SW0801-CS090420Page 1 of 1
DiWanna Baskins -Special Inspection -Sidewalk project
From: "Ginna Harris" <Ginna~license.state.tx.us>
To: <dbaskins~a ci.coppell.tx.us>
Date: 4/20/2009 8:56 AM
Subject: Special Inspection -Sidewalk project
Attachments: AB045. pdf
Good Morning DiWanna!
I spoke with Bob Posey this morning regarding the special inspection for the sidewalk project.
He would like for you to complete the attached Special Registration Form............you can disregard the form I
sent you last week. Please complete this form and send back to me at your earliest convenience. As soon as I
receive the completed form, the project will be registered and we can move forward with the inspection.
Please give me a call or email if you have any questions.
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)TemplXPgrpwise149EC38C6City_o... 9/2/2009
(9/2/2009) DiWanna Baskins - AB045.pdf
TEXAS DEPARTMENT OF LI LENSING AND REGULATION
COMPLIANCE DIVISION -ARCHITECTURAL BARRIERS
P.O. Box 12157 ^-lusti n, TE~cas 78711 ^(512) 463-6599 ^(800) 803-9202 ^FAX (512) 475-2871
customer.s~vi oe C~J i oense.state.t x.us ^www.l icensestat e.tz.us
SPECIAL REGISTRATION FORM
Buildings or facilities with an estimated construction cost of less than $50,000 or projects that are not subject to the Act maybe
registered, reviewed, and/or inspected by the department, a registered accessibility specialist, orconti-act provider by mailing, shipping, or
hand-delivering this form with the following applicable fees.
**Special projects may not be registered on-line**
For special projects submitted for review and/or inspection to TDLR, this form must be accompanied by the following fees. For special
projects submitted to a registered accessibility specialist or a contract provider, only the project filing fee must be submitted to the
department.
Less than $50,000 TDLR Filin Fee TDLR Plan Review Fee TDLR Ins ection Fee
R istration & Review Onl 175 200 NA
R istration & Ins ection Onl 175 NA 200
Registration, Review & Inspection ~ 175 ~ 200 ~ 200
Not Sub'ect to the Act
R istration & Review Onl 175 licable Fee-See 68.80 NA
R istration & Ins ection Onl 175 NA licable Fee-See 68.80
Registration, Review & Inspection ~ 175 ~ Applic able Fee-See 68.80 ~ Applicable Fee-See 68.80 ~
PRINT OR TYPE
1. Project Name
2. Building or Facility Name
3. Address City Zip Code County
4. Building or Facility Owner Name (Person or Entity That Holds Title to Property) Phone
5. Mailing Address City State Zip
6. Designated Agent Name (if other than owner) Phone
( )
7. Mailing Address City State Zip
8. Scheduled Construction Start
Date (MM/YY): 9. Scheduled Construction Completion
Date (MMIYY): 10. Estimated Project Construction Cost
$
11. Description: Indicate type ofwork by checking all that apply and describe.
~ Construction ®ditions to Existing Bldg. gyrations ®toric Preservation
Detailed Description of Construction Activity:
~lic Right of Way
12. I HEREBY NOTIFYTHE TEXAS DEPARTMENT OF LICENSING AND REGULATION OF MY INTENT TO COMPLY WITH THE PROVISIONS OF THE
TEXAS ARCHITECTURAL BARRIERS ACT, TEXAS GOVERNMENT CODE, CHAPTER 469. ALL INFORMATION SUBMITTED ON THIS APPLICATION
AND ALL ATTACHMENTS ARE TRUEAND CORRECT.
Building Owner or Designated Agent (Printed Name)
~ ~-
Signature of Building Owner or Designated Agent Date Email
TDLR FORM 045AB 12 OS NOTE: An individual who completes and files this form with the Texas Department of Licensing and Regulation (the Dept.) is entkled to the following:
1) tobe informed about the information thatthe Dept. collects about the individual, upon their request and subject to a fewexceptions;
2) toreceive and review the information, under Sections 552.021 and 552.023 of the Texas Govt. Code; and
3) have the Dept. correct information about the individual that is incorrect, under Section 559.004 of the Texas Govt. Code.
**The Department will add your address to the Arch~ectural Barriers email notification list, which automatically provides Department information on matters affecting Arch~ectural Barriers.
Your email address is
confidential pursuant to theTexas Public Information Act; the Department will not share k w~h the public. Foradd~ional information link to: http:/lwww.license.state.tx.usln=wsletters/TDLRn
otificationLists .asp
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