Form Center

2. Project Address*
4. Permit Number*
5. Applicant's Name*
7. Applicant's Email Address*
8. Applicant's Phone No.*
10. What is the total cost of all construction contemplated for this project?*
11. Do you certify that the existing building and site comply 100% with current State Title 24 Accessibility Standards?*
    -- Select One --YesNo
15. Item A- Primary Entrance. Is the primary entrance (including but not limited to, a level threshold, landings, door hardware, maximum door pull, etc.) compliant?
    -- Select One --YesNo
17. If the primary entrance is not compliant, how much would it cost to bring it fully into compliance?
19. Item B- Primary path of travel. Is the primary path of travel to the specific area of alteration, structural repair, or addition compliant?
    -- Select One --YesNo
21. If the primary path of travel to the specific area of alteration, structural repair, or addition is not compliant, how much would it cost to bring it fully into compliance?
23. Item C- Accessible toilet and bathing facilities. Are the restroom facilities compliant?
    -- Select One --YesNo
25. If the restrooms are not compliant, how much would it cost to bring them fully into compliance?
27. Item D- Drinking Fountains. If there are drinking fountains, are they accessible?
    -- Select One --YesNo
29. If the drinking fountains are not compliant, how much would it cost to bring them fully into compliance?
31. Item E- Public Telephones. If there are public telephones, are they compliant?
    -- Select One --YesNo
33. If the public telephones are not compliant, how much would it cost to bring them fully into compliance?
35. Item F- Path of travel to the main entrance. Is the path of travel to the main entrance, including but not limited to signage, parking, loading/unloading, ramps, and walks compliant?
    -- Select One --YesNo
37. If the path of travel to the main entrance is not compliant, how much would it cost to bring it fully into compliance?

    If the project is not 100% compliant, 20% of the construction cost must be spent on accessibility upgrades.

39. I agree to allocate 20% of the total cost in expenditures for the following accessibility upgrades:

    1. Item A- An accessible entrance
    2. Item B- A primary path of travel to the area
    3. Item C- Toilet and bathing facilities
    4. Item D- Accessible drinking fountains
    5. Item E- Accessible public telephones
    6. Item F- Accessible path to the main entrance

    If the project is not 100% compliant, 20% of the construction cost must be spent on accessibility upgrades.

    
    

41. Describe how much you will spend on an accessible entrance and describe the improvements that will be made.
43. Describe how much you will spend on a primary path of travel to the area and describe the improvements that will be made.
45. Describe how much you will spend on toilet and bathing facilities and describe the improvements that will be made.
47. Describe how much you will spend on drinking fountains and describe the improvements that will be made.
49. Describe how much you will spend on public telephones and describe the improvements that will be made.
51. Describe how much you will spend on an accessible main entrance including parking and describe the improvements that will be made.
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field