ST0301A-CS101208Page 1 of 1
Rhonda Adloo - Re: Request for Post - Project Inspection
From: "Kathleen Felker" <Kathleen @license.state.tx.us>
To: "Rhonda Adloo" <radloo @coppelltx.gov >, "Morgan Okeefe" <Morgan @license.state.tx.us >, "Sue
Williams" <SueW @license.state.tx.us >, "AB TechInfo" < techinfo .ab @license.state.tx.us>
Date: 12/8/2010 8:45 AM
Subject: Re: Request for Post - Project Inspection
CC: "Keith Marvin" <KMARVIN @coppelltx.gov>
Rhonda,
Our record shows the completion date of this project is February 1, 2011.
I am including the personnel in this email that schedule inspections.
Please contact Morgan or Sue to schedule.
Thank you,
Kath leen
Kathleen Felker
Administrative Assistant III
TX Dept. of Licensing &Regulation
Fort Worth Region Field Office
(817)321 -8350
1- 800 - 687 -4102
Fax: (817)321 -8365
>>> "Rhonda Adloo" < rad loo @coppel Itx.gov> 12/7/2010 1:56 PM >>>
Attached please find a request for a final inspection for EABPRJ# B0000922 (Bethel Rd II) in the city of Coppell,
Texas. Also included is documentation that payment for the inspection was made in May 2010. Please call if
you have any questions.
Rhonda Adloo
Engineering Department
Administrative Technician
972/304 -3682
radloo@coppelltx.gov
Consider the environment before printing this email.
file: HC: \Documents and Settings \radloo \Local Settings\Temp\XPgrpwise\4CFF4 5 8F City_... 12/8/2010
TEXAS DEPARTMENT OF LICENSING AND REGULATION
COMPLIANCE DIVISION - ARCHITECTURAL BARRIERS
P.O. Box 12157 • Austin, Texas 78711 • (512) 539 -5669 • (877) 278 -0999 • FAX (512) 539 -5690
architectural. barriersCIicense. state. tx.us • www.6cense.state.tx.us
REQUEST FOR INSPECTION
In accordance with the Texas Architectural Barriers Act, Texas Government Code, Chapter 469.105, and
Administrative Rule 68.52, the owner of a building or facility subject to Chapter 469.101 of the Act shall obtain an
inspection from the department, a registered accessibility specialist, or a contract provider not later than the first
anniversary of the completion of construction.
The request for an inspection must be made by completing this form and submitting it to the authorized party not later
than 30 calendar days after the completion of construction.
The completed Request for Inspection form must be received prior to proceeding with the inspection. Following the
inspection, the owner will be advised in writing of the results.
PROJECT INFORMATION
PLEASE PRINT OR TYPE
1. Project Name:
$ETREL a St fojetf JR.S .
2. EABPRJ #:
q22.
3. Project Address:
Suite #:
loo 0 3 e e
of Co
City:
D PE LL
County:
r>AL .1--5
Zip:
75o1
OWNER / AGENT INFORMATION (Check One)
I am ❑ the Owner (the person /entity that holds title to the property) or the Owner's Designated Agent "
"If you are not the owner, a completed Owner Agent Designation Form must accompany this form.
4. Name:
RAS #
5. Company /Agency:
Keif k R.
State:
of Co
6. Address:
Fax:
Suite #:
City:
State:
Zip:
CoP L
1)X
75019
7. Phone:
9 72-304-3621
8. Fax:
72-
o4 - 35 70
9. **Email:
k m4f vin GCo ll
10. Signature of Owner/Designated Agent
Date
I have authorized the following to perform the inspection (Check One)
TEXAS DEPARTMENT OF LICENSING AND REGULATION
If TDLR is authorized to perform the inspection, the Request for Inspection form must be submitted to TDLR and
accompanied by the inspection fee identified in Rule 68.80. All fees received by TDLR are non - refundable
❑ REGISTERED ACCESSIBILITY SPECIALIST
If a RAS is authorized to perform the inspection, the Request for Inspection form must be submitted directly to the
RAS identified below. Forms and inspection fees received by TDLR will not be forwarded or refunded.
RAS Name:
RAS #
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
TDLR FORM 041 AB 06 -10 NOTE: An individual who completes and files this form with the Texas Department of Licensing and Regulation (the Dept.) is
entitled 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) 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 Architectural Barriers email notification list, which automatically provides Department information on matters affecting Architectural
Barriers. Your email address is confidential pursuant to the Texas Public Information Act. the Department will not share it with the public. For additional information link to:
htto: //www. "cans.. state.lx. us/ newsletters /TDL RnotificationLists. asp
Print Form
CITY OF COPPELL
PAYMENT AUTHORIZATION MEMO
Vendor #: 268
Pay to: Texas Department of Licensing and Regulation (TDLR)
Date: 5/4/2010
(Do not use initials /acronyms /abbreviations)
Address: P.O. Box 12157
Austin, TX 78711
Charge To: Bethel Road II (P 1) ST 03 -01 A
(Fund- Dept- Division- Expense Code)
Amount: $775.00
Description/ Explanation $775 for TDLR Project Filing Fee, i Reg
Fee-
Plan Review & Inspections
Approval
t fAl —
I
ACCOUNTING USE ONLY
Approved for payment by:
Date Paid
Check Number
Invoice No.
CITY OF COPPELL
Post Office Box 9478, Coppell, Texas 75019
(972) 462 - 0022
INVOICE DATE
INVOICE NO.
REMARKS
ACCOUNT
AMOUNT
5 -04 -10
5/4/10
FILING FEE
625-638-715 -5210
775.00
T H E. • C I T Y 0 F
COPPELL PO. Box 9478
Coppeil, Texas 75019
(972) 462 0022 F
x A
PAY * * * * * * * * ** * 775 DOLLARS AND 00 CENTS
TO THE ORDER OF
189966 18 9 9 6 6
CHECK NO.
3OST NATIONAL BANK
CHECK DATE
05 -14 -2010
PAY THIS AMOUNT
* * * * ** *775.00
VOID AFTER 90 DAYS
TEXAS DEPARTMENT OF LICENSING Q-
& REGULATION
PO BOX 12157
AUSTIN TX 78711
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