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HTFC Physical Needs Assessment Form Applicant Name

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					                                                              HTFC Physical Needs Assessment Form
      Applicant Name:                                                                                   Project Name:
      Instructions:                                                                                     Project Address:
    1. The information in this form must be completed by a professional architect or engineer.
    2. Fill out the form for all site and building elements to indicate what is being replaced and what will be maintained.
    3. Describe existing conditions (materials, age, level of deterioration, etc.) and proposed rehabilitation in as much detail as possible for each item.
    4. Indicate the percentage of replacement for each item in Column E, Proposed Rehabilitation.
    5. If any item is not applicable to this specific project identify as "not applicable" (NA). If there are any conditions that are not specifcally identified below, identify in "Other" rows.
    6. For items not being replaced in current work scope, indicate the total life span in Col.F and remaining life in Col G. For items being replaced indicate the total life span in Columns F & G.
    7. Attach back-up material and reports, as necessary, to explain conditions which cannot be fully explained herein.
    8. Provide current hazardous material testing report for the existing building, including asbestos, lead based paint and mold.
    9. For mechanical, life safety and other specialized equipment to be maintained, attach an engineers report which evaluates the complete system,
      all required maintenance, life expectancy and applicable code compliance issues.
  10. Cite the reference standard, or other evaluation method used, in determining the expected life span of the evaluated items in the space below.
  11. Coordinate this HTFC Physical Needs Assessment Form with the mandatory items listed in Appendix G of the Design Handbook.
  12. The cost of the current work scope items should be entered in Column H "Cost of Proposed Rehabilitation."
  13. In Colmn.C, provide the Life Cycle Replacement Cost in current dollars as a total cost for the category. These costs and the indicated average life span for the category will be transferred
       to the HTFC Life Cycle Analysis Form (LCAF). The LCAF shows the anticpated replacement costs of the projet for 15 years.
General Information
      Date constructed:                                                               Is this building on or eligible for listing on the National Register of Historic Places?        Yes: _____     No:____
      Date of previous renovations:                                                                                                                                                   Date listed:
      Type of construction:                                                           Life Span determination reference standard:
Physical Needs Certification:
      As, the undersigned for the above referenced development, I hereby certify as project architect/ engineer, that based on our inspection of the property and findings set forth in this part that all
      improvements for each building and each unit listed in the “HTFC Physical Needs Assessment” form are sufficient for the project to function in good repair, as affordable housing for a period equal to
      at least fifteen (15) years.

      Architect/Engineering Firm:

      Printed name:                                                                                                                                       Seal:


      Signature:                                                                      Date:

                                                                                                                                      NYS License Number:

                                                                                                         Page 1 of 13
         Life Cycle                                            C. Life                                                               F.
                                                                                                                                            G.      H. Cost of
                          B. Physical Needs Assessment         Cycle                                                               Total Remaining
          Analysis                                             Replace-   D. Existing Conditions      E. Proposed Rehabilitation                     Proposed
                                   Categories                                                                                       Life
A.         Items                                               ment                                                                Span
                                                                                                                                           Life    Rehabilitation
Hazardous Materials                                            Cost
                        Site
                        Asbestos
                        Lead Based Paint
                        Underground Storage Tanks
                        Radon
                        Mold
                        Fluorescent Light Ballasts
                        Stored Hazardous Materials
                        Other

Site Work
Paved parking and roadways life cycle replacement cost total

                        Parking lots
                        Roadways
                        Site drainage structures
                        Retention basins
                        Walkways & ramps
                        Patios
                        Exterior stairs & railings
                                     Structure
                                     Balustrade
                                     Railing
                                     Handrail
                        Site amenities:
                                     Fences
                                     Playgrounds
                                     Benches
                                     Mail stations
                                     Swimming pool
                                     Other:
                        Accessory structures
                                     Storage Sheds
                                     Garbage stations
                                     Other:
                        Landscaping
                                     Lawns
                                     Plantings

