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FOR FPC USE ONLY: __________________________________ ___ SPACE MODIFICATION REQUEST DATE: ______________________ REQUESTING DEPARTMENT: ____________________________________________________________________________________ COLLEGE:____________________________________________ CAMPUS ADDRESS: _____________________________________ REQUESTOR: _________________________________________ PHONE No. _____________________________________________ E-MAIL: ______________________________________________ FAX No. _______________________________________________ DESCRIPTION OF REQUEST (Include map or diagram of campus location, if applicable): ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ REASON FOR REQUEST: _________________________________________________________________________________________ ________________________________________________________________________________________________________________ ANTICIPATED SOURCE OF FUNDS OR GRANT NUMBER:___________________________________________________________ ________________________________________________________________________________________________________________ COST ESTIMATE (Include draft budget, if applicable): $________________________________________________________________ SIGNATURES BELOW ARE REQUIRED PRIOR TO REVIEW AND DO NOT IMPLY APPROVAL OF THIS REQUEST Dean/Director (Print) Signature Date Regional Vice Chancellor (Print) Signature Date Space Committee (Print) Signature Date RETURN COMPLETED FORM TO FACILITIES PLANNING & CONSTRUCTION FACILITIES PLANNING AND CONSTRUCTION SERVICES University of South Florida St. Petersburg 140 Seventh Avenue South, TER 100 St. Petersburg, FL 33701 727-873-4822 FAX 727-873-4194 [Revised 01/14/2014] RENOVATIONS The construction and renovations of buildings are managed by Facilities Planning and Construction Services. Questions regarding construction and renovation projects should be directed to Facilities Planning and Construction Services at 873-4822. When requesting renovation of any space, departments should submit a completed “Space Modification Request” form to Facilities Planning and Construction Services. Examples of space renovations include, but not limited to: Installing new circuits Install plumbing fixtures Changing/reconfiguring lab/office/classroom layout Upgrading lab/classroom/office spaces Hanging large frame boards/pictures Provide engineering services for major building equipment installs Painting for reasons other than normal wear and tear Provide space and utility infrastructure modifications to support new occupants Purchase of furniture is handled by Facilities Planning and Construction Services only when in the context of the creation of new space through remodeling or new construction. For all other occasions, the purchase of furniture should be handled directly by the department or college. FACILITIES PLANNING AND CONSTRUCTION SERVICES University of South Florida St. Petersburg 140 Seventh Avenue South, TER 100 St. Petersburg, FL 33701 727-873-4822 FAX 727-873-4194 [Revised 01/14/2014]