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40 <br />llazard Mitigation Grant Program Shelter Projects Only Henefil Cost Data Collection Form <br />A. Protect Information <br />Complete <br />A separate workshcet is required for each structure <br />✓ yes _ nn <br />Photographs of all elements of the building to be retrofitted <br />, yes ✓ nn <br />Engineer's certification for level of protection proposed <br />f yes ✓ no <br />Attach completed LRDM Table and Survey Checklist <br />J yes no <br />B. Building Data <br />0 <br />Select Building Type (Before Mitigation) <br />Recovery Shelter <br />Refuge <br />Risk Shelter <br />Secondary Host Shelter <br />Other (attach explanation) <br />Lightly Engineered <br />0 <br />Fully Engineered J <br />0 <br />Building Site (Miles Inland) 2 <br />Number of Stories above Grade 2 <br />Construction Date 1965 <br />Historic Building Controls <br />Disaster Number FEMA -1300 -DR -FL <br />C. Building Size and Use <br />Describe the normal day-to-day function of the facility: <br />Public Education <br />Total floor area 232.471 (so <br />Area occupied by owner or Public/Non-profit Agencies23_ <br />4471 (sf) <br />For the following, enter the square <br />feet for the applicable <br />Building <br />Existing (SF) <br />Area to be used <br />Proposed (SF) <br />Critical Facility <br />0 <br />10,000 <br />20.940 <br />10,000 <br />Host Shelter <br />20,940 <br />Hurricane Evacuation Shelter (HES) <br />0 <br />Primary Host Shelter <br />0 <br />10,000 <br />20.940 <br />Recovery Shelter <br />Refuge <br />Risk Shelter <br />Secondary Host Shelter <br />Other (attach explanation) <br />20,840 <br />0 <br />10,000 <br />10,000 <br />NIA <br />0 <br />NIA <br />D. Building Value <br />Building Replacement. Value $1 million <br />Page 14 of 15 <br />