SW0801-CS110426 T H E C 1 T Y O F
COPPELL
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April 26, 2011
Texas Department of Licensing and Regulation
Compliance Division — Architectural Barriers
P.O. Box 12157
Austin, TX 78711
RE: SW 08 -01 Denton Tap Sidewalk In -fill Project
EABPRJB 1000034
To Whom It May Concern:
This letter will serve as our official request for inspection on the referenced project. Due to
the nature of this project, I would ask that your inspector contact me prior to the inspection
so that someone on our staff can attend the inspection.
If you have any questions or need any additional information please feel free to contact me.
Sincerely,
George Marshall, P.E.
Civil Engineer
Office: 972 - 304 -3562
Fax: 972 - 304 -3570
gmarshall@coppelltx.gov
cc: Larry Davis, Construction Inspector
A FAMILY COMMUNITY FOR A LIFETIME
255 PARKWAY * P.O. BOX 9478 * COPPELL TX 75019 * TEL 972/462 0022 * WWW.COPPELLTX. GOV
TEXAS DEPARTMENT OF LICENSING AND REGULATION
• . :41\ COMPLIANCE DIVISION - ARCHITECTURAL BARRIERS
yyi ' P.O. Box 12157 • Austin, Texas 78711 • (512) 539 -5669 • (877) 278 -0999 • FAX (512) 539-5690
architectural .barriers @license.state.tx.us • www.license.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: 2. EABPRJ #:
SW08 -01 Denton Tap Sidewalk Infill B1000034
3. Project Address: Suite #:
Denton Tap Road
City: County: Zip:
Connell Dallas 75019
OWNER / AGENT INFORMATION (Check One)
I am Nthe 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: 5. Company / Agency:
Ken Griffin, P.E. City of Coppell, TX
6. Address: Suite #:
255 Parkway Blvd.
City: State: Zip:
Connell TX 75019
7. Phone: 8. Fax: 9. "`Email
972 - 304 -3679 972 - 304 -3570 kgriffin(&coppelltx.Pov
--1 4- .Z &•I!
10. Signa r e of Owner /Desi na d Agent Date
/ 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 041AB 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
http: / /www. license. state. tx. us/ newsletters /TDLRnotificationLists. asp