Form 125602 - Project Authorization Request - Oregon Department Of Administrative Services
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1
2PROJECT AUTHORIZATION REQUEST
Submit by 5 p.m. Friday for review at Wednesday meeting
Project Title ___________________________________________
DAS NUMBER: ____________________________________
DAS USE ONLY
Form available electronically at
Agency & Division
Address
City, State, Zip:
Name of Contact Person (Requester):
Contact phone number:
Email address:
Floor at current location
Location request applies to:
DAS-owned facility
Building Name:
OR
Reason for Services
:
Describe project in scope of work on reverse side
State-owned facility
$
Construction - New Building or Remodel
Estimated project cost
Expansion / reduction of existing program unit
OR
Multiple work units impacted
State-leased facility
Create a new program unit in existing building
Lease - relocation to a new location
Estimated start date:
Lease - with remodeling & space planning required
Space design services for efficient use of space
Estimated Completion
Workstation add, remove, change
Other (see reverse of this form)
Provide project details on separate sheet and attach
Funding by:
DAS
Requesting Agency
additional documents as necessary.
Project Managed
DAS
Requesting Agency
by:
Signature of DAS Program Manager
Services Requested - Please check all that apply
Leased Space in
Interior Project Management
Planning & Construction
DAS-owned buildings
Management
Initial needs assessment only
Needs assessment only.
Initial needs assessment only
Consultation (finishes and furniture)
Relocation
Office Planning Services
Planning
Office space addition
Interior Design Services
Design
Office space reduction
Interior Project Management
Construction
Parking spaces required:
Single Cubicle move / change
Remodel
Lease term requested:
Computer / phone temporary move
Other - Explain on separate sheet
Storage space
Computer / phone move
Funding Source:
Other - Explain on reverse side
Other - Explain on reverse side
LFO Analyst:
The Requesting Agency must comply with all local government regulations and permitting requirements as well as DAS policies,
standards, relevant OARs, and construction standards as part of the approval of this request. Requests received by 5 p.m. Friday
will be reviewed at the following Wednesday meeting of the Project Authorization Committee.
st
All approved authorizations expire on the 181
day after Committee “Approval Date”.
Approved:
Denied:
Authorization IS GIVEN to the Requesting Agency to
Authorization is NOT GIVEN to the
proceed with the project as described in this request, subject to any
Requesting Agency for the following reasons:
specific requirements indicated on reverse side.
By
By
Project Authorization Committee Coordinator
Approval Date
DAS EAM Contact Person
Phone
DAS Internal Accounting:
DAS USE ONLY
PCA / Project / Phase:
Project Manager Assigned:
125602 Rev 11-2017
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