Construction approval request, Mayor's Office Emergency Management, Mar 1998

NYC 9/11 Public Portal Document CAPITAL SUBPROJECT QUESTIONNAIKt (Pitwe Edm cieiriy) W«eW

AGENCY CODE PROJECT CODE SUBPROJECT CODE PROPOSED Lf UPPU MODIFICATION NO.

I. General

A. Budget Line Number: B. (APIS Identification Number fW C. Project Manager / Program Officer (for DCS, EDC and HPD managed projects):

■we PHONE:

D. Nature of Capital Improvement / Asset g kquisition of Equi^mmt^^'icle(s) Q ^quisition or Imrovem^to Real Property (i.e. buildings, land)

E. Ifother than an HPD loan or grant describe apital project__________________________________________________________________________

F. Scope of Work or Purchase: □ Scope of Work attached □ Equipment/System information attached

I. Engineer's/Architect's estimate of the economic life of capital improvement/asset years. I Estimate provided by: NAME: FHONE PlO&'J

H. If capital project involves a building, indicate whether ■ QassA Fireproof: No Wooden Structural Elements) □ Class B Fire-Resistant Outer Walls of No Wooden Elements) □ Class C(Non-Fireprool)

I. Environmental Review: L Has tiw projecta^g counsel detained if this proje^iiis subject to Environmental Review (i.e., CEQR, SEQRA, etc.) ? □ Yes □ No 3. Has Environmental Review bee^mpleted? J Yes BUS 4. Name and Phone of person making determination: NAME: PHONE:

J. HPD and EDC ONLY: If this project is an urban renewal project, provide name of urban renewal area and plan:

L HPDONLY: If provision of loan or grant, cite underlying statutory authority along with name of attorney assigned to the project NAME: PHONE:

II. Ownership, Location and Use of Capital Improvement / Asset

A. Ownership: □ Owned by City ■ Leased by City Term of Lease (Actual Dates):

B. If acquisition or improvement(s) to real property, or improvement to infrastructure or provision of housing grant or loan, indicate location:

Block and Lot Number Park Number

C. Does the City intend to dispose of the capital improvement/asset:? □ Yes □ No If "Yes", attach specific information regarding disposition.

D. Is it anticipated that any portion of the capital improvement/asset may be leased, operated or otherwise used by a non-City entity? □ fe ■ No If "Yes", submit a copy of the proposed or executed agreement Indicate below (or on a separate attached sheet) names of parties and type of agreement Parties to Agreement____________________________ ______ _ __________________________ Typeof Agreement__________________ _ _____________________________________________ _ _____ _ □ Agreement attached □ Agreement requested from agency

IMPORTANT: 0MB Counje/'j (Mfke must be MtifieBus soon aspossible ifany proposal would nsult in a change ofthe above information. E. I. If provision of loan or grant, indicate: □ Loan □ (irant I Name of borrower or grantee:

•3. Purpose of loan orgrant:

4. Terms and conditions of loan or grant

5. If loan, is 9% low-income tax credit involved? □ Yes □ No

Name of 0MB Capital Analyst (Please Print) Date

NYC-WTC_000167829