20121030101502807.pdfLetter of Transmittal
October 30, 2012 Washington State Department of
(41*Health
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
Project Info:
CRS# 60302419 Project 21701 3rd 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
Box 356031
Box 356031
Seattle, WA 98125
Seattle, WA 98125
(206) 598-6306 x.
(206) 598-4910 x.
helens@u.washington.edu
kathsch@u.washington.edu
Architect /
TGB Architects
Local AHJ: City of Edmonds
Engineer:
Kent Gregory
Leif Bjorback
21911 76`h Ave W, Ste 210
121 5th Avenue North
Edmonds, WA 98026
Edmonds, WA 98020
(425) 778-1530 x.
(425) 771-0220 x.
kgregory@tgbarchitects.com
Bjorback@ci.edmonds.wa.us
Consultant:
Bellevue Mechanical
Consultant: Case Engineering
Frank Fisher
Michael Case
1331 1201h Ave NE
10614 Beardslee Blvd, Ste C
Bellevue, WA
Bothell, WA 98011
(425) 579-5932 x.
(425) 402-9400 x.
frank.fisher@bellevuemechanical.com
michael@caseeng.com
Contact:
Gina Dais
Contact: N/A
TGB Architects
21911 76th Ave W, Ste 210
Edmonds, WA 98026
(425) 778-1530 x.
X.
gdais@tgbarchitects.com
Copies To:
® 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.
❑ Contact: N/A
®
L&I, Bill Eckroth, Electrical Section
® CRS File
❑
L&I, John Harvey, Factory Assembled Structures
Page 1 of 4 Plan Review Comments for Project #60302419
Facility Data Certificated
Facility Flame: University of Washington Medical Center
Site Address: 21701 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
5-A
Applicable Code:
2000 NFPA 101
Based on size of common rooms Residents
Group:
Type:
U
Qualifies for Assisted Living Funding Program ❑ Yes ❑No Number of qualifying units:
2009 IBC
2010 FGI Guidelines
Number of Current:
N/A
Added:
Removed:
Total:
Beds:
Automatic Fire Sprinkler System: ❑ Yes
® No
Type
dAutomatic
Fire Alarm System:
® Yes
❑ No
Compartmentation req'd:
❑Yes
❑No
Smoke Control System Provided:
❑ Yes ❑No
40
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
C
V)
Based on size of common rooms Residents
Maximum allowable licensable beds:
U
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:
�, I 1 J , �1 f � ✓ � li � ,� [�� i� � � � t � Jai t 1 ^�, t t { ] �„ t ,�� � 1
f 1,
"�1i � �u11°11,J•l�, L,;.�IJ��Ii Ir=` �I�l
The construction documents have been reviewed and found acceptable. Construction can begin, subject to
construction permitting from the local building official. The project is not approved for use until CRS has
notified the Office of Investigations and Inspections that the project has been completed.
Once the Project Close-out Requirements below have been completed, we will notify DOH Office of
Investigations and Inspections that you have completed the review process and are ready for licensing. Any
revisions to the documents (change orders or addenda) shall be submitted to the department for review.
Additional comments may follow based on documents received 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 must be 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.
® 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:
ltb t /J ar µ 11 I
✓ 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: fslc (r�7a)Mc Il w�yllo civ.
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 wiv .dohs lya .gm /c lmmg.
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:
Q
b
El Provide two sets of fire alarm drawings for review. WAC 246-320-505 & 2009 IFC
Section 907
Not Approved 10/9/12 —Identify a manual fire alarm pull for this floor near the main
exit. At least one must be installed. 2000 NFPA 101: 9.6.2 and IFC 907
Approved 10/23/12 — Fire alarm pull added per revised drawings received 10/23/12
2 El Identify the fire extinguishers located on this floor. 2000 NFPA 101:8.3.5
Approved 10/9/12 — Plans received 9/14/12
El 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
Approved 10/9/12 — Plans received 9/14/12
4 ❑x Identify convenient wheelchair storage space. 2010 FGI 3.1-6.1.7
Approved 10/9/12 — Per response received 9/14/12
M Provide privacy curtains at the exam room patient doors. 2010 FGI 3.1-1.2.2
Approved 10/9/12 — Plans received 9/14/12
6 FX1 Clarify the building's construction type. The application states type VB and drawings
VB.
Approved 10/9/12 — Per email received 8/23/12, building is VA
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 facilityfrom 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