ST0501-CS130708 TEXAS DEPARTMENT OF LICENSING AND REGULATION
P. O. Box 12157,Austin,Texas 78711
iO4 ., (512)463-3211 • (800) 803-9202 • FAX(512)475-2886
' a f , tl�l architectural.barriers @license.state.tx.us • www.license.state.tx.us
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�- ARCHITECTURAL BARRIERS - INSPECTION RESPONSE FORM
Building or facility owners or the owners'designated agent may use this form to indicate the status of outstanding violations
associated with the referenced construction project that were identified during the inspection performed by a Registered
Accessibility Specialist(RAS)or TDLR Investigator to verify compliance with the Texas Accessibility Standards(TAS).
This form must be submitted to the RAS or TDLR representative noted in Step 4.
STEP 1 -PROJECT INFORMATION PRINT OR TYPE
Name: EABPRJ#:
ST05-01 Deforest Road Reconstruction B2817531
Project Address: Suite No: City: Zip:
Deforest Road-MacArthur Blvd to Windsor Estates Coppell 75019
STEP 2-INSPECTION STATUS INFORMATION
All violations cited on the inspection report relating to the referenced project
A. X
have been corrected.
All violations cited on the inspection report relating to the above referenced project
will be corrected by: (completion date).
B. Note: Projects inspected by a RAS, have 270 calendar days from the date of the inspection
report to correct inspection violations.
Completion dates after 270 calendar days of the inspection report must be approved by TDLR.
The following violations cited on the inspection report relating to the above referenced project
will not be corrected:
C.
TAS violation reference(s)
A Variance Application has been submitted and/or approved for:
STEP 3-OWNER/AGENT INFORMATION
Owner/Agent Name: Company/Firm:
Ken Griffin, P.E.,CFM City of Coppell
Address: City: State: Zip:
255 Parkway Coppell TX 75019
Phone#: Fax#: **E-mail:
972-304-3679 kgriffin @coppelltx.gov,gmarshall @coppelltx.gov
I am the owner of this building/facility or the agent designated by the owner to act on their behalf(check one):
X Owner(Person or entity that holds title to this property) n Owner's Designated Agent
I certify by my signature below that the information provided is true and accurate. I also understand that failure to
correct the violations(s) /ay result in this project being forwarded to the Enforcement Division of TDLR for action.
XSignature: -hn Date:7'8' I
STEP 4—S BMITTAL INFORMATION:
FOR RAS AND/OR TDLR USE ONLY
Name: RAS# Of applicable): Company/Agency:
Blair Baker 0019 Texas Access
Address: City: State: Zip:
3415 Misty Meadow Dr. Dallas TX 75287
Phone: Fax: **E-mail:
(972)306-2800 1+(800)880-6986 blairb @texasaccess.com
NOTE An individual who completes and files this form with the Texas Department of Licensing and Regulation(the Dept)is entitled to the following:
TDLR AB 029 03 07 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 550004 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 Information Act the Department will not share it with the public.For additional information link to lilts/Mnviv license state lx uo/neisislettters/rOLRnotificationLists ass