VA Form 40-0895-3 State or Tribal Government Cemetery Grants Service Space

OMB NUMBER: 2900-XXXX
Respondent Burden: 3 hours

STATE OR TRIBAL GOVERNMENT CEMETERY GRANTS SERVICE
SPACE PROGRAM ANALYSIS - BUILDINGS
PROJECT LOCATION

PROJECT NAME

PROJECT FAI (Federal Application Identifier) NO.

PROPOSED
BY APPLICANT

1. SUPPORT FACILITIES

VA
CRITERIA

TOTAL VA
ALLOWED

3,090 GSF

BUILDING NUMBER 1 - SUPPORT FACILITIES - 2,555 NSF
A. PUBLIC INFORMATION CENTER (PIC) 660 NSF (1.12 NG MULTIPLIER)

740 GSF
150 NSF

1. ENTRY VESTIBULE
with KIOSK (GRAVE LOCATOR)

280 NSF

2. LOBBY

(25 NSF)

KIOSK CLOSET (Included)
ELECTRIC WATER COOLERS (2) (Included)

(40 NSF)

JANITOR CLOSET with Utility Sink (Included)

230 NSF

3. TOILETS MEN & WOMEN (1 each @ 115 NSF each)

1,275 GSF

B. ADMINISTRATIVE OFFICES - 1,030 NSF (1.24 NG Multiplier)

155 NSF

1. WAITING ROOM - Seats 4-6 persons

150 NSF

2. RECEPTION/SECRETARY/CEMETERY REPRESENTATIVE

10 NSF

3. CLOSET (coats & storage)

150 NSF

4. OPERATIONS (COPY/WORK/FILES)

165 NSF

5. DIRECTOR

165 NSF

6. CONFERENCE

90 NSF

7. HALL

50 NSF

8. TOILET (1 unisex) wheelchair accessible

95 NSF

9. MECHANICAL/ELECTRICAL/COMMUNICATIONS
C. SHARED/HON GD/MAINTENANCE STAFF - 865 NSF (1.24 NG Multiplier)

260 NSF

1. HONOR GUARD - (meeting room with 1 - 2 tables/chairs)
Kitchenette unit with under counter recycling containers (Included)

40-0895-3

(175 NSF)
(35 NSF)

Lockers/Bench in changing area (Included)
VA FORM
MAR 2010

1,075 GSF

Adobe LiveCycle Designer

PAGE 1 OF 3

BUILDING NUMBER 1 - SUPPORT FACILITIES (Continued from previous page)

PROPOSED
BY APPLICANT

VA
CRITERIA

TOTAL VA
ALLOWED

(50 NSF)

Toilet unisex (Included)

605 NSF

2. MAINTENANCE STAFF

(140 NSF)

(1) FOREMAN

(110 NSF)

(2) BOOTS & LOCKERS with bench to change shoes

(10 NSF)

(3) CLOSET (housekeeping)

(75 NSF)

(4) SHOWER & TOILET (1 unisex)

(105 NSF)

(5) HALL

(165 NSF)

(6) BREAK ROOM
BUIDLING NUMBER 2 - MAINTENANCE SERVICE/GARAGE - 2,465 NSF

2,465 NSF
1,365 NSF

A. MAINTENANCE SERVICE AREA

(540 NSF)

1. OPTIONAL WASH BAY #1 (open or open 3 sides or closed)
with Optional wash equipment room TBD

(600 NSF)

2. SERVICE BAY #1/#2
for routine maintenance with work bench at rear or side, heated and air-conditioned by climate
location.
Optional - Heavy lift if equipment is not sent out for maintenance.

(150 NSF)

3. PARTS AND TOOL STORAGE CAGE

(50 NSF)

4. AIR COMPRESSOR ROOM

(25 NSF)

5. FLAMMABLE STORAGE CABINET

1,100 NSF

B. VEHICLE AND EQUIPMENT STORAGE GARAGE
unheated area at most locations

1,025 GSF

BUIDLING NUMBER 3 - COMMITTAL SHELTER

(900 GSF)

1. COVERED AREA - open on 3 sides
with Bier to hold casket, seating for 20 persons, with 2 speakers

(125 GSF)

2. STORAGE closet
locate behind the Bier, with 2 wall sconces and the 5-service seals, locate at the front of the
shelter, include shelf for equipment to play Taps, include storage of cleaning equipment,
pressure wash, include storage to stack extra chairs

200 GSF

3. UNCOVERED PAVED AREA
with standing room for 20-30 additional persons
COMPUTATIONS
PROPOSED BY APPLICANT
VA FORM 40-0895-3, MAR 2010

TOTAL VA ALLOWED
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CERTIFICATION: I certify that this accurately reflects the proposed space program analysis for this project.
SIGNATURE OF A & E FIRM REPRESENTATIVE

DATE SIGNED

SIGNATURE OF STATE OR TRIBAL GOVERNMENT PROJECT MANAGER

DATE SIGNED

SIGNATURE OF DESIGNATED STATE OR TRIBAL GOVERNMENT OFFICIAL

DATE SIGNED

SIGNATURE OF STATE CEMETERY GRANTS SERVICE REVIEWER

DATE SIGNED

Respondent Burden: Public reporting burden for this collection of information is estimated to average 3 hours. Statutory authority for a State
Cemetery Grant is 38 U.S.C. 2408. The information requested is necessary to provide documentation on the appropriate size of the building, based
on VA guidance on the net and gross square footage standards for cemetery buildings. VA may not conduct or sponsor and you are not required to
respond to this collection of information unless it displays a valid OMB number. Respond to this collection is voluntary. Send comments regarding
the burden estimate or any other aspects of this collection of information, including suggestions for reducing the burden to VA Clearance Officer
(005R1B), 810 Vermont Avenue NW, Washington, DC 20420. SEND COMMENTS ONLY. Please do not send applications for a grant to this
address.

VA FORM 40-0895-3, MAR 2010

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