Loading...
ST0501-CS120724 TEXAS ACCESS WWW.TEXASACCESS.COM TEXAS ARCHITECTURAL BARRIERS PLAN REVIEW SUBMITTAL CHECKLIST This checklist is provided as a convenience aid to ensure that all items submitted to Texas Access are done so in accordance with the Rules and Procedures of the Texas Dept. of Licensing and Regulation (TDLR). Click on the blue links below to obtain the forms required by this checklist, or visit: http://www.texasaccess.com/tdlr forms.htm. For a more comprehensive list of submittal instructions and forms, please visit: http://www.texasaccess.com/tdlr plan review.htm. To avoid delays in processing, all forms must be fully completed, signed, and dated (when applicable). Forms may be mailed, couriered, faxed, or emailed in portable document format (pdf). []"TDLR Architectural Barriers Project Registration Form This is the paper version of the official state architectural barriers project registration form. If this form is submitted to us in lieu of the below Confirmation Page, we will register the project online for you and include a copy of the Confirmation Page (with the EABPRJ Number)to the end of the plan review report. OR: ❑ TDLR Architectural Barriers Project Registration Confirmation Page Visit the state's website to register your project online and pay the $175 Project Filing Fee. For projects registered online at the TDLR's website, the resulting Confirmation Page with the EABPRJ Number will be required in lieu of the above Registration Form. To register your project online, begin here: http://www.texasaccess.com/tdlr project registration.htm The Building/Facility Owner's Email Address is: kgriffln @coppelltx.gov gmarshall @coppelltx.gov We are required to address and issue our reports to the Owner(unless an Agent has been previously designated). If the project was registered online, refer to the Confirmation Page and write in the email address of the Contact Name for the Owner. NOTE: The person making the submittal will also receive a copy of the report. ❑v TDLR Proof of Submission Form (POS) The Proof of Submission form must be fully completed, signed and dated, by the design professional with overall responsibility for the design of the project. In the absence of such a design professional, the Owner is required to make the submittal. In that event, this form will not be required. NOTE: It is critical that the Date Construction Documents Issued/Submitted is accurate. The two dates should not be more than twenty(20) business days apart. O'One complete set of construction documents This includes all plans and specifications applicable to the project, including architecturals, civils, MEP's, specifications, etc. Construction documents must be plotted to-scale and in a hard format. Er Plan Review Fee with *Project Filing Fee payable to `Texas Access' in the amount of $ 950 .00 To determine the fee, see our published Fee Schedule. *If you already registered the project online and paid the $175.00 Project Filing Fee, do not include that amount. You may pay the mandatory final inspection fee at time of submittal (recommended). The applicable fees MUST be included with the submittal per TDLR Rule 68.50(c) and 68.80(q). Temporary checks are not acceptable and will be returned to the person making the submittal, thus delayinq the project. ErTDLR Request for Inspection Form (RFI) (OPTIONAL) If your payment amount includes the final inspection fee, we encourage you to include this form at time of project submittal. There is no penalty for submitting this form prior to construction. This form must be signed and dated by the Owner holding title to the property. If any party other than the Owner signs this form as 'the Owner's Agent', then we must also be in receipt of a TDLR Owner Agent Designation Form (OAD) signed by the Owner and naming that party as its Agent. SUBMIT THE ABOVE ITEMS TO: Texas Access 3415 Misty Meadow Dr. Dallas, TX 75287-6025 Need Help? Toll Free: 1 + (800) 880-6986 ! 