| AppID | 3089a |
| I. Administrative Section | |
| Project Name: |
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| Project Description (One Sentence): |
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| Project Location: County: |
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| Project Location: City: |
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| Department (department requesting project): |
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| Division (division requesting project): |
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| Agency (agency requesting project): |
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| Agency contact person: |
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| Contact phone: |
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| Contact email: |
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| At the Department level ranking of this project: |
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| The Department will rank their projects 1 through the lowest ranked project (i.e., If 5 projects were submitted by the Department a ranking of 1 would be assigned to the most important or most needed project and a ranking of 5 would be the least needed project). |
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| Has this project been previously requested in a prior CIP? |
Unknown
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| SPWD 4 digit Building No. (for existing buildings) |
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| Facility Condition Analysis Project No. (if recommended) |
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| II. Narrative Section | |
| Project Justification (Essay) |
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| Project Description: |
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| Project Justification: |
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| Project Background Information: |
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| Mechanical and/or Electrical Equipment Replacement Projects: |
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| Type of equipment to be replaced: |
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| Year existing equipment was installed: |
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| Manufacturer of existing equipment: |
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| Model of existing equipment: |
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| Hazardous Materials (Asbestos, Lead Paint, etc.): |
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| Will this project require any hazardous material abatement? |
Unknown
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| Ramifications if the Project is not Approved |
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| (Short Essay): |
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| Health, Life Safety, and/or Legal Issues |
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| Please describe any health, life safety, and/or legal issues that will be resolved by completing this project (Short Essay): |
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| Proposed Project Schedule Impacts/Issues |
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| 1. Will this project require relocating personnel or vacating the building for any period of time? |
Unknown
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| Explain: |
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| Has any design work been completed on the proposed project? |
Unknown
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| What is the latest date this project could be completed without disrupting your program? |
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| What is the driving proposed completion date? |
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| III. Cost Estimate Section | |
| Preliminary Cost Estimate and Funding Sources (The SPWD will prepare all final cost estimates. This schedule is for preliminary purposes only.) |
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| 1. Land Cost (if land must be purchased): |
0.0000
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| 2. Off-site construction cost: |
0.0000
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| 3. On-site connection fees: |
0.0000
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| 4. Utility connection fees: |
0.0000
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| 5. Water rights deeded: |
0.0000
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| 6. Furniture, Fixture and equipment costs: |
0.0000
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| 7. Specialty equipment costs |
0.0000
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| 8. Data and network equipment costs: |
0.0000
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| 9. Telephone equipment costs: |
0.0000
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| 10. Moving costs: |
0.0000
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| 11. Costs for renovation of vacated space: |
0.0000
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| 12. Costs for correction of known deficiencies: |
0.0000
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| (describe deficiencies) |
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| 13. Costs of any known commitments: |
0.0000
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| (describe commitments) |
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| 14. Costs of any hazardous material abatement: |
0.0000
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| (describe hazardous materials) |
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| 15. Total project costs: |
0.0000
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| NOTE: COSTS FOR EXTENDED LEASE AGREEMENTS MUST BE INCLUDED IN YOUR OPERATING BUDGET |
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| 16. Proposed funding of total project cost: |
0.0000
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| a. Agency: |
0.0000
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| b. Federal |
0.0000
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| c. Other/Donor |
0.0000
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| d. State |
0.0000
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| (describe source of 'Other' funding): |
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| Total: |
0.0000
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| 17. Agency point of contact for outisde funding if 16a, 16b, or 16c funding sources are providing funds. |
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| a. Name |
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| b. Phone Number |
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| c. Email Address |
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| IV. Analysis Section | |
| Site Analysis (New construction only) |
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| 1. Estimated land area to be acquired (acres) |
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| 2. Will this project require new parking spaces? |
Unknown
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| 3. Are utilities available to site? |
Unknown
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| 4. Will project require relocation of existing utilities? |
Unknown
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| 5. Are there any required off-site improvements (or right-of-way dedications)? |
Unknown
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| 6. Is the site in a flood plane? |
Unknown
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| 7. Is the site in an airport impact zone? |
Unknown
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| 8. Does the site contain any underground storage tanks? |
Unknown
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| 9. Does the site contain any adverse soil conditions? |
Unknown
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| 10. Will the site require an environmental assessment? |
Unknown
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| 11. Will rezoning or a special use permit be required? |
Unknown
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| 12. Will any connection fees need to be paid? |
Unknown
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| 13. Will any water rights need to be deeded? |
Unknown
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| 14. Will construction traffic degrade existing access or facilities? |
Unknown
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| 15. Will the site require any hazardous material abatement? |
Unknown
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| 16. Other site considerations affecting cost? (describe): |
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| V. Programming Section | |
| Programming (New construction, building remodels, and building additions only) |
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| 1. Has any architectural programming occurred? |
Unknown
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| (Programming is an architectural definition of the needs/problems that must be addressed by the project) |
Unknown
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| 2. Has any advanced planning occurred in previous CIPs? |
Unknown
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| 3. Net Square footage required (including storage space) |
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| New Construction SF: |
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| Remodel/Renovation SF: |
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| Addition SF |
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| Total project SF: |
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| 4. Occupancy type (Assembly, business, educational, factory/industrial, high hazard, institutional, mercantile, residential, storage, utility/miscellaneous) : |
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| 5. Approximate quantity of staff to occupy facility: |
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| 6. Approximate number of visitors per day: |
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| 7. Will this project require funding for any furnishings, fixtures and equipment? |
Unknown
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| 8. For existing facilities, are there any known hazardous materials? (i.e., Asbestos, lead paint or underground storage tanks): |
Unknown
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| 9. How many years of future growth will this project accommodate? |
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| 10. List of required facilites (laboratory space, classroom space, office space, conference rooms, cafeterias, maintenance shops, garages) and any unusual related equipment required for your project: |
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| Submit Status |
Edit
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