Medical Facility Construction

Choosing between a shell suite and a new building

Practices opening a new location usually choose between leasing or buying shell space in an existing building and putting up something new on their own lot. A shell suite is often quicker to occupy, but the building decides a lot for you: column spacing, ceiling height, where plumbing can run, how much power is available. A new building gives you control and asks for more time, more approvals and more decisions.

Steve can walk a candidate space or site with you before you sign anything. In an empty suite he checks the slab, the plumbing stubs, the electrical service and how the space above the ceiling is laid out. On a lot, the questions are about access, grading, utilities and what the site needs before a foundation can go in. Neither visit replaces your architect and engineers, but it gives you a builder's view while the decision is still open.

If you are buying a building or a lot, zoning and parking requirements can matter as much as the construction. Those belong to your attorney and design team, but we can tell you early what the physical work on a given site is likely to involve.

Either way, the work is planned in writing from the start, with a scope that names what is included and what belongs to other contractors or to the owner.

Accessibility planned before the first wall

New medical space in Massachusetts has to meet 521 CMR, the Architectural Access Board's regulations, as well as the ADA. In a new building or a full shell build-out there is no reason to design it in late. The parking and route to the door, the entrance, corridor widths, door clearances, accessible exam rooms, restrooms, reception counters and the room a patient needs to transfer from a wheelchair are all set in the drawings.

Our part is building exactly to those dimensions. A door that ends up an inch narrow or grab bar backing set at the wrong height means a failed inspection and rework. We check clearances at framing, again before drywall and again before finishes, and we flag any conflict between the drawings and field conditions as soon as we find it.

We also look at the practice from the patient's side: how a person with a walker gets from the car to a chair, where someone who feels unwell waits, and how easily they find the restroom. Those details make the space work beyond the minimum.

We coordinate those runs so the slab is cut once and the room layout follows what the building can support.

Mechanical, plumbing and power decided early

Medical spaces ask a lot of their building systems. Exam rooms need sinks, often one in every room. Procedure rooms may need more power, task lighting or particular ventilation. Lab areas and imaging rooms have their own needs, and imaging may call for shielding designed by a specialist. Engineers design those systems and licensed trades install them, and where they go shapes the framing, the ceilings and the slab.

In a shell build-out, the plumbing layout often decides where the exam rooms can go, since every new drain means cutting the slab back to the main line. We coordinate those runs so the slab is cut once and the room layout follows what the building can support.

Data and low-voltage cabling for records, phones and equipment need pathways through walls and ceilings. Planning them early avoids conduit stuck to finished walls later. Waste needs a plan as well. A practice produces sharps, regulated medical waste and plenty of ordinary trash, and each needs a storage room and a route out of the building that does not pass through the waiting room. Planning those spaces early keeps them from being squeezed into a closet.

Finishes belong in the early decisions too. Floors, walls and countertops that will be disinfected every day should be chosen for that before they are ordered, not swapped out after the first year.

Footings, framing and the envelope for a new clinic

For a new building, the work starts below ground. Footings in Massachusetts go below frost depth, commonly about four feet, and the foundation has to be right before anything else can be. Then come framing, roofing, windows and the building envelope, built to the state building code, 780 CMR, and to the stretch energy code where the town has adopted it, with insulation and air sealing done to meet it.

Site work comes before the foundation and continues after it: grading so water runs away from the building, a stable base under the parking and walkways, and an accessible route from the parking to the door. We plan that work from the civil engineer's drawings so the site is ready when the building is.

Commercial buildings follow their own code paths, design professionals and inspections, and a new medical building involves a full team. Our job is to build carefully, keep the site organized and keep the owner informed so decisions get made on time.

New England weather shapes a new build. Getting the building closed in before winter, keeping materials out of the rain and planning around freeze-thaw are part of the schedule we talk through with you from the beginning.

Inspections, occupancy and move-in day

A practice cannot see patients until the building department signs off, usually ending with a certificate of occupancy. Before that come the rough and final inspections, the licensed trades' own inspections and fire department sign-offs where they apply. We keep those on one schedule so you can plan equipment deliveries, staff start dates and the first patients.

A longer build needs steady communication. You get regular updates on progress, upcoming inspections, decisions that need your input and anything that affects the move-in date. Changes are written and priced before they are built.

Before move-in, we walk the finished space with you room by room: doors that close and latch, hardware at the right heights, finishes without damage, access panels where they belong. Every item on that list gets fixed and checked off with you, and you receive photographs of what went into the walls and ceilings. When we hand over the space, it is clean, documented and ready for your equipment and furniture.

See the rest of our commercial work, or browse the gallery for rooms we have finished.