Tdlr Form Ab05 04-08 - Architectural Barriers Project Registration Form

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TEXAS DEPARTMENT OF LICENSING AND REGULATION
For Department Use Only
P.O. Box 12157, Austin, Texas 78711
(512) 463-6599 • (800) 803-9202 • FAX (512) 475-2871
customer.service@license.state.tx.us ●
IMPORTANT INSTRUCTIONS - PLEASE READ BEFORE BEGINNING
A project registration is not complete unless a complete set of construction documents and applicable
fees are also submitted with this form to the Department, a Registered Accessibility Specialist, or a
Contract Provider. Failure to submit any of these items will delay processing. Please print or type.
EABPRJ
ARCHITECTURAL BARRIERS PROJECT REGISTRATION FORM
1. Project Name
2. Project Address
City
Zip
County
3. TENANT Name
Phone
(if other than owner)
(
)
4. Tenant Address
City
Zip
County
5. Contact Name
Phone
(
)
6. Contact Address
City
Zip
County
7. BUILDING/FACILITY Name
8. Building /Facility Owner
Phone
(Person or entity that holds title to property)
(
)
9. Owner Address
City
State
Zip
10. Contact Name
Phone
(if other than owner)
(
)
11. Contact Address
City
State
Zip
12. DESIGN FIRM
Phone
(
)
13. Firm Address
City
State
Zip
14. Designer Name
**Email
15. Type of License: (Check One)
Architect
Engineer
License Number: (if applicable)
Interior Designer
Landscape Architect
Other
PROJECT DESCRIPTION
16. Start Date (MM/YY):
17. Completion Date (MM/YY):
18. Estimated Cost: $
19. Type of Work: (Check One)
New Construction
Additions to Existing Bldg.
Alterations
Historic Preservation
Public Right-of-Way
20. Does this building(s) have more than one level?
(Check One)
Yes
No
21. Are there any elevators, escalators, or platform lifts in this building?
(Check One)
Yes
No
22. Type of Funds: (Check One)
Public Funds or is a State Lease
23. State Lease No. (if applicable)
Privately Funded, on Private Land, for Private Use
24. Scope of Work: (Detailed description of construction activities)
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
TDLR FORM AB05 04-08
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)
to 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:

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