ST9301-CS0406080'6/08/04
16:47 c~2146963499
JACOBS
.JACOBS SYERDRUP
~001/007
q3-ol
6688 N. Central Expwy
Suite 400, MB 13
Dallas, TX 75206-3914
214~24-7500
214-696-3499 (fax)
Facsimile
Date
Attention
Firm Name
Fax No.
Phone No.
June 8,2004
Suzan Taylor
Ci~ of Coppell
(972) 304-3570
972-462-0022
No. of pages, including cover sheet
From Bill Pembroke
Phone No. 214-424-7591
Project No. C3X35200
Copies to
In case of a problem with this fax transmission, please call: Jan
Suzan:
Attached is the TDLR Registration Form and the final Opinion of Probable Construction Cost,
Based on the OPCC the following fees will be required:
Project Registration Fee - $100
Project Review Fee - $575
Inspection Filing Fee - $100
Inspection Fee - $575
As discussed we are plotting a final set of full sized plans on 9~h for your last review prior to
plotting mylars
Bill
Action Requested
Reply ASAP
[] Please Comment
Please notif3/us immediately if the message is unclear or incomplete.
This message is intended only for the use of the individual or entity to which it is addressed and may contain information which is privileged,
confidential, and exempt from disclosure under applicable laws. If you are neither the intended recipient nor the employee or agent responsible
for delivedng this message to the intended recipient, you are hereby notified that any retention, dissemination, copying, disclosure, distribution
or taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this telecopy in error, please
immediately notify us at our telephone number, above. At no cost to you, we will arrange for the return of this message to us via post.
06/08/g4 16:47 82146963499 JACOBS SVERDRiP [~] 002/007
TEXAS DEPARTMENT OF LICENSING AND REGULATION
ARCHITECTURAL BARRIERS - PROJECT REGISTRATION FORM
P.O. Box 12157, Austin, Texas 78711 · (512) 463-6599 · (800) 803-9202 · FAX (512) 475~2871
architectural.barriers~license.state.tx.us www.license.state.tx.u s
PLEASE SEE IMPORTANT INSTRUCTIONS BEFORE BEGINNING
NOTE: A completed project registration form, fee payment, and construction documents are required to register a project.
Failure to submit any of these items will delay processing.
1. Project Name Sandy Lake Road
2. Building/Facility Name Sandy Lake Road
3. Loc~tjon/,~d. dress
r~ac^r[nurBIvd. To East City Limit Line
4. Tenant (if other than owner)
Mailing Address
6. Contact Name
7. Mailing Address
Telephone Number
( )
City State
8. Building/Facility Owner (NOT tenant) City of Coppell, Texas
9.
Mailing
Address
P.O. Box 9478 J ~"~'Yoppell
10. Contact Name
Ken Griffin, P.E.
11. Mailing Address
P.O. Box 9478
I City
Coppel
~T~lephone Number
( )
State
Zip Code
Zip Code
I Zip Code
State Texas 75019
Telephone Number
( 972) 462-0022
Zip Code
State Texas 75019-9478
,ne Number
12. Design Firm Jacobs Civil, Inc. 424-7500
13. Mailing Address ~Y
6688 N. Central Expressway, Suite 400 [ Daltas
14.~igner Information: Print Name:
[]Architect r~lnterior Designer William G. Pembroke
~.Engineer E]LandsCape Architect License No. (if applicable)
E]Other , 65143
State
15. Scheduled Construction Start
Date (MM/YY): 07/04
16. Scheduled Construction Completion
Date (MM/YY): 01/06
Zip Code
Texas 75205
I Date Construction uocuments
Issued:
June 2004
17. Estimated Project Construction Cost
$ 5,600,000
1~, Description: Indicatetypeofworkandbrieflydescribescope. ~lewConstruction r-IRenovation/Alteration E}Additions/Renovations
[:3Addition to Existing Bldg. E]New Construction/Renovation E]Histodc Preservation
Scope of work: _ Roadway Construction
~This project involves Public Funds, Public Land, or is a State Lease 20. State Lease No.
D This project is Privately Funded, on Private Land, for Private Use (if applicable)
'~1.1 hereby notify the Texas Department of Licensing and Regulation of the described project and of my intent to perform, or cause to be
performed, all services necessary to design said project in accordance with the provisions of Article 9102, Texas Civil Statutes. I certify
that I am the registered design professional with overall responsibility for the design of the project and whose seal is a~xed to the
construction documents.
I I bill.pembroke @jacobs.corn__
Signature of Architect, Engineer, Interior Designer, or Landscape Architect Date Email Address
OR
I hereby notify the Texas Department of Licensing and Regulation of my intent to comply with the provisions of Article 9102, Texas Civil
Statutes.
.I
Signature of Building Owner or Designated Agent Date Email Address
Side I of 2 Sided Form ,
06,08,O4 16:48 82146963499 JACOBS SYERDRUP ~003/007
REGISTERED ACC__~ESSIBILITY SPECIALIST USE ONLY
RAS Contact Information REVIEW STATUS --
DisAPPRovED ! CONDIT,ONAL
APPROVAL
- RAS#: J Ph#:
Name:
Address:
E-mail:
-[ certify that the information pertaining to the submission date of the
APPROVED
I will be performing TAS inspection for this project
E) Inspection Filing Fee is enclosed.
construction documents is
rue and correct.
