The complete renovation of 10,000 square feet of storage and office space into a 23 bed medical surgical unit required demolition of all existing interior partitions and non-structural items, working around plumbing stacks and HVAC chases serving occupied spaces on multiple floors below. Complicated by hard ceilings in the occupied psychiatric care unit below, the floor plan was carefully planned to group plumbing fixtures where possible to minimize floor penetrations and work below the floor. All new infrastructure was installed with new mechanical systems located in the attic space above.