A new ground-up 6,000 SF Ambulatory Surgery Center for International Council for Quality Care in Clayton, NC.S3DA was tasked with the MEPF and Structural Engineering for this project. S3DA managed to come up with creative solutions to make the structure and MEP design more cost-efficient, through continuous communication with the architectural firm, Studio Design Group Architects, and the GC. In the end, in order to help the GC and the Developer to get more insight on the costs, we provided BOQ considering the materials available in the local market.The aesthetic look was another challenge in this project and concern to the Developer and the Architect. They wanted to avoid any rooftop units (HVAC), and there was no approval from the City to place them on the ground. Eventually, mechanical screens were considered to reach the client’s satisfaction.