Fillable Variance Application Form printable pdf download

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

architectural.barriers@license.state.tx.us •

VARIANCE APPLICATION

A separate variance application for each (non-compliant) condition within a single building or facility must be submitted by the owner (or

owner’s designated agent) and must include a $175.00 non-refundable application fee and if the project has not already been registered

and assigned a TDLR project number

an additional $175.00 non-refundable registration fee.

In addition, the application must be accompanied by plans (site and/or architectural) of all affected areas and any supporting

documentation that provides adequate proof to the commission that compliance with the specific Texas Accessibility Standard (TAS) is

impractical or irrelevant to the nature, use, or function of the building or facility. The department shall issue a decision based on Chapter

469.151 and 469.152 and the information submitted with the application.

**IMPORTANT INFORMATION**

Variance Applications submitted more than 270 calendar days after the date of the inspection report will not be processed.

Incomplete applications and applications received without the required fee(s) will not be processed.

FORM MUST BE COMPLETED IN FULL

PLEASE PRINT OR TYPE

1. Has this project been reviewed?

Yes

2. If yes, name of reviewer:

3. Has this project been inspected?

Yes

4. If yes, name of inspector:

5. If yes, date of inspection:

6. Project

Name:

EABPRJ#:

(If registered.)

8. Building/Facility Name:

9. Address:

Suite No. :

City:

Zip

Code:

10. Description: Indicate the type of project:

11. Scope of Work (Describe the construction activities):

New Construction

Addition

Alteration

12. Estimated Project Construction Cost:

13. Original date of construction of this building/facility:

14. Square Footage of Building:

15. Square Footage Per Floor:

16. Is this building a qualified historic building?

Yes

17. Is this building being considered for a state lease?

Yes

If yes, a copy of the determination of effect letter from the Texas

Is a state agency currently located in this building?

Yes

Historical Commission (THC) must accompany this application.

If yes, provide the state lease number:

18. State the TAS reference number

19. State the specific location of the violation within the building or site:

for which the variance is requested:

20. Explain in detail, why compliance with this TAS standard cannot be achieved (attach additional sheets if necessary)

21. Intent to Apply: I hereby apply for a variance or waiver from the Texas Accessibility Standards as required for compliance with the Texas

Architectural Barriers Act, Government Code, Chapter 469.

(Check One)

I am the

Owner

Owner’s Agent

22. Name:

23. Company/Firm:

24. Address:

City:

State:

Zip:

25. Phone::

26. Fax:

27. **Email:

28. Signature:

29. Date:

TDLR FORM 013AB 07-09

NOTE:

An individual who completes and files this form with the Texas Department of Licensing and Regulation (the Dept.) is entitled to the following:

to be informed about the information that the Dept. collects about the individual, upon their request and subject to a few exceptions;

to receive and review the information, under Sections 552.021 and 552.023 of the Texas Govt. Code; and

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:

Variance Application Form

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