This project involved creating a new operating room suite on the seventh floor of an eight-story high rise medical office building. The new suite included operating rooms, two endoscopy rooms, and a recovery area and support space. Among the more challenging aspects of this project was the fact that the building was not originally designed to accommodate an operating suite. Therefore, a completely new mechanical system was provided to handle the new suite. This new system included an air handling unit located on the roof with pre-filters and final filters, an air-cooled chiller located on the roof, exhaust for the endoscopy rooms, and new boilers, pumps and piping systems for hot water heating. The plumbing work involved adding a new room for the medical gas manifolds, a vacuum pump and an air compressor. The medical gas manifold room was located in the basement of the facility, requiring the new medical gas lines to be routed up through seven floors of the existing building. New lighting, a nurse call system and critical power were also part of the project.