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["ALL","Housing Trust Fund Corporation",null,null,null,null,null,"Instructions: "]
[null,"Project Setup & Completion Form",null,null,null,null,null,"Project Setup Form - The Project Setup Form is used to commit program funds for a specific property or project activity. A Project Setup Form is required for each building or separate project activity. The Setup should be included with the site-specific environmental review materials and the written scope of work."]
["ALL","Program:","DRI",null,null,null,null,"Select the program name from the drop-down menu."]
["ALL","Date:","2025-05-05",null,null,null,null,"Project Completion Form - The form is submitted as a Project Completion Form once the activities are complete to provide a final budget and summary of the environmental clearances.The Completion Form must be provided with a final disbursement request."]
["ALL","LPA Name:","Village of Amityville Storefront Façade Improvement/Downtown Revitalization Committee"]
["ALL","Project Status:","Initial Project Setup",null,null,null,null,"Select the status of the project: Initial Setup, Revised Setup, or Project Completion."]
["MED, REST","Date of Birth:",null,null,null,null,null,"Provide client date of birth for Access to Home for Medicaid Members and RESTORE."]
["MED","Medicaid Member CIN Number:",null,null,null,null,null,"Provide Medicaid Client ID # for Access to Home for Medicaid Members."]
["ATH, MED, VETS, REST, MMHR","Income Target Group:","Select One",null,null,null,null,"Select the AMI% of the homeowner. "]
["REST, MRTL","Construction Start Date:",null,null,null,null,null,"Provide the date construction will begin. RESTORE Only: Construction must be complete 60 business days after construction start date. Submit documentation supporting any deviation from required timeline."]
["REST, MRTL","Construction End Date:",null,null,null,null,null,"Provide the date construction is complete."]
["ATH, MED, VETS, REST","Nature of Disability:",null,null,null,null,null,"Provide a brief explanation of the nature of the disability"]
["ATH, MED, VETS","Type of Modification: ",null,null,null,null,null,"Describe the type of modification for Access to Home projects."]
["REST","Type of Emergency Repair: ",null,null,null,null,null,"Briefly describe the nature of the emergency for RESTORE projects."]
["ALL","Name of Individual Preparing Form:","Tawaun Whitty(Vision long Island",null,null,null,null,"Provide the name of the staff member completing this form."]
["ALL","Email of Individual Preparing Form:","tw@visionli.org",null,null,null,null,"Provide the email of the staff member completing this form."]
["ALL","PROJECT/SITE INFORMATION"]
["ALL","Project Name (Owner or Business):","Cloak Room",null,null,null,null,"Provide a clear project name or the homeowners name to identify this project or activity."]
["MED","Medicaid Client Name (If Different):",null,null,null,null,null,"Provide the name of the Medicaid client if different than the homeowner. "]
["ALL","Primary Activity:","Building Renovation/Construction",null,null,null,null,"Select the primary activity for this form."]
["ALL","Project Street Address:","225-227 Broadway",null,null,null,null,"Project street address. Confirm the address using a tax bill or the local assessment roll."]
["ALL","City:","Amityville",null,null,null,null,"Provide the city."]
["ALL","Zip Code:",11701.0,null,null,null,null,"Provide the zip code. "]
["ALL","County:","Suffolk",null,null,null,null,"Confirm the county. County must be within the Service Area specified in the Schedule A of the Grant Agreement."]
["ALL","Municipality:","Village of Amityville",null,null,null,null,"Confirm the municipality, an Imagemate search for the county may be available to verify this. "]
["ALL","Section/Block/Lot:","0101-005-00-03-001-000",null,null,null,null,"Provide the Section Block Lot (S/B/L) for the building. Confirm the address using a tax bill or the local assessment roll."]
["ATH, MED, VETS, REST","Mobile Home Park Name (MHP):",null,null,null,null,null,"Please specify the name of the park, if applicable. "]
["ATH, MED, VETS, REST","Type of Unit:","Select One",null,null,null,null,"Specify the type of unit. "]
["ATH, MED, VETS, REST, MMHR","Year Unit Built:",null,null,null,null,null,"Enter the year the property was built."]
["ALL","Previously Assisted? (SHARS ID):",2.0230017E7,null,null,null,null,"Enter SHARS ID that the building was previously assisted under and total dollar amount of previous assistance."]
["ALL","PROJECT ACTIVITY COSTS",null,null,null,null,null,"Project Activity Costs"]
["ALL","Type of Cost:",{"$f":"C3","v":"DRI"}," Owner Match"," Other (Specify Below)"," Project Total",null,"Use the \"Select Program\" column to select the program. Use the Other (Specify Below) column to Identify the total amount of other funding sources of funds."]
