This form is required for the creation of a new project. A project is defined as any construction or alternation of an existing public structure, public work, or utility, regardless of cost of durability. In order to submit a capital or operating budget request to accomplish this work, the form below much be completed in full and approved. The form is designed to help anticipate future questions and fully vet projects prior to their introduction to the capital plan or going out for bid.

Name:*

Date:*

Division*

Administration Engineering Garage Sewer Water Drains Parks Forestry Highway PSAB - General

Answering the Four Questions

1. Define the Project Scope

1a. Why does the Town need to do this project (indicate in boxes all that apply and include in narrative).*

Safety Efficiency

Legal Reasons

Narrative:*

1b. Provide a map or sketch of the project area.*

1c. Provide supplemental information (i.e. utilities, flood plains, wetlands) or other pertantnent documentation for this project. *

1d. Provide the quanitites of work needed to be done.*

1e. Provide an estimate of the cost of the project as broken down below. *

1f. Provide a total estimate of the cost of the project as broken down below.

Project Cost from Item 1e:*

Add 15% for Engineering & Contingency:*

Add 20% PIIS (Percentage Increase in Scope) factor:*

Total Esimated Cost of Project (Sum of Items Above):*

Include Inflation Factor (3.5% per year):*

1g. Source of Project Estimate:*

In-House Consultant

Estimate Previous Project

Describe the scope of the proposed work.*

Create project folder.*

Yes

2. Identify the source of funding.

2a. Source(s) of funding.*

Operating Budget Operating Capital Capital Budget - Cash Capital Budget - Borrowing Grant SRF

Chapter 90 MWPAT Community Preservation Fund Revolving Fund Gift Other

3. Designate a project leader.

3a. Will the project involve other persons, departments, agencies, or entities? If so, indicate below.*

3b. Inform all affected partieis that they will be involved in this project. *

Complete

Not Applicable

3e. Who is identified as the project leader?*

3d. Identify all team members for this project.*

4. Identify appoximately when the project will be done.

4a. What year and season is desired for the work to begin.*

4b. It a capital project, what year in the capital plan should this project be assigned?

4c. If Capital project, can the proposed project be entered into the fifth year of the CIP?

4d. If Capital project, and it is not the fifth year, what project(s) of equal value can be removed from the CIP?

4e. Is this project an emergency, and what makes this project an emergency?

5. Permitting Requirements

What types of permits does this project require?

Conservation Commission Planning Board Zoning Board of Appeals

Building Permit Other

Please describe how all permitting requirements can be satisfied for this project.

Email Address*