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Town of Mashpec <br /> Capital Improvement Program FY 2012 Project Request Form <br /> (Please Type All Responses) <br /> Date <br /> Project No. <br /> 1, Project or Equipment(Short Title) <br /> 2, Description and Purpose of Project or Equipment: <br /> Estimate Life of Project or Equipment _ Years <br /> 4. Status of Project or Equipment <br /> Site Secured Not Secured - Not Required <br /> Survey of Need Under Study Completed -Not Required <br /> Preliminary Plans/Specs Under Study Completed - Not Required <br /> Final Plans or Specs Under Study Completed -Not Required <br /> 5. Priority 6. Cost Estimates <br /> Urgent Preliminary Final <br /> Necessary <br /> Desirable Land Costs <br /> Construction Cost <br /> Other Cost <br /> Total Cost <br /> 7. Effect on Actual Operating Budget 8. Source of Funds <br /> Operational Current Revenue $ <br /> Maintenance Bond Issue Years <br /> Total(+)(-) Short Term Note Years <br /> Revenue from Project $- /yr Other(describe) <br /> New Personnel Required <br /> 9. Year Proposed for Construction or Acquisition FY <br /> 10. Comments and Justification(Please attach a sheet describing need in detail include the cost of not <br /> completing this project) <br /> I Signature Title <br />