["ATH, MED, VETS, REST, MMHR","Project Delivery:",0.0,0.0,0.0,{"$f":"SUM(C33:E33)","v":0},null,"Project Delivery represents both soft costs (filing fees, env. testing, etc. as well as staff time directly linked to projects that were assisted with program funds.Foe ADU projects Costs associated with delivering the project; i.e. staff time and OTPS, accounting, etc. "]
["NYMS, BMSI ,DRI","Soft Costs:",4608.05,1152.01,0.0,5760.06,null,"Professional service costs, or “soft costs,” that can be attributed directly to the delivery of the renovation activities such as filing fees, env. testing, design, etc. "]
["ALL","Building Renovation/Construction:",72091.95,18022.99,0.0,90114.94,null,"Building Reno/Const are the hard costs of construction."]
["LBI, DRI","Non-Capital Activity:",0.0,0.0,0.0,0,null,"Examples: Non-construction activities, purchases, programming, business assistance, art projects"]
["NYMS, BMSI ,DRI","Streetscape / Sitework Activity:",0.0,0.0,0.0,0,null,"NYMS/BMSI Streetscape activity or DRI/NYF  site improvement projects"]
["LBI","Acquisition:",0.0,0.0,0.0,0]
["ALL","Total:",{"$f":"SUM(C33:C38)","v":76700},19175,0,95875,null,"Verify program project total does not exceed the per-project cap amount. "]
["ALL","List Other Funding Sources:",null,null,null,null,null,"List every other funding source being used for the project."]
["ALL","Break down scope of work and the funding source for each scope item:"]
["ALL","New traditional storefront trim at front facade-Azek cornice, trim and panels, stucco over brick and closed openings on side façade.",null,null,null,null,null,"Explain the break-down of individual costs by funding source and specify which work scope items are being paid for by each funding source. "]
[]
["ALL","ENVIRONMENTAL CLEARANCES"]
[null,"Clearances Required for Project Set Up & Project Completion",null,null,null,null,null,"Enter the information in the following fields for the Project Set up form and the Project Completion Form."]
["NYMS, BMSI ,DRI, MMHR, LBI","EAU Env. Clearance Letter Date:","2025-03-26",null,null,null,null,"Enter the date of the Environmental Clearance Letter provided by HTFC's Environmental Analysis Unit."]
["NYMS, BMSI ,DRI, MMHR, LBI","Project-Specific Checklist Date:","2025-03-26",null,null,null,null,"Enter the date of the Site-specific Environmental Compliance Checklist."]
["ALL ","Describe Env. Hazards:","none found",null,null,null,null,"Identify environmental hazards that require follow up or clearances for this project."]
["ALL","SHPO Review Date:","2025-04-25",null,null,null,null,"Enter the date on the SHPO letter received. "]
["NYMS, BMSI ,DRI, MMHR, LBI","Describe SHPO Conditions:","no adverse impacts",null,null,null,null,"Briefly explain any conditions required by SHPO: e.g. Retain windows. Enter N/A if not applicable."]
[null,"FloodPlain","Select One"]
["ALL","Clearances Required for Project Completion ",null,null,null,null,null,"Enter the information in the following fields for the Project Completion Form"]
["ALL","Date Unit(s) free of Env. Hazards:","2025-03-26",null,null,null,null,"Provide the date of the final environmental hazard clearance."]
["ALL","Date Unit(s) Determined Lead-Safe:","2025-03-26",null,null,null,null,"Provide the date the assisted residential units were determined lead-safe. Enter N/A if project did not assist residential units."]
["NYMS, BMSI ,DRI, MMHR, LBI","Date SHPO Conditions Met:","2025-04-25",null,null,null,null,"Provide the date SHPO conditions were met. "]
["NYMS, BMSI ,DRI, MMHR, LBI","Initial that SHPO Conditions Met:","TW",null,null,null,null,"If SHPO conditions were noted above, confirm that the requirements were met."]
["NYMS, BMSI ,DRI, MMHR ","Initial Permits and Approvals rec'd:",null,null,null,null,null,"Confirm that all required permits were received and relevant codes/regulations were followed."]
["NYMS, BMSI ,DRI, MMHR ","Date of Final Inspection and/or issuance of Certificate of Occupancy",null,null,null,null,null,"Provide the date of the final local inspection and the issuance of Certificate of Occupancy / Completion if applicable"]
["ALL","UNITS ",null,null,null,null,null,"Units"]
[null,"For renovation activities: provide total # of units in building and # of units directly assisted",null,null,null,null,null,"For renovation activities: provide total # of units in the building in the left column and # of units directly assisted in the right column."]
["ALL","Total Residental Units:",0.0,"Prog. Assisted Residential Units:",null,0.0,null,"Provide total # of residential units in the building in the left column and # of units directly assisted in the right column."]
[null,"Total Residential Rehab Units:",0.0,"Total Residential New Construction",null,0.0,null,"Provide the total # of assisted residential that are rehab projects and the total that will be new construction"]
["NYMS, BMSI ,DRI, LBI","Total Commercial Units:",2.0,"Prog. Assisted Commercial Units:",null,2.0,null,"Provide total # of commercial units in the building in the left column and # of units directly assisted in the right column."]
["NYMS, BMSI ,DRI, LBI","Total Civic/Cmty Units:",0.0,"Prog. Assisted Civic/Cmty Units:",null,0.0,null,"Provide total # of civic units in the building in the left column and # of units directly assisted in the right column."]