Please print out and complete the form below for
Facilities Operations installation of a Department supplied air conditioner.
Contact Wendy Salisbury at 486-0942 with questions.
UNIVERSITY OF
CONNECTICUT
AIR CONDITIONING REQUEST FORM
Date________________________
Facilities Operations has
received a request for installation of air conditioning in the area(s) as
described below:
|
Building & Room Number |
Department |
JUSTIFICATION
|
Occupant Comfort |
Energy Cost @ /KW-Hour |
|
Laboratory Requirements |
Rating of Unit KW |
|
Computer/Copier
Requirements |
Hours of Use HRS |
|
Other- Letter Attached |
Estimated Yearly Energy
Cost $ /YR |
|
|
|
ENGINEERING OBSERVATION
RECOMMENATION/ALTERNATIVES ELECTRICAL SERVICE CAPACITY:
YES NO
|
Outlet Extension Required |
|
|
|
New Circuit Required |
|
|
|
New Panel Required |
|
|
|
New Building service |
|
|
REFERENCES AND ASSUMPTIONS
|
|
|
Estimated Unit Cost: |
|
Engineering Labor: |
|
Estimated Installation
Cost: |
|
Bond (2.5%): |
|
Estimated Contingency: |
| Estimated Total Cost: |
Recommended __________ Not Recommended__________
____________________________________________________________
Director, Facilities
Operations Date