Project Registration Form
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3TEXAS 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
•
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.
PRINT OR TYPE
1. Project Name
2. Building/Facility Name
3. Location/Address
City
Zip Code
County
4. Tenant (if other than owner)
Telephone Number
(
)
5. Mailing Address
City
State
Zip Code
6. Contact Name
Telephone Number
(
)
7. Mailing Address
City
State
Zip Code
8. Building/Facility Owner (NOT tenant)
Telephone Number
(
)
9. Mailing Address
City
State
Zip Code
10. Contact Name
Telephone Number
(
)
11. Mailing Address
City
State
Zip Code
12. Design Firm
Telephone Number
(
)
13. Mailing Address
City
State
Zip Code
14. Designer Information:
Print Name:
Date Construction Documents
Issued:
Architect
Interior Designer
Engineer
Landscape Architect
License No. (If applicable)
Other
15. Scheduled Construction Start
16. Scheduled Construction Completion
17. Estimated Project Construction Cost
Date (MM/YY):
Date (MM/YY):
$
18. Description: Indicate type of work and briefly describe scope.
New Construction
Renovation/Alteration
Additions/Renovations
Addition to Existing Bldg.
New Construction/Renovation
Historic Preservation
Scope of work: ___________________________________________________________________________________________________
19.
This project involves Public Funds, Public Land, or is a State Lease
20. State Lease No.
This project is Privately Funded, on Private Land, for Private Use
(if applicable)
21. I 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 affixed to the
construction documents.
____________________________________________________________|________________|___________________________________
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.
____________________________________________________________|________________|___________________________________
Signature of Building Owner or Designated Agent
Date
Email Address
Side 1 of 2 Sided Form
TDLR FORM AB 005 01-02
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 Department correct information about the individual that is incorrect, under Section 559.004 of the Texas Govt. Code.
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