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ST0702-CS090727
TEXAS DEPARTMENT OF LICENSING AND REGULATION -b- - P.O. Box 12157, Austin, Texas 78711 ry " (512) 463 -6599 " (800) 803 -9202 • FAX (512) 475 -2871 h cct stomer serviceCallicense state tx us . www.license state tx us IMPORTANT INSTRUCTIONS -PLEASE READ BEFORE BEGINNING This is only the REGISTRATION of the 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 Specialist (RAS) for the required review and inspection of the project. Please print or type. For Department Use Only I EABPRJ ARCHITECTURAL BARRIERS PROJECT REGISTRATION FORM TL.. TDLR FORM AB05 10-08 NOT E: An Indvidual who completes and files this form with the Texas Department of Licensing and Regulation (the DepL) Is entitled to the following: 1) to be Wormed about the Information that the Dept. collects about the Individual, upon their request and subject to a few exospoons; 2) to receive and review the Information, under Sections 552.021 and 552.023 of the Texas GovL Code; and 3) to have the Dept correct Information about the Individual that is Incorrect, under Section 559.001 of the Texas Govt. Code. - The Department will add your address to the Architectural Barriers email notification list, which automatically provides Department Information on matters affecting Architectural Barriers. Your small address Is confidential pursuant to the Texas Public Information Act, the Department will not share It with the pudic For additional information link to: http: /Avww. licenses( ate. bcus / newsletters /TDLRnotlfx;ationLists .asp v r ayuatlu pidtI Idvlew will De perrormea Dy: (Check One) )_jv TDLR j. J RAS (Name /Lic #): TE ING PROJECT 1.Name RAS # (a applicable) I AdIV .L 2.Address 0 j /�. i `T Sir O�5 , Cs Sl CIty Q ,¢S State T Zip "Za2 3. Phone ' *Email 2rq he ( 217- Z2 o 4raasa. PROJECT 4. Project Name Coy SIX-7-Al 5. Building or Facility Name 6.Address Cit Zip County `u 7 " c TENANT if other than owner 7. Tenant Contact Name Phone e. Name BUILDING OR FAC ILITY OWNER (person or entity that holds title to propert C' Phone OF 97Z 3691 9. Address City - 2 t; #t" �L v (O . G'D State ix Zip 7S 10. Own r Contact Na �• N1AtZ i �. 11. Adore s c ( A y Ci Ssr ,rte `' State � Zip 12. P one " "Email Y7Z a�f - S(o qr vi h CPGL Co& 6i-L DESIGN FIRM 13. Name) Phone 14. A d dre ss City `u 21 State - 2 Z ea Zip S -. dS20 L/0s 1 ^�.4 -S 79 Z 15. Desig r N me "Email Q LL � ( 4FSQ. CO3-7 16. Type of License: (Check One) Architect ngineer ❑ Interior Designer ❑ Landscape Architect ❑ Other includes not licensed)Y LicenseJaluxnber (if applicable) L Z 3 PROJECT DESCRIPTION 17. Start Date MM/YY : : 18. Completion Date Ml �� O q 19. Estimated Cost $ (7 /0 U 20. Type of Work: (Check One) ❑New Construction Rl' enovation /Alterations ❑ Additions to Existing Building ❑Historic Preservation 21. Type of Funds: (Check One) ublic Funds, public land, or is a state lease 22. State Lease No. (d applicable) []Privately funded, on private land for private use 23. Does this building(s) have more than one level? (Check One) Yes fj;�No 24. Are there any elevators, escalators, or platform lifts in this building? (Check One) Q Yes 2flo 25. Does this building(s) have any boilers? Check One Yes o 26. Scope of Work oNSIsrs of ZMe lAnf -,41. .J et- 7 7 S. or` a+4j&r 10 . 4.+z„+T 4fM ARAr4cC Add1 u nt.i /Y /M v�..SvfS llfl. �yAla a` LSc/ STw(, /�4�+4L�►i .F 4z,(- Ad"lliA r d6"Awy 7 f wrx N' SSC.ier To onolpt Ye TDLR FORM AB05 10-08 NOT E: An Indvidual who completes and files this form with the Texas Department of Licensing and Regulation (the DepL) Is entitled to the following: 1) to be Wormed about the Information that the Dept. collects about the Individual, upon their request and subject to a few exospoons; 2) to receive and review the Information, under Sections 552.021 and 552.023 of the Texas GovL Code; and 3) to have the Dept correct Information about the Individual that is Incorrect, under Section 559.001 of the Texas Govt. Code. - The Department will add your address to the Architectural Barriers email notification list, which automatically provides Department Information on matters affecting Architectural Barriers. Your small address Is confidential pursuant to the Texas Public Information Act, the Department will not share It with the pudic For additional information link to: http: /Avww. licenses( ate. bcus / newsletters /TDLRnotlfx;ationLists .asp CITY OF COPPELL Post Office Box 9478, Coppell, Texas 75019 (972) 462 - 0022 INVOICE DATE INVOICE NO. REMARKS ACCOUNT AMOUNT 7- 14- 09 I I FEES TDLR PROJECT 628 - 641 - 565 -4220 775.00+ T'H E 1 T Y O�F P.O. Bx 9478 COPPELL C ppeol Texas 75019 ,tea,, �-. - (972) 462 -0022 gy F 4 9 q k A S t o PAY * * * * * * * * ** *775 DOLLARS AND 00 CENTS TO THE ORDER OF TEXAS DEPARTMENT OF LICENSING & REGULATION PO BOX 12157 AUSTIN TX 78711 181967 CHECK NO. FROST NATIONAL BANK CHECK D ATE 07 -24 -2009 PAY THIS AMOUNT ********775.00 VOID AFTER 90 DAYS 11' 18 196 711 1 :1140000931: 9S 000 2 169110 CITY OF COPPELL PAYMENT AUTHORIZATION MEMO Note: Use mouse to navigate inform Vendor#: 268 Date: 7/14/2009 Pay to: Texas Department of Licensing and Regulation Address: P. O. Box 12157 Austin, TX 78711 Charge To: South Coppell CIP Project (ST 07 -02) 628- 641- 665 -4220 Amount: $ 775.00 Description /Explanation: $775 for TDLR Project Filing Fee, includes Registration, Plan Review & Inspection Fee Approval: ACCOUNTING USE ONLY Approved for payment by: Date Paid: Check Number: Invoice No. o. Updated 12/01/05 USA Airbill 2195545203 F print) Date __ Sender's FedEx Account Number Sender's rn r I i �� q ► Name L �bts. v Phone - �1�A �OOI Dept/Roor /Surte/Room Company CITY W CCWPELL- Address 255 PARKWAY cit COP PE stat zip- !# l q — © Your Internal Billing Reference Information (Optional) (First 24 characters will appear on invoice) To (please print) . r�Q%j�/y �� - / / Q /�Q Recipients - - - �� - '`7`•'�/ "a/ • — ? l _l _ IS _ — ` Name v (/ Ph000_ DepOeor /Suite/Room CompanI Address (To *HOLD' at FedEx location, p��rintFedE address here) (we Cannot Deliver to P.O. Boxes or P.O. Zip Codes) I�d�L, City �/IIV State Tap For HOLD at FedEx Location check here For Saturday Delivery check here ❑ Hold Weekday Hold Saturday (Not available at all loesumms) Ex ra Charge. No available ro all lecationsl (NOtaveilehle with ❑I Not available with Fed Ex First Overnight or (Net. vailable with FedEx First Overnight FedEx First Overnight) FedEx Standard Overnight) or FedEx Standard Overnight) Service Conditions, Declared Value, and Limit of liability — By using this Airbill, you agree to the service conditions in our current Service Guide or U.S. Government Service Guide. Both are available on request SEE BACK OF SENDERS COPY OFTHIS AIRBILL FOR INFORMATION AND ADDITIONALTERMS. we will not be responsible for any claim in excess of $100 per package whether the result-of loss, damage, or delay, non - delivery, misdelivery, or misinformation, unless you declare a higher value, pay an additional charge, and document your actual loss in a timely manner. Your right to recoverfrom us for any loss includes intrinsic value of the package, loss of sales, interest, profit, attorney's fees, costs, and other forms of damage, whether direct, incidental, consequential, or special, and is limited to the greater of $100 or the declared value but cannot exceed actual documented loss. The maximum declared value for any FedEx Letter and FedEx Pak is $500. Federal Express may, upon your request, and with some limitations, refund all transportation charges paid. See the FedEx Service Guide for further details. Sender's Co 2Z977 00090/001 LW Express Package Service Packages under150lbs- Da b r c om somaa,0as ❑ FedEx Priority Overnight �j FedEx Standard Overnight FedEx 2Da (Nerthusineas morning) (Next business afternoon) ❑ ISecond busin� day) ❑ 1:1 NEWFedEx First Overnit FedEx Letter Rate not available. (Earliest next business morning delivery to select locations) Minimum charge: (Higher mites apply) one pound FedEx Way rate. Express Freight Service Packages over150/bs. Deuverycommtmentmay bis later in some areas. ❑ FedEx Overnight Freight ❑FedEx 2Day Freight ❑FedEx Express Saver Freight (organ busyness -day service (second business -day Npto96usiness -day service f yd [ante) service for any distance) based upon distance) (Call for delivery schedule. See back for detailed descriptions of freight products.) Packaging FedEx [] FedEx {{�� FedEx Other ❑ Letter Pak ❑ Box Y�lTube ❑ Pk L Declared value limit $500. —� g' Special Handling IAereaaehetl Shippms Does this shipment contain dangerous goods? ❑Yes tie p aea�pnl ❑Yes o anon e a 6 ❑ Dry Ice x Dry Ice, 9, UN 1845 III kg. 904 CA[:] Cargo Aircraft Only (Dangerous Goods Shipper's Declaration not required) Payment S Bill ction I end in er ii ❑Recipient ❑Third Party ❑Credit Card E] Cash/ Bill o l will be bill (Enter FedEx account no. or Credit Card no. below) -- Check FedEx Account No Credit Exp Card No. Date_ Total Packages Total Weight Total Declared Value` Total Charges $ .00 $ When declaring a value higher than $100 per shipment, you pay an additional charge. See SERVICE CONDmONS, DECLARED VALUE AND UNIT OF LIABILITY section for further information. Release Signature Sign to authorize de very without o inin si ature. Your signature authorizes Federal Express to deliver this ship - meat without obtaining a signature and agrees to indemnify and hold harmless Federal Express from any resulting claims. Questions? Th World 0 n Tim Call1.800•GO•Fedi - 800 - 463 - 3339) 272 rp� Rev. Dare 6t96 PART 0147956 ©l 994.96 FedEx PRINTED IN J.S.A.