2_ :y Date 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 s architectural.barriers(d,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#: ST05-01 Deforest Road Reconstruction 3. Project Address: Suite#: Deforest Road City: County: Zip: Coppell Dallas 75019 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: 5.Company/Agency: Ken Griffin, P.E., CFM City of Coppell Department of Engineering &Public Vii Suite#: 6. Address: 255 Parkway City: State: Zip: Coppell Texas 75019 7. Phone: 1 8. Fax: 9. **Email: 972-304-3679 972-304-3570 kgriffin @coppelltx.gov I 1ti�- x 10. Signature f Owner/Design 41-- o 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. El 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# Blair Baker 0019 Address: City: State: Zip: 3415 Misty Meadow Dr. Dallas TX 75287-6025 Phone: Fax: Email: (800) 880-6986 1 (800) 880-6986 BlairB @TexasAccess.com 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://wvwa license.state.tx.us/newsietterslTDLRnotificationLists.asp TEXAS DEPARTMENT OF LICENSING AND REGULATION For Department Use Only P.O. Box 12157,Austin,Texas 78711 ,. ,a; (512)463-6599•(800)803-9202• FAX(512)475-2871 '‘,� ,�•,,ks: customer service cense.state.tx.us • wuvw.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 e mailed,r the required or hand to TDLR of a EABPRJ Registered Accessibility Specialist the project. Please print or type. ARCHITECTURAL BARRIERS PROJECT REGISTRATION FORM The required plan review will be performed by:(Check One) ❑TDLR RAS NamelLic#1: BLAIR BAKER (RAS #0019) PE•SON REGISTERING P:• CT __.. RAS#Of appl,cao c 1.Name George Marshall City State Zip 2.Address Coppell TX 75019 255 Parkway *Email Phone ( )972-304-3562 gmarshall @coppelltx.gov PROJECT 4. Project Name ST05-01 Deforest Road Reconstruction 5. Building or Facility Name City Zip County 6.Ad Coppell 75019 Dallas Deforest st Road ■ p► • II- 8.11 Sall" 7. Tenant Contact Name Phone = Phone 972-304-3679 8. Name City of Coppell City State Zip 9. Address Coppell TX 75019 255 Parkway 10, Owner Contact Name George Marshall, P.E. &Ken Griffin, P.E. CFM City State Zip 11. Address Coppell TX 75019 255 Parkway 12 Phone '"Email 972-304-3679 kgriffin(coppelltx.gov &gmarshaWcoppelltx.gov DESIGN FIRM _ --- one 13. Name ?72-620-1255 Burgess&Niple, Inc. — — _-- City State Zip 14.Address Dallas Texas 7p229 11117 Shady Trail **Email 15. Designer Name Email Lowell DeGroot p En ineer License Number>r.ppr�ablet 16.Type of License: (Check One) ❑ Architect g TX 93862 Landsca.e Architect [' Other includes not licensed ❑ Interior Desisner ❑ an PROJECT DESCRIPTION 19. Estimated Cost$2,096,463.73 17. Start Date MM/YY : 12/12 18. Com•letion Date MM/YY : 09/1 20.Type of Work: (Check One) [New Construction ® Renovation/Alterations traionse❑ Additions to Existing Building OH(saoncbPreservation 21. Type of Funds: (Check One) El Public Funds. public ❑Privately funded, on private land for private use Are the •rivate funds •rovided b the tenant? ❑ Yes❑No (Check One) ■ Yes 01- No 23. Does this building(s)have more than one level? 24. Are there any elevators,escalators, or platform lifts in this building? (Check One) ❑Yes © No Check One ❑ Yes D No 25 Does this buildin. s have an boilers? 26. Scope of Work: Reconstruction of Sidewalks&street is entitled to the tol9o••wng� NOTE' An individual.44r completes and files this form with the I exas Department of Licensing and Regulation(the Dept) I I)1.R FORM A1305 02-12 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.arid 3) to have the Dept.correct information about the individual that is incorrect.under Section 559.004 of the Texas Govt.Code. Department will d to Barriers email notification list. automatically Department k t matters t r is con enl purl nttothe Texas Pub Information Architectural ct;the Department not sh re4 with the public or add tional informa onlino h p hvww I cense state tx usnewsletters/TDLRnolficaionlistsasp ` TEXAS DEPARTMENT OF