ࡱ> PSO_ 1bjbj H<jA\jA\%< < 8$$|O)dddd?DI$'(((((($*-J(9m??mm(dd )mFdd'm'r&T'df|IR'')0O)#'--'-'$mmmmmmm((mmmO)mmmm-mmmmmmmmm< > z: ý Fabricated Equipment Request FormInsert cursor in first grey box, enter information, tab to next grey box, etc. Submit one copy of the completed form and the component parts list before beginning the fabrication to ORSP, Quinn Administration Building, 2nd floor room 028. For questions and assistance, call ext. 7-5370.PI name: Phone: E-mail: PIs Title: PIs Department: Descriptive name for the fabricated equipment (200 characters): Justification for undertaking the fabrication (50 words): Purpose or use of the fabricated equipment (50 words):Sponsor to be charged: Project/grant #:Estimate of the total cost of the fabrication: Prepare and attach to this form a complete listing and associated cost of each of the component materials and supplies, as well as the costs of each external service or internal recharge required to complete the fabrication. The ORSP staff can assist with this task.Estimated placed-in-service date: This is the point in time at which the fabricated equipment will become operational for the intended purpose.Can the fabricated equipment be tagged?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Will the fabricated equipment be affixed to a building or structure?  FORMCHECKBOX  Yes  FORMCHECKBOX  No Will the fabricated equipment have a useful life of more than one (1) year?  FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf this equipment is being fabricated on campus, indicate which building:  FORMTEXT       and room:  FORMTEXT       If this equipment is being fabricated off-campus, provide details of the location: Waltham Field StationIs this equipment being fabricated for the sponsor or an organization other than UMass Boston to which ownership will be transferred upon completion?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If Yes, provide details:  FORMTEXT      Does the fabrication involve the upgrading of the constituent parts or components of an existing piece of equipment?  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