Real Estate Office – RE-1 Form Exhibit 1
NCSU Lease Request For Space
Any University department proposing to rent space from a private property owner must complete this form whether the desired lease is an original or a renewal. The request should be forwarded to NCSU Real Estate (Box 7230). The requesting department should complete all numbered items on the form. Questions should be addressed to Real Estate (Phone 515-3235).If bids are required, the requesting department pays newspaper ad charges.
1. Department: ___________________________________________________________________________
2. Why is this space needed? ________________________________________________________________
______________________________________________________________________________________
3. State preference for general location and give justification for preference: _____________________________
______________________________________________________________________________________
4. What available properties have been examined? Will they meet your needs? ___________________________
______________________________________________________________________________________
______________________________________________________________________________________
5. Special requirements for space (special air conditioning, special wiring, special telephone, computers and other related equipment, copy machine, etc.): _____________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
6. Duration of lease: ______________________________________________________________________
7. Original ______ or renewal ______
8. Desired commencement date of lease: _________________________________________
9. Fund sources:
a. For rental: Account No. _____________________________________________________________
Project Name and No. ______________________________________________________________
b. For janitorial and utilities: _____________________________________________________________
c. For requirements if needed beyond the upfitting allowance by lessor:
_________________________________________________________________________________
d. For restoring upon vacating premises: ____________________________________________________
10. Gross square feet needed: _________________________________________________________________
11. Acceptable cost per square foot range (with janitorial and utilities):
12. Attach organization chart of those to occupy leased space and work sheet used in computing gross square feet needed. Number of people to occupy space: _________
Fax No. _____________ Box No. __________
13. Requestor: _____________ Phone Number:_____________ Date:_____________
14. Department Head: ____________________________________________ Date: _________________
15. Dean’s Office: By: ____________________________________________ Date: _________________