ࡱ> ceb#` Nbjbj5G5G kW-W-!$|(T v%x|WYYYYYY$h }] "%  }yKKK .WK WKKK| 5&)́;vKk0 K!!K!K  K     }}5          TEXAS DEPARTMENT OF LICENSING AND REGULATION COMPLIANCE DIVISION - ARCHITECTURAL BARRIERS P.O. Box 12157 Austin, Texas 78711 (512) 463-3211 (877) 278-0999 FAX (512) 475-2886 architectural.barriers@license.state.tx.us www.license.state.tx.us REQUEST FOR INSPECTION In accordance with the Texas Architectural Barriers Act, Texas Government Code, Chapter 469, and Administrative Rule 68.52, the owner of a building or facility subject to Chapter 469.101 of the Act shall obtain an inspection from the department, a registered accessibility specialist, or a contract provider not later than the first anniversary of the completion of construction. The request for an inspection must be made by completing this form and submitting it to the department, a registered accessibility specialist, or contract provider not later than 30 calendar days after the completion of construction. If the Request for Inspection form is submitted to the Department, the form must be accompanied by the applicable inspection fee. The department, a registered accessibility specialist, or a contract provider must receive the completed Request for Inspection form prior to proceeding with the inspection. Following the inspection, the owner will be advised in writing of the results. PROJECT INFORMATION PLEASE PRINT OR TYPE 1. Project Name:  FORMTEXT      2. EABPRJ #:  FORMTEXT      3. Project Address:  FORMTEXT      Suite #:  FORMTEXT      City:  FORMTEXT      County:  FORMTEXT      Zip:  FORMTEXT       OWNER / AGENT INFORMATION (Check One) I am  FORMCHECKBOX  the Owner (the person/entity that holds title to the property) or  FORMCHECKBOX  the Owner s Agent 4. Name:  FORMTEXT      5. Company / Agency  FORMTEXT      6. Address:  FORMTEXT      Suite #:  FORMTEXT      City:  FORMTEXT      State:  FORMTEXT      Zip:  FORMTEXT      7. Phone: ( FORMTEXT    )  FORMTEXT    - FORMTEXT     8. Fax: ( FORMTEXT    )  FORMTEXT    - FORMTEXT     9. **Email  FORMTEXT      :  FORMTEXT        FORMTEXT       10. Signature of Owner/Designated Agent Date I have authorized the following to perform the inspection (Check One)  FORMCHECKBOX  Texas Department of Licensing and Regulation  FORMCHECKBOX  Contract Provider  FORMCHECKBOX  Registered Accessibility Specialist RAS #  FORMTEXT 22 RAS Name  FORMTEXT WILLIAM T WINNING III  TDLR FORM AB041 03-07 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; .Z[      Ѵ|gU=.jhD5B*OJQJU\^JaJph#hDB*CJOJQJ^JaJph)hD5B*CJOJQJ\^JaJphhD#hDB*CJOJQJ^JaJphhDOJQJ^JhDB*CJaJphhDB*CJaJph hD5>*B*CJ\aJphhDB*CJaJphhDB*CJaJphhD5B*\phhDB*phjhDCJUmHnHu.[         $ 1$7$8$H$]^ a$  d]^ d+1$7$8$H$^ d+1$7$8$H$^  ` d1$7$8$H$^ d1$7$8$H$^d1$7$8$H$^d1$7$8$H$^N (PRz_vkd $$If94    0%& 0    4V4a f4d+$1$7$8$H$If]1$7$8$H$d1$7$8$H$^   (*>@Bѹp[>p8jhD5B*CJOJQJU\^JaJph)hD5B*CJOJQJ\^JaJph2jhD5B*CJOJQJU\^JaJph#hDB*CJOJQJ^JaJph9jhD5B*OJQJU\^JaJmHnHphu.jhD5B*OJQJU\^JaJph4jhD5B*OJQJU\^JaJph%hD5B*OJQJ\^JaJph BLNPRz|ƱƱvƱƱYƱƱ8jOhD5B*CJOJQJU\^JaJph8jhD5B*CJOJQJU\^JaJph#hDB*CJOJQJ^JaJphhDB*CJaJph)hD5B*CJOJQJ\^JaJph2jhD5B*CJOJQJU\^JaJph=jhD5B*CJOJQJU\^JaJmHnHphu"JT|vvkd$$If94    0%& 0    4V4a