Free VA Form VA40-0895-3 - State or Tribal Government Cemetery Grants Service Space Program Analysis - Buil - Federal


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STATE OR TRIBAL GOVERNMENT CEMETERY GRANTS SERVICE SPACE PROGRAM ANALYSIS - BUILDINGS
PROJECT LOCATION PROJECT NAME

PROJECT FAI (Federal Application Identifier) NO.

1. SUPPORT FACILITIES BUILDING NUMBER 1 - SUPPORT FACILITIES - 2,555 NSF A. PUBLIC INFORMATION CENTER (PIC) 660 NSF (1.12 NG MULTIPLIER) 1. ENTRY VESTIBULE with KIOSK (GRAVE LOCATOR) 2. LOBBY KIOSK CLOSET (Included) ELECTRIC WATER COOLERS (2) (Included) JANITOR CLOSET with Utility Sink (Included) 3. TOILETS MEN & WOMEN (1 each @ 115 NSF each) B. ADMINISTRATIVE OFFICES - 1,030 NSF (1.24 NG Multiplier) 1. WAITING ROOM - Seats 4-6 persons 2. RECEPTION/SECRETARY/CEMETERY REPRESENTATIVE 3. CLOSET (coats & storage) 4. OPERATIONS (COPY/WORK/FILES) 5. DIRECTOR 6. CONFERENCE 7. HALL 8. TOILET (1 unisex) wheelchair accessible 9. MECHANICAL/ELECTRICAL/COMMUNICATIONS C. SHARED/HON GD/MAINTENANCE STAFF - 865 NSF (1.24 NG Multiplier) 1. HONOR GUARD - (meeting room with 1 - 2 tables/chairs) Kitchenette unit with under counter recycling containers (Included) Lockers/Bench in changing area (Included)
VA FORM JUL 2009

PROPOSED BY APPLICANT

VA CRITERIA 3,090 GSF 740 GSF 150 NSF

TOTAL VA ALLOWED

280 NSF (25 NSF)

(40 NSF) 230 NSF 1,275 GSF 155 NSF 150 NSF 10 NSF 150 NSF 165 NSF 165 NSF 90 NSF 50 NSF 95 NSF 1,075 GSF 260 NSF (175 NSF) (35 NSF)
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40-0895-3

BUILDING NUMBER 1 - SUPPORT FACILITIES (Continued from previous page) Toilet unisex (Included) 2. MAINTENANCE STAFF (1) FOREMAN (2) BOOTS & LOCKERS with bench to change shoes (3) CLOSET (housekeeping) (4) SHOWER & TOILET (1 unisex) (5) HALL (6) BREAK ROOM BUIDLING NUMBER 2 - MAINTENANCE SERVICE/GARAGE - 2,465 NSF A. MAINTENANCE SERVICE AREA 1. OPTIONAL WASH BAY #1 (open or open 3 sides or closed) with Optional wash equipment room TBD 2. SERVICE BAY #1/#2 for routine maintenance with work bench at rear or side, heated and air-conditioned by climate location. Optional - Heavy lift if equipment is not sent out for maintenance. 3. PARTS AND TOOL STORAGE CAGE 4. AIR COMPRESSOR ROOM 5. FLAMMABLE STORAGE CABINET B. VEHICLE AND EQUIPMENT STORAGE GARAGE unheated area at most locations BUIDLING NUMBER 3 - COMMITTAL SHELTER 1. COVERED AREA - open on 3 sides with Bier to hold casket, seating for 20 persons, with 2 speakers 2. STORAGE closet locate behind the Bier, with 2 wall sconces and the 5-service seals, locate at the front of the shelter, include shelf for equipment to play Taps, include storage of cleaning equipment, pressure wash, include storage to stack extra chairs 3. UNCOVERED PAVED AREA with standing room for 20-30 additional persons COMPUTATIONS PROPOSED BY APPLICANT
VA FORM 40-0895-3, JUL 2009

PROPOSED BY APPLICANT

VA CRITERIA (50 NSF) 605 NSF (140 NSF) (110 NSF) (10 NSF) (75 NSF) (105 NSF) (165 NSF) 2,465 NSF 1,365 NSF (540 NSF)

TOTAL VA ALLOWED

(600 NSF)

(150 NSF) (50 NSF) (25 NSF) 1,100 NSF

1,025 GSF (900 GSF)

(125 GSF)

200 GSF

TOTAL VA ALLOWED
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CERTIFICATION: I certify that this accurately reflects the proposed space program analysis for this project.
SIGNATURE OF A & E FIRM REPRESENTATIVE DATE SIGNED

SIGNATURE OF STATE OR TRIBAL GOVERNMENT PROJECT MANAGER

DATE SIGNED

SIGNATURE OF DESIGNATED STATE OR TRIBAL GOVERNMENT OFFICIAL

DATE SIGNED

SIGNATURE OF STATE CEMETERY GRANTS SERVICE REVIEWER

DATE SIGNED

The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of this Act. The public reporting burden for this collection of information is estimated to average 6 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. We may not collect or sponsor, and you are not required to respond to, a collection unless it has a valid OMB Control Number. This collection of information is collected under the authority of 38 U.S. Code Sections 8133(a) and 8135(a). VA will use this information, along with other documents submitted by the States to determine the feasibility of the projects for VA participation, to meet VA requirements for a grant award and to rank the projects in establishing the annual fiscal year priority list. Although response is voluntary, VA will be unable to authorize a grant without a complete package. Your failure to furnish this information will have no effect on any other benefits to which you are entitled.

VA FORM 40-0895-3, JUL 2009

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