                                                                                       Page 2 of 13
         Life Cycle                                        C. Life                                                               F.
                                                                                                                                        G.      H. Cost of
                            B. Physical Needs Assessment   Cycle                                                               Total Remaining
          Analysis                                         Replace-   D. Existing Conditions      E. Proposed Rehabilitation                     Proposed
                                     Categories                                                                                 Life
A.         Items                                           ment                                                                Span
                                                                                                                                       Life    Rehabilitation
                                       Retaining walls     Cost
                                       Grading
                                       Other:
Structural Evaluation
Structure / Foundation life cycle replacement cost total

                          Foundation
                          Floors
                          Frame
                          Walls
                          Roof
                          Other
Roof and Bulkheads
Roofs life cycle replacement cost total

                          Low Slope Roofs:
                                     Membrane
                                     Insulation
                                     Deck
                                     Drains
                                     Flashings
                                     Railings
                                     Penetrations
                                     Parapets
                                     Copings
                                     Other:
                          Steep Slope Roofs:
                                     Shingles
                                     Sheathing
                                     Flashings
                                     Vents
                                     Penetrations
                                     Gutters
                                     Downspouts
                                     Other:
Building Exterior
Exterior Walls life cycle replacement cost total
Exterior painting life cycle replacement cost total
Doors life cycle replacement cost total

                                                                                   Page 3 of 13
         Life Cycle                                       C. Life                                                               F.
                                                                                                                                       G.      H. Cost of
                          B. Physical Needs Assessment    Cycle                                                               Total Remaining
          Analysis                                        Replace-   D. Existing Conditions      E. Proposed Rehabilitation                     Proposed
                                   Categories                                                                                  Life
A.         Items                                          ment                                                                Span
                                                                                                                                      Life    Rehabilitation
Windows life cycle replacement cost total                 Cost

                         Walls:
                                      Masonry
                                      Siding
                                      Curtain wall
                                      Insulation
                                      Other:
                         Foundations:
                                      Masonry
                                      Concrete
                                      Stone
                                      Vents
                                      Other:
                         Doors:
                                      Main entry door
                                      Hardware
                                      Operators
                                      Exit doors
                                      Secondary doors
                                      Door hardware
                                      Weather stripping
                         Windows:
                                      Insect screens
                                      Security guards
                                      Child guards
                                      Weather stripping
                         Balconies:
                                      Floor
                                      Railings
                         Exterior painting:

                         Caulking and sealants:
                                       Windows
                                       Doors
                                       Roof
                                       Building Joints
                         Attic insulation:
                                       Type/ Thickness

                                                                                  Page 4 of 13
         Life Cycle                                         C. Life                                                               F.
                                                                                                                                         G.      H. Cost of
                           B. Physical Needs Assessment     Cycle                                                               Total Remaining
          Analysis                                          Replace-   D. Existing Conditions      E. Proposed Rehabilitation                     Proposed
                                    Categories                                                                                   Life
A.         Items                                            ment                                                                Span
                                                                                                                                        Life    Rehabilitation
                                       Condition            Cost
Building Interiors: Public Spaces
Public doors life cycle replacement cost total
Vinyl flooring life cycle replacement cost total
Carpet life cycle replacement cost total
Other flooring life cycle replacement cost total
Laundry equipment life cycle replacement cost

                         Floors:
                                      Wood
                                      Vinyl
                                      Carpet
                                      Terrazzo
                                      Other
                         Walls:
                                      Finishes
                                      Trim
                                      Railings
                                      Ceilings finishes
                         Stairs:
                                         Structure
                                         Risers & treads
                                         Railings
                                         Handrails
                            Interior Doors:
                                         Hardware
                                         Operator
                            Kitchen equipment
                            Laundry equipment
                            Mailboxes
                            Toilet Room accessories
                            Other Appliances or Equipment
                            Trash compactor / Chutes
                            Other
Building Interiors: Apartment Spaces
Apartment doors life cycle replacement cost total
Vinyl flooring life cycle replacement cost total
Carpet life cycle replacement cost total
Other flooring life cycle replacement cost total

                                                                                    Page 5 of 13
         Life Cycle                                             C. Life                                                               F.
                                                                                                                                             G.      H. Cost of
                           B. Physical Needs Assessment         Cycle                                                               Total Remaining
          Analysis                                              Replace-   D. Existing Conditions      E. Proposed Rehabilitation                     Proposed
                                    Categories                                                                                       Life
A.         Items                                                ment                                                                Span
                                                                                                                                            Life    Rehabilitation
Kitchen cabinets / counters life cycle replacement cost total   Cost
Kitchen appliances life cycle replacement cost total
Bathroom cabinets life cycle replacement cost total

