SW0801-CS090414Page 1 of 1
DiWanna Baskins -Special Inspection
From: "Ginna Harris" <Ginna~license.state.tx.us>
To: <dbaskins~a ci.coppell.tx.us>
Date: 4/14/2009 4:13 PM
Subject: Speciallnspection
Attachments: ab005.pdf
Hello,
Please complete the attached Project Registration Form and return to me at your earliest convenience.
I'll be in touch as soon as I speak with Bob Posey.
Thank you,
Ginna Harris
Administration Team Leader
Texas Dept of Licensing and Regulation
PO Box 12157
Austin, Texas 78711
512-539-5669 (voice line}
512-539-5690 (fax}
ginna a~license.state.tx.us
file://C:1Documents and SettingslradloolLocal Settings)TemplXPgrpwise149E4B614City_of... 9/2/2009
(9/2/2009) DiWanna Baskins - ab005.pdf
TEXAS DEPARTMENT OF LICENSING AND REGULATION
P.O. Box 12157, Austin, Texas 78711
~~ ,,~ ~ ~ ~;:, ~, (512) 463-6599 • (800) 803-9202 • FAX (512) 475-2871
'i'~''' r ~ ` ~' `~' customerservice @licensestate.t x.us ~ www.licensestate.tx.us
l~, .i~~ ~ ~G.'
1 ,~
- IMPORTANT INSTRUCTIONS -PLEASE READ BEFORE BEGINNING
This is only the REGISTRATION ofthe construction project. The building/facility
owner is responsible for ensuring that the Project Registration Form, construction
documents, and applicable fees are mailed, shipped, or hand delivered to TDLR or a
Registered Accessibility Speaalist (RAS) for the required review and inspection of
the project. Please print ortype.
For Department Use Only
EABPRJ
ARCHITECTURAL BARRIERS PROJECT REGISTRATION FORM
The required plan review will be performed by: (Check One) ~ TDLR ^RAS (Name/Lic #):
1.Name RAS # (if applicable)
2.Address City State Zip
3. Phone
( ) Email
PROJECT
4. Project Name
5. Building or Facility Name
6.Address City Zip County
TENANT (if other than owner)
7. Tenant Contact Name Phone
BUILDING OR FACILITY OWNER (Derson or entity that holds titre to property) I
8. Name Phone
9. Address City State Zip
10.Owner Contact Name
11. Address City State Zip
12. Phone Email
DESIGN FIRM
13. Name Phone
14. Address City State Zip
15. Designer Name **Email
16. Type of License: (Check One) ^ Architect ^ Engineer
^ Interior Designer ^ Landscape Architect ^ Other (includes not licensed) License Number (if applicable)
PROJECT DESCRIPTION
17. Start Date (MMIYY): 18. Completion Date (MMIYY): 19. Estimated Cost $
20. Type of Work: (Check One) ^New Construction ^ RenovationlAl terations ^ Additions to E~asting Building ^Historic Preservation
21. Type of Funds: (Check One) Public Funds, public land, or is a state lease
Private) funded on rivate land for rivate use 22. State Lease No. (if applicable)
23. Does this building(s) have more than one level? (Check One) ^Yes No
24. Are there any elevators, escalators, or platform lifts in this building? (Check One) ^Yes ^ No
25. Does this building(s) have any boilers? (Check One) Yes No
26. Scope of Work:
TDLR FORMAB05 10-08 NOTE: Anindividual who completes and files this formw~h the Texas Department of Licensing and Regulati on (the Dept.) is ent~led to the following:
1) to be informed about the information that the Dept. collects about the individual, upon their request and subject to a few exceptions;
2) to receive and review the information, under Sections 552.021 and 552.023 of the Texas Govt. Code; and
3) to have the Dept. correct information about the individual that is incorrect, under Section 559.004 of theTexas Govt. Code.
*"The Department will add your address to theArch~ectural Barriers email notification list, which automatically provides Depa rtment information on matters affecting Architectural Barriers.
Your email address is
confidential pursuant to the Texas Public Information Act; the Department will not share it w~h the public. For add~ional information link to: http:llwww.license.state.tx.uslnewsletters
lTDLRnotificatio nLists.asp
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(9/2/2009) DiWanna Baskins - ab005.pdf
INSTRUCTIONS FOR COMPLETING A PROJECT REGISTRATION FORM - AB 005
1. Person Registering Project Name -Enter the name of the person completing the form
2. Address -Enter the mailing address and suite number (if applicable) of the person named in #1
3. Phone -Enter the phone number and email address (optional) of the person named in #1
4. Project Name -Enter the name of the project (examples: CLASSROOM ADDITION, TENANT FINISH OUT FOR DR. SMITH)
5. Building I Facility Name - If this project is located in a building or facility with a name, enter the name (examples: the "CLASSROOM ADDITION"
is located in the building or facility named "WASHINGTON HIGH SCHOOL"; the "TENANT FINISH OUT FOR DR. SMITH" is located in the office
building named "MEDICAL PLAZA II")
6. Project Address -Enter the hp ysical address (if available) and the suite number (if applicable) of the project. Post Office Box numbers are not
acceptable.