LICENSING AND REGULATION P.O.Box 12157•Austin,Texas 78711 '--,.5, . , • (512)475 2871 ' :, .i 512 463-6599• (800)803-9202 FAX{ ) s �, j . wvmlicerrse state.Uc es ` '.. �s, ( customer serrNie.br us PROOF OF SUBMISSION Chapter 469,Section 469.101'All plans and specifications for the Per the Texas o Architectural Barriers tan ial Act,Texas Government Code, In accordance and construction po al t(1of)thor e for the substantial facdlt renovate to thchapter:and(2)tthe estimated construction cot is at $ 0,000." In architect, approval a as the nistrati°r ��' � ter 68.50(a),"an architect, with a Texas overall responsibility Texas design Administrative Rules Chap engineer with ovtdoc documents the roof of Submission form tolth depa t rtm§469.101,a registered accessibiliity specialist,or a contract the construction provider n tc lat documents along with specifications are issued." provider not later than the twentieth day after the plans and spe provisions of 16 Texas Administrative Code Texas The date that plans and specifications are issued shall be as defined in the following p contractor,subcontractor,or Administrative Rule 68.10(15): Issue-To mail,deliver,transmit,or otherwise release plans or specifications permit, or obtaining se of construction,applying for a building pe to an owner,lessee, on architect,contractor, subcontractor,b o t ac o the any other person acting such an owner or lessee for the purpose regulatory approval after such plans have been sealed by an architect,interior designer,landscape architect,or engineer. case of a state-funded or other public works project,,it an the time etat which interior designer is dscape ns are publicly posted for bids, after such plans or specifications have been sealed PLEASE PRINT OR TYPE DESIGN PROFESSIONAL INFORMATION Middle First Name: Dana 1. Last Name: Lowell DeGroot 3. License#: 2. ❑ Architect ❑ Landscape Architect ❑ Interior Designer ® Engineer . tense 4.Address: Zip:lijiliaIIIIIII 11117 Shady Trail 75229 City: Dallas 7."Email: 6.Fax: dan.deproot(a burgessniple.com 5.Phone: 972-620-8028 972-620-1255 PROJECT INFORMATION 8.Project Name: ST05-01 Deforest Road Reconstruction iiiii 10.Project Address: Zip: Deforest Road County: 75019 City:o Dallas Copp ell 11. I hereby Chapter 469. I certify that I am the registered notify the Texas Department in Licensing f and Regulation provisions of Texas Government of Code,intent to perform,or cause to be performed,all design ro necessary to with overall project design pr,tran mitt with otherwise responsibility releasing these cons ruction documents nts to an owner,whose lessee,contractor,subcontractor u--bcon construction documents. I am other public rko project!it is purpose of transmitting,construction, pthervn purpose of construction,applying for a building permit,or obtaining regulatory approval. In t the time at which construction documents are publicly posted for bids. 9 i_ 27 / 2011 Date Construction struction Documents Issued 7 /� 1 8 I 2012 to ❑TDLR 0019 Name: B�'IR BAR Date Construction Documents Submitted Da RAS#_� � 2012 Si t nature of Desi e n Professional: - - — Date of Sf nature: 7 18 DO NOT WRITE BELOW THIS LINE TDLR USE ONLY i :j (the s entitled to the Waging: and ties this fora tin tie Texas Department of Licensing and Regulation( e a few to t e fo a upai their request and subject TDLR FORM AB042 09-09 NOTE: M)ndor be informed about the information t Dom. �`," . and review the Stagnation,under Sedions 552.021 aid 562.023 d the Texas Govt.Code:and 2) to have the Department correct tdort�tton about the ndtviduat that is incorrect,under Section 559.004 of the Texas Govl.Code. 3) rot a tsi,which a to rntic�Y pry Department nation on maters a ectlr aArchitedn+at Barters.You email address in ''The Deparpursu n t add Ter s Public to the Mtlnned,t vA net sham it wth the public For additional a tormation ink to: c�txus-sl ell PrsrEDE I conOdeMiaf pursuant q the Texas Pubic kdorrrwthn Ad;the Department