~stered Acces~ecialist
DEPARTMENT USE ONLY
AB Number
Date
Date construction
documents were
submitted to RAS for Plan
{eview
Date Submitted to TDLR
_~ Complaint Number
Side 2 of 2 Sided Form
06/08/04 16:48 ~2146963499 JACOBS SVERDRUP ~004/007
INSTRUCTIONS FOR COMPLETING PROJECT REGISTRATION FORM - AB 005
1. Project Name - Enter the actual name of the project (examples: CLASSROOM ADDITION, PEDIATRIC FLOOR RENOVATION, CARD SHOP,
DR. SMITH'S OFFICE. etc.) If named for a person, use the last name only (ex: WASHINGTON HIGH SCHOOL).
2. Building/Facility Name - If the "project" is part of another building or facility, enter the name of the building or facility (examples: Project:
CLASSROOM ADDITION, Building/Facility: WASHINGTON HiGH SCHOOL; Project: JONES & SMITH, INC. OFFICE RENOVATION,
Bui[ding/Facllity: AMERICAN OFFICE PLAZA: Project: CARD SHOP, Building/Facility: MAIN STREET MALL; Project: DR. SMITH's OFFICE.
Building/Facility; MEDICAL OFFICE TOWER). For facilities named after a person, use only the last name (example: WASHINGTON HIGH
SCHOOL).
3. Location - Enter the physlcai location, including the street address if available and the suite number if applicable Post Office Box numbers are not
acceptable.
4. Tenant - Enter the name and telephone number of the person or persons, company, corporation, authority, commission, board, governmental entity,
institution or any other unit that intends to occupy project space,
5. Mailing Address - Enter the complete mailing address of the tenant listed in ~4.
6. Contact - Enter the name and telephone number of the person representing the tenant (as listed in ~).
7. Mailing Address - Enter the mailing address of the person named in #6, if different than the address entered in #5.
8. Building/Facility Owner - Enter the name and telephone number of the person or persons, company, corporation, authority, commission, board,
governmental e~fity, institution or any other unit that holds litle to subject building or facility.
9. Mailing Addrees - Enter the mailing address of Ihe owner named in #8.
t0. Contact - Enter the name and telephone number of the person representing the owner (as listed in #8) who is to receive all correspondence
pertaining to the proiect, including post-construction reports,
11. Mailing Address - Enler the mailing address of the person named in #10, if di[ferent than the address entered in #9.
12. Design Firm - Enter the name and lelephone number of the firm or company responsible for the design of the project.
13. Mailing Address. Enter the mailing address of the firm or company named in #12'
14. Contact - Enter the name of the architect, engineer, interior designer' landscape architect' °r building designer having °verell responsibility f°r the
design of the project and whose seal is affixed to the drawings. Include type of license and license number, if applicable. The date the construction
documents were issued must also be entered. NOTE: Issue is defined in Administrative Rule 68.10.
15. Start Date. Enter the dare construction is scheduled to begin (month and yeaQ.
16. Completion Date - Enter the scheduled completion date (month and year) If this date changes notify TDLR. NOTE: Administrative Rule 68,80
stipulates owner must pay applicable inspection fees and notify TDLR of the point of contact within 30 days of completion of conslruction.
17. Project Cost - Enter the estimated cost of construction.
t8. Project Description - Furnish a brief description of the project. Include square footage, floor levels, special features, etc.
19. Funding. Indicate the method of funding.
20. State Lease Number(if applicable) - Enter the state lease number if construction project is tor purposes of a state agency lease contract and/or
occupancy by a state agency.
21. Name and Signature - of either person noted below:
Signature of Project ArchftectJEngineer/Interior Designer/Landscape Architect - Signature of registered design professional who has overall
responsibility for the design of the project and whose seal is affixed to lhe drawings; or
Signature of Owner/Agent - Signalure and title of the owner or owner agent named in #10. in the absence of a registered design professional,
building designer may sign as owner's agent.
WHAT TO SUBMIT
1. One complete set of construction documents/plans and specifications) for all disciplines. Ali documents applicable to the project should be
submitted as one package to ensure inclusion in the review.
2. A fully completed and signed Architectural Barriers Project Registration Form for each site/address or State Lease Registration Form if applicable.
3. For TDLR services, submit check or money order payable to "Texas Depa~ment of Licensing and Regulation" at P.O, Box 12157, Austin, Texas
76711. NOTE: If inspection fees are not paid with review fees, owner must pay applicable inspection fees and notify TDLR cf the point cf contact
within 30 days 0f completion of construction (based on date in #16).
4. When construction documents are submilled after compleEon of construction, the late submitlal fee shall apply
5. For Registered Accessibility Specialist (PAS) review andJor inspection services, contact the respective RAS.
TDLRFEESCHEDULE
>75,000,001 - Contact TDLR for negotiated Fee
Example: Estimated C0'~struction cost is $250,000, submll the project filing fee of $100.00 and the review fee of $315,00 for a total of $415,00 This will
Preliminary Review $145 (no construction involved)
Speclal Inspection $215 Per Hour (2hr min.) (annual lease expense In excess of $12,000)