HomeMy WebLinkAbout0144427-Building (convert office to exam rooms) DIVISION OF QUALITY ASSURANCE
SOUTHEASTERN REGIONAL OFFICE
' + ; w 819 NORTH SIXTH STREET, Rm. 609B
Jim Doyle i r 1 j ° , MILWAUKEE WI 53203 -1606
GovemorI ,1
r Telephone: 414 - 227 -5000
State of Wisconsin FAX: 414-227-4139 consin.gov
Karen E. Timberlake dhs.wisconsin.gov
Secretary Department of Health Services
December 17, 2010
Robert H. Grapentin, R.A.
Grapentin Architectural Services
29 Julie Street
Appleton, WI 54915
RE: Alteration Plans - Office to Exam Rooms
Mercy Medical Center — Kennedy Center
WCBC IBC 2006 Business Occupancy; LSC 2000 New
320 sq ft
500 S. Oakwood Road
Oshkosh, WI 54904
DHS #6915 -10703
Dear Mr. Grapentin:
Final Architectural, HVAC & Lighting alteration plans that were received in the Department of Health
Services on December 9, 2010 have been stamped CONDITIONALLY APPROVED on December 17,
2010. These plans were reviewed for conformance to the 2006 IBC Wisconsin Commercial Building
Code, Chapters Comm 61 -66. The plans have NOT been reviewed for conformance to the Plumbing
Code (Chapters Comm 81 -87), the Elevator Code (Chapter Comm 18) and any other Commercial code
not specifically mentioned.
Additionally, these plans and specifications have been reviewed for compliance with the 2000 edition of
NFPA 101 Chapter 38.
The plans have not been reviewed for conformance to DHS 124 Hospitals.
Approval of these construction plans does not constitute approval of the facility for a specific Medicaid
reimbursement rate. For further assistance with billing rate questions, contact the Division of Health Care
Financing, Department of Health Services, at (608) 261 -7838.
Subject to local regulations, construction may proceed, except for those conditions listed below. The
necessary corrections shall be made before construction begins. Any deviation from or additions to the
plans made subsequent to this review is specifically not approved.
The owner, as defined in Chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all
code requirements. The owner shall notify the department and local officials before taking possession of
the newly constructed building. The building will be inspected during and after construction, at which
time additional code implications can be identified by the department.
This conditional approval does not constitute a guarantee of endorsement that the plans and specifications
are free of design defects or omission; that the systems submitted will be installed in conformity with the
plans, or that the systems will operate acceptably even if installed in conformity with the plans,
calculations, and specifications. The Department approval is limited to a determination that the systems,
as detailed in the submittal, adequately conform to the above - referenced code requirements.
Wisconsin.gov
Robert Grapentin, Grapentin Architectural Services
Office to Exam Room Alteration, Mercy Medical Center, Oshkosh
COMM 61.33 Evidence of Plan Approval. The architect, professional engineer, designer, builder
or owner shall keep one set of plans bearing the appropriate stamp of approval at the building site.
A written and satisfactory response to the following items of conditional approval is required.
1. Ensure the air- handling unit serving the exam room area has a filtration efficiency of at
least 90 %. COMM 64.0300 AIA Guidelines 2006 Table 2.1 -3
2. New electrical wiring and receptacle installation shall comply with the National
Electrical Code NEC 70 2008 edition or 1999 edition, whichever is more restrictive.
NFPA 101 9.1.2
DHFS will require a Completion Statement from an electrical authority having jurisdiction regarding
electrical distribution inspection and approval. Primary electrical responsibilities are performed by
Commerce Delegated Municipalities or Commerce Electrical Inspectors. Projects occurring in areas
without electrical distribution inspection authority or in need of assistance are encouraged to contact
Commerce at: http: / /www. commerce. state .wi.us /SB /SB- HomePage.html and then select the `Electrical"
option. Requests for Electrical assistance can be achieved by using Safety and Building Form SBD-
10822.
The documentation listed in OQA -2494, those that are applicable, shall be submitted to this office prior to
the final inspection for this remodeling project. Until such documentation is received and approved, no
patients are allowed to occupy these portions of the renovated areas of this hospital. And no facility
employees are allowed to occupy or use the remodeled areas until conditionally approved for occupancy
by the DQA -BHS Engineer of Record.
Three approved title sheets are returned to you.
If you have any further questions, please contact me at (414) 227 -2004, or email at
ganesh.shrestha @wisconsin.gov
Sincerely,
Oft.tek/
Ganesh L. Shrestha, P.E.
Bureau of Health Services
Division of Quality Assurance
cc: - Brian Noe, City of Oshkosh Building Inspector,
215 Church Avenue, Oshkosh, WI 54901
- Tony Rodman, Project Coordinator
Affinity Health System, 500 S. Oakwood Road, Oshkosh, WI 54904
arodman@affinityhealth.org
2
C:\Documents and Settings \briann\Local Settings \Temporary Internet Files \QLK3C \Office to Exam Room Alteration Plans Appr
Dec 17.doc