Tdlr Form Ab05 - Architectural Barriers Project Registration Form

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

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 are mailed, shipped, or hand delivered to TDLR or a

Registered Accessibility Specialist (RAS) for the required review and inspection of

EABPRJ

the project. Please print or type.

ARCHITECTURAL BARRIERS PROJECT REGISTRATION FORM

The required plan review will be performed by:

TDLR

RAS

(Check One)

(Name/Lic #):

PERSON REGISTERING PROJECT

1.Name

RAS #

(if applicable)

2.Address

City

State

Zip

3. Phone

**Email

(

)

PROJECT

4. Project Name

5. Building or Facility Name

6.Address

City

Zip

County

TENANT (if other than owner)

7. Tenant Contact Name

Phone

(

)

BUILDING OR FACILITY OWNER (person or entity that holds title to property)

8. Name

Phone

(

)

9. Address

City

State

Zip

10. Owner Contact Name

11. Address

City

State

Zip

12. Phone

**Email

(

)

DESIGN FIRM

13. Name

Phone

(

)

14. Address

City

State

Zip

15. Designer Name

**Email

16. Type of License: (Check One)

Architect

Engineer

License Number

(if applicable)

Interior Designer

Landscape Architect

Other (includes not licensed)

PROJECT DESCRIPTION

17. Start Date (MM/YY):

18. Completion Date (MM/YY):

19. Estimated Cost $

20. Type of Work: (Check One)

New Construction

Renovation/Alterations

Additions to Existing Building

Historic Preservation

21. Type of Funds: (Check One)

Public Funds, public land, or is a state lease

22. State Lease No.

(if applicable)

Privately funded, on private land for private use

Are the private funds provided by a tenant?

Yes

No

23. Does this building(s) have more than one level?

(Check One)

Yes

No

24. Are there any elevators, escalators, or platform lifts in this building?

(Check One)

Yes

No

25. Does this building(s) have any boilers?

(Check One)

Yes

No

26. Scope of Work:______________________________________________________________________________________________

______________________________________________________________________________________________________________

TDLR FORM AB05 04-12

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: