Tenant Commercial Kitchen & Breakroom Alteration Request Form

1. Tenant & Property Identification

Please provide accurate tenant and property information for this alteration request.


Tenant/Lessee Name

Contact Person Full Name

Contact Email Address

Contact Phone Number

Property Address

Current Space Square Meterage/Square Footage

Lease Agreement Reference Number

2. Project Overview & Scope of Work

Describe the nature and extent of your proposed kitchen and breakroom alterations.


Type of Alteration

Detailed Description of Proposed Work

Will this alteration involve structural changes to walls, floors, or ceilings?


Will you be using licensed professionals (architects, engineers, contractors)?


3. Design & Technical Specifications

Provide technical details about your proposed design and specifications.


Do you have detailed architectural/engineering plans?



Key Equipment to be Installed (if applicable)

Materials & Finishes Proposed

Does the design include accessibility improvements?


4. Project Timeline & Scheduling

Provide your proposed timeline for the alteration work.


Preferred Start Date

Expected Completion Date


Total Estimated Project Duration (in days)

Preferred Working Hours

Will the work require temporary closure of your business operations?


Do you require access to common areas (hallways, elevators, loading docks)?


5. Budget & Cost Information

Provide estimated costs for the proposed alterations.


Total Estimated Project Cost

Cost for Kitchen Portion


Cost for Breakroom Portion

Contingency Amount (if any)


Will this alteration increase the value of the property?


6. Compliance, Safety & Permits

Confirm compliance requirements and permit status for the proposed work.


Required Permits & Approvals (check all that apply)

Have you already obtained any required permits?


Will the alteration comply with fire safety and emergency egress requirements?


Does the design meet health and sanitation standards for commercial food preparation?


Will you be using any hazardous materials (asbestos, lead paint, etc.)?


7. Building Systems Impact Assessment

Assess how the alteration will affect building infrastructure and other tenants.


Will this require modifications to electrical systems?


Will this require modifications to plumbing or water supply?


Will this require modifications to HVAC systems?


Will this require new gas lines or modifications to existing gas supply?


Could this work impact adjacent tenants or common areas?


Noise, Dust & Disruption Mitigation Plan

8. Insurance, Liability & Risk Management

Provide insurance and liability information for the alteration work.


Will your contractors carry valid general liability insurance?



Will your contractors carry workers' compensation insurance?

Do you have property damage insurance covering this alteration?


Risk Management & Safety Protocols

9. Waste Management & Site Cleanup

Outline your plan for construction waste management and daily site cleanliness.


Will the project generate significant construction debris?


Will you be recycling any materials?


Daily Cleanup & Site Maintenance Plan

Will you require dumpster or waste container placement on-site?


10. Post-Alteration Requirements

Confirm requirements for project completion and handover.


Will you provide as-built drawings upon completion?

Will equipment come with manufacturer warranties?


Will staff require training on new equipment or systems?


Will you conduct a final cleaning before handover?

Proposed Final Inspection Date

11. Declarations & Authorization

Final declarations and authorization signatures.


I confirm that all information provided is accurate and complete to the best of my knowledge.

I understand that this request is subject to property management approval and may require additional documentation.

I agree to comply with all building rules, regulations, and lease terms during the alteration work.

I accept responsibility for any damages caused to the property or other tenants during the alteration work.

Has the landlord/property management provided preliminary approval?


Tenant Authorized Signature

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