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Capital Improvements Program Request Form
FY 2012-2021
Printer-Friendly Version
A Capital Improvement Project is a specified activity with a cost of $10,000 or more and a useful life of 2 years or more.
Please check all of the following reasons that apply to your request.
Choose from the following:
Checkboxes
Checkbox Description
Checkboxes
Checkbox Description
Safeguards Public Health or Safety
Responds to Federal or State Requirements
Provides Added Capacity to Serve Growth
Provides Incentive to Economic Development
Continues Existing Project
Alleviates Substandard Conditions or Deficiencies
Improves Quality of Existing Services/Infrastructure
Reduces Long Term Operating Costs
Responds to Public Demand
Reflects Master Plan
Please provide the following information:
Field Description
Field Data
Required Field
NAME
required
EMAIL
required
PHONE
required
DEPARTMENT
required
CAPITAL PLANS AT THIS TIME? (YES OR NO)
required
PROJECT TITLE
required
ESTIMATED TOTAL COST
required
ESTIMATED USEFUL LIFE (YEARS)
required
ESTIMATED NON-TAX FUNDING
required
PREVIOUSLY PRESENTED? (YES OR NO) (IF YES, PLEASE UPDATE PROJECT DESCRIPTION BELOW.)
required
TYPE OF PROJECT (SELECT ONE)
Field Data
Building Renovation, Addition or New Construction
Equipment Replacement or Lease
New Equipment or New Vehicle
Property/Rights Acquisition
Road Improvement
Professional Consultation
Other
PROJECT PRIORITY
Field Data
Cannot be Delayed (for health, safety or ADA compliance)
Needed within 5 Years (to maintain quality/level of service/infrastructure)
Needed within 5-10 Years (to improve quality/level of service/infrastructure)
Can Hold for 10+ Years (but supports community development goals)
Needs More Research (planning and coordination)
PROJECT DESCRIPTION (If new, please include how this project ties in with the Master Plan. If previously submitted, please either specify any interim changes in project plans, or confirm no change.)
Tuftonboro, New Hampshire P.O. Box 98 240 Middle Road, Tuftonboro, NH 03816 | (603) 569-4539
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