Facilities Planning  and Construction




Step  1- Who is requesting this work?


Name of Contact
(If other than requestor)


Step 2 Describe the work you are requesting in detail?


Building Name :
Room Number(s) :
Description of Work::


Step 3 - What are you trying to accomplish?




Step 4 How much do you anticipate spending for this project?



 Less than $10,000   $10,000 to $50,000    $50,000 to $100,000  $100,000 to $200,000

$200,000 - $500,000  Over $500,000


Step 5 If funded, who has authority to approve payment for this work?


Authorizing Department
Authorized Representative:
  Has this individual approved this request for an estimate? Yes   No*


Step 6- Where will this work take place?



Is the space currently assigned to your department? (confirm by contacting Jennifer Dam or Shawn Languis at IRP 472-2097)
Yes   No 

Are you changing the use of an existing space (e.g. from a conference room to an office)?
Yes   No 

Are you adding any new space?
Yes, as an addition to an existing facility     Yes, as a new facility   No


Step 7 - What are your time parameters?


An estimate is requested by this date:
The work needs to be substantially complete by this date :
What is the rationale for the requested completion date?






For FMP Office Use Only

Amount of A Estimate: ___________                                         H drive location of file:___________

Estimating contact:        ___________                                         Service order #

BSM comments:  (attach if necessary)