                          Flooring:
                                        Wood
                                        Vinyl
                                        Carpet
                                        Tile
                                        Other:
                          Wall finishes
                          Ceilings finishes
                          Door- Main Entry
                                        Hardware
                                        Chime & viewer
                          Doors- Rooms
                                        Condition
                                        Hardware
                          Kitchen equipment
                                        Cabinets
                                        Appliances
                                        Other:
                          Bathroom equipment
                                        Cabinets
                                        Sink top
                                        Mirror
                                        Accessories
                          Other
Elevators
                          Hoisting equipment & rails
                          Motors
                          Hydraulic lines
                          Controllers
                          Emergency phone
                          Door operation
                          Door Safety mechanisms
                          Accessible route requirements
                          Call system buttons, indicators
                          Cabs size

                                                                                        Page 6 of 13
         Life Cycle                                                C. Life                                                                     F.
                                                                                                                                                      G.      H. Cost of
                         B. Physical Needs Assessment              Cycle                                                                     Total Remaining
          Analysis                                                 Replace-   D. Existing Conditions            E. Proposed Rehabilitation                     Proposed
                                  Categories                                                                                                  Life
A.         Items                                                   ment                                                                      Span
                                                                                                                                                     Life    Rehabilitation
                            Cab interiors finish                   Cost
                            Other
Mechanical Systems Note: Provide attached engineer's report on all existing equipment to remain.
Heating equipment life cycle replacement cost total
Air conditioning / ventilation life cycle replacement cost total

                           Heating equipment
                                        Efficiency (AFUE)
                                        Exhaust vents
                                        Flue
                                        Fuel tanks
                                        Fuel lines
                                        Distribution
                                        Pumps
                                        Fans
                                        Radiation
                                        Registers & grilles
                                        Controls
                                        Thermostat
                                        Other:
                           Mechanical room equipment
                                        Fans
                                        Registers & grilles
                                        Vents
                                        Other:
                           Central air conditioning equipment
                           Building ventilation
                                        Fans
                                        Registers & grilles
                                        Vents
                                        Other:
Plumbing Systems Note: Provide attached engineer's report on all existing equipment to remain.
Domestic hot water heater life cycle replacement cost total
Public plumbing fixtures life cycle replacement cost total
Apartment kitchen & bathroom sinks life cycle repl cost total
Apartment water closets life cycle replacement cost total
Apartment bathtub / showers life cycle replacement cost total

                        Building Supply

                                                                                                 Page 7 of 13
         Life Cycle                                                 C. Life                                                                   F.
                                                                                                                                                     G.      H. Cost of
                          B. Physical Needs Assessment              Cycle                                                                   Total Remaining
          Analysis                                                  Replace-   D. Existing Conditions          E. Proposed Rehabilitation                     Proposed
                                   Categories                                                                                                Life
A.         Items                                                    ment                                                                    Span
                                                                                                                                                    Life    Rehabilitation
                                  Water meter & valves              Cost
                                  Water distribution piping
                                  Water control valves
                                  Water pumps
                                  Rooftop storage tanks
                                  Other:
                       Domestic Hot Water
                                  Hot water heaters
                                  Storage tanks
                                  Control valves
                                  Mixing valves
                                  Circulators
                                  Domestic hot/ cold water lines
                                  Other:
                       Plumbing Fixtures
                                  Water closets
                                  Urinals
                                  Lavatories
                                  Sinks
                                  Service sinks
                                  Public toilets
                                  Other:
                       Drain and Vent Systems
                                  Sanitary drains
                                  Sanitary cleanouts
                                  Storm drains
                                  Storm cleanouts
                                  Sewage ejector pumps
                                  Sump pumps
                                  Other:
                       Apartment bathrooms
                                  Water closets
                                  Bathtubs
                                  Showers
                                  Lavatories
                                  Sinks
                                  Fittings & faucets
                                  Shower valves
Fire Protection Systems Note: Provide attached engineer's report on all existing equipment to remain.

