KrugerDOH.pdfLetter of Transmittal
December 22, 2011
i*HeaWashington State Department of
l
t
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# 60237493
Project
21401 72nd Ave W
Kruger Orthopaedics
location:
Edmonds, WA 98026
NFPA 101, 2000 Version ASC
Suite 3A
TA - Relocation of ASC
Local Permit #:
Key People:
Assigned DOH Steve Pennington
Reviewer: steve.pennington@doh.wa.gov
Facility Kruger Clinic Orthopaedics, PLLC
Facility Contact:
Same As Administrator
Administrator: Marilyn Degan
21600 Highway 99 Ste 130
Edmonds, WA 98026
(425) 774-2637 x.
X.
judy@krugerortho.com
Architect / Architectural Werks Inc
Local AHJ:
City of Edmonds
Engineer: Janet Monda
Leif Bjorback
12020 1131h Ave NE, Ste 210
Kirkland, WA 98034
(425)823-2244 x.
(425)771-0220 x.
janet@awerks.com
Bjorback@ci.edmonds.wa.us
Consultant: Pennon Construction Company Inc
Consultant:
Bellevue Mechanical Inc
Mac Sele
Larry Boyer
5303 1" Ave S Ste 100
1331 120th Ave NE
Seattle, WA 98108
Bellevue, WA 98005
(206) 418-0235 x.
(425) 679-5931 x.
macs@pennonconstruction.com
larry.boyer@bellevuemechanical.com
Contact: SME Inc of Seattle
Contact:
N/A
Dallas Anderson PE
828 Poplar PI S
Seattle, WA 98144
(206) 788-3829 x.
X.
dallasa@smeincofseattle.com
Copies To:
®
Local AHJ: City of Edmonds
❑
DOH Child Birth Center Licensing
®
Architect / Engineer: Architectural Werks Inc
❑
DOH Office of Accommodations & Res. Care Survey
®
Consultant: Pennon Construction Company Inc
®
DOH Office of Investigations & Inspections
®
Consultant: Bellevue Mechanical Inc
❑
DSHS, Div. Of Alcohol & Substance Abuse
®
Contact: SME Inc of Seattle
El
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 13 Plan Review Comments for Project 460237493
Facilitv Data Certificate:
Facility Name: Kruger Orthopaedics
Site Address: 21401 72nd Ave W
Edmonds, WA 98026
Estimated Date of Occupancy: 12/2012
Licensee UBI#: 601850391
Critical Access Facility: ❑ Yes ® No
Occupancy B
Construction
2-13
Applicable Code: 2000 NFPA 101
Group:
Type:
Z
aNumber
of Current:
N/A
Added:
Removed: Total:
>0
Beds:
Automatic Fire Sprinkler System: ® Yes
❑ No
Type 13
aAutomatic
Fire Alarm System:
® Yes
❑ No
w
Compartmentation req'd:
®Yes
❑No
Smoke Control System Provided: ❑ Yes ®No
aSpecial
Delayed Egress Control:
❑ Yes
®No
Location:
Certificate of Need Required:
❑ Yes
❑No
CON Approval Granted: ❑ Yes ❑No
CON Number:
Number of units: Private occupancy: Two person Occupancy:
09 >0
Based on size of rooms used for sleeping Residents
az
O
Based on size of common rooms Residents
H
Maximum allowable licensable beds:
W a
A �
Qualifies for Assisted Living Funding Program ❑Yes ❑No Number of qualifying units:
�U
W w
This facility will be using general anethesia.
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 13 Plan Review Comments for Project 460237493
Project Status:
- Authorized to Begin Construction —
- Comments Not Approved —
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:
✓ Verify that you have resolved all of the comments on this form and have submitted any revisions
✓ Complete the Online Notification of Construction Completed at:
http://static.doh.wa.gov/hsqa/fst/CRS/pink card.htm
✓ 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
✓ Email or fax the assigned reviewer a floor plan showing the scope of work.
You will be recommended to Licensing, when you have completed these items.
You can monitor project status at www.doh.wa. og v/crs.
Page 3 of 13 Plan Review Comments for Project 460237493
Technical Assistance (TA) Comments
TA —July 1 lth, 2011
Attendees:
Steve Pennington (steve.pennin ongdoh.wa.gov) - Department of Health
Marilyn Degan - Premier Orthopedics
Janet Monda — Architectural Werks
Mac Sele — Pennon Construction
Design and Construction team
The preceding are preliminary comments provided as information and for use preparing the
construction documents. These preliminary comments may be revised during subsequent
submissions/conferences. Additional preliminary comments may be made during subsequent
submissions.
