Draft Application for a 2019 CIP Project

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AppID 19388
I. Administrative Section 
1. Project Name:
2. Project Description (One Sentence):
3a. Project Location: County:
3b. Project Location: City:
4. Department (department requesting project):
5. Division (division requesting project):
6. Agency (agency requesting project):
7. Agency contact person:
8. Contact phone:
9. Contact email:
Department level ranking of this project:
10. The Department will rank their projects 1 through the lowest ranked project (e.g., 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).
11. Has this project been previously requested in a prior CIP?
12. SPWD 4 digit Building No. (for existing buildings) from SPWD website
13. Facility Condition Analysis Project No. (if recommended) from SPWD website
14. Is the property State Owned?
15. If the facility is existing, is it State owned?
II. Narrative Section 
Project Justification (Essay)
16. Project Description:
(Please describe the requested project)
17. Project Justification:
(Please describe the requested project)
18. Project Background Information:
19. Mechanical and/or Electrical Equipment Replacement Projects:
a. Type of equipment to be replaced:
b. Year existing equipment was installed:
c. Manufacturer of existing equipment:
d. Model of existing equipment:
e. Are there any known hazardous materials?
20. Environmental Considerations 
20a. Hazardous Materials (Asbestos, Lead Paint, etc.):
20b. Will the site require any hazardous materials abatement?
21. Ramifications if project is not approved (short essay):
Health, Life Safety, and/or Legal Issues
22. Please describe any health, life safety, and/or legal issues that will be resolved by completing this project (Short Essay):
23. Proposed Project Schedule Impacts/Issues
23a. Will this project require relocating personnel or vacating the building for any period of time?
23b. Explain:
23c. Has any design work been completed on the proposed project?
23d. What is the latest date this project could be completed without disrupting your program? Please Enter a Valid Date
23e. What is driving the proposed completion date:
III. Preliminary Construction Cost Estimate and Funding Sources Section 
Preliminary Cost Estimate and Funding Sources (The SPWD will prepare all final cost estimates. This schedule is for preliminary purposes only.)
24. Land (if land must be purchased): Enter Dollar Amount Only (No $ sign)
25. Offsite construction: Enter Dollar Amount Only (No $ sign)
26. Onsite development: Enter Dollar Amount Only (No $ sign)
27. Utility connection fees: Enter Dollar Amount Only (No $ sign)
28. Water rights deeded: Enter Dollar Amount Only (No $ sign)
29. Furniture, Fixtures and Equipment: Enter Dollar Amount Only (No $ sign)
30. Specialty Equipment: Enter Dollar Amount Only (No $ sign)
31. Data and network equipment: Enter Dollar Amount Only (No $ sign)
32. Telephone equipment: Enter Dollar Amount Only (No $ sign)
33. Moving: Enter Dollar Amount Only (No $ sign)
34. Renovation of vacated space: Enter Dollar Amount Only (No $ sign)
35a. Correction of known deficiencies: Enter Dollar Amount Only (No $ sign)
35b. (describe deficiencies)
36a. Known commitments: Enter Dollar Amount Only (No $ sign)
36b. (describe commitments)
37a. Costs of any hazardous materials abatement: Enter Dollar Amount Only (No $ sign)
37b. (describe hazardous materials):
38. Total project costs: Enter Dollar Amount Only (No $ sign)
39. Proposed funding of total project costs:  
39a. Agency: Enter Dollar Amount Only (No $ sign)
39b. Federal Enter Dollar Amount Only (No $ sign)
39c. State Enter Dollar Amount Only (No $ sign)
39d. Other/Donor Enter Dollar Amount Only (No $ sign)
39e. (describe source of 'Other/Donor' funding):
39f. Total: Enter Dollar Amount Only (No $ sign)
40. Agency point of contact for outisde funding if 39a, 39b, or 39d funding sources are providing funds.
40a. Name
40b. Phone Number
40c. Email Address
IV. Site Analysis Section 
Site Analysis (New construction only)
41. Estimated land area to be acquired (acres) Enter Estimated Acres
42 Will this project require new parking spaces?
43. Are utilities available to site?
44. Will project require relocation of existing utilities?
45. Are there any required offsite improvements (or right-of-way dedications)?
46. Is the site in a flood plain?
47. Is the site in an airport impact zone?
48. Does the site contain any underground storage tanks?
49. Does the site contain any adverse soil conditions?
50. Will the site require an environmental assessment?
51. Will rezoning or a special use permit be required?
52. Will any utility connection fees need to be paid?
53. Will any water rights need to be deeded?
54. Will construction traffic degrade existing access or facilities?
55. Will the site require any hazardous material abatement?
56a. Other site considerations affecting cost?
56b. Describe Site Considerations:
V. Programming Section 
Programming (New construction, building remodels, and building additions only)
57. Has any architectural programming occurred?
(Programming is an architectural term defining the needs/problems that must be addressed by the project)
58. Has any advanced planning occurred in previous CIPs?
59. Net Square footage required (including storage space)
59a. New Construction SF: Enter Square Footage
59b. Remodel/Renovation SF: Enter Square Footage
59c. Addition SF Enter Square Footage
59d. Total project SF: Enter Square Footage
60. Occupancy type (Assembly, business, educational, factory/industrial, high hazard, institutional, mercantile, residential, storage, utility/miscellaneous) :
61. Approximate number of staff to occupy facility: Enter Number of Staff
62. Approximate number of visitors per day: Enter Number of Visitors
63. Will this project require funding for any furnishings, fixtures and equipment?
64. For existing facilities, are there any known hazardous materials? (e.g., Asbestos, lead paint or underground storage tanks):
65. How many years of future growth will this project accommodate?
66. List of required facilities (e.g. laboratory space, classroom space, office space, security systems, conference rooms, cafeterias, maintenance shops, garages) and any unusual related equipment required for your project):
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