ST9302-CS010531 TEXAS DEPARTMENT OF LICENSING AND REGULATION
PROJECT REGISTRATION FORM
Code Review and Inspections / ARCHITECTURAL BARRIERS
P.O. Box 12157, Austin, Texas 78711 (512) 463-1668 (800) 803-9202 FAX (512)475-2871
Email Address: Architectural. Barriers @/icense. state, tx. us Internet Address: w~n~.license.state, tx. us
~LEASE PRINT OR TYPE PLEASE SEE IMPORTANT INSTRUCTIONS ON REVERSE SIDE BEFORE BEGINNIN(
1. Project Name
Coppell Sandy Lake Road Paving, Drainage and Water System Improvements
2. Building/Facility Name
N/A
3. Location/Address Sandy l_aka Road I City Zip Code
County
Coppell 75019 I Dallas
4. Tenant (if other than owner) N/A Telephone Number (
5. Mailing Address [ City State [ Zip Code
6. Contact Name Telephone Number
(
7. Mailing A4dress ICily State I Zip Code
Telephone Number
8. Building/FacilityOwner(NOTtenant) City of ¢Op~l/ [97211 304-3679
9, Mailing Address 255 Parkway Blvd. Coppell State TX Zip Code75019
10. Contact Name Telephone Number
Ken Griffin, P.E, (972) 304-3679
11. Mailing Addresssame as above IciLy State I Zip Code
12. Design Firm Kimley-Horn & Associatest Inc. Telephone Number (817)335-6511
13. I)4~iling.~ddress I City State j Zip Code ....
ou]. bnerry Street, Unit f/ll , Fort Worth TX ~ /OLUZ
14. Designer Information: I-IArchitect ~Engineer DlnteHor Designer I-ILandscape Architect r-IOther License No. (If applicable) [ Date Drawings Sealed
Print Name: Jeff James, P.E. 82677 I 06/29/98
15. Scheduled Construction [ 16. Scheduled Construction 17. Estimated Project
Start date (mm/w): 10 / 98, Completion Date (MM/YY): 02 ! 02 Constn~onco~ $9,963~,3~9.~5
18. Description: Indicate type o[ work and briefly describe scope.
t"lNew Const~'uction r-IRenovation/Alte~ation r-lAdditions/Renovafions I-IAddition to Existing Bldg. nNew Construction/Renovation F1Histo~c Preservation
Scopeofwo~:Reconst~'-dction of 10,000 LF of 2-lane asphalt road to 4-lane divided concrete
pavement with sidewalks, new 30" water line,:Jd-jQStment to existing utilities
19. i~ This project involves Public Funds, Public Land, Tax Abatement or is a State Lease [ 20. State Lease No.
[] This project is Privately Funded, on Pdvate Land, fer Private Use [ (if applicable)
21. I hereby notify the Texas Department of Licensing and Regulation of the described project and of my intent to pedorm, o~ cause to be pedo~med, all
se~ices necessary to design said project in accordance with the provisions of Article 9102, Texas Civil Statutes. I certify that I am the regis{erod design
professional with overall responsibility [o~ the design of the project and whose seal is affixed to the drawing(s).
I
Signature of Architect. Engineer. Intedor Designer, o~ Landscape Architect Date Email Address
OR
I hereby noti~j the Te/~ Department of Licensing and Regulation of my intent to comply with the provisions of Article 9102, Texas Civil Statutes.
Signat~Jre of Building~Owr~r o~ Designated Agent Date Email Address
INDEPENDENT/MUNICIPAL CONTRACT PROVIDER USE ONLY Oatoconstructiondocumentswe~e
ICP/MCP Project Number ICP/MCP Number: Plan Review submitted to the ICP/MCP for Plan Review
ICP/IVICP Number: Inspection
I ce~ that the infocmation pertaining to the submission date of the construction documents is true and
correct.
S~nature of Independont/Municipal Con,'act Provider Date
DEPARTMENT USE ONLY D~te Submitted to TDLR
AB Number Complaint Number