Project / Space Requests

Revised on 10/17/17

Note: For instructions on how to fill out this form, please visit our Project Requests page.

Please check if this request will involve the reconfiguration of existing space, changes the current function/use of space, or requires the construction of new space. If space is affected, please select what type:

Date Requesting Department Dept. Number

Contact Name Contact E-Mail Phone Number

Impacted Building Room Number Building Security Coordinator

Project Scope (Include as much detail as possible and if there is a critical completion date):

Request submitted by: Building Security Coordinator:

Project No. Project Title Project Manager Estimated Cost Date

Facilities Proposal:

The estimated cost is good for 30 days from date below. After 30 days, the project will be canceled if this form is not returned with appropriate approvals.

Facilities Project Manager: Project Manager Supervisor:

I acknowledge that State Law requires an Asbestos and Lead Survey prior to any renovation or demolition project if a survey has not been completed within three years. The survey must be completed before an estimate can be provided. The survey is provided at no cost to the department; however, if asbestos and/or lead are present, the project estimate will include abatement costs.

I hereby authorize the performance of the above request and certify that funds equal to the above estimate are made available from the accounts indicated below. Work will not continue beyond the approved budget without additional authorization.

Account number(s) to be charged Amount Project Director or Department Head

Dean or Director

Sect

ion

A –

Depa

rtmen

t Use

Se

ctio

n B

– Un

ivers

ity F

acilit

ies

Sect

ion

C - A

ppro

vals

Project / Space Requests

Revised on 10/17/17

I hereby authorize the performance of the work request for additional scope outlined in Change Order 1 and certify that funds equal to the above estimate are made available from the accounts indicated below. Work will not continue beyond the approved budget without additional authorization.

Account number(s) to be charged Amount

Project Director or Department Head

Dean or Director

I hereby authorize the performance of the work request for additional scope outlined in Change Order 2 and certify that funds equal to the above estimate are made available from the accounts indicated below. Work will not continue beyond the approved budget without additional authorization.

Account number(s) to be charged Amount

Project Director or Department Head

Dean or Director

I hereby authorize the performance of the work request for additional scope outlined in Change Order 3 and certify that funds equal to the above estimate are made available from the accounts indicated below. Work will not continue beyond the approved budget without additional authorization.

Account number(s) to be charged Amount

Project Director or Department Head

Dean or Director

Sect

ion

F –

Chan

ge O

rder

3

Sect

ion

D –

Chan

ge O

rder

1 Se

ctio

n E

– Ch

ange

Ord

er 2

Project / Space Requests

Revised on 10/17/17

I hereby authorize the performance of the work request for additional scope outlined in Change Order 4 and certify that funds equal to the above estimate are made available from the accounts indicated below. Work will not continue beyond the approved budget without additional authorization.

Account number(s) to be charged Amount

Project Director or Department Head

Dean or Director

I hereby authorize the performance of the work request for additional scope outlined in Change Order 5 and certify that funds equal to the above estimate are made available from the accounts indicated below. Work will not continue beyond the approved budget without additional authorization.

Account number(s) to be charged Amount

Project Director or Department Head

Dean or Director

I hereby authorize the performance of the work request for additional scope outlined in Change Order 6 and certify that funds equal to the above estimate are made available from the accounts indicated below. Work will not continue beyond the approved budget without additional authorization.

Account number(s) to be charged Amount

Project Director or Department Head

Dean or Director

Sect

ion

I – C

hang

e O

rder

6

Sect

ion

G –

Chan

ge O

rder

4

Sect

ion

H –

Chan

ge O

rder

5