f4d+$1$7$8$H$If]"$8:<FHJTVjlnxz|~ɪɕɕfɪɕɕIɪɕ=hDB*CJaJph8jhD5B*CJOJQJU\^JaJph8jhD5B*CJOJQJU\^JaJph#hDB*CJOJQJ^JaJph)hD5B*CJOJQJ\^JaJph=jhD5B*CJOJQJU\^JaJmHnHphu2jhD5B*CJOJQJU\^JaJph8jhD5B*CJOJQJU\^JaJph|~"Jrvjh^RRRR $1$7$8$H$If h7$8$H$^h 1$7$8$H$]kd*$$If94    F %&   0        4V4a f4~ȹȹہoWD%hD5B*OJQJ\^JaJph.jhD5B*OJQJU\^JaJph#hDB*CJOJQJ^JaJphhDCJOJQJaJ+johD5CJOJQJU\aJ+jhD5CJOJQJU\aJhD5CJOJQJ\aJ%jhD5CJOJQJU\aJhDCJOJQJaJhDCJaJhDhDB*CJaJph "JL`bdnpͰ͝q\?q q=jhD5B*CJOJQJU\^JaJmHnHphu8j{hD5B*CJOJQJU\^JaJph)hD5B*CJOJQJ\^JaJph2jhD5B*CJOJQJU\^JaJph#hDB*CJOJQJ^JaJph%hD5B*OJQJ\^JaJph9jhD5B*OJQJU\^JaJmHnHphu.jhD5B*OJQJU\^JaJph4jhD5B*OJQJU\^JaJph pr "$2ؾ꡾ؾeؾH8jy hD5B*CJOJQJU\^JaJph8j3 hD5B*CJOJQJU\^JaJph=jhD5B*CJOJQJU\^JaJmHnHphu8jhD5B*CJOJQJU\^JaJph2jhD5B*CJOJQJU\^JaJph#hDB*CJOJQJ^JaJph)hD5B*CJOJQJ\^JaJphrtxxxx $1$7$8$H$Ifzkd$$If@4    #0?%&u&u0    44V4+a f4$2Zdxxxxxx $1$7$8$H$Ifzkd $$If@4    #0X %&&\0    44V4+a f424HJLVXZdfz|~ѴуfуQ>%hD5B*OJQJ\^JaJph)hD5B*CJOJQJ\^JaJph8js hD5B*CJOJQJU\^JaJph#hDB*CJOJQJ^JaJph=jhD5B*CJOJQJU\^JaJmHnHphu8j hD5B*CJOJQJU\^JaJph)hD5B*CJOJQJ\^JaJph2jhD5B*CJOJQJU\^JaJph2Bqeeeeee $1$7$8$H$Ifkd $$If@4    #FX %&&&\0        44V4+a f4  "$&.02B`bպՂgU@)hD5B*CJOJQJ\^JaJph#hDB*CJOJQJ^JaJph4j hD5B*OJQJU\^JaJph4jO hD5B*OJQJU\^JaJph9jhD5B*OJQJU\^JaJmHnHphu4j hD5B*OJQJU\^JaJph%hD5B*OJQJ\^JaJph.jhD5B*OJQJU\^JaJphbdxz|պՂgU;2jhD5B*CJOJQJU\^JaJph#hDB*CJOJQJ^JaJph4jshD5B*OJQJU\^JaJph4jhD5B*OJQJU\^JaJph9jhD5B*OJQJU\^JaJmHnHphu4jghD5B*OJQJU\^JaJph%hD5B*OJQJ\^JaJph.jhD5B*OJQJU\^JaJph 0ͳr^E0(hD5>*B*OJQJ\^JaJph1jhD5>*B*OJQJU\^JaJph&hD>*B*CJOJQJ^JaJphhDB*OJQJ^JaJph#hDB*CJOJQJ^JaJph=jhD5B*CJOJQJU\^JaJmHnHphu2jhD5B*CJOJQJU\^JaJph8jhD5B*CJOJQJU\^JaJph)hD5B*CJOJQJ\^JaJph tqeSA 0!$1$7$8$H$If 0#$1$7$8$H$If $1$7$8$H$Ifkd{$$If@4    F %& & & 0        44V4+a f4024>@BFJL`bdnprʫʖʖgʫUC7hDB*CJ aJph#hDB*CJOJQJ^JaJph"hD>*B*OJQJ^JaJph7jhD5>*B*OJQJU\^JaJph%hD5B*OJQJ\^JaJph(hD5>*B*OJQJ\^JaJph<jhD5>*B*OJQJU\^JaJmHnHphu1jhD5>*B*OJQJU\^JaJph7jShD5>*B*OJQJU\^JaJphbdwwg V6$7$8$H$^ 7$8$H$^ 7$8$H$^ 1$7$8$H$]gkdU$$If@4    %&$0    44V4+a f4 ^bdf&'()VӾӇyaӇyFӇ5jhhhD5CJOJQJU\^JaJ/jhD5CJOJQJU\^JaJhDCJOJQJ^JaJhDCJOJQJ^JaJ/jhD5CJOJQJU\^JaJ hD5CJOJQJ\^JaJ)jhD5CJOJQJU\^JaJhDCJOJQJ^JaJ hD5CJOJQJ\^JaJhDCJOJQJ^JaJVWXbcdfghstuLTNǭٕmٕ^R@>@U#hDB*CJ OJQJ^JaJ phhDB*CJaJphhD>*CJOJQJ^JaJ2jhD5>*CJOJQJU\^JaJhDCJOJQJ^JaJ.hh5>*CJOJQJ\^JaJmHnHu2jhD5>*CJOJQJU\^JaJ#hD5>*CJOJQJ\^JaJ,jhD5>*CJOJQJU\^JaJhD>*CJOJQJ^JaJ1MmLLLMTNNdn1$7$8$H$^d{1$7$8$H$^d{1$7$8$H$^d{1$7$8$H$^`dn1$7$8$H$^ d1$7$8$H$^   d1$7$8$H$^d+1$7$8$H$] 2) to receive and review the information, under Sections 552.021 and 552.023 of the Texas Govt. Code; and 3) have the Dept. correct information about the individual that is incorrect, under Section 559.004 of the Texas Govt. Code. **The Department will add your address to the Architectural Barriers email notification list, which automatically provides Department information on matters affecting Architectural Barriers. Your email address is confidential pursuant to the Texas Public Information Act; the Department will not share it with the public. For additional information link to: http://www.license.state.tx.us/newsletters/TDLRnotificationLists.asp TNNNhDOJQJ^J&hD>*B*CJ OJQJ^JaJ ph/0P/ =!"#r$j% 2 00P/ =!"#r$j% Fre$li(JFIFC    $.' 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