Submitted Application from prior CIP Planning Cycle

AppID7225
I. Administrative Section 
1. Project Name: 5528 3242 Michael L Johnson 4-1816 Blasdel Building Fire Sprinkler System
2. Project Description (One Sentence):
3a. Project Location: County:
3b. Project Location: City: Carson City
4. Department (department requesting project): Administration
5. Division (division requesting project): Buildings & Grounds
6. Agency (agency requesting project):
7. Agency contact person:
8. Contact phone:
9. Contact email:
The Department 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). 78
11. Has this project been previously requested in a prior CIP?
12. SPWD 4 digit Building No. (for existing buildings)
13. Facility Condition Analysis Project No. (if recommended)
14. Is the property State Owned?
15. If the facility is existing, is it State owned?
II. Narrative Section 
16. Project Description:
17. Project Justification:
18. Project Background Information:
19. Mechanical and/or Electrical Equipment Replacement Projects:
19a. Type of equipment to be replaced:
19b. Year existing equipment was installed:
19c. Manufacturer of existing equipment:
19d. Model of existing equipment:
19e. Are there any known hazardous materials?
Environmental Considerations
20a. Hazardous Materials (Asbestos, Lead Paint, etc.):
20b. Will the site require any hazardous material abatement?
21. Ramifications if the 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?
23e. What is the driving proposed completion date?
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.)
24. Land (if land must be purchased):
25. Offsite construction:
26. On-site Development:
27. Utility connection fees:
28. Water rights deeded:
29. Furniture, Fixtures and Equipment:
30. Specialty equipment:
31. Data and network equipment:
32. Telephone equipment costs:
33. Moving:
34. Renovation of vacated space:
35a. Correction of known deficiencies:
35b. (describe deficiencies)
36a. Any known commitments:
36b. (describe commitments)
37a. Known hazardous material abatement:
37b. (describe hazardous materials)
38. Total project costs: 588,150
NOTE: COSTS FOR EXTENDED LEASE AGREEMENTS MUST BE INCLUDED IN YOUR OPERATING BUDGET
39. Proposed funding of total project cost:
39a. Agency:
39b. Federal
39c. State
39d. Other/Donor
39e. (describe source of 'Other/ Donor' funding):
39f. Total:
40. Agency point of contact for outisde funding if 39a, 39b, or 39c 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)
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? (describe):
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 definition of the needs/problems that must be addressed by the project)
58. Has any advanced planning occurred in previous CIPs?
59. Usable Square footage required (including storage space)
59a. New Construction SF:
59b. Remodel/Renovation SF:
59c. Addition SF
59d.Total project SF:
60. Occupancy type (Assembly, business, educational, factory/industrial, high hazard, institutional, mercantile, residential, storage, utility/miscellaneous) :
61. Approximate number of staff to occupy facility:
62. Approximate number of visitors per day:
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 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.