HomeMy WebLinkAboutCO2020-2539 UNDER CONSTRUCTION
CORRECTION LETTER
PW OR LD NEEDED_
TD NO LETTER_
WAITING FIRE
HOLD _
CODE _
C/O CHECK LIST
C/O PERMIT # P19 - �
ADDRESS: � 4-CJ U 1 kart'\ D TGte- jkye ' cCo
BUSINESS NAME: -3-11 ITKe, c pV
BUSINESS/PROPERTY
— CHANGE NAME / OWNER NEW CONST/ADDITION PERMIT #
NEW TENANT/ OCCUPANT V REMODEL/ALTERATION PERMIT
/ ISSUE D���`�fFI'INAL DATE
y 1. APPLICATION FORM COMPLETED
2. ZONING MAP COPIED &WORKORDER FORM COMPLETED
3. HAZARDOUS MATERIAL SAFETY DATA SHEETS TO FIRE DATE
(SCAN TO C/O IN MYGOV-IF LARGE SET,ALSO SCAN TO LF&FORWARD SET TO FIRE)
4. FIRE DEPARTMENT APPROVAL OF HAZARDOUS MATERIAL DATE
5. ZONING CHECKED & COMPLETED ON APPLICATION
✓6. BUILDING INSPECTION SCHEDULED DATE J c�`� TIME
�. FIRE DEPT. INSPECTION SCHEDULED DATE TIME QL✓
FIRE INSPECTOR:
CITY SECRETARY(ALCOHOL) NOTIFICATION DATE:
s 9. HEALTH INSPECTION NOTIFICATION DATE:
10. PUBLIC WORKS INSPECTION E-MAIL DATE
11. LOT DRAINAGE INSPECTION E-MAIL DATE
12. CORRECTION LETTER SENT DATE
13. BUILDING INSPECTORS SIGN OFF LETTER: YES / NO
✓14. FIRE DEPARTMENTS SIGN OFF LETTER: YES / NO
15. HEALTH DEPARTMENT SIGN OFF
16. CITY SECRETARY(Alcohol License Sign Off)
17. PUBLIC WORKS SIGN OFF
1 LOT DRAINAGE SIGN OFF
19. LANDSCAPING SIGN OFF-
'� 20. BUILDING OFFICIALS SIGNATURE
_L,--21. C/O CERTIFICATE ISSUED ELECTRIC RELEASED:
SCAN CERTIFICATE TO MYGOV:
CONDITIONS TO BE TYPED ON C/O? YES / NO MAILED:
O'\FORMS\DSCOINFORMATIONICKLIST
12f301041 Rev.11111,11M,5ryS
N DATE OF ISSUANCE: C]t—�
r r x a s PERMIT#: 7 �
V 1. ����
CERTIFICATE OF OCCUPANCY REQUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OF 0CCUPANCYIS ASSOCIATED FffTH AN A CTIVE CURRENT BUILDING PERMIT
ADDRESS OF OCCUPANCY: 1401 William D Tate Ave //�� SUITE# 300
LOT:�BLOCK: 1 SUBDIVISION: i-l-/, q`yp V A(Ac tT orb
****CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUEDTHOU LEGAL DESCRIPTION****
NAME OF BUSINESS: ATI Physical Therapy
NEW OCCUPANT: YES NO NEW BUILDING/PROPERTY OWNER: YES NO
NEW BUILDING: YES NO NEW BUSINESS NAME CHANGE: YES NO
NUMBER OF EMPLOYEES: 71 FREIGHT FORWARDING: YES NO
NEW BUSINESS OWNER: YES�NO
TYPE OF BUSINESS: Physical Therapy Clinic
SQUARE FOOTAGE
(Example:Retail Clothing/Attorneys Office/Office-Warehouse/Restaurant)
NAME OF TENANT [PERSON'S NAME]: Bryan Wietrzykowski
CURRENT MAILING ADDRESS: 790 Remington Blvd
CITY/STATE/ZIP: Bolingbrook, IL 60440 PHONE NUMBER: 630-296-2222
PROPERTY OWNER: John T Evans Company- Susan Estrada
MAILING ADDRESS: 830 N Central Expy-Suite 1300
CITY/STATE/ZIP: Dallas, TX 75206 PHONE NUMBER: 214-891-3217
♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW?(if yes,provide copy of Sales Tax Certificate)---- YES_NO
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES?(if yes,provide copy of Alcoholic Beverage Permit)-YES_NO
♦ PERMITS ARE REQUIRED FOR SIGNS. WILL ANY SIGNS BE INSTALLED?---------------- -- YES-NO
♦ WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE TO SEWER SYSTEM?------YES_NO
♦ WILL OUTSIDE REFUSE/RECYCLING/COMPACTING CONTAINERS BE NECESSARY?
(if yes,screening is required)___________________________________________________________ YES NO
♦ WILL THERE BE ANY OUTSIDE STORAGE(including storage of company/fleet vehicles),DISPLAY,
USEOR DINING?------------------------------------------------------------------ YES NO
♦ WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING?------------------------ YES NO
♦ IS BUILDING SPRINKLERED?------------------------------------------------------- YES NO
♦ WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS?
(if yes,provide list of types& quantities,along with material safety data sheets)----------------------YES_NO
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THE SAID
OCCUPANCY IS IN CONFORMANCE WITH THE INFORMATION HEREIN SET FORTH.
(If access to the building/space is not provided at the time of the scheduled inspection,a$42.00 re-inspection fee will be charged)
FOR QUESTIONS PEASE CALL(817)410-3165.