Items Received: Sketch
T1 Contact Certificate of Need at (360) 236-2955 to confirm what actions are needed with the
relocation of your Ambulatory Surgery facility.
LIFE SAFETY:
T2 The main entry stair is a communicating space that the life safety code will look at more
restrictively and will require a separation of the floors environmentally with a smoke barrier
separation on the third floor in a fully sprinklered building. The doors on the third floor leading
into the vestibule will need relytes in order for the public to ascertain whether there is an risk in
using this exit way in the event of a fire.
T3 The wall separating the ASF from the clinic will need to be a fire partition as noted in the
Washington state amendments to the International building codes in Chapter 422.
T4 The wall around the medical gas storage/manifold room on the 1st floor level of the parking garage
will be required to have a one hour fire barrier surrounding it.
T5 The number 5 gauss line will have to be contained within the MR1 area, so that it does not affect
ASF patients or the public using the exit access corridors.
T6 Doors must swing in the path of egress where there are 50 or more occupants using the allowance
of 100 square feet per person.
Page 4 of 13 Plan Review Comments for Project 460237493
Architectural:
T7 Drugs must be stored in a secured location, including refrigerated medications.
T8 Patient toilets rooms must have doors that prevent entrapment.
T9 Rooms that a clean or dirty with required pressure relationships should be provided with door
closers to ensure that the pressure relationship is always maintained.
T10 Public corridors are required to be a minimum of 5 feet wide except where stretchers are moved
and then an 8 foot wide corridor is required.
T11 A washable drop ceiling is permitted in the surgery corridor as long as it is clipped or gaskets or
uses a ceiling tile that is a minimum of one pound in weight per square foot and sits flat in the
ceiling grid.
T 12 Clearances for the PACU stations are 5 feet between gurneys and 4 feet off of a wall.
T13 Patient restrooms supporting the PACU would need a means for disposing of fluid waste, a spray
wand would be acceptable.
T14 A clinical flush sink is required for the decontamination room.
T15 The soiled utility room could be used as a soiled holding space for the Neptune unit docking
station, soiled linen storage and infectious waste storage.
T16 The billing office being open to the corridor is of a concern if they have any substantial amount of
fuel load from files above that of a normal hazard level for a business occupancy.
Mechanical:
T 17 A level one medical gas system is required, with a duplex vacuum pump and redundant oxygen
supplied from a fully piped manifold gas systems.
T18 Only two vacuum outlets per operating room will be required to be piped in, as the Neptune unit
will satisfy the requirement of the third vacuum outlet.
T 19 A medical gas zone valve is required outside of each operating room and one for the recovery
room is also required outside of the outlets environment.
Page 5 of 13 Plan Review Comments for Project 460237493
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U
T20 Inferred controls for the scrub sink and faucet is acceptable as long as the faucet is a gooseneck.
Handle controls for hand -washing can be either wing handles or single lever.
T21 A hot water re -circulating loop must be provided for the domestic hot water.
T22 A fully ducted supply and return air system is required for the ASF.
T23 Insulation of ducting should be exterior mounted to allow cleaning of ducting.
T24 Low wall returns on the opposite walls and as far apart as possible shall be installed in the
operating rooms. Laminar, non aspirating diffusers shall be used on the supply air.
T25 Air exchanges in the operating rooms shall not exceed 20 ACH. Any amount over the 20 ACH
would need to be reviewed and supported by an ICRA, studies and consistent with
recommendations from ASHRAE, CDC, NIH.
T26 Back flow protection for the building and any equipment connected to the domestic water system
will be required.
Electrical:
T27 An emergency power generator systems shall be provided meeting NFPA 110 and NFPA 99.
T28 Security of the generator and fuel tank shall be provided.
T29 A remote generator enunciator shall be provided at a nurse station where it can be monitored
during business hours.
T30 The branches of emergency power shall be provided, consisting of the Life safety branch, critical
power branch and a equipment branch. The associate devices shall be placed on those branches as
permitted by code.
T31 All outlets shall be hospital grade.
T32 Medical gas area alarms shall be provided for the PACU and the operating rooms.
T33 Lighting in the operating rooms shall have lens and gaskets.
T34 All patient bed locations shall be served from two sources of power.
Page 6 of 13 Plan Review Comments for Project 460237493
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0
U
T35 Provide exit signs that clearly delineate the required exit pathways.
