AppID | 7048 |
I. Administrative Section | |
1. Project Name: |
5114 Darrel Hansen 702-486-6333 DLHansen@drc.nv.gov – ADA Upgrades(Building 1301)
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2. Project Description (One Sentence): |
ADA Upgrades – Building 1301
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3a. Project Location: County: |
Clark
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3b. Project Location: City: |
Las Vegas
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4. Department (department requesting project): |
DHHS
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5. Division (division requesting project): |
Aging & Disability Services
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6. Agency (agency requesting project): |
Desert Regional Center
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7. Agency contact person: |
Darrel Hansen
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8. Contact phone: |
702-486-6333
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9. Contact email: |
DLHansen@drc.nv.gov
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The Department ranking of this project: |
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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). |
29
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11. Has this project been previously requested in a prior CIP? |
Yes
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12. SPWD 4 digit Building No. (for existing buildings) |
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13. Facility Condition Analysis Project No. (if recommended) |
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14. Is the property State Owned? |
Yes
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15. If the facility is existing, is it State owned? |
Yes
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II. Narrative Section | |
16. Project Description: |
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17. Project Justification: |
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18. Project Background Information: |
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19. Mechanical and/or Electrical Equipment Replacement Projects: |
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19a. Type of equipment to be replaced: |
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19b. Year existing equipment was installed: |
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19c. Manufacturer of existing equipment: |
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19d. Model of existing equipment: |
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19e. Are there any known hazardous materials? |
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Environmental Considerations |
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20a. Hazardous Materials (Asbestos, Lead Paint, etc.): |
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20b. Will the site require any hazardous material abatement? |
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21. Ramifications if the Project is not Approved (short essay): |
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Health, Life Safety, and/or Legal Issues |
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22. Please describe any health, life safety, and/or legal issues that will be resolved by completing this project (Short Essay): |
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23. Proposed Project Schedule Impacts/Issues |
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23a. Will this project require relocating personnel or vacating the building for any period of time? |
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23b. Explain: |
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23c. Has any design work been completed on the proposed project? |
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23d. What is the latest date this project could be completed without disrupting your program? |
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23e. What is the driving proposed completion date? |
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III. Preliminary Construction Cost Estimate 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.) |
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24. Land (if land must be purchased): |
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25. Offsite construction: |
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26. On-site Development: |
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27. Utility connection fees: |
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28. Water rights deeded: |
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29. Furniture, Fixtures and Equipment: |
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30. Specialty equipment: |
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31. Data and network equipment: |
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32. Telephone equipment costs: |
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33. Moving: |
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34. Renovation of vacated space: |
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35a. Correction of known deficiencies: |
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35b. (describe deficiencies) |
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36a. Any known commitments: |
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36b. (describe commitments) |
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37a. Known hazardous material abatement: |
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37b. (describe hazardous materials) |
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38. Total project costs: |
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NOTE: COSTS FOR EXTENDED LEASE AGREEMENTS MUST BE INCLUDED IN YOUR OPERATING BUDGET |
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39. Proposed funding of total project cost: |
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39a. Agency: |
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39b. Federal |
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39c. State |
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39d. Other/Donor |
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39e. (describe source of 'Other/ Donor' funding): |
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39f. Total: |
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40. Agency point of contact for outisde funding if 39a, 39b, or 39c funding sources are providing funds. |
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40a. Name |
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40b. Phone Number |
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40c. Email Address |
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IV. Site Analysis Section | |
Site Analysis (New construction only) |
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41. Estimated land area to be acquired (acres) |
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42. Will this project require new parking spaces? |
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43. Are utilities available to site? |
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44. Will project require relocation of existing utilities? |
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45. Are there any required offsite improvements (or right-of-way dedications)? |
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46. Is the site in a flood plain? |
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47. Is the site in an airport impact zone? |
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48. Does the site contain any underground storage tanks? |
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49. Does the site contain any adverse soil conditions? |
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50. Will the site require an environmental assessment? |
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51. Will rezoning or a special use permit be required? |
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52. Will any Utility connection fees need to be paid? |
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53. Will any water rights need to be deeded? |
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54. Will construction traffic degrade existing access or facilities? |
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55. Will the site require any hazardous material abatement? |
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56a. Other site considerations affecting cost? (describe): |
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56b. Describe Site Considerations: |
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V. Programming Section | |
Programming (New construction, building remodels, and building additions only) |
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57. Has any architectural programming occurred? |
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(Programming is an architectural definition of the needs/problems that must be addressed by the project) |
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58. Has any advanced planning occurred in previous CIPs? |
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59. Usable Square footage required (including storage space) |
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59a. New Construction SF: |
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59b. Remodel/Renovation SF: |
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59c. Addition SF |
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59d.Total project SF: |
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60. Occupancy type (Assembly, business, educational, factory/industrial, high hazard, institutional, mercantile, residential, storage, utility/miscellaneous) : |
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61. Approximate number of staff to occupy facility: |
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62. Approximate number of visitors per day: |
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63. Will this project require funding for any furnishings, fixtures and equipment? |
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64. For existing facilities, are there any known hazardous materials? (e.g., Asbestos, lead paint or underground storage tanks): |
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65. How many years of future growth will this project accommodate? |
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66. 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
NOTE: AFTER SUBMITTING THE COMPLETED APPLICATION, A PROJECT MANAGER FROM THE PUBLIC WORKS DIVISION WILL CONTACT YOU TO REVIEW THIS APPLICATION.
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