Center Facility Contact: University of Washington Medical Center
Administrator: Helen Shawcroft Kathleen Schaefers
Copies To:
M
Box 356031
Box 356031
DOH Child Birth Center Licensing
Seattle, WA 98125
Seattle, WA 98125
❑
(206) 598-6306 x.
(206) 598-4910 x.
Consultant: Bellevue Mechanical
helens@uw.edu
kathsch@u.wshington.edu
Architect /
TGB Architects
Local AHJ: City of Edmonds
Engineer:
Kent Gregory
Leif Bjorback
❑
21911 76th Ave W, Ste 210
121 5th Avenue North
Edmonds, WA 98026
Edmonds, WA 98020
❑
(425) 778-1530 x.
(425) 771-0220 x.
L&I, John Harvey, Factory Assembled Structures
kgregory@tgbanccitects
Bjorback@ci.edmonds.wa.us
Consultant:
Bellevue Mechanical
Consultant: Case Engineering
Frank Fisher
Michael Case
1331 120' Ave NE
10614 Beardslee Blvd, Ste C
Bellevue, WA
Bothell, WA 98011
(425) 579-5932 x.
(425) 402-9400 x.
fi-ank.fisher@bellevuemechanical.com
michael@caseeng.com
Contact:
Gina Dais
Contact: N/A
TGB Architects
X.
X.
GDais@TGBArchitects.com
Copies To:
M
Local. AHJ: City of Edmonds
❑
DOH Child Birth Center Licensing
®
Architect / Engineer: TGB Architects
❑
DOH Office of Accommodations & Res. Care Survey
❑
Consultant: Bellevue Mechanical
❑
DOH Office of Investigations & Inspections
❑
Consultant: Case Engineering
❑
DSHS, Div. Of Alcohol & Substance Abuse
®
Contact: Gina Dais
❑
DSHS, Aging & Adult Services Admin.
❑
L&I, Bill Eckroth, Electrical Section
❑
Contact: N/A
❑
L&I, John Harvey, Factory Assembled Structures
®
CRS File
Page 1 of 4 Plan Review Comments for Project #60302419
Facility Name: University of Washington Medical Center
v
Site Address: 217017, Ave W, Ste 200
Edmonds, WA 98026
Estimated Date of Occupancy: Dec 2012
Licensee UBI#: 178019988
Critical Access Facility: ❑ Yes ❑ No
Tenant improvement: 4,137 SF outpatient clinic in an existing non -licensed medical office building.
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 4 Plan Review Comments for Project #60302419
Occupancy B
Construction
?
Applicable Code:
2000 NFPA 101
Based on size of common rooms Residents
Group:
Type:
d
Qualifies for Assisted Living Funding Program ❑ Yes ❑No Number of qualifying units:
2009 IBC
2010 FGI Guidelines
PW
Number of Current:
N/A
Added:
Removed:
Total:
�0
Beds:
Automatic Fire Sprinkler System: ❑ Yes
® No
Type
aAutomatic
Fire Alarm System:
® Yes
❑ No
Compartmentation req'd:
®Yes
❑No
Smoke Control System Provided: ❑ Yes []No
Special Delayed Egress Control:
❑ Yes
❑No
Location:
Certificate of Need Required:
❑ Yes
®No
CON Approval Granted:
❑ Yes ❑No
CON Number:
Tenant improvement: 4,137 SF outpatient clinic in an existing non -licensed medical office building.
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 4 Plan Review Comments for Project #60302419
Number of units: Private occupancy: Two person occupancy:
Based on size of rooms used for sleeping Residents
®
V)
Based on size of common rooms Residents
Maximum allowable licensable beds:
d
Qualifies for Assisted Living Funding Program ❑ Yes ❑No Number of qualifying units:
Tenant improvement: 4,137 SF outpatient clinic in an existing non -licensed medical office building.
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 4 Plan Review Comments for Project #60302419
University of Washington Medical Center
Chapter 246-320 WAC Hospitals
Licensure/TI of Heart Center
Project Status:
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 stamped 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:
✓ Verify that you have resolved all of the comments on this form and have submitted any revisions
✓ Complete the Notification of Construction Completed at:
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✓ Email a copy of the approval from the local building department (final permit approval or
certificate of occupancy); and
✓ Email a floor plan showing the scope of work to: fsIc w Loh.gwgr v.
Once your construction project is complete, you may contact the DOH Office of Customer Service (360)
236-4700 for help with adjusting or amending your license to add this project. You can monitor project status
at w�v day➢us ge�y/tis.
Page 3 of 4 Plan Review Comments for Project # 60302419
University of Washington Medical Center
Chapter 246-320 WAC Hospitals
Licensure/TI of Heart Center
Plan Review Comments:
1 0 Provide two sets of fire alarm drawings for review. WAC 246-320-505 & 2009 IFC
Section 907
2 0 Identify the fire extinguishers located on this floor. 2000 NFPA 101:8.3.5
3 0 Provide instructions to the contractor to ensure all penetrations (HVAC, plumbing,
electrical, etc) in the one -rated wall corridor are protected in accordance with NFPA
10:8.2.3.2.4.2
4 0 Identify convenient wheelchair storage space. 2010 FGI 3.1-6.1.7
5 0 Provide privacy curtains at the exam room patient doors. 2010 FGI 3.1-1.2.2
6 0 Clarify the building's construction type. The application states type VB and drawings
VB.
Compliance with the comments above provided by the Department of Health, Constniction Review Services, are necessaryfor 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 4 of 4 Plan Review Comments for Project # 60302419