Fillable Printable VA Form 40-0895-3
Fillable Printable VA Form 40-0895-3
VA Form 40-0895-3
OMB NUMBER: 2900-0559
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.
1. SUPPORT FACILITIES
PROPOSED
BY APPLICANT
VA
CRITERIA
TOTAL VA
ALLOWED
BUILDING NUMBER 1 - SUPPORT FACILITIES - 2,555 NSF
3,090 GSF
A. PUBLIC INFORMATION CENTER (PIC) 660 NSF (1.12 NG MULTIPLIER)
740 GSF
1. ENTRY VESTIBULE
150 NSF
with KIOSK (GRAVE LOCATOR)
2. LOBBY
280 NSF
KIOSK CLOSET (Included)
(25 NSF)
ELECTRIC WATER COOLERS (2) (Included)
JANITOR CLOSET with Utility Sink (Included)
(40 NSF)
3. TOILETS MEN & WOMEN (1 each @ 115 NSF each)
230 NSF
B. ADMINISTRATIVE OFFICES - 1,030 NSF (1.24 NG Multiplier)
1,275 GSF
1. WAITING ROOM - Seats 4-6 persons
155 NSF
2. RECEPTION/SECRETARY/CEMETERY REPRESENTATIVE
150 NSF
3. CLOSET (coats & storage)
10 NSF
4. OPERATIONS (COPY/WORK/FILES)
150 NSF
5. DIRECTOR
165 NSF
6. CONFERENCE
165 NSF
7. HALL
90 NSF
8. TOILET (1 unisex) wheelchair accessible
50 NSF
9. MECHANICAL/ELECTRICAL/COMMUNICATIONS
95 NSF
C. SHARED/HON GD/MAINTENANCE STAFF - 865 NSF (1.24 NG Multiplier)
1,075 GSF
1. HONOR GUARD - (meeting room with 1 - 2 tables/chairs)
260 NSF
Kitchenette unit with under counter recycling containers (Included)
(175 NSF)
Lockers/Bench in changing area (Included)
(35 NSF)
VA FORM
OCT 2010
40-0895-3
PAGE 1 OF 3
BUILDING NUMBER 1 - SUPPORT FACILITIES (Continued from previous page)
PROPOSED
BY APPLICANT
VA
CRITERIA
TOTAL VA
ALLOWED
Toilet unisex (Included)
(50 NSF)
2. MAINTENANCE STAFF
605 NSF
(1) FOREMAN
(140 NSF)
(2) BOOTS & LOCKERS with bench to change shoes
(110 NSF)
(3) CLOSET (housekeeping)
(10 NSF)
(4) SHOWER & TOILET (1 unisex)
(75 NSF)
(5) HALL
(105 NSF)
(6) BREAK ROOM
(165 NSF)
BUIDLING NUMBER 2 - MAINTENANCE SERVICE/GARAGE - 2,465 NSF
2,465 NSF
A. MAINTENANCE SERVICE AREA
1,365 NSF
1. OPTIONAL WASH BAY #1 (open or open 3 sides or closed)
(540 NSF)
with Optional wash equipment room TBD
2. SERVICE BAY #1/#2
(600 NSF)
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.
3. PARTS AND TOOL STORAGE CAGE
(150 NSF)
4. AIR COMPRESSOR ROOM
(50 NSF)
5. FLAMMABLE STORAGE CABINET
(25 NSF)
B. VEHICLE AND EQUIPMENT STORAGE GARAGE
1,100 NSF
unheated area at most locations
BUIDLING NUMBER 3 - COMMITTAL SHELTER
1,025 GSF
1. COVERED AREA - open on 3 sides
(900 GSF)
with Bier to hold casket, seating for 20 persons, with 2 speakers
2. STORAGE closet
(125 GSF)
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
3. UNCOVERED PAVED AREA
200 GSF
with standing room for 20-30 additional persons
COMPUTATIONS
PROPOSED BY APPLICANT
TOTAL VA ALLOWED
VA FORM 40-0895-3, OCT 2010
PAGE 2 OF 3
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, OCT 2010 PAGE 3 OF 3