SIGNATURE: ////(I PRINT NAME: Steven Kolber-Architect
PHONE#: 847-492-1992 EMAIL:
Development Services Department (OVER)
The City of Grapevine*P.O.Box 95104 * Grapevine, Texas 76099 * (817)410-3165
Fax(817)410-3012 *www.grapevinetexas.gov
O:FORMSIDSAPPLICATIORSIC/
3/22/2001/Rew 5106,2107,4/09,2H3,11/15,10/16,8/16
TEXASSALESTAX
Texas Sales Tax is charged and collected on sales within the State and City of Grapevine,Texas of"taxable items."Taxable
items include both tangible personal property,specified services. If you are in a business that will be selling"taxable items"
within the City of Grapevine,Texas you will be required to collect State and Local Sales Tax in the amount of 8.25%.
A"Seller or Retailer"means a person engaged in the business of making sales of"taxable items",the receipts from which are
included in the measure of sales or use tax.
The term,"place of business"includes any location at which three or more orders are received by the"Seller or Retailer
in a calendar year.If an order is received at the place of business of a retailer in Texas,but delivery or shipment is made
from a location within the state other than the retailer's place of business. State and local sales tax is due and is allocated to
the city where the order was received.
I have read the above and I understand that I will be required to provide a copy of the Sales Tax Permit to the City of
Grapevine,Texas if the circumstance applies to my business.
Texas Sales Tax Number:
Signature:
WHERE DO YOU WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED?
ADDRESS: 790 Remington Blvd
CITY, STATE, ZIP: Bolingbrook, IL 60440
OFFICE USE
TYPE OF CONSTRUCTION: l ^f] 5P�2��1 K 5 OCCUPANCY: 8 DIVISION:
ZONING DISTRICT: 14 C, CONDITIONAL USE:
PERMITTED USE: I :
BUILDING DEPARTMENT: u j DATE: 7 Z 1p
BUILDING INSPECTOR: C (S/rVl DATE: �O•- c3f�
ZONING APPROVAL: DATE:: / n
FIRE DEPARTMENT: f_�
LOT DRAINAGE INSPECTION: DATE:
PUBLIC WORKS DEPARTMENT: DATE:
HEALTH DEPARTMENT: DATE:
CITY SECRETARY: DATE: I
LANDSCAPING APPROVAL: DATE:
APPROVAL FOR ISSUANCE: DATE:
O:FORMSMSAPPLICATIONW/
3/22/2001/Rm 5/06,2/07,C/09,2/13,11/15,10/16,6116
CERTIFICATE OF OCCUPANCY
Issue Date:June 1,2020
PROJECT DESCRIPTION:C/O(Physical Therapy Clinic)"ATI Physical Therapy'(BLDG 19-2536)
PROJECT# (817)410-3010 WWW.mygOV.us
CO-19-2539 Inspections Permits
City of Grapevine
LOCATION TENANT LEGAL
P.O.Box 1401 William D Tate Ave. ATI Physical Therapy 1 hayley Addition Elk 1 Lot
TX Grapevine,,TX 76099
Suite#300 2a1
(817)410-3165 Voice Grapevine,TX 76051
(817)410-3012 Fax
CONTRACTOR INFORMATION
Steven Kolber-Architect *CONSTRUCTION TYPE VB-Sprinklered
1401 William D.Tate Avenue#300 *OCCUPANCY GROUP B
Grapevine,TX 76051 *ZONING DISTRICT HC
(847)492-1992 Phone
**NAME OF BUSINESS ATI Physical Therapy
**TYPE OF BUSINESS Physical Therapy Clinic
OWNER **APPLICANT NAME Steven Kolber
114 Gv Towers Uc **APPLICANT PHONE NUMBER 847-492-1992
8350 N Central Expwy Ste 1300 **TENANT NAME Bryan Wietrzykowski
Dallas,TX 75206-1620 **TENANT PHONE NUMBER 630-296-2222
ph. (214)891-3200
*Sales Tax NO
AVAILABLE INSPECTIONS *Sales Tax Number
Final Building C/O Inspection(required) Alcoholic Beverage Sales NO
Final Fire Dept Inspection(required)
� Landscaping(required) Alterations NO
C/O APPROVED FOR ISSUANCE Change of Business Name NO
(required) Change of Business Owner NO
County Tarrant
Fire Sprinkler System? YES
Freight Forwarding Business NO
Hazardous Material NO
Industrial Waste NO
New Building/Addition NO
New Building or Property Owner NO
New Occupant/Tenant YES
Number of Employees
Outside Refuse/Recycling NO
Outside Storage NO
Signs YES
Square Footage 1830
Zoning HC-Highway Commercial
READ AND SIGN
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST
OF MY KNOWLEDGE AND THE SAID OCCUPANCY IS IN CONFORMANCE
WITH THE INFORMATION HEREIN SET FORTH.
MYGOV.US City of Grapevine I CERTIFICATE OF OCCUPANCY I CO-19-2539I Printed 06/02/20 at 8:51 a.m. Page 1 of 3
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CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 19 - ?�i� —�I— /�
ADDRESS OF INSPECTION: � 4-()+ ��\� l\CcYI� V IC��C A\ e-A �CC�
DATE OF INSPECTION: aFj ate) TIME OF INSPECTION:
NAME OF BUSINESS: 1 ���1 S\ Q a
TYPE OF BUSINESS:
USE OF BUILDING AND/OR PREMISES: C C
REASON FOR APPLYING: ��II z rd-
CONTACT PERSON: G UJ 6
TELEPHONE NUMBER: �—
COMMENTSNIOLATIONS:
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: NG
TYPE OF BUILDING: V--o GROUP AND DIVISION:
ZONING RESTRICTIONS:
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