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AppID5239
I. Administrative Section 
1. Project Name: Seismic Gas Shut-Off Valve
2. Project Description (One Sentence): This project would provide for the installation of a seismic gas shut-off valve.
3a. Project Location: County: Clark
3b. Project Location: City: Boulder City
4. Department (department requesting project): Veterans Services
5. Division (division requesting project): Veterans Nursing Home
6. Agency (agency requesting project): N/A
7. Agency contact person: Robert Robinson
8. Contact phone: 702-378-0411
9. Contact email: robinsonr@veterans.nv.gov
The Department ranking of this project:
10. 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). 1
11. Has this project been previously requested in a prior CIP? No
12. SPWD 4 digit Building No. (for existing buildings) 2106
13. Facility Condition Analysis Project No. (if recommended) 9889
14. Is the property State Owned? Yes
15. If the facility is existing, is it State owned? Yes
II. Narrative Section 
1. Project Description: This project would provide for the installation of a seismic gas shut-off valve on the main natural gas service piping just prior to entering the building.
2. Project Justification: The Nevada State Veterans Home is requesting installation of a seismic gas shut-off valve to protect the facility's primary gas main against earthquake damage. Although there are no direct regulations requiring this installation, at $4,000 this is a cost effective way to mitigate potential damage to the facility and prevent harm to the staff and residents at the home in the event of an earthquake. Southern Nevada is an area that is at risk for an earthquake. CFR 483.75 requires the facility to create emergency action plans to protect the facility against natural and manmade disasters. The installation of this shut-off valve eliminates the need to jeopardize personnel in the event of earthquake.
3. Project Background Information: The Nevada State Veterans Home is an 85,000 square foot 180 bed long term care facility governed by multiple federal regulations including 42 CFR 483 - Requirements for States and Long Term Care facilities and 38 CFR 51.60 - Standards applicable for payment of per diem. CFR 483.70 and CFR 51.70 require that the facility be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel, and the public. Project Identified on The Facility Condition Analysis at a cost of $4,000
4. Mechanical and/or Electrical Equipment Replacement Projects:
a. Type of equipment to be replaced: Pacific Seismic Products or approved equal
b. Year existing equipment was installed: N/A
c. Manufacturer of existing equipment: N/A
d. Model of existing equipment: N/A
e. Are there any known hazardous material abatement? Unknown
5. Ramifications if the Project is not Approved (short essay): According to NBMAG/NESC, Nevada is ranked third in the nation for being at risk for large magnitude seismic activity, behind Alaska and California. Boulder city measured an earthquake of 4.0 in 1983. UNLV and UNR scientists estimate a potential for earthquake of magnitude of 6.6 in Las Vegas. Although there are no specific regulations requiring this installation, at $4,000 this is a cost effective way to mitigate potential damage to the facility and prevent harm to the staff and residents at the home in the event of an earthquake. Ramifications of failure to complete this project would be realized in the event of an earthquake and would potentially include loss of life.
Health, Life Safety, and/or Legal Issues
6. Please describe any health, life safety, and/or legal issues that will be resolved by completing this project (Short Essay): CFR 483.75 requires the facility to create emergency action plans to protect the facility against natural and manmade disasters. The installation of this shut-off valve eliminates the need to jeopardize personnel in the event of earthquake.
7. Proposed Project Schedule Impacts/Issues
a. Will this project require relocating personnel or vacating the building for any period of time? No
Explain:
b. Has any design work been completed on the proposed project? No
c. What is the latest date this project could be completed without disrupting your program? 06-30-17
d. What is the driving proposed completion date? According to NBMAG/NESC, Nevada is ranked third in the nation for being at risk for large magnitude seismic activity, behind Alaska and California. Boulder city measured an earthquake of 4.0 in 1983. UNLV and UNR scientists estimate las Vegas has a potential for earthquake of magnitude of 6.6
III. Preliminary Construction and Funding Sources Section 
Preliminary Construction Cost Estimate and Funding Sources (The SPWD will prepare all final cost estimates. This schedule is for preliminary purposes only.)
1. Land (if land must be purchased):
2. Off-site construction:
3. On-site Development:
4. Utility connection fees:
5. Water rights deeded:
6. Furniture, Fixture and Equipment:
7. Specialty equipment:
8. Data and network equipment:
9. Telephone equipment costs:
10. Moving:
11. Renovation of vacated space:
12. Correction of known deficiencies:
(describe deficiencies)
13. Any known commitments:
(describe commitments)
14. Known hazardous material abatement:
(describe hazardous materials)
15. Total project costs:
NOTE: COSTS FOR EXTENDED LEASE AGREEMENTS MUST BE INCLUDED IN YOUR OPERATING BUDGET
16. Proposed funding of total project cost:
a. Agency:
b. Federal
c. Other/Donor
d. State
(describe source of 'Other/ Donor' funding):
Total:
17. Agency point of contact for outisde funding if 16a, 16b, or 16c funding sources are providing funds.
a. Name
b. Phone Number
c. Email Address
IV. Site Analysis Section 
Site Analysis (New construction only)
1. Estimated land area to be acquired (acres)
2. Will this project require new parking spaces?
3. Are utilities available to site?
4. Will project require relocation of existing utilities?
5. Are there any required off-site improvements (or right-of-way dedications)?
6. Is the site in a flood plain?
7. Is the site in an airport impact zone?
8. Does the site contain any underground storage tanks?
9. Does the site contain any adverse soil conditions?
10. Will the site require an environmental assessment?
11. Will rezoning or a special use permit be required?
12. Will any Utility connection fees need to be paid?
13. Will any water rights need to be deeded?
14. Will construction traffic degrade existing access or facilities?
15. Will the site require any hazardous material abatement?
16. Other site considerations affecting cost? (describe):
Describe Site Considerations:
V. Programming Section 
Programming (New construction, building remodels, and building additions only)
1. Has any architectural programming occurred?
(Programming is an architectural definition of the needs/problems that must be addressed by the project)
2. Has any advanced planning occurred in previous CIPs?
3. Usable Square footage required (including storage space)
a. New Construction SF:
b. Remodel/Renovation SF:
c. Addition SF
d.Total project SF:
4. Occupancy type (Assembly, business, educational, factory/industrial, high hazard, institutional, mercantile, residential, storage, utility/miscellaneous) :
5. Approximate number of staff to occupy facility:
6. Approximate number of visitors per day:
7. Will this project require funding for any furnishings, fixtures and equipment?
8. For existing facilities, are there any known hazardous materials? (i.e., Asbestos, lead paint or underground storage tanks):
9. How many years of future growth will this project accommodate?
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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NOTE:  AFTER SUBMITTING THE COMPLETED APPLICATION, A PROJECT MANAGER FROM THE PUBLIC WORKS DIVISION WILL CONTACT YOU TO REVIEW THIS APPLICATION.