T36 Provide exit access pathway lighting.
T37 Surgery suites will need a code blue emergency call button.
Intake conference 11115111:
T38 How will the generator be fueled when there is no access within the property of the owner?
WAC 246-330-510
T39 How are the .5 guass lines for the MRI contained away from public area's.
T40 Structural engineering buy off on overhead booms for lights or service must be provided.
T41 Freeze protection in exterior stair must be provide for wet sprinkler systems per NFPA 13
T42 Revise life safety plan to show travel distances to the two require exit stairs that meet NFPA 101.
T43 Smoke venting for anesthetizing locations to be provided per NFPA 99 Chapter 5.
T45 The life safety branch of the emergency power system shall provide power to exit sign, exit access
pathway lighting and services required to be on the life safety branch per NFPA 99 Chapter 3-4.
Page 7 of 13 Plan Review Comments for Project 460237493
Kruger Orthopaedics
NFPA 101, 2000 Version ASC
TA - Relocation of ASC
Plan Review Comments:
Q U
>
General:
0 Two complete plans and specifications for the fire alarm system installation or
modification shall be submitted for review and approval prior to system installation.
The department reserves the right to defer plan review and inspections to the local
authority having jurisdiction (AHJ). Plans and specifications shall include, but not be
limited to, a floor plan; location of all alarm -initiating and alarm -signaling devices;
alarm -control and trouble -signaling equipment; annunciation; power connection; battery
calculations; conductor type and sizes; voltage drop calculations; name, address, and
phone number of the agency receiving off -premises transmission of alarm; and the
manufacturer, model numbers, and listing information for all equipment, devices, and
materials. Incomblete Mans and specifications will be returned without review. Plans
and specifications may be submitted separately from construction documents during the
construction of the project. For small renovation projects in which devices are only to be
relocated or very few devices are to be added, provide two plans that shows the
relocation of devices which may be submitted for review in lieu of the above
requirements. This information can be included on the electrical or architectural plans.
Verify with Department staff to determine if the scope of your project meets this criteria.
Section 907.1, International Fire Code
2 0 Two sets of sprinkler system working plans shall be submitted for review and approval
before any equipment is installed or remodeled. The department reserves the right to
defer plan review and inspections to the local authority having jurisdiction (AHJ).
Deviation ftom approved plans will require permission. Plans and specifications,
including hydraulic calculations, that are incomplete or are not stamped by a Washington
State Licensed Fire Sprinkler Contractor, will be returned without review. Plans and
specifications may be submitted separately from construction documents during the
construction of the project. For small renovation projects in which heads are only to be
relocated, a plan that shows the relocation of devices can be submitted for review in lieu
of the above requirements. Section 903.1, International Fire Code
(A)Note: Sprinkler heads in the operating rooms are required to be the clean room
concealed type to meet the monolithic ceiling finish requirements of the 2006 FGI.
Approved 11/5/11 — Based on cut sheets provided that meet the above requirement.
(B)Provide fire sprinkler protection in the stairwells to meet the minimum of one at the
top of the stair shaft and under the first landing above the bottom of shaft per NFPA 13
Page 8 of 13 Plan Review Commcnts for Projcct 4 60237493
Kruger Orthopaedics
NFPA 101, 2000 Version ASC
TA - Relocation of ASC
5-13.3 (reference sheet 4 of 4 of Patriots drawing)
Approved 1115111 — Based on cut sheets provided and response that the heads will
be provided.
3 ❑x Contact the Certificate of need program with the Department of Health at (360) 236-2955
to process the change of location for your Licensed Ambulatory surgery facility.
4 ❑x Provide in the functional program per 2006 FGI 1.2-2.1 the following:
(a)What types of procedure will be performed at the new site.
(b)Where are medications stored and secured. This would also include securing of
refrigerated medications.
(c)Is the ice machine conveniently located for emergency use for patient in
hypothermia?
(d)How/ where are laundry services provided?
5 ❑x How will continued access be provided to the emergency power generator for fuel
re -supply with no direct access from on -the -property is provided? WAC 246-330-510
(reference sheet A-101)
6 ❑x Provide steel bollard protection from vehicle damage to the generator and fuel tank from
the neighboring parking lots per International Fire Code 3404.4.6
Locate these bollards no less than four feet on center per IFC Section 312.
