GRANT APPLICATION PACKAGE

FOR CONSTRUCTION GRANTS

Cost Estimate Outline (FS-26) – must be completed for construction applications only. This form is to be submitted with the general grant application.

New Jersey Department of Health

APPLICATION FOR CONSTRUCTION GRANT

COST ESTIMATE OUTLINE

Name of Grantee

Title of Proposed Grant

Estimate the costs in which the Department of Health is requested to participate (costs shall include both grant funds and program income).

1.	Demolition and Removal	$
2.	General Alteration and Renovation (e.g., carpentry, masonry, painting)	$
3.	Plumbing	$
4.	Heating, Ventilation and Air Conditioning	$
5.	Electrical	$
6.	Architect’s and Engineer’s Fee	$
7.	Land	$
8.	Structural Costs	$
9.	Relocation	$
10.	Other Costs (Specify):	$
11.	Equipment	$

List Source and Amount of Funds for Total Project:

Grant Funds and Amounts:

Other Sources and Amounts:

Total Net Square Feet of Floor Area in Proposal
Estimated Cost Per Net Square Foot Including Fixed Equipment	$
FS-26

AUG 12

FS, Grant Application Package, Construction Grants

FS, Financial Services, Grant Application Package, grant, application, funding, construction funds, FS-26

EWhite

2005-12-02

NJDOH