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V. PROJECT INFORMATION

Yes

Will there be federal grant or contract funding for this project?

If yes, Davis-Bacon Act provisions may apply.

Is this project identified in the faculty or department annual or 5 yr. capital budget?

If yes, specify fiscal years and amounts:

FY:

Attach explanation if sole source or if “other.”

3a. How will design services be procured?

design – build

design competition

competitive criteria based selection

sole source

other

3b. Please provide name(s) of architects/consultants if available.

Architect(s):

Consultant(s):

Attach explanation if sole source or if “other.”

How will contracting services be procured?

competitive bid

sole source

other

Will the Capital Project Review Committee (CPRC) review this project?

Required if project is over $5 million and under other circumstances as described in form instructions.

Will Engineering & Utilities at UOS perform engineering review?

Required if project is $500,000 or more. If no,

attach explanation of how project will receive engineering review or why review is unnecessary.

Will this project require new or upgraded utility services or any utility relocation?

If yes, check all that apply:

City Water

Storm Drain

Chilled Water

Telephone

High Speed Data Network

Steam

Fire Alarm Reporting

Electrical

City Sewer

Does the project involve the following?

If yes, check all that apply (contact EH&S (5-2060) for additional information) :

Sewer discharge; hazardous waste storage, generation or

Site de-watering

disposal

Storage tank installation or removal

Asbestos, lead paint, CFC’s, UFFI or PCB-containing

Installation of any fuel combustion equipment, emergency diesels,

materials or equipment; new buildings access/egress routes

or any new air emission vents, hood exhausts or pipes

Temporary or permanent use or storage of hazardous chemicals

Modification or installation of confined spaces or other safety-related

Installation of grease traps or food waste storage

hazards

Soil excavation and disposal

Does the project require pre-construction or operating permits/licenses for one or more of the following? I

f yes,

check all that apply (contact EH&S Dept. (5-2060) for additional information):

Sewer connection/discharge (MWRA, DEP, City)

Water quality – de-watering, runoff (EPA, DEP, MWRA, City)

Air quality – demolition, asbestos, combustion equipment,

Hazardous waste storage or disposal (EPA, DEP, DOT)

fume hoods (EPA, DEP)

General environmental impact statements (NEPA, MEPA)

Fire prevention – flammable storage, temporary heating

Radiation, x-ray or lasers (NRC, DPH)

devices (Fire Dept)

Solid waste (DEP, DPH, City)

Grease trap installation or waste storage (City)

Occupancy permits (Fire Dept.)

Wetlands and floodplains (FEMA, City)

10. Will this project incorporate any specific design features that support sustainable development and/or reduce environmental impacts?

If yes, please explain.

11. Does the project involve any of the following?

If yes, check all that apply:

Demolition (full or partial) of an existing building

Construction of a new building

Relocation of a building (or portion of bldg.)

Exterior renovation that does not add GSF to the bldg.

Interior renovation that adds GSF within the building

Exterior renovation that adds GSF to the bldg.

envelope (e.g. attic or mechanical space conversion)

Alterations that add to the height of the existing bldg.

Specify the approximate additional sq. ft.:

Specify approximate additional height:

Exterior work on an existing building including, but not

Eliminate or relocate existing parking spaces

limited to, repair, replacement, or alteration of, windows,

New construction within a Historic District or near any district

exterior wall cladding, entrances, roofs, or site elements

or property listed on the State Register or the MHC Inventory

Construction or relocation of a curb cut

12.

Please use the following use classifications to answer 12a and 12b:

Administrative; Affiliate Housing; Classroom; Commercial

Office; Dormitory; Institutional/Faculty Office; Laboratory; Library; Athletics; Restaurant; Retail; Institutional Dining; Other (specify).

a) What is the current use of the building or portion of the building undergoing renovation?

b) Will the proposed project result in a change in use?

If yes, what is the proposed new use(s)?

13.

Will the project require a building permit?

If yes, complete 13a and 13b.

a) Estimated construction costs to be reported on building permit application: $

b) Estimated building permit application date:

14. Will the project require the issuance of any licenses for operation of the proposed activities?

If yes, check all that apply:

Common Victualers

Lodging House

Entertainment

Parking

Fuel Storage

Other:

15.

Does the project advance one or more of the following areas?

If yes, check all that apply.

Science

Technology

Executive Education

Libraries

International Studies

Other:

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