7 ❑x Provide an exterior door or access next to the storage room on the east wall of the first
floor to provide easy access to the generator for maintenance and testing purposes per
NFPA 110 Chapter 6. (reference sheet A-111 grid line H2/3)
8 ❑x Provide a detail for the concrete service pad and seismic restraint for the emergency
power generator and how clear service access will be provided per the manufacturer
around the unit. WAC 246-330-505 (reference sheet C2)
9 ❑x Note: On fire rated doors that are designated to have door protection, the maximum
height of an non -listed applied panel is 16 inches above the bottom of door
per NFPA 80 2-4.5 unless the door comes as an approved assembly with the door
protection. Revise specifications per the above. (reference note # 7 on sheet A9.1)
Approved 11/5/11 — Based on comment response and modification of the door
schedule to meet the above requirement on fire rated doors.
10 ❑x Provide door closers on the following doors to maintain the required pressure
relationships per Table 2.1-2 of the 2006 FGI:
A307A, A313A, A313A, A315A, A302A, A325A, A324A and A324A
Page 9 of 13 Plan Review Comments for Projcct 4 60237493
Kruger Orthopaedics
NFPA 101, 2000 Version ASC
TA - Relocation of ASC
(reference sheet A2.1,A9.1 &A9.1B)
11 0 Provide verification that the .5 gauss line for the MRI is contained away from public
areas per 2006 FGI 2.1-5.5.5.8 (2) in the Lobby/Latte area. (reference sheet A2.4)
Approved 11/5/11 — Based on sheet A2.6 dated 11/30/11 that shows the .5 gauss lined
contained.
12 0 Provide a structural engineered sign off on the support systems for the surgical lighting
system per WAC 246-330-505 (reference sheet A6.3 section # 11)
Approved 11/5/11 — Based on sheet 58.02 that provides an engineered support
system.
13 0 Provide details showing how the vertical and horizontal joints in the hygienic wall
covering wainscot in the operating rooms will be joined to form a monolithic finish per
2006 FGI 3.7-5.2.2.4 (3) (reference sheet A9.2 and A6.1)
14 0 Provide a stamped and signed plumbing drawing by the engineer of record
per WAC 246-330-505
Life Safety:
15 0 Provide a 45 minute rated fire door to the medical gas storage room that is one hour rated
per NFPA 101 Chapter 8.2.3.2.3.1 (2) (reference sheet A-119 and A-111)
16 0 Provide a two hour fire barrier with a 90 minute rated fire door around the elevator
equipment room per the International Building Code Section 3006.4
(reference sheet A-111)
17 0 Provide a one hour fire barrier around the Electrical service room on the first floor and a
second exit meeting NFPA 70 f Article 110.26 (C) (2) for rooms with over 1200 amps of
service and equipment over 6 feet wide.
18 0 Provide an updated life safety plan for the 3rd floor showing the two required exits per
NFPA 101 Chapter 20 separate from the atrium exit that has been separated by a one
hour smoke barrier. WAC 246-330-505
Approved 1115111 — Based on comment response that made the two exit stair
enclosures # 2 and #3 the two required exits for the ASF.
19 0 Change the swing of door # A331B to swing in the path of travel to access the second
NFPA exit stair # 3 per NFPA 101 Chapter 7.2.1.4.2
Page 10 of 13 Plan Review Commcnts for Projcct 4 60237493
Kruger Orthopaedics
NFPA 101, 2000 Version ASC
TA - Relocation of ASC
Approved 1115111 — Based on comment response and sheet A2.1 that changed the
door swing in the path of egress.
20 0 Verify or provide the rating of the 3rd floor door and wall assembly that door # 300A is
part of to form a smoke barrier to provide the communicating space separation per
NFPA 101 Chapter 8.2.5.5
Approved 1115111 — Based on comment response that these doors are in a one hour
rated fire/smoke barrier wall.
21 0 Boiler room/mechanical room on roof that has direct access into stair well # 3, which
cannot have direct access to that stairwell per NFPA 101 Chapter 7.1.3.2.1 (d) and the
International building code Section 1022.3
Mechanical:
22 0 Modify the following pressure relationships per Table 2.1-2 of the 2006 FGI:
(A)Room A324 sub sterile is required to be positive.
23 0 How is smoke venting provided for anesthetizing locations per NFPA 99 Chapter 5-4.1.2
24 0 How is humidity addressed for the operating rooms? WAC 246-330-505
25 0 How are pressure relationship maintained during off hours and weekends?
WAC 246-320-505
26 0 Provide the locations and rating for the pre and final filters for the ambulatory surgery
facility meeting Table 3.1-1 of the 2006 FGI.
(Found the Hepa filters in the supply diffusers of the operating rooms, but could not find
the filtering for the rest of the unit.
Electrical:
27 0 Provide a shared medical gas alarm for the operating rooms located in the same corridor
per NFPA 99 Chapter 4-3.1.2.2 (c) (reference elevations on sheet A7.2)
The recovery area is required to have one of its own.
28 0 Provide sprinkler freeze protection in stair wells # 2 & #3 per NFPA 13 5-14.3.3
(reference sheet M2.01)
29 0 Provide a physical separation between the normal power distribution and the emergency
distribution transfer switches on the first floor electrical room to prevent essential power
interruption by a failure in the normal distribution per NFPA 70 Article 517.35 (C)
Page 11 of 13 Plan Review Commcnts for Projcct 4 60237493
Kruger Orthopaedics
NFPA 101, 2000 Version ASC
TA - Relocation of ASC
(note this could be a hard wall partition of the room into two areas)
30 0 Recommend that the ice machine in room # A304 be placed on the critical branch of
emergency power as it will supply the ice for patients in hypothermic shock and without
power the ice would not be dispensed from the machine.
31 ❑X Atrium door hold open circuits NL1-3 need to dropout on fire alarm as this is a rated fire
barrier. Are these hold open devices on a relay with the fire alarm? WAC 246-330-505
(reference sheet E2.3A)
32 0 Provide two sources of outlet power in operating rooms # A320, # A319 and # A318 per
NFPA 70 article 517.19(A) that requires both normal and emergency power.
(reference sheet E2.3B)
33 0 Provide manual pull stations at the entrance to star well # 2 & #3 and at the exit/entrance
to the ASF per 1999 NFPA 72 2-8.2.2 and 2006 FGI 3.7-6.4.1 (reference sheet FA1.3)
34 0 Provide a ground wire that is the same size of the conductor in anesthetizing locations
per NFPA 99 Chapter 3-3.2.1.2 (5)(b)
35 0 What is the run time on the emergency power generator at full load with the fuel supply
allowance provided? WAC 246-330-505
Plumbing:
36 0 The faucet for the following hand washing stations must be a gooseneck with either wrist
blades or single lever controls per 2006 FGI 1.6-2.1.3.1:
➢Faucet for sink # P2A convert to gooseneck device
37 0 Provide a bed pan spray wand on any two of the recovery room patient toilets to facilitate
disposal of fluid waste in the recover area per 2006 FGI 3.7-2.5.6 (2)
38 0 Provide reduced pressure back flow devices to each sterilizer, the instrument washer and
for the Neptune docking bay hot and cold water connections
per 2006 FGI 3.1-7.1.2.3 (3)(a) (reference sheet P05)
39 0 Provide a service isolation valve on the oxygen, Vacuum, nitrous oxide medical gas lines
on the horizontal branch lines as they come off of the vertical riser on the third floor per
NFPA 99 Chapter 4-3.1.2.3 (e) (reference sheet P05)
Recommend that the compressed air branch line also receive a service isolation valve.
Page 12 of 13 Plan Review Commcnts for Projcct 4 60237493
Kruger Orthopaedics
NFPA 101, 2000 Version ASC
TA - Relocation of ASC
40 0 The zone valve for the medical gas outlets in the recovery area cannot be located in the
same environment as the outlets per NFPA 99 Chapter 4-3.1.2.3 (d). But there is no other
location to locate it behind a door/wall where it is accessible in the egress route.
Recommend that the location for the zone valve remain, but that a cross corridor door be
added west of the ante room to form a separate environment.
41 0 Note: The third required vacuum outlet is credited to the use of the Neptune units in
each of the operating rooms.
42 0 Provide a detail showing the air gap to the drain for the ice machine drain hose of a
minimum 1" per International plumbing code Chapter 801.2
43 0 Provide a one line drawing off all the medical gas manifold systems showing source
valves, check valves, relief valve, and redundancy switch over device, gauges, master
alarm switch etc meet NFPA 99 Chapter 4-3 and figure 4-3.1.1.6 of the 1999 version.
44 0 Specifications on sheet P 10 part 4.14 A speaks to using dental surgical vacuum. This
system is not a level 3 dental system and must meet all the requirements of a level 1
medical gas system per NFPA 99 Chapter 4-3.
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 13 of 13 Plan Review Commcnts for Projcct 4 60237493