Tdlr Form Ab05 10-08 - Architectural Barriers Project Registration Form
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2TEXAS 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
PRINT PAGE
The required plan review will be performed by:
TDLR
RAS
(Check One)
(Name/Lic #):
PERSON REGISTERING PROJECT
1. Name
RAS #
(if applicable)
TPD or District Design Engineer (suggested)
Date:
2. Address
City
State
Zip
N/A
N/A
N/A
N/A
3. Phone
**Email
N/A
N/A
PROJECT
4. Project Name
Highway Name such as IH 30
5. Building or Facility Name
CCSJ 0000-00-000
City
Zip
6. Address
County
At FM 551
Aransas Pass (near)
N/A
Nueces
TENANT (if other than owner)
7. Tenant Contact Name
Phone
N/A
N/A
BUILDING OR FACILITY OWNER (person or entity that holds title to property)
8 Name
Phone
TxDOT District: Corpus Christi
(xxx) xxx-xxxx
9. Address
Zip
City
State
1701 S. Padre Island Dr
Corpus Christi
Texas
78416
10. Owner Contact Name
TxDOT Area Engineer Name
11. Address
City
State
Zip
Area Engineer's Address
Sinton
Texas
78420
12. Phone
**Email
(xxx) xxx-xxxx
AE's email
DESIGN FIRM
13. Name
Phone
Texas Department of Transportation (TxDOT)
(xxx) xxx-xxxx
14. Address
City
State
Zip
1701 S. Padre Island Dr,
Corpus Christi
Texas
78416
15. Designer Name
**Email
Dist Plan Suprv. or PM
N/A
16. Type of License: (Check One)
Architect
Engineer
License Number
Interior Designer
Landscape Architect
Other (includes not licensed)
(if applicable)
PROJECT DESCRIPTION
17. Start Date (MM/YY):
18. Completion Date (MM/YY):
19. Estimated Cost
10/13
05/14
$152,488.00
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
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
Construction of sidewalks & ADA ramps, Consisting of grading, base, Pavement and Landscape
26. Scope of Work:______________________________________________________________________________________________
$250.00
$175.00
Total
$425.00
Plan Review
Filing
Inspection
Late
Other
TDLR FORM AB05 10-08
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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