Project Number:

							                                                Facilities Management Project Questionnaire


       Date:                    Project Number:                           Project Name:                       Speed Type:
       Project Manager/Consultant:                                        Project Coordinator:
       Brief Description:

             Project Client –                                                               ADA/Planning/ – Phil Simpson
             CAD – Phil Martin                                                              Civil/Structural – Will Johnson
             Construction – Bill Ward                                                       EH&S – ehslead@colorado.edu, Brandon Boger
             Electrical – Joe Branchaw                                                      Facilities Operations – Kevin Orin
             Fire Protection – Zachary Niehues                                              Mechanical – Pieter van der Mersch
             Parking – Melissa Yates; Christian Dino                                        Telecom – David Lindblad
             ITS – David Bodnar (only if there are computer room upgrades)

       Are walls being built or removed? Yes No                        If “yes”, please provide a sketch.
       Area of Project:                                                Anticipated project cost:
       Are outside consultants being retained? Yes No                  If “yes”, which disciplines?
       Is the existing use of the area changing? Yes No                If “yes”, please explain.
       Is this an exterior project?     Yes No                         If “yes”, please explain.
       Will staging for this project be exterior?   Yes No             If “yes”, please explain.
       Is the number of persons in the area increasing/decreasing (indicate # of persons)?
       Are fire rated doors, partitions, dampers or other fire         If “yes”, please explain.
       barriers affected? Yes No
       Is door hardware or electronic door hardware or door            If “yes”, please explain.
       frames affected?       Yes No
       Are there new ventilation requirements (i.e. fresh air,         If “yes”, please explain.
       exhaust, fume hood)? Yes No
       Are there plumbing additions or changes (i.e. grease traps,     If “yes”, please explain.
       storm/sanitary sewers? Yes No
       Are equipment loads being changed (added/reduced)?              If “yes”, please provide a list of volts/amps and special
          Yes No                                                       requirements (i.e. water, cooling) for each device.
       Is lighting being changed? Yes No                               If “yes”, please explain.
       Is the project area sprinklered? Yes No                         If “no”, will sprinklers be installed?
       Will voice-data jacks be added or removed? Yes No               If “yes”, how many?
       Are there smoke detectors, heat detectors, or fire alarm devices in the project area? Yes No
       Are hazardous materials to be used or stored (i.e. chemicals, If “yes”, what types?
       radioactive, biohazards, etc.)? Yes No
       Proposed materials/equipment for construction:
       Does the project involve the removal or addition of any         If “yes”, please explain.
       emergency generators, tanks, drums, or other vessels > 55
       gallons, used for petroleum products or oils of any kind?
          Yes No


      Response comments:
      Is a Certificate of Occupancy required?                    If “yes”, please explain.
         Yes No
      (For Fire Protection only) Is a sprinkler waiver request acceptable?
         Yes No
      Is an Authorization to Proceed with Construction           If “yes”, which permits are required?
      required?                                                     Building
         Yes No                                                     Civil/Utilities Systems
                                                                    Electrical
                                                                    Elevators
                                                                    Fire Alarm
                                                                    Fire Suppression
                                                                    Mechanical
                                                                    Voice/Data Communicat.

                    Responder:                                                   Date:

File name and path:




Revised September 21, 2011