ALTERATIONS TO A PRIMARY FUNCTION AREA 
DISPROPORTIONATE COSTS TO PROVIDING AN ACCESSIBLE ROUTE
A. TOTAL COST OF ALTERATION TO PRIMARY 
FUNCTION AREA. 
(Excluding costs in B.) 
$____________________________ 
MINIMUM COSTS FOR ACCESSIBLE ROUTE: 
(20% of total cost of alteration to a primary 
function) 
$____________________________ 
B. COSTS REQUIRED TO PROVIDE AN ACCESSIBLE ROUTE: 
(Listed in order of priority in the event the cost is disproportionate) 
1. Costs associated with providing an accessible 
entrance: 
Costs associated with providing accessible route to 
the altered area: 
2. Costs associated with making toilet rooms 
accessible, such as installing grab bars, enlarging 
toilet stalls, insulating pipes or installing 
accessible faucet controls: 
3. Costs associated with relocating an inaccessible 
drinking fountain: 
4. Costs associated with providing accessible 
elements such as parking, storage and alarms: 
TOTAL COSTS TO PROVIDE AN ACCESSIBLE ROUTE: 
$____________________________ 
$____________________________ 
$____________________________ 
$____________________________ 
$____________________________ 
$____________________________ 
C. DISPROPORTIONATE COSTS: 
If the total cost of the expenditures in B. is greater 
than 20% of the total cost of the alteration in A., list 
the accessibility features that will equal or exceed 
20% of the total cost of the alteration. 
ADDRESS:________________________________________________________________ 
OWNER’S NAME (PLEASE PRINT) ___________________________________________ 
OWNER’S SIGNATURE ___________________________Date: _____________________ 
222 Third Avenue North, Suite 701 – Nashville, TN 37201-1604 
Phone: (615) 862-8744 -TTY: (615) 862-8951 -Fax: (615) 880-2836 Adopted 04/01/04 Email: contactADA@Nashville.gov 
URL: http://www.nashville.gov/finance/support_services/ada/ada_compliance.htm