7. Tenant Contact Name -Enter the name and phone number for the contact person or persons, company, corporation, authority, commission,
board, governmental entity, institution or any other unit that will occupy the project space.
8. Building or Facility Owner -Enter the name and phone number of the person or entity (company, corporation, authority, commission, board,
governmental entity, institution or any other unit) that holds title to the property.
9. Owner Address -Enter the mailing address and the suite number (ifapplicable) of the facility owner named in#9.
10. Contact Name - If there is a contact person other than the facility owner (as listed in #9), enter the name and phone number of the person
representing the owner
11. Contact Address -Enter the mailing address and the suite number (ifapplicable) of the person named in#11 if other than the owner.
12. Contact Phone -Enter the phone number and email address (optional) of the person named in #11 if other than the owner
13. Design Firm -Enter the name and phone number of the design firm or company responsible for the design of the project.
14~ Firm Address -Enter the mailing address and the suite number (if applicable) of the firm named in #14.
15. Designer Name -Enter the name of the architect, engineer, interior designer, or landscape architect with overall responsibility for the design of the
project and whose seal is affixed to the drawings and enter their a-mail address.
16. Type of License -Check the box for the applicable license type of the designer and enter the license number (if applicable). If no design
professional, check the box for "other".
17. Start Date -Enter the date construction is scheduled to begin (month and year).
18. Completion Date -Enter the date construction is scheduled to be completed (month and year).
19. Estimated Cost -Enter the estimated cost of construction. Cost should not include site acquisition, furnishings, or equipment that is not part of the
building mechanical systems.
20. Type of Work -Check the box for the applicable type of work.
21. Type of Funds- Check the box for the applicable method of funding.
22. State Lease No. (if applicable) -Enter the state lease number if the construction project is for purposes of a state agency lease contract and /or
occupancy by a state agency.
23. Does this building(s) have more than one level? -Check yes or no
24~ Are there any elevators, escalators, or platform lifts in this building?-Check yes or no
25. Does this building(s) have any boilers? -Check yes or no
26. Scope of Work - Enter a detailed description of the construction activities. WHAT TO SUBMIT
1. One complete set of construction documents (plans and
TDLR FEE SCHEDULE specifications) for all disciplines. All documents applicable to the
The following fees are applicable only to services performed by TDLR. project should be subm fitted as one package.
(Note: If services will be performed bya RAS, please contact the RAS forfee
information as they set and collect their own fees.) 2. A completed Architectural Barriers Project Registration Form or
AB Project Registration Confirmation page for each site/address
or State Lease Registration Form (if applicable).
Estimated Construction Cast Plan Rerieuv Fee TDLRProject Inspection Fee
Filing Fee
3. If the review and/or inspection will be performed by TDLR,
50,000 -200,000 $250 $175 $35o submit a check or money order payable to "Texas Department
of Licensing and Regulation" at P.O. Box 12157, Austin, Texas
200.001 -500.000 $315 $175 $375 78711.
500,001 -1,000,000 ~o $175 ~ 4. When construction documents are submitted after completion of
1,000,001 - 5,000,000 $445 $175 $445 construction, the late submitta I Project Filing fee shall apply.
5. An architect, interior designer, landscape architect, or engineer
5.000.001 -10.000.000 $575 $175 $575 with overall responsibility for the design of a building or facility
subject to §469.101 of the Act, shall mail, ship, or hand-deliver
10,000,001 -15,000,000 $520 $175 ~ the construction documents along with a Proof of Submission
form to the department, a registered accessibility specialist, or a
15,000,001- 25,000,000 $785 $175 $785 contract provider not later than the fifth day after the plans and
25.000.001 -50.000.000 X55 $175 specifications are issued. In computing time under this
subsection, a Saturday, Sunday or legal holiday is not included.
50,000,001 -75,000,000 $1175 $175 $1175
6. In instances when there is not a design professional with overall
> 75,000,000 ConfadTDLR $175 Conrad TDLR responsibility, the owner of a building or facility subject to
§469.101 of the Act, shall mail, ship, or hand-deliver
LateProied Filina Fee ~ construction documents to the department, a registered
PrdinimaryRevian~Fee $145 ~ accessibility specialist, or a contract provider prior to filing an
application for building construction permit or commencement of
State Leaselr~p~ion (noocnstn.iction) $225 per~~ construction.
7. An Elimination of Architectura I Barriers Project Registration form
sp~al Inspection Fee $215 perhou~.one hax mrimum or Architectural Barriers Project Registration Confirmation Page
Vanaix;e Application Fee $175 each must be completed for each subject building or facility and
submitted along with the applicable fees when the design
Vanaix;e Appeal Fee $200 each professional or owner submits the construction documents. (One
- - - - - - - - - complete set of construction documents (plans and
Example: Estimatedconstrudioncost is$250,000; submittheprojedfilingfe eof$175.OOand specifications) for all disciplines). All documents applicable to
the review fee of $315.OOfora total o f$490.00. The ins pectionfee would be $375.00. the project should be Submitted aS one package.
NOTE: All fees are non-refundable .
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