                                                                                                Page 8 of 13
         Life Cycle                                                 C. Life                                                                      F.
                                                                                                                                                        G.      H. Cost of
                          B. Physical Needs Assessment              Cycle                                                                      Total Remaining
          Analysis                                                  Replace-   D. Existing Conditions             E. Proposed Rehabilitation                     Proposed
                                   Categories                                                                                                   Life
A.         Items                                                    ment                                                                       Span
                                                                                                                                                       Life    Rehabilitation
                             Fire pump                              Cost
                             Sprinkler supply manifold
                             Valves
                             Test valves
                             Flow alarms
                             Sprinkler heads
                             Distribution piping
                             Fire standpipe system
                             Hoses / valves
                             Cabinets
                             Hose cabinets
                             Other
Electrical Systems Note: Provide attached engineer's report on all existing equipment to remain.
Exterior lighting life cycle replacement cost total
Common area lighting life cycle replacement cost total
Apartment lighting life cycle replacement cost total
Exit lights life cycle replacement cost total
Emergency lights life cycle replacement cost total
Smoke / heat / fire alarms life cycle replacement cost total

                        Service Entrance
                                     Service equipment
                                     Distribution equip.
                                     Electric meters
                        Main electric panels
                        Exterior & site lighting
                        Public areas
                                     Audible alarms
                                     Visual alarms
                                     Pull stations
                                     Detectors
                                     Annunciator panels
                        Apartments
                                     Apartment panels
                                     Wire and cable
                                     Lighting
                                     Cover plates
                                     GFI-Circuits
                                     Arc-Circuits

                                                                                                   Page 9 of 13
        Life Cycle                                    C. Life                                                               F.
                                                                                                                                   G.      H. Cost of
                      B. Physical Needs Assessment    Cycle                                                               Total Remaining
         Analysis                                     Replace-   D. Existing Conditions      E. Proposed Rehabilitation                     Proposed
                               Categories                                                                                  Life
A.        Items                                       ment                                                                Span
                                                                                                                                  Life    Rehabilitation
                     Fire Protection                  Cost
                                  Smoke detectors
                                  Heat detectors
                                  Audible alarms
                                  Visual alarms
                                  Exit lights
                                  Emergency lights
                                  Alarm systems
                     Security System(s)
                     Communication systems
                     Apartment systems
                                  Master TV antenna
                                  Cable TV
                                  Telephone
                                  Data systems
                                  Intercom System
                     Lightning protection
                     Emergency generator
                     Other
Total Cost                                                                                                                                $0




                                                                             Page 10 of 13
HTFC Life Cycle Analysis Form

Applicant Name:                                                                                                       Directions: This form must be completed to show the projected annual expenditures from the replacement reserve acount for fifteen years. Life
Project Name:                                                                                                         spans and replacement costs are populated automatically from the PNAF. Enter the remaining useful life for each item. If the remaining useful life is
Date:                                                                                                                 15 years or less, enter the replacement cost (in current $'s) in the year that it will need to be replaced. For example, if the remaining life for kitchen
# Units:                                                                                                              cabinets is 10 years, the replacement cost should be entered in year 11.The spreadsheet calculates the total expense for each year in current dollars,
                                                                                                                      and then adjusts for inflation to arrive at projected future cost on the final row of the spreadsheet. The inflated totals for each year will populate the
                                                                                                                      annual expense field in the third worksheet, Replacement Reserve Cash Flow Analysis. Use the Explanatory notes box to provide any needed
                                                                                                                      clarification.


                                                        Replacement    Repl.
Category                           Total Life Remaining     Cost      Cost per
                                     Span       Life    (current $'s)   unit                            Year 1           Year 2           Year 3           Year 4           Year 5           Year 6           Year 7           Year 8          Year 9           Year 10          Year 11         Year 12          Year 13          Year 14          Year 15         Total Yr 15
Building Exterior:
Paved Parking &
Roadways                                      0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Structure/Foundation                          0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Roof                                          0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Exterior walls                                0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Exterior Painting                             0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Doors                                         0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Windows                                       0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Building Interior:
Public Doors                                  0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Flooring - public space:           ------------- -------------                                     -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                  ----------------- -----------------
                          Vinyl               0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
                        Carpet                0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
                 Other: identify              0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Laundry Equipment                             0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Apartment Doors                               0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Flooring - apartments:                           ---------------------------------- -----------
                                   -----------------                                                 -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                          Vinyl               0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
                        Carpet                0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
                 Other: identify              0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Kitchen cabinets/counters                     0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Kitchen appliances                            0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Bathroom Cabinets                             0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Mechanical Systems:
Heating Equipment                             0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -
Air Conditioning &
Ventilation Equipment                         0                  0 $           -        #DIV/0!                                                                                                                                                                                                                                                                     $           -



                                                                                                                                                                            Page 11 of 13
                                                Replacement    Repl.
Category                   Total Life Remaining     Cost      Cost per
                             Span       Life    (current $'s)   unit        Year 1        Year 2        Year 3        Year 4        Year 5        Year 6        Year 7        Year 8        Year 9    Year 10    Year 11    Year 12    Year 13    Year 14    Year 15    Total Yr 15
Plumbing:
Hot water heaters                 0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Public Plumbing Fixtures          0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Apartment kitchen &
bathroom sinks                    0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Apt. Water closets                0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Apt. bathtubs & showers           0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Electrical Systems:
Exterior Lighting                 0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Common Area lighting              0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Apartment Lighting                0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Exit Lights                       0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Emergency Lights                  0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Smoke/heat/fire alarms            0          0 $        -     #DIV/0!                                                                                                                                                                                                   $       -
Other:
identify                                                      #DIV/0!                                                                                                                                                                                                   $       -
identify                                                      #DIV/0!                                                                                                                                                                                                   $       -
identify                                                      #DIV/0!                                                                                                                                                                                                   $       -
identify                                                      #DIV/0!                                                                                                                                                                                                   $       -
identify                                                      #DIV/0!                                                                                                                                                                                                   $       -
                                                     Uninflated Totals $        -     $       -     $       -     $       -     $       -     $       -     $       -     $       -     $       -     $    -     $    -     $    -     $    -     $    -     $    -     $       -
                                                   3% Annual Inflation         103%          106%          109%          112%          115%          118%          121%          124%          127%       130%       133%       136%       139%       142%       145%
                                                        Inflated Totals $       -     $       -     $       -     $       -     $       -     $       -     $       -     $       -     $       -     $    -     $    -     $    -     $    -     $    -     $    -     $       -



Explanatory Notes:




                                                                                                                                    Page 12 of 13
Replacement Reserve Cash Flow Analysis

Applicant Name:
Project Name:                                                                               Date:
# Units:

                             Directions: This sheet must be completed to show the projected 15 year cash flow of the replacement reserve
                             account. In Table 1 enter the beginning reserve balance (including any amount capitalized in the development budget),
                             the amount to be contributed annually, and the number of units in the project. Table 2 will be populated based on
                             information from Table 1 and the Life Cycle Analysis form.



Table 1
Beginning Balance/Initial Capitalization       $        -
Annual Contribution                            $        -
# Units                                                      0
Per unit annl. contribn.                           #DIV/0!

Table 2
                                  YEAR                       1    2          3          4           5          6          7          8           9   10


Beginning Reserve Balance                                    $0   $0        $0         $0           $0        $0         $0         $0          $0   $0
Interest                               3.00%                 $0   $0        $0         $0           $0        $0         $0         $0          $0   $0
Expenses                                                     $0   $0        $0         $0           $0        $0         $0         $0          $0   $0
Annual Contribution                                          $0   $0        $0         $0           $0        $0         $0         $0          $0   $0
End of Year Balance                                          $0   $0        $0         $0           $0        $0         $0         $0          $0   $0



                                                             11   12        13         14           15


Beginning Reserve Balance                                    $0   $0        $0         $0           $0
Interest                               3.00%                 $0   $0        $0         $0           $0
Expenses                                                     $0   $0        $0         $0           $0
Annual Contribution                                          $0   $0        $0         $0           $0
End of Year Balance                                          $0   $0        $0         $0           $0

				
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