This project consisted of two major phases. First, an addition to the existing hospital was built to house the Emergency Department. Once that phase was completed, the old ER was completely renovated to create an Ambulatory Care area. Mechanically the project included plumbing, medical gas, medical vacuum and the installation of a new vacuum pump, high-pressure steam piping, low-pressure steam piping, hydronic heating and chilled water piping, installation of a new 300 Ton chiller, and BAS controls. The project was complex because much of the mechanical work was done in and around occupied areas, with